Τετάρτη 27 Απριλίου 2016

Functional Reach Test / Modified Functional Reach Test

Acronym:
FRT / MFRT
Purpose:
Assesses a patient's stability by measuring the maximum distance an individual can reach forward while standing in a fixed position.  The modified version of the FRT, requires the individual to sit in a fixed position.
Description:

The Functional Reach Test: Standing instructions (Weiner, D. K., Duncan, P. W., et al. (1992). "Functional reach: a marker of physical frailty." J Am Geriatr Soc 40(3): 203-207.)

  • The patient is instructed to stands close to, but not touching, a wall and position the arm that is closer to the wall at 90 degrees of shoulder flexion with a closed fist
  • The assessor records the starting position at the 3rd metacarpal head on the yardstick
  • Instruct the patient to "Reach as far as you can forward without taking a step"
  • The location of the 3rd metacarpal is recorded
  • The difference between the start and end position is the reach distance, usually measured in inches
  • The test allows for five total trials: two practice trials, followed by three "test" trials. The distances of the last three trials are averaged to obtain the patient's score.

The Modified Functional Reach Test: Adapted for individuals who are unable to stand (Katz-Leurer, M., Fisher, I., et al. (2009). "Reliability and validity of the modified functional reach test at the sub-acute stage post-stroke." Disabil Rehabil 31(3): 243-248.)

  • Performed with a leveled yardstick that has been mounted on the wall at the height of the patient's acromion level in the non-affected arm while sitting in a chair
  • Hips, knees and ankles are positioned at 90 degree of flexion, with feet positioned flat on the floor
  • The initial reach is measured with the patient sitting against the back of the chair with the upper-extremity flexed to 90 degrees, measure was taken from the distal end of the third metacarpal along the yardstick
  • Consists of three conditions over three trials
    • Sitting with the unaffected side near the wall and leaning forward
    • Sitting with the back to the wall and leaning right
    • Sitting with the back to the wall leaning left
  • Instructions should include leaning as far as possible in each direction without rotation and without touching the wall
  • Once the individual leans, mark the position of the fifth finger along the yardstick 
  • SCI population - ulnar styloid process was used as landmark since tetraplegic population may not be able to make a fist
  • Record the distance in centimeters covered in each direction
  • If the patient is unable to raise the affected arm, the distance covered by the acromion during leaning is recorded
  • First trial in each direction is a practice trial and should not included in the final result
  • A 15 second rest break should be allowed between trials
Area of Assessment: Balance Vestibular, Balance Non-Vestibular, Functional Mobility, Vestibular
Body Part: Not Applicable
ICF Domain: Activity
Domain: Motor
Assessment Type: Performance Measure
Length of Test: 05 Minutes or Less
Time to Administer:
5 minutes
Number of Items: 1 (3 for modified version)
Equipment Required:
  • Yardstick
  • Duct tape (to tape the yardstick to the wall)
Training Required:
No Training
Type of training required: No Training
Cost: Free
Actual Cost:
Free
Age Range: Adult: 18-64 years, Elderly adult: 65+
Administration Mode: Paper/Pencil
Diagnosis: Geriatrics, Parkinson's Disease, Spinal Cord Injury, Stroke, Vestibular Disorders
Populations Tested:
  • Community Dwelling Elderly
  • Parkinson's Disease
  • Peripheral Vestibular Disorders
  • Spinal Cord Injury
  • Stroke
  • Vestibular Disorders
Standard Error of Measurement (SEM):

Modified Functional Reach Test:

 

Parkinson's Disease:

(calculated from values given in Smithson et al, 1998; n = 30 total, n = 10 with PD and a history of falling age, mean age = 70.6 (6.4), mean Hoehn and Yahr Disability Scale score = 3.0, disease duration 11.6 (4.3) years; n = 10 with PD and no history of falling, mean age = 70.8 (5.7), mean Hoehn and Yahr Disability Scale Score = 2.5, disease duration = 6.9(5.6) years; n = 10 with no neurological issues, mean age = 70.6 (6.2), Parkinson's Disease)

