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ABSTRACT
Purpose: We adapted the original Functional Reach so that
sitting balance could be quantifiably measured in 2 directions.
Purposes of the study were to determine if sitting forward or
lateral reach: (1) are reliable among younger, middle-aged, and
older adults without balance problems; (2) provide reference
values for clinicians; and (3) examine factors (age and anthropometrics) that may influence such measures. Methods: This
descriptive study involved 146 apparently healthy adults in 3
age groups: 62 younger (21 to 39 yr), 41 middle-aged (40 to
59 yr), and 43 older (60 to 97 yr). After anthropometric measurements were obtained, participants reached forward and
laterally (shoulder elevated 90o) with a closed fist while sitting
in a chair. Intrarater reliability was calculated on a subset of 84
participants. Results: Intrarater reliability of sitting forward and
lateral reach measured with a yardstick was excellent (ICC3,1 =
.98 and .96 respectively). Means and standard deviations by age
group and sex are reported. Regression analysis showed that
body segment anthropometrics did not affect performance.
Differences between age groups for both the sitting reaches
were found. Post hoc analysis revealed that older participants
differed from both younger and middle-aged participants.
Conclusions: Forward and lateral reach from the seated position can be reliably measured and offer therapists a way to
quantify sitting balance. This study provides reference values
for younger, middle-aged, and older adults for clinical use.
While anthropometrics do not affect performance, older adults
perform differently from younger and middle-aged adults.
Key Words: sitting balance, aging, functional reach
INTRODUCTION
The United States population continues to shift to increasing numbers of older adults with longer life expectancies.1 At
the same time, 30% to 60% of community dwelling older adults
fall each year and that rate increases with age.2 For older adults
living in nursing homes, the annual fall rate is as high as 75%.3
The high rate of falls combined with the growth in percent and
Address all correspondence to: Mary Thompson, Texas
Womans University, School of Physical Therapy, 8194 Walnut
Hill Lane, Dallas, TX 74231 Ph: 214-585-1332, Fax: 214-7062361 (MThompson@twu.edu).
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Figure 1. Starting and ending positions for forward and lateral sitting reach. A. Starting position for forward reach. B.
Ending position for forward reach. C. Starting position for
lateral reach. D. Ending position for lateral reach.
All data were analyzed using SPSS software, version 12.
Intraclass coefficient (ICC3,1) determined intrarater reliability
across the 3 trials on a subset of 84 participants. Height, weight,
age, and gender were used to calculate body mass index for
each subject. The mean performance of the 146 participants
on each task was used for all remaining analyses. Group means
and standard deviations were calculated for each task. The old
group was further divided into young-old and old-old groups
to make the age span comparable to the other two groups.
Regression analysis was performed to determine the contribution of anthropometric characteristics (body mass index and
arm, trunk, and femur lengths) to forward or lateral reach. A
multivariate analysis of variance (MANOVA) was calculated to
determine differences between age groups on the two tasks
with post-hoc analysis as necessary.
RESULTS
Participants were very similar to each other in that 87% had
college education. In addition, 77% of the participants lived
with someone and 51% used no medications. Sixty-six percent
participated in some form of regular exercise. They were also
similar in terms of anthropometric characteristics (Table 1).
The intrarater reliability (ICC3,1) of sitting forward and lateral
reach performed with a yardstick was .98 and .96 respectively.
Mean scores on the sitting forward reach and lateral reach by
group are presented in Table 2. The MANOVA revealed differences between age groups for both the sitting forward reach (F
= 17.5, p = .0001) and sitting lateral reach (F = 15.4, p = .0001).
Post hoc analysis revealed that participants in the 2 older age
groups did not differ from each other. Furthermore, the older
participants (in total and also divided into young-old and
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Characteristic
Age 40-59
n=41
Age 60-97
n=43
Entire Sample
n=146
Height (cm)
167.0
167.6
165.8
166.9
Weight (kg)
67.2
70.6
66.9
68.1
24.0
24.5
24.3
24.2
55.6
55.1
53.6
54.9
42.0
41.5
41.3
41.7
66.6
68.1
66.5
66.9
Note: There were no significant differences between groups on any of the characteristics.
