1151
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Bauman CA, Milligan JD, Patel T, Pritchard S, Labreche T, Dillon-Martin S, Ilich A, Riva JJ. Community-based falls prevention: lessons from an Interprofessional Mobility Clinic. THE JOURNAL OF THE CANADIAN CHIROPRACTIC ASSOCIATION 2014; 58:300-11. [PMID: 25202159 PMCID: PMC4139769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Falls are a common and serious risk with an aging population. Chiropractors commonly see firsthand the effects of falls and resulting injuries in their senior patients and they can reduce falls risk through active screening. Ongoing research has provided proven approaches for making falls less likely. Screening for falls should be done yearly for all patients 65 years and older or in those with a predisposing medical condition. Additional specific falls prevention professional education would enable the chiropractor to best assist these patients. Collaboration and communication with the patient's family physician offers an opportunity for improved interprofessional dialogue to enhance patient care related to falls risk. Frequently falls prevention strategies are implemented by an interprofessional team. Chiropractors increasingly contribute within multidisciplinary teams. Collaboration by the chiropractor requires both simple screening and knowledge of health care system navigation. Such awareness can permit optimal participation in the care of their patient and the best outcome.
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Affiliation(s)
- Craig A. Bauman
- Department of Family Medicine, McMaster University, Hamilton, Ontario
- The Centre for Family Medicine Family Health Team, Kitchener, Ontario
| | - James D. Milligan
- Department of Family Medicine, McMaster University, Hamilton, Ontario
- The Centre for Family Medicine Family Health Team, Kitchener, Ontario
| | - Tejal Patel
- Department of Family Medicine, McMaster University, Hamilton, Ontario
- The Centre for Family Medicine Family Health Team, Kitchener, Ontario
- School of Pharmacy, University of Waterloo, Kitchener, Ontario
| | - Sarah Pritchard
- The Centre for Family Medicine Family Health Team, Kitchener, Ontario
| | - Tammy Labreche
- School of Optometry and Vision Science, University of Waterloo, Waterloo, Ontario
| | | | - Alexandra Ilich
- The Centre for Family Medicine Family Health Team, Kitchener, Ontario
| | - John J. Riva
- Department of Family Medicine, McMaster University, Hamilton, Ontario
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1152
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Pasquetti P, Apicella L, Mangone G. Pathogenesis and treatment of falls in elderly. CLINICAL CASES IN MINERAL AND BONE METABOLISM : THE OFFICIAL JOURNAL OF THE ITALIAN SOCIETY OF OSTEOPOROSIS, MINERAL METABOLISM, AND SKELETAL DISEASES 2014; 11:222-5. [PMID: 25568657 PMCID: PMC4269147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Falls in the elderly are a public health problem. Consequences of falls are increased risk of hospitalization, which results in an increase in health care costs. It is estimated that 33% of individuals older than 65 years undergoes falls. Causes of falls can be distinguished in intrinsic and extrinsic predisposing conditions. The intrinsic causes can be divided into age-related physiological changes and pathological predisposing conditions. The age-related physiological changes are sight disorders, hearing disorders, alterations in the Central Nervous System, balance deficits, musculoskeletal alterations. The pathological conditions can be Neurological, Cardiovascular, Endocrine, Psychiatric, Iatrogenic. Extrinsic causes of falling are environmental factors such as obstacles, inadequate footwear. The treatment of falls must be multidimensional and multidisciplinary. The best instrument in evaluating elderly at risk is Comprehensive Geriatric Assessment (CGA). CGA allows better management resulting in reduced costs. The treatment should be primarily preventive acting on extrinsic causes; then treatment of chronic and acute diseases. Rehabilitation is fundamental, in order to improve residual capacity, motor skills, postural control, recovery of strength. There are two main types of exercises: aerobic and muscular strength training. Education of patient is a key-point, in particular through the Back School. In conclusion falls in the elderly are presented as a "geriatric syndrome"; through a multidimensional assessment, an integrated treatment and a rehabilitation program is possible to improve quality of life in elderly.
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Affiliation(s)
- Pietro Pasquetti
- Specialization in Physical Medicine and Rehabilitation, Director of Recovery and Rehabilitation Agency, University Hospital of Careggi, Florence, Italy
| | - Lorenzo Apicella
- Postgraduate Specialization School in Physical Medicine and Rehabilitation, Recovery and Rehabilitation Agency, University Hospital of Careggi, Florence, Italy
| | - Giuseppe Mangone
- Specialization in Physical Medicine and Rehabilitation, Recovery and Rehabilitation Agency, University Hospital of Careggi, Florence, Italy
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1153
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Build better bones with exercise: protocol for a feasibility study of a multicenter randomized controlled trial of 12 months of home exercise in women with a vertebral fracture. Phys Ther 2014; 94:1337-52. [PMID: 24786946 PMCID: PMC4155040 DOI: 10.2522/ptj.20130625] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Our goal is to conduct a multicenter randomized controlled trial (RCT) to investigate whether exercise can reduce incident fractures compared with no intervention among women aged ≥65 years with a vertebral fracture. OBJECTIVES This pilot study will determine the feasibility of recruitment, retention, and adherence for the proposed trial. DESIGN The proposed RCT will be a pilot feasibility study with 1:1 randomization to exercise or attentional control groups. SETTING Five Canadian sites (1 community hospital partnered with an academic center and 4 academic hospitals or centers affiliated with an academic center) and 2 Australian centers (1 academic hospital and 1 center for community primary care, geriatric, and rehabilitation services). PARTICIPANTS One hundred sixty women aged ≥65 years with vertebral fracture at 5 Canadian and 2 Australian centers will be recruited. INTERVENTION The Build Better Bones With Exercise (B3E) intervention includes exercise and behavioral counseling, delivered by a physical therapist in 6 home visits over 8 months, and monthly calls; participants are to exercise ≥3 times weekly. Controls will receive equal attention. MEASUREMENTS Primary outcomes will include recruitment, retention, and adherence. Adherence to exercise will be assessed via calendar diary. Secondary outcomes will include physical function (lower extremity strength, mobility, and balance), posture, and falls. Additional secondary outcomes will include quality of life, pain, fall self-efficacy, behavior change variables, intervention cost, fractures, and adverse events. Analyses of feasibility objectives will be descriptive or based on estimates with 95% confidence intervals, where feasibility will be assessed relative to a priori criteria. Differences in secondary outcomes will be evaluated in intention-to-treat analyses via independent Student t tests, chi-square tests, or logistic regression. The Bonferroni method will be used to adjust the level of significance for secondary outcomes so the overall alpha level is .05. LIMITATIONS No assessment of bone mineral density will be conducted. The proposed definitive trial will require a large sample size. CONCLUSIONS The viability of a large-scale exercise trial in women with vertebral fractures will be evaluated, as well as the effects of a home exercise program on important secondary outcomes.
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1154
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Stubbs B, Eggermont L, Patchay S, Schofield P. Older adults with chronic musculoskeletal pain are at increased risk of recurrent falls and the brief pain inventory could help identify those most at risk. Geriatr Gerontol Int 2014; 15:881-8. [DOI: 10.1111/ggi.12357] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Brendon Stubbs
- School of Health and Social Care; University of Greenwich; London UK
| | - Laura Eggermont
- Department of Clinical Neuropsychology; VU University Amsterdam; Amsterdam the Netherlands
| | - Sandhi Patchay
- School of Psychology and Counselling; University of Greenwich; London UK
| | - Pat Schofield
- School of Health and Social Care; University of Greenwich; London UK
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1155
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Gschwind YJ, Eichberg S, Marston HR, Ejupi A, Rosario HD, Kroll M, Drobics M, Annegarn J, Wieching R, Lord SR, Aal K, Delbaere K. ICT-based system to predict and prevent falls (iStoppFalls): study protocol for an international multicenter randomized controlled trial. BMC Geriatr 2014; 14:91. [PMID: 25141850 PMCID: PMC4145835 DOI: 10.1186/1471-2318-14-91] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 08/14/2014] [Indexed: 11/25/2022] Open
Abstract
Background Falls are very common, especially in adults aged 65 years and older. Within the current international European Commission’s Seventh Framework Program (FP7) project ‘iStoppFalls’ an Information and Communication Technology (ICT) based system has been developed to regularly assess a person’s risk of falling in their own home and to deliver an individual and tailored home-based exercise and education program for fall prevention. The primary aims of iStoppFalls are to assess the feasibility and acceptability of the intervention program, and its effectiveness to improve balance, muscle strength and quality of life in older people. Methods/Design This international, multicenter study is designed as a single-blinded, two-group randomized controlled trial. A total of 160 community-dwelling older people aged 65 years and older will be recruited in Germany (n = 60), Spain (n = 40), and Australia (n = 60) between November 2013 and May 2014. Participants in the intervention group will conduct a 16-week exercise program using the iStoppFalls system through their television set at home. Participants are encouraged to exercise for a total duration of 180 minutes per week. The training program consists of a variety of balance and strength exercises in the form of video games using exergame technology. Educational material about a healthy lifestyle will be provided to each participant. Final reassessments will be conducted after 16 weeks. The assessments include physical and cognitive tests as well as questionnaires assessing health, fear of falling, quality of life and psychosocial determinants. Falls will be followed up for six months by monthly falls calendars. Discussion We hypothesize that the regular use of this newly developed ICT-based system for fall prevention at home is feasible for older people. By using the iStoppFalls sensor-based exercise program, older people are expected to improve in balance and strength outcomes. In addition, the exercise training may have a positive impact on quality of life by reducing the risk of falls. Taken together with expected cognitive improvements, the individual approach of the iStoppFalls program may provide an effective model for fall prevention in older people who prefer to exercise at home. Trial registration Australian New Zealand Clinical Trials Registry Trial ID:
ACTRN12614000096651. International Standard Randomised Controlled Trial Number:
ISRCTN15932647.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Kim Delbaere
- Neuroscience Research Australia, University of New South Wales, Barker Street, Randwick, Sydney, New South Wales 2031, Australia.
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1156
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Donath L, Kurz E, Roth R, Hanssen H, Schmidt-Trucksäss A, Zahner L, Faude O. Does a single session of high-intensity interval training provoke a transient elevated risk of falling in seniors and adults? Gerontology 2014; 61:15-23. [PMID: 25138109 DOI: 10.1159/000363767] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 05/21/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Balance and strength training can reduce seniors' fall risk up to 50%. Available evidence suggests that acute bouts of neuromuscular and endurance exercise deteriorate postural control. High-intensity endurance training has been successfully applied in different populations. Thus, it seemed valuable to examine the acute effects of high-intensity interval training (HIIT) on neuromuscular performance in seniors and young adults. OBJECTIVE The acute impact of a HIIT session on balance performance and muscle activity after exercise cessation and during post-exercise recovery was examined in young and old adults. We intended to investigate whether a transient exercise-induced fall-risk may occur in both groups. METHODS 20 healthy seniors (age 70 (SD 4) years) and young adults (age 27 (SD 3) years) were examined on 3 days. After exhaustive ramp-like treadmill testing in order to determine maximal heart rate (HRmax) on the first day, either a 4 × 4 min HIIT at 90% of HRmax or a control condition (CON) was randomly performed on the second and third day, respectively. Balance performance (postural sway) was assessed during single limb stance with open eyes (SLEO) and double limb stance with closed eyes (DLEC). EMG was recorded for the soleus (SOL), anterior tibialis (TIB), gastrocnemius (GM) and peroneus longus (PL) muscles at the dominant leg. All measures were collected before, immediately as well as 10, 30 and 45 min after HIIT and CON, respectively. RESULTS Compared to CON, HIIT induced significant increases of postural sway immediately after exercise cessation during SLEO in both groups (adults: p < 0.001, Δ = +25% sway; seniors: p = 0.007, Δ = +15% sway). Increased sway during DLEC was only found for seniors immediately and 10 min after HIIT (post: p = 0.003, Δ = +14% sway, 10 min post: p = 0.004, Δ = +18% sway). Muscle activity was increased during SLEO for TIB until 10 min post in seniors (0.008 < p < 0.03) and immediately after HIIT in adults (p < 0.001). CONCLUSION HIIT training may cause an acute 'open-fall-window' with a transient impairment of balance performance for at least 10 min after exercise cessation in both groups. Occluded vision in seniors seems to prolong this period up to 30 min. Thus, the advantage of HIIT with regard to time efficiency seems debatable when considering transient HIIT-induced impairments of neuromuscular function.