  • Forward Functional Reach Test for PD patients with a history of falling = 1.56 cm
  • Forward Functional Reach Test for PD patients with no history of falling = 2.91 cm

(calculated from values given in Schenkman et al, 1997; n = 15, mean age = 74.5 (5.7); disease duration = 6.2 (5.92); Hoehn and Yahr Disability Scale Score = 2.7 (0.32), Parkinson's Disease)

  • Forward Functional Reach Test= 2.64 cm

SCI Population:

(calculated from Lynch et al., 1998; n = 30 males, mean age: 30.8 (7.2) years old; time since onset: ≥ 1 month post-rehab;severity of injury: AIS A or B, SCI)

Group
SD (cm)
SEM (cm)
1; n = 10, C5-C6
7.6
1.86
2; n = 10, T1-4
4.3
1.66
3; n = 10, T10-12
5.6
1.48

Stroke:

(calculated from values given in Outermans et al, 2010; n = 21, mean age = 56.3 (8.6) years, Subacute Stroke)

  • Forward Functional Reach Test = 2.45 cm

 

(calculated from statistics in Katz-Leurer et al, 2009; n = 10 stroke and 10 healthy controls; mean stroke sample age 63 (6) years; first ischemic stroke was 14 to 21 days prior; Israeli sample, Acute Stroke)

  • Forward Modified Functional Reach Test = 2.65 cm
  • Paretic side Modified Functional Reach Test = 1.62 cm
  • Non-paretic side Modified Functional Reach Test = 2.67 cm

 

Vestibular Disorder:

(calculated from values given in Mann et al, 1996; mean age = 58.3 (14.0); Time since onset of dizziness symptoms = 20.7 (33.7); group 1: n = 18, Dizziness Handicap Inventory (DHI) less than or equal to 49; group 2: n = 10, Dizziness Handicap Inventory greater than or equal to 50, Vestibular Disorders)

  • Forward Functional Reach Test; group 1 = 2.29 cm
  • Forward Functional Reach Test; group 2 = 2.45 cm
Minimal Detectable Change (MDC):

Functional Reach Test:

 

Parkinson's Disease:

  • Smallest Detectable Difference (SDD) = 11.5 (Lim et al, 2005; n = 26; mean age = 62.5 (range 44–80) years; mean duration of symptoms = 6.5 years; Hoehn and Yahr ranged from 1 to 3)
  • Forward functional reach test, MDC = 9
  • Backward functional reach test, MDC = 5 (Steffen & Seney, 2008, n = 37; mean age = 71 (12) years, Hoehn and Yahr score = 2, range = 1 to 4)

 

 (calculated from values given in Smithson et al, 1998, Parkinson's Disease)

  • MDC for PD patients with a history of falls = 4.32 cm
  • MDC for PD patients with no history of falls = 8.07 cm

 

(calculated from values given in Schenkman et al, 1997, Parkinson's Disease)

  • MDC for Forward Functional Reach Test = 7.32 cm

Modified Functional Reach Test:

 

Stroke:

(calculated from statistics in Katz-Leurer et al, 2009, Acute Stroke)

  • Forward Modified Functional Reach Test = 3.7 cm
  • Paretic side Modified Functional Reach Test = 2.3 cm
  • Non-paretic side Modified Functional Reach Test = 2.67 cm

 

(calculated from values given in Outermans et al, 2010, Subacute Stroke)

  • Forward Functional Reach Test = 6.79 cm

 

SCI:

(calculated from Lynch et al, 1998, SCI)

  • C5-6 SCI = 5.16 cm
  • T1-4 SCI = 4.63 cm
  • T10-12 SCI = 4.10 cm

 

Vestibular Disorder:

(calculated from values given in Mann et al, 1996, Vestibular Disorder)

  • MCD group 1 subjects with DHI < 49 = 6.35 cm
  • MCD group 2 subjects with DHI > 50 = 6.79 cm
Minimally Clinically Important Difference (MCID):
Not Established
Cut-Off Scores:

