8/6/2019 Critiquing Assessment Tool
1/32
Functional Reach Test- Duncan, 1990; Eagle, 1999; Langley, 2007
8/6/2019 Critiquing Assessment Tool
2/32
A. Title Functional Reach Test
B.Authors uncan, P.W., Weiner, .K.,Chandler, J., & Studenski, S.(1 )
C. Time required toadminister the test
1 to 2 minutes
. Materials Meter/yard Stick
8/6/2019 Critiquing Assessment Tool
3/32
A. Purpose of the Test
Descriptive: to etect balance impairment or look
at changes in balance performance over-time ofgeriatric patients
Pre ictive: assess risk of falling
. Target Population
Geriatric / El erly population
8/6/2019 Critiquing Assessment Tool
4/32
A. Ease ofAdministration
Easy to perform , accessible practical measure
of balance
. Clarity of Directions
mount a yardstick on the wall on shoulder level stand near wall, but not touching it
outstretch arm, with hand in a fist, parallel tofloor
8/6/2019 Critiquing Assessment Tool
5/32
8/6/2019 Critiquing Assessment Tool
6/32
C. coring Procedures
Compare pre post measurement
scores less than 6-7 inches: limited functionalbalance
scores 10 inches or more: adequate functionalbalance
D. Examiner Qualifications Training
No training required
8/6/2019 Critiquing Assessment Tool
7/32
A. Norms
. Reliability
Test-retest reliability: r = 0.89
Interrater reliability: r = 0 .98
Age Men Women
20 40 y/o 16.7 + 1.9 14.6 + 2.241 69 y/o 14.9+ 2.2 13.8+ 2.2
70 87 y/o 13.2+ 1.6 13.2+ 1.6
8/6/2019 Critiquing Assessment Tool
8/32
C. Validity
FRT was strongly associated with measurements:
centre of pressure excursion r = 0.71
linear regression r= 0.51
Moderate correlations
Tandem walk Gait peed: r= 0.67 0.71 Fair correlations
BBS: r= 0.42
POMA: r= 0.47
8/6/2019 Critiquing Assessment Tool
9/32
Sensitivity
ability to detect falls when they are present = 76%
Specificity ability to identify correctly the absence of falls =
34%
Positive Predictive Value
how well test predicted compared to actualnumber of falls = 33%
8/6/2019 Critiquing Assessment Tool
10/32
Negative Predictive Value how well negative test correctly predicts absence
of falls = 77% Accuracy
overall rate of agreement between the test andthe actual number of falls = 46%
Prevalence ratio of the number of people who have fallen
divided by the total number of people at risk forfalling = 30%
8/6/2019 Critiquing Assessment Tool
11/32
Measures one direction of functional
movement (forward reach)
May not identify balance difficulties evidentduring locomotion related activities
8/6/2019 Critiquing Assessment Tool
12/32
Duncan, P. ., Weiner, D. ., Chandler, J.Studenski S.(1990). Functional reach: a new clinical measure ofbalance.Journal of Gerontology, 145: 192-197.
Eagle, J., Salamara, S., Whitman, D., Evans, L.A., Ho, E.,Olde, J. (1999).Comparison of three instruments in
predicting accidental falls in selected inpatients in ageneral teaching hospital.Journal of Gerontological
Nursing, 25(7), 40-45.Langley, F.A., Mackintosh, S.F. (2007). Functionalbalance assessment of older community dwellingadults: A systemic review of literature.Internet Journalof Allied Health Sciences and Practice, 4(5), 1-11.
