Background
Objectives
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Which features of the statokinesigram in older patients (≥ 60 years) during a bipedal quiet stance test differ between fallers and non-fallers?
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How well can the risk of falling in older adults be predicted from COP characteristics and analysis?
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Which parameters should be included in a predictive or a classification model of fall risk assessment for an older population?
Methods
Research protocol
Search strategy
Components (apply AND for search) | Keyword used (apply OR for search) |
---|---|
Population | “OLDER ADULTS” |
“COMMUNITY-DWELLING PEOPLE” | |
“ELDERLY” | |
“SENIORS” | |
“OUTPATIENT” | |
“FALL PRONE ELDER” | |
“NURSING HOME” | |
“INSTITUTIONAL CARE” | |
Intervention | “BALANCE” |
“EQUILIBRIUM” | |
“QUIET STANDING” | |
“STANCE” | |
“STANDING” | |
“STABILITY” | |
“POSTURE” | |
“POSTURAL STABILITY” | |
Comparison | “POSTUROGRAPHY” |
“FALL*” | |
“RISK OF FALLING” | |
“CENTER OF PRESSURE” | |
“CENTRE OF PRESSURE” | |
“COP TRAJECTORY” | |
“COP DISPLACEMENT” | |
“SWAY” | |
“STATOKINESIGRAM” | |
“STABILOGRAM” | |
“FORCE PLATFORM” | |
Outcomes | “PREDICT*” |
“DIAGNOS*” | |
“CLASSIF*” | |
“DISTING*” | |
“DIFFERENC*” |
Inclusion and exclusion criteria
Inclusion criterion domains | Explicit criterion |
---|---|
General criteria | - Published before July 1, 2018. - Related to the main topics: “the risk of falling in elderly people.” Articles not related to this topic will not be included based on the two-reviewer evaluation system. |
Language criteria | - No language criteria are applied. However, for non-French, non-English, or non-Spanish articles, we will contact professional translators if no French, Spanish, or English version is found. Such translations will be indicated in the main article. - All full papers will be retrieved (or translated) and used. |
Type-of-study criteria | - Retrospective and prospective clinical trials, randomized, or not. - Observational, time series, and cross-sectional studies. |
Participants criteria | - Older patients (aged ≥ 60 years of age) considered to be otherwise healthy/without neurological disease as determined by a diagnostic assessment (or any specification from the authors) which could impact their posture including (but not limited to) Parkinson disease (PD), multiple sclerosis (MS), hemiplegia, paraplegic, stroke, or brain trauma. Orthopedic disorders affecting balance such as recent arthroplasty or amputation will also not be included in the review. |
Intervention criteria | - Articles analyzing the balance through COP recordings during quiet standing with both feet on the ground and evaluating the risk of falling by the number of falls during a period of time (retrospectively or prospectively) - Any article measuring the risk of falling without an estimation of the number of falls per participant (i.e., indirect assessment through fear of falling tests or epidemiologic data only) or not related to the risk of falling (comparing elderly vs. young for example) will be discarded. - If training (e.g., exercise training or a physiotherapy program) is a part of the intervention, the article will be discarded unless a baseline of the quiet standing capacities is recorded. In this case, only the data from the baseline will be used. |
Comparison criteria | - Fallers versus non-fallers (it can include “healthy elderly people” versus “fall prone elderly” or “low risk elderly” vs “high risk elderly” or “single fallers” versus “multiple fallers” or “infrequent fallers” versus “recurrent fallers”) |
Outcomes criteria | - Primary outcomes will be the features in the COP analysis and their differences between the groups (odds ratio for dichotomous outcomes and mean differences for continuous outcomes). - Secondary outcomes will be the precision of the prediction (or the model) of the risk of falling, such as sensibility, specificity, area under the curve (AUC) of receiver operating characteristic (ROC) curves, number of true(/false) positive(/negative), positive predictive value (PPV), and negative predictive value (NPV), odd-ratio or other evaluation of the system. |
Exclusion criterion domains | Explicit criterion |
---|---|
Human criteria | - All animal or pendulum-based studies will be discarded. |
Intervention criteria | - All studies quantifying other activities than quiet standing (e.g., gait and equivalent, using a moving platform or moving environment for assessment, obstacle dodging, external destabilization, functional reach tests, one leg standing, or any forms of assessment of balance other than standing upright). - Romberg coefficient (difference between eyes opened and closed) will be accepted as well as standing on foam if there is a comparison with a firm surface. - Cognitive tasks which do not require to move (e.g., counting or memorizing) will be accepted. - A standardized posture is not an exclusion criterion but will be noted. |
Outcome criteria | - A COP recording is mandatory to not be excluded. All studies than do not compute any parameter to quantify balance through COP data but focus on sway measurement only through sway meter, cumulative balance score (e.g., Sensory Organization Test) or motion capture will be discarded. Studies using Center of Mass (COM) without a COP recording will be discarded too. |
Equipment criteria | - There are no equipment criteria as long as the research recorded COP displacement over time. Force platforms, pressure insoles, or any other COP recording systems are all accepted but will be noted. |
Population criteria | - All studies including young (< 60 years old), healthy people without a comparison group of older people will be discarded. - The presence of a neurologic pathology that could influence posture will be an exclusion criterion. - All studies including recently post-operative participants will be discarded. |
Comparison criteria | - All studies than do not compare elderly fallers and non-fallers but focus on methodological issues (e.g., COP features reliability, force platform methodology and validation, biomechanical model validation) will be discarded. |
Paper review process
Risk of bias evaluation
Data extraction and analysis
Strategy for data synthesis
Confidence in cumulative evidence
Quality | Risk of bias score (mean of the 32-score) | Number of studies (n) | Heterogeneity (I2) | Cumulative sample size | |
---|---|---|---|---|---|
High | > 22 | > 10 | < 30% (low heterogeneity) | > 400 | |
Moderate | 16–22 | 3–10 | 30–75% (moderate) | 200–400 | |
Low | < 16 | 0–3 | > 75% (high heterogeneity) | < 200 | |
Score | Total |