Functional Reach Test:

 

Community Dwelling Elderly:

(Weiner et al, 1992; n = 45, mean age = 78(8.4) years, Community Dwelling Elderly)

  • FRT < 7 inches:
    • Unable to leave neighborhood without help
    • Limited in mobility skills
    • Most restricted in ADLs

 

Frail Elderly Patients:

(Thomas et al, 2005; n = 30, fallers mean age = 79.7 (6.7) non-faller mean age = 81.4 (6.7) years, Frail Elderly Patients)

  • < 18.5 cm indicates fall risk (75% Sensitivity, 67% Specificity)

 

Parkinson's Disease:

(Behrman, A.L. et al, 2002; n = 58; mean age = 64.3 (9.3) years)

  • Cut-off of 25.4 cm indicates fall risk (sensitivity of 30%), but a cut-off of 30.1 increases sensitivity to 56%
  • Cut-off of 25.4 cm indicates fall risk (specificity of 92%), and a cut-off of 30.1cm decreases specificity to 77%

(Dibble & Lange, 2006; n = 45; mean age = 69.94 (11.28) years, mean Hoehn and Yahr score = 2.60 (0.66) points)

  • < 31.75 cm indicates fall risk (sensitivity of 0.86, specificity of 0.52 for risk of falling)

Stroke:

(Acar & Karatas, 2010; n = 26; mean age = 59.3 (16.8) years, Hemiplegic Patients Post-Stroke)

  • < 15 cm indicates fall risk
Normative Data:

Functional Reach Test:

 

Parkinson's Disease:

(Lim et al, 2005; n = 26; mean age = 62.5 (8.2) years, Parkinson's Disease)

  • Functional Reach Test = 33.54 (7.36) cm
  • Range = 22 - 50 cm

(Shenkman et al., 2011; N = 339, 238 males, mean age (y) 66.1 (9.34) range 37-92, time since onset (y): mean 6.0 (5.12) range 0-32, H&Y stages 1-3, UPDRS total: mean 39.2(9.56), UPDRS motor: mean 25.2(9.56). Subset of n = 152 performed FR.)

H&Y Stage
1-1.5
2
2.5
3
Linear trend
Cohen f
Mean
16.07
14.28
12.13
10.79
F value, 46.00
0.30
SD
1.6
2.58
2.88
2.95
p < 0.0001
Min
13.33
6.70
6.00
3.50
Q1
15.50
12.70
10.30
9.20
Median
16.33
14.40
12.20
11.00
Q3
16.80
15.80
14.00
12.50
Max
18.20
19.20
17.30
16.70

(Steffen & Seney, 2008, Parkinson's Disease)

  • Forward mean = 21 (6); 95% CI = 18 - 23
  • Backward mean = 14 (5); 95% CI = 13 - 16

Stroke:

(Acar & Karatas, 2010, Hemiplegic Patients Post-Stroke)

  • With Arm Sling:
    • Functional Reach test mean (SD) = 16.8 (9) cm
  • Without Arm Sling:
    • Functional Reach test mean (SD) = 15.2 (8.5) cm

(Outermans et al, 2010; n = 21; mean age = 56.3 (8.6) years, Subacute Stroke)

  • Functional Reach Test mean (SD): 25.6 (7.4) cm

(Erel et al, 2011; n = 14; mean age = 50.64 (9.22) years, Chronic Hemiplegic Patients Post-Stroke)

  • Functional Reach Test mean (SD)
    • initial assessment = 27.11 (5.41) cm
    • after 3 months = 28.46 (4.40) cm

(Erel et al, 2011; n = 14; mean age = 42.50 (14.89) years, Chronic Hemiplegic Paients Post-stroke with In-sole Dynamic AFO)

  • Functional Reach Test mean (SD)
    • initial assessment = 28.50 (8.49) cm
    • after 3 months = 33.43 (9.59) cm

Vestibular Disorders:

(Mann et al, 1996, Vestibular Disorders)

  • Functional Reach Test mean 31.7 (7.5) cm

Modified Functional Reach Test:

