3 Meter Backward

Walk Test
By: Lauren Sawle, SPT
Central Michigan University
Disclaimer

• Information collected for this

Inservice presentation has been
obtained from Shirlely Ryan
Ability Lab, Published Research
Journals, additional online
resources, and supportive
information from CMU DPT
program research project
Objectives

1. Learn what is the 3 meter backward walk test

2. Learn how to perform/implement the 3 meter
backward walk test with patients in the
outpatient setting.
3. Learn about normative data available of the 3
meter backward walk test for select diseases
and age-related norms
4. Learn how to further utilize the 3 meter
backward walk test to obtain additional
objective information
What is the 3 Meter
Backward Walk
Test? (3MBWT)

• The 3MBWT is an objective

measure assessing an individual’s
functional capacity to perform
backwards walking and to assist in
determining patient’s relative fall
risk
What does the 3MBWT
Assess?
• The main purpose of the 3MBWT
is to assess an individual’s fall risk
through examining dynamic
balance and mobility of
ambulation

• Increase time to complete the test

has been correlated with increased
fall risk
How to 1. Place two lines of tape on the floor indicating the
beginning and the end of the timed portion of the test, 3-
Perform the 2.
meters total (9.84ft. or 118.11in.)
Instructions for the patient: “When I say go, I want you to
3MBWT walk backwards as quickly as you safely can until I say
stop. I will be walking behind you for the duration of this
test”
3. Have the patient standing with back faced towards the
testing zone approximately 1-2ft from the starting line.
4. Begin the test when the patient first crosses the starting
line and end when they cross the finish mark (allow the
patient to fully cross the end line to prevent early
deceleration)
5. Record time required to complete test
How to • Record the time required for the patient to
complete the test in seconds (s)
Perform the • You can repeat the 3MBWT one more time and
3MBWT take the average of the two tests as the final score
• Document any additional modifications, physical
assistance, use of assistive device, occurrence of
LOB, etc.
• Consistency between testing sessions
• Tracking of quantitative and qualitative
changes in performance
Precautions for 3MBWT
Patients are at an increased fall risk
and additional injuries when
performing this test due to tripping
potential, poor reactive balance
strategies, poor proprioception, etc
Do not perform if actions
contradict patient specific
precautions
Must be able to follow simple
directions if cognitive function is
affected
 • Neurological and orthopedic
conditions
• Parkinson’s Disease
What • Multiple Sclerosis
• Stroke
Populations can • Traumatic Brain Injury
Benefit from the •
•
Older Adults
Total Hip Arthroplasty
3MBWT • Vestibular (balance focus)
Evidence Based
Research
• Parkinson’s disease:
• < 3.8 sec are less likely to report
falls
• >4.2sec are more likely to report
falls
• Cut-off score: 0.50 m/s prediction
faller from a non-faller
 • Primarily data pertains to
individuals 40+ years old

• Minimal detectable change as

Normative per Kocer et al. for Parkinson’s
Disease was shown to be 2.13s
Data
Statistical analysis
• Table obtain from Carter V, Jain T, James J, Cornwall M, Aldrich
A, de Heer HD. The 3-m Backwards Walk and Retrospective
Falls: Diagnostic Accuracy of a Novel Clinical Measure. J Geriatr
Phys Ther. 2019;42(4):249-255.
doi:10.1519/JPT.0000000000000149
Statistical analysis
Population Specific
MDC
• Meta-analysis performed
by Erica DeMarch for Step &
Connect online resource
Why Should the
3MBWT be Used in the
Clinic?
• Application to activities of daily life that have
components of backward walking
• Most falls occur in the backwards and lateral
directions often due to poor awareness of
proprioception of when COM extends outside of
limits of stability
• Increased falls has been correlated with decrease
community participation and quality of life
• Decreased time required to perform test correlates
with decreased occurrence of falls
• Can help to support implementation of
interventions targeting balance and gait with
defensible documentation for NMR activities
How the 3MBWT can be implemented in the clinic