8/6/2019 Critiquing Assessment Tool
13/32
PATIEN
T ASS
ESS
MEN
T
8/6/2019 Critiquing Assessment Tool
14/32
Name: RMAge: 58 y/o
Gender: MHandedness: (R)
Dx: S/P (R) CVA (2010);(L) Hemiparesis
8/6/2019 Critiquing Assessment Tool
15/32
c/c: pt. c/o weakness on (L) UE LE; difficulty in
maintaining balance
PMHX: (+) HTN, controlled by meds. since 2000 (+) DM, controlled by meds
Personal/Social Hx (+) alcoholic beverage drinker (-) smoker
8/6/2019 Critiquing Assessment Tool
16/32
VS: WNL OI:
Ambulatory without assistive device Alert/coherent/cooperative
(+) obvious physical findings: (+) Trophic skin changes: dry, scaly skin
(+) Postural Deviation (+) Gait Deviation
(-) facial asymmetry, typical arm posture, atrophy,deformities
8/6/2019 Critiquing Assessment Tool
17/32
Palpation:
Normothermic on all exposed body parts
Normotonic on (B) UE LE (-) shoulder sublaxation, tenderness, edema
8/6/2019 Critiquing Assessment Tool
18/32
Neurologic Eval:
50% sensory deficit as to light touch, pain
pressure on (L) UE LE 100% intact kinesthesia proprioception
Reflex Testing:
Normoreflexia on (B) UE LE
(-) babinski, clonus, associated reactions
8/6/2019 Critiquing Assessment Tool
19/32
ROM:
WNL, pain free actively passively done on (R)
LOM on (L) UE secondary to pain
MMT:
Major muscles of (L) UE LE grossly graded 3+/5
8/6/2019 Critiquing Assessment Tool
20/32
Postural Analysis
Pt. in standing position assessed in all views
with postural landmark symmetrical leveledexcept for:
Upper back slightly more rounded
Feet pointing outwards
Gait Analysis Pt. ambulates with wide BOS / toeing-out with
limited arm swing
8/6/2019 Critiquing Assessment Tool
21/32
ADL
Independent in all aspects ofADL except for:
UE dressing requires minimal to moderate assistance
8/6/2019 Critiquing Assessment Tool
22/32
Functional Mobility:
Independent as to bed mobility
Minimal assist require during sit to stand transfer
Balance
Good sitting balance and tolerance Fair standing balance
pt is able to maintain balance with handhold support;may require occasional minimal assistance
8/6/2019 Critiquing Assessment Tool
23/32
Functional Outcome Measure:
Functional Reach Test (FRT) to assess balance impairmentrisk of falling
sig.: impaired functional balance
Trial Starting Position End Position Difference
1 8.5 14.5 6
2 8 14 6
3 8.7 14.8 6.1Ave. 8.4 14.03 6.03 / 15.3 cm.
8/6/2019 Critiquing Assessment Tool
24/32
Scores:
25.4 cm.): adequate functional balance
8/6/2019 Critiquing Assessment Tool
25/32
Norms
Age Men (cm.) Women(cm.)
20 40 y/o 42.4 cm. 4.8 cm. 37.1 cm 5.6 cm.
41 69 y/o 37.8 cm. 5.6 cm. 35.1 cm. 5.6 cm.
70 87 y/o 33.5 cm. 4.1 cm. 33.5 cm. 4.1 cm.
8/6/2019 Critiquing Assessment Tool
26/32
PT Diagnosis
Impaired Motor Function Sensory Integrity
Associated withNon Progressive Disorders of theCNS- Acquired in Adulthood
Impression
Pt. condition is further defined with (L)hemiparesis , hemianesthesia, impaired balance,LOM on (L) UE LE, postural gait deviation.
8/6/2019 Critiquing Assessment Tool
27/32
Problem List:1. ImpairedBalance
2. Weakness on (L) UE LE3. LOM on (L) UE4. Gait deviation
5. Postural deviation
8/6/2019 Critiquing Assessment Tool
28/32
Goals1. pt. will be able to demonstrate Good standing
balance as manifested by ability maintainbalance without handhold support withlimited postural sway.
2. Pt. will demonstrate increase mm. strengthfrom 3+ to 5/5.
3. Pt. will be able to demonstrate increase in ROMas manifested by ability to do overhead motionwithout pain difficulty.
8/6/2019 Critiquing Assessment Tool
29/32
To develop PT protocol / intervention to
improve functional balance.
Justine Ramos, PTRP
8/6/2019 Critiquing Assessment Tool
30/32
8/6/2019 Critiquing Assessment Tool
31/32
Functional Reach Test: Static vs. Dynamic?
Dynamic measure of balance regardless of
movement strategy (Duncan et.al, 1990) Compensatory movement strategies (e.g. hip
flexion and ankle PF) are more of static whichdoes not increase the moment arm during FR
(Wernick-Robinson et.al, 1999)
8/6/2019 Critiquing Assessment Tool
32/32
RCT on Therapeutic Exercises (flexibility,strength, balance, endurance UE function) inSubacute Stroke (Duncan et.al, 2003)
RCT onSpecific balance-strategy trainingprogramme for preventing falls among olderpeople (Nitz Choy, 200)
Case study on NDT focusing on postural trainingto improve Functional Reach (Zacharewicz,2002)