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Table of Contents
ORIGINAL ARTICLE
Year : 2019  |  Volume : 6  |  Issue : 2  |  Page : 89-92

Functional reach test: Establishing the reference value in healthy adults of Gujarat, India


1 Department of Physiotherapy, K M Patel Institute of Physiotherapy, Shree Krishna Hospital, Karamsad, Anand, Gujarat, India
2 Physiotherapist, Clinical Practitioner, Nadiad, Gujarat, India

Date of Web Publication18-Nov-2019

Correspondence Address:
Dr. Vyoma Bharat Dani
K M Patel Institute of Physiotherapy, Shree Krishna Hospital, Karamsad - 388 325, Anand, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ami.ami_81_18

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  Abstract 

Context: Functional reach test (FRT) is a quick and simple, single-task dynamic test to measure the balance of an individual during functional task and is considered to be a predictor of fall in older adults. There is a lack of availability of data from a large population-based study, especially in India. Aim: The aim of the present study is to establish the reference value for FRT in healthy adults of Gujarat, India. Materials and Methods: It was a cross-sectional, observational study. Five hundred and twenty-one healthy individuals, aged 40–70 years, were recruited based on convenience sampling. All the participants were made to perform FRT in a controlled environment in community. Three readings of the actual test were obtained and averaged. Results: Data were analyzed with mean, standard deviation, confidence intervals (confidence interval 95%), and Pearson's correlation coefficient (r) with α = 0.05 by the age groups (40–50, 51–60, 61–70 years) and gender. The mean FRT value for healthy adults of Gujarat (age 40–70 years) was found to be 34.94 ± 3.9 cm and 33.43 ± 3.69 cm for males and females, respectively. It also showed significant negative correlation with weight and body mass index and also demonstrated age-related decline for both male and female participants. Conclusion: The reference value for FRT in healthy adults was found to be 34.18 (±3.79) cm. These large population-based data can be used as a reference with a specific age group considering due variability with regards to age, sex, anthropometric measures, genetics, and geographical changes.

Keywords: Accidental falls, adults, balance, functional reach test, India, reference value


How to cite this article:
Dani VB, Shah R, Sheth R. Functional reach test: Establishing the reference value in healthy adults of Gujarat, India. Acta Med Int 2019;6:89-92

How to cite this URL:
Dani VB, Shah R, Sheth R. Functional reach test: Establishing the reference value in healthy adults of Gujarat, India. Acta Med Int [serial online] 2019 [cited 2019 Dec 14];6:89-92. Available from: http://www.actamedicainternational.com/text.asp?2019/6/2/86/271115


  Introduction Top


Balance or the postural stability is the state of the body in which all the forces acting on the body are equalized such that the center of mass is within the boundaries of the base of support.[1] The ability to balance and maintain a stable posture is integral in the execution of most movements. As postural control mechanism deteriorates with age and disease, balance becomes increasingly tenuous resulting in an enhanced susceptibility to falls.[2],[3],[4] The farther the person is able to displace his/her center of gravity, the better is his/her dynamic balance.

Elderly individuals progressively lose their balance leading to increase chances of fall due to decline in their sensory-motor functions. Reduction in their cognitive and functional status can have detrimental effect on their quality of life, increased risk of fall and frequent hospitalizations. Frequent fall among elderly individuals is a serious public health concern which contributes to increased morbidity and mortality. The use of standardized tool to evaluate balance and fall predication among elderly individuals has been promoted in rehabilitation to plan and execute effective preventive and curative strategies.[5],[6]

Several tests and measures are available for balance and functional performance. One of these is functional reach test (FRT).[2],[5]

Internationally, FRT was introduced as a new clinical measure of balance and to provide a quick screen of balance problems in older adults by Duncan et al., in 1990.[2] FRT is the highest distance one can reach forward beyond normal arm length, sustaining a fixed base of support in standing.[7] FRT is a dynamic measure of stability during self-initiated movements which is designed as a clinical measure of balance. This test is used to assess the anterior functional reach and measures stability limits when the individual is standing.[8]