• Performed at initial evaluations as a

component of the objective measures
• Additional components of gait can be
analyzed as well
• Short-term and long-term goals can be
formulated based on the results
• Can be implemented within a
performance report card as was
performed at part of my research pilot
study under supervision of Research
Advisor: Dr. Jamie Haines, PT, DScPT,
NCS through Central Michigan
University
PERFORMANCE REPORT CARD TO
IMPROVE CHRONIC DISEASE
MANAGEMENT IN COMMUNITY
DWELLING SENIORS: PILOT STUDY
Authors: Devyn Brough, Kyra Bussell, Kamryn Fields, Michele
Haske, Lauren Sawle
Research Advisor: Jamie Haines, PT, DScPT, NCS
Intergrated
Behavioral
Model6
Introduction
› Chronic Disease: conditions that last 1 year or more.1
› Require ongoing medical attention.1
› 6 in 10 adults in the United States have a chronic disease.1
› Symptoms can affect quality of life, cause difficulty
completing activities of daily living, and reduce their
functional ability. 2-3
› A person's environment, knowledge, skills and self-efficacy
play a vital role in health management of chronic disease.4
› Depression is higher among people who suffer from chronic
diseases.5
The purpose of this study was to determine the
effectiveness of a performance report card
program for community dwelling seniors to
improve their self-efficacy for management of a
chronic disease.
 • 7 subjects
• 3 men, 3 women, 1 dropped out due
to medical reasons

• Mean age: 75.9 y.o.

SUBJECTS
• Sample of Convenience

• Inclusion Criteria
(1) history of chronic condition >1 year
(2) able to walk in community 500ft
(3) able to follow 2 step directions
Data Collection
• IRB approval
• Obtained consent for testing and interviews

October/November 2022 February/March 2023

Testing Session 1 Testing Session 2/Report Card 2/Interview

Educational Session with Report Card 1

1 Week Post Testing Session 1

 Activities-Specific Balance Confidence
Scale7,8

5 Times Sit-to-Stand9

OUTCOME 10 Meter Walk Test (Comfortable and

MEASURES Fast)10,11

3 Meter Backward Walk Test12

33 Item Chronic Disease Self-Efficacy

Scale (CDSE)13
Data Analysis
› Analysis included 6 subjects (1 dropped out) except for
the 5TSTS in which one subject was unable to complete
› Paired two sample for means one tail test determine the
significance for group improvements
› p = 0.05 as statistically significant
› Interviews were conducted after the second testing session
– Transcribed for accuracy and reviewed
– Coded by 2 people
– 3 themes were generated from comparing the results
Results
Quantitative Results
Quantitative Results14
Self-Management • Exercise Regularly
• Get Information About Disease

Behaviors (p-value = • Obtain Help from Community, Family, & Friends

• Communicate with Physician

0.408)

Manage Disease in • Manage Disease in General

General (p-value =
0.198)

• Do Chores

Achieve Goals (p- • Social/Recreational Activities

• Manage Symptoms

value = 0.017) • Manage Shortness of Breath

• Control/Manage Depression
Major Themes
• "It's important to know how I'm doing, whether I'm getting worse, whether I'm getting better."

Improved
• "...one of the biggest gains was learning how to walk backwards, I did not understand that I didn’t know how to do it, I
mean I was totally unaware that I was not walking backwards very fast or even out, but being more aware of it and
some of the instruction got me more thinking about it to the point where now I see where I do it in everyday life"

awareness

• "Most helpful is the encouragement to do something...encouragement is having a goal or having something that you
have to report on or someone else is aware of, kind of like a doctor's check-up, you know it's coming you know you

Motivated by the
need to do certain things"
• "….am I progressing with the abilities that I still have, you know am I regressing, there is just so much unknown that’s
it's kind of fun to have something you can see concrete."

numbers
• "...recognizing or realizing that exercise and movement has a definite play in prolonging the progression"
• "...even seeing some improvement gives me courage to keep going. Not that I expect to reverse the disease but to
certainly hold it off appeals me"

