Abstract：
The objective of this systematic review is to identify motion analysis parameters measured during challenging walking tasks which can predict fall risk in the older population. Numerous studies have attempted to predict fall risk from the motion analysis of standing balance or steady walking. However, most falls do not occur during steady gait but occur due to challenging centre of mass displacements or environmental hazards resulting in slipping, tripping or falls on stairs. We conducted a systematic review of motion analysis parameters during stair climbing, perturbed walking and obstacle crossing, predictive of fall risk in healthy older adults. We searched the databases of Pubmed, Scopus and IEEEexplore.A total of 78 articles were included, of which 62 simply compared a group of younger to a group of older adults. Importantly, the differences found between younger and older adults did not match those found between older adults at higher and lower risk of falls. Two prospective and six retrospective fall history studies were included. The other eight studies compared two groups of older adults with higher or lower risk based on mental or physical performance, functional decline, unsteadiness complaints or task performance. A wide range of parameters were reported, including outcomes related to success, timing, foot and step, centre of mass, force plates, dynamic stability, joints and segments. Due to the large variety in parameter assessment methods, a meta-analysis was not possible. Despite the range of parameters assessed, only a few candidate prognostic factors could be identified: older adults with a retrospective fall history demonstrated a significant larger step length variability, larger step time variability, and prolonged anticipatory postural adjustments in obstacle crossing compared to older adults without a fall history. Older adults who fell during a tripping perturbation had a larger angular momentum than those who did not fall. Lastly, in an obstacle course, reduced gait flexibility (i.e., change in stepping pattern relative to unobstructed walking) was a prognostic factor for falling in daily life. We provided recommendations for future fall risk assessment in terms of study design.In conclusion, studies comparing older to younger adults cannot be used to explore relationships between fall risk and motion analysis parameters. Even when comparing two older adult populations, it is necessary to measure fall history to identify fall risk prognostic factors.
摘要：
这项系统评价的目的是确定在具有挑战性的步行任务中测量的运动分析参数，这些参数可以预测老年人群的跌倒风险。许多研究试图通过站立平衡或稳定行走的运动分析来预测跌倒风险。然而,大多数跌倒不会发生在稳定的步态中，而是由于具有挑战性的质心位移或导致滑倒的环境危害而发生的。绊倒或摔倒在楼梯上。我们对爬楼梯过程中的运动分析参数进行了系统的回顾，扰乱步行和障碍物穿越，预测健康老年人的跌倒风险。我们搜索了Pubmed的数据库,Scopus和IEEEexplore。共收录了78篇文章,其中62人只是简单地比较了一组年轻人和一组老年人。重要的是,年轻人和老年人之间的差异与跌倒风险较高和较低的老年人之间的差异不匹配.包括两项前瞻性和六项回顾性跌倒史研究。其他八项研究比较了两组基于心理或身体表现的风险较高或较低的老年人，功能衰退，不稳定的抱怨或任务表现。报告了广泛的参数，包括与成功相关的结果，定时,脚和步，质心,力板,动态稳定性,关节和节段。由于参数评估方法种类繁多，无法进行荟萃分析.尽管评估的参数范围很大，只有少数候选的预后因素可以确定：具有回顾性跌倒史的老年人表现出显著较大的步长变异性，更大的步进时间可变性，与没有跌倒史的老年人相比，障碍物穿越的预期姿势调整时间延长。在绊倒扰动中跌倒的老年人比没有跌倒的老年人具有更大的角动量。最后,在障碍赛中，步态灵活性降低(即，相对于通畅行走的步法变化）是日常生活下降的预后因素。我们在研究设计方面为未来的跌倒风险评估提供了建议。总之,比较老年人和年轻人的研究不能用于探索跌倒风险与运动分析参数之间的关系.即使比较两个老年人群，有必要测量跌倒史，以确定跌倒风险预后因素。
