Physical Therapy and Rehabilitation

Physical Therapy and Rehabilitation

ISSN 2055-2386
Original Research

Relationship of backward walking to clinical outcome measures used to predict falls in the older population: A factor analysis

Carol A. Maritz1*, Karin Grävare Silbernagel2 and Ryan Pohlig3

*Correspondence: Carol A. Maritz

1. Associate Dean and Professor of Physical Therapy, Samson College of Health Sciences, University of the Sciences, Philadelphia, PA 19104, USA.

Author Affiliations

2. Assistant Professor, Department of Physical Therapy, University of Delaware, STAR Health Sciences Complex Campus, 540 South College Avenue Newark, DE 19713 USA.

3. Sr. Biostatistician, Dean’s Office, University of Delaware, STAR Health Sciences Complex Campus, 540 South College Avenue, Newark, DE 19713 USA.


Background: Backward walking has been found to be a more sensitive measure to detect fallers than forward walking. It involves greater reliance on neuromuscular control to make up for the lack of vision. In fact, backward walking speed has been determined to more accurately identify fallers in the older population than forward walking. This study examined if backward walking measures more than one underlying factor while also examining the relationship between it and other clinical measures used to identify falls risk.

Methods: A convenience sample of 57 older adults (10 males and 47 females) with a mean age of 78.8 years (SD 8.9 years) participated in this cross-sectional study. Subjects walked backward on the GAITRite® computerized walkway system recording gait velocity, stride and step length, stance and swing time, single and double support. Additionally, subjects were tested on clinical measures commonly used to assess falls risk which included the Timed up and go test, Four square step test, Activity-specific balance confidence scale, single heel rise test and the 30-second chair stand test. An exploratory factor analysis with Maximum Likelihood extraction and Varimax rotation was performed on various aspects of backward walking. The relationship between the backwards walking factor scores and selected clinical measures was tested using Spearman correlations and regression.

Results: Results revealed that there are two factors associated with backward walking: cadence and velocity. Cadence was only mildly correlated to 30-second chair stand test, r=0.29; whereas velocity was highly correlated with each of the known predictors of falls used, all r>0.44.

Conclusion: Given theses findings, a clinician could quickly measure backward walking velocity and count the number of steps an individual takes in order to screen those at-risk for falls.

Keywords: Falls, gait, backward walking, older adults, balance, balance confidence

ISSN 2055-2386
Volume 4
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