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RehabMeasures Instrument

Multidirectional Reach Test; Reach in Four Directions Test

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Purpose

The MDRT is an inexpensive screening tool to determine the limits of stability of individuals in 4 directions. It measures how far an individual can voluntarily reach, thereby shifting the COG to the limits of the BOS with the feet stationary.

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Instrument Details

Acronym MDRT; RFDT

Area of Assessment

Balance – Non-vestibular

Assessment Type

Performance Measure

Administration Mode

Paper & Pencil

Cost

Free

Key Descriptions

  • The following procedures are used to complete the MDRT:
  • A yardstick is affixed to a telescoping tripod or the wall at the level of the subject’s acromion process.
  • Prior to the reach the yardstick is leveled so that it is horizontal to the floor.
  • The subject lifts an outstretched arm to shoulder height, pauses for an initial reading and then reaches as far forward as possible.
  • Instructions to the to the subject include, “without moving your feet or taking a step, reach as far (direction given) as you can and try to keep your hand along the yardstick.” For the backward direction, the subject is asked to “lean as far back as you can.”
  • Subjects use their typical strategy to accomplish the task.
  • Subjects use their arm of choice for the forward and backward tasks and use the respective arm for the right and left reaches.
  • The start and end positions of the index finger of the outstretched hand is recorded and the difference represents the total reach for that direction.
  • Feet are maintained flat on the floor about 10 cm apart. If the feet move, the trial is discarded.
  • Literature varies on whether a practice trial is performed.
  • Literature varies on whether 2 or 3 trials with the average recorded.
  • Procedure is repeated for the backward reach, right reach and left reach.

Number of Items

4

Equipment Required

  • Yardstick
  • Level

Time to Administer

Less than 5 minutes

Required Training

No Training

Age Ranges

Adult

18 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers

Alicia Esposito, PT, DPT, NCS & the PD EDGE Task Force of the Neurology Section of the APTA

ICF Domain

Body Function

Professional Association Recommendation

Recommendations for use of the instrument from the Neurology Section of the American Physical Therapy Association’s Multiple Sclerosis Taskforce (MSEDGE), Parkinson’s Taskforce (PD EDGE), Spinal Cord Injury Taskforce (PD EDGE), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE), and Vestibular Taskforce (Vestibular EDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.

For detailed information about how recommendations were made, please visit:  http://www.neuropt.org/go/healthcare-professionals/neurology-section-outcome-measures-recommendations

Abbreviations:

 

HR

Highly Recommend

R

Recommend

LS / UR

Reasonable to use, but limited study in target group / Unable to Recommend

NR

Not Recommended

 

Recommendations Based on Parkinson Disease Hoehn and Yahr stage: 

 

I

II

III

IV

V

PD EDGE

LS/UR

LS/UR

LS/UR

LS/UR

NR

 

Recommendations for entry-level physical therapy education and use in research:

 

Students should learn to administer this tool? (Y/N)

Students should be exposed to tool? (Y/N)

Appropriate for use in intervention research studies? (Y/N)

Is additional research warranted for this tool (Y/N)

PD EDGE

No

No

No

Not reported

Considerations

Variations occur regarding mounting of yardstick, number of trials performed and whether practice trial is performed. Ensure consistency when performing serial measures. 

Although there is more literature to support the Functional Reach Test, further exploration into the utility of the multidirectional reach test in necessary as individuals can fall in any direction and it does not appear that forward reach predicts reach distance in different directions.

Do you see an error or have a suggestion for this instrument summary? Please e-mail us!

Older Adults and Geriatric Care

back to Populations

Cut-Off Scores

Community Dwelling Elderly: (Newton, R, 2001; Mean age: 74.1 (7.9); Gender: Men 21.5%, Women 78.5%; Self-Reported Status: Excellent: 13.5%, Good: 53.6%, Fair: 27.8%, Poor: 5.2%; Race: African American 69.0%, Hispanic 17.1%, Caucasian 11.9%, Other 2.0%; Assistive Devices: Yes 69.6%, No 30.4%; Living Status: Alone 51.6%, With others 48.4%; Fear of Falling: Not Afraid 58.6%, Afraid (same activity level) 24.3%, Afraid (decreased activity level) 17.1%; Medications: None 19.3%, 1-4 70.5%, > 4 10.2%; Tripped/Fallen In Last 6 MO: No 78.6 %, Yes 21.4%)

(Newton, 2001) 

Mean score in each direction of individuals who reported a trip or fall in the last 6 months 

