Background: Falls are a major cause of injuries in older adults. To evaluate the risk of falls in older adults, clinical assessments such as the 5-time sit-to-stand (5xSTS) test can be performed. The development of inertial measurement units (IMUs) has provided the possibility of a more in-depth analysis of the movements’ biomechanical characteristics during this test. The goal of the present study was to investigate whether an instrumented 5xSTS test provides additional information to predict multiple or serious falls compared to the conventional stopwatch-based method. Methods: Data from 458 community-dwelling older adults were analyzed. The participants were equipped with an IMU on the trunk to extract temporal, kinematic, kinetic, and smoothness movement parameters in addition to the total duration of the test by the stopwatch. Results: The total duration of the test obtained by the IMU and the stopwatch was in excellent agreement (Pearson’s correlation coefficient: 0.99), while the total duration obtained by the IMU was systematically 0.52 s longer than the stopwatch. In multivariable analyses that adjusted for potential confounders, fallers had slower vertical velocity, reduced vertical acceleration, lower vertical power, and lower vertical jerk than nonfallers. In contrast, the total duration of the test measured by either the IMU or the stopwatch did not differ between the 2 groups. Conclusions: An instrumented 5xSTS test provides additional information that better discriminates among older adults those at risk of multiple or serious falls than the conventional stopwatch-based assessment.

1.
Guralnik
JM
,
Simonsick
EM
,
Ferrucci
L
,
Glynn
RJ
,
Berkman
LF
,
Blazer
DG
,
A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission
.
J Gerontol
.
1994
;
49
(
2
):
M85
. .
2.
Whitney
SL
,
Wrisley
DM
,
Marchetti
GF
,
Gee
MA
,
Redfern
MS
,
Furman
JM
.
Clinical measurement of sit-to-stand performance in people with balance disorders: validity of data for the five-times-sit-to-stand test
.
Phys Ther
.
2005
;
85
(
10
):
1034
45
. .
3.
Lord
SR
,
Murray
SM
,
Chapman
K
,
Munro
B
,
Tiedemann
A
.
Sit-to-stand performance depends on sensation, speed, balance, and psychological status in addition to strength in older people
.
J Gerontol A Biol Sci Med Sci
.
2002
;
57
(
8
):
M539
. .
4.
Guralnik
JM
,
Ferrucci
L
,
Pieper
CF
,
Leveille
SG
,
Markides
KS
,
Ostir
GV
,
Lower extremity function and subsequent disability: consistency across studies, predictive models, and value of gait speed alone compared with the short physical performance battery
.
J Gerontol A Biol Sci Med Sci
.
2000
;
55
(
4
):
M221
. .
5.
Buatois
S
,
Miljkovic
D
,
Manckoundia
P
,
Gueguen
R
,
Miget
P
,
Vançon
G
,
Five times sit to stand test is a predictor of recurrent falls in healthy community-living subjects aged 65 and older
.
J Am Geriatr Soc
.
2008
;
56
:
1575
7
. .
6.
Bergquist
R
,
Weber
M
,
Schwenk
M
,
Ulseth
S
,
Helbostad
JL
,
Vereijken
B
,
Performance-based clinical tests of balance and muscle strength used in young seniors: a systematic literature review
.
BMC Geriatr
.
2019
;
19
(
1
):
9
. .
7.
World Health Organization
.
WHO global report on falls prevention in older age. [Internet]. Community health
.
2007
. Available from: http://www.who.int/ageing/publications/Falls_prevention7March.pdf.
8.
Harandi
VJ
,
Ackland
DC
,
Haddara
R
,
Lizama
LEC
,
Graf
M
,
Galea
MP
,
Gait compensatory mechanisms in unilateral transfemoral amputees
.
Med Eng Phys
.
2020
;
77
:
95
106
. .
9.
Atrsaei
A
,
Dadashi
F
,
Hansen
C
,
Warmerdam
E
,
Mariani
B
,
Maetzler
W
,
Postural transitions detection and characterization in healthy and patient populations using a single waist sensor
.