 

Acute Stroke:

(Katz-Leurer et al, 2009, Acute Stroke)

Stroke Norms at 3 & 6 Weeks Post Stroke:

 

@ 3 Weeks

@ 6 Weeks

Measures Mean

Mean (SD)

ICC (95% CI)

Mean (SD)

ICC (95% CI)

Forward MFRT

31.7 (7.8)

0.94 (0.92 – 0.96)

37.6 (5.2)

0.97 (0.93 – 0.99)

Paretic side MFRT/Non-dominant

13.8 (3.7)

0.95 (0.93 – 0.97)

17.7 (4.9)

0.95 (0.93 – 0.97)

Non-paretic side MFRT/dominant

15.5 (6.8)

0.90 (0.86 – 0.94)

18.1 (5.0)

0.96 (0.94 – 0.98)

 

Test-retest Reliability:

Modified Functional Reach Test:

 

SCI:

(Lynch, et al 1998, SCI)

  • Excellent test-retest reliability (ICC C5-6 group = 0.94, ICC T1-T4 group = 0.85, ICC T10-12 group = 0.93)
    • Test-retest reliability results are from single rater in study

 

Stroke:

(Katz-Leurer et al, 2009, Acute Stroke)

  • Excellent test-retest reliability (ICC = 0.90 to 0.95)
    • Forward Modified Functional Reach Test (ICC = 0.94)
    • Paretic side Modified Functional Reach Test/Non-dominant (ICC = 0.95)
    • Non Paretic side Modified Functional Reach Test Dominant (ICC = 0.90)

 

 

Functional Reach Test:

 

Community Dwelling Elderly:

(Weiner et al, 1992, Community Dwelling Elderly)

  • Excellent test-retest reliability (ICC = 0.89)

(Duncan et al, 1990, Community Dwelling Elderly)

  • Excellent test-retest reliability (ICC = 0.92)

 

Parkinson's Disease:

(Schenkman et al, 1997, Parkinson's Disease)

  • Excellent test-retest reliability (ICC = 0.84)

(Smithson et al, 1998, Parkinson's Disease)

  • Poor test-retest reliability for PD with no history of falls Pearson Product Moment Correlation = 0.47, ICC = 0.42
  • Excellent test-retest reliability for PD with a history of falls Pearson Product Moment Correlation = 0.92, ICC = 0.93
Interrater/Intrarater Reliability:

Functional Reach Test:

 

Asymptomatic Adults:

(Bennie et al, 2003; n = 20, mean age = 68(14.5) years, Asymptomatic Adults)

  • Excellent interrater reliability (ICC = 0.99)
  • Excellent intrarater reliability (ICC = 0.90)

 

Community Dwelling Elderly:

(Duncan et al, 1990; 2 clinicians blinded to other's assessment recorded reach on 17 of 128 participants, Community Dwelling Elderly)

  • Excellent inter observer "yardstick" reach reliability (ICC = 0.98)

 

Frail Elderly Patients:

(Thomas et al, 2005; n = 30, fallers mean age = 79.7 (6.7) non-faller mean age = 81.4 (6.7) years, Frail Elderly Patients)

  • Excellent intrarater reliability (ICC = 0.87)
  • Excellent Intrarater reliability (ICC = 0.92)
  • Excellent interrater reliability (ICC = 0.97)

Parkinson's Disease:

(Lim et al, 2005, Parkinson's Disease)

  • Adequate inter observer reliability (ICC = 0.64)
  • Adequate intra observer reliability (ICC = 0.74)

 

Stroke:

(Outermans et al, 2010, Subacute Stroke)

  • Excellent intrarater reliability (ICC = 0.89)

 

Vestibular Disorders:

(Mann et al, 1996; 2 physical therapists, 10 undiagnosed volunteers, Vestibular Disorder)

  • Excellent Intrarater reliability (ICC = 0.89)

 

Modified Functional Reach:

 

SCI Population: (Lynch, et al, 1998) Not Established; single rater used in the study.  

