PPA QuickScreen© test
Since there are many risk factors for falls which vary from person to person, individualised risk factor assessment should be the first step in developing effective intervention strategies for the prevention of falls in older people.
The QuickScreen© Clinical Falls Risk Assessment was developed by researchers at the Prince of Wales Medical Research Institute and is a multifactorial assessment tool which was designed specifically for use in clinical settings. It has been rigorously tested in a large sample of community-dwelling older people in which it was found that performance in the QuickScreen© was able to accurately predict faller status. In a sub-group of these people, the QuickScreen© measures exhibited good reliability, demonstrating low measurement error and a high ability to detect change in physical status over time.
The QuickScreen© assessment has been trialled in several clinical settings with general practitioners, practice nurses and physiotherapists, where it was found to be quick and easy to administer, taking an average of 10 minutes to complete. The clinicians reported that the assessment provided useful information about risk factors and guided the implementation of intervention strategies. The QuickScreen© consists of the following measures: previous falls, medication usage, vision, peripheral sensation, lower limb strength, balance and co-ordination and requires the use of minimal equipment. This makes it a portable, easy to use assessment which has a low cost yet high accuracy in determining who is at risk of falling and which particular factors contribute to that risk.
The assessment also allows the user to calculate the combined risk increase that the identified risk factors present for future falls. The inclusion of this scoring system in the QuickScreen© allows for the identification of people who are at a high risk of falling, in addition to its ability to determine which specific factors contribute to that risk. This information can then be used to determine which intervention strategies are likely to be most beneficial in reducing the risk of future falls.
Low contrast visual acuity test
Visual acuity is measured using a chart with low-contrast (10%) letters (similar to a Snellen scale). The client must be able to correctly identify all of the letters on line 10 (fifth line down) to pass the test.
For the remaining tests, the client needs to remove their shoes and socks.
Tactile sensitivity test
This test involves the use of a pressure aesthesiometer placed on the lateral malleolus of the ankle of the dominant side. The client is seated. The client must be able to feel at least two of the three test trials to pass the test.
Near tandem stand test
This is a measure of balance and ankle strength and involves testing whether the client can stand with feet in a near tandem position for a period of 10 seconds with their eyes closed. Equipment required is a stopwatch and 2.5cm square cardboard template for foot positioning. The client must be able to balance in this position for at least 10 seconds to pass the test.
Alternate step test
This is a measure of strength, balance and co-ordination. Equipment required includes a stopwatch and 18cm high step. The client must complete the task in less than 10 seconds to pass the test.
Sit to stand test
This test involves timing how long it takes the client to stand up and sit down five times from a seated position. Equipment required includes a 45cm high, straight-backed chair and a stopwatch. The client must complete the task in less than 12 seconds to pass the test.
Additional information to assess during the physiotherapy specialist assessment
- Upper limb range of movement (screen)
- Lower limb range of movement (check knee ligament stability if client complaining of knees giving way)
- Gait analysis (Rank the TUAG, other comments, aids used)