J Neuroeng Rehabil
.
2020
;
17
(
1
):
70
14
. .
10.
Van Lummel
RC
,
Ainsworth
E
,
Hausdorff
JM
,
Lindemann
U
,
Beek
PJ
,
van Dieën
JH
.
Validation of seat-off and seat-on in repeated sit-to-stand movements using a single-body-fixed sensor
.
Physiol Meas
.
2012
;
33
(
11
):
1855
67
. .
11.
Najafi
B
,
Aminian
K
,
Loew
F
,
Blanc
Y
,
Robert
PA
.
Measurement of stand-sit and sit-stand transitions using a miniature gyroscope and its application in fall risk evaluation in the elderly
.
IEEE Trans Biomed Eng
.
2002
;
49
(
8
):
843
51
. .
12.
Zijlstra
W
,
Bisseling
RW
,
Schlumbohm
S
,
Baldus
H
.
A body-fixed-sensor-based analysis of power during sit-to-stand movements
.
Gait Posture
.
2010
;
31
(
2
):
272
8
. .
13.
Lepetit
K
,
Mansour
KB
,
Letocart
A
,
Boudaoud
S
,
Kinugawa
K
,
Grosset
JF
,
Optimized scoring tool to quantify the functional performance during the sit-to-stand transition with a magneto-inertial measurement unit
.
Clin Biomech
.
2019
;
69
:
109
14
. .
14.
Van Lummel
RC
,
Walgaard
S
,
Maier
AB
,
Ainsworth
E
,
Beek
PJ
,
van Dieën
JH
.
The instrumented Sit-To-Stand test (iSTS) has greater clinical relevance than the manually recorded sit-to-stand test in older adults
.
PLoS One
.
2016
;
11
(
7
):
e0157968
. .
15.
Warmerdam
E
,
Hausdorff
JM
,
Atrsaei
A
,
Zhou
Y
,
Mirelman
A
,
Aminian
K
,
Long-term unsupervised mobility assessment in movement disorders
.
Lancet Neurol
.
2020
;
19
:
462
70
. .
16.
Millor
N
,
Lecumberri
P
,
Gómez
M
,
Martínez-Ramírez
A
,
Izquierdo
M
.
An evaluation of the 30-s chair stand test in older adults: frailty detection based on kinematic parameters from a single inertial unit
.
J Neuroeng Rehabil
.
2013
;
10
(
1
):
86
. .
17.
Millor
N
,
Lecumberri
P
,
Gomez
M
,
Martìnez-Ramirez
A
,
Izquierdo
M
.
Kinematic parameters to evaluate functional performance of sit-to-stand and stand-to-sit transitions using motion sensor devices: a systematic review
.
IEEE Trans Neural Syst Rehabil Eng
.
2014
;
22
(
5
):
926
36
. .
18.
Van Lummel
RC
,
Ainsworth
E
,
Lindemann
U
,
Zijlstra
W
,
Chiari
L
,
Van Campen
P
,
Automated approach for quantifying the repeated sit-to-stand using one body fixed sensor in young and older adults
.
Gait Posture
.
2013
;
38
(
1
):
153
6
. .
19.
Ganea
R
,
Paraschiv-Ionescu
A
,
Büla
C
,
Rochat
S
,
Aminian
K
.
Multi-parametric evaluation of sit-to-stand and stand-to-sit transitions in elderly people
.
Med Eng Phys
.
2011 Nov
;
33
(
9
):
1086
93
. .
20.
Costantini
G
,
Carota
M
,
Maccioni
G
,
Giansanti
D
.
Classification of sit-to-stand locomotion task based on spectral analysis of waveforms generated by accelerometric transducer
.
Electron Lett
.
2006
;
42
(
3
):
27
8
.
21.
Doheny
EP
,
Fan
CW
,
Foran
T
,
Greene
BR
,
Cunningham
C
,
Kenny
RA
.
An instrumented sit-to-stand test used to examine differences between older fallers and non-fallers
.