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Affiliation(s)
- Lars Donath
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
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1157
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[Fall prevention counselling for patients with hearing and balance disorders]. HNO 2014; 62:640-3. [PMID: 25103988 DOI: 10.1007/s00106-013-2792-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Otolaryngologists caring for patients with hearing and balance disorders are also responsible for advising patients about their increased risk of falling and informing them of fall prevention measures. This review will give a brief overview of appropriate programs. METHODS This systematic review is based on a selective literature search. RESULTS Intrinsic and extrinsic fall risk factors can be distinguished. The former include not only hearing and balance disorders, but also increasing age, nocturia, dementia, limited mobility and poor nutritional status. Extrinsic factors include, for example, unfixed carpet edges, poor lighting and poor footwear. Fall prevention can be achieved through appropriate counselling about risk factors and fall prevention courses. DISCUSSION The frequency of falls--with potentially very adverse consequences--increases continuously beyond the age of 60 years. Furthermore, the risk of falling is significantly increased in patients with hearing and balance disorders. Otolaryngologists caring for this patient group should inform them about their fall risk and advise appropriate countermeasures during counselling. A basal knowledge of fall prevention measures is therefore helpful.
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1158
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Lin SI, Chang KC, Lee HC, Yang YC, Tsauo JY. Problems and fall risk determinants of quality of life in older adults with increased risk of falling. Geriatr Gerontol Int 2014; 15:579-87. [DOI: 10.1111/ggi.12320] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Sang-I Lin
- Department of Physical Therapy; National Cheng Kung University; Tainan City Taiwan
| | - Ku-Chou Chang
- Division of Cerebrovascular Diseases; Department of Neurology; Chang Gung Memorial Hospital; Kaohsiung Taiwan
- College of Medicine; Chang Gung University; Taoyuan Taiwan
| | - Hsuei-Chen Lee
- Department of Physical Therapy and Assistive Technology; Exercise and Health Science Research Center; National Yang-Ming University; Taipei Taiwan
| | - Yi-Ching Yang
- Department of Family Medicine; College of Medicine; National Cheng Kung University; Tainan City Taiwan
| | - Jau-Yih Tsauo
- School and Graduate Institute of Physical Therapy; College of Medicine; National Taiwan University; Taipei Taiwan
- Physical Therapy Center; National Taiwan University Hospital; Taipei City Taiwan
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1159
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Gill TM. Disentangling the disabling process: insights from the precipitating events project. THE GERONTOLOGIST 2014; 54:533-49. [PMID: 25035454 PMCID: PMC4155452 DOI: 10.1093/geront/gnu067] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 04/28/2014] [Indexed: 12/31/2022] Open
Abstract
Among older persons, disability in activities of daily living is common and highly morbid. The Precipitating Events Project (PEP Study), an ongoing longitudinal study of 754 initially nondisabled, community-living persons, aged 70 or older, was designed to further elucidate the epidemiology of disability, with the goal of informing the development of effective interventions to maintain and restore independent function. Over the past 16 years, participants have completed comprehensive, home-based assessments at 18-month intervals and have been interviewed monthly to reassess their functional status and ascertain intervening events, other health care utilization, and deaths. Findings from the PEP Study have demonstrated that the disabling process for many older persons is characterized by multiple and possibly interrelated disability episodes, even over relatively short periods of time, and that disability often results when an intervening event is superimposed upon a vulnerable host. Given the frequency of assessments, long duration of follow-up, and recent linkage to Medicare data, the PEP Study will continue to be an outstanding platform for disability research in older persons. In addition, as the number of decedents accrues, the PEP Study will increasingly become a valuable resource for investigating symptoms, function, and health care utilization at the end of life.
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Affiliation(s)
- Thomas M Gill
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.
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1160
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Svantesson U, Babagbemi B, Foster L, Alricsson M. Influences on modern multifactorial falls prevention interventions and fear of falling in non-frail older adults: a literature review. J Clin Med Res 2014; 6:314-20. [PMID: 25110534 PMCID: PMC4125325 DOI: 10.14740/jocmr1874w] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2014] [Indexed: 11/24/2022] Open
Abstract
This review explores underlying features that may influence fear of falling and the effectiveness of multifactorial falls prevention programs in community dwelling non-frail adults aged 65 and older. It also examines the interrelationship between fear of falling and multifactorial falls prevention interventions. A literature search of medical databases was conducted to identify articles that address the fear of falling and multifactorial programs as either a primary or secondary component of their findings. Multifactorial interventions were assessed in terms of their program content, design, demographics, implementation techniques, and cost-effectiveness. Falls are a common, but preventable, cause of morbidity and injury in older adults 65 and over. In addition to physiological variables, fear of falling and self-efficacy are psychosocial factors that impact the incidence of falls in this population. Addressing fear of falling in addition to physiological parameters may influence the success of multifactorial falls prevention programs for adults 65 and over.
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Affiliation(s)
- Ulla Svantesson
- Institute of Neuroscience and Physiology/Physiotherapy, The Sahlgrenska Academy, University of Gothenburg, SE 405 30 Goteborg, Sweden ; Mid Sweden University, Swedish Winter Sports Research Centre, Department of health Science, SE 83125 Ostersund, Sweden
| | - Buki Babagbemi
- Johns Hopkins University School of Nursing, 525 North Wolfe Street, Baltimore, MD 21205, USA
| | - Lakicia Foster
- Johns Hopkins University School of Nursing, 525 North Wolfe Street, Baltimore, MD 21205, USA
| | - Marie Alricsson
- Mid Sweden University, Swedish Winter Sports Research Centre, Department of health Science, SE 83125 Ostersund, Sweden
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1161
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Schwickert L, Becker C, Lindemann U, Maréchal C, Bourke A, Chiari L, Helbostad JL, Zijlstra W, Aminian K, Todd C, Bandinelli S, Klenk J. Fall detection with body-worn sensors : a systematic review. Z Gerontol Geriatr 2014; 46:706-19. [PMID: 24271251 DOI: 10.1007/s00391-013-0559-8] [Citation(s) in RCA: 110] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS Falls among older people remain a major public health challenge. Body-worn sensors are needed to improve the understanding of the underlying mechanisms and kinematics of falls. The aim of this systematic review is to assemble, extract and critically discuss the information available in published studies, as well as the characteristics of these investigations (fall documentation and technical characteristics). METHODS The searching of publically accessible electronic literature databases for articles on fall detection with body-worn sensors identified a collection of 96 records (33 journal articles, 60 conference proceedings and 3 project reports) published between 1998 and 2012. These publications were analysed by two independent expert reviewers. Information was extracted into a custom-built data form and processed using SPSS (SPSS Inc., Chicago, IL, USA). RESULTS The main findings were the lack of agreement between the methodology and documentation protocols (study, fall reporting and technical characteristics) used in the studies, as well as a substantial lack of real-world fall recordings. A methodological pitfall identified in most articles was the lack of an established fall definition. The types of sensors and their technical specifications varied considerably between studies. CONCLUSION Limited methodological agreement between sensor-based fall detection studies using body-worn sensors was identified. Published evidence-based support for commercially available fall detection devices is still lacking. A worldwide research group consensus is needed to address fundamental issues such as incident verification, the establishment of guidelines for fall reporting and the development of a common fall definition.
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Affiliation(s)
- L Schwickert
- Department of Clinical Gerontology, Robert-Bosch Hospital, Stuttgart, Germany
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1162
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Hiorth YH, Larsen JP, Lode K, Pedersen KF. Natural history of falls in a population-based cohort of patients with Parkinson's disease: an 8-year prospective study. Parkinsonism Relat Disord 2014; 20:1059-64. [PMID: 25048614 DOI: 10.1016/j.parkreldis.2014.06.023] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 06/26/2014] [Accepted: 06/27/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Prospective long-term studies of falls in Parkinson's disease (PD) are scarce. OBJECTIVE To examine the development of falls over 8 years in a population-based cohort of ambulatory patients with PD, and to investigate predictors of future falls in non-fallers at baseline. METHODS All patients were examined at baseline and after 4 and 8 years, including the UPDRS, MMSE, Montgomery and Aaberg Depression Rating Scale, Functional Comorbidity Index, and a clinical dementia interview. Logistic regression models were applied to investigate baseline risk factors for future falls. A total of 211 patients were included at baseline, whereas 121 and 64 were re-examined at 4 and 8 years, respectively. RESULTS The prevalence of falls increased from 41% (87 of 211) at baseline to 72% (46 of 64) after 8 years of prospective follow-up (disease duration 16.2 ± 4.8 years). Forty-seven non-falling patients at baseline completed all study visits, of these 68% (n = 32) changed fall status during follow-up. Predictive variables for current falling after 4 years were rare or occasional freezing of gait (OR 6.6, 95% CI 1.2-36.9), higher levodopa equivalent doses and more severe speech and axial impairment (both OR 1.3, 95% CI 1.0-1.7) in non-fallers at baseline. Higher baseline age was the only risk factor for current falling after 8 years. CONCLUSIONS Nearly ¾ of the PD cohort reported falling after 8 years of follow-up. Disease-specific gait and axial impairments were the major risk factors for future falls in non-fallers at baseline. This has implications for patient education and management.
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Affiliation(s)
- Ylva Hivand Hiorth
- The Norwegian Centre for Movement Disorders, Stavanger University Hospital, PO Box 8100, N-4068 Stavanger, Norway.
| | - Jan Petter Larsen
- The Norwegian Centre for Movement Disorders, Stavanger University Hospital, PO Box 8100, N-4068 Stavanger, Norway
| | - Kirsten Lode
- The Norwegian Centre for Movement Disorders, Stavanger University Hospital, PO Box 8100, N-4068 Stavanger, Norway
| | - Kenn Freddy Pedersen
- The Norwegian Centre for Movement Disorders, Stavanger University Hospital, PO Box 8100, N-4068 Stavanger, Norway; Department of Neurology, Stavanger University Hospital, Stavanger, Norway
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1163
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Abstract
Over the years, a number of strategies have been investigated to prevent falls in older people in a number of settings. Over 200 randomised controlled trials now exist, and the challenge for the discerning clinician is to read and interpret the existing literature so as to be able to implement effective strategies, targeting the right individual with the right intervention. This chapter reviews the current literature and attempts to simplify what has become an enormously complex area. Interventions are reviewed in three main settings - community, hospital and care facilities and based on the type of approach - single, multiple or multifactorial interventions. It also considers the reality in which we practise and provides some 'best bets' to consider at this point in time.
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Affiliation(s)
- Jacqueline C T Close
- Neuroscience Research Australia and Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia.
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1164
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Vitamin E in sarcopenia: current evidences on its role in prevention and treatment. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2014; 2014:914853. [PMID: 25097722 PMCID: PMC4109111 DOI: 10.1155/2014/914853] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 06/06/2014] [Indexed: 01/01/2023]
Abstract
Sarcopenia is a geriatric syndrome that is characterized by gradual loss of muscle mass and strength with increasing age. Although the underlying mechanism is still unknown, the contribution of increased oxidative stress in advanced age has been recognized as one of the risk factors of sarcopenia. Thus, eliminating reactive oxygen species (ROS) can be a strategy to combat sarcopenia. In this review, we discuss the potential role of vitamin E in the prevention and treatment of sarcopenia. Vitamin E is a lipid soluble vitamin, with potent antioxidant properties and current evidence suggesting a role in the modulation of signaling pathways. Previous studies have shown its possible beneficial effects on aging and age-related diseases. Although there are evidences suggesting an association between vitamin E and muscle health, they are still inconclusive compared to other more extensively studied chronic diseases such as neurodegenerative diseases and cardiovascular diseases. Therefore, we reviewed the role of vitamin E and its potential protective mechanisms on muscle health based on previous and current in vitro and in vivo studies.
