The predictive capacity of the 3-meter backward walk test for falls in older adults: a case–control analysis

Abstract

Background: The early detection of fall risk in older adults is crucial for prevention. This study assessed the 3-Meter Backward Walk Test (3m-BWT) as a predictor of falls. Methods: A retrospective observational case–control study was conducted with 483 community-dwelling participants (mean age 76.3 ± 6.5 years), including 101 individuals with a history of falls in the previous 12 months. A standardized battery of functional assessments was applied. Results: Significant differences were observed between fallers and non-fallers across all functional variables (p < 0.001), with fallers demonstrating slower performance on the 3m-BWT (6.8 ± 3.4 s vs. 5.1 ± 1.3 s). The 3m-BWT showed moderate correlations with Short Physical Performance Battery, 5-repetition Sit-to-Stand, gait speed, and 4-Square Step Test, and a moderate-to-strong correlation with Timed Up-and-Go (r = 0.632), even after adjusting for age, sex, and BMI. Although the 3m-BWT exhibited superior discriminative ability compared to other tests (AUC = 0.655), its predictive power in isolation remains limited. The optimal cut-off point was identified at 5.5 s (sensitivity: 59.5%; specificity: 68.6%), while a threshold of <3.5 s yielded high sensitivity (98%) but low specificity, supporting its use in fall risk screening. Conclusions: These findings support the integration of the 3m-BWT as a complementary tool within comprehensive geriatric assessments, particularly in contexts requiring high sensitivity. Given the multifactorial nature of falls, combining the 3m-BWT with other clinical evaluations and fall history is recommended to enhance risk stratification and inform preventive strategies.