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Chang FH, Latham NK, Friedman RH, Jette AM. Interactive voice response version of the late-life function and disability instrument. J Am Geriatr Soc 2015; 63:770-5. [PMID: 25900491 DOI: 10.1111/jgs.13337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To develop an interactive voice response (IVR) version of the Late-Life Function and Disability Instrument Computer Adaptive Test (LLFDI-CAT) and to evaluate its reliability and acceptability in older adults. DESIGN The IVR system was embedded within the LLFDI-CAT program. To test the test-retest reliability and concordance of the IVR version of LLFDI-CAT with the telephone interviewer form (TIF), participants received the two versions of the LLFDI at baseline and at 1-week follow-up. SETTING Community. PARTICIPANTS Community-dwelling adults aged 65 and older (N = 50). MEASUREMENTS The LLFDI is a self-reported outcome measure developed to assess function and disability in older adults. RESULTS The IVR version of the LLFDI-CAT showed acceptable overall test-retest reliability (intraclass correlation coefficient (ICC) = 0.79-0.80) and concordance (ICC = 0.74-0.97) with the TIF. Although most participants preferred the TIF, the majority did not find the IVR version more difficult to use. CONCLUSION The IVR version of the LLFDI-CAT achieved reliability levels that were comparable with those of the TIF version. Future work is needed to improve the IVR design to better fit older adults' needs and preferences.
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Affiliation(s)
- Feng-Hang Chang
- Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei City, Taiwan; Health and Disability Research Institute, School of Public Health, Boston University, Boston, Massachusetts
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152
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Forjaz MJ, Ayala A, Abellán A. Hierarchical nature of activities of daily living in the Spanish Disability Survey. Rheumatol Int 2015; 35:1581-9. [PMID: 25804957 DOI: 10.1007/s00296-015-3255-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 03/13/2015] [Indexed: 11/24/2022]
Abstract
Many studies have addressed the issue of dimensionality in activities of daily living (ADL) and its hierarchy, with contradictory results. This paper aims to study the unidimensional structure and the hierarchy of ADL in the Spanish Disability Survey. We analysed a sample of 8381 people aged 65 and over with at least one disability and receiving personal help with one of them. The following Rasch model properties were studied in 14 items enquiring about basic and instrumental ADL: fit to the model, reliability, unidimensionality, local independency between items and differential item functioning (DIF) by gender, age and proxy. The unidimensionality of the scale was confirmed. The final analysis of eight items showed a satisfactory fit, good reliability, local independency, unidimensionality and no DIF by age. The disability linear measure showed significant differences by gender and age. The obtained disability scale is a simple and reliable measure, and it suggests a hierarchical order of ADL and predicts a schedule of functional impairment in older adults. Rating the disability of older community-dwelling people has a predictive value that policy makers might find useful in service planning.
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Affiliation(s)
- M J Forjaz
- National School of Public Health, Carlos III Health Institute and REDISSEC, Avd/. Monforte de Lemos, 5, 28029, Madrid, Spain
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153
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Best KL, Miller WC, Eng JJ, Routhier F, Goldsmith C. Randomized controlled trial protocol feasibility: The Wheelchair Self-Efficacy Enhanced for Use (WheelSeeU). The Canadian Journal of Occupational Therapy 2015; 81:308-19. [PMID: 25702375 DOI: 10.1177/0008417414546743] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Manual wheelchairs (MWCs) can improve mobility and social participation for individuals who experience difficulty walking; however, older adults receive little training for wheelchair use. The Wheelchair Self-Efficacy Enhanced for Use (WheelSeeU) research program provides peer-led training that may positively influence wheelchair use while reducing clinician burden. PURPOSE The purpose of this study is to evaluate the feasibility and clinical outcomes of WheelSeeU. METHOD A randomized control trial (RCT) recruits and randomly assigns 40 MWC users (55+ years). Feasibility indicators assessing process, resource, management, and treatment issues are measured, and clinical outcomes (wheelchair skills, safety, confidence, mobility, social participation, quality of life, health utility) are collected at three time points. IMPLICATIONS WheelSeeU provides an innovative approach for teaching wheelchair skills to an aging population that may improve wheelchair use and decrease clinician burden. Since RCTs are expensive and challenging in rehabilitation, establishing feasibility prior to larger effectiveness trials is prudent.
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154
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Chiu CY, Motl RW. Further validation of the Multiple Sclerosis Self-Efficacy Scale. Disabil Rehabil 2015; 37:2429-2438. [DOI: 10.3109/09638288.2015.1021022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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155
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Murrock CJ, Graor CH, Sues-Mitzel A. Effects of dance on upper extremity activities in underserved adults. J Am Assoc Nurse Pract 2015; 27:584-90. [PMID: 25736592 DOI: 10.1002/2327-6924.12232] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 05/23/2014] [Indexed: 11/11/2022]
Abstract
PURPOSE This secondary analysis examined the immediate and maintaining effects of a 12-week line-dancing intervention on upper and lower extremity activities in underserved adults who receive care from a nurse-managed clinic (NMC). DATA SOURCES This one-group, repeated measures, feasibility study consisted of 40 participants recruited from an urban apartment complex that housed a NMC. Of the 40 participants, 21 participants completed the 12-week line-dancing intervention. Physical function of the upper and lower extremities was measured with the Late Life Function and Disability Instrument at baseline, 12, and 18 weeks to determine the maintaining effects. CONCLUSIONS Age ranged from 45 to 87 years (M = 63; SD = 7.8), body mass index (BMI) was 33.4 (SD = 7.8), 92% were female, and 75% were African American. At baseline, participants showed limitations in all aspects of physical function. Significant improvements in upper and lower extremity activities were noted at 12 weeks and maintained at 18 weeks. IMPLICATIONS FOR PRACTICE Although line-dancing mainly involves the lower body, there were significant improvements in upper extremity activities at 12 weeks, which were maintained at 18 weeks. The maintaining effects support line-dancing as an intervention to improve upper and lower extremity activities needed for independent living. NMCs are important settings for health promotion interventions in underserved adults.
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Affiliation(s)
- Carolyn J Murrock
- Nursing Center for Community Health, College of Health Professions, School of Nursing, The University of Akron, Akron, Ohio
| | - Christine Heifner Graor
- Nursing Center for Community Health, College of Health Professions, School of Nursing, The University of Akron, Akron, Ohio
| | - Annette Sues-Mitzel
- Nursing Center for Community Health, College of Health Professions, School of Nursing, The University of Akron, Akron, Ohio
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156
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Blair CK, Morey MC, Desmond RA, Cohen HJ, Sloane R, Snyder DC, Demark-Wahnefried W. Light-intensity activity attenuates functional decline in older cancer survivors. Med Sci Sports Exerc 2015; 46:1375-83. [PMID: 24389524 DOI: 10.1249/mss.0000000000000241] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
UNLABELLED While moderate- to vigorous-intensity physical activities (MVPA) confer the greatest health benefits, evidence suggests that light-intensity activities are also beneficial, particularly for older adults and individuals with moderate to severe comorbidities. PURPOSE To examine cross-sectional and longitudinal associations between light-intensity activity and physical function in older cancer survivors at increased risk for age- and treatment-related comorbidities, including accelerated functional decline. METHODS The analysis included data from 641 breast, prostate, and colorectal cancer survivors (54% female) age 65 yr and older who participated in a 1-yr home-based diet and exercise intervention designed to reduce the rate of physical function decline. ANCOVA was used to compare means of physical function across levels of PA intensity (low-light [LLPA]: 1.5-2.0 METs; high-light [HLPA]: 2.1-2.9 METs; MVPA: ≥3.0 METs). RESULTS In cross-sectional analyses, increasing tertiles of light-intensity activity were associated with higher scores for all three measures of physical function (all P values <0.005), after adjusting for age, sex, body mass index, comorbidity, symptoms, and MVPA. Associations were stronger for HLPA than for LLPA. Compared with survivors who had decreased MVPA or maintained stable MVPA and HLPA at the postintervention follow-up, those who had increased HLPA, but had decreased MVPA or maintained stable MVPA, reported higher physical function scores (LS means [95% confidence interval]: SF-36 Physical Function Subscale: -5.58 [-7.96 to -3.20] vs -2.54 [-5.83 to 0.75], P = 0.14; Basic Lower Extremity Function: -2.00 [-3.45 to -0.55] vs 0.28 [-1.72 to 2.28], P = 0.07; Advanced Lower Extremity Function: -2.58 [-4.00 to -1.15] vs 0.44 [-1.52 to 2.40], P = 0.01). CONCLUSIONS Our findings suggest that increasing light-intensity activities, especially HLPA, may be a viable approach to reducing the rate of physical function decline in individuals who are unable or reluctant to initiate or maintain adequate levels of moderate-intensity activities.
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Affiliation(s)
- Cindy K Blair
- 1Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN; 2Center for the Study of Aging/Claude D. Pepper Older Americans Independence Center, Duke University Medical Center, Durham, NC; 3Department of Medicine, Duke University Medical Center, Durham, NC; 4Geriatric Research, Education, and Clinical Center, VA Medical Center, Durham, NC; 5Department of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, 6Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, 7University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL
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157
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Pak S, Patten C. Strengthening to Promote Functional Recovery Poststroke: An Evidence-Based Review. Top Stroke Rehabil 2015; 15:177-99. [DOI: 10.1310/tsr1503-177] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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158
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Beauchamp MK, Jette AM, Ward RE, Kurlinski LA, Kiely D, Latham NK, Bean JF. Predictive validity and responsiveness of patient-reported and performance-based measures of function in the Boston RISE study. J Gerontol A Biol Sci Med Sci 2014; 70:616-22. [PMID: 25512569 DOI: 10.1093/gerona/glu227] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 11/12/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patient-reported and performance-based measures (PBMs) are commonly used to measure physical function in studies of older adults. Selection of appropriate measures to address specific research questions is complex and requires knowledge of relevant psychometric properties. The aim of this study was to examine the predictive validity for adverse outcomes and responsiveness of a widely used patient-reported measure, the Late-Life Function and Disability Instrument (LLFDI), compared with PBMs. METHODS We analyzed 2 years of follow-up data from Boston RISE, a cohort study of 430 primary care patients aged ≥65 years. Logistic and linear regression models were used to examine predictive validity for adverse outcomes and effect size and minimal detectable change scores were computed to examine responsiveness. Performance-based functional measures included the Short Physical Performance Battery, 400-m walk, gait speed, and stair-climb power test. RESULTS The LLFDI and PBMs showed high predictive validity for poor self-rated health, hospitalizations, and disability. The LLFDI function scale was the only measure that predicted falls. Absolute effect size estimates ranged from 0.54 to 0.64 for the LLFDI and from 0.34 to 0.63 for the PBMs. From baseline to 2 years, the percentage of participants with a change ≥ minimal detectable change was greatest for the LLFDI scales (46-59%) followed by the Short Physical Performance Battery (44%), gait speed (35%), 400-m walk (17%), and stair-climb power test (9%). CONCLUSIONS The patient-reported LLFDI showed comparable psychometric properties to PBMs. Our findings support the use of the LLFDI as a primary outcome in gerontological research.