  • Forward (in): 8.38 (4.07) 
  • Backward (in): 4.06 (2.94) 
  • Right (in): 6.12 (2.76) 
  • Left (in): 5.67 (3.06)

Normative Data

Community Dwelling Elderly 

(Newton, R, 2001; Mean age: 74.1 (7.9); Gender: Men 21.5%, Women 78.5%; Self-Reported Status: Excellent: 13.5%, Good: 53.6%, Fair: 27.8%, Poor: 5.2%; Race: African American 69.0%, Hispanic 17.1%, Caucasian 11.9%, Other 2.0%; Assistive Devices: Yes 69.6%, No 30.4%; Living Status: Alone 51.6%, With others 48.4%; Fear of Falling: Not Afraid 58.6%, Afraid (same activity level) 24.3%, Afraid (decreased activity level) 17.1%; Medications: None 19.3%, 1-4 70.5%, > 4 10.2%; Tripped/Fallen In Last 6 MO: No 78.6 %, Yes 21.4%)

(Newton, 2001)

 

Mean

SD

Min

Max

Forward Reach (in)

8.89

3.4

0.5

16.8

Backward Reach (in)

4.64

3.1

0.4

14.0

Right Reach (in)

6.86

3.0

0.7

18.2

Left Reach (in)

6.61

2.9

0.0

14.4

 

Inner City Older Adult Population 

(Newton, 1997; n = 252; mean age = 74.3 years (7.7), range = 60-95 years; gender: men = 53, women = 199; race: African American = 176, Hispanic = 40, Caucasian = 30, Asian = 3, missing =  3; marital status: married = 54, not married/widowed = 198; living arrangement: alone = 130, living with others = 120; education (years completed): none or elementary = 45, middle school = 63, high school = 105, college = 31, vocational school = 5; occupation (prior to retirement): manual = 148, clerical/technical = 42, managerial/professional = 56; number of medications: none = 45, 1-3 = 141, 4 or more = 57; health status: excellent: 34, good=133, fair = 70, poor = 13; assistive device: no = 220; yes = 31; health conditions (top 4): vision corrected by glasses=137, arthritis=105, high blood pressure = 90, hearing loss = 44; tripped or fallen in the past 6 months: yes = 55, no = 195)

(Newton, 1997)

 

 

N

Mean

SD

Min

Max

Forward reach (in)

250

8.9

3.3

0.8

16.7

Reach backward (in)

204

4.6

3.0

0.5

13

Reach right (in)

204

6.8

3.0

0.7

18.2

Reach left (in)

204

6.6

2.8

0.4

14.4

 

Personal Care Home (PCH) Residents 

(Holbein-Jenny, M, et al, 2005; typically PCHs offer 24-hour staff availability for assistance with ADLs where residents may live in an apartment type setting and generally, are more independent than institutionalized elderly such as those in skilled nursing facilities; n = 26; female = 21, male = 5; mean age = 85.3 (4.9) years, range = 74-92; inclusion criteria: at least 65 years old, capability of flexing and holding the shoulders at 90 degrees of flexion or abduction for the MDRS, ability to stand for each component of the test without the use of an assistive device; medications: 1 individual reported taking only 1 daily medication, 6 individuals reported taking 2 medications, 10 individuals reported taking 3 or 4 medications and 8 individuals reported taking 5 or more medications daily, 1 person declined to share the information; falls: 52% of participants reported that they did not fall in the past year, 24% fell once and 24% report of falling from 2 to 5 times in the past year; fear of falling: half of participants who reported that they did not fall in the past year also reported having a fear of falling, 42% of those who reported falling in the past year denied a fear of falling.

(Holbein-Jenny, M, et al, 2005)

 

 

Mean

SD

Range

95% CI

Forward reach (in)

5.6

3.0

0-11.7

4.4-6.8

Backward reach (in)

2.9

2.2

0-7.3

2.0-3.8

Right reach (in)

3.3

2.5

0-10.5

2.3-4.2

Left reach (in)

3.7

3.1

0-10.2

2.6-4.9

 

Community Dwelling Adults 

(Steffen, TM, Mollinger, LA, 2005) 

  • Forward reach: 29 (7) cm 95% CI: 28-29 
  • Backward reach: 19 (8) cm 95% CI: 17-20 
  • Right reach: 17 (5) cm 95% CI: 16-18 
  • Left reach: 17 (5) cm 95% CI: 16-18

Test/Retest Reliability

Personal Care Home (PCH) Residents 

(Holbein-Jenny, M, et al, 2005) 