This test has been widely used to assess the balance of patients with various neuromuscular diseases namely encephalic vascular accidents, Parkinson's disease, medullar injuries, vestibular disorders, multiple sclerosis, and hip fracture.[9],[10],[11],[12],[13],[14],[15]

The main advantage of this test is that it takes 1–2 min to administer, easy to perform, requires minimal equipment, and has also been shown to predict fall risk and thus, need for therapy.[10],[16] It is also sensitive to change following balance training and is widely used for screening, assessing, and monitoring over time. It even predicts the functional status of adults and elderly individuals.[8],[17] Functional reach is a simple and easy-to-use clinical measure that has predictive validity in identifying recurrent falls[18] and correlates with physical frailty even more than with age.[19]

Duncan et al. in 1990, observed that there are several factors which affect the functional reach distance such as age and height.[2] FRT has also been associated with an increased risk of fall and frailty in elderly people who are unable to reach more than 15 cm[8] and is believed to correlates with physical frailty even more than with the age of an individual.[8]

Till date, there is no literature available on large population regarding the norms of FRT in healthy adults especially in India, and therefore, it is necessary to have a reference value which can be used for comparison in a variety of health-care settings and in the community to identify the individuals with significant fall risks. Therefore, the present study was undertaken to establish the reference value of FRT in healthy adults of Gujarat, India, and to identify the influence of anthropometric measures on the test results.


  Materials And Methods Top


Study design: It was a cross-sectional, observational, community-based study.

The ethical approval (HMPCMCE/HREC/UG/PG/9/Session-1/6) was obtained from the Intuitional Ethics Committee before initiating a trial.

A total of 521 normal healthy individuals were recruited by convenience sampling based on inclusion and exclusion criteria.

Inclusion criteria

  • Normal healthy individuals (self-reported, not on any medications)
  • Age group: 40–70 years
  • Both males and females.


Exclusion criteria

  • History of any upper or lower extremity injury/surgery
  • Individuals with any neuromuscular, musculoskeletal, respiratory, or cardiovascular problems
  • Individuals with any psychiatric illness or difficulty in understanding.


Materials required were wall-mounted measure tape, height scale, and weighing machine.

After explaining the study procedure and objectives, written informed consent was obtained from all participants. The general information was collected from each participant, including name, age, gender, height, weight, etc.

Description of functional reach test

The test used a leveled measure tape, mounted on the wall and positioned at the height of the individual's acromion process. The individual stood sideward next to the wall without touching, erect with their feet at shoulder-width apart and one arm elevated to 90° of shoulder flexion with elbow straight and handed fisted. The individual placed his/her closed fist against the wall-mounted measure tape. The initial measurement was made of the position of third metacarpal along the measure tape. After taking the initial measurement, the individuals were instructed to lean forward and slide the fist against the measure tape without losing their balance or moving their feet. A second measurement was also taken using third metacarpal for reference. The difference in the centimeters between the two positions of fist on the measure tape was considered as the functional reach. Three readings were obtained of each individual and average reading was considered for the statistical analysis.


  Results Top


Data analysis was carried out by calculating the mean, standard deviation, t-test, and Pearson's correlation coefficient (r) with 95% confidence interval (α = 0.05). A total of 521 normal healthy individuals were evaluated for FRT [Table 1].
Table 1: Distribution of the study participants according to age group and gender

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The mean value of FRT was found to be 34.18 (±3.79) cm among the whole population (n = 521). [Table 2] shows the values of FRT in different age groups and gender.
Table 2: Functional reach test values in different age groups and gender