Linked behaviors
• "Well, thinking that or knowing that Parkinsons is a degenerative disease to realize that there were actually some
improvements proves to me that exercise and movement and that if anything has slowed down the progression. "
• "I have been making lots of changes over the last 4-5 months on how I’m handling symptoms, and some of them

to disease
have been physical and some of them have been emotional changes and some of them have been medical changes"

management
Summary of Findings
› Self-Efficacy scores were statistically significant as a group
– Self-efficacy for goal attainment

› Interviews suggested:
– Improved awareness of their condition
– Motivated them for behavior change
– Linked how behavior change could impact disease management
Integrated Behavior Model6
Discussion
› Our results are consistent with other studies15-19 monitoring chronic
disease progression over time
– Suggesting that monitoring systems + traditional treatment may help
prolong maintenance or remission of chronic disease conditions
Limitations
Small sample size/convenience sample

Bias with subjects already participating in a local older

adult exercise class
Variety of disorders seen

No objective measure monitoring behavior change

Conclusion
› Tracking performance outcomes through
an individualized report card program that includes
education and follow up support appears to impact self-
efficacy for chronic disease management in this small
group of community dwelling seniors.
Future Research
› Results of this pilot program resulted in expansion of the
report card program to include people with Parkinson's
disease living in rural communities supported by a grant
from the Parkinson's Foundation.
 References
1. About Chronic Diseases. Centers for Disease Control and Prevention. July 21, 2022. Accessed October 12, 2023. https://www.cdc.gov/chronicdisease/about/index.htm.

2. About Chronic Disease. Center for Managing Chronic Disease. Accessed October 17, 2023. https://cmcd.sph.umich.edu/about/about-chronic-disease/.

3. About Chronic Conditions. About Chronic Conditions - MN Dept. of Health. Accessed October 17, 2023. https://www.health.state.mn.us/diseases/chronic/about.html.

4. Farley H. Promoting self-efficacy in patients with chronic disease beyond traditional education: A literature review. Nurs Open. 2019;7(1):30-41. Published 2019 Oct 20.
doi:10.1002/nop2.382

5. The Intersection of Mental Health and Chronic Disease. Johns Hopkins Bloomberg School of Public Health. Accessed October 17, 2023.
https://publichealth.jhu.edu/2021/the-intersection-of-mental-health-and-chronic-disease.

6. Glanz K, Rimer BK, Viswanath K. Chapter Four Theory of Reasoned Action, Theory of Planned Behavior, and the Integrated Behavioral Model. In: Health Behavior
and Health Education: Theory, Research and Practice. Jossey-Bass; 2008.

7. Activities-specific balance confidence scale. Shirley Ryan AbilityLab. March 22, 2013. Accessed October 22, 2023.
https://www.sralab.org/rehabilitation-measures/activities-specific-balance-confidence-scale.

8. Activities-specific balance confidence scale (ABC). April 1, 2020. Accessed October 22, 2023.
https://neuropt.org/docs/default-source/cpgs/core-outcome-measures/activities-specific-balance-confidence-scale-proof8-(2)17db36a5390366a68a96ff00001fc240.pdf?sfvr
sn=d7d85043_0
.

9. Five times sit to stand test. Shirley Ryan AbilityLab. June 20, 2013. Accessed October 22, 2023. https://www.sralab.org/rehabilitation-measures/five-times-sit-stand-test.

10. 10 meter walk test. Shirley Ryan AbilityLab. January 22, 2014. Accessed September 15, 2023. https://www.sralab.org/rehabilitation-measures/10-meter-walk-test.

11. Adam, C.E., Fitzpatrick, A.L., Leary, C.S. et al. Change in gait speed and fall risk among community-dwelling older adults with and without mild cognitive impairment: a
retrospective cohort analysis. BMC Geriatr 23, 328 (2023). https://doi.org/10.1186/s12877-023-03890-6
https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-023-03890-6#:~:text=A%20gait%20speed%20threshold%20of,(1.0%20m%2Fs).