Annu Int Conf IEEE Eng Med Biol Soc
.
2011
;
2011
:
3063
6
.
22.
Zhang
W
,
Regterschot
GRH
,
Geraedts
H
,
Baldus
H
,
Zijlstra
W
.
Chair rise peak power in daily life measured with a pendant sensor associates with mobility, limitation in activities, and frailty in old people
.
IEEE J Biomed Heal Informatics
.
2017
;
21
(
1
):
211
7
.
23.
Na
E
,
Hwang
H
,
Woo
Y
.
Study of acceleration of center of mass during sit-to-stand and stand-to-sit in patients with stroke
.
J Phys Ther Sci
.
2016
;
28
(
9
):
2457
60
. .
24.
Riley
PO
,
Krebs
DE
,
Popat
RA
.
Biomechanical analysis of failed sit-to-stand
.
IEEE Trans Rehabil Eng
.
1997
;
5
(
4
):
353
9
. .
25.
Soangra
R
,
Lockhart
TE
.
A comparative study for performance evaluation of sit-to-stand task with body worn sensor and existing laboratory methods
.
Biomed Sci Instrum
.
2012
;
48
:
407
.
26.
Kerr
A
,
Pomeroy
VP
,
Rowe
PJ
,
Dall
P
,
Rafferty
D
.
Measuring movement fluency during the sit-to-walk task
.
Gait Posture
.
2013
;
37
(
4
):
598
602
. .
27.
Galán-Mercant
A
,
Cuesta-Vargas
AI
.
Differences in trunk accelerometry between frail and nonfrail elderly persons in sit-to-stand and stand-to-sit transitions based on a mobile inertial sensor
.
J MIR Mhealth Uhealth
.
2013
;
1
(
2
):
e21
.
28.
Park
C
,
Sharafkhaneh
A
,
Bryant
MS
,
Nguyen
C
,
Torres
I
,
Najafi
B
.
Toward remote assessment of physical frailty using sensor-based sit-to-stand test
.
J Surg Res
.
2021
;
263
:
130
9
. .
29.
Doheny
EP
,
Walsh
C
,
Foran
T
,
Greene
BR
,
Fan
CW
,
Cunningham
C
,
Falls classification using tri-axial accelerometers during the five-times-sit-to-stand test
.
Gait Posture
.
2013
;
38
(
4
):
1021
5
. .
30.
Ghahramani
M
,
Stirling
D
,
Naghdy
F
.
The sit to stand to sit postural transition variability in the five time sit to stand test in older people with different fall histories
.
Gait Posture
.
2020
;
81
:
191
6
. .
31.
Santos-Eggimann
B
,
Karmaniola
A
,
Seematter-Bagnoud
L
,
Spagnoli
J
,
Büla
C
,
Cornuz
J
,
The Lausanne cohort Lc65+: a population-based prospective study of the manifestations, determinants and outcomes of frailty
.
BMC Geriatr
.
2008
;
8
:
20
.
32.
Hauer
K
,
Lamb
SE
,
Jorstad
EC
,
Todd
C
,
Becker
C
.
Systematic review of definitions and methods of measuring falls in randomised controlled fall prevention trials
.
Age Ageing
.
2006
;
35
(
1
):
5
10
. .
33.
Granbom
M
,
Clemson
L
,
Roberts
L
,
Hladek
MD
,
Okoye
SM
,
Liu
M
,
Preventing falls among older fallers: study protocol for a two-phase pilot study of the multicomponent LIVE LiFE program
.
Trials
.
2019
;
20
(
1
):
2
. .
34.
Bland
JM
,
Altman
DG
.
Applying the right statistics: analyses of measurement studies
.
Ultrasound Obstet Gynecol
.
2003
;
22
:
85
93
. .
35.
Cohen
J
.
A power primer
.
Psychol Bull
.
1992
;
112
(
1
):
155
9
. .
36.
Taetz
B
,
Bleser
G
,
Miezal
M
.
Towards self-calibrating inertial body motion capture
.