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Affiliation(s)
- Marla K Beauchamp
- Spaulding Rehabilitation, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Cambridge, Massachusetts. Spaulding Rehabilitation Hospital, Boston, Massachusetts. Health and Disability Research Institute, Boston University School of Public Health, Boston, Massachusetts
| | - Alan M Jette
- Health and Disability Research Institute, Boston University School of Public Health, Boston, Massachusetts
| | - Rachel E Ward
- Spaulding Rehabilitation, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Cambridge, Massachusetts. Spaulding Rehabilitation Hospital, Boston, Massachusetts. Health and Disability Research Institute, Boston University School of Public Health, Boston, Massachusetts
| | | | - Dan Kiely
- Spaulding Rehabilitation Hospital, Boston, Massachusetts
| | - Nancy K Latham
- Health and Disability Research Institute, Boston University School of Public Health, Boston, Massachusetts
| | - Jonathan F Bean
- Spaulding Rehabilitation, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Cambridge, Massachusetts. Spaulding Rehabilitation Hospital, Boston, Massachusetts. Health and Disability Research Institute, Boston University School of Public Health, Boston, Massachusetts
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159
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Wójcicki TR, Fanning J, Awick EA, Olson EA, Motl RW, McAuley E. Maintenance Effects of a DVD-Delivered Exercise Intervention on Physical Function in Older Adults. J Gerontol A Biol Sci Med Sci 2014; 70:785-9. [PMID: 25324220 DOI: 10.1093/gerona/glu188] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 09/08/2014] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Exercise training has been demonstrated to enhance physical function and to have a protective effect against functional limitations and disability in older adults. PURPOSE The objective of this study was to determine whether the effects of a home-based, DVD-delivered exercise intervention on functional performance and limitations were maintained 6-month postintervention termination. METHODS Follow-up assessments of functional performance and limitations were conducted in a sample of community-dwelling older adults (N = 237) who participated in a 6-month randomized controlled exercise trial. Participants were initially randomized to a DVD-delivered exercise intervention or an attentional control condition. The Short Physical Performance Battery, measures of flexibility and strength, and functional limitations were assessed immediately before and after the intervention and then again 6 months later. Analyses of covariance were conducted to examine changes in physical function between the two conditions at the end of the intervention to 6-month follow-up. RESULTS There were statistically significant adjusted group differences in the Short Physical Performance Battery (η(2) = 0.03, p = .01), upper-body strength (η(2) = 0.03, p = .005), and lower-body flexibility (η(2) = 0.02, p = .05), indicating that gains brought about by the intervention were maintained 6 months later. CONCLUSIONS A DVD-delivered exercise program specifically designed to target elements of functional fitness in older adults can produce clinically meaningful gains in physical function that are maintained beyond intervention cessation.
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Affiliation(s)
- Thomas R Wójcicki
- Exercise Science, Lansing School of Nursing and Health Sciences, Bellarmine University, Louisville, Kentucky
| | - Jason Fanning
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign
| | - Elizabeth A Awick
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign
| | - Erin A Olson
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign
| | - Robert W Motl
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign
| | - Edward McAuley
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign.
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Winger JG, Mosher CE, Rand KL, Morey MC, Snyder DC, Demark-Wahnefried W. Diet and exercise intervention adherence and health-related outcomes among older long-term breast, prostate, and colorectal cancer survivors. Ann Behav Med 2014; 48:235-45. [PMID: 24648018 PMCID: PMC4156898 DOI: 10.1007/s12160-014-9598-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Diet and exercise interventions for cancer survivors result in health benefits; however, few studies have examined health outcomes in relation to adherence. PURPOSE We examined associations between adherence to components of a diet-exercise intervention and survivors' physical and mental health. METHODS A randomized controlled trial tested a telephone and mailed print intervention among 641 older, overweight, long-term survivors of breast, prostate, and colorectal cancer. Dietary and exercise behaviors were assessed at 14 time points throughout the year-long intervention; health outcomes were examined postintervention. RESULTS Telephone session attendance had significant indirect relationships with health outcomes through intervention-period exercise and dietary behavior. Attendance showed positive indirect relationships with physical function (β = 0.11, p < 0.05), basic and advanced lower extremity function (β = 0.10, p < 0.05/β = 0.09, p < 0.05), and mental health (β = 0.05, p < 0.05), and a negative indirect relationship with body mass index (β = -0.06, p < 0.05). CONCLUSIONS Session attendance is vital in facilitating improvement in health behaviors and attendant outcomes (Clinicaltrials.gov number NCT00303875).
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Affiliation(s)
- Joseph G Winger
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 North Blackford Street, LD 134, Indianapolis, IN, 46202, USA,
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161
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Winters-Stone KM, Dobek JC, Bennett JA, Dieckmann NF, Maddalozzo GF, Ryan CW, Beer TM. Resistance training reduces disability in prostate cancer survivors on androgen deprivation therapy: evidence from a randomized controlled trial. Arch Phys Med Rehabil 2014; 96:7-14. [PMID: 25194450 DOI: 10.1016/j.apmr.2014.08.010] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 08/05/2014] [Accepted: 08/08/2014] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To investigate whether functionally based resistance exercise could improve strength, physical function, and disability among prostate cancer survivors (PCS) on androgen deprivation therapy (ADT); and to explore potential mediators of changes in outcomes from exercise. DESIGN Randomized controlled trial. SETTING Academic medical center. PARTICIPANTS PCS (N=51; mean age, 70.2y) on ADT. INTERVENTION PCS were randomized to moderate to vigorous intensity resistance training or stretching (placebo control) for 1 year. MAIN OUTCOME MEASURES Maximal leg press and bench press strength, objective and self-reported physical function, and self-reported disability. Hierarchical linear modeling was used to test for significant group × time differences adjusting for covariates. RESULTS Retention in the study was 84%, and median attendance to supervised classes was 84% in the resistance group. No study-related injuries occurred. Maximal leg strength (P=.032) and bench press strength (P=.027) were improved after 1 year of resistance training, whereas little change occurred from stretching. Self-reported physical function improved with resistance training, whereas decreases occurred from stretching (P=.016). Disability lessened more with resistance training than stretching (P=.018). One-year change in leg press strength mediated the relation between groups (resistance or stretching) and 1-year change in self-reported disability (P<.05). CONCLUSIONS One year of resistance training improved muscle strength in androgen-deprived PCS. Strengthening muscles using functional movement patterns may be an important feature of exercise programs designed to improve perceptions of physical function and disability. Findings from this study contribute to the mounting evidence that exercise should become a routine part of clinical care in older men with advanced prostate cancer.
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Affiliation(s)
- Kerri M Winters-Stone
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR; School of Nursing, Oregon Health & Science University, Portland, OR.
| | - Jessica C Dobek
- School of Nursing, Oregon Health & Science University, Portland, OR
| | - Jill A Bennett
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR; School of Nursing, Oregon Health & Science University, Portland, OR
| | | | - Gianni F Maddalozzo
- Department of Exercise and Sport Science, School of Biologic and Population Health, Oregon State University, Corvallis, OR
| | - Christopher W Ryan
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR; School of Medicine, Oregon Health & Science University, Portland, OR
| | - Tomasz M Beer
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR; School of Medicine, Oregon Health & Science University, Portland, OR
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162
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Halvarsson A, Franzén E, Ståhle A. Balance training with multi-task exercises improves fall-related self-efficacy, gait, balance performance and physical function in older adults with osteoporosis: a randomized controlled trial. Clin Rehabil 2014; 29:365-75. [PMID: 25142277 DOI: 10.1177/0269215514544983] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the effects of a balance training program including dual- and multi-task exercises on fall-related self-efficacy, fear of falling, gait and balance performance, and physical function in older adults with osteoporosis with an increased risk of falling and to evaluate whether additional physical activity would further improve the effects. DESIGN Randomized controlled trial, including three groups: two intervention groups (Training, or Training+Physical activity) and one Control group, with a 12-week follow-up. SETTING Stockholm County, Sweden. PARTICIPANTS Ninety-six older adults, aged 66-87, with verified osteoporosis. INTERVENTIONS A specific and progressive balance training program including dual- and multi-task three times/week for 12 weeks, and physical activity for 30 minutes, three times/week. MAIN MEASURES Fall-related self-efficacy (Falls Efficacy Scale-International), fear of falling (single-item question - 'In general, are you afraid of falling?'), gait speed with and without a cognitive dual-task at preferred pace and fast walking (GAITRite®), balance performance tests (one-leg stance, and modified figure of eight), and physical function (Late-Life Function and Disability Instrument). RESULTS Both intervention groups significantly improved their fall-related self-efficacy as compared to the controls (p ≤ 0.034, 4 points) and improved their balance performance. Significant differences over time and between groups in favour of the intervention groups were found for walking speed with a dual-task (p=0.003), at fast walking speed (p=0.008), and for advanced lower extremity physical function (p=0.034). CONCLUSIONS This balance training program, including dual- and multi-task, improves fall-related self-efficacy, gait speed, balance performance, and physical function in older adults with osteoporosis.
