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Published on: October 25, 2024
Assessing Fall Risk in Older Adults: The Role of Reaction Time and Inhibitory Control Testing With ReacStick
Pawarut Palakawong Na Ayudhya1, Chatkaew Pongmala2, James K Richardson3
1Residency Training Curriculum in Rehabilitation Medicine, Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Objectives:
To determine whether ReacStick parameters can differentiate recurrent fallers from nonfallers and to compare their diagnostic precision with that of functional tests.
Design:
Cross-sectional study.
Setting:
Outpatient Rehabilitation Clinic in a Tertiary Hospital.
Participants:
Community-dwelling older adults were recruited using convenience sampling. Ninety participants were enrolled, with those having recurrent falls (>1 time) in the prior year, age- and sex-matched with nonfallers.
Interventions:
Not applicable.
Main Outcome Measures:
Sensorimotor functions (visual acuity, vibratory sensation, and knee extensor strength), cognition, timed Up and Go, and Berg Balance Scale were evaluated. ReacStick parameters, which assessed simple reaction time (SRT) using the ruler-drop method and reaction accuracy by requiring participants to grasp or release the device within 390 ms based on a light cue, were collected. The percentage of correctly caught light on trials (ON Accuracy), correctly released light off trials (OFF Accuracy), and the combination (All Accuracy) was recorded. Group comparisons and receiver operating characteristic curves were used to assess the ability of the parameters to discriminate between fallers and nonfallers. Multivariate logistic regression identified independent variables for faller status.
Results:
Recurrent fallers showed significantly worse SRT, OFF Accuracy, All Accuracy, and OFF Accuracy/SRT. The highest area under the curves was observed for All Accuracy (0.80), OFF Accuracy/SRT (0.79), and OFF Accuracy (0.76). OFF Accuracy/SRT best predicted faller status (adjusted odds ratio, 12.18; 95% confidence interval, 3.75-39.53). Timed Up and Go and Berg Balance Scale showed nonsignificant trends, while knee extensor strength was protective (adjusted odds ratio, 0.53; 95% confidence interval, 0.29-0.97).
Conclusions:
Diminished short-latency inhibitory control was the most accurate means to identify faller status, whereas good knee extensor strength showed a protective effect. ReacStick may offer potential as a sensitive tool for assessing short-latency inhibitory control and processing speed related to faller status in older adults. When combined with strength assessment, incorporating ReacStick in clinical practice may improve the accuracy of fall-status classification.
