Four Bedside Tests and Measures to Determine Walking Safety

Bernard falls. Truth be told, he falls a lot. His wife has become so used to the falls that it no longer seems unusual to her that her man is on the floor at least 3 times a week. But, this last fall was different.

Bernard is now slouching on the edge of a hospital bed, cloaked in the quintessential hospital gown, staring down at his fuzzy one-size-fits-all, anti-skid socks.

Enter the physio, stage left. A formal assessment is in order. The physio has a million tools to assess how bad-off Bernard is, but time is not renewable and therapists are meant to be productive.

A good starting point is these easy-to-administer bedside tests. These 4 tests are so simple and so predictive, they can make testing and retesting a joy for both therapist and medical staff.

1. Five Times Sit-to-Stand Test

The five times sit-to-stand test is an incredibly simple way to assess lower limb strength in older adults. It can be performed bedside in about 30 seconds.

The patient is instructed to sit in a chair with arms across chest, stand up, then return to the seated position. The patient repeats this five times while the practitioner documents their completion speed.

While this test seems simple at first, a recent study found it to be a great predictor of future disability (Makizako et al. 2017). Patients who exhibited poor performance on the five times sit-to-stand test were found to be at higher risk than those who did well. The cutoff point for predicting disability was just 10 seconds. In other words, those who were unable to complete 5 repetitions in under 10 seconds were nearly twice as likely to develop a disability. That is a powerfully predictive tool.

Normative values for this test:

	Male/Female
Age 60-69	11.4 seconds
Age 70-79	12.6 seconds
Age 80-89	14.8 seconds

(Whitney et al. 2005)

2. 30-Second Chair Rise

The 30-second chair rise is similar to the five times sit-to-stand test in that the patient is instructed to fold their arms across the chest and stand from a seated position. In this test, the patient is timed to see how many repetitions he can complete within a span of 30 seconds. This test can be a great way to assess leg strength and endurance.

While assessing frailty has been difficult (although useful in predicting mortality), researchers found the 30-second chair rise to be an accurate method to gauge frailty.

Using body sensors, they were able to clearly differentiate patterns in different levels of frailty among the patients (Millor et al. 2013). In this way, practitioners combine new technology with a tried-and-true chair rise test to get information that might be hard to come by otherwise.

Normative values for this test:

	Male	Female
Age 60-64	14-19	12-17
Age 65-69	12-18	11-16
Age 70-74	12-17	10-15
Age 75-79	11-17	10-15
Age 80-84	10-15	9-14
Age 85-89	8-14	8-13
Age 90-94	7-12	4-11

(Jones & Rikli 2002)

3. Timed Up-and-Go

In the timed up-and-go test, the practitioner marks a line three metres away from the patient. The patient is instructed to stand up, walk to the line at a normal pace, turn, and return to the original seat. The goal is to complete the test in under 12 seconds.

Though an exceedingly simple test, there are some directions that should be followed – details for testing are available online (Podsiadlo & Richardson 1991).

While this test can be a great predictor of fall risk, that’s not all it can do; it can also be a predictor of sarcopenia. Researchers found a cut-off time of 10.85 seconds was an accurate predictor that the patients in the study would experience reduced muscle mass (Martinez et al. 2015).

Normative values for this test:

	Male	Female
Age 60-69*	7.3 seconds	8.1 seconds
Age 71-75	8.6 seconds	10.7 seconds
Age 76-80	9.42 seconds	10.71 seconds
Age 81-85	10.34 seconds	12.36 seconds
Age 86-99	11.13 seconds	13.15 seconds

(Pondal & del Ser 2001)

4. Two Minute Walk Test

While the six minute walk test has historically been used as a go-to assessment tool, recent publications suggest that the much shorter alternative is sufficient (Andersen et al. 2016) for assessing walking capability, at least in patients with neuromuscular diseases.

In the two minute walk test, patients are instructed to walk for two minutes at one of two paces, maximal walking speed or comfortable walking speed. For the former, the rater will state, “When I say ‘go,’ walk as fast as you can – but walk safely – and I will measure how far you can walk in two minutes.” For the self-selected ‘comfortable’ walking speed, the rater will state, “When I say ‘go,’ walk at your comfortable pace and I will measure how far you can walk in two minutes.”

For both tests, the timer starts when the rater says ‘go‘. It is possible to do this test with a hallway of 25 metres or longer. It is best to do a practice trial to minimise training effect (but this is not always possible).