 
Internal Consistency:
Not Established
Criterion Validity (Predictive/Concurrent):

Functional Reach Test:

 

Asymptomatic Adults:

(Bennie et al, 2003, Asymptomatic Adults)

  • Adequate correlation with BBS (r = 0.42)
  • Adequate correlation with (TUG and FRT) and BBS (r = 0.56)

Community Dwelling Elderly

(Weiner et al, 1992, Community Dwelling Elderly)

  • Excellent correlation with:
    • Walking speed (r = 0.71)
    • Life space (r = 0.71)
    • iADL (r = 0.66)
    • Tandem walk (r = 0.67)
    • Mobility skills (r = 0.65)
    • 1 footed stand (r = 0.64)
  • Adequate correlation with:
    • Physical Activities of Daily Living (PADL) (r = 0.48)

Frail Elderly Patients:

(Thomas et al, 2005, Frail Elderly Patients)

  • < 18.5 cm indicates fall risk (75% Sensitivity, 67% Specificity)

Parkinson's Disease

(Behrman, A.L. et al, 2002; n = 58; mean age = 64.3(9.3) years)

  • Sensitivity: A functional reach criterion of less than 25.4 cm for risk of falls identified only 30% of the individuals with PD known to be at risk from their history of falls. Negative predictive value (the probability that a person who tests negative (< 25.4 cm) actually does not have a history of falls = 36%. Positive predictive value (probability that those showing a positive fall risk reach (< 25.4cm) actually do have a positive history for falls) = 90%
  • An increase in the reach criterion to 30.1 cm for falls risk nearly doubled the test sensitivity of the FRT, although 44% of the persons at risk remained unidentified by the FRT
  • Specificity (those that truly had no history of falls were identified by the FRT as having a negative fall risk (> 25.4cm) = 92%

(Dibble and Lange, 2006, Parkinson's Disease)

·         Adequate validity: AUC = 0.80

(Kerr et al. 2010, n = 101, mean age 66.4y (8.20; range 43-84, 67.3% male)

ROC characteristics: (to predict falls)

  • Accuracy(&) = 0.52
  • Area under curve = 0.52
  • Sensitivity = 0.52
  • Specificity = 0.53

(Jenkens et al. 2010, Parkinson's Disease)

  • Good predictive validity of Functional Reach Test at predicting maximum top, middle and bottom reaches for Parkinson's Disease Patients (r = 0.72, 0.76, and 0.73 respectively)

(Nocera et al, 2010; n = 44, mean age = 66 (11) years, Modified HY disability score = 2.3 (0.5), Parkinson's Disease)

Functional Measures (Pearson Correlations)
Functional Reach
Knee Strength
Dynamic Stability
6 Minute Walk Test
Functional Reach
0.221
0.367
-0.017
P Value
0.177
0.018
0.914
Knee Strength
0.221
0.500
0.248
P Value
0.177
0.001
0.127
Dynamic Stability
0.367
0.500
0.529
P Value
0.018
0.001
0.000
6 Minute Walk Test
-0.017
0.248
0.529
P Value
0.914
0.127
0.000
Functional Measures
UPDRS Motor
UPDRS Total
HY
Functional Reach
-0.266
-0.275
-0.248
P Value
0.08
0.07
0.1

 

 

Modified Functional Reach Test:

Stroke:

(Katz-Leurer et al, 2009, Acute Stroke) 

 

Correlations Between Measures :

First Evaluation

Second Evaluation

Rating

BM#

FIM~

SAS~

Rating

BM#

FIM~

SAS ~

Forward MFRT

Adequate

0.55*

0.49*

0.30

Adequate

0.50*

0.45*

0.21

Paretic side MFRT

Adequate

0.48*

0.51*

0.50*

Adequate

0.48*

0.40

0.20

Non-paretic side MFRT

Adequate

0.56**

0.37

0.35

Adequate

0.52*

0.30

0.37

*p < 0.05, **p < 0.01

# = Pearson correlations
~ = Spearman correlations
BM = Balance Master
FIM = Functional Independence Measure
SAS = Stroke Activity Scale
MFRT = Modified Functional Reach Test

