Time up and Go Classic, Manual and Cognitive: prediction analysis of the risk of falling physically active elderly
DOI:
https://doi.org/10.17921/2447-8938.2020v22n1p100-105Resumo
Abstract
Elderly falls affect public health, which justifies the evaluation of their risk. The present study analyzed gait performance of physically active elderly women by means of the test, predicting the risk of falls in this population, as well as determining the levels of sensitivity and specificity of these tests. A quantitative cross-sectional study was carried out with 191 women (67,30±5,13 years), practicing Pilates and water aerobics, divided into fallers and non-fallers groups. The tests applied were the classic Time Up and Go (TUG), its manual version (TUGm) and cognitive (TUGc). A drop rate of 28.8% was found. Participants from both groups did not indicate performance deficits in the evaluation of TUG, TUGm and TUGc (p≥0.05). According to the logistic regression analysis, the TUG, TUGm and TUGc tests did not explain the occurrence of falls (p≥0,05). The ROC curve showed an accuracy of 0.520 for TUG (p=0.673), 0.517 for TUGm (0.711) and 0.526 for TUGc (p=0.570). The cut-off points suggested to determine the risk of falling for TUG, TUGm and TUGc were ≤9,95sec., ≥10,35sec. and ≥11,30 sec., respectively. The TUG, TUGm, and TUGc tests showed predictive capacity and low diagnostic accuracy, thus reduced competence to discriminate fallers from non-fallers among physically active elders. Its application is suggested in association with balance tests, lower limb strength and gerontological scales.
Keywords: Accidental Falls. Aged. Physical Fitness.
Resumo
Quedas de idosos incidem em questão de saúde pública, o que justifica a avaliação do seu risco. O presente estudo analisou o desempenho da marcha de idosas fisicamente ativas por meio do teste, predizendo o risco de queda dessa população, além de determinar os níveis de sensibilidade e especificidade desses testes. Estudo transversal quantitativo desenvolvido com 191 mulheres (67,30±5,13 anos) praticantes do Pilates e hidroginástica, divididas em grupo caidor e não-caidor. Os testes aplicados foram o Time Up and Go (TUG) clássico, sua versão manual (TUGm) e cognitiva (TUGc). Verificou-se taxa de queda de 28,8%. Participantes de ambos os grupos não indicaram déficits de desempenho na avaliação do TUG, TUGm e TUGc (p≥0,05). Segundo a análise de regressão logística, os testes TUG, TUGm e TUGc não explicaram a ocorrência de quedas (p≥0,05). A curva ROC apontou acurácia de 0,520 para o TUG (p=0,673), 0,517 para o TUGm (0,711) e 0,526 para o TUGc (p=0,570). Os pontos de corte sugeridos à determinação do risco de queda para o TUG, TUGm e TUGc foram ≤9,95seg., ≥10,35seg. e ≥11,30 seg., respectivamente. Os testes TUG, TUGm e TUGc mostraram capacidade preditiva e acurácia diagnóstica baixa, logo reduzida competência para discriminar caidores de não-caidores entre idosas fisicamente ativas. Sugere-se sua aplicação associada à testes de equilíbrio, força de membros inferiores e escalas gerontológicas.
Palavras-chave: Acidentes por Quedas. Idoso. Aptidão Física.
Referências
McCrum C, Gerards MHG, Karamanidis K, Zijlstra W, Meijer K. A systematic review of gait perturbation paradigms for improving reactive stepping responses and falls risk among healthy older adults. Eur Rev Aging Phys Act. 2017;14:3.
Auvinet B, Touzard C, Montestruc F, Delafond A, Goeb V. Gait disorders in the elderly and dual task gait analysis: a new approach for identifying motor phenotypes. J Neuroeng Rehabil. 2017;14(1):1-14.
Howcroft J, Kofman J, Lemaire ED, McIlroy WE. Analysis of dual-task elderly gait in fallers and non-fallers using wearable sensors. J Biomech. 2016;49(7):992-1001.
Sherrington C, Michaleff ZA, Fairhall N, Paul SS, Tiedmann S, Whitney J, et al. Exercise to prevent falls in older adults: An updated systematic review and meta-analysis. Br J Sports Med. 2017;51(24):1749-1757.
Plummer P, Zukowski LA, Guiliani C, Hall AM, Zurakowski D. Effects of physical exercise interventions on gait-related dual-Task interference in older adults: A systematic review and meta-analysis. Gerontology. 2015;62(1):94-117.
Daskalopoulou C, Stubbs B, Kralj C, Koukounari A, Prince M, Prina AM. Physical activity and healthy ageing: A systematic review and meta-analysis of longitudinal cohort studies. Ageing Res Rev. 2017;38:6-17.
Rispens SM, Van Dieën JH, Van Schooten KS, Lizama LEC. Fall-related gait characteristics on the treadmill and in daily life. J Neuroeng Rehabil. 2016;13(1).
Tinetti M. Preventing Falls in Elderly Persons. N Engl J Med. 2003;348(1):42-49.
WHO-World Health Organisation-European Office. What are the main risk factors for falls amongst older people and what are the most effective interventions to prevent these falls? World Heal Organ. 2004;1(1):28.
Tinetti M, Kumar C. The patient who falls:“It’s always a trade-off.” Jama. 2010;303(3):258-266.
Shumway-Cook A, Brauer S. Predicting the Probability for Falls in Community-Dwelling Older Adults Using the Timed Up & Go Test. Phys Ther. 2000;80(9):896-903.