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Affiliation(s)
- Alexandra Halvarsson
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Stockholm, Sweden Karolinska University Hospital, Department of Physical Therapy, Stockholm, Sweden
| | - Erika Franzén
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Stockholm, Sweden Karolinska University Hospital, Department of Physical Therapy, Stockholm, Sweden
| | - Agneta Ståhle
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Stockholm, Sweden Karolinska University Hospital, Department of Physical Therapy, Stockholm, Sweden
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163
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Burton E, Lewin G, Clemson L, Boldy D. Determining the Feasibility of a Lifestyle Activity Program for Inclusion in a Restorative Home Care Service: A Pilot Study. ACTIVITIES, ADAPTATION & AGING 2014. [DOI: 10.1080/01924788.2014.901031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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164
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Roaldsen KS, Halvarsson A, Sahlström T, Ståhle A. Task-specific balance training improves self-assessed function in community-dwelling older adults with balance deficits and fear of falling: a randomized controlled trial. Clin Rehabil 2014; 28:1189-97. [PMID: 24895381 PMCID: PMC4230376 DOI: 10.1177/0269215514534087] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Objective: To evaluate the effects of a 12-week balance training programme on self-assessed function and disability in healthy community-dwelling older adults with self-perceived balance deficits and fear of falling. Design: A prospective, randomized controlled trial. Setting: Stockholm County, Sweden. Participants: A total of 59 community-dwelling older adults (42 women and 17 men) aged 67–93 were randomized to either an intervention group (n = 38) or to serve as controls (n = 21) after baseline testing. Intervention: The intervention was a 12-week, three times per week, progressive, specific and individually adjusted group balance-training programme. Main measures: Self-perceived function and disability measured with Late Life Function and Disability Instrument. Results: The intervention group reported improvement in overall function (p = 0.016), as well as in basic (p = 0.044) and advanced lower extremity function (p = 0.025) compared with the control group. The study showed no improvement in overall disability or upper extremity function. Conclusion: This group balance training programme improves self-assessed function in community-dwelling older adults with balance deficits and fear of falling.
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Affiliation(s)
- Kirsti Skavberg Roaldsen
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden Department of Research, Sunnaas Rehabilitation Hospital, Norway
| | - Alexandra Halvarsson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden Department of Physical Therapy, Karolinska University Hospital, Stockholm, Sweden
| | | | - Agneta Ståhle
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden Department of Physical Therapy, Karolinska University Hospital, Stockholm, Sweden
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Mänty M, Møller A, Nilsson C, Lund R, Christensen U, Avlund K. Association of physical workload and leisure time physical activity with incident mobility limitations: a follow-up study. Occup Environ Med 2014; 71:543-8. [PMID: 24879373 DOI: 10.1136/oemed-2013-101883] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To examine individual as well as joint associations of physical workload and leisure time physical activity with incident mobility limitations in initially well-functioning middle-aged workers. METHODS This study is based on 6-year follow-up data of the Danish Longitudinal Study on Work, Unemployment and Health. Physical workload was reported at baseline and categorised as light, moderate or heavy. Baseline leisure time physical activity level was categorised as sedentary or active following the current recommendations on physical activity. Incidence of mobility limitations in climbing stairs and running among initially well-functioning workers (n=3202 and n=2821, respectively) was assessed during follow-up. RESULTS Higher workload increased whereas active leisure time decreased the risk of developing mobility limitations. The incidence of limitations increased progressively with higher workload regardless of level of leisure time physical activity, although the risks tended to be higher among those with sedentary leisure time compared with their active counterparts. All in all, the risk for onset of mobility limitations was highest among those with heavy workload combined with sedentary leisure time and lowest among those with light workload combined with active leisure time. CONCLUSIONS Although leisure time physical activity prevents development of mobility decline, high workload seems to accelerate the progression of mobility limitations among both those with active and sedentary leisure time. Therefore, efforts should be made to recommend people to engage in physical activity regardless of their physical workload.
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Affiliation(s)
- M Mänty
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark Department of Public Health, Hjelt Institute, University of Helsinki, Helsinki, Finland
| | - A Møller
- Department of Occupational Medicine, Køge Hospital, Køge, Denmark The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark National Research Centre for the Working Environment, Copenhagen, Denmark
| | - C Nilsson
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - R Lund
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - U Christensen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - K Avlund
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark The Danish Aging Research Centre, Universities of Odense, Aarhus and Copenhagen, Denmark
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166
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Pedersen MM, Holt NE, Grande L, Kurlinski LA, Beauchamp MK, Kiely DK, Petersen J, Leveille S, Bean JF. Mild cognitive impairment status and mobility performance: an analysis from the Boston RISE study. J Gerontol A Biol Sci Med Sci 2014; 69:1511-8. [PMID: 24799356 DOI: 10.1093/gerona/glu063] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The prevalence of mild cognitive impairment (MCI) and mobility limitations is high among older adults. The aim of this study was to investigate the association between MCI status and both performance-based and self-report measures of mobility in community-dwelling older adults. METHODS An analysis was conducted on baseline data from the Boston Rehabilitative Impairment Study in the Elderly study, a cohort study of 430 primary care patients aged 65 or older. Neuropsychological tests identified participants with MCI and further subclassified those with impairment in memory domains (aMCI), nonmemory domains (naMCI), and multiple domains (mdMCI). Linear regression models were used to assess the association between MCI status and mobility performance in the Habitual Gait Speed, Figure of 8 Walk, Short Physical Performance Battery, and self-reported Late Life Function and Disability Instrument's Basic Lower Extremity and Advanced Lower Extremity function scales. RESULTS Participants had a mean age of 76.6 years, and 42% were characterized with MCI. Participants with MCI performed significantly worse than participants without MCI (No-MCI) on all performance and self-report measures (p < .01). All MCI subtypes performed significantly worse than No-MCI on all mobility measures (p < .05) except for aMCI versus No-MCI on the Figure of 8 Walk (p = .054) and Basic Lower Extremity (p = .11). Moreover, compared with aMCI, mdMCI manifested worse performance on the Figure of 8 Walk and Short Physical Performance Battery, and naMCI manifested worse performance on Short Physical Performance Battery and Basic Lower Extremity. CONCLUSIONS Among older community-dwelling primary care patients, performance on a broad range of mobility measures was worse among those with MCI, appearing poorest among those with nonmemory MCI.
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Affiliation(s)
- Mette M Pedersen
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts. Clinical Research Centre, Hvidovre Hospital, University of Copenhagen, Denmark.
| | - Nicole E Holt
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts
| | - Laura Grande
- Psychology Service, VA Boston Healthcare System, Massachusetts. Department of Psychiatry, Boston University School of Medicine, Massachusetts
| | - Laura A Kurlinski
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts
| | - Marla K Beauchamp
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts. Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
| | - Dan K Kiely
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts
| | - Janne Petersen
- Clinical Research Centre, Hvidovre Hospital, University of Copenhagen, Denmark
| | | | - Jonathan F Bean
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts. Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
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Computer-adaptive balance testing improves discrimination between community-dwelling elderly fallers and nonfallers. Arch Phys Med Rehabil 2014; 95:1320-1327.e1. [PMID: 24685388 DOI: 10.1016/j.apmr.2014.03.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 03/08/2014] [Accepted: 03/14/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To build an item response theory-based computer adaptive test (CAT) for balance from 3 traditional, fixed-form balance measures: Berg Balance Scale (BBS), Performance-Oriented Mobility Assessment (POMA), and dynamic gait index (DGI); and to examine whether the CAT's psychometric performance exceeded that of individual measures. DESIGN Secondary analysis combining 2 existing datasets. SETTING Community based. PARTICIPANTS Community-dwelling older adults (N=187) who were aged ≥65 years (mean age, 75.2±6.8y, 69% women). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The BBS, POMA, and DGI items were compiled into an initial 38-item bank. The Rasch partial credit model was used for final item bank calibration. CAT simulations were conducted to identify the ideal CAT. CAT score accuracy, reliability, floor and ceiling effects, and validity were examined. Floor and ceiling effects and validity of the CAT and individual measures were compared. RESULTS A 23-item bank met model expectations. A 10-item CAT was selected, showing a very strong association with full item bank scores (r=.97) and good overall reliability (.78). Reliability was better in low- to midbalance ranges as a result of better item targeting to balance ability when compared with the highest balance ranges. No floor effect was noted. The CAT ceiling effect (11.2%) was significantly lower than the POMA (40.1%) and DGI (40.3%) ceiling effects (P<.001 per comparison). The CAT outperformed individual measures, being the only test to discriminate between fallers and nonfallers (P=.007), and being the strongest predictor of self-reported function. CONCLUSIONS The balance CAT showed excellent accuracy, good overall reliability, and excellent validity compared with individual measures, being the only measure to discriminate between fallers and nonfallers. Prospective examination, particularly in low-functioning older adults and clinical populations with balance deficits, is recommended. Development of an improved CAT based on an expanded item bank containing higher difficulty items is also recommended.
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168
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Gong Y, Gallacher J, Palmer S, Fone D. Neighbourhood green space, physical function and participation in physical activities among elderly men: the Caerphilly Prospective study. Int J Behav Nutr Phys Act 2014; 11:40. [PMID: 24646136 PMCID: PMC3994572 DOI: 10.1186/1479-5868-11-40] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 03/05/2014] [Indexed: 11/12/2022] Open
Abstract
Background The built environment in which older people live plays an important role in promoting or inhibiting physical activity. Most work on this complex relationship between physical activity and the environment has excluded people with reduced physical function or ignored the difference between groups with different levels of physical function. This study aims to explore the role of neighbourhood green space in determining levels of participation in physical activity among elderly men with different levels of lower extremity physical function. Method Using data collected from the Caerphilly Prospective Study (CaPS) and green space data collected from high resolution Landmap true colour aerial photography, we first investigated the effect of the quantity of neighbourhood green space and the variation in neighbourhood vegetation on participation in physical activity for 1,010 men aged 66 and over in Caerphilly county borough, Wales, UK. Second, we explored whether neighbourhood green space affects groups with different levels of lower extremity physical function in different ways. Results Increasing percentage of green space within a 400 meters radius buffer around the home was significantly associated with more participation in physical activity after adjusting for lower extremity physical function, psychological distress, general health, car ownership, age group, marital status, social class, education level and other environmental factors (OR = 1.21, 95% CI 1.05, 1.41). A statistically significant interaction between the variation in neighbourhood vegetation and lower extremity physical function was observed (OR = 1.92, 95% CI 1.12, 3.28). Conclusion Elderly men living in neighbourhoods with more green space have higher levels of participation in regular physical activity. The association between variation in neighbourhood vegetation and regular physical activity varied according to lower extremity physical function. Subjects reporting poor lower extremity physical function living in neighbourhoods with more homogeneous vegetation (i.e. low variation) were more likely to participate in regular physical activity than those living in neighbourhoods with less homogeneous vegetation (i.e. high variation). Good lower extremity physical function reduced the adverse effect of high variation vegetation on participation in regular physical activity. This provides a basis for the future development of novel interventions that aim to increase levels of physical activity in later life, and has implications for planning policy to design, preserve, facilitate and encourage the use of green space near home.