 

Construct Validity (Convergent/Discriminant):

Functional Reach Test:

Parkinson's Disease:

(Dibble & Lange, 2006, Parkinson's Disease)

  • FRT scores for fallers and nonfallers were significantly different (p < 0.05)
    • Fallers mean (sd) = 23.11 (8.12) cm
    • Nonfallers mean (sd) = 31.70 (5.61) cm
    • Fallers & Nonfallers mean (sd) = 27.43 (8.38) cm

 

(Smithson et al, 1998, Parkinson's Disease)

  • Successfully able to detect differences between patients with and without a history of falls
    • Between subjects with PD who had a history of falls and the subjects with PD who had no history of falls P < 0.05
    • Between the subjects with PD who had a history of falls and the comparison subjects P < 0.05

 

(Kerr et al, 2010, Parkinson's Disease)

  • Significant difference in Functional Reach Test scores between fallers and nonfallers (p < 0.05)
    • fallers mean: 52.8 (3.4) cm
    • nonfallers mean: 54.2 (1.9)
    • all patients 53.6 (2.8)
  • Sensitivity and Specificity were found to be 0.52 and 0.53 respectively which are moderate scores and may render this test less significant of an indicator of fall risk than the statistics show

Peripheral Vestibular Disorders:

(Mann et al, 1996; n = 28; mean age = 58.3 (14) years; mean time since onset dizziness symptoms = 20.7 (33.7) months)

  • FRT and right single leg stance time were adequately correlated (r = 0.59)
  • FRT and DHI (Dizziness Handicap Inventory) were poorly correlated (r = -0.23)
    • Significant difference in FRT when divided into groups based on DHI scored ( t = 2.08, p 0.05)
      • Group 1 DHI < 49: FRT was 33.7 (SD = 6.9) cm
      • Group 2 DHI > 50: FRT was 28.0 (SD = 7.4) cm
Content Validity:
Not Established
Face Validity:

Functional Reach Test:

Stroke:

(Outermans et al, 2010, Subacute Stroke)

  • High validity of the functional reach test in patients with stroke (r = 0.71)
Floor/Ceiling Effects:
Not Established
Responsiveness:

Functional Reach Test

 

Frail Elderly Patients:

(Thomas et al, 2005; n = 30, fallers mean age = 79.7 (6.7) non-faller mean age = 81.4 (6.7) years, Frail Elderly Patients)

  • 18.5 cm cutoff for fall risk demonstrated % Sensitivity (95% C.I.) of 75 (0.46 - 0.91)
  • 18.5 cm cutoff for fall risk demonstrated % Specificity (95% C.I.) of 67 (0.44 - 0.84)

 

 

Modified Functional Reach Test

 

Stroke:

(Katz-Leurer et al, 2009; n = 35 measured 2-3 weeks post stroke and again 6 weeks later, Acute Stroke)

  • Mean change score of the MFRT forward = 6 cm (d = 0.60, moderate change)
  • Mean change score of the MFRT to nonparetic side = 4 cm (d = 0.57, moderate change)
  • Mean change score of the MFRT to the paretic side = 4 cm (d = 0.80, large change)
Considerations: Do you see an error or have a suggestion for this instrument summary? Please e-mail us!
Bibliography:

Acar, M. and Karatas, G. K. (2010). "The effect of arm sling on balance in patients with hemiplegia." Gait Posture 32(4): 641-644. Find it on PubMed

Behrman, A. L., Light, K. E., et al. (2002). "Is the functional reach test useful for identifying falls risk among individuals with Parkinson's disease?" Archives of Physical Medicine and Rehabilitation 83(4): 538-542. Find it on PubMed

Bennie, S., Bruner, K., et al. (2003). "Measurements of balance: comparison of the Timed" Up and Go" test and Functional Reach test with the Berg Balance Scale." Journal of Physical Therapy Science 15(2): 93-97.

