QTUG for assessing falls risk and frailty

The innovation

QTUG provides an objective assessment of mobility, falls risk and frailty. It uses proprietary algorithms to identify specific mobility impairments by comparing a person's results against reference values.

QTUG can be administered by non‑specialists and it is wireless and portable.

Current NHS options

The NICE guideline on falls in older people recommends that older people with a history of falls, or who are considered to be at risk of falling, should be observed for balance and gait deficits. The TUG test is a frequently used test of balance and gait. This test is referred to in the NICE guideline on falls in older people and in the joint American Geriatric Society/British Geriatrics Society guidelines (2010). In the TUG test, a person is observed and timed as they rise from a chair, walk 3 metres, turn, walk back to the chair and sit down. It can be used in any setting and needs no specialist equipment. The time taken to complete the test, measured using a stopwatch, is compared with standard values. Longer times are associated with a greater risk of falls. Clinical judgement of stability, gait, stride and sway can also be used as a component of the assessment. Other clinical tests used in current practice to assess balance and mobility include the Turn 180 degree test, the Tinetti scale, the Functional reach test and the Berg balance test. None of these assess frailty, which is generally determined using a range of indices within a clinical assessment.

NICE is aware of the following CE‑marked devices with gait assessment functions:

Population, setting and likely place in therapy

QTUG would be used in the same settings as the TUG test. This would be in primary, secondary or social care as a component of a multifactorial falls assessment of someone at risk of falling or who has had one or more falls. This could include older adults, people with disabilities affecting mobility and gait, and people with long‑term neurological conditions such as Parkinson's disease or multiple sclerosis. In addition, QTUG could potentially be used to monitor response to interventions such as rehabilitation or medication.

Approximately 30% of all people 65 years and over fall each year and this rises to approximately 50% in those 80 years and over (Age UK 2015). Their risk of falling can be increased further by conditions such as dementia or delirium (Royal College of Physicians 2015).

Chronic difficulties with gait and balance can also increase the risk of falls. For example, people with cerebral palsy may fall frequently, and report greater fear of falling (Morgan 2013).

Neurological conditions such as Parkinson's disease, multiple sclerosis or stroke are estimated to affect over 10 million people in the UK (Neurological Alliance 2003). People with these conditions have an increased risk of falling, with reported fall rates varying from 43‑70% in stroke survivors and 35‑90% in Parkinson's disease (Multiple Sclerosis Trust; Weerdesteyn 2008; Allen 2013). Falling is a common issue among young people who have neurological disorders, although the prevalence of falling is difficult to quantify.

Falls risk assessments are generally done by physiotherapists, geriatricians, occupational therapists or nurses. The manufacturer states that QTUG can be administered by non‑specialists with some additional training. The manufacturer provides instructional videos and training over the telephone or in a face‑to‑face training session. QTUG would be used as part of a standard falls risk assessment and is therefore unlikely to need any changes to the relevant care pathways (these include falls in older people, multiple sclerosis and stroke rehabilitation).

Costs

Resource consequences

The manufacturer states that QTUG is currently in use in 3 NHS trusts. The QTUG manufacturer, Kinesis Health Technologies Ltd, has been selected to participate in the NHS England Test Beds initiative.

If adopted, QTUG would be used in place of the standard TUG test and is not considered to need any significant changes to current infrastructure.

Potential benefits of QTUG include use by lower grades of staff such as health care support staff, with further clinical assessment by appropriately qualified professionals. Improved prediction of falls risk and frailty could contribute to falls prevention measures and could help to assess whether therapies to improve gait were effective. It is unclear whether fewer resources would be needed to administer and interpret QTUG compared with TUG.

Regulatory information

QTUG was CE‑marked as a class I device in July 2014 to Kinesis Health Technologies Ltd.

A search of the Medicines and Healthcare Products Regulatory Agency website revealed that no manufacturer Field Safety Notices or Medical Device Alerts have been issued for this technology.