At the end of the test, the practitioner measures the distance covered. While this test is a little more lengthy than the other three already discussed, it is an easily calculated test for therapists and nurses who work in an environment where it is possible to standardise distances.

This shorter test option makes it feasible to test patients who could never complete a six minute test. Individuals looking for additional tips on how to administer this test can find useful tips here (Brooks et al. 2007).

Normative values for this test:

	Distance
Long-term care group	77.5 meters
Retirement-dwelling older adults	150.4 meters

(Connelly et al. 2009)

Conclusion

Sometimes, simple is best. These four tests take no more than 2 minutes each and yet they can provide a goldmine of data on the functional status of almost every geriatric patient. It’s time to add them to your repertoire!

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References

• Andersen, LK, Knak, KL, Witting, N & Vissing, J 2016, ‘Two-and 6-minute walk tests assess walking capability equally in neuromuscular diseases’, Neurology, vol. 86, no. 5, pp. 442-5, viewed 16 May 2017, https://www.ncbi.nlm.nih.gov/pubmed/26740680
• Brooks, D, Davis AM & Naglie, G 2007, ‘The feasibility of six-minute and two-minute walk tests in in-patient geriatric rehabilitation’, Canadian Journal on Aging = La Revue Canadienne du Vieillissement, vol. 26, no. 2, pp. 159-62, viewed 16 May 2017, https://www.ncbi.nlm.nih.gov/pubmed/17613447 
• Connelly, DM, Thomas, BK, Cliffe, SJ, Perry, WM & Smith, RE 2009, ‘Clinical Utility of the 2-Minute Walk Test for Older Adults Living in Long-Term Care’, Physiotherapy Canada, vol. 61, no. 2, pp. 78-87, viewed 16 May 2017, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2792234/
• Jones, CL & Rikli, RE 2002, ‘Measuring Functional’, The Journal on Active Aging, March-April, viewed 16 May 2017, http://www.dsnm.univr.it/documenti/OccorrenzaIns/matdid/matdid182478.pdf
• Makizako, H, Shimada, H, Doi, T, Tsutsumimoto, K, Nakakubo, S, Hotto, R & Suzuki, T 2017, ‘Predictive Cutoff Values of the Five-Times Sit-to-Stand Test and the Timed “Up & Go” Test for Disability Incidence in Older People Dwelling in the Community’, Physical Therapy, vol. 97, no. 4, pp. 417-424, viewed 16 May 2017, https://www.ncbi.nlm.nih.gov/pubmed/28371914
• Martinez, BP, Gomes, IB, Oliveira, CS, Ramos, IR, Rocha, MD, Forgiarini Junior, LA, Camelier, FW & Camelier, AA 2015, ‘Accuracy of the Timed Up and Go test for predicting sarcopenia in elderly hospitalized patients’, Clinics (Sao Paulo, Brazil),  vol. 70, no. 5, pp. 369-72, viewed 16 May 2017, https://www.ncbi.nlm.nih.gov/pubmed/26039955%20
• Millor, N, Lecumberri, P, Gomez, M, Martinez-Ramirez, A & Izquierdo, M 2013, ‘An evaluation of 30-s chair stand test in older adults: frailty detection based on kinematic parameters from a single inertial unit’, Journal of Neuroengineering and Rehabilitation, vol. 1, no. 10, p. 86, viewed 16 May 2017, https://www.ncbi.nlm.nih.gov/pubmed/24059755
• Podsiadlo, D & Richardson, S 1991, ‘The timed “Up & Go”: a test of basic functional mobility for frail elderly persons’, Journal of American Geriatrics Society, vol. 39, no. 2, pp. 142-8, viewed 16 May 2017, https://www.ncbi.nlm.nih.gov/pubmed/?term=The+timed+%22Up+%26+Go%…ail+elderly+persons.
• Pondal, M & del Ser, T 2001, ‘Normative data and determinants for the timed “up and go” test in a population-based sample of elderly individuals without gait disturbances’, Journal of Geriatric Physical Therapy, vol. 31, no. 2, pp. 57-63, viewed 16 May 2017, https://wwww.unboundmedicine.com/medline/…disturbances_
• Whitney, SL, Wrisley, Dm, Marchetti, GF, Gee, MA, Redfern, MS & Furman, JM 2005, ‘Clinical measurement of sit-to-stand performance in people with balance disorders: validity of data for the Five-Times-Sit-to-Stand Test’, Physical Therapy, vol. 85, no. 10, pp. 1034-45, viewed 16 May 2017, https://www.ncbi.nlm.nih.gov/pubmed/16180952

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