Tool Name: Multi Directional Reach test

Brief Summary of the test and how it is administered:

Populations Tested:

Community Dwelling Elderly Parkinson's Disease Spinal Cord Injury Stroke Vestibular Disorders

This test assesses a patient's stability by measuring the maximum distance an individual can reach forward, backward, sideways to the left, and sideways to the right while standing in a fixed position.

Using a yardstick mounted on the wall at shoulder height, ask the subject to position themselves close to, but not touching the wall with their arm outstretched and hand fisted. Take note of the starting position by determining what number the 3rd MCP joints line up with on the yardstick. For the forward reach test, have the subject reach as far forward as possible parallel with the measuring device or floor.

Instructions to the patient: Please reach as far forward as you can without losing your balance. Keep your feet flat on the floor. You are not allowed to touch the wall or the ruler as you reach. You will have two practice trials and then I will record the distance that you reach forward.

They are free to use various reaching strategies. Take note of the end position of the 3rd MCP joint against the ruler, and record the difference between the starting and ending position numbers. If they move their feet, that trial must be discarded and the trial repeated. Subjects are given two practice trials, and then their performance on an additional three trials is recorded and averaged. Note: To prevent a starting position with the scapula protracted, have the person hold both arms out horizontally. If the fingers match, they are not protracting. Then lower the non-testing arm and begin the test.

1. Forward: (same as Functional Reach)2. Backward: the starting position is the same as the Functional Reach. Keep the elbow extended and

the arm reaching forward (along the yardstick), however the person leans backward as far as possible.

3. Sideways to the right: stand with back to wall, and right elbow extended with arm reaching along the level of the yardstick (without touching yardstick or the wall). Lean to the right as far as possible.

4. Sideways to the left.

Precautions/Contraindications to test administration (if applicable):

Guard the subject to prevent a fall.

Criteria to stop the test:

The patient’s feet lifted up from the floor or they fell forward. Most patients fall forward with this test. The therapist should guard from the front as that is the direction that you reach forward.

Cut-off Scores

Reference Values: (mean age in study was 74)

Forward 8.9 + 3.4 Backward 4.6 + 3.1 Right 6.2 + 3.0 Left 6.6 + 2.8

Scores less than 6 or 7 inches indicate limited functional balance. Most health individuals with adequate functional balance can reach 10 inches or more.

Reliability and validity of the test (include population and reference):

One study determined the Multi-Directional Reach Test as an inexpensive, reliable, and valid tool for measuring the limits of stability as derived by reach in four directions. Values obtained on relatively healthy community-dwelling older adults serve as norms for screening patient populations.

Interclass Correlation (ICC2,1) for the reaches were greater than .92. (Excellent agreement)Reliability analysis (Cronbach's Alpha was .842, (Good internal consistency)

In another study… validity was assessed, reporting fair correlations of the MDRT with both the TUG and BBS. Excellent intra-rater reliability for the LRT is reported (ICC=.90-.99), however inter-rater reliability was not investigated. Neither the LRT or MDRT has been established to be reliable both between raters and test administrators, and valid for use for community dwelling older adults. With the exception of forward reach test (ICC=.94), poor intra-rater reliability was reported for all directions of the MDRT.

Equipment/environment required to complete the test:

Yardstick

Gait belt

Resources used: http://www.rehabmeasures.org/Lists/RehabMeasures/PrintView.aspx?ID=950

http://web.missouri.edu/~proste/tool/Functional-Reach.rtf

http://lib.bioinfo.pl/pmid:11283199

http://ijahsp.nova.edu/articles/vol5num4/pdf/langley.pdf