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Affiliation(s)
- Yi Gong
- Sustainable Places Research Institute, Cardiff University, Cardiff, Wales, UK.
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Hansen ÅM, Darsø L, Manty M, Nilsson C, Christensen U, Lund R, Holtermann A, Avlund K. Psychosocial factors at work and the development of mobility limitations among adults in Denmark. Scand J Public Health 2014; 42:417-24. [PMID: 24637677 DOI: 10.1177/1403494814527526] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIM Psychosocial factors in the working environment have been shown to be associated with mobility limitations, but this has not yet been confirmed in a Danish population. We aimed to examine how psychosocial factors at work are related to developing mobility limitations in Denmark. METHODS This study is based on data from 2952 middle-aged men and women without mobility limitations in 2000. RESULTS We found increased risk of incident mobility limitations during 6-year follow up among men who often perceived high work pace (OR 5.45, 95% CI 1.21-24.52) vs. never, who only sometimes or/never perceived the work to be meaningful (OR 6.54, 95% CI 1.55-27.55) vs. always, and who sometimes perceived high emotional demands at work (OR 7.85, 95% CI 1.78-34.65) vs. never. Among women, lower risk of incident mobility limitations was observed among those who in 2000 perceived high work pace sometimes (OR 0.46, 95% CI 0.24-0.87) or often (OR 0.43, 95% CI 0.22-0.85) vs. never in 2000. Also, women who always or often experienced high emotional demands had an increased risk. CONCLUSIONS The most important finding was that high work pace was strongly associated with increased risk of mobility limitations among men, but associated with lower risk of mobility limitations among women. This knowledge may be used to better target interventions among men and women in midlife from physical deterioration later in life.
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Affiliation(s)
- Åse Marie Hansen
- Department of Public Health, University of Copenhagen, Denmark National Research Centre for Working Environment, Copenhagen, Denmark
| | - Lilie Darsø
- Department of Public Health, University of Copenhagen, Denmark
| | - Minna Manty
- Department of Public Health, University of Copenhagen, Denmark Center for Healthy Ageing, University of Copenhagen, Denmark
| | - Charlotte Nilsson
- Department of Public Health, University of Copenhagen, Denmark Center for Healthy Ageing, University of Copenhagen, Denmark
| | | | - Rikke Lund
- Department of Public Health, University of Copenhagen, Denmark Center for Healthy Ageing, University of Copenhagen, Denmark
| | | | - Kirsten Avlund
- Department of Public Health, University of Copenhagen, Denmark Center for Healthy Ageing, University of Copenhagen, Denmark Danish Aging Research Center, Universities of Aarhus, Southern Denmark (Odense) and Copenhagen, Denmark
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Seidel UK, Gronewold J, Volsek M, Todica O, Kribben A, Bruck H, Hermann DM. Physical, cognitive and emotional factors contributing to quality of life, functional health and participation in community dwelling in chronic kidney disease. PLoS One 2014; 9:e91176. [PMID: 24614180 PMCID: PMC3948783 DOI: 10.1371/journal.pone.0091176] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 02/10/2014] [Indexed: 11/28/2022] Open
Abstract
Background Quality of life (QoL) impairment is a well-known consequence of chronic kidney disease (CKD). The factors influencing QoL and late life functional health are poorly examined. Methods Using questionnaires combined with neuropsychological examinations, we prospectively evaluated physical, cognitive, and emotional factors influencing QoL, functional health and participation in community dwelling in 119 patients with CKD stages 3–5 including hemodialysis (61.5±15.7years; 63% men) and 54 control patients of the same age without CKD but with similar cardiovascular risk profile. Results Compared with control patients, CKD patients showed impairment of the physical component of QoL and overall function, assessed by the SF-36 and LLFDI, whereas disability, assessed by LLFDI, was selectively impaired in CKD patients on hemodialysis. Multivariable linear regressions (forced entry) confirmed earlier findings that CKD stage (β = −0.24; p = 0.012) and depression (β = −0.30; p = 0.009) predicted the QoL physical component. Hitherto unknown, CKD stage (β = −0.23; p = 0.007), cognition (β = 0.20; p = 0.018), and depression (β = −0.51; <0.001) predicted disability assessed by the LLFDI, while age (β = −0.20; p = 0.023), male gender (B = 5.01; p = 0.004), CKD stage (β = −0.23; p = 0.005), stroke history (B = −9.00; p = 0.034), and depression (β = −0.41; p<0.001) predicted overall function. Interestingly, functional health deficits, cognitive disturbances, depression, and anxiety were evident almost only in CKD patients with coronary heart disease (found in 34.2% of CKD patients). The physical component of QoL and functional health decreased with age and depressive symptoms, and increased with cognitive abilities. Conclusions In CKD, QoL, functional health, and participation in community dwelling are influenced by physical, cognitive, and emotional factors, most prominently in coronary heart disease patients.
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Affiliation(s)
- Ulla K. Seidel
- Department of Neurology, University Hospital Essen, Essen, Germany
| | - Janine Gronewold
- Department of Neurology, University Hospital Essen, Essen, Germany
| | - Michaela Volsek
- Department of Nephrology, University Hospital Essen, Essen, Germany
| | - Olga Todica
- Department of Neurology, University Hospital Essen, Essen, Germany
| | - Andreas Kribben
- Department of Nephrology, University Hospital Essen, Essen, Germany
| | - Heike Bruck
- Department of Nephrology, University Hospital Essen, Essen, Germany
| | - Dirk M. Hermann
- Department of Neurology, University Hospital Essen, Essen, Germany
- * E-mail:
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Higgins TJ, Janelle CM, Manini TM. Diving below the surface of progressive disability: considering compensatory strategies as evidence of sub-clinical disability. J Gerontol B Psychol Sci Soc Sci 2014; 69:263-74. [PMID: 24170713 PMCID: PMC3968860 DOI: 10.1093/geronb/gbt110] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Accepted: 09/19/2013] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To provide a comprehensive review regarding the role of activity and participation compensations within the disablement process, identify directions for future research, and discuss the implications of compensation pertaining to public health initiatives aimed at preventing and reversing disability. METHOD This article evaluated how using compensatory strategies to cope with functional deficits reveals important transitions within the disablement process and signifies a unique opportunity to identify early declines in function. RESULTS Previous research suggests that (a) adopting compensatory strategies to maintain activity/participation is strongly associated with functional decline and disease severity and significantly predicts the onset of limitations/restrictions; (b) compensation can be reliably quantified; and (c) contextual knowledge about how individuals adapt to functional decline can be used to describe transitions in the disablement process. DISCUSSION Characterizing subtle adaptations prior to the onset of activity limitations and participation restrictions will not only aid in understanding the complex disablement process but also help inform social services and future prevention strategies. Overall, this article integrates the concept of compensation into the current model of disability and proposes a framework for identifying and interpreting compensatory behavior.
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Affiliation(s)
- Torrance J Higgins
- Correspondence should be addressed to Todd M. Manini, Department of Aging and Geriatrics, University of Florida, 210 Mowry Road, Gainesville, Gainesville, FL 32611. E-mail:
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Comparisons of Dyspnea, Fatigue, and Exercise Intolerance Between Individuals with Heart Failure with High Versus Low Knee Extensor Muscle Strength. Cardiopulm Phys Ther J 2014. [DOI: 10.1097/01823246-201403000-00004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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173
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Ramos-Pichardo JD, Cabrero-García J, González-Llopis L, Cabañero-Martínez MJ, Muñoz-Mendoza CL, Sanjuan-Quiles A, Richart-Martínez M, Reig-Ferrer A. What do older people understand by mobility-related difficulties? Arch Gerontol Geriatr 2014; 59:122-30. [PMID: 24613103 DOI: 10.1016/j.archger.2014.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 12/28/2013] [Accepted: 02/06/2014] [Indexed: 10/25/2022]
Abstract
UNLABELLED Despite the centrality of the difficulty concept in the study of disability, there has been little research on its significance from the point of view of people with functional limitations. The main objective of this study was to describe what older people understand when asked about difficulty in undertaking mobility activities. As a secondary objective, we considered whether there are any differences depending on the type of activities, according to the International Classification of Functioning (ICF) mobility domains. METHODS Seventeen community-dwelling men and women aged 70 years old or over were interviewed by means of a questionnaire containing 55 items covering the ICF mobility domains. The participants responded to the items while thinking aloud, saying what led them to give a specific answer about their level of difficulty. Inductive content analysis was conducted and categories, subthemes and themes were identified. RESULTS Causes of difficulty (pathologies, impairments, symptoms) and accommodations (task modifications and use of aids) were the two themes identified; and their importance (and that of the subthemes included) varied across the types of activity. All the participants said that they had no difficulty in at least one task, despite mentioning changes in the way they performed them. CONCLUSIONS Older people's opinions were consistent with theoretical models of disability and with the standard practice of measuring functional limitations by asking about the degree of difficulty; however, the design of these measures needs to be improved in order to detect perceptions of no difficulty in the presence of task modification.
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Affiliation(s)
| | | | | | | | | | | | | | - Abilio Reig-Ferrer
- Department of Health Psychology, University of Alicante, Alicante, Spain.