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1165
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Guo JL, Tsai YY, Liao JY, Tu HM, Huang CM. Interventions to reduce the number of falls among older adults with/without cognitive impairment: an exploratory meta-analysis. Int J Geriatr Psychiatry 2014; 29:661-9. [PMID: 24318959 DOI: 10.1002/gps.4056] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 10/29/2013] [Indexed: 12/31/2022]
Abstract
OBJECTIVE This exploratory meta-analysis aimed to examine and compare the effective interventions to prevent falls among institutionalized/non-institutionalized older adults without cognitive impairment with interventions to prevent falls for older adults with cognitive impairment. DESIGN A database search identified 111 trials published between January 1992 and August 2012 that evaluated fall-prevention interventions among institutionalized/non-institutionalized older adults with and without cognitive impairment as measured by valid cognition scales. RESULTS Exercise alone intervention was similar effective on reducing the numbers of falls among older adults without cognitive impairment regardless of setting (non-institutionalized: OR = 0.783, 95% confidence interval (CI) = 0.656-0.936; p = 0.007 institutionalized: OR = 0.799, 95% CI = 0.646-0.988, p = 0.038). Vitamin D/calcium supplementation had a positive effect on the reduction of numbers of falls among non-institutionalized older adults without cognitive impairment (OR = 0.789, 95% CI = 0.631-0.985, p = 0.036), as did home visits and environment modification (OR = 0.751, 95% CI = 0.565-0.998, p = 0.048). Exercise alone, exercise-related multiple interventions, and multifactorial interventions were associated with positive outcomes among both institutionalized and non-institutionalized older adults with cognitive impairment, but studies are limited. CONCLUSIONS Single exercise interventions can significantly reduce numbers of falls among older adults with and without cognitive impairment in institutional or non-institutional settings. Vitamin D and calcium supplementation, home visits, and environment modification can reduce the risk of falls among older adults in non-institutional settings. Exercise-related multiple interventions and multifactorial interventions may only be effective for preventing falls in older adults with cognitive impairment.
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Affiliation(s)
- Jong-Long Guo
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan
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1166
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Bolland MJ, Grey A, Gamble GD, Reid IR. Vitamin D supplementation and falls: a trial sequential meta-analysis. Lancet Diabetes Endocrinol 2014; 2:573-80. [PMID: 24768505 DOI: 10.1016/s2213-8587(14)70068-3] [Citation(s) in RCA: 113] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Vitamin D supplementation is often recommended to prevent falls, although vitamin D trials and meta-analyses of these trials have reported conflicting results for this outcome. We aimed to assess if there was a need for further research. METHODS We explored the value of doing further randomised controlled trials assessing the effects of vitamin D supplements on falls with trial sequential analysis with a risk reduction threshold of 15%. All analyses were done using the numbers of participants who had a fall in intention-to-treat analyses. Trial sequential analysis performs a cumulative meta-analysis, but reduces the risk of false-positive results from repetitive statistical testing by maintaining the overall risk of type 1 error at 5%. FINDINGS In 20 existing randomised controlled trials (n=29,535), the effect estimate for vitamin D with or without calcium on falls lay within the futility boundary, providing evidence that vitamin D supplementation does not alter the relative risk by 15% or more. In a sensitivity analysis using a risk reduction threshold of 10%, the effect estimate also lay within the futility boundary. In subgroup analyses using a risk reduction threshold of 15%, the effect estimate also lay within the futility boundary for trials of vitamin D supplementation (16 trials, n=22,291) and trials of vitamin D with calcium (six trials, n=9919). INTERPRETATION In pooled analyses, supplementation with vitamin D, with or without calcium, does not reduce falls by 15% or more. Future trials with similar designs are unlikely to alter these conclusions. At present, there is little justification for prescribing vitamin D supplements to prevent falls. FUNDING Health Research Council of New Zealand.
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Affiliation(s)
- Mark J Bolland
- Department of Medicine, University of Auckland, Auckland, New Zealand.
| | - Andrew Grey
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Greg D Gamble
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Ian R Reid
- Department of Medicine, University of Auckland, Auckland, New Zealand
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1167
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BAKKE HK, DEHLI T, WISBORG T. Fatal injury caused by low-energy trauma - a 10-year rural cohort. Acta Anaesthesiol Scand 2014; 58:726-32. [PMID: 24773521 PMCID: PMC4171781 DOI: 10.1111/aas.12330] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2014] [Indexed: 12/20/2022]
Abstract
Background Death after injury with low energy has gained increasing focus lately, and seems to constitute a significant amount of trauma-related death. The aim of this study was to describe the epidemiology of deaths from low-energy trauma in a rural Norwegian cohort. Methods All deaths from external causes in Finnmark County, Norway, from 1995 to 2004 were identified retrospectively through the Norwegian Cause of Death Registry. Deaths caused by hanging, drowning, suffocation, poisoning, and electrocution were excluded. Trauma was categorised as high energy or low energy based on mechanism of injury. All low-energy trauma deaths were then reviewed. Results There were 262 cases of trauma death during the period. Low-energy trauma counted for 43% of the trauma deaths, with an annual crude death rate of 13 per 100,000 inhabitants. Low falls accounted for 99% of the injuries. Fractures were sustained in 89% of cases and head injuries in 11%. Ninety per cent of patients had pre-existing medical conditions, and the median age was 82 years. Death was caused by a medical condition in 85% of cases. Fifty-two per cent of the patients died after discharge from the hospital. Conclusion In this cohort, low-energy trauma was a significant contributor to trauma related death, especially among elderly and patients with pre-existing medical conditions.
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Affiliation(s)
- H. K. BAKKE
- Anaesthesia and Critical Care Research Group Faculty of Health Sciences University of Tromsø Tromsø Norway
- Department of Surgery Mo i Rana Hospital Helgeland Hospital Trust Mo i Rana Norway
| | - T. DEHLI
- Department of Gastrointestinal Surgery University Hospital of North Norway Tromsø Tromsø Norway
| | - T. WISBORG
- Anaesthesia and Critical Care Research Group Faculty of Health Sciences University of Tromsø Tromsø Norway
- Department of Anaesthesiology and Intensive Care Finnmark Health Trust Hammerfest Hospital Hammerfest Norway
- Norwegian Trauma Competency Service Division of Emergencies and Critical Care Oslo University Hospital Oslo Norway
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1168
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Guthrie DM, Pitman R, Fletcher PC, Hirdes JP, Stolee P, Poss JW, Papaioannou A, Berg K, Ezekiel HJ. Data sharing between home care professionals: a feasibility study using the RAI Home Care instrument. BMC Geriatr 2014; 14:81. [PMID: 24975375 PMCID: PMC4083131 DOI: 10.1186/1471-2318-14-81] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 06/20/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Across Ontario, home care professionals collect standardized information on each client using the Resident Assessment for Home Care (RAI-HC). However, this information is not consistently shared with those professionals who provide services in the client's home. In this pilot study, we examined the feasibility of sharing data, from the RAI-HC, between care coordinators and service providers. METHODS All participants were involved in a one-day training session on the RAI-HC. The care coordinators shared specific outputs from the RAI-HC, including the embedded health index scales, with their contracted physiotherapy and occupational therapy service providers. Two focus groups were held, one with care coordinators (n = 4) and one with contracted service providers (n = 6). They were asked for their opinions on the positive aspects of the project and areas for improvement. RESULTS The focus groups revealed a number of positive outcomes related to the project including the use of a falls prevention brochure and an increased level of communication between professionals. The participants also cited multiple areas for improvement related to data sharing (e.g., time constraints, data being sent in a timely fashion) and to their standard practices in the community (e.g., busy workloads, difficulties in data sharing, duplication of assessments between professionals). CONCLUSIONS Home care professionals were able to share select pieces of information generated from the RAI-HC system and this project enhanced the level of communication between the two groups of professionals. However, a single information session was not adequate training for the rehabilitation professionals, who do not use the RAI-HC as part of normal practice. Better education, ongoing support and timely access to the RAI-HC data are some ways to improve the usefulness of this information for busy home care providers.
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Affiliation(s)
- Dawn M Guthrie
- Department of Kinesiology and Physical Education, Wilfrid Laurier University, 75 University Ave. W, Waterloo, ON N2L 3C5, Canada
| | - Robyn Pitman
- Department of Family Relations and Applied Nutrition, University of Guelph, 50 Stone Rd. E, Guelph, ON N1G 2W1, Canada
| | - Paula C Fletcher
- Department of Kinesiology and Physical Education, Wilfrid Laurier University, 75 University Ave. W, Waterloo, ON N2L 3C5, Canada
| | - John P Hirdes
- Ontario Home Care Research and Knowledge Exchange Chair, School of Public Health and Health Systems, University of Waterloo, 200 University Ave. W, Waterloo, ON N2L 3G1, Canada
| | - Paul Stolee
- Ontario Home Care Research and Knowledge Exchange Chair, School of Public Health and Health Systems, University of Waterloo, 200 University Ave. W, Waterloo, ON N2L 3G1, Canada
| | - Jeffrey W Poss
- Ontario Home Care Research and Knowledge Exchange Chair, School of Public Health and Health Systems, University of Waterloo, 200 University Ave. W, Waterloo, ON N2L 3G1, Canada
| | - Alexandra Papaioannou
- Department of Medicine, Director, Division of Geriatric Medicine, McMaster University, Chedoke Hospital, Wilcox Building, Sanatorium Road, Hamilton, ON L9C 1C4, Canada
| | - Katherine Berg
- Department of Physical Therapy, University of Toronto, 160-500 University Ave., 8th Floor, Toronto, ON M5G 1V7, Canada
| | - Helen Janzen Ezekiel
- Waterloo Wellington Community Care Access Centre, 450 Speedvale Avenue West, Suite 201, Guelph, ON N1H 7G7, Canada
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1169
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An individually-tailored multifactorial intervention program for older fallers in a middle-income developing country: Malaysian Falls Assessment and Intervention Trial (MyFAIT). BMC Geriatr 2014; 14:78. [PMID: 24951180 PMCID: PMC4080753 DOI: 10.1186/1471-2318-14-78] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 06/06/2014] [Indexed: 11/10/2022] Open
Abstract
Background In line with a rapidly ageing global population, the rise in the frequency of falls will lead to increased healthcare and social care costs. This study will be one of the few randomized controlled trials evaluating a multifaceted falls intervention in a low-middle income, culturally-diverse older Asian community. The primary objective of our paper is to evaluate whether individually tailored multifactorial interventions will successfully reduce the number of falls among older adults. Methods Three hundred community-dwelling older Malaysian adults with a history of (i) two or more falls, or (ii) one injurious fall in the past 12 months will be recruited. Baseline assessment will include cardiovascular, frailty, fracture risk, psychological factors, gait and balance, activities of daily living and visual assessments. Fallers will be randomized into 2 groups: to receive tailored multifactorial interventions (intervention group); or given lifestyle advice with continued conventional care (control group). Multifactorial interventions will target 6 specific risk factors. All participants will be re-assessed after 12 months. The primary outcome measure will be fall recurrence, measured with monthly falls diaries. Secondary outcomes include falls risk factors; and psychological measures including fear of falling, and quality of life. Discussion Previous studies evaluating multifactorial interventions in falls have reported variable outcomes. Given likely cultural, personal, lifestyle and health service differences in Asian countries, it is vital that individually-tailored multifaceted interventions are evaluated in an Asian population to determine applicability of these interventions in our setting. If successful, these approaches have the potential for widespread application in geriatric healthcare services, will reduce the projected escalation of falls and fall-related injuries, and improve the quality of life of our older community. Trial registration ISRCTN11674947
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1170
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Cattaneo D, Jonsdottir J, Regola A, Carabalona R. Stabilometric assessment of context dependent balance recovery in persons with multiple sclerosis: a randomized controlled study. J Neuroeng Rehabil 2014; 11:100. [PMID: 24912561 PMCID: PMC4065075 DOI: 10.1186/1743-0003-11-100] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 05/22/2014] [Indexed: 11/26/2022] Open
Abstract
Background Balance control relies on accurate perception of visual, somatosensory and vestibular cues. Sensory flow is impaired in Multiple Sclerosis (MS) and little is known about the ability of the sensory systems to adapt after neurological lesions reducing sensory impairment. The aims of the present study were to verify whether: 1. Balance rehabilitation administered in a challenging sensory conditions would improve stability in upright posture. 2. The improvement in a treated sensory condition would transfer to a non treated sensory condition. Methods Fifty three persons with MS, median (min-max) EDSS score of 5 (2.5-6.5), participated in a RCT and were randomly assigned to two groups. The Experimental group received balance rehabilitation aimed at improving motor and sensory strategies. The Control group received rehabilitation treatment which did not include training of sensory strategies. Persons with MS were blindly assessed by means of a stabilometric platform with eyes open, eyes closed and dome, on both firm surface and foam. Anterior-posterior and medio-lateral sway, velocity of sway and the length of Center of Pressure (CoP) trajectory were calculated in the six sensory conditions. Results Experimental group showed statistically significant improvement (P < 0.05) in stability in upright posture in eyes closed condition on firm surface, and in eyes open, closed, and dome conditions on foam. No differences were observed between groups in the eyes open condition on firm surface nor in the sensory condition not addressed during the treatment. Conclusions After rehabilitation people with MS can recover from sensory impairments thus improving upright balance. Further, the improvement seems to be context-dependent and present just in the treated sensory conditions. Trial registration ClinicalTrials NCT02131285
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Affiliation(s)
- Davide Cattaneo
- Fondazione Don Gnocchi, Via Capecelatro, 66-20148 Milan, Italy.
