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Accuracy of Physical Function-based Fall Risk Assessments Among Community-Dwelling Older Adults: An ROC Analysis.

Estefania Zamarripa^1,2, Kworweinski Lafontant^1,2, David H Fukuda¹

¹Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, FL, USA.

Research in Health and Medicine

|January 8, 2026

Summary

Timed-Up-and-Go (TUG) and Short Physical Performance Battery (SPPB) show low accuracy for fall risk screening in older adults. Center-of-pressure postural sway path length (PS) may be a more effective measure for identifying high fall risk.

Keywords:

Balance Fall Prevention Screening

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Published on: February 8, 2019

Area of Science:

Gerontology
Biomechanics
Clinical Assessment

Background:

Physical function assessments like the Timed-Up-and-Go (TUG) and Short Physical Performance Battery (SPPB) are widely used for fall risk evaluation in older adults.
However, these common assessments may misclassify individuals, leading to potential under or overestimation of fall risk.
Center-of-pressure postural sway path length (PS) is a criterion measure for fall risk, but its comparative performance against TUG and SPPB is not well-established.

Purpose of the Study:

To compare the sensitivity, specificity, and accuracy of TUG, SPPB, and PS in classifying community-dwelling older adults as high or low fall risk.
To determine if TUG and SPPB are more suitable for assessing general physical function rather than specific fall risk.
To provide evidence-based recommendations for clinicians regarding the most effective fall risk screening tools.

Main Methods:

A cross-sectional study was conducted with 234 community-dwelling older adults (mean age 75.0±7.0 years).
Standard cutoff values were used: SPPB (<7), TUG (≥20 seconds), and PS (>30 cm) to categorize participants.
McNemar tests were employed to compare the classification agreement between the three fall risk assessments.

Main Results:

Postural sway path length (PS) identified 115 participants at high risk, while TUG identified 10 and SPPB identified 40.
Compared to PS, TUG demonstrated a sensitivity of 4.3%, specificity of 95.8%, and accuracy of 50.9%.
SPPB showed a sensitivity of 23.5%, specificity of 89.1%, and accuracy of 56.8% when compared against PS.

Conclusions:

Both TUG and SPPB exhibited low sensitivity and accuracy in identifying high fall risk when compared to PS.
These findings suggest that TUG and SPPB may be better indicators of general physical function than specific fall risk.
Clinicians are advised to consider using PS or other criterion measures for more accurate fall risk screening in older adults.