  • Excellent test-retest reliability Forward reach: ICC = 0.75 
  • Adequate test-retest reliability Backward Reach: ICC = 0.71 
  • Adequate test-retest reliability Right reach: ICC = 0.66 
  • Excellent test-retest reliability Left Reach: ICC = 0.83

Interrater/Intrarater Reliability

Community Dwelling Elderly 

(Newton, 2001) 

Intrarater Reliability 

  • Forward reach: excellent: ICC = 0.942 
  • Backward reach: poor: ICC = 0.0929 
  • Right reach: poor: ICC = 0.0926
  • Left reach: poor: ICC = 0.0947 

Indicates a practice effect across the 2 trials for backward, right and left reach 

 

Personal Care Home (PCH) Residents 

(Holbein-Jenny, M, et al, 2005) 

Interrater Reliability 

  • Forward reach: excellent: ICC = 0.98 
  • Backward reach: excellent: ICC = 0.96 
  • Right reach: excellent: ICC = 0.94 
  • Left reach: excellent: ICC = 0.91

Internal Consistency

Community Dwelling Elderly 

(Newton, 2001) 

  • Excellent internal consistency: Cronbach’s alpha = 0.842 
  • Measurements in a single direction (e.g.: forward reach) does not necessarily predict reach values in the other directions) 

 

Personal Care Home (PCH) Residents 

(Holbein-Jenny, M, et al, 2005) 

  • Excellent internal consistency: Cronbach’s alpha = 0.89

Construct Validity

Community Dwelling Elderly 

(Newton, 2001) 

  • Adequate correlation between Forward reach compared to the Berg Balance Test: r = 0.476 
  • Adequate correlation between Backward reach compared to the Berg Balance Test: r = 0.356 
  • Adequate correlation between Right reach compared to the Berg Balance Test: r = 0.389 
  • Adequate correlation between Left reach compared to the Berg Balance Test: r = 0.390 
  • Adequate correlation between forward reach and the TUG: r = -0.442 
  • Adequate correlation between backward reach and the TUG: r = -0.333 
  • Poor correlation between right reach and the TUG: r = -0.260 
  • Adequate correlation between left reach and the TUG: r = -0.310 

 

Personal Care Home (PCH) Residents 

(Holbein-Jenny, M, et al, 2005) 

  • Excellent Construct validity when the forward reach is compared to the BBS: ICC = 0.78 
  • Excellent Construct validity when the backward reach is compared to the BBS: ICC = 0.77 
  • Adequate Construct validity when the right reach is compared to the BBS: ICC = 0.53 
  • Excellent Construct validity when the left reach is compared to the BBS: ICC = 0.63 
  • Excellent Construct validity when the forward reach is compared to the backward reach: ICC = 0.69 
  • Excellent Construct validity when the forward reach is compared to the right reach: ICC = 0.72 
  • Excellent Construct validity when the forward reach is compared to the left reach: ICC = 0.68 
  • Adequate Construct validity when the forward reach is compared to the ABC: ICC = 0.48 
  • Adequate Construct validity when the backward reach is compared to the ABC: ICC = 0.43 
  • Adequate Construct validity when the right reach is compared to the ABC: ICC = 0.59 
  • Adequate Construct validity when the left reach is compared to the ABC: ICC = 0.41

Responsiveness

Community Dwelling Elderly 

(Newton, 2001) 

  • Forward reach: small change: effect size = 0.09 
  • Backward reach: small change: effect size = 0.14 
  • Right reach: small change: effect size = 0.18 
  • Left reach: moderate change: effect size = 0.21

Bibliography

Holbein-Jenny, M. A., Billek-Sawhney, B., et al. (2005). "Balance in personal care home residents: a comparison of the Berg Balance Scale, the Multi-Directional Reach Test, and the Activities-Specific Balance Confidence Scale." J Geriatr Phys Ther 28(2): 48-53. Find it on PubMed  

Newton, R. A. (1997). "Balance screening of an inner city older adult population." Arch Phys Med Rehabil 78(6): 587-591. Find it on PubMed

Newton, R. A. (2001). "Validity of the multi-directional reach test: a practical measure for limits of stability in older adults." J Gerontol A Biol Sci Med Sci 56(4): M248-252. Find it on PubMed

Steffen, T. M. and Mollinger, L. A. (2005). "Age- and gender-related test performance in community-dwelling adults." J Neurol Phys Ther 29(4): 181-188. Find it on PubMed

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