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1171
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Boffin N, Moreels S, Vanthomme K, Van Casteren V. Falls among older general practice patients: a 2-year nationwide surveillance study. Fam Pract 2014; 31:281-9. [PMID: 24532609 DOI: 10.1093/fampra/cmu002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Falling among older persons is a multifactorial health condition needing multifactorial care. Several targeted preventive interventions and their coordination are considered to be general practitioner (GP)-specific tasks. OBJECTIVES To estimate the incidence of falls among older non-institutionalized general practice patients in Belgium (2009-10) and to describe the main characteristics of falls, fallers and fall risks; factors associated with multiple fall risks and the co-occurrence of fall risks; patient status 3 months later and care delivery. METHODS A 2-year nationwide cross-sectional study based on data collected by the Belgian network of Sentinel General Practices on all non-institutionalized persons aged ≥65 years consulting their GP for new fall-related injuries. RESULTS Baseline data were collected on 1503 persons and valid follow-up data were available on 715 persons (79%). The yearly incidence of older persons with fall-related injuries was estimated at 2.5% of the older general practice population; 39% of patients had also received hospital care, physician-specialist or nursing home care. A multifactorial risk profile was observed in 59% and associated with increasing age, recurrent falling, falling at home and during lower level activity. The clustering of frailty-specific fall risks was higher than expected by chance. At follow-up, 46% of at-risk patients had received physical therapy, 47% were using assistive devices, and medication had been reviewed in 28% of patients taking psychopharmacy and 17% of patients with polypharmacy. CONCLUSIONS Our study shows a high burden of care for fall-related injuries in older general practice patients and provides baseline data for its future monitoring.
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Affiliation(s)
- Nicole Boffin
- OD Public Health and Surveillance, Scientific Institute of Public Health and
| | - Sarah Moreels
- OD Public Health and Surveillance, Scientific Institute of Public Health and
| | - Katrien Vanthomme
- Faculty of Economic, Social and Political Sciences, and Solvay Business School, Vrije Universiteit Brussel, Brussels, Belgium
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1172
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Kauppi M, Stenholm S, Impivaara O, Mäki J, Heliövaara M, Jula A. Fall-related risk factors and heel quantitative ultrasound in the assessment of hip fracture risk: a 10-year follow-up of a nationally representative adult population sample. Osteoporos Int 2014; 25:1685-95. [PMID: 24658297 DOI: 10.1007/s00198-014-2674-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Accepted: 02/22/2014] [Indexed: 12/22/2022]
Abstract
UNLABELLED Maximal walking speed and quantitative ultrasound index (QUI) were significant and independent predictors of hip fracture among subjects aged ≥ 55 years. A model including readily available variables along with simple fall-related factors may be clinically useful in the assessment of hip fracture risk even without a QUI measurement. INTRODUCTION This study assessed fall-related risk factors along with heel bone quantitative ultrasound (QUS) measurements for the prediction of hip fracture during a mean follow-up of 9.8 years in a nationally representative population sample. METHODS The study population consisted of 2,300 subjects (1,331 women and 969 men) aged 55 years or over, who had participated in a comprehensive health survey in 2000-2001. Information on the subjects’ health and fall-related risk factors was obtained with interviews, questionnaires and tests carried out by specially trained professionals. QUS measurements were made by means of the Hologic Sahara device. First emerging cases of hip fracture were identified from the National Hospital Discharge Register. RESULTS During the follow-up, 96 subjects sustained a hip fracture. Slow maximal walking speed, low quantitative ultrasound index (QUI), high age, tallness, short waist circumference, Parkinson's disease and the number of central nervous system active medication were significant and independent predictors of hip fracture. The model including all of these risk factors explained 68 % of the variation in hip fracture risk. Excluding QUI from this model reduced the percentage to 66%. CONCLUSIONS Maximal walking speed and QUI were significant and independent predictors of hip fracture. A model including readily available variables such as age, gender, height and waist circumference along with simple fall-related factors may be of clinical use in the assessment of hip fracture risk even without a QUS measurement.
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1173
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Grant A, Mackenzie L, Clemson L. How do general practitioners engage with allied health practitioners to prevent falls in older people? An exploratory qualitative study. Australas J Ageing 2014; 34:149-54. [PMID: 24889661 DOI: 10.1111/ajag.12157] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM To explore general practitioners' (GPs') perceptions about their use of Chronic Disease Management (CDM) items to access allied health interventions, in particular occupational therapy and physiotherapy, with the purpose of preventing falls, as well as to identify GP support needs with regard to development of partnerships with local allied health practitioners. METHOD A qualitative study was conducted in the Sydney metropolitan area through individual semistructured interviews with eight GPs, which were recorded, transcribed and analysed thematically. RESULTS Themes included (i) difficulties and opportunities associated with multidisciplinary care; (ii) potential for CDM items to be used to support falls prevention strategies; and (iii) the user-friendliness of the CDM items. CONCLUSION Effective coordination of multidisciplinary care between GPs and allied health professionals was desired but difficult to achieve through the CDM system, making translation of falls prevention evidence into clinical practice challenging. Further education on falls prevention and CDM item modification is needed to bridge this gap.
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Affiliation(s)
- Alasdair Grant
- Injury Treatment: Occupational Injury Management, Sydney, New South Wales, Australia
| | - Lynette Mackenzie
- Discipline of Occupational Therapy, Faculty of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Lindy Clemson
- Ageing Work and Health Research Unit, Faculty of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
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1174
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Li F, Harmer P. Protocol for disseminating an evidence-based fall prevention program in community senior centers: evaluation of translatability and public health impact via a single group pre-post study. Implement Sci 2014; 9:63. [PMID: 24884784 PMCID: PMC4048055 DOI: 10.1186/1748-5908-9-63] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Accepted: 05/21/2014] [Indexed: 12/03/2022] Open
Abstract
Background Falls are the leading cause of injury death in older adults and present a significant public health problem and a major burden to healthcare. Although there is sufficient evidence from randomized controlled trials to indicate that exercise can prevent falls in older people, few effective, evidence-based fall prevention programs exist in community practice. Thus, there is a pressing need to translate and disseminate evidence-based exercise programs to community providers that serve older adults at increased risk of falling. The current study addresses this public health need by disseminating the evidence-based Tai Ji Quan: Moving for Better Balance (TJQMBB) program through community senior centers. Methods/Design The study uses a single-group design in which the TJQMBB program is being delivered to community-dwelling older adults through collaboration with senior centers in selected counties in Oregon, USA, for 48 weeks, followed by a 24-week post-intervention follow-up. Study process and outcome measures will be evaluated in accordance with the components of the RE-AIM framework that focus on Reach, Effectiveness, Adoption, Implementation and Maintenance. Discussion This study will determine whether the evidence-based TJQMBB fall prevention program can be disseminated through a broad spectrum of community-based senior centers that often cater to low-income, underserved community-dwelling older adults at risk of falling. If shown to be both practically implementable and sustainable, the TJQMBB program will provide an effective, potentially low-cost, easy-to-implement intervention that could be used by public health practitioners and community-based organizations to address the problem of falls among older adults. Trial registration ClinicalTrials.gov Identifier: NCT01854931
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Affiliation(s)
- Fuzhong Li
- Oregon Research Institute, 1776 Millrace Dr, Eugene, OR 97403, USA.
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1175
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Breisinger TP, Skidmore ER, Niyonkuru C, Terhorst L, Campbell GB. The Stroke Assessment of Fall Risk (SAFR): predictive validity in inpatient stroke rehabilitation. Clin Rehabil 2014; 28:1218-24. [PMID: 24849795 DOI: 10.1177/0269215514534276] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate relative accuracy of a newly developed Stroke Assessment of Fall Risk (SAFR) for classifying fallers and non-fallers, compared with a health system fall risk screening tool, the Fall Harm Risk Screen. DESIGN AND SETTING Prospective quality improvement study conducted at an inpatient stroke rehabilitation unit at a large urban university hospital. PARTICIPANTS Patients admitted for inpatient stroke rehabilitation (N = 419) with imaging or clinical evidence of ischemic or hemorrhagic stroke, between 1 August 2009 and 31 July 2010. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Sensitivity, specificity, and area under the curve for Receiver Operating Characteristic Curves of both scales' classifications, based on fall risk score completed upon admission to inpatient stroke rehabilitation. RESULTS A total of 68 (16%) participants fell at least once. The SAFR was significantly more accurate than the Fall Harm Risk Screen (p < 0.001), with area under the curve of 0.73, positive predictive value of 0.29, and negative predictive value of 0.94. For the Fall Harm Risk Screen, area under the curve was 0.56, positive predictive value was 0.19, and negative predictive value was 0.86. Sensitivity and specificity of the SAFR (0.78 and 0.63, respectively) was higher than the Fall Harm Risk Screen (0.57 and 0.48, respectively). CONCLUSIONS An evidence-derived, population-specific fall risk assessment may more accurately predict fallers than a general fall risk screen for stroke rehabilitation patients. While the SAFR improves upon the accuracy of a general assessment tool, additional refinement may be warranted.
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Affiliation(s)
- Terry P Breisinger
- UPMC Rehabilitation Institute, Pittsburgh, PA, USA Centers for Rehab Services, Pittsburgh, PA, USA
| | - Elizabeth R Skidmore
- Department of Occupational Therapy, University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, PA, USA Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Christian Niyonkuru
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Lauren Terhorst
- Department of Occupational Therapy, University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, PA, USA
| | - Grace B Campbell
- UPMC Rehabilitation Institute, Pittsburgh, PA, USA University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
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1176
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Lee H, Bein KJ, Ivers R, Dinh MM. Changing patterns of injury associated with low-energy falls in the elderly: a 10-year analysis at an Australian Major Trauma Centre. ANZ J Surg 2014; 85:230-4. [DOI: 10.1111/ans.12676] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Hugo Lee
- Orthopedic Department; Mona Vale Hospital; Sydney New South Wales Australia
| | - Kendall J. Bein
- Emergency Department; Department of Trauma Services; Royal Prince Alfred Hospital; Sydney New South Wales Australia
| | - Rebecca Ivers
- Sydney Medical School; The University of Sydney; Sydney New South Wales Australia
- Injury Division; The George Institute for Global Health; Sydney New South Wales Australia
| | - Michael M. Dinh
- Emergency Department; Department of Trauma Services; Royal Prince Alfred Hospital; Sydney New South Wales Australia
- Sydney Medical School; The University of Sydney; Sydney New South Wales Australia
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1177
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Pritchard EK, Brown GT, Barker AL, Haines TP. Exploring the association between volition and participation in daily life activities with older adults living in the community. Clin Rehabil 2014; 28:1136-44. [PMID: 24844237 DOI: 10.1177/0269215514529803] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To explore the association between volition and participation in daily activities with older adults living in the community. DESIGN Cross-sectional study. SETTING Community-dwelling, residing in Victoria (Australia). PARTICIPANTS A total of 244 adults, of 70 years and older, drawn from a convenience sample, living in their own homes. MAIN MEASURES Individuals' participation in daily activities was obtained via phone interviews, from the completion of the Phone-FITT survey. Levels of volition (identified under three items; personal causation, values and interests) were collected using the Volition Scale. Analyses were completed through linear regression. RESULTS The participants' mean age was 77.5 years (SD 5.7) with 60% being female. Higher levels of participation were associated with higher levels of volition in light housework (n = 225, p = 0.008), shopping (n = 239, p = 0.018), lifting weights to strengthen legs (n = 23, p = 0.031), walking for exercise (n = 163, p < 0.001) and gardening (n = 183, p = 0.001). CONCLUSIONS Increased volition is associated with increased participation in physical activities with community-dwelling older adults.
