Functional Reach Test

A functional reach of 14 cm in an older adult falls below the commonly cited 15 cm risk threshold and indicates meaningful balance impairment. This should prompt a comprehensive falls assessment including medication review (particularly anticholinergics, benzodiazepines, and antihypertensives), vision screening, assessment of orthostatic hypotension, vestibular evaluation, and review of the home environment for hazards. Refer to physical therapy for balance training. Consider the STRATIFY or Morse Fall Scale for complete inpatient fall-risk stratification if the patient is hospitalized. Document the result and retest after 6-8 weeks of balance training to assess response.

A modified version of the FRT can be performed in a seated position for patients who cannot stand safely. The Seated Functional Reach Test measures forward reach from a seated position with arms at 90 degrees and is validated in wheelchair users and patients with spinal cord injury, severe lower-limb weakness, and advanced Parkinson's disease. However, the standard standing FRT reference values do not apply to the seated version. Use seated FRT reference norms, which are separate from standing norms, and note that the test is a seated variant when documenting.

The Berg Balance Scale (BBS) is a comprehensive 14-item tool that takes 15-20 minutes and assesses multiple balance dimensions including static, dynamic, and transitional balance. The FRT is a single-item, 2-minute screen that measures only forward limits of stability. The BBS is more sensitive to detecting incremental balance changes and is used to guide rehabilitation programming, while the FRT is better suited for rapid screening in busy clinical settings. The two tools complement each other: use the FRT for quick screening and the BBS for detailed balance profiling and rehabilitation tracking.

An FRT below 10 cm in an adult under 65 is abnormal and warrants investigation beyond simple age-related balance decline. Consider musculoskeletal causes (severe lower extremity weakness, joint instability, foot problems), neurological conditions (Parkinson's disease, cerebellar ataxia, peripheral neuropathy, multiple sclerosis, stroke), vestibular disorders, visual impairment, or significant deconditioning. Orthostatic hypotension should also be considered if the patient reports dizziness during the reach. Refer to neurology if no musculoskeletal explanation is apparent.

Centimeters are the standard unit in published research and clinical guidelines. The commonly cited thresholds — 25 cm for adults under 70, 15 cm for adults 70 and older, and below 15 cm indicating approximately 2x fall risk — are all expressed in centimeters. The original Duncan et al. paper used inches (10 inches being approximately 25 cm), which is still cited in some older American references. Use centimeters for documentation to ensure consistency with current evidence and to allow direct comparison with published normative data.