Dibble, L. E. and Lange, M. (2006). "Predicting falls in individuals with Parkinson disease: a reconsideration of clinical balance measures." J Neurol Phys Ther 30(2): 60-67. Find it on PubMed

Duncan, P. W., Weiner, D. K., et al. (1990). "Functional reach: a new clinical measure of balance." J Gerontol 45(6): M192-197. Find it on PubMed

Erel, S., Uygur, F., et al. (2011). "The effects of dynamic ankle-foot orthoses in chronic stroke patients at three-month follow-up: a randomized controlled trial." Clin Rehabil 25(6): 515-523. Find it on PubMed

Jenkins, M. E., Johnson, A. M., et al. (2010). "Predictive validity of the UPDRS postural stability score and the Functional Reach Test, when compared with ecologically valid reaching tasks." Parkinsonism Relat Disord 16(6): 409-411. Find it on PubMed

Kage, H., Okuda, M., et al. (2009). "Measuring methods for functional reach test: comparison of 1-arm reach and 2-arm reach." Archives of Physical Medicine and Rehabilitation 90(12): 2103-2107. Find it on PubMed

Katz-Leurer, M., Fisher, I., et al. (2009). "Reliability and validity of the modified functional reach test at the sub-acute stage post-stroke." Disabil Rehabil 31(3): 243-248. Find it on PubMed

Kerr, G., Worringham, C., et al. (2010). "Predictors of future falls in Parkinson disease." Neurology 75(2): 116-124.

Kerr, G. K., Worringham, C. J., et al. (2010). "Predictors of future falls in Parkinson disease." Neurology 75(2): 116-124. Find it on PubMed

Lim, L. I., van Wegen, E. E., et al. (2005). "Measuring gait and gait-related activities in Parkinson's patients own home environment: a reliability, responsiveness and feasibility study." Parkinsonism Relat Disord 11(1): 19-24. Find it on PubMed

Lynch, S. M., Leahy, P., et al. (1998). "Reliability of measurements obtained with a modified functional reach test in subjects with spinal cord injury." Phys Ther 78(2): 128-133. Find it on PubMed

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Mann, G. C., Whitney, S. L., et al. (1996). "Functional reach and single leg stance in patients with peripheral vestibular disorders." J Vestib Res 6(5): 343-353. Find it on PubMed

Nocera, J. R., Buckley, T., et al. (2010). "Knee extensor strength, dynamic stability, and functional ambulation: are they related in Parkinson's disease?" Archives of Physical Medicine and Rehabilitation 91(4): 589-595. Find it on PubMed

Outermans, J. C., van Peppen, R. P., et al. (2010). "Effects of a high-intensity task-oriented training on gait performance early after stroke: a pilot study." Clin Rehabil 24(11): 979-987. Find it on PubMed

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Schenkman, M., Ellis, T., et al. (2011). "Profile of functional limitations and task performance among people with early-and middle-stage Parkinson disease." Physical therapy 91(9): 1339-1354.

Smithson, F., Morris, M. E., et al. (1998). "Performance on clinical tests of balance in Parkinson's disease." Phys Ther 78(6): 577-592. Find it on PubMed

Steffen, T. and Seney, M. (2008). "Test-retest reliability and minimal detectable change on balance and ambulation tests, the 36-item short-form health survey, and the unified Parkinson disease rating scale in people with parkinsonism." Physical Therapy 88(6): 733-746. Find it on PubMed

Tanji, H., Gruber‐Baldini, A. L., et al. (2008). "A comparative study of physical performance measures in Parkinson's disease." Movement Disorders 23(13): 1897-1905.

Thomas, J. I. and Lane, J. V. (2005). "A pilot study to explore the predictive validity of 4 measures of falls risk in frail elderly patients." Archives of Physical Medicine and Rehabilitation 86(8): 1636-1640. Find it on PubMed

Weiner, D. K., Duncan, P. W., et al. (1992). "Functional reach: a marker of physical frailty." J Am Geriatr Soc 40(3): 203-207. Find it on PubMed

Year published: 1990
Instrument in PDF Format: Yes


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