Functional Reach Test (FRT)

Original Editor - Evan Thomas

Top Contributors - Tolulope Adeniji, Uchechukwu Chukwuemeka, Nehal Shah, Kim Jackson, Janine van Dyk, Lucinda hampton, Rachael Lowe, Momina Khalid, Admin, Evan Thomas and Lauren Lopez

Introduction

As age advances, elderly people face postural instability and it poses a major public health issue. Routine clinical evaluations involve detection, analysis and understanding of gait and balance alterations. In order to assess risk of fall in elderly, Functional Reach test (FRT) has shown to be a clinical tool. It is complex and involves multiple joints like leg, hip and spinal joints

Development

In 1990, Pamela Duncan and colleagues first developed the Functional Reach test. It is a quick, single-task, dynamic test that is used to predicting falls in older adults. This test measures the margin of stability along with the ability to measure balance during a functional task.

Intended Population

• FRT was made to predict fall risk in the elderly and adult patients living with frailty.
• It is one of the 4 tests used in the The Balance Outcome Measure for Elder Rehabilitation along with Step Test, Timed Up and Go test and Timed Static Stance test.

Method of Performing FRT

• The patient is instructed to stand next 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.
• Patient is instructed to reach as farther as possible without moving from the ground
• The location of the 3rd metacarpal is recorded again.
• Scores are determined by assessing the difference between the start and end position is the reach distance, usually measured in inches.
• Three trials are done and the average of the last two is noted

Functional Reach Test

Criteria to stop the test

The patient’s feet lifted up from the floor or they fell forward. Most patients fall forward with this test. The therapist should guard from the front as that is the direction that you reach forward.

Reduced ability to reach has shown increases in future falls with odds ratios of 8.2 if unable to reach at all and 4 if able to reach < 15.2cm

Measurement Interpretation:

In general terms, FRT normative value is 26.6 cm for community older adults and normative value is 15.4 cm for non-community older adults

• 10”/25 cm or greater: Low risk of falls;
• 6”/15cm to 10”/25cm Risk of falling is 2x greater than normal;
• 6”/15cm or less Risk of falling is 4x greater than normal;
• Unwilling to reach: Risk of falling is 8x greater than normal

Functional Reach Norm

Functional Reach Norms

Age	Men	Women
20-40	16.73 inches	14.64 inches
41-69	14.98 inches	13.81 inches
70-87	13.15 inches	10.47 inches

Purpose

Functional Reach Test (FRT) is a clinical outcome measure and assessment tool for ascertaining dynamic balance in in simple task. As we know that this test measures the distance between the length of an outstretched arm in a maximal forward reach, while maintaining a fixed base of support. Hence this information helps in understanding risk of fall. A number of factors exert a major influence on this evaluation and Researches reveal that movement strategy and reduced spinal flexibility both affect reach distance.

Maximum distance that the center of mass can be moved safely without changes in the base of support defines limits of stability. In order to perform activities of daily living safely which mainly involve reaching in different directions, limits of stability control is essential. Postural mechanisms play a major role to maintain or recover the limits of stability

Though there laboratory tests available that assess limits of stability using force platform, there was a need found to transform laboratory measurement of limits of stability into an affordable, quick and simple clinical test that can be easily performed in different settingswhich is provided by FRT.

Evidence

Reliability

• The ordinal level tests (supported sitting and standing balance and static tandem standing tests) showed 100% agreement in all aspects of reliability.
• Intra-class correlations for the other tests ranged from 0.93 to 0.99. All the tests showed significant correlations with the appropriate comparator tests (r=0.32-0.74 p≤0.05)
• Test-retest reliability r = 0.89
• Inter-rater agreement on reach measurement = 0.98

Validity

Eagle et al. found out the following:

• Sensitivity = 76%

• Accuracy = 46%

• Specificity = 34%

• Positive Predictive Value = 33%
• Negative Predictive Value = 77%

Some research found that decreased spinal flexibility and the movement strategy affects the distance reached and also question the ability of FRT to differentiate elderly non-fallers and fallers.Research also noted that trunk mobility has a greater contribution to the test than the center of pressure displacement.

Responsiveness

FRT increased to 28 cm from 18 cm in 22 community-dwelling adults with knee osteoarthritis following a 10weeks aquatic exercise program under the guidance of a physiotherapist.

Resources

• FRT Summary