What is the Functional Reach Test (FRT)?
The Functional Reach Test, often referred to as the FRT, is a performance-based assessment used in clinical settings to measure a person's standing balance and stability. It was developed in 1990 by Duncan et al. as a way to determine the anterior limits of standing balance in the elderly population. The test is simple to administer, requires minimal equipment, and is considered a valuable tool for screening individuals for their risk of falls. The core principle of the test is to challenge an individual's balance by having them lean forward as far as possible without moving their feet, and measuring the distance reached.
How is the Functional Reach Test Performed?
The standard FRT is conducted with the individual standing alongside a wall, and a simple measuring device such as a yardstick or tape measure. The procedure typically involves the following steps:
- The individual stands with their feet shoulder-width apart and parallel to a wall, but not touching it. The arm closest to the wall is raised to 90 degrees of shoulder flexion, forming a closed fist.
- The healthcare provider records the initial position of the third knuckle (third metacarpal head) on the measuring device.
- The individual is instructed to “reach as far as you can forward without taking a step or losing your balance”.
- The final position of the third knuckle is recorded at the point of maximum comfortable reach.
- The total distance is calculated by subtracting the starting measurement from the ending measurement.
- The test is typically performed three times after one or two practice trials, and the average of the test trials is recorded as the final score.
Scoring and Interpretation for Elderly People
The interpretation of the FRT score provides a clear indication of an individual's balance ability and risk of falling. The reach distance is categorized to help clinicians identify individuals at high, moderate, or low risk.
- High Fall Risk (less than 6 inches or 15.24 cm): A score in this range indicates significantly compromised balance and a heightened risk of falling, often four times greater than normal.
- Moderate Fall Risk (7–10 inches or 15.24–25.40 cm): This score suggests a moderate risk of falling, approximately twice as high as those with normal reach.
- Low Fall Risk (greater than 10 inches or 25.40 cm): Scores above this threshold are generally associated with a low risk of falling.
It is important to note that normative values can vary by age and sex. For example, a 70-87 year old man might have a normal reach of 13.16 inches, while a woman in the same age group might have a normal reach of 10.47 inches.
Functional Reach vs. Modified Functional Reach Test
For individuals who are unable to stand, there is a variation of the test called the Modified Functional Reach Test (mFRT). This version allows for the assessment of sitting balance.
| Feature | Standing Functional Reach Test (FRT) | Modified Functional Reach Test (mFRT) |
|---|---|---|
| Patient Position | Standing with feet shoulder-width apart | Seated with hips and knees at 90 degrees, feet flat on floor |
| Equipment Setup | Yardstick mounted on a wall at shoulder height | Yardstick mounted on a wall at acromion (shoulder) height |
| Test Movement | Leans forward by moving trunk forward and reaching as far as possible | Leans forward by moving trunk while sitting, reaching as far as possible |
| Measurement Reference | Third metacarpal head (third knuckle) | Distal end of the third metacarpal or fifth finger |
| Primary Use | Assessing dynamic balance and anterior stability in standing | Assessing sitting balance for those unable to stand, such as stroke survivors |
Clinical Implications and Benefits
Knowing an individual's FRT score has several significant benefits for both healthcare providers and patients.
- Risk Identification: It helps identify individuals who are at a high risk of falling so that preventive measures can be put in place, such as physical therapy or home modifications.
- Treatment Planning: The results can be used to justify and guide specific therapeutic interventions designed to improve balance and stability.
- Motivation and Progress Tracking: Patients can track their progress over time by comparing their scores, which provides positive reinforcement and motivation during rehabilitation.
- Functional Mobility Assessment: A low score can highlight limitations in everyday activities that require reaching, such as dressing, cooking, or retrieving items from high shelves.
Limitations of the FRT
While the FRT is a useful tool, it has some limitations. Research suggests it may be a weak measure of overall stability limits in healthy elderly individuals, as it primarily assesses forward reach and may be more influenced by trunk movement than by the displacement of the center of pressure. It also assesses only one plane of motion at a time and requires the individual to be able to follow directions and have a sufficient range of motion in their shoulder. For a more comprehensive falls risk assessment, it is recommended to use a test battery that includes other balance tests.
How to Improve Functional Reach
Improving your functional reach involves exercises that enhance balance, core stability, and functional mobility. A physical or occupational therapist can provide a personalized plan, but here are some general exercises and activities:
- Forward Reaching: Stand with feet shoulder-width apart and practice reaching forward as far as possible without moving your feet. Start with a smaller range and gradually increase as stability improves.
- Lateral Reaching: From a standing position, practice reaching sideways to improve side-to-side stability.
- High Reaching: Reach upwards toward the ceiling or a target on the wall to improve overhead reach and balance.
- Wall Pushups: Lean against a wall and perform modified pushups. This strengthens the arms and core, improving stability during reaching tasks.
- Daily Activity Integration: Incorporate reaching movements into daily life, such as reaching for items on shelves, gardening, or cleaning.
Regular, consistent practice of these types of exercises can help improve your FRT score and reduce your risk of falls.
Conclusion
The functional reach test for elderly people is a simple, non-invasive, and effective tool for assessing standing balance and predicting fall risk. By measuring the maximum forward reach distance, healthcare professionals can gain valuable insights into an individual's functional mobility and stability. While it has some limitations and should be used as part of a broader assessment, the FRT remains a cornerstone in proactive senior care, enabling targeted interventions and providing a clear metric for tracking progress over time. For more information and resources on senior balance and mobility, see the expert guides on Verywell Health: The Functional Reach Test to Measure Your Balance.
