Functional Reach Test (FRT)

Objective

Functional Reach Test (FRT) is a clinical outcome measure and assessment tool for ascertaining dynamic balance in one simple task. FRT was developed by Pamela Duncan and co-workers in 1990; defining functional reach as "the maximal distance one can reach forward beyond arm's length, while maintaining a fixed base of support in the standing position".[1] Based on a leaning task, FRT is proposed to measure the limit of stability. This test measures the distance between the length of an outstretched arm in a maximal forward reach from a standing position,while maintaining a fixed base of support. It was developed to predict fall in elderly people; being unable to reach more than 15 centimetres (6 inches) depicts a high fall risk and frailty.[2]

A number of factors exert a major influence on this evaluation. Earlier research revealed that the movement strategy and a reduced spinal flexibility, both affect the reach distance .[3]

Intended Population

FRT was made to predict fall risk in the elderly and Frail adult[1][2]

Method of Use

Using a yardstick or tape measure mounted on the wall, parallel to the floor, at the height of the acromion of the subject's dominant arm, the subject was asked to stand with the feet bare and a comfortable distance apart, make a fist, and forward flex the dominant arm to approximately 90 degrees; that is Position themselves close to, but not touching the wall with their arm outstretched and fist. Taking note of the starting position by determining what number the metacarpophalangeal (MCP) joints line up with on the yardstick. Have the subject reach as far forward as possible in a plane parallel with the measuring device. Instruct them to “Reach as far forward as you can without taking a step” and make them know that they are free to use various reaching strategies. Take note of the end position of the MCP joints against the ruler, and the distance between the start and end point was then measured using the head of the metacarpal of the third finger as the reference point[1].The distance between the position of the third metacarpal and the yardstick mounted on the wall at shoulder height in each position is the Functional Reach.

If they move their feet, that trial must be discarded and the trial repeated. Guard the subject as the task is performed to prevent a fall. Subjects were given two practice trials, and then their performance on an additional three trials were recorded and averaged. Scores less than 15 or 18 centimetres indicate limited functional balance. Most healthy individuals with adequate functional balance can reach 25 centimetres or more[1].

[4]

Instructions to the patient:

Please reach as far forward as you can without losing your balance. Keep your feet on the floor. You are not allowed to touch the wall or the ruler as you reach. You will have two practice trials and then I will record the distance that you reach forward.

Criteria to stop the test:

The patient’s feet lifted up from the floor or they fell forward. Most patients fall forward with this test. The therapist should guard from the front as that is the direction that you reach forward.

Reduced ability to reach has shown increases in future falls with odds ratios of 8.2 if unable to reach at all and 4 if able to reach < 15.2cm[5]

Evidence

Reliability[1][5]

The ordinal level tests (supported sitting and standing balance and static tandem standing tests) showed 100% agreement in all aspects of reliability.

Intra-class correlations for the other tests ranged from 0.93 to 0.99. All the tests showed significant correlations with the appropriate comparator tests (r=0.32-0.74 p≤0.05)

Test-retest reliability r = 0.89

Inter-rater agreement on reach measurement = 0.98

Validity

Functional Reach Test was strongly associated with measurements of centre of pressure excursion r = 0.71 and the R2 using linear regression was 0.51[5]

Concurrent validity between FRT and timed up and go test (TUGT) : rs = -0.47; FRT and Step test: rs=0.50; FRT and Four Square Step Test (FSST): rs = -0.47[6]

Eagle et al.[7] found out the following:

  • Sensitivity = 76%
  • Accuracy = 46%
  • Specificity = 34%
  • Positive Predictive Value = 33%
  • Negative Predictive Value = 77%

Some research found that decreased spinal flexibility and the movement strategy affects the distance reached and also question the ability of FRT to differentiate elderly non-fallers and fallers[8][9]. A research also noted that trunk mobility has a greater contribution to the test than the centre of pressure displacement. [10]

Responsiveness

FRT increased to 28 cm from 18 cm in 22 community-dwelling adults with knee osteoarthritis following a 10weeks aquatic exercise program under physiotherapist lead[11]

Resources

References

  1. 1.0 1.1 1.2 1.3 1.4 Duncan PW, Weiner DK, Chandler J, Studenski S. Functional reach: a new clinical measure of balance.J Gerontol. 1990;45(6):M192-197.
  2. 2.0 2.1 Weiner DK, Duncan PW, Chandler J, Studenski SA. Functional reach: a marker of physical frailty. J Am Geriatr Soc. 1992;40(3):203-207.
  3. Schenkman M, Morey M, Kuchibhatla M. Spinal flexibility and balance control among community-dwelling adults with and without Parkinson's. J Gerontol A Biol Sci Med Sci. 2000;55(8):M441-445.
  4. SAFA Production. Funtional Reach Test. Available from: http://www.youtube.com/watch?v=yYBmBkbvAyk[last accessed 8/5/2019]
  5. 5.0 5.1 5.2 Duncan PW, Studenski S, Chandler J, Prescott B. Functional reach: predictive validity in a sample of elderly male veterans. Gerontol. 1992;47(3):M93-98.
  6. Dite W, Temple VA. A clinical test of stepping and change of direction to identify multiple falling older adults. Archives of Physical Medicine and Rehabilitation. 2002; 83(11):1566 - 1571
  7. Eagle JD, Salama S, Whitman D, Evans LA, Ho E, Olde J. Comparison of three instruments in predicting accidental falls in selected inpatients in a general teaching hospital. Journal of Gerontology Nursing. 1999; 25(7): 40-45.
  8. Wernick-Robinson M, Krebs DE, Giorgetti MM. Functional reach: Does it really measure dynamic balance? Archives of Physical Medicine and Rehabilitation. 1999; 80(3): 262 - 269
  9. Wallmann HW. Comparison of elderly nonfallers and fallers on performance measures of functional reach, sensory organization, and limits of stability.J Gerontol A Biol Sci Med Sci. 2001;56(9):M580-583.
  10. Jonsson E, Henriksson M, Hirschfeld H. Does the functional reach test reflect stability limits in elderly people? J Rehabil Med. 2003;35(1):26-30.
  11. Lau MC, Lam JK, Siu E, Fung CS, Li KT, Lam MW. Physiotherapist-designed aquatic exercise programme for community-dwelling elders with osteoarthritis of the knee: a Hong Kong pilot study. Hong Kong Med J. 2014;20(1):16-23.