Related Experiment Video
Updated: Nov 24, 2025
Author Spotlight: Innovations in iTUG Test for Enhanced Risk Assessment and Cognitive Insights
Published on: October 25, 2024
Stepping impairment and falls in older adults: A systematic review and meta-analysis of volitional and reactive step
Yoshiro Okubo1, Daniel Schoene2, Maria Jd Caetano1
1Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, Australia; School of Population Health, University of New South Wales, Sydney, Australia.
Objective:
To systematically examine stepping performance as a risk factor for falls. More specifically, we examined (i) if step tests can distinguish fallers from non-fallers and (ii) the type of step test (e.g. volitional vs reactive stepping) that is required to distinguish fallers from non-fallers.
Data Source:
PubMed, EMBASE, CINAHL, Cochrane Database of Systematic Reviews and reference lists of included articles.
Study Selection:
Cross-sectional and cohort studies that assessed the association between at least one step test and falls in older people (age ≥ 60 and/or mean age of 65).
Results:
A meta-analysis of 61 studies (n = 9536) showed stepping performance was significantly worse in fallers compared to non-fallers (Cohen'sd 0.56, 95 % CI 0.48 to 0.64, p < 0.001, I2 66 %). This was the case for both volitional and reactive step tests. Twenty-three studies (n = 3615) were included in a diagnostic meta-analysis that showed that step tests have moderate sensitivity (0.70, 95 % CI 0.62 to 0.77), specificity (0.68, 95 % CI 0.58 to 0.77) and area under the receiver operating characteristics curve (AUC) (0.75, 95 % CI 0.59 to 0.86) in discriminating fallers from non-fallers.
Conclusions:
This large systematic review demonstrated that both volitional and reactive stepping impairments are significant fall risk factors among older adults. Step tests can identify fallers from non-fallers with moderate accuracy.
