Do clinical balance measures have the ability to predict falls among ambulatory individuals with spinal cord injury? A systematic review and meta-analysis

Study design: Systematic review and meta-analysis. Background and purpose: Fall prevalence is high among individuals with spinal cord injury (SCI) and falls may lead to serious consequences. The objective of this study was to investigate the ability of clinical balance measures to predict falls among ambulatory individuals with SCI. Methods: We searched the online databases MEDLINE, Web of Science, Scopus, SportDiscuss, and CINAHL. Two reviewers independently selected prospective and cross-sectional studies of ambulatory adults with SCI, with a method of falls tracking and a clinical balance evaluation. Risk of bias was assessed using the Newcastle-Ottawa Quality Assessment Scale. A meta-analysis of prospective and cross-sectional studies was performed using Review Manager 5.3. Results: Ten studies from the 2672 studies identified were included in the qualitative synthesis. Nine studies were included in the meta-analyses. The Berg Balance Scale (BBS) and the Timed Up and Go Test demonstrate ability to differentiate between fallers and non-fallers, mean difference 5.25 (95% CI, 0.29 to 10.20) and 6.65 (95% CI, 0.17 to 13.12) respectively. The BBS presents moderate predictive ability (area under the receiver operating characteristic curve of 0.61 and sensitivity of 65%). Individuals with a BBS score ≥ 40 are likely at risk of falls. Conclusion: The BBS is the most appropriate and specific clinical balance measure with the ability to discriminate between ambulatory fallers and non-fallers. However, the fall predictive abilities of the measure need to be further explored and improved for this population.