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Affiliation(s)
| | - G Ted Brown
- Department of Occupational Therapy, Monash University, Melbourne, Australia
| | - Anna L Barker
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Terry P Haines
- Department of Physiotherapy, Monash University, Melbourne, Australia
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1178
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Chippendale T, Boltz M. The Neighborhood Environment: Perceived Fall Risk, Resources, and Strategies for Fall Prevention. THE GERONTOLOGIST 2014; 55:575-83. [DOI: 10.1093/geront/gnu019] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 02/14/2014] [Indexed: 11/15/2022] Open
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1179
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Pérez-Ros P, Martínez-Arnau F, Tormos Miñana I, López Aracil A, Oltra Sanchis MC, Pechene Mera LE, Tarazona-Santabalbina FJ. [Preliminary results of a community fall prevention programme: Precan study (falls prevention in La Ribera)]. Rev Esp Geriatr Gerontol 2014; 49:179-83. [PMID: 24793176 DOI: 10.1016/j.regg.2014.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 03/06/2014] [Accepted: 03/06/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the results of a fall prevention programme designed to be applied to the elderly living in the community. MATERIAL AND METHODS The sample consisted of 249 participants ≥70 years of age, who were randomly assigned to one of three groups. The monthly intervention group (GIM): instructions on fall prevention and healthy exercises to improve physical function and balance at beginning of the study, and a monthly theoretical and practical refresher session. The quarterly intervention group (GIT), with the same beginning intervention and a refresher session every three months. The control group (GC), the same beginning intervention but no refresher sessions. RESULTS The mean age of the sample was 74.47 years (SD 5.33), with 64% women. The incidence of falls was reduced from 0.64 per patient year in the previous year to 0.39 in the post-intervention year in GIM, from 0.49 to 0.47 in GIT, and in the GC it remained at 0.47 before and twelve months after, but with no significant differences in the reduction between groups (P=.062). At the end of the study there was a decrease in Rizzo scale of 0.72 points (95% CI: 0.57-0.88, P<.001). CONCLUSION An interdisciplinary community intervention programme can contribute to reducing the incidence of falls. Further studies are required to continue research into the incidence of falls in the elderly living in the community.
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Affiliation(s)
- Pilar Pérez-Ros
- Facultad de Enfermería, Universidad Católica de Valencia San Vicente Mártir, Valencia, España.
| | | | | | - Aranzazu López Aracil
- Facultad de Enfermería, Universidad Católica de Valencia San Vicente Mártir, Valencia, España
| | - M Carmen Oltra Sanchis
- Facultad de Enfermería, Universidad Católica de Valencia San Vicente Mártir, Valencia, España
| | - Leidy E Pechene Mera
- Facultad de Enfermería, Universidad Católica de Valencia San Vicente Mártir, Valencia, España
| | - Francisco José Tarazona-Santabalbina
- Facultad de Enfermería, Universidad Católica de Valencia San Vicente Mártir, Valencia, España; Hospital Universitario de La Ribera, Alzira, Valencia, España
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1180
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White ND. Bisphosphonate Drug Holidays and Fall Prevention in the Reduction of Postmenopausal Fractures. Am J Lifestyle Med 2014. [DOI: 10.1177/1559827614520941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Bisphosphonates are commonly used as first-line agents in the treatment of postmenopausal bone fragility. Recently, concern has been raised regarding the risk of atypical fracture with long-term therapy. A potential solution to obtaining the benefits while minimizing the risks of bisphosphonate therapy is the use of a drug holiday, or temporary cessation of medication. For drug holidays to be an effective approach, patients must maintain fracture protection while off therapy. One way to optimize fracture protection during this time is to prevent falls. Risk of atypical fracture and bisphosphonate drug holiday will be discussed, along with a summary of the most effective fall prevention modalities.
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Affiliation(s)
- Nicole D. White
- School of Pharmacy and Health Professions, Creighton University, Omaha, Nebraska
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1181
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Pohl P, Ahlgren C, Nordin E, Lundquist A, Lundin-Olsson L. Gender perspective on fear of falling using the classification of functioning as the model. Disabil Rehabil 2014; 37:214-22. [PMID: 24786969 PMCID: PMC4364267 DOI: 10.3109/09638288.2014.914584] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Purpose: To investigate associations between fear of falling (FOF) and recurrent falls among women and men, and gender differences in FOF with respect to International Classification of Functioning (ICF). Methods: Community-dwelling people (n = 230, 75–93 years, 72% women) were included and followed 1 year regarding falls. Data collection included self-reported demographics, questionnaires, and physical performance-based tests. FOF was assessed with the question “Are you afraid of falling?”. Results were discussed with a gender relational approach. Results: At baseline 55% women (n = 92) and 22% men (n = 14) reported FOF. During the follow-up 21% women (n = 35) and 30% men (n = 19) experienced recurrent falls. There was an association between gender and FOF (p = 0.001), but not between FOF and recurrent falls (p = 0.79), or between gender and recurrent falls (p = 0.32). FOF was related to Personal factors and Activity and Participation. The relationship between FOF and Personal factors was in opposite directions for women and men. Conclusions: Results did not support the prevailing paradigm that FOF increases rate of recurrent falls in community-dwelling people, and indicated that the answer to “Are you afraid of falling?” might be highly influenced by gendered patterns. Implications for Rehabilitation The question “Are you afraid of falling?” has no predictive value when screening for the risk of falling in independent community-dwelling women or men over 75 years of age. Gendered patterns might influence the answer to the question “Are you afraid of falling?” Healthcare personnel are recommended to be aware of this when asking older women and men about fear of falling.
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Affiliation(s)
- Petra Pohl
- Department of Community Medicine and Rehabilitation, Physiotherapy and
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1182
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Avenell A, Mak JCS, O'Connell D. Vitamin D and vitamin D analogues for preventing fractures in post-menopausal women and older men. Cochrane Database Syst Rev 2014; 2014:CD000227. [PMID: 24729336 PMCID: PMC7032685 DOI: 10.1002/14651858.cd000227.pub4] [Citation(s) in RCA: 201] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Vitamin D and related compounds have been used to prevent osteoporotic fractures in older people. This is the third update of a Cochrane review first published in 1996. OBJECTIVES To determine the effects of vitamin D or related compounds, with or without calcium, for preventing fractures in post-menopausal women and older men. SEARCH METHODS We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (to December 2012), the Cochrane Central Register of Controlled Trials (2012, Issue 12), MEDLINE (1966 to November Week 3 2012), EMBASE (1980 to 2012 Week 50), CINAHL (1982 to December 2012), BIOSIS (1985 to 3 January 2013), Current Controlled Trials (December 2012) and reference lists of articles. SELECTION CRITERIA Randomised or quasi-randomised trials that compared vitamin D or related compounds, alone or with calcium, against placebo, no intervention or calcium alone, and that reported fracture outcomes in older people. The primary outcome was hip fracture. DATA COLLECTION AND ANALYSIS Two authors independently assessed trial risk of selection bias and aspects of methodological quality, and extracted data. Data were pooled, where possible, using the fixed-effect model, or the random-effects model when heterogeneity between studies appeared substantial. MAIN RESULTS We included 53 trials with a total of 91,791 participants. Thirty-one trials, with sample sizes ranging from 70 to 36,282 participants, examined vitamin D (including 25-hydroxy vitamin D) with or without calcium in the prevention of fractures in community, nursing home or hospital inpatient populations. Twelve of these 31 trials had participants with a mean or median age of 80 years or over.Another group of 22 smaller trials examined calcitriol or alfacalcidol (1-alphahydroxyvitamin D3), mostly with participants who had established osteoporosis. These trials were carried out in the setting of institutional referral clinics or hospitals.In the assessment of risk of bias for random sequence generation, 21 trials (40%) were deemed to be at low risk, 28 trials (53%) at unclear risk and four trials at high risk (8%). For allocation concealment, 22 trials were at low risk (42%), 29 trials were at unclear risk (55%) and two trials were at high risk (4%).There is high quality evidence that vitamin D alone, in the formats and doses tested, is unlikely to be effective in preventing hip fracture (11 trials, 27,693 participants; risk ratio (RR) 1.12, 95% confidence intervals (CI) 0.98 to 1.29) or any new fracture (15 trials, 28,271 participants; RR 1.03, 95% CI 0.96 to 1.11).There is high quality evidence that vitamin D plus calcium results in a small reduction in hip fracture risk (nine trials, 49,853 participants; RR 0.84, 95% confidence interval (CI) 0.74 to 0.96; P value 0.01). In low-risk populations (residents in the community: with an estimated eight hip fractures per 1000 per year), this equates to one fewer hip fracture per 1000 older adults per year (95% CI 0 to 2). In high risk populations (residents in institutions: with an estimated 54 hip fractures per 1000 per year), this equates to nine fewer hip fractures per 1000 older adults per year (95% CI 2 to 14). There is high quality evidence that vitamin D plus calcium is associated with a statistically significant reduction in incidence of new non-vertebral fractures. However, there is only moderate quality evidence of an absence of a statistically significant preventive effect on clinical vertebral fractures. There is high quality evidence that vitamin D plus calcium reduces the risk of any type of fracture (10 trials, 49,976 participants; RR 0.95, 95% CI 0.90 to 0.99).In terms of the results for adverse effects: mortality was not adversely affected by either vitamin D or vitamin D plus calcium supplementation (29 trials, 71,032 participants, RR 0.97, 95% CI 0.93 to 1.01). Hypercalcaemia, which was usually mild (2.6 to 2.8 mmol/L), was more common in people receiving vitamin D or an analogue, with or without calcium (21 trials, 17,124 participants, RR 2.28, 95% CI 1.57 to 3.31), especially for calcitriol (four trials, 988 participants, RR 4.41, 95% CI 2.14 to 9.09), than in people receiving placebo or control. There was also a small increased risk of gastrointestinal symptoms (15 trials, 47,761 participants, RR 1.04, 95% CI 1.00 to 1.08), especially for calcium plus vitamin D (four trials, 40,524 participants, RR 1.05, 95% CI 1.01 to 1.09), and a significant increase in renal disease (11 trials, 46,548 participants, RR 1.16, 95% CI 1.02 to 1.33). Other systematic reviews have found an increased association of myocardial infarction with supplemental calcium; and evidence of increased myocardial infarction and stroke, but decreased cancer, with supplemental calcium plus vitamin D, without an overall effect on mortality. AUTHORS' CONCLUSIONS Vitamin D alone is unlikely to prevent fractures in the doses and formulations tested so far in older people. Supplements of vitamin D and calcium may prevent hip or any type of fracture. There was a small but significant increase in gastrointestinal symptoms and renal disease associated with vitamin D and calcium. This review found that there was no increased risk of death from taking calcium and vitamin D.