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The FRT value was found to be significantly more in males compared to females (P = 0.01). The Pearson's correlation coefficient was calculated to explore the relationship between the FRT value and its determinants, namely age, height, weight, and body mass index (BMI). Significant correlation of FRT was found with age, weight, and BMI. This suggests that as the age, weight and BMI increase, the FRT value decreases significantly in healthy individuals [Table 3].
Table 3: Correlation of functional reach test with its determinants

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  Discussion Top


The FRT distance is the greatest distance one can reach forward, maintaining a fixed base of support in the standing position.[20] Duncan et al. found functional reach highly reproducible and thus is highly recommended for patients with balance problems.[2] Functional reach is a reliable clinical measure in an elderly population demonstrating moderate to high inter-rater and intra-rater reliability.[17] The present study was aimed to evaluate the functional reach distance in normal healthy individuals within 40–70 years of age group and establish its reference value for comparison in a variety of clinical settings and community.

The individuals in the present study had an average of 34.18 ± 3.79 cm distance on FRT with males having significantly more distance compared to females (P < 0.05).

While comparing all three age groups for functional reach, the individual between the age group of 40 and 50 years had the greatest distance covered on functional reach whereas the lowest distance was found in the age group of 61–70 years. The age was also found to be significantly correlated (negative correlation) with functional reach. The balance function deteriorates as the age of individual increases, which may be due to slow reaction time, reduction in nerve conduction velocities and decrease in sensory-motor and proprioceptive response.[21] Proprioceptive input is considered to be an important factor for maintenance of balance. Advancing age causes decline in proprioceptive response at both central and peripheral levels. The peripheral level includes anatomical and physiological age-related changes in muscle spindle resulting in muscle spindle decline. Along with this, advancing age contributes to decline in processing of sensory input (myelin abnormalities, axonal atrophy, and declined nerve conduction velocity) and neuromuscular functions. The central somatosensory pathways conductive function is also affected by normal aging, progressively affecting the number and function of neurons and receptors in motor cortex leading to reduction in motor and sensory functions.[22] Age-related functional declines in sensory system, muscle strength (force-generating capacity of a muscle) and the sensory systems, in addition to many other problems namely slow reaction time, vestibular function, and vision occur with aging and are believed to collectively contribute to the increased likelihood of falling.[23],[24] All these changes affect the reaching capabilities of a person ultimately leading to significant reduction in functional reach with increase in age. The deterioration in balance starts relatively at younger ages and further declines after 60 years.[25]

The present study also found a significant negative correlation of functional reach with weight and BMI. The balance and stability are strongly correlated with body weight and so with BMI; and it is considered to be an important risk factor for fall. It has also been found that reduction in body weight improves functional reach in obese person and the extent of improvement directly relates to the amount of weight loss.[26]

Duncan et al. found the significant influence of height on functional reach;[2] however, the present study did not find a significant correlation of height with functional reach.


  Conclusion Top


FRT can be easily assessed for patients/individuals in community without having great resources; thus, is beneficial for assessing the balance function and can be used as a fall predictor. The reference value for functional reach among the healthy individuals of Gujarat, India was found to be 34.18 ± 3.79 cm, with males having more functional reach distance compared to females. The study also found that age, weight, and BMI significantly affect the functional reach. This reference value should be limited to a specific population due to its variability with regards to age, gender, anthropometric measures, geographical variations, and health status among the individuals.

Acknowledgment

The authors would like to acknowledge the principal, K M Patel Institute of Physiotherapy for allowing conducting this research work. Authors also have gratitude toward all the participants of the study for their cooperation throughout the research work. The authors especially acknowledge the researchers who have developed the norms for FRT in other population which has provided the strong base for the successful completion of the present study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

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Horak F, Kuo A. Postural adaptation for altered environments, tasks, and intentions. In: Winters JM, Crago PE, editors. Biomechanics and Neural Control of Posture and Movement. 1st ed. New York: Springer-Verlag; 2000. p. 267-81.  Back to cited text no. 1
    
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    Tables

  [Table 1], [Table 2], [Table 3]



 

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