Proceedings of the FUSION 2016: 19th International Conference on Information Fusion
.
2016
. p.
1751
9
.
37.
Bohannon
RW
.
Reference values for the five-repetition sit-to-stand test: a descriptive meta-analysis of data from elders
.
Percept Mot Skills
.
2006
;
103
(
1
):
215
22
. .
38.
Hellmers
S
,
Fudickar
S
,
Lau
S
,
Elgert
L
,
Diekmann
R
,
Bauer
JM
,
Measurement of the chair rise performance of older people based on force plates and IMUs
.
Sensors
.
2019
;
19
(
6
):
1370
. .
39.
Ejupi
A
,
Brodie
M
,
Gschwind
YJ
,
Lord
SR
,
Zagler
WL
,
Delbaere
K
.
Kinect-based five-times-sit-to-stand test for clinical and in-home assessment of fall risk in older people
.
Gerontology
.
2015
;
62
(
1
):
118
24
. .
40.
Baltasar-Fernandez
I
,
Alcazar
J
,
Rodriguez-Lopez
C
,
Losa-Reyna
J
,
Alonso-Seco
M
,
Ara
I
,
Sit-to-stand muscle power test: comparison between estimated and force plate-derived mechanical power and their association with physical function in older adults
.
Exp Gerontol
.
2021
;
145
:
111213
. .
41.
Bollinger
LM
,
Walaszek
MC
,
Seay
RF
,
Ransom
AL
.
Knee extensor torque and BMI differently relate to sit-to-stand strategies in obesity
.
Clin Biomech
.
2019
;
62
:
28
33
. .
42.
Watt
AA
,
Clark
C
,
Williams
JM
.
Differences in sit-to-stand, standing sway and stairs between community-dwelling fallers and non-fallers: a review of the literature
.
Physical Therapy Reviews
.
2018
;
23
(
4–5
):
273
90
. .
43.
Pijnappels
M
,
van der Burg
PJ
,
Reeves
ND
,
van Dieën
JH
.
Identification of elderly fallers by muscle strength measures
.
Eur J Appl Physiol
.
2008
;
102
(
5
):
585
92
. .
44.
Millor
N
,
Lecumberri
P
,
Gomez
M
,
Martinez
A
,
Martinikorena
J
,
Rodriguez-Manas
L
,
Gait velocity and chair sit-stand-sit performance improves current frailty-status identification
.
IEEE Trans Neural Syst Rehabil Eng
.
2017
;
25
(
11
):
2018
25
. .
45.
Qiu
H
,
Rehman
RZU
,
Yu
X
,
Xiong
S
.
Application of wearable inertial sensors and a new test battery for distinguishing retrospective fallers from non-fallers among community-dwelling older people
.
Sci Rep
.
2018
;
8
(
1
):
16349
. .
46.
Schwenk
M
,
Hauer
K
,
Zieschang
T
,
Englert
S
,
Mohler
J
,
Najafi
B
.
Sensor-derived physical activity parameters can predict future falls in people with dementia
.
Gerontology
.
2014
;
60
(
6
):
483
92
. .
47.
Wang
C
,
Patriquin
M
,
Vaziri
A
,
Najafi
B
.
Mobility performance in community-dwelling older adults: potential digital biomarkers of concern about falling
.
Gerontology
.
2021
;
67
(
3
):
365
73
.
48.
Beauchet
O
,
Dubost
V
,
Revel Delhom
C
,
Berrut
G
,
Belmin
J
.
How to manage recurrent falls in clinical practice: guidelines of the French society of geriatrics and gerontology
.
J Nutr Health Aging
.
2011
;
15
(
1
):
79
84
. .
49.
Pohl
P
,
Nordin
E
,
Lundquist
A
,
Bergström
U
,
Lundin-Olsson
L
.
Community-dwelling older people with an injurious fall are likely to sustain new injurious falls within 5 years: a prospective long-term follow-up study
.
BMC Geriatr
.
2014
;
14
(
1
):
120
. .
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.