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Affiliation(s)
- Alison Avenell
- Health Services Research Unit, Health Sciences Building, University of Aberdeen, Foresterhill, Aberdeen, UK, AB25 2ZD
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1183
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Smebye KL, Granum S, Wyller TB, Mellingsæter M. Medical findings in an interdisciplinary geriatric outpatient clinic specialising in falls. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2014; 134:705-9. [PMID: 24721857 DOI: 10.4045/tidsskr.13.1287] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Falls are common among elderly people, leading to increased morbidity and reduced quality of life. A broad-based interdisciplinary study, for example in an outpatient clinic specialising in falls, has been recommended in light of the multiple and complex causes that tend to be involved. At present there are few outpatient clinics in Norway specialising in falls, and no data from such studies have yet been published. MATERIAL AND METHOD The information stems from 111 patients at the Fallpoliklinikken, Oslo University Hospital, from its establishment in 2008 until 2011. An interdisciplinary study was undertaken by a nurse, a doctor and a physiotherapist. Further investigations and measures were proposed on the basis of individual risk factors. RESULTS The patient group had a number of known risk factors for falls. The most frequently identified risk factors included orthostatism (26 of 110 patients, 24%), vitamin D deficiency (14 of 79 patients, 18%) and carotid sinus hypersensitivity (6 of 55 patients examined, 11%). Rare, but significant findings included colon cancer, subdural haematoma (one case of each) and normal pressure hydrocephalus (two cases). The most frequent measures for preventing new falls included exercise/physiotherapy (close to all patients), adjustment of medications (25 patients, 23%) and implantation of a pacemaker (six patients, 5%). INTERPRETATION Falls among elderly people have varying and complex causes and a serious underlying pathology may manifest itself as a tendency to fall. This testifies to the importance of a thorough interdisciplinary study of falls.
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Affiliation(s)
| | - Solveig Granum
- Institutt for helse og samfunn Universitetet i Oslo og Avdeling for medisinsk klinisk service Oslo universitetssykehus
| | - Torgeir Bruun Wyller
- Institutt for klinisk medisin Universitetet i Oslo og Geriatrisk avdeling Oslo universitetssykehus
| | - Marte Mellingsæter
- Institutt for klinisk medisin Universitetet i Oslo og Geriatrisk avdeling Oslo universitetssykehus
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1184
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Theodoratou E, Tzoulaki I, Zgaga L, Ioannidis JPA. Vitamin D and multiple health outcomes: umbrella review of systematic reviews and meta-analyses of observational studies and randomised trials. BMJ 2014; 348:g2035. [PMID: 24690624 PMCID: PMC3972415 DOI: 10.1136/bmj.g2035] [Citation(s) in RCA: 647] [Impact Index Per Article: 64.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To evaluate the breadth, validity, and presence of biases of the associations of vitamin D with diverse outcomes. DESIGN Umbrella review of the evidence across systematic reviews and meta-analyses of observational studies of plasma 25-hydroxyvitamin D or 1,25-dihydroxyvitamin D concentrations and randomised controlled trials of vitamin D supplementation. DATA SOURCES Medline, Embase, and screening of citations and references. ELIGIBILITY CRITERIA Three types of studies were eligible for the umbrella review: systematic reviews and meta-analyses that examined observational associations between circulating vitamin D concentrations and any clinical outcome; and meta-analyses of randomised controlled trials assessing supplementation with vitamin D or active compounds (both established and newer compounds of vitamin D). RESULTS 107 systematic literature reviews and 74 meta-analyses of observational studies of plasma vitamin D concentrations and 87 meta-analyses of randomised controlled trials of vitamin D supplementation were identified. The relation between vitamin D and 137 outcomes has been explored, covering a wide range of skeletal, malignant, cardiovascular, autoimmune, infectious, metabolic, and other diseases. Ten outcomes were examined by both meta-analyses of observational studies and meta-analyses of randomised controlled trials, but the direction of the effect and level of statistical significance was concordant only for birth weight (maternal vitamin D status or supplementation). On the basis of the available evidence, an association between vitamin D concentrations and birth weight, dental caries in children, maternal vitamin D concentrations at term, and parathyroid hormone concentrations in patients with chronic kidney disease requiring dialysis is probable, but further studies and better designed trials are needed to draw firmer conclusions. In contrast to previous reports, evidence does not support the argument that vitamin D only supplementation increases bone mineral density or reduces the risk of fractures or falls in older people. CONCLUSIONS Despite a few hundred systematic reviews and meta-analyses, highly convincing evidence of a clear role of vitamin D does not exist for any outcome, but associations with a selection of outcomes are probable.
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Affiliation(s)
- Evropi Theodoratou
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh EH8 9AG, UK
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1185
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Klein D, Rapp K, Küpper M, Becker C, Fischer T, Büchele G, Benzinger P. A population-based intervention for the prevention of falls and fractures in home dwelling people 65 years and older in South Germany: protocol. JMIR Res Protoc 2014; 3:e19. [PMID: 24686959 PMCID: PMC4004152 DOI: 10.2196/resprot.3126] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Revised: 03/03/2014] [Accepted: 03/14/2014] [Indexed: 11/13/2022] Open
Abstract
Background Falls and fall-related injuries pose a major threat to older peoples’ health, and are associated with increased morbidity and mortality. In the course of demographic changes, development and implementation of fall prevention strategies have been recognized as an urgent public health challenge. Various risk factors for falls and a number of effective interventions have been recognized. A substantial proportion of falls occur for people who are neither frail nor at high risk. Therefore, population-based approaches reaching the entire older population are needed. Objective The objective of the study presented is the development, implementation, and evaluation of a population-based intervention for the prevention of falls and fall-related injuries in a medium sized city in Germany. Methods The study is designed as a population-based approach. The intervention community is a mid sized city named Reutlingen in southern Germany with a population of 112,700 people. All community dwelling inhabitants 65 years and older are addressed. There are two main measures that are defined: (1) increase of overall physical activity, and (2) reduction of modifiable risk factors for falls such as deficits in strength and balance, home and environmental hazards, impaired vision, unsafe footwear, and improper use of assistive devices. The implementation strategies are developed in a participatory community planning process. These might include, for example, training of professionals and volunteers, improved availability of exercise classes, and education and raising awareness via newspaper, radio, or lectures. Results The study starts in September 2010 and ends in December 2013. It is evaluated primarily by process evaluation as well as by telephone survey. Conclusions Physical activity as a key message entails multiple positive effects with benefits on a range of geriatric symptoms. The strength of the design is the development of implementation strategies in a participatory community planning. The problems that we anticipate are the dependency on the stakeholders’ willingness to participate, and the difficulty of evaluating population-based programs by hard end points.
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Affiliation(s)
- Diana Klein
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany.
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1186
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McMahon S, Vankipuram M, Hekler EB, Fleury J. Design and evaluation of theory-informed technology to augment a wellness motivation intervention. Transl Behav Med 2014; 4:95-107. [PMID: 24653780 DOI: 10.1007/s13142-013-0221-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Integrating mobile technology into health promotion strategies has the potential to support healthy behaviors. A new theory-informed app was designed to augment an intervention promoting wellness motivation in older adults with fall risk and low levels of physical activity. The app content was evaluated for clarity, homogeneity, and validity of motivational messages; both the app and device were evaluated for acceptability and usability. The initial evaluation included nine adults (mean age, 75); four of whom also assessed the app's sensing abilities in the field. As part of an intervention feasibility study, 14 older adults (mean age, 84) also provided a follow-up evaluation of app usability. Evaluation participants assessed the app as valid, usable, acceptable, and able to sense most reported free-living activities, and provided feedback for improving the app. Design processes illustrate methodologic and interpretive efforts to operationalize motivational content in a theory-informed app promoting change in physical activity behavior.
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Affiliation(s)
- Siobhan McMahon
- School of Nursing, University of Minnesota, Minneapolis, MN USA
| | - Mithra Vankipuram
- Hewlett-Packard Laboratories, 1501 Page Mill Road, Palo Alto, CA 94304-1126 USA
| | - Eric B Hekler
- School of Nutrition and Health Promotion, Arizona State University, 500 N. Third Street, Phoenix, AZ 85004 USA
| | - Julie Fleury
- College of Nursing and Health Innovation, Arizona State University, 500 N. 3rd Street, Phoenix, AZ 85004 USA
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1187
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Osteoporosis and the orthopaedic surgeon: basic concepts for successful co-management of patients' bone health. INTERNATIONAL ORTHOPAEDICS 2014; 38:1731-8. [PMID: 24652422 DOI: 10.1007/s00264-014-2317-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 02/27/2014] [Indexed: 01/12/2023]
Abstract
Osteoporosis has been recognised as a public health concern for at least three decades but it has been relatively recent that the push has been for orthopaedic surgeons to take a more active role in the diagnosis and treatment of patients with decreased bone mineral density (BMD). Most often these patients are encountered after they have suffered a fracture making secondary prevention the area where orthopaedists may exert the greatest influence on patient care. The purpose of this article is to provide a succinct framework for the diagnosis and treatment of patients with decreased BMD. Patients are deemed to have decreased BMD if they have suffered a fragility fracture, a fracture caused by a low-energy traumatic event. These patients are often encountered in the emergency department and admitted for further treatment of their fractures or recommended for follow-up in the clinic. Regardless of treatment course these are opportunities for the orthopaedic surgeon to intervene in the osteoporotic disease process and positively affect a patient's bone health. This article compiles the available literature on osteoporosis and presents it succinctly with the incorporation of both a diagnosis algorithm and treatment profile table. With the use of these two tools, orthopaedic surgeons everywhere should be able to take a more active role in their patients' bone health.
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1188
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Stevens JA, Voukelatos A, Ehrenreich H. Preventing falls with Tai Ji Quan: A public health perspective. JOURNAL OF SPORT AND HEALTH SCIENCE 2014; 3:21-26. [PMID: 26744633 PMCID: PMC4701043 DOI: 10.1016/j.jshs.2013.10.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Falls among people aged 65 and older are a significant public health problem and one that is expected to increase as the population ages. Randomized controlled trials have demonstrated that Tai Ji Quan can reduce falls and associated injuries among older adults. In this paper, we describe how Tai Ji Quan community programs are being utilized by public health and aging services organizations to reduce older adult falls. We conclude that, to have a population-level impact on reducing falls and improving the health of older adults, Tai Ji Quan interventions must be translated into community programs that meet the needs and abilities of older adults. These programs must be adapted to fit into existing community structures, disseminated through multiple delivery channels, adopted and implemented broadly by organizations, and institutionalized to ensure sustainability.
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Affiliation(s)
- Judy A. Stevens
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | - Alexander Voukelatos
- School of Public Health and Community Medicine, The University of New South Wales, Sydney 2052, Australia
| | - Heidi Ehrenreich
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
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1189
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Ishigaki EY, Ramos LG, Carvalho ES, Lunardi AC. Effectiveness of muscle strengthening and description of protocols for preventing falls in the elderly: a systematic review. Braz J Phys Ther 2014; 18:111-8. [PMID: 24760166 PMCID: PMC4183251 DOI: 10.1590/s1413-35552012005000148] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 12/21/2013] [Accepted: 01/21/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Falls are a geriatric syndrome that is considered a significant public health problem in terms of morbidity and mortality because they lead to a decline in functional capacity and an impaired quality of life in the elderly. Lower limb muscle strengthening seems to be an effective intervention for preventing falls; however, there is no consensus regarding the best method for increasing lower limb muscle strength. OBJECTIVES To analyze the effectiveness of lower limb muscle strengthening and to investigate and describe the protocols used for preventing falls in elderly subjects. METHOD We performed a systematic review of randomized and controlled clinical trials published between 2002 and 2012 in the databases PubMed, EMBASE, Scopus, Web of Science, and PEDro that cited some type of lower limb muscle strengthening protocol and that evaluated the incidence of falls as the primary outcome exclusively in elderly subjects. Twelve studies met the inclusion criteria. Qualitative analysis was performed by independent reviewers applying the PEDro scale. RESULTS The data obtained from the selected studies showed lower fall rates in the intervention groups compared to controls. Six studies described the lower limb muscle strengthening protocol in detail. High methodological quality was found in 6 studies (PEDro score ≥ 7/10 points). CONCLUSIONS The methodological quality of the studies in this area appears to leave little doubt regarding the effectiveness of lower limb strengthening exercises for preventing falls in elderly subjects, however the interventions in these studies were poorly reported.