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174
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Psychometric properties of the Late-Life Function and Disability Instrument: a systematic review. BMC Geriatr 2014; 14:12. [PMID: 24476510 PMCID: PMC3909447 DOI: 10.1186/1471-2318-14-12] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 01/22/2014] [Indexed: 12/22/2022] Open
Abstract
Background The choice of measure for use as a primary outcome in geriatric research is contingent upon the construct of interest and evidence for its psychometric properties. The Late-Life Function and Disability Instrument (LLFDI) has been widely used to assess functional limitations and disability in studies with older adults. The primary aim of this systematic review was to evaluate the current available evidence for the psychometric properties of the LLFDI. Methods Published studies of any design reporting results based on administration of the original version of the LLFDI in community-dwelling older adults were identified after searches of 9 electronic databases. Data related to construct validity (convergent/divergent and known-groups validity), test-retest reliability and sensitivity to change were extracted. Effect sizes were calculated for within-group changes and summarized graphically. Results Seventy-one studies including 17,301 older adults met inclusion criteria. Data supporting the convergent/divergent and known-groups validity for both the Function and Disability components were extracted from 30 and 18 studies, respectively. High test-retest reliability was found for the Function component, while results for the Disability component were more variable. Sensitivity to change of the LLFDI was confirmed based on findings from 25 studies. The basic lower extremity subscale and overall summary score of the Function component and limitation dimension of the Disability component were associated with the strongest relative effect sizes. Conclusions There is extensive evidence to support the construct validity and sensitivity to change of the LLFDI among various clinical populations of community-dwelling older adults. Further work is needed on predictive validity and values for clinically important change. Findings from this review can be used to guide the selection of the most appropriate LLFDI subscale for use an outcome measure in geriatric research and practice.
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175
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Burton E, Lewin G, Clemson L, Boldy D. Effectiveness of a lifestyle exercise program for older people receiving a restorative home care service: a pragmatic randomized controlled trial. Clin Interv Aging 2013; 8:1591-601. [PMID: 24324331 PMCID: PMC3854921 DOI: 10.2147/cia.s44614] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Restorative home care services are short-term and aimed at maximizing a person’s ability to live independently. They are multidimensional and often include an exercise program to improve strength, mobility, and balance. The aim of this study was to determine whether a lifestyle exercise program would be undertaken more often and result in greater functional gains than the current structured exercise program delivered as part of a restorative home care service for older adults. Methods A pragmatic randomized controlled trial was conducted in an organization with an established restorative home care service. Individuals who were to have an exercise program as part of their service were randomized to receive either a lifestyle and functional exercise program called LiFE (as this was a new program, the intervention) or the structured exercise program currently being used in the service (control). Exercise data collected by the individuals throughout and pre and post intervention testing was used to measure balance, strength, mobility, falls efficacy, vitality, function, and disability. Results There was no difference between the groups in the amounts of exercise undertaken during the 8-week intervention period. Outcome measurement indicated that the LiFE program was as effective, and on 40% of the measures, more effective, than the structured exercise program. Conclusion Organizations delivering restorative home care services that include an exercise component should consider whether LiFE rather than the exercise program they are currently using could help their clients achieve better outcomes.
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Affiliation(s)
- Elissa Burton
- Faculty of Health Sciences, Curtin University, Perth, WA, Australia ; Research Department, Silver Chain, Perth, WA, Australia
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Brach JS, Van Swearingen JM, Perera S, Wert DM, Studenski S. Motor learning versus standard walking exercise in older adults with subclinical gait dysfunction: a randomized clinical trial. J Am Geriatr Soc 2013; 61:1879-86. [PMID: 24219189 DOI: 10.1111/jgs.12506] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To compare the effect of motor learning with that of standard exercise on measures of mobility and perceived function and disability. DESIGN Single-blind randomized trial. SETTING University research center. PARTICIPANTS Older adults (n = 40) with a mean age of 77.1 ± 6.0, normal walking speed (≥ 1.0 m/s), and impaired motor skills (Figure of 8 walk time >8 seconds). INTERVENTIONS The motor learning program incorporated goal-oriented stepping and walking to promote timing and coordination within the phases of the gait cycle. The standard program employed endurance training by treadmill walking. Both included strength training and were offered twice weekly for 1 hour for 12 weeks. MEASUREMENTS Primary outcomes were mobility performance (gait efficiency, motor skill in walking, gait speed, walking endurance); secondary outcomes were perceived function and disability (Late-Life Function and Disability Instrument). RESULTS Thirty-eight of 40 participants completed the trial (motor learning, n = 18; standard, n = 20). The motor learning group improved more than the standard group in gait speed (0.13 vs 0.05 m/s, P = .008) and motor skill (-2.2 vs -0.89 seconds, P < .001). Both groups improved in walking endurance (28.3 and 22.9 m, P = .14). Changes in gait efficiency and perceived function and disability were not different between the groups (P > .10). CONCLUSION In older adults with subclinical gait dysfunction, motor learning exercise improved some parameters of mobility performance more than standard exercise.
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Affiliation(s)
- Jennifer S Brach
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania
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Burton E, Lewin G, Clemson L, Boldy D. Effectiveness of a lifestyle exercise program for older people receiving a restorative home care service: study protocol for a pragmatic randomised controlled trial. BMC Health Serv Res 2013; 13:419. [PMID: 24134491 PMCID: PMC3853313 DOI: 10.1186/1472-6963-13-419] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 10/09/2013] [Indexed: 11/29/2022] Open
Abstract
Background Restorative home care services help older people maximise their independence using a multi-dimensional approach. They usually include an exercise program designed to improve the older person’s strength, balance and function. The types of programs currently offered require allocation of time during the day to complete specific exercises. This is not how the majority of home care clients prefer to be active and may be one of the reasons that few older people do the exercises regularly and continue the exercises post discharge. This paper describes the study protocol to test whether a Lifestyle Functional Exercise (LiFE) program: 1) is undertaken more often; 2) is more likely to be continued over the longer term; and, 3) will result in greater functional gains compared to a standard exercise program for older people receiving a restorative home care service. Methods/Design Design: A pragmatic randomised controlled trial (RCT) design was employed with two study arms: LiFE program (intervention) and the current exercise program (control). Setting: Silver Chain, a health and community care organisation in Perth, Western Australia. Participants: One hundred and fifty restorative home care clients, aged 65 years and older. Measurements: The primary outcome is a composite measure incorporating balance, strength and mobility. Other outcome measures include: physical functioning, falls efficacy, and levels of disability and functioning. Discussion If LiFE is more effective than the current exercise program, the evidence will be presented to the service management accompanied by the recommendation that it be adopted as the generic exercise program to be used within the restorative home care service. Trial registration Australian and New Zealand Clinical Trials Registry ACTRN12611000788976.
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Affiliation(s)
- Elissa Burton
- Faculty of Health Sciences, Curtin University, Perth, Australia.
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Shapiro ME, Mahoney JR, Zingman BS, Pogge DL, Verghese J. Apathy correlates with cognitive performance, functional disability, and HIV RNA plasma levels in HIV-positive individuals. J Clin Exp Neuropsychol 2013; 35:934-45. [PMID: 24090038 DOI: 10.1080/13803395.2013.838941] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We examined the relationship of apathy with neurocognitive performance, age, disease markers, and functional disability in 116 HIV-infected individuals. Apathy was assessed with the Apathy Evaluation Scale and was significantly associated with highest HIV plasma level, functional disability, and neurocognitive performance. Individuals with higher apathy levels demonstrated a stronger association between age and processing speed performance. Our findings suggest that apathy is related to poor neuropsychological functioning, HIV plasma levels, and increased functional disability in individuals with HIV. Additionally, to our knowledge, this is the first study to demonstrate an interactive effect of age and apathy on neuropsychological performance in HIV.
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Affiliation(s)
- Miriam E Shapiro
- a Department of Psychology , Fairleigh Dickinson University , Teaneck , NJ , USA
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Neighborhood environment and physical activity among older adults: do the relationships differ by driving status? J Aging Phys Act 2013; 22:421-31. [PMID: 24084049 DOI: 10.1123/japa.2012-0332] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Some attributes of neighborhood environments are associated with physical activity among older adults. This study examined whether the associations were moderated by driving status. Older adults from neighborhoods differing in walkability and income completed written surveys and wore accelerometers (N = 880, mean age = 75 years, 56% women). Neighborhood environments were measured by geographic information systems and validated questionnaires. Driving status was defined on the basis of a driver's license, car ownership, and feeling comfortable to drive. Outcome variables included accelerometer-based physical activity and self-reported transport and leisure walking. Multilevel generalized linear regression was used. There was no significant Neighborhood Attribute × Driving Status interaction with objective physical activity or reported transport walking. For leisure walking, almost all environmental attributes were positive and significant among driving older adults but not among nondriving older adults (five significant interactions at p < .05). The findings suggest that driving status is likely to moderate the association between neighborhood environments and older adults' leisure walking.
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Feuering R, Vered E, Kushnir T, Jette AM, Melzer I. Differences between self-reported and observed physical functioning in independent older adults. Disabil Rehabil 2013; 36:1395-401. [DOI: 10.3109/09638288.2013.828786] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Wert DM, Brach JS, Perera S, VanSwearingen J. The association between energy cost of walking and physical function in older adults. Arch Gerontol Geriatr 2013; 57:198-203. [PMID: 23680536 PMCID: PMC3690945 DOI: 10.1016/j.archger.2013.04.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2013] [Revised: 04/15/2013] [Accepted: 04/17/2013] [Indexed: 10/26/2022]
Abstract
To assess the association between energy cost of walking and self-report of function, independent of comorbidity and gait speed, in older adults with mobility limitations. This cross-sectional observational study was conducted within an ambulatory clinical research training center. Forty-two older adults, age 65 and older, with slow and variable gait participated. Function was assessed using the Late Life Function and Disability Index-Basic Lower Extremity Subscale, while energy cost of walking was derived by standardizing the mean oxygen consumption recorded during physiological steady state by gait speed. Comorbidity and gait speed were collected as co-variates. Pearson's r correlation coefficient and regression analyses were used to assess the relationship between energy cost and function. Energy cost of walking was significantly correlated with self-reported function (Pearson's r=-0.50, p<0.001); furthermore, energy cost of walking explained an additional 17% (p=0.002) of the variance in self-reported function above and beyond the variance explained by comorbidity and gait speed combined. Energy cost of walking is emerging as another significant factor related to functional performance among older adults, even after controlling for comorbidity and gait speed - robust variables known for their strong contributions to function. Knowledge of and attention to the efficiency of how one moves (high energy cost of walking) may enhance rehabilitation efforts to further reduce "functional burden" in older adults.
