Mobile Fall Risk Screening Using the 4-Stage Balance Test With Vestibular Challenge

PURPOSE: The purpose of this study is to explore the use of mobile device technology to measure postural stability and to assess the preliminary effect of an added dynamic vestibular task in the 4-Stage Balance Test (4SBT) in adults over 65 years. It was hypothesized that adding a dynamic vestibular task would make the 4SBT more sensitive in identifying fall risk. METHOD: Twenty-eight adults aged 70-100 years completed the 4SBT with and without an added vestibular challenge (i.e., with and without a headshake). Postural sway was measured using a mobile device. Participants also completed the Stay Independent Questionnaire (SIQ) and provided self-reported fall and health history. Differences in sway score were compared between conditions. Correlational analyses assessed the association between fall history, fall risk, and sway scores. RESULTS: The addition of a headshake task significantly increased postural sway across all 4SBT stages. Self-reported fall risk was not predicted by sway score; however, significant correlations were observed between self-reported fall risk and sway in more challenging balance conditions, and these relationships were largely unchanged with the added dynamic vestibular task. Although sway score did not reliably distinguish between individuals who did and did not report a fall, fall history was moderately associated with self-reported fall risk and fear of falling. CONCLUSIONS: Significant correlations were observed between SIQ and sway score measured in the more challenging balance conditions. These relationships generally remained stable even with the added dynamic vestibular task, suggesting that the SIQ may reflect real-world balance challenges involving vestibular input. Self-reported fear of falling or perceived fall risk likely captures aspects of imbalance not directly reflected in sway scores. Further research with larger, more diverse samples is warranted to assess added the clinical utility of sway score beyond perceived aspects of imbalance to identify fall risk.