Tests of dynamic balance, motor function and fear of falling as indicators of fall risk in children with Duchenne muscular dystrophy

Abstract

Objectives: This study aims to examine dynamic balance, motor function, and fear of falling (FOF) as indicators of fall risk in children with Duchenne Muscular dystrophy (DMD).

Methods: This cross-sectional study included 92 children with DMD (ages 5-15; mean age 7.44 ± 2.10; mean BMI 17.70 ± 2.96), recruited from Shenzhen Children's Hospital between August 2023 and January 2024. Data collected included demographics, clinical characteristics, and fall history over the past month and year. Dynamic balance was assessed using the four-square step test (FSST), motor function with the motor function measure (MFM-32), 6-min walk test, and timed function tests (TFTs), and FOF using Lim's single-item question.

Results: 85.9 % reported falls in the past year, with 45.7 % classified as recurrent fallers (≥1 fall/week or day) and 51.1 % reporting recurrent falls (≥3) in the past month. FSST, MFM, and TFTs scores differed significantly between recurrent and non-recurrent fallers across both timeframes (FSST and MFM: p < 0.001; TFTs: p ≤ 0.01). FOF showed no significant group differences (month: p = 0.066; year: p = 0.054). FSST showed high accuracy in identifying recurrent fallers (AUC = 0.856-0.890; cut-off = 10.41s; sensitivity = 80.9 %-81.0 %; specificity = 88.0 %-95.6 %). In contrast, MFM and TFTs had limited discriminative value.

Conclusion: Dynamic balance, as assessed by the FSST, is a sensitive and specific indicator for identifying recurrent fallers in children with DMD, supporting its clinical utility in fall risk screening and prevention.