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Affiliation(s)
- David M. Wert
- Dept. of Physical Therapy, University of Pittsburgh, 6035 Forbes Tower, Pittsburgh, PA 15260, USA
| | - Jennifer S. Brach
- Dept. of Physical Therapy, University of Pittsburgh, 6035 Forbes Tower, Pittsburgh, PA 15260, USA
| | - Subashan Perera
- Dept. of Medicine, Division of Geriatric Medicine, Univ. of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Jessie VanSwearingen
- Dept. of Physical Therapy, University of Pittsburgh, 6035 Forbes Tower, Pittsburgh, PA 15260, USA
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182
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McDonough CM, Jette AM, Ni P, Bogusz K, Marfeo EE, Brandt DE, Chan L, Meterko M, Haley SM, Rasch EK. Development of a self-report physical function instrument for disability assessment: item pool construction and factor analysis. Arch Phys Med Rehabil 2013; 94:1653-60. [PMID: 23542402 PMCID: PMC4046327 DOI: 10.1016/j.apmr.2013.03.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Revised: 02/27/2013] [Accepted: 03/04/2013] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To build a comprehensive item pool representing work-relevant physical functioning and to test the factor structure of the item pool. These developmental steps represent initial outcomes of a broader project to develop instruments for the assessment of function within the context of Social Security Administration (SSA) disability programs. DESIGN Comprehensive literature review; gap analysis; item generation with expert panel input; stakeholder interviews; cognitive interviews; cross-sectional survey administration; and exploratory and confirmatory factor analyses to assess item pool structure. SETTING In-person and semistructured interviews and Internet and telephone surveys. PARTICIPANTS Sample of SSA claimants (n=1017) and a normative sample of adults from the U.S. general population (n=999). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE Model fit statistics. RESULTS The final item pool consisted of 139 items. Within the claimant sample, 58.7% were white; 31.8% were black; 46.6% were women; and the mean age was 49.7 years. Initial factor analyses revealed a 4-factor solution, which included more items and allowed separate characterization of: (1) changing and maintaining body position, (2) whole body mobility, (3) upper body function, and (4) upper extremity fine motor. The final 4-factor model included 91 items. Confirmatory factor analyses for the 4-factor models for the claimant and the normative samples demonstrated very good fit. Fit statistics for claimant and normative samples, respectively, were: Comparative Fit Index=.93 and .98; Tucker-Lewis Index=.92 and .98; and root mean square error approximation=.05 and .04. CONCLUSIONS The factor structure of the physical function item pool closely resembled the hypothesized content model. The 4 scales relevant to work activities offer promise for providing reliable information about claimant physical functioning relevant to work disability.
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Affiliation(s)
- Christine M McDonough
- Health and Disability Research Institute, Department of Health Policy and Management, School of Public Health, Boston University Medical Campus, Boston, MA, USA.
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183
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Allen JD, Robbins JL, Vanbruggen MD, Credeur DP, Johannsen NM, Earnest CP, Pieper CF, Johnson JL, Church TS, Ravussin E, Kraus WE, Welsch MA. Unlocking the barriers to improved functional capacity in the elderly: rationale and design for the "Fit for Life trial". Contemp Clin Trials 2013; 36:266-75. [PMID: 23900005 PMCID: PMC3785077 DOI: 10.1016/j.cct.2013.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 07/12/2013] [Accepted: 07/22/2013] [Indexed: 01/22/2023]
Abstract
Advancing age is associated with an increase in physical impairment, functional limitations, disability, and loss of independence. Regular physical activity conveys health benefits, but the yield on physical function in the elderly, is less clear. Current exercise guidelines are focused predominantly on aerobic programs despite evidence that age-associated declines are mediated by peripheral tissue changes. The Fit for Life trial proposes a new paradigm of exercise training for the elderly that uses a low-mass high-repetition training regimen specifically focused on peripheral tissue beds or body regions (Regional Specific Training Stimulus - RSTS). RSTS is designed to deliver a localized stimulus to the peripheral vasculature, bone and muscle, without imposing a significant central cardiorespiratory strain. The purpose of this study is three-fold; 1) to derive effect sizes from the RSTS intervention by which to power a subsequent larger, confirmatory trial; 2) to assess fidelity of the RSTS intervention; and 3) to assess the interrelationship of the primary endpoints of physical impairment/fitness (VO(2peak), 1 repetition maximal contraction) and function (Senior Fitness Test scores) following two versions of a 4 + 8 week protocol. Men and women over 70 years, at risk for losing independence will be randomized to either 4 weeks of RSTS or "aerobic" exercise, followed by an identical 8 weeks of progressive whole-body training (aerobic plus resistance). The guiding hypothesis is that the magnitude of adaptation after 12 weeks will be greatest in those initially randomized to RSTS. Possible mediators of the intervention effect - physical impairment/fitness and function relationship, including vascular function, muscle mass, strength, and physiology will also be assessed.
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Affiliation(s)
- Jason D Allen
- Duke University Medical Center, Division of Cardiology, Durham, NC, USA.
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184
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Sakakibara BM, Routhier F, Lavoie MP, Miller WC. Reliability and validity of the French-Canadian Late Life Function and Disability Instrument in community-living wheelchair-users. Scand J Occup Ther 2013; 20:365-73. [PMID: 23786550 PMCID: PMC4019580 DOI: 10.3109/11038128.2013.810304] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To examine the test-retest reliability, standard error of measurement, minimal detectable change, construct validity, and ceiling and floor effects in the French-Canadian Late Life Function and Disability Instrument (LLFDI-F). METHOD The LLFDI-F is a measure of activity (i.e. physical functioning of upper and lower extremities), and participation (i.e. frequency of and limitations with). The measure was administered over the telephone to a sample of community-living wheelchair-users, who were 50 years of age and older, in this 10-day retest methodological study. The sample (n = 40) was mostly male (70%), had a mean age of 62.2 years, and mean experience with using a wheelchair of 20.2 years. Sixty-five percent used a manual wheelchair. RESULTS The test-retest intraclass correlation coefficients (ICC2,1) for the participation component ranged from 0.68 to 0.90 and from 0.74 to 0.97 for the activity component. Minimal detectable changes ranged from 7.18 to 22.56 in the participation component and from 4.71 to 16.19 in the activity component. Mann-Whitney U-tests revealed significant differences between manual and power wheelchair-users in the personal and instrumental role domains, and all areas in the activity component. CONCLUSION There is support for the test-retest reliability and construct validity of the LLFDI-F in community-living wheelchair-users, 50 years of age and older. However, because the majority of items in the lower-extremity domains of the activity component do not account for assistive device use, they are not recommended for use with individuals who have little or no use of their lower-extremities.
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Affiliation(s)
- Brodie M. Sakakibara
- Graduate Program in Rehabilitation Sciences, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- GF Strong Rehabilitation Research Lab, Vancouver Coastal Research Institute, Vancouver, BC, Canada
| | - François Routhier
- Department of Rehabilitation, Université Laval, Quebec City, QC, Canada
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Institut de réadaptation en déficience physique de Québec, Québec City, QC, Canada
| | - Marie-Pier Lavoie
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Institut de réadaptation en déficience physique de Québec, Québec City, QC, Canada
| | - William C. Miller
- Graduate Program in Rehabilitation Sciences, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- GF Strong Rehabilitation Research Lab, Vancouver Coastal Research Institute, Vancouver, BC, Canada
- Department of Occupational Sciences and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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185
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Bean JF, Latham NK, Holt N, Kurlinksi L, Ni P, Leveille S, Percac-Lima S, Jette A. Which neuromuscular attributes are most associated with mobility among older primary care patients? Arch Phys Med Rehabil 2013; 94:2381-2388. [PMID: 23973445 DOI: 10.1016/j.apmr.2013.07.026] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 07/31/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To identify the neuromuscular attributes that are associated with self-reported mobility status among older primary care patients. DESIGN Cohort study. SETTING Metropolitan-based health care system. PARTICIPANTS Community-dwelling primary care patients aged ≥65 years (N=430), with self-reported modification of mobility tasks resulting from underlying health conditions. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Basic and Advanced Lower Extremity Function as measured by the Late Life Function and Disability Instrument. RESULTS We constructed multivariable linear regression models evaluating both outcomes. For Basic Lower Extremity Function, leg strength, leg velocity, trunk extensor muscle endurance, and ankle range of motion (ROM) were statistically significant predictors (P<.001, R(2)=.21). For Advanced Lower Extremity Function, leg strength, leg strength asymmetry, leg velocity, trunk extensor muscle endurance, and knee flexion ROM were statistically significant predictors (P<.001, R(2)=.39). Sensitivity analyses conducted using multiple imputations to account for missing data confirmed these findings. CONCLUSIONS This analysis highlights the relevance and importance of 5 categories of neuromuscular attributes: strength, speed of movement, ROM, asymmetry, and trunk stability. It identifies novel attributes (leg velocity and trunk extensor muscle endurance) relevant to mobility and highlights that impairment profiles vary by the level of mobility assessed. These findings will inform the design of more thorough and potentially more effective disability prevention strategies.
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Affiliation(s)
| | | | - Nicole Holt
- Spaulding Rehabilitation Hospital, Boston, MA
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186
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Roaldsen KS, Halvarsson A, Sarlija B, Franzen E, Ståhle A. Self-reported function and disability in late life - cross-cultural adaptation and validation of the Swedish version of the late-life function and disability instrument. Disabil Rehabil 2013; 36:813-7. [PMID: 23944179 PMCID: PMC4046868 DOI: 10.3109/09638288.2013.819387] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Purpose To translate and perform a cross-cultural adaptation of the Late-Life Function and Disability Instrument (LLFDI) to Swedish, to investigate absolute and relative reliability, concurrent validity, and floor and ceiling effects within a Swedish-speaking sample of community-dwelling older adults with self-reported balance deficits and fear of falling. Method Translation, reliability and validation study of the LLFDI. Sixty-two community-dwelling, healthy older adults (54 women and 8 men) aged 68–88 years with balance deficits and fear of falling performed the LLFDI twice with an interval of 2 weeks. Results Test–retest agreement, intra-class correlation coefficient was very good, 0.87–0.91 in the LLFDI function component and 0.82–0.91 in the LLFDI disability component. The standard error of measure was small, 5–9%, and the smallest real difference was 14–24%. Internal consistency (Cronbach’s alpha) was high (0.90–0.96). Correlation with the SF-36 PCS and PF-10 was moderate in both LLFDI function, r = 0.39–0.68 and r = 0.35–0.52, and LLFDI disability, r = 0.40–0.63 and 0.34–0.57, respectively. There was no floor or ceiling effects. Conclusion The Swedish version of the LLFDI is a highly reliable and valid instrument for assessing function and disability in community-dwelling older women with self-reported balance deficits and fear of falling.Implications for Rehabilitation The Swedish LLFDI is a highly reliable and valid instrument for assessing function and disability in older women with self-reported balance deficits and fear of falling. The instrument may be used both in clinical settings and in research. The instrument is sensitive to change and a reasonably small improvement is enough to detect changes in a group or a single individual.