SD
Male (n=6)
45.4
9.3
Female (n=56)
44.8
Total (n=62)
Mean
SD
Min-Max
29.6-55.0
31.6
8.8
21.2-44.2
6.7
25.7-58.4
29.3
5.8
17.8-47.4
44.9
6.9
25.7-58.4
29.5
6.1
17.8-47.4
Male (n=17)
44.4
6.9
33.8-63.3
28.5
5.0
18.2-36.1
Female (n=24)
40.4
6.7
25.0-53.3
24.8
4.7
16.3-33.3
Total (n=41)
42.1
7.0
25.0-63.3
26.3
5.1
16.3-36.1
Male (n=7)
36.6
9.2
26.7-54.1
25.8
8.2
14.0-37.9
Female (n=13)
33.5
9.9
16.0-51.6
17.9
6.2
7.4-26.2
Total (n=20)
34.6
9.5
16.0-54.1
20.6
7.8
7.4-37.9
Male (n=8)
35.6
10.9
21.6-51.6
24.8
3.4
19.5-28.8
Female (n=15)
31.8
9.3
16.1-48.3
19.9
7.7
11.9-36.0
Total (n=23)
33.1
9.8
16.1-51.6
21.6
6.8
11.9-36.0
Male (n=38)
41.3
9.3
21.6-63.3
27.7
6.3
14.0-44.2
Female (n=108)
40.7
9.0
16.0-58.4
25.6
7.3
7.4-47.4
Total (n=146)
40.8
9.1
16.0-63.3
26.2
7.1
7.4-47.4
21-39 Years
40-59 Years
60-79 Years
80-97 Years
Entire Sample
DISCUSSION
Sitting balance is important for functional independence,
especially for people who cannot stand. Any limitations in the
ability to safely shift the center of gravity toward stability limits may limit wheelchair mobility and activities of daily living.
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60
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In addition, our groups were very similar in size and shape and
none of our participants were obese so excess adipose tissue did
not limit movement.
Age is another factor that affects balance. Declines in standing balance have been attributed to sensory, musculoskeletal,
and cognitive changes, typically in some combination as multiple systems fall below minimal functional thresholds. These
same changes may influence sitting balance as well. Based on
results from cohort studies of standing balance,13,25 we expected
the sitting functional reach excursions to be smaller for the older
adult group. This finding was true for both forward and lateral
reach. An alternative explanation for the age differences in performance may be group differences on anthropometric measures, but this was not the case. Other unmeasured factors such
as medications, hydration status, and perceived functional ability may also contribute to differences in performance between
the age groups.
While not assessed directly in this sample, fear of falling could
influence sitting functional reach performance, more so in older
adults than the younger age groups. To establish baseline values
we collected performance data on healthy participants without
sitting balance problems, who did not express a fear of falling
from a seated position. Therefore, fear of falling from a seated
position did not appear to be a factor in their performance. This
lack of fear may not be the case for persons with or without a
history of falls who have impairments that limit sitting balance.
Newton16 found fear of falling in a sample of older adults contributed to a decreased amount of backward reach while standing. Therefore, future studies should examine the relationship
between fear of falling and sitting functional reach performance
in people with sitting balance impairments, falls, or both.
In addition to examining people with sitting balance impairments, further examination of the psychometric properties of
the sitting forward and lateral reach need to be explored in
larger sample sizes. Specifically, the clinical usefulness of the
measures should be addressed as well as concurrent and predictive validity.
In conclusion, forward and lateral reach from the seated
position can be reliably measured in apparently healthy adults.
These sitting reach tests challenge balance beyond static sitting
and simulate functional movements. This study provides reference values for younger, middle-aged, and older adults that may
be useful for clinical comparisons. While anthropometrics do
not affect performance, older adults perform differently from
younger and middle-aged adults.
Acknowledgement
We thank our graduate students who assisted with this
work.
REFERENCES
1. He W, Sengupta M, Velkoff VA, DeBarros KA. 65+ in the United
States: 2005, US Census Bureau, Current Population Reports,
P23-209. Washington, DC: U.S. Government Printing Office;
2005.
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