Let’s Consider Taking a Step Backwards When Assessing Balance

A few months ago we reviewed how gait speed is not only a great test to measure mobility, but why it should also be considered a vital sign (link). But have you ever wondered about assessing your patient’s ability to walk backwards? This is a more complex task needed for tasks such as backing up to a chair, opening a door, or avoiding a sudden obstacle. Or,  have you ever wondered if there was a standardized testing protocol for backwards walking with normative data? 

The study by Carter in 2017, called “The 3m Backwards Walk & Retrospective Falls: Diagnostic Accuracy of a Novel Clinical Measure” looked at walking backwards and falls. The study reviews:

1. How relevant fall prevention is as 1 in 3 adults fall each year. With that, falls have an enormous impact on the quality of life for the individual and the cost to society as a whole.
2. Their standardized testing protocol and normative data for the 3m Backwards Walk (3MBW) test.
3. Other tests commonly used to assess balance and mobility such as the Timed Up and Go (TUGS) and the 5 Times Sit to Stand test.

Before we review the instructions for the 3MWB test and the results of the study we should review what the risk factors are for a fall. 

What are the risk factors for a fall?

• Limited balance and gait.
• Taking multiple medications.
• History of falls.
• Advanced age.
• Cognitive decline.
• Visual impairment.
• Environmental factors. 

What are the instructions for the 3m Backwards Walk test?

1. Before the test measure and mark a distance of 3m with black tape on a smooth surface floor (i.e. not carpet, grass, etc). 
2. Ask participant to align their heels with the black tape.
3. Instruct the participant to walk backwards as quickly, but safely as possible when signalled to “go” and to stop when the distance of 3m is reached. 
4. The examiner walks backwards with the participant to ensure safety. 
5. The average of 3 time trials is made. 

Note: Running backwards by the participant is not allowed, but they are allowed to look backwards if they want.

Normative data found with the 3MWB test:

• Those walking backwards to complete the test in  3 sec or less were unlikely to report falling in the previous year.
• Found those walking backwards to complete the test in 4.5 sec or more were likely to report falling in the previous year. 

Study Pros:

• Great review of how to perform other tests (i.e. TUGS and 5 Times Sit To Stand) that measure functional ability, balance and fall prediction. 
• Outlines that the 3MWB test is a simple test to administer. 
• Provides normative data for the test.
• Interesting, as 25 of the 59 healthy, mobile seniors (ave age 71.5 yrs) in the study reportedly fell in the year preceding the study.  

Study Cons:

• Only assessed healthy older adults who did not require the use of an ambulatory aide.  
• The study results provide no predictive indicator of how at risk someone was for falling (i.e. mild, moderate, significant). 
• Small sample size (n=57).
• Did not define the criteria for what a fall was. 

Summary

This study provides a novel, functionally relevant, and clinically simple test to administer. Further research is needed in this area, but as it stands, the 3MWB test is another tool that a clinician can use to get an objective measure of balance that can be tested serially over time.