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Successful 10-second one-legged stance performance predicts survival in middle-aged and older individuals
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    Re: Successful 10-second one-legged stance predicts survival in middle-aged and older individuals.
    • Andrew J Larner, Consultant Neurologist Walton Centre for Neurology and Neurosurgery, Liverpool, UK

    Dear Editor,

    Dr Araujo and colleagues have demonstrated the utility for mortality risk assessment of the 10-second one leg standing (10s-OLS) test,1 colloquially known as the “flamingo test” (although every amateur ornithologist will know that the 10s-OLS test posture, illustrated in Figure 1 of Araujo et al., is different from that adopted by a flamingo, and that many other birds adopt a single-legged stance when roosting). The 10s-OLS test is easily administered, safe, and simply categorised (binary yes/no), so should be easy to apply in clinical practice. Failure to achieve 10s-OLS (“NO 10s-OLS”) was found to be associated with patient age, high waist-height ratio, and prevalence of diabetes mellitus.

    Contrary to the view expressed by Dr Araujo and colleagues that "balance assessment is not routinely incorporated in the clinical examination",1 we suggest that most neurologists would include such an assessment in the neurological examination, particularly in older patients,2 and invariably if there is a complaint of imbalance or falling. Hence for neurologists, the findings of the study beg questions about underlying neurobiological mechanisms. Aside from speculating that "subclinical central or autonomic nervous system dysfunction" might contribute, the authors do not specifically address these issues, other than to indicate the exclusion from the study of patients with unstable gait or with signs of acute vestibular or otoneuro...

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    Conflict of Interest:
    None declared.