Functional Reach Test (FRT): Difference between revisions
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* The location of the 3rd metacarpal is recorded again. | * The location of the 3rd metacarpal is recorded again. | ||
* Scores are determined by assessing the difference between the start and end position is the reach distance, usually measured in inches. | * Scores are determined by assessing the difference between the start and end position is the reach distance, usually measured in inches. | ||
* Three trials are done and the average of the last two is noted | * Three trials are done and the average of the last two is noted<ref>Billek-Sawhney B, Gay J. The functional reach test: Are 3 trials necessary?. Topics in Geriatric Rehabilitation. 2005 Apr 1;21(2):144-8.</ref> | ||
[[File:Performance-of-the-instrumented-functional-reach-test-SEH-Participants-were-asked-to.png|center|thumb|418x418px|Functional Reach Test <ref>Ivan Miguel Pires, Garcia NM, Eftim Zdravevski. Measurement of Results of Functional Reach Test with Sensors: A Systematic Review. Electronics [Internet]. 2020 Jun 30 [cited 2024 Feb 6];9(7):1078–8. Available from: <nowiki>https://www.mdpi.com/2079-9292/9/7/1078</nowiki> | [[File:Performance-of-the-instrumented-functional-reach-test-SEH-Participants-were-asked-to.png|center|thumb|418x418px|Functional Reach Test <ref>Ivan Miguel Pires, Garcia NM, Eftim Zdravevski. Measurement of Results of Functional Reach Test with Sensors: A Systematic Review. Electronics [Internet]. 2020 Jun 30 [cited 2024 Feb 6];9(7):1078–8. Available from: <nowiki>https://www.mdpi.com/2079-9292/9/7/1078</nowiki> | ||
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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. | 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 and Traumatic Brain Injury|falls]] with odds ratios of 8.2 if unable to reach at all and 4 if able to reach < 15.2cm | Reduced ability to reach has shown increases in future [[Falls and Traumatic Brain Injury|falls]] with odds ratios of 8.2 if unable to reach at all and 4 if able to reach < 15.2cm | ||
== Measurement Interpretation: == | == Measurement Interpretation: == | ||
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* '''6”/15cm to 10”/25cm''' Risk of falling is 2x greater than normal; | * '''6”/15cm to 10”/25cm''' Risk of falling is 2x greater than normal; | ||
* '''6”/15cm or less''' Risk of falling is 4x greater than normal; | * '''6”/15cm or less''' Risk of falling is 4x greater than normal; | ||
* '''Unwilling to reach:''' Risk of falling is 8x greater than normal | * '''Unwilling to reach:''' Risk of falling is 8x greater than normal<ref name=":0" /> | ||
== Functional Reach Norm == | == Functional Reach Norm == | ||
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Though there laboratory tests available that assess limits of stability using force platform, there was a need found to transform laboratory measurement of limits of stability into an affordable, quick and simple clinical test that can be easily performed in different settings<ref name=":4" />which is provided by FRT. | Though there laboratory tests available that assess limits of stability using force platform, there was a need found to transform laboratory measurement of limits of stability into an affordable, quick and simple clinical test that can be easily performed in different settings<ref name=":4" />which is provided by FRT. | ||
== Evidence == | == Evidence == | ||
'''Reliability'''<ref name=":0 | '''Reliability'''<ref name=":0" /> | ||
* The ordinal level tests (supported sitting and standing balance and static tandem standing tests) showed 100% agreement in all aspects of reliability. | * 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) | * 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) | ||
Latest revision as of 21:17, 26 June 2024
Original Editor - Evan Thomas
Top Contributors - Tolulope Adeniji, Uchechukwu Chukwuemeka, Nehal Shah, Kim Jackson, Lucinda hampton, Momina Khalid, Evan Thomas, Lauren Lopez, Admin and Rachael Lowe
Introduction[edit | edit source]
As age advances, elderly people face postural instability and it poses a major public health issue. Routine clinical evaluations involve detection, analysis and understanding of gait and balance alterations. In order to assess risk of fall in elderly, Functional Reach test (FRT) has shown to be a clinical tool. It is complex and involves multiple joints like leg, hip and spinal joints[1]
Development[edit | edit source]
In 1990, Pamela Duncan and colleagues first developed the Functional Reach test. It is a quick, single-task, dynamic test that is used to predicting falls in older adults. This test measures the margin of stability along with the ability to measure balance during a functional task.