Mathias S, Nayak USL, Isaacs B. The, Balance in elderly patients. Phys Med Rehabil. 1986;67:387-389.
Podsiadlo D.; Richardson S. The timed “Up & Go”: a test of basic functional mobility for frail elderly pearsons. J Am Geriatr Soc. 1991;39:142-148.
Karuka AH, Silva JAMG, Navega MT. Análise da concordância entre instrumentos de avaliação do equilíbrio corporal em idosos. Rev Bras Fisioter. 2011;15(6):460-466.
Schoppen T, Boonstra A, Groothoff JW, De Vries J, Göeken LN, Eisma WH. The Timed “up and go” test: reliability and validity in persons with unilateral lower limb amputation. Arch Phys Med Rehabil. 1999;80(7):825-828.
Lusardi MM, Fritz S, Middleton A, Alison L, Wingood M, Philips E, et al. Determining Risk of falls in community dwelling older adults: A systematic review and meta-analysis using posttest probability. J Geriatr Phys Ther. 2017;40(1):1-36.
Bischoff HA, Stähelin HB, Monsch AU, Iversen MD, Weyh D, Von Deschebd M, et al. Identifying a cut-off point for normal mobility: A comparison of the timed “up and go” test in community-dwelling and institutionalised elderly women. Age Ageing. 2003;32(3):315-320.
Gregório LPP, de Medeiros PA, Mazo GZ. The “Timed Up and Go” in the prediction and explanation of falls in old people practicing physical exercises. Rev Bras Cineantropometria e Desempenho Hum. 2014;16(4):381-389.
Fraser SA, Li K, Berryman N, Dejardins-Crépeau L, Lussier M, Vadaga K, et al. Does Combined Physical and Cognitive Training Improve Dual-Task Balance and Gait Outcomes in Sedentary Older Adults? Front Hum Neurosci. 2017;10(January):1-12.
Bahureksa L, Najafi B, Saleh A, Sabbagh M, Coon D, Mohler MJ, et al. The Impact of Mild Cognitive Impairment on Gait and Balance: A Systematic Review and Meta-Analysis of Studies Using Instrumented Assessment. Gerontology. 2016;63(1):67-83.
Ghai S, Ghai I, Effenberg AO. Effects of dual tasks and dual-task training on postural stability: A systematic review and meta-analysis. Clin Interv Aging. 2017;12(1):557-577.
Coppin AK, Shumway-Cook A, Saczynski JS, Patel KV, Ble A, Ferrucci L, et al. Association of executive function and performance of dual-task physical tests among older adults: Analyses from the InChianti study. Age Ageing. 2006;35(6):619-624.
Buracchio TJ, Mattek NC, Dodge HH, Hayes TL, Pavel M, Howieson DB, et al. Executive function predicts risk of falls in older adults without balance impairment. BMC Geriatr. 2011;11(1):74.
Lundin-Olsson L, Nyberg L, Gustafson Y. Attention, frailty, and falls: the effect of a manual task on basic mobility. J Am Geriatr Soc. 1988;46(6):758-761.
Bohannon RW. Reference Values for the Timed Up and Go Test. J Geriatr Phys Ther. 2006;29(2):64-68.
Lipschitz DA. Screening for nutritional status in the elderly. Prim Care. 1994;21(1):55-67.
Brucki SMD, Nitrini R, Caramelli P, Bertolucci PHF, Okamoto IH. Sugestões para o uso do mini-exame do estado mental no Brasil. Arq Neuropsiquiatr. 2003;61(3-B):777-781.
Podsiadlo D.; Richardson S. The time up and go, a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991;39(2):142-148.
Shumway-Cook A, Brauer S, Woollacott M. Predicting the Probability for Falls in Community-Dwelling Older Adults Using the Timed Up & Go Test. Phys Ther. 2000;80(9):896-903.
Fluss R, Faraggi D, Reiser B. Estimation of the Youden Index and Its Associated Cutoff Point. Biometrical J. 2005;47(458-472).
Streit IA, Mazo GZ, Virtuoso JF, Menezes EC, Gonçalves E. Aptidão física e ocorrência de quedas em idosos praticantes de exercícios físicos. Rev Bras Atividade Física Saúde. 2012;16(4):346-352.
Sandoval A, Sá M, Antônio AC, Menezes L De, Nakatani YK, Márcia M. Ocorrência de quedas em idosos não institucionalizados: revisão sistemática da literatura. Rev Bras Geriatr Gerontol Rio Janeiro. 2013;16(4):855-853.
Barry E, Galvin R, Keogh C, Horgan F, Fahey T. Is the Timed Up and Go test a useful predictor of risk of falls in community dwelling older adults: a systematic review and meta- analysis. BMC Geriatr. 2014;14(1):2-14.
Downloads
Publicado
Como Citar
Edição
Seção
Licença
Os autores devem ceder expressamente os direitos autorais à Kroton Educacional, sendo que a cessão passa a valer a partir da submissão do artigo, ou trabalho em forma similar, ao sistema eletrônico de publicações institucionais. A revista se reserva o direito de efetuar, nos originais, alterações de ordem normativa, ortográfica e gramatical, com vistas a manter o padrão culto da língua, respeitando, porém, o estilo dos autores. As provas finais serão enviadas aos autores. Os trabalhos publicados passam a ser propriedade da Kroton Educacional, ficando sua reimpressão total ou parcial, sujeita à autorização expressa da direção da Kroton Educacional. O conteúdo relatado e as opiniões emitidas pelos autores dos artigos são de sua exclusiva responsabilidade.