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Affiliation(s)
- Kirsti Skavberg Roaldsen
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy , Stockholm , Sweden
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187
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Hornyak V, Brach JS, Wert DM, Hile E, Studenski S, VanSwearingen JM. What is the relation between fear of falling and physical activity in older adults? Arch Phys Med Rehabil 2013; 94:2529-2534. [PMID: 23816923 DOI: 10.1016/j.apmr.2013.06.013] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 05/29/2013] [Accepted: 06/04/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To describe the association between fear of falling (FOF) and total daily activity in older adults. DESIGN Cross-sectional observational study. SETTING Ambulatory clinical research training center. PARTICIPANTS Community-dwelling older adults aged ≥64 years (N=78), who were independent in ambulation with or without an assistive device. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES FOF was defined by self-reported fear ratings using the Survey of Activities and Fear of Falling in the Elderly and self-reported fear status determined by response to the following question: Are you afraid of falling? Physical function was assessed using the Late Life Function and Disability Instrument. Physical activity was recorded using an accelerometer worn on the waist for 7 consecutive days, and mean daily counts of activity per minute were averaged over the 7-day period. RESULTS Fear ratings were related to total daily activity (r=-.26, P=.02). The relation was not as strong as the relation of function and physical activity (r=.45, P<.001). When stratified by exercise status or functional status, fear was no longer related to total daily activity. Physical function explained 19% of the variance in physical activity, whereas the addition of fear status did not add to the explained variance in physical activity. CONCLUSIONS FOF is related to total daily physical activity; however, FOF was not independently associated with physical activity when accounting for physical function. Some FOF may be reported as a limitation in function.
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Affiliation(s)
- Victoria Hornyak
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA.
| | - Jennifer S Brach
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA
| | - David M Wert
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA
| | - Elizabeth Hile
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA
| | - Stephanie Studenski
- Department of Medicine, Division of Geriatrics, University of Pittsburgh, Pittsburgh, PA
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188
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Bai X, Chow N. Chinese Elders' Self-Image and Their Perceived Peer-Image: Possibility of Self-Enhancement Bias. Int J Aging Hum Dev 2013; 77:1-16. [PMID: 23986977 DOI: 10.2190/ag.77.1.a] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Decades of research with Western participants has documented that there is a pervasive motivation for people to view themselves as better off than others while evidence for the existence of such self-enhancement bias (SEB) among East Asians varies considerably across studies. Considering the traditional culture of Confucius on modesty, the present study hypothesizes that there should be no significant SEB among Chinese elders. Structured face-to-face interviews were conducted with 445 older people in China-Wuhan, in which the revised Chinese version of Image of Aging Scale (IAS-C) was filled out. SEB was calculated by subtracting participants' ratings of “Peer-Image” (P) from their ratings of Self-Image (S). However, inconsistent with our hypothesis, a significant SEB was observed among the Chinese older participants and significant differences in the magnitude of SEB were discerned among older people in different characteristic groups. Possible explanations were further provided for the mismatch between Chinese values and the existence of SEB.
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Affiliation(s)
- Xue Bai
- The Hong Kong Polytechnic University
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189
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Lowry KA, Vanswearingen JM, Perera S, Studenski SA, Brach JS. Walking smoothness is associated with self-reported function after accounting for gait speed. J Gerontol A Biol Sci Med Sci 2013; 68:1286-90. [PMID: 23689828 DOI: 10.1093/gerona/glt034] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Gait speed has shown to be an indicator of functional status in older adults; however, there may be aspects of physical function not represented by speed but by the quality of movement. The purpose of this study was to determine the relations between walking smoothness, an indicator of the quality of movement based on trunk accelerations, and physical function. METHODS Thirty older adults (mean age, 77.7±5.1 years) participated. Usual gait speed was measured using an instrumented walkway. Walking smoothness was quantified by harmonic ratios derived from anteroposterior, vertical, and mediolateral trunk accelerations recorded during overground walking. Self-reported physical function was recorded using the function subscales of the Late-Life Function and Disability Instrument. RESULTS Anteroposterior smoothness was positively associated with all function components of the Late-Life Function and Disability Instrument, whereas mediolateral smoothness exhibited negative associations. Adjusting for gait speed, anteroposterior smoothness remained associated with the overall and lower extremity function subscales, whereas mediolateral smoothness remained associated with only the advanced lower extremity subscale. CONCLUSION These findings indicate that walking smoothness, particularly the smoothness of forward progression, represents aspects of the motor control of walking important for physical function not represented by gait speed alone.
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Affiliation(s)
- Kristin A Lowry
- PT, 3471 Fifth Avenue, Suite 500, Kaufmann Building, Pittsburgh, PA 15213.
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190
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Conway F, Magai C, Jones S, Fiori K, Gillespie M. A six-year follow-up study of social network changes among African-American, Caribbean, and U.S.-born Caucasian urban older adults. Int J Aging Hum Dev 2013; 76:1-27. [PMID: 23540157 DOI: 10.2190/ag.76.1.a] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study explores dynamic changes in network size and composition by examining patterns of older adults' social network change over time, that is: types of movements; the reason for the loss of network members; and the relation of movement and composition in concert. This study is a 6-year follow up of changes in the social networks of U.S.-Born Caucasian, African-American, and Caribbean older adults. One hundred and twenty-four community-dwelling older adults were interviewed during 2 data collection points over a 6-year period. Differences between Wave 1 and Wave 2 data were examined using paired sample t-tests confirmed with post-hoc tests and multivariate analyses. Results regarding types of movement showed that network changes were attributed to attrition--the "loss" of network members and a novel movement--the "addition" of network members not heretofore discussed. The results show an interaction between kinship status, ethnicity, and time--the attrition of non-kin members was underscored by ethnic differences. The type of network change was specific for type of network affiliation, such that children were more likely to be added to the networks of the young-old and kin were more likely to be lost in networks of the old-old. Older adults engage in social network interactions marked by compensatory processes beyond loss of network members such as social promotion and demotion. These social network processes are of emotional and functional significance for the older adult.
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Affiliation(s)
- Francine Conway
- Derner Institute of Advanced Psychological Studies, Adelphi University, Garden City 11530-0701, New York, USA.
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191
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Fried LP, Carlson MC, McGill S, Seeman T, Xue QL, Frick K, Tan E, Tanner EK, Barron J, Frangakis C, Piferi R, Martinez I, Gruenewald T, Martin BK, Berry-Vaughn L, Stewart J, Dickersin K, Willging PR, Rebok GW. Experience Corps: a dual trial to promote the health of older adults and children's academic success. Contemp Clin Trials 2013; 36:1-13. [PMID: 23680986 PMCID: PMC4112377 DOI: 10.1016/j.cct.2013.05.003] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 04/18/2013] [Accepted: 05/03/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND As the population ages, older adults are seeking meaningful, and impactful, post-retirement roles. As a society, improving the health of people throughout longer lives is a major public health goal. This paper presents the design and rationale for an effectiveness trial of Experience Corps™, an intervention created to address both these needs. This trial evaluates (1) whether senior volunteer roles within Experience Corps™ beneficially impact children's academic achievement and classroom behavior in public elementary schools and (2) impact on the health of volunteers. METHODS Dual evaluations of (1) an intention-to-treat trial randomizing eligible adults 60 and older to volunteer service in Experience Corps™, or to a control arm of usual volunteering opportunities, and (2) a comparison of eligible public elementary schools receiving Experience Corps™ to matched, eligible control schools in a 1:1 control:intervention school ratio. OUTCOMES For older adults, the primary outcome is decreased disability in mobility and Instrumental Activities of Daily Living (IADL). Secondary outcomes are decreased frailty, falls, and memory loss; slowed loss of strength, balance, walking speed, cortical plasticity, and executive function; objective performance of IADLs; and increased social and psychological engagement. For children, primary outcomes are improved reading achievement and classroom behavior in Kindergarten through the 3rd grade; secondary outcomes are improvements in school climate, teacher morale and retention, and teacher perceptions of older adults. SUMMARY This trial incorporates principles and practices of community-based participatory research and evaluates the dual benefit of a single intervention, versus usual opportunities, for two generations: older adults and children.
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Affiliation(s)
- Linda P Fried
- Mailman School of Public Health, Columbia University, New York, NY, USA.
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192
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Tate RB, Swift AU, Bayomi DJ. Older Men's Lay Definitions of Successful Aging over Time: The Manitoba Follow-up Study. Int J Aging Hum Dev 2013; 76:297-322. [DOI: 10.2190/ag.76.4.b] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The concept of “successful aging” has become widely accepted in gerontology, yet continues to have no common underlying definition. Researchers have increasingly looked to older individuals for their lay definitions of successful aging. The present analysis is based on responses to five questionnaires administered to surviving participants of the male Manitoba Follow-up Study cohort ( www.mfus.ca ) in 1996, 2000, 2002, 2004, and 2006 ( n = 2,043 men were alive at a mean age of 78 years in 1996). One question on each survey asked: “What is YOUR definition of successful aging?” Applying content analysis to the 5,898 narratives received over the 11 years, we developed a coding system encompassing 21 main themes and 86 sub-themes defining successful aging. We quantitatively analyzed trends in prevalence of themes of successful aging prospectively over time. Our findings empirically support colleagues' past suggestions to shift from defining successful aging in primarily biomedical terms, by taking lay views into account.
