Accuracy of Physical Function-based Fall Risk Assessments Among Community-Dwelling Older Adults - An ROC Analysis

Q: What assessments were compared for fall risk classification?

The study compared Timed-Up-and-Go (TUG), Short Physical Performance Battery (SPPB), and center-of-pressure postural sway path length (PS).

Q: How were participants classified as high or low fall risk?

Cutoffs were used: SPPB ( 30 cm) to categorize high versus low fall risk.

Sep 29, 2026

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Physical function assessments such as the Timed-Up-and-Go (TUG) and Short Physical Performance Battery (SPPB) are widely used to evaluate fall risk in older adults, but they can misclassify individuals. Center-of-pressure postural sway path length (PS) is a criterion measure of fall risk; however, comparisons with TUG and SPPB remain unclear. This study tested sensitivity, specificity, and overall accuracy for classifying high versus low fall risk using TUG, SPPB, and PS.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages13

Reading Time33 min

AccessFree to download

Introduction

Physical function and multifactorial fall risk

Common assessments: TUG, SPPB, and PS

Methods

Study design and participants

Cutoff values and risk classification

Statistical comparisons

Author Manuscript Author Manuscript Author Manuscript Author Manuscript | | HHS Public Access
Author manuscript
Res Health Med. Author manuscript; available in PMC 2026 January 07. | | --- | --- | Published in final edited form as: Res Health Med. 2025 ; 5(1): . doi:10.53520/rhm2025.104142 . Accuracy of Physical Function-based Fall Risk Assessments Among Community-Dwelling Older Adults: An ROC Analysis Estefania Zamarripa 1,2 , Kworweinski Lafontant 1,2 , David H. Fukuda 1 , Jeffrey R. Stout 1,3 , Ladda Thiamwong2,3 1 Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, FL, USA; 2College of Nursing, University of Central Florida, Orlando, FL, USA; 3 Disability, Aging, and Technology Cluster, University of Central Florida, Orlando, FL, USA; Abstract Introduction: Physical function assessments, such as the Timed-Up-and-Go (TUG) and Short Physical Performance Battery (SPPB), are commonly used to evaluate fall risk among older adults, yet they may misclassify individuals. Center-of-pressure postural sway path length (PS) is a criterion for assessing fall risk, but it is unclear how TUG and SPPB compare. This study examined the sensitivity, specificity, and accuracy of these three assessments in classifying older adults as high or low fall risk. Methods: We conducted a cross-sectional study of 234 community-dwelling older adults (women=203, age=75 .0±7 .0 years, height=159±7 .9cm, Body Mass Index=30 .0±6 .3kg/m2) . Cutoff values for SPPB (<7 out of 12), TUG (≥20 seconds), and PS (>30 cm) were used to categorize participants as high or low fall risk. McNemar tests were used to compare fall risk assessment between assessments. Results: Participants had a mean TUG time of 10.2±6 .3 seconds, SPPB score of 8 .7±2 .3, and PS of 34 .7±21 .3cm. Both TUG (high risk=10, low risk=224; X2=95 .9, p<0 .001) and SPPB (high risk=40, low risk=194; X2=55 .7, p<0 .001) significantly differed in fall risk assessment compared to PS (high risk=115, low risk=119) . Compared to postural sway, TUG had a sensitivity of 4.3%, specificity of 95.8%, and accuracy of 50.9% . Similarly, SPPB had a sensitivity of 23.5%, specificity of 89.1%, and accuracy of 56.8% . Conclusions: TUG and SPPB both demonstrated low sensitivity and accuracy, suggesting that they may be better as measures of physical function rather than fall risk. Clinicians may benefit from using PS or other criterion measures to screen for fall risk. Keywords Screening; Fall Prevention; Balance the work is licensed under the Creative Commons Attribution 4.0 International License. To view a copy of this license, visit[http://](http://)[ ](http://)[creativecommons.org/licenses/by/4.0/](creativecommons.org/licenses/by/4.0/) Corresponding author: Kworweinski Lafontant, MS, [Kworweinski.lafontant@ucf.edu](Kworweinski.lafontant@ucf.edu). Author Manuscript Author Manuscript Author Manuscript Author Manuscript Zamarripa et al. Page 2 Introduction Older adults (≥65 years old) are increasingly susceptible to preventable falls, which are the leading cause of injury and injury-related deaths among this age group.1 Each fall has the potential of worsening physical function and increasing the risk of frailty beyond natural aging.2 To reduce the risk of falls among older adults and intervene in a timely manner, it is crucial to assess physical function and identify those at high risk of falls. Previous research has demonstrated a strong relationship between physical function and fall risk among older adults. While fall risk is multi-factorial, encompassing mental, social, psychological, and physical factors,3 physical function assessments typically gauge fall risk primarily via measures of strength, balance, muscle weakness, and walking capabilities.4 Common physical function assessments include the Timed-Up-and-Go (TUG), the Short Physical Performance Battery (SPPB), and center-of-pressure postural sway path length (

FAQs

What assessments were compared for fall risk classification?

The study compared Timed-Up-and-Go (TUG), Short Physical Performance Battery (SPPB), and center-of-pressure postural sway path length (PS).

How were participants classified as high or low fall risk?

Cutoffs were used: SPPB (<7 out of 12), TUG (≥20 seconds), and PS (>30 cm) to categorize high versus low fall risk.

What were the main findings about accuracy and sensitivity?

Compared with PS, both TUG and SPPB showed low sensitivity and only moderate accuracy, indicating they may be better suited as physical function measures than direct fall risk measures.

Sep 29, 2026

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