Intended Population[edit | edit source]
- FRT was made to predict fall risk in the elderly and Frail adult[2][3]
- It is one of the 4 tests used in the The Balance Outcome Measure for Elder Rehabilitation (BOOMER) along with Step Test, Timed Up and Go test and Timed Static Stance test.
Method of Performing FRT[edit | edit source]
- The patient is instructed to stand next to, but not touching, a wall and position the arm that is closer to the wall at 90 degrees of shoulder flexion with a closed fist.
- The assessor records the starting position at the 3rd metacarpal head on the yardstick.
- Patient is instructed to reach as farther as possible without moving from the ground
- The location of the 3rd metacarpal is recorded again.
- Scores are determined by assessing the difference between the start and end position is the reach distance, usually measured in inches.
- Three trials are done and the average of the last two is noted[4]
Criteria to stop the test[edit | edit source]
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
Measurement Interpretation:[edit | edit source]
In general terms, FRT normative value is 26.6 cm for community older adults and normative value is 15.4 cm for non-community older adults[6]
- 10”/25 cm or greater: Low risk of falls;
- 6”/15cm to 10”/25cm Risk of falling is 2x greater than normal;
- 6”/15cm or less Risk of falling is 4x greater than normal;
- Unwilling to reach: Risk of falling is 8x greater than normal[2]
Functional Reach Norm[edit | edit source]
| Age | Men | Women |
|---|---|---|
| 20-40 | 16.73 inches | 14.64 inches |
| 41-69 | 14.98 inches | 13.81 inches |
| 70-87 | 13.15 inches | 10.47 inches |
Purpose[edit | edit source]
Functional Reach Test (FRT) is a clinical outcome measure and assessment tool for ascertaining dynamic balance in in simple task. As we know that this test measures the distance between the length of an outstretched arm in a maximal forward reach, while maintaining a fixed base of support. Hence this information helps in understanding risk of fall. A number of factors exert a major influence on this evaluation and Researches reveal that movement strategy and reduced spinal flexibility both affect reach distance.[7]
Maximum distance that the center of mass can be moved safely without changes in the base of support defines limits of stability. In order to perform activities of daily living safely which mainly involve reaching in different directions, limits of stability control is essential. Postural mechanisms play a major role to maintain or recover the limits of stability[6]
Though there laboratory tests available that assess limits of stability using force platform, there was a need found to transform laboratory measurement of limits of stability into an affordable, quick and simple clinical test that can be easily performed in different settings[6]which is provided by FRT.
Evidence[edit | edit source]
Reliability[2]
- 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
Eagle et al.[8] 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[9][10].Rresearch also noted that trunk mobility has a greater contribution to the test than the cenere of pressure displacement. [11]
Responsiveness
FRT increased to 28 cm from 18 cm in 22 community-dwelling adults with knee osteoarthritis following a 10weeks aquatic exercise program under the guidance of a physiotherapist.[12]
Resources[edit | edit source]
References[edit | edit source]
- ↑ de Waroquier-Leroy L, Bleuse S, Serafi R, Watelain E, Pardessus V, Tiffreau AV, Thevenon A. The Functional Reach Test: strategies, performance and the influence of age. Annals of physical and rehabilitation medicine. 2014 Aug 1;57(6-7):452-64.
- ↑ 2.0 2.1 2.2 Duncan PW, Weiner DK, Chandler J, Studenski S. Functional reach: a new clinical measure of balance.J Gerontol. 1990;45(6):M192-197.
- ↑ Weiner DK, Duncan PW, Chandler J, Studenski SA. Functional reach: a marker of physical frailty. J Am Geriatr Soc. 1992;40(3):203-207.
- ↑ Billek-Sawhney B, Gay J. The functional reach test: Are 3 trials necessary?. Topics in Geriatric Rehabilitation. 2005 Apr 1;21(2):144-8.
- ↑ Ivan Miguel Pires, Garcia NM, Eftim Zdravevski. Measurement of Results of Functional Reach Test with Sensors: A Systematic Review. Electronics [Internet]. 2020 Jun 30 [cited 2024 Feb 6];9(7):1078–8. Available from: https://www.mdpi.com/2079-9292/9/7/1078
- ↑ 6.0 6.1 6.2 Rosa MV, Perracini MR, Ricci NA. Usefulness, assessment and normative data of the Functional Reach Test in older adults: a systematic review and meta-analysis. Archives of Gerontology and Geriatrics. 2019 Mar 1;81:149-70.
- ↑ 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.
- ↑ 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.
- ↑ 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
- ↑ 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.
- ↑ 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.
- ↑ 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.
