Clinician reference · Geriatric outpatient

Special tests, cutoffs, and the dose that actually works.

The evidence base underneath the fallrisks.com screener, laid out for the clinician doing the evaluation. Fall risk, strength, endurance, and frailty measures with their published thresholds — then the dosing parameters that separate a program that reduces falls from one that merely happens.

Use this as a reference, not a protocol. Cutoffs are screening thresholds drawn from specific study populations and vary by age, sex, and setting. No single measure is sufficient on its own — the sections below flag where that matters most. Clinical judgment governs.

01 · Fall risk & balance

Balance and fall-risk measures

Fast, clinic-friendly discriminators. Pair at least two.

Test	Cutoff	What it detects
30-Second Chair Stand	<8 reps	Fall risk plus a lower-extremity strength/power proxy. Age- and sex-specific norms (Rikli & Jones). Fast, and fits inside a standard functional battery.
Timed Up and Go (TUG)	>13.5 sec	Widely used, but modest sensitivity and specificity in isolation (Barry et al. meta-analysis). Treat as one input, never the determinant.
4-Stage Balance (CDC STEADI)	Tandem stance <10 sec	Fast, free, and a strong discriminator for fall risk. Requires no equipment.
Berg Balance Scale	<45/56	More sensitive to change over time than TUG — the better choice for documenting progress across a plan of care.
Functional Gait Assessment	<22/30	Outperforms DGI for vestibular- and balance-specific deficits. Useful where dizziness or BPPV overlaps the picture.
5× Sit-to-Stand	>12 sec	Overlaps the 30-second chair stand; the better option when a patient can’t tolerate the full 30 seconds (Whitney et al.).

TUG alone is not enough. Its sensitivity and specificity as a solo screen are modest. Combine it with a second balance measure before drawing a conclusion about fall risk.

02 · Strength

Strength and sarcopenia measures

Test	Cutoff	What it detects
30-Second Chair Stand	<8 reps	The most clinic-friendly lower-extremity strength proxy available (Rikli & Jones norms).
Grip Strength (dynamometry)	<27 kg men · <16 kg women	EWGSOP2 sarcopenia screen. Correlates with frailty and predicts hospitalization and mortality.
Manual Muscle Testing	0–5 scale	Standard grading, but subject to ceiling effects in ambulatory older adults.

MMT ceilings out. In ambulatory, higher-functioning older adults a 5/5 grade tells you very little. Favor the functional strength measures above for this population.

03 · Endurance

Aerobic capacity

Test	Reference	What it detects
6-Minute Walk Test	vs. age/sex norms	The gold standard. Distance plus heart-rate and SpO₂ response; predicts hospitalization and mortality in frail elderly.
2-Minute Step Test	r ≈ 0.7–0.8 vs 6MWT	A good substitute when you lack the corridor space for a 6MWT. Normative data by age and sex (Rikli & Jones).
2-Minute Walk Test	—	Alternative for lower-endurance or more impaired patients where six minutes isn’t feasible.

04 · Frailty & composite

The two measures worth putting in every evaluation

Test	Cutoff	What it detects
Short Physical Performance Battery	≤6 of 12 = high risk	Combines gait speed, chair stand, and balance. Strong predictive validity for disability and mortality, and well recognized in the Medicare and geriatric literature.
Gait Speed (alone)	<0.8 m/s	The most replicated single predictor of hospitalization, mortality, and disability. Cheap and fast enough that there is no good reason to omit it.

These two carry weight in documentation. SPPB and gait speed are well recognized in the Medicare and geriatric literature, which makes them useful to cite directly when justifying the medical necessity of skilled therapy — the same measures that predict the outcome also support the claim.

05 · Dosing

What dose actually reduces falls

Measuring risk is the easy half. These are the program parameters with fall-reduction evidence behind them — and the thresholds below which the effect largely disappears.

Otago Exercise Programme

Strength 3×/week (5 LE exercises, progressive ankle cuff weights from ~0.5 kg, ~10 reps, 1–2 sets). Balance 3×/week (12 progressive exercises). Walking 2×/week, ~30 min. Delivered and progressed by a PT at weeks 1, 4, 8, then monthly.

~35% reduction in falls and fall-related injuries (Robertson et al. 2001; Campbell & Robertson 2003). Minimum 12 months for full effect; best evidence in adults 80+ or with a fall history.

LiFE — Lifestyle Integrated Functional Exercise

Balance and strength embedded into daily routines rather than a scheduled exercise block — one-leg stand while brushing teeth, sit-to-stand before answering the phone. Roughly 7 PT visits over 6 months, then self-managed on principle-based training.

Comparable fall reduction to structured Otago-style programs at 12 months (Clemson et al. 2012). Best fit where adherence to a formal HEP is poor — habit cueing outlasts a checklist.

Progressive Resistance Training

60–80% 1RM in healthy-enough older adults; start 40–60% in frail or deconditioned patients and build over 4–6 weeks. 1–3 sets of 8–12 reps, 2–3×/week on non-consecutive days.

Progress load ~2–5% once 12 reps are achieved with good form. Never progress load and volume simultaneously. (ACSM/AGS position stands; Fiatarone Singh trials in frail elderly.)

Balance dose-response — the thresholds

3×/week minimum — 2×/week shows meaningfully smaller effect sizes.
≥50 hours cumulative — total exposure matters more than any single session length; programs under this threshold show weaker fall reduction.
Challenge calibrated — reduced base of support, minimal upper-extremity support, controlled weight shifting. Target “somewhat difficult, not mastered.”

Challenge level correlates with effect size more than exercise type does, and benefit attenuates after the program stops — so discharge planning has to include a maintenance HEP (Sherrington et al. 2017/2019; Cochrane falls prevention review).

This is the part most programs get wrong. Sherrington’s dose-response work is the strongest available evidence linking specific parameters — frequency, cumulative hours, and difficulty — to actual fall reduction. It is also the most defensible anchor available when justifying plan-of-care frequency and duration. A program at 2×/week, well under 50 cumulative hours, at a comfortable difficulty, is not a smaller version of the evidence-based program. It is a different intervention with a weaker effect.

Where these measures get captured

The patient-facing screener →

Nine questions, no account. What patients and families complete before they reach you.

Walk test →

The at-home functional walk, structured so the result maps onto the measures above.

Gait speed on-device →

healthgait.com measures the <0.8 m/s threshold directly — the single most predictive metric here.

Programs & resources →

STEADI materials, home modification, and where to send patients next.

Sources

Rikli & Jones (Senior Fitness Test norms) · Shumway-Cook et al. 2000 (TUG cutoff) · Barry et al. 2014 (TUG meta-analysis) · Whitney et al. (5× Sit-to-Stand) · EWGSOP2 2019 (sarcopenia grip strength cutoffs) · CDC STEADI toolkit · Robertson et al. 2001 and Campbell & Robertson 2003 (Otago) · Clemson et al. 2012 (LiFE) · Sherrington et al. 2017/2019 (balance dose-response; Cochrane falls prevention review) · ACSM/AGS position stands (PRT dosing).

This page is a clinical reference for licensed clinicians. It is not a diagnosis, not a plan of care, and not a substitute for clinical judgment or current practice guidelines. Thresholds are drawn from the cited literature and vary by population and setting.