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193
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McAuley E, Wójcicki TR, Gothe NP, Mailey EL, Szabo AN, Fanning J, Olson EA, Phillips SM, Motl RW, Mullen SP. Effects of a DVD-delivered exercise intervention on physical function in older adults. J Gerontol A Biol Sci Med Sci 2013; 68:1076-82. [PMID: 23401566 DOI: 10.1093/gerona/glt014] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Given the rapidly increasing demographic of older adults, it is vital to implement effective behavioral strategies to improve physical function to maintain activities of daily living. However, changing physical activity in older adults remains extremely difficult. The current trial tested the efficacy of a novel, 6-month, home-based, DVD-delivered exercise program focusing on flexibility, balance, and toning on the physical function of older adults. METHODS Older adults (N = 307) were recruited from 83 towns and cities throughout central Illinois. The trial consisted of 4 waves of recruitment and randomization from May 2010 through January 2012. Inclusion criteria included being inactive, at least 65 years of age, English speaking, providing physician's consent, and willingness to be randomized. Eligible participants were randomly assigned to 1 of 2 treatment conditions: the exercise intervention or a healthy aging, attentional control. Functional assessments were completed at baseline and following the 6-month DVD intervention. Measures included the Short Physical Performance Battery, assessments of flexibility and strength, and self-reported functional limitations. RESULTS Participants in the DVD intervention condition demonstrated significant improvements in the Short Physical Performance Battery (p = .005), lower extremity flexibility (p = .04), and upper body strength (p = .003). There were no effects of the intervention on self-reported functional limitations. CONCLUSIONS The exercise intervention produced a clinically significant improvement in the Short Physical Performance Battery and improvements in flexibility and strength, demonstrating the effectiveness of a low-cost DVD exercise program in improving physical function in older adults.
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Affiliation(s)
- Edward McAuley
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, 906 S. Goodwin Avenue, Urbana, IL 61801, USA.
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195
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Cabrero-García J, Ramos-Pichardo JD, Muñoz-Mendoza CL, Cabañero-Martínez MJ, González-Llopis L, Reig-Ferrer A. Validation of a mobility item bank for older patients in primary care. Health Qual Life Outcomes 2012; 10:147. [PMID: 23216846 PMCID: PMC3547751 DOI: 10.1186/1477-7525-10-147] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2012] [Accepted: 11/29/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To develop and validate an item bank to measure mobility in older people in primary care and to analyse differential item functioning (DIF) and differential bundle functioning (DBF) by sex. METHODS A pool of 48 mobility items was administered by interview to 593 older people attending primary health care practices. The pool contained four domains based on the International Classification of Functioning: changing and maintaining body position, carrying, lifting and pushing, walking and going up and down stairs. RESULTS The Late Life Mobility item bank consisted of 35 items, and measured with a reliability of 0.90 or more across the full spectrum of mobility, except at the higher end of better functioning. No evidence was found of non-uniform DIF but uniform DIF was observed, mainly for items in the changing and maintaining body position and carrying, lifting and pushing domains. The walking domain did not display DBF, but the other three domains did, principally the carrying, lifting and pushing items. CONCLUSIONS During the design and validation of an item bank to measure mobility in older people, we found that strength (carrying, lifting and pushing) items formed a secondary dimension that produced DBF. More research is needed to determine how best to include strength items in a mobility measure, or whether it would be more appropriate to design separate measures for each construct.
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Affiliation(s)
- Julio Cabrero-García
- Department of Nursing, University of Alicante, San Vicente del Raspeig, Alicante, Spain.
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Martin P, Deshpande-Kamat N, Margrett JA, Franke W, Garasky S. Exceptional Longevity: An Introduction to the IOWA Centenarian Study. Int J Aging Hum Dev 2012; 75:297-316. [DOI: 10.2190/ag.75.4.a] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The primary objective of the Iowa Centenarian Study is to further our understanding of determinants of exceptional longevity above and beyond health outcomes, particularly in rural environments. This introductory article provides a general overview of the study, its methodology and basic descriptive results. One hundred and fifty-two centenarians from a rural state participated in the study (average age was 101.6 years). Baseline data collection included questions on demographics, cognitive representation of being a centenarian, mental status, past family history, life events, activities of daily living, coping, physical health and health history, nutrition, exercise, personality, social support, mental health, economic status and perceptions, and fatigue. A subset of the baseline sample (n = 28) participated in a short-term longitudinal study that assessed stability and change in mental status, mental health, and activity. Four additional papers in this issue (Franke, Margrett, Heinz, & Martin, 2012; Garasky, Martin, Margrett, & Cho, 2012; Margrett, Hsieh, Heinz, & Martin, 2012; Martin, da Rosa, Margrett, Garasky, & Franke, 2012) will highlight substantive findings, including longitudinal analyses, in activities of daily living, economic status, mental status, and positive and negative affect.
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Franke WD, Margrett JA, Heinz M, Martin P. Handgrip Strength, Positive Affect, and Perceived Health are Prospectively Associated with Fewer Functional Limitations among Centenarians. Int J Aging Hum Dev 2012; 75:351-63. [DOI: 10.2190/ag.75.4.d] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study assessed the association between perceived health, fatigue, positive and negative affect, handgrip strength, objectively measured physical activity, body mass index, and self-reported functional limitations, assessed 6 months later, among 11 centenarians (age = 102 ± 1). Activities of daily living, assessed 6 months prior to assessment of functional limitations, were also included in the model. Handgrip strength, positive affect, and self-rated current health were associated with higher functioning, expressed as either global, upper body, or lower body functioning (r > .60). Objectively measured physical activity was inversely related to the aforementioned measures of functioning. Thus, physical health as assessed by handgrip strength, but not by physical activity, is associated with better functioning in centenarians.
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Robinson MJ, Burd NA, Breen L, Rerecich T, Yang Y, Hector AJ, Baker SK, Phillips SM. Dose-dependent responses of myofibrillar protein synthesis with beef ingestion are enhanced with resistance exercise in middle-aged men. Appl Physiol Nutr Metab 2012; 38:120-5. [PMID: 23438221 DOI: 10.1139/apnm-2012-0092] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Aging impairs the sensitivity of skeletal muscle to anabolic stimuli, such as amino acids and resistance exercise. Beef is a nutrient-rich source of dietary protein capable of stimulating muscle protein synthesis (MPS) rates in older men at rest. To date, the dose-response of myofibrillar protein synthesis to graded ingestion of protein-rich foods, such as beef, has not been determined. We aimed to determine the dose-response of MPS with and without resistance exercise to graded doses of beef ingestion. Thirty-five middle-aged men (59 ± 2 years) ingested 0 g, 57 g (2 oz; 12 g protein), 113 g (4 oz; 24 g protein), or 170 g (6 oz; 36 g protein) of (15% fat) ground beef (n = 7 per group). Subjects performed a bout of unilateral resistance exercise to allow measurement of the fed state and the fed plus resistance exercise state within each dose. A primed constant infusion of l-[1-(13)C]leucine was initiated to measure leucine oxidation and of l-[ring-(13)C(6)]phenylalanine was initiated to measure myofibrillar MPS. Myofibrillar MPS was increased with ingestion of 170 g of beef to a greater extent than all other doses at rest and after resistance exercise. There was more leucine oxidation with ingestion of 113 g of beef than with 0 g and 57 g, and it increased further after ingestion of 170 g of beef (all p < 0.05). Ingestion of 170 g of beef protein is required to stimulate a rise in myofibrillar MPS over and above that seen with lower doses. An isolated bout of resistance exercise was potent in stimulating myofibrillar MPS, and acted additively with feeding.
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Affiliation(s)
- Meghann J Robinson
- Exercise Metabolism Research Group, Department of Kinesiology, McMaster University, 1280 Main St. West, Hamilton, ON L8S 4K1, Canada
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Zech A, Drey M, Freiberger E, Hentschke C, Bauer JM, Sieber CC, Pfeifer K. Residual effects of muscle strength and muscle power training and detraining on physical function in community-dwelling prefrail older adults: a randomized controlled trial. BMC Geriatr 2012; 12:68. [PMID: 23134737 PMCID: PMC3538686 DOI: 10.1186/1471-2318-12-68] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 11/03/2012] [Indexed: 02/07/2023] Open
Abstract
Background Although resistance exercise interventions have been shown to be beneficial in prefrail or frail older adults it remains unclear whether there are residual effects when the training is followed by a period of detraining. The aim of this study was to establish the sustainability of a muscle power or muscle strength training effect in prefrail older adults following training and detraining. Methods 69 prefrail community-dwelling older adults, aged 65–94 years were randomly assigned into three groups: muscle strength training (ST), muscle power training (PT) or controls. The exercise interventions were performed for 60 minutes, twice a week over 12 weeks. Physical function (Short Physical Performance Battery=SPPB), muscle power (sit-to-stand transfer=STS), self-reported function (SF-LLFDI) and appendicular lean mass (aLM) were measured at baseline and at 12, 24 and 36 weeks after the start of the intervention. Results For the SPPB, significant intervention effects were found at 12 weeks in both exercise groups (ST: p = 0.0047; PT: p = 0.0043). There were no statistically significant effects at 24 and 36 weeks. In the ST group, the SPPB declined continuously after stop of exercising whereas the PT group and controls remained unchanged. No effects were found for muscle power, SF-LLFDI and aLM. Conclusions The results showed that both intervention types are equally effective at 12 weeks but did not result in statistically significant residual effects when the training is followed by a period of detraining. The unchanged SPPB score at 24 and 36 weeks in the PT group indicates that muscle power training might be more beneficial than muscle strength training. However, more research is needed on the residual effects of both interventions. Taken the drop-out rates (PT: 33%, ST: 21%) into account, muscle power training should also be used more carefully in prefrail older adults. Trial registration This trial has been registered with clinicaltrials.gov (NCT00783159)
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Affiliation(s)
- Astrid Zech
- Department of Movement Science, University of Hamburg, Hamburg, Germany.
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Koo JP, Moon OK. Effect of Aerobic Exercise on Cognitive Function in the Elderly persons. ACTA ACUST UNITED AC 2012. [DOI: 10.5854/jiaptr.2012.10.30.453] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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