Comparison of the Real-World Performance of Timed-Up-and-Go Test, Short Physical Performance Battery, and SARC-F in the Validity for Predicting Fall Events – A Prospective Cohort Study

Introduction: Falls are a major public health concern, particularly in high-risk populations. Several functional assessment tools, including the Timed-Up-and-Go test (TUG), Short Physical Performance Battery (SPPB), and SARC-F questionnaire, have been proposed for fall risk prediction. However, their real-world performance and comparative validity in high-risk populations remain uncertain. This prospective cohort study aimed to compare the validity of TUG, SPPB, and SARC-F in predicting fall events in a high-risk population.

Methods: A total of 103 participants (mean age 75.4±7.6 years, 95% female) were recruited from our local osteoporosis outpatient clinic between October 2020 to March 2021. Baseline assessments included TUG, SPPB, and SARC-F evaluations. Participants were followed up for 2 years to determine fall events, which were defined as unintentional loss of balance resulting in contact with the ground or lower surface. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the discriminative ability of each tool, and area under the curve (AUC) values were calculated. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were also determined.

Results: 26 fall events were observed during the follow-up period. The AUC values for TUG, SPPB, and SARC-F were 0.671, 0.589, and 0.580 respectively. TUG demonstrated 0.80 sensitivity, 0.56 specificity, PPV: 0.63, and NPV: 0.80. SPPB showed 0.75 sensitivity, 0.50 specificity, PPV: 0.55, and NPV: 0.65. SARC-F exhibited 0.74 sensitivity, 0.66 specificity, PPV: 0.26, and NPV: 0.91. The differences in AUC values among the three tools were statistically not significantly different determined by DeLong’s test.

Discussion: In this prospective cohort study of a high-risk population, TUG, SPPB, and SARC-F showed moderate to good validity in predicting fall events. While TUG demonstrated the highest discriminative ability, SPPB and SARC-F also exhibited satisfactory performance. The findings suggest that these functional assessment tools can be valuable for fall risk assessment in high-risk populations. However, further research is needed to explore their complementary roles and to develop a comprehensive fall risk prediction model that integrates multiple assessment tools.

Keywords: falls, fall risk assessment, Timed-Up-and-Go test, Short Physical Performance Battery, SARC-F, high-risk population, prospective cohort study

Korrespondenzadresse: Moritz Kraus, Universitätsspital Zürich, Universität Zürich, Klinik für Traumatologie, Rämistrasse 100, 8091 Zürich, Schweiz, E-Mail: [e-mail]