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Published on: December 11, 2013
Clinical significance of decline in balance function assessed by the Functional Reach Test in older patients
Takuji Adachi1, Kenichi Shibata2, Masataka Kameshima2
1Major in Rehabilitation Science, Department of Health Sciences, Nagoya City University Medical School, Nagoya, Japan.
Background:
The impact of cardiovascular surgery on balance function decline has not been well characterized.
Objectives:
This study investigated the frequency, associated factors, and prognostic significance of balance decline after cardiovascular surgery in older patients.
Methods:
This observational study included patients aged 65 years or older who underwent elective cardiovascular surgery. Balance function was assessed using the Functional Reach Test before surgery and at discharge. Balance decline was defined as a reduction of at least 8 cm, based on previously reported minimal detectable change. Logistic regression identified factors associated with balance decline, and Cox regression assessed its prognostic impact.
Results:
A total of 393 patients were analyzed (median age, 75 years). The prevalence of Functional Reach Test < 26.0 cm, indicating reduced mobility, increased significantly after surgery (preoperative 10.9% vs. postoperative 17.8%, p < 0.001). Balance decline occurred in 10.4% (n = 41). In multivariate analysis, higher N-terminal pro-brain natriuretic peptide, lower knee extensor strength, and longer operative time were significantly associated with balance decline (all p < 0.05). Patients with balance decline during hospitalization had a higher mortality rate than those without (p < 0.001). This association remained significant after adjusting for age, N-terminal pro-brain natriuretic peptide, and knee extensor strength at discharge (adjusted hazard ratio, 3.03; 95% confidence interval, 1.49-6.14; p = 0.002).
Conclusion:
Balance function decline after cardiovascular surgery was an independent predictor of poor prognosis in older patients. This decline was associated with preoperative cardiac dysfunction, reduced muscle strength, and longer operative time.