12. Carter V, Jain T, James J, Cornwall M, Aldrich A, de Heer HD. The 3-m Backwards Walk and Retrospective Falls: Diagnostic Accuracy of a Novel
Clinical Measure. J Geriatr Phys Ther. 2019;42(4):249-255. doi:10.1519/JPT.0000000000000149 https://pubmed.ncbi.nlm.nih.gov/29095771/
 References
13. Chronic disease self-efficacy scales (original 33-item). June 27, 2022. Accessed October 22, 2023.
https://selfmanagementresource.com/wp-content/uploads/English_-_chronic_disease_self-efficacy_33.pdf.

14. Brady TJ. Measures of self-efficacy: Arthritis Self-Efficacy Scale (ASES), Arthritis Self-Efficacy Scale-8 Item (ASES-8), Children's Arthritis Self-Efficacy Scale (CASE),
Chronic Disease Self-Efficacy Scale (CDSES), Parent's Arthritis Self-Efficacy Scale (PASE), and Rheumatoid Arthritis Self-Efficacy Scale (RASE). Arthritis Care Res (Hoboken).
2011;63 Suppl 11:S473-S485. doi:10.1002/acr.20567

15. What you need to know about exercise and chronic disease. Mayo Clinic. January 14, 2023. Accessed October 15, 2023.
https://www.mayoclinic.org/healthy-lifestyle/fitness/in-depth/exercise-and-chronic-disease/art-20046049.

16. Glasziou P, Irwig L, Mant D. Monitoring in chronic disease: A rational approach. BMJ. 2005;330(7492):644-648. doi:10.1136/bmj.330.7492.644

17 Jiang J, Cameron A-F. It-enabled self-monitoring for chronic disease self-management: An interdisciplinary review. MIS Quarterly. 2020;44(1):451-508.
doi:10.25300/misq/2020/15108

18. Lucas B, Home Monitoring and self-management of blood pressure in chronic kidney disease. http://isrctn.com/. Published online 2023. doi:10.1186/isrctn56336493

19. McCartney DE, McManus RJ. Self-monitoring and self-management. Current Opinion in Nephrology and Hypertension. 2016;25(6):502-507.
doi:10.1097/mnh.0000000000000279
References
1. Timed backwards walk. Shirley Ryan AbilityLab. January 8, 2014. Accessed October 15, 2023. https://www.sralab.org/rehabilitation-measures/timed-backwards-
walk.
2. Taulbee L, Yada T, Graham L, et al. Use of Backward Walking Speed to Screen Dynamic Balance and Mobility Deficits in Older Adults Living Independently in the
Community. J Geriatr Phys Ther. 2021;44(4):189-197. doi:10.1519/JPT.0000000000000290
3. Kocer B, Soke F, Ataoglu NEE, et al. The reliability and validity of the 3-m backward walk test in people with Parkinson's disease [published online ahead of print,
2023 May 9]. Ir J Med Sci. 2023;10.1007/s11845-023-03384-9. doi:10.1007/s11845-023-03384-9
4. Katirci Kirmaci Zİ, Adiguzel H, Erel S, Neyal AM, Neyal A, Ergun N. Validity and reliability of the 3-meter backward walk test in patients with multiple
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Apparently Healthy Adults. Med Princ Pract. 2023 Oct 18. doi: 10.1159/000534649. Epub ahead of print. PMID: 37852188.
10. Carter V, Jain T, James J, Cornwall M, Aldrich A, de Heer HD. The 3-m Backwards Walk and Retrospective Falls: Diagnostic Accuracy of a Novel Clinical
Measure. J Geriatr Phys Ther. 2019;42(4):249-255. doi:10.1519/JPT.0000000000000149
11. DeMarch E. Backwards walking: A sensitive measure to detect fallers. Step and Connect. June 9, 2022. Accessed October 15, 2023.
https://stepandconnect.com/blogs/the-balance-buzz/backwards-walking-a-sensitive-measure-to-detect-fallers.
12. Brough D., Bussell K., Fields K., Haske M., Sawle L. Performance Report Card To Improve Chronic Disease Management in Community Dwelling Seniors: Pilot Study.
Lecture presented at: APTA Michigan Fall Conference; 27 October 2023; Grand Rapids, MI
Questions?