Association between backward walking speed and physical balance and fall risk in community-dwelling older adults

Backward walking is increasingly recognized as an alternative task for detecting balance deficits and fall risk in older adults. However, its utility as a functional indicator in healthy populations remains underexplored. This study aimed to investigate the potential associations between the backward walking speed (BWS), physical balance, and fall risk in community-dwelling older adults. In this cross-sectional study, 90 community-dwelling older adults were recruited. Self-selected backward walking speed (SBWS) was assessed together with the Berg Balance Scale (BBS), the Performance-Oriented Mobility Assessment (POMA), and the Fall Risk Index (FRI). Grip strength and cognitive function, evaluated using the Montreal Cognitive Assessment (MoCA), were also measured as covariates. Fear of backward walking (FoBW) was investigated using a self-administered questionnaire prior to the walking tests. Pearson correlation and multiple regression analyses were performed to examine the associations between SBWS, physical balance, and fall risk. The data of 84 participants (mean ± SD age 75.7 ± 5.0 years) were analyzed. Their mean forward and backward walking speeds were 1.36 ± 0.23 m/s and 0.73 ± 0.24 m/s, respectively. The SBWS showed moderate correlations with the Timed Up and Go (TUG) test (r = -0.52), forward speed (r = 0.49), and grip strength (r = 0.41), and weaker correlations with the BBS (r = 0.38), MoCA (r = 0.23) and FES-I (r = -0.34) . No statistically significant correlations were found between SBWS and POMA-Total (r = 0.20), FRI (r = 0.09). In adjusted regression models, SBWS was significantly associated with higher BBS scores (β = 3.744, p = 0.023) and lower TUG times (β = -1.488, p = 0.029) but not with the POMA-Total (β = 1.052, p = 0.344) or FRI (β = 3.001, p = 0.096). BWS may serve as a multidimensional indicator of physical and psychological vulnerability in older adults. Longitudinal studies with dynamic or dual-task assessments are necessary to validate its predictive value for fall risk screening.