The Functional Reach Test (FRT) serves as both a clinical outcome measure and an assessment tool designed to evaluate dynamic balance through a straightforward task. When conducted in a standing position, the FRT gauges the extent of a maximal forward reach, considering the distance covered by the length of an outstretched arm while maintaining a stable base of support. This measurement is closely linked to the risk of falling, offering valuable insights into an individual’s balance capabilities.
The interpretation of FRT results is crucial in understanding fall risk:
- Reach of 10 inches (25 cm) or more indicates a low risk of falls.
- Reach between 6 inches (15 cm) and 10 inches (25 cm) suggests a risk of falling that is twice as high as normal.
- Reach of 6 inches (15 cm) or less signifies a fourfold increase in the risk of falling.
- Unwillingness to reach is associated with an eightfold greater risk of falling.
Several factors play a significant role in influencing FRT outcomes, with research highlighting the impact of movement strategy and reduced spinal flexibility on reach distance.
The FRT is specifically designed to predict fall risk in the elderly and frail adult population and is one of the four tests included in the Balance Outcome Measure for Elder Rehabilitation (BOOMER).
In conducting the FRT, the patient is instructed to stand beside a wall, without touching it, and position the arm closer to the wall at a 90-degree angle of shoulder flexion with a closed fist. The assessor records the starting position at the 3rd metacarpal head on a yardstick. The patient is then directed to reach as far forward as possible without taking a step, and the location of the 3rd metacarpal is recorded. The scores are determined by assessing the difference between the start and end positions, usually measured in inches, with three trials conducted, and the average of the last two noted.
The test is halted if the patient’s feet lift from the floor or if they fall forward, emphasizing the importance of guarding from the front during the test. Reduced ability to reach has been linked to an increased risk of future falls.
Reliability and validity assessments of the FRT indicate high levels of consistency and accuracy. Test-retest reliability is notable at r = 0.89, and inter-rater agreement on reach measurement is 0.98. However, validity measures, as reported by Eagle et al., reveal sensitivity at 76%, accuracy at 46%, specificity at 34%, positive predictive value at 33%, and negative predictive value at 77%.
While FRT has demonstrated responsiveness to interventions, such as a 10-week aquatic exercise program in community-dwelling adults with knee osteoarthritis, some research questions its ability to differentiate between elderly non-fallers and fallers. Additionally, concerns have been raised about the impact of decreased spinal flexibility and movement strategy on FRT outcomes, with trunk mobility playing a substantial role in the test.