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Affiliation(s)
- Erika Y. Ishigaki
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São
Paulo (USP), São Paulo, SP, Brazil
| | - Lidiane G. Ramos
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São
Paulo (USP), São Paulo, SP, Brazil
| | - Elisa S. Carvalho
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São
Paulo (USP), São Paulo, SP, Brazil
| | - Adriana C. Lunardi
- Physical Therapy Department, Faculdade de Medicina, USP, São Paulo,
SP, Brazil
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1190
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Green S, McDonald S, Holland AE, Elkins M. Informing physiotherapy decisions with reliable evidence: how physiotherapists have contributed to Cochrane and how Cochrane has informed evidence-based physiotherapy. J Physiother 2014; 60:1-4. [PMID: 24856934 DOI: 10.1016/j.jphys.2013.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 12/15/2013] [Indexed: 11/30/2022] Open
Affiliation(s)
- Sally Green
- Australasian Cochrane Centre, School of Public Health and Preventative Medicine, Monash University
| | - Steve McDonald
- Australasian Cochrane Centre, School of Public Health and Preventative Medicine, Monash University
| | - Anne E Holland
- La Trobe University; Alfred Health, Melbourne, Australia
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1191
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Harmer PA. So much research, so little application: Barriers to dissemination and practical implementation of Tai Ji Quan. JOURNAL OF SPORT AND HEALTH SCIENCE 2014; 3:16-20. [PMID: 25089214 PMCID: PMC4114720 DOI: 10.1016/j.jshs.2013.10.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Despite the large number of articles published in the medical literature advocating the use of Tai Ji Quan for a wide variety of health-related outcomes, there has been little systematic broad-scale implementation of these programs. It may be argued that the lack of funding from organizations capable of implementing and overseeing large-scale programs, such as governmental health agencies or national non-governmental organizations concerned with healthcare for older adults, is to blame. However, the evidence these organizations need to justify underwriting such programs is in short supply because of conflicting priorities and standards related to determining the efficacy and effectiveness of Tai Ji Quan. Establishing efficacy through acceptable designs such as randomized controlled trials involves strict protocols to ensure meaningful internal validity but different approaches are needed to demonstrate meaningful effectiveness (external validity) outside the study setting. By examining the quality, quantity, and relative proportions of the randomized controlled trials, systematic reviews, and dissemination studies reported in the medical literature, this paper highlights the disparity in emphasis between efficacy and effectiveness research that has impeded the development of a cohesive literature on Tai Ji Quan and concludes that until more researchers develop a systematic, long-range commitment to investigating its health-related benefits, the research related will remain fractured and sporadic, limiting the incentive of large funding agencies to support its wide-spread use.
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Affiliation(s)
- Peter A Harmer
- Department of Exercise Science, Willamette University, Salem, OR 97301, USA
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1192
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Joshua AM, D’Souza V, Unnikrishnan B, Mithra P, Kamath A, Acharya V, Venugopal A. Effectiveness of progressive resistance strength training versus traditional balance exercise in improving balance among the elderly - a randomised controlled trial. J Clin Diagn Res 2014; 8:98-102. [PMID: 24783093 PMCID: PMC4003699 DOI: 10.7860/jcdr/2014/8217.4119] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 01/23/2014] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Falls are important health issues among the elderly people. Most falls in elderly result from abnormal balance control mechanisms. Balance and muscle force generation are directly related, and are associated with age related muscular changes. Studies addressing fall prevention have focused on various group and individualised strength training. However, evidence on strengthening of key muscles necessary for maintaining balance and postural control is lacking. OBJECTIVES To evaluate the effectiveness of individualised progressive resistance strength training (PRT) programme in improving balance for forward limits of stability in elderly with balance impairment, compared to traditional balance exercise (TBE), and combination of both (COMBI). MATERIALS AND METHODS This randomised controlled trial included three groups; 18 subjects in each aged ≥ 65 years, from the elderly care centres of Mangalore city in Southern India (between June 2008 and December 2012). Block randomisation technique was used and allocation concealment was done using sequentially arranged sealed opaque envelopes. The TBE group received 8 component traditional balance exercise; 4 times a week for 6 months. The PRT group received resistance training for the key muscles of lower extremities, using DeLormes and Watkins protocol. The COMBI group received PRT and TBE alternately (2 days of PRT and 2 days of TBE per week). Functional reach test (FRT) was used for measurement of forward limits of stability. The data was analyzed using Statistical Package for Social Sciences (SPSS) version 15. RESULTS For functional reach, PRT group had steady progression from baseline to 6 months (p<0.001). The TBE and COMBI groups showed considerable initial improvement; beyond 3 months, moderate improvement was seen. The changes in scores of FRT were significantly better for PRT than TBE. CONCLUSION Individualised PRT intervention targeting the key muscles of lower limbs is more effective than TBE in improving forward limits of stability among non-frail elderly aged ≥65 years.
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Affiliation(s)
- Abraham M. Joshua
- Associate Professor, Department of Physical Therapy, Kasturba Medical College, Mangalore, India
| | - Vivian D’Souza
- Associate Dean Professor, Department of Biochemistry, Kasturba Medical College, Mangalore, India
| | - B. Unnikrishnan
- Professor and Head, Department of Community Medicine, Kasturba Medical College, Mangalore, India
| | - Prasanna Mithra
- Associate Professor, Department of Community Medicine, Kasturba Medical College, Mangalore, India
| | - Asha Kamath
- Selection Grade Lecturer, Department of Community Medicine, Kasturba Medical College, Manipal, India
| | - Vishak Acharya
- Associate Professor, Department of Pulmonary Medicine, Kasturba Medical College, Mangalore, India
| | - Anand Venugopal
- Medical Superintendent, Kasturba Medical College Hospital, Mangalore, India
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1193
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Cianferotti L, Brandi ML. Muscle-bone interactions: basic and clinical aspects. Endocrine 2014; 45:165-77. [PMID: 23990248 DOI: 10.1007/s12020-013-0026-8] [Citation(s) in RCA: 113] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 07/25/2013] [Indexed: 12/19/2022]
Abstract
Muscle and bone are anatomically and functionally closely connected. The traditional concept that skeletal muscles serve to load bone and transform skeletal segments into a system of levers has been further refined into the mechanostat theory, according to which striated muscle is essential for bone development and maintenance, modelling and remodelling. Besides biomechanical function, skeletal muscle and bone are endocrine organs able to secrete factors capable of modulating biological function within their microenvironment, in nearby tissues or in distant organs. The endocrine properties of muscle and bone may serve to sense and transduce biomechanical signals such as loading, unloading or exercise, or systemic hormonal stimuli into biochemical signals. Nonetheless, given the close anatomical relationship between skeletal muscle and bone, paracrine interactions particularly at the periosteal interface can be hypothesized. These mechanisms can assume particular importance during bone and muscle healing after musculoskeletal injury. Basic studies in vitro and in rodents have helped to dissect the multiple influences of skeletal muscle on bone and/or expression of inside-organ metabolism and have served to explain clinical observations linking muscle-to-bone quality. Recent evidences pinpoint that also bone tissue is able to modulate directly or indirectly skeletal muscle metabolism, thus empowering the crosstalk hypothesis to be further tested in humans in vivo.
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Affiliation(s)
- Luisella Cianferotti
- Unit of Bone and Mineral Metabolism, Department of Surgery and Translational Medicine, Section of Endocrinology and Metabolism, School of Human Health Sciences, University of Florence, Viale Pieraccini, 6, 50139, Florence, Italy
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1194
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Ferrer A, Formiga F, Sanz H, de Vries OJ, Badia T, Pujol R. Multifactorial assessment and targeted intervention to reduce falls among the oldest-old: a randomized controlled trial. Clin Interv Aging 2014; 9:383-93. [PMID: 24596458 PMCID: PMC3940644 DOI: 10.2147/cia.s57580] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background The purpose of this study was to assess the effectiveness of a multifactorial intervention to reduce falls among the oldest-old people, including individuals with cognitive impairment or comorbidities. Methods A randomized, single-blind, parallel-group clinical trial was conducted from January 2009 to December 2010 in seven primary health care centers in Baix Llobregat (Barcelona). Of 696 referred people who were born in 1924, 328 were randomized to an intervention group or a control group. The intervention model used an algorithm and was multifaceted for both patients and their primary care providers. Primary outcomes were risk of falling and time until falls. Data analyses were by intention-to-treat. Results Sixty-five (39.6%) subjects in the intervention group and 48 (29.3%) in the control group fell during follow-up. The difference in the risk of falls was not significant (relative risk 1.28, 95% confidence interval [CI] 0.94–1.75). Cox regression models with time from randomization to the first fall were not significant. Cox models for recurrent falls showed that intervention had a negative effect (hazard ratio [HR] 1.46, 95% CI 1.03–2.09) and that functional impairment (HR 1.42, 95% CI 0.97–2.12), previous falls (HR 1.09, 95% CI 0.74–1.60), and cognitive impairment (HR 1.08, 95% CI 0.72–1.60) had no effect on the assessment. Conclusion This multifactorial intervention among octogenarians, including individuals with cognitive impairment or comorbidities, did not result in a reduction in falls. A history of previous falls, disability, and cognitive impairment had no effect on the program among the community-dwelling subjects in this study.
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Affiliation(s)
- Assumpta Ferrer
- Primary Healthcare Centre "El Plà" CAP-I, Sant Feliu de Llobregat, Spain
| | - Francesc Formiga
- Geriatric Unit, Internal Medicine Service, Hospital Universitari de Bellvitge, Spain ; Bellvitge Biomedical Research Institute, IDIBELL, L'Hospitalet de Llobregat, Spain
| | - Héctor Sanz
- Support Research Unit, Primary Health Department Costa Ponent, IDIAP Jordi Gol, Barcelona, Spain
| | - Oscar J de Vries
- Department of Internal Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | - Teresa Badia
- Primary Healthcare Centre Martorell, Barcelona, Spain
| | - Ramón Pujol
- Geriatric Unit, Internal Medicine Service, Hospital Universitari de Bellvitge, Spain ; Bellvitge Biomedical Research Institute, IDIBELL, L'Hospitalet de Llobregat, Spain
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1195
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Mignardot JB, Deschamps T, Barrey E, Auvinet B, Berrut G, Cornu C, Constans T, de Decker L. Gait disturbances as specific predictive markers of the first fall onset in elderly people: a two-year prospective observational study. Front Aging Neurosci 2014; 6:22. [PMID: 24611048 PMCID: PMC3933787 DOI: 10.3389/fnagi.2014.00022] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 02/06/2014] [Indexed: 12/01/2022] Open
Abstract
Falls are common in the elderly, and potentially result in injury and disability. Thus, preventing falls as soon as possible in older adults is a public health priority, yet there is no specific marker that is predictive of the first fall onset. We hypothesized that gait features should be the most relevant variables for predicting the first fall. Clinical baseline characteristics (e.g., gender, cognitive function) were assessed in 259 home-dwelling people aged 66 to 75 that had never fallen. Likewise, global kinetic behavior of gait was recorded from 22 variables in 1036 walking tests with an accelerometric gait analysis system. Afterward, monthly telephone monitoring reported the date of the first fall over 24 months. A principal components analysis was used to assess the relationship between gait variables and fall status in four groups: non-fallers, fallers from 0 to 6 months, fallers from 6 to 12 months and fallers from 12 to 24 months. The association of significant principal components (PC) with an increased risk of first fall was then evaluated using the area under the Receiver Operator Characteristic Curve (ROC). No effect of clinical confounding variables was shown as a function of groups. An eigenvalue decomposition of the correlation matrix identified a large statistical PC1 (termed “Global kinetics of gait pattern”), which accounted for 36.7% of total variance. Principal component loadings also revealed a PC2 (12.6% of total variance), related to the “Global gait regularity.” Subsequent ANOVAs showed that only PC1 discriminated the fall status during the first 6 months, while PC2 discriminated the first fall onset between 6 and 12 months. After one year, any PC was associated with falls. These results were bolstered by the ROC analyses, showing good predictive models of the first fall during the first six months or from 6 to 12 months. Overall, these findings suggest that the performance of a standardized walking test at least once a year is essential for fall prevention.
