Discriminative ability and exploratory cutoff of six-minute walk distance for recent self-reported fall history in community-dwelling older adults with type 2 diabetes

Abstract

Older adults with type 2 diabetes mellitus (T2DM) are at increased risk of mobility impairment and falls. Although the Six-Minute Walk Test (6MWT) is widely used to assess functional exercise capacity, evidence relating six-minute walk distance (6MWD) to recent self-reported fall history in this population remains limited. This study aimed to evaluate the discriminative ability of 6MWD, derive an exploratory cutoff, and examine its associations with fall history, physical performance, and concern about falling. This cross-sectional study included 115 community-dwelling adults aged ≥ 60 years with T2DM. Participants were classified as fallers or non-fallers based on self-reported falls during the previous six months. Assessments included 6MWD, handgrip strength, Timed Up and Go (TUG), Short Physical Performance Battery (SPPB), and Falls Efficacy Scale-International (FES-I). Receiver operating characteristic analysis evaluated the discriminative ability of 6MWD, while multivariable logistic regression assessed its association with fall history. Of 115 participants, 41 (35.7%) reported at least one fall during the previous six months. Fallers had shorter 6MWD, poorer physical performance, and greater concern about falling than non-fallers ( p < 0.001). Among participants with available 6MWD data, the apparent AUC was 0.89 (95% CI 0.83–0.96). The internally derived cutoff of ≤ 325 m yielded 80.49% sensitivity and 87.50% specificity. Each 10-m shorter 6MWD was associated with higher odds of fall history after adjustment for age, sex, and comorbidity status (adjusted OR 1.42, 95% CI 1.21–1.65; p < 0.001). This association was attenuated after additional adjustment for TUG (OR 1.15, 95% CI 0.92–1.43; p = 0.214). Shorter 6MWD was associated with recent self-reported fall history and poorer functional status in community-dwelling older adults with T2DM. The internally derived ≤ 325-m cutoff showed potentially useful apparent discrimination and may provide an exploratory reference for broader fall-related functional assessment. Prospective external validation is required before clinical application.

The authors' abstract, as published at the source. BMC Geriatrics, 2026 · DOI ↗