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Affiliation(s)
- Jean-Baptiste Mignardot
- Laboratory "Motricité, Interactions, Performance" (UPRES EA 4334), University of Nantes Nantes, France ; Up-COURTINE Lab, Centre for Neuroprosthetics and Brain Mind Institute, Ecole Polytechnique Fédérale de Lausanne Lausanne, Switzerland
| | - Thibault Deschamps
- Laboratory "Motricité, Interactions, Performance" (UPRES EA 4334), University of Nantes Nantes, France
| | - Eric Barrey
- Unité de Biologie Intégrative des Adaptations à l'Exercice (Inserm U902) Genople, Université d'Evry Val d'Essonne Évry, France ; GABI, UMR-1313, INRA Jouy-en-Josas, France
| | - Bernard Auvinet
- Service de Rhumatologie, Centre Hospitalier de Laval Laval, France
| | - Gilles Berrut
- Laboratory "Motricité, Interactions, Performance" (UPRES EA 4334), University of Nantes Nantes, France ; Gérontopôle des Pays de la Loire, CHU de Nantes Nantes, France
| | - Christophe Cornu
- Laboratory "Motricité, Interactions, Performance" (UPRES EA 4334), University of Nantes Nantes, France
| | - Thierry Constans
- Geriatrics Department, Centre Hospitalier Universitaire de Tours Tours, France
| | - Laure de Decker
- Gérontopôle des Pays de la Loire, CHU de Nantes Nantes, France
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1196
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Giannì C, Prosperini L, Jonsdottir J, Cattaneo D. A systematic review of factors associated with accidental falls in people with multiple sclerosis: a meta-analytic approach. Clin Rehabil 2014; 28:704-16. [DOI: 10.1177/0269215513517575] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 11/30/2013] [Indexed: 11/15/2022]
Abstract
Objective: To determine whether there are demographic, clinical, and instrumental variables useful to detect fall status of patients with multiple sclerosis. Data sources: PubMed and the Cochrane Library. Review methods: Eligible studies were identified by two independent investigators. Only studies having a clear distinction between fallers and non-fallers were included and meta-analysed. Odds ratios (ORs) and standard mean differences (SMDs) were calculated and pooled using fixed effect models. Results: Among 115 screened articles, 15 fulfilled criteria for meta-analyses, with a total of 2425 patients included. Proportion of fallers may vary from 30% to 63% in a time frame from 1 to 12 months. No significant publication bias was found, even though 12/15 studies relied on retrospective reports of falls, thus introducing recall biases. Risk factors for falls varied across studies, owing to heterogeneity of populations included and clinical instruments used. The meta-analytic approach found that, compared with non-fallers, fallers had longer disease duration (SMD = 0.14, p = 0.02), progressive course of disease (OR = 2.02, p < 0.0001), assistive device for walking (OR = 3.16, p < 0.0001), greater overall disability level (SMD = 0.74, p < 0.0001), slower walking speed (SMD = 0.45, p = 0.0005), and worse performances in balance tests (Berg Balance Scale: SMD = −0.48, p = 0.002; Timed up-and-go test, SMD = 0.31, p = 0.04), and force-platform measures (postural sway) with eyes opened (SMD = 0.71, p = 0.006) and closed (SMD = 0.83, p = 0.01), respectively. Conclusion: Elucidations regarding risk factors for accidental falls in patients with multiple sclerosis (PwMs) are provided here, with worse disability score, progressive course, use of walking aid, and poorer performances in static and dynamic balance tests strongly associated with fall status.
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Affiliation(s)
- Costanza Giannì
- Department of Neurology and Psychiatry, Sapienza University, Rome, Italy
| | - Luca Prosperini
- Department of Neurology and Psychiatry, Sapienza University, Rome, Italy
| | - Johanna Jonsdottir
- LaRiCE: Gait and Balance Disorders Laboratory, Don Gnocchi Foundation I.R.C.C.S, Italy
| | - Davide Cattaneo
- LaRiCE: Gait and Balance Disorders Laboratory, Don Gnocchi Foundation I.R.C.C.S, Italy
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1197
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Denommé LT, Mandalfino P, Cinelli ME. Strategies used by individuals with multiple sclerosis and with mild disability to maintain dynamic stability during a steering task. Exp Brain Res 2014; 232:1811-22. [PMID: 24562410 DOI: 10.1007/s00221-014-3873-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 02/06/2014] [Indexed: 11/29/2022]
Abstract
Changing direction during walking is a common task humans encounter every day. This destabilizing event requires the central nervous system (CNS) to quickly produce an appropriate response, maintain stability, and propel the body in the intended direction. Previous research has demonstrated that 'individuals with multiple sclerosis' (IwMS) with mild balance impairment display differences in gait characteristics during clinical tests compared with controls. The current study used dynamic stability margin [DSM, difference between COM (i.e. the weighted average of the central point of an individual's total body mass) and lateral BOS (i.e. the most lateral border of the foot that is in contact with the ground)] calculations in addition to gait kinematics to determine whether dynamic stability differences during a steering task were present between IwMS with mild balance impairment and 'healthy age-matched individuals' (HAMI) as well as between IwMS with mild balance impairment and 'community-dwelling older adults' (OA). All IwMS reported mild balance impairment with expanded disability status scale scores ranging between 1.0 and 3.0. The steering task required participants to walk 3 m towards a pressure sensitive trigger mat that would illuminate one of five lights to indicate the future direction of travel (i.e. straight, 45° or 60° to the left or right of the midline). Results revealed that IwMS displayed reduced walking speed and cadence during the approach phase in addition to a smaller DSM range (i.e. COM remained close to lateral BOS) during the entire steering task when compared with HAMI. However, when compared to OAs, IwMS did not display differences in any of the gait kinematics or DSM calculations. Findings suggest that the IwMS displayed a conservative gait strategy in order to maintain stability during the steering task. Lack of dynamic stability differences between IwMS and OAs indicate that both groups use similar strategies to adapt locomotion as a result of impaired somatosensory quality and/or processing.
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Affiliation(s)
- Luke T Denommé
- Department of Kinesiology and Physical Education, Wilfrid Laurier University, 75 University Avenue West, Waterloo, ON, N2L 3C5, Canada
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1198
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Bunn F, Dickinson A, Simpson C, Narayanan V, Humphrey D, Griffiths C, Martin W, Victor C. Preventing falls among older people with mental health problems: a systematic review. BMC Nurs 2014; 13:4. [PMID: 24552165 PMCID: PMC3942767 DOI: 10.1186/1472-6955-13-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 02/10/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Falls are a leading cause of mortality and morbidity in older people and the risk of falling is exacerbated by mental health conditions. Existing reviews have focused on people with dementia and cognitive impairment, but not those with other mental health conditions or in mental health settings. The objective of this review is to evaluate the effectiveness of fall prevention interventions for older people with mental health problems being cared for across all settings. METHODS A systematic review of fall prevention interventions for older people with mental health conditions. We undertook electronic database and lateral searches to identify studies reporting data on falls or fall related injuries. Searches were initially conducted in February 2011 and updated in November 2012 and October 2013; no date restrictions were applied. Studies were assessed for risk of bias. Due to heterogeneity results were not pooled but are reported narratively. RESULTS Seventeen RCTs and four uncontrolled studies met the inclusion criteria; 11 involved single interventions and ten multifactorial. Evidence relating to fall reduction was inconsistent. Eight of 14 studies found a reduction in fallers (statistically significant in five), and nine of 14 reported a significant reduction in rate or number of falls. Four studies found a non-significant increase in falls. Multifactorial, multi-disciplinary interventions and those involving exercise, medication review and increasing staff awareness appear to reduce the risk of falls but evidence is mixed and study quality varied. Changes to the environment such as increased supervision or sensory stimulation to reduce agitation may be promising for people with dementia but further evaluation is needed. Most of the studies were undertaken in nursing and residential homes, and none in mental health hospital settings. CONCLUSIONS There is a dearth of falls research in mental health settings or which focus on patients with mental health problems despite the high number of falls experienced by this population group. This review highlights the lack of robust evidence to support practitioners to implement practices that prevent people with mental health problems from falling.
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Affiliation(s)
- Frances Bunn
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, Hertfordshire AL10 9AB, UK.
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1199
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Goodwin VA, Abbott RA, Whear R, Bethel A, Ukoumunne OC, Thompson-Coon J, Stein K. Multiple component interventions for preventing falls and fall-related injuries among older people: systematic review and meta-analysis. BMC Geriatr 2014; 14:15. [PMID: 24495705 PMCID: PMC3928080 DOI: 10.1186/1471-2318-14-15] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 02/03/2014] [Indexed: 11/18/2022] Open
Abstract
Background Limited attention has been paid in the literature to multiple component fall prevention interventions that comprise two or more fixed combinations of fall prevention interventions that are not individually tailored following a risk assessment. The study objective was to determine the effect of multiple component interventions on fall rates, number of fallers and fall-related injuries among older people and to establish effect sizes of particular intervention combinations. Methods Medline, EMBASE, CINAHL, PsychInfo, Cochrane, AMED, UK Clinical Research Network Study Portfolio, Current Controlled Trials register and Australian and New Zealand Clinical Trials register were systematically searched to August 2013 for randomised controlled trials targeting those aged 60 years and older with any medical condition or in any setting that compared multiple component interventions with no intervention, placebo or usual clinical care on the outcomes reported falls, number that fall or fall-related injuries. Included studies were appraised using the Cochrane risk of bias tool. Estimates of fall rate ratio and risk ratio were pooled across studies using random effects meta-analysis. Data synthesis took place in 2013. Results Eighteen papers reporting 17 trials were included (5034 participants). There was a reduction in the number of people that fell (pooled risk ratio = 0.85, 95% confidence interval (95% CI) 0.80 to 0.91) and the fall rate (pooled rate ratio = 0.80, 95% CI 0.72 to 0.89) in favour of multiple component interventions when compared with controls. There was a small amount of statistical heterogeneity (I2 = 20%) across studies for fall rate and no heterogeneity across studies examining number of people that fell. Conclusions This systematic review and meta-analysis of randomised controlled trials found evidence that multiple component interventions that are not tailored to individually assessed risk factors are effective at reducing both the number of people that fall and the fall rate. This approach should be considered as a service delivery option.
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Affiliation(s)
- Victoria A Goodwin
- PenCLAHRC, University of Exeter Medical School, Veysey Building, Salmon Pool Lane, Exeter EX2 4SF, UK.
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1200
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Tousignant M, Corriveau H, Kairy D, Berg K, Dubois MF, Gosselin S, Swartz RH, Boulanger JM, Danells C. Tai Chi-based exercise program provided via telerehabilitation compared to home visits in a post-stroke population who have returned home without intensive rehabilitation: study protocol for a randomized, non-inferiority clinical trial. Trials 2014; 15:42. [PMID: 24479760 PMCID: PMC3912257 DOI: 10.1186/1745-6215-15-42] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 01/22/2014] [Indexed: 11/10/2022] Open
Abstract
Background The incidence of strokes in industrialized nations is on the rise, particularly in the older population. In Canada, a minority of individuals who have had a stroke actually receive intensive rehabilitation because most stroke patients do not have access to services or because their motor recovery was judged adequate to return home. Thus, there is a considerable need to organize home-based rehabilitation services for everyone who has had a stroke. To meet this demand, telerehabilitation, particularly from a service center to the patient’s home, is a promising alternative approach that can help improve access to rehabilitation services once patients are discharged home. Methods/Design This non-inferiority study will include patients who have returned home post-stroke without requiring intensive rehabilitation. To be included in the study, participants will: 1) not be referred to an Intensive Functional Rehabilitation Unit, 2) have a Rankin score of 2 or 3, and 3) have a balance problem (Berg Balance Scale score between 46 and 54). Participants will be randomly assigned to either the teletreatment group or the home visits group. Except for the delivery mode, the intervention will be the same for both groups, that is, a personalized Tai Chi-based exercise program conducted by a trained physiotherapist (45-minute session twice a week for eight consecutive weeks). The main objective of this research is to test the non-inferiority of a Tai Chi-based exercise program provided via telerehabilitation compared to the same program provided in person at home in terms of effectiveness for retraining balance in individuals who have had a stroke but do not require intensive functional rehabilitation. The main outcome of this study is balance and mobility measured with the Community Balance and Mobility Scale. Secondary outcomes include physical and psychological capacities related to balance and mobility, participants’ quality of life, satisfaction with services received, and cost-effectiveness associated with the provision of both types of services. Study/trial registration ClinicalTrials.gov: NCT01848080
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