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Wu S, Guo Y, Cao Z, Nan J, Zhang Q, Hu M, Ning H, Huang W, Xiao LD, Feng H. Effects of Otago exercise program on physical function in older adults: A systematic review and meta-analysis of randomized controlled trials. Arch Gerontol Geriatr 2024; 124:105470. [PMID: 38718487 DOI: 10.1016/j.archger.2024.105470] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 04/21/2024] [Accepted: 05/01/2024] [Indexed: 06/17/2024]
Abstract
BACKGROUND Maintaining physical function is critical for older adults to achieve healthy aging. The Otago exercise program (OEP) has been widely used to prevent falls for older adults. However, the effects of OEP on physical function remain controversial and the possible effects modifiers have not been assessed. OBJECTIVE To evaluate the effects of OEP on physical function in older adults and to explore potential moderators underlying the effects of OEP. METHODS We searched five electronic databases and relevant systematic reviews to identify studies. We included randomized controlled trials (RCTs) evaluating the effects of OEP as a single intervention on physical function among older adults aged 65 and over. Meta-analysis was performed using the random-effects model. Standardized mean differences (SMD) for physical function changes, pertinent to balance, strength, and mobility, were outcome measures. Subgroup analyses on exercise protocol and participants' characteristics were performed. RESULTS Thirteen RCTs consisting of 2402 participants were included in this systematic review and meta-analysis. Results indicated a significant effect of OEP on balance (SMD = 0.59, 95 % CI: 0.22∼0.96), lower body strength (SMD = 0.93, 95 % CI: 0.31∼1.55), and mobility (SMD = -0.59, 95 % CI: -0.95∼-0.22) against control groups. No significant OEP effects were found on upper body strength (MD = 1.48, 95 % CI: -0.58∼3.55). Subgroup analysis revealed that the video-supported delivery mode was more effective for improving balance (P = 0.04) and mobility (P = 0.02) than the face-to-face mode. Session durations over 30 min was more effective on lower body strength (P < 0.001) and mobility (P < 0.001) than those 1-30 min. Program period of 13-26 weeks was more effective on mobility (P = 0.02) than those of 4-12 weeks. However, the effects of OEP on physical function were not associated with age groups, and baseline falling risks. CONCLUSION The OEP could improve physical function including balance, lower body strength, and mobility in older adults. Implementing the OEP in video-supported, more than 30 min per session and 4-12 weeks may be the most appropriate and effective exercise protocol for improving physical function among older adults. More RCTs with rigorous design and larger scale are needed to further assess the effectiveness of diverse OEP protocols and quantify the dose-effect relationship.
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Affiliation(s)
- Shuang Wu
- Xiangya School of Nursing, Central South University, China; College of Nursing and Health Sciences, Flinders University, Australia
| | - Yongzhen Guo
- Xiangya School of Nursing, Central South University, China
| | - Zeng Cao
- Division of Cardiac Rehabilitation, Department of Physical Medicine & Rehabilitation, Xiangya Hospital, Central South University, China
| | - Jiahui Nan
- The first affiliated hospital of Zhengzhou University, Zhengzhou University, China
| | - Qiuxiang Zhang
- The Third Xiangya Hospital, Central South University, China
| | - Mingyue Hu
- Xiangya School of Nursing, Central South University, China
| | - Hongting Ning
- Xiangya School of Nursing, Central South University, China
| | - Weiping Huang
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, China
| | - Lily Dongxia Xiao
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia.
| | - Hui Feng
- Xiangya School of Nursing, Central South University, China; Xiangya-Oceanwide Health Management Research Institute, Central South University, China; Xiangya Research Center of Evidence-Based Healthcare, Central South University, China.
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Özata Değerli MN, Şahİn S, Altuntaş O, Uyanık M, Yılmaz AA, Yiğit AY, Uçan A, Yapar IL. The effect of CLOSER-computer-based exercise program in older adults with a history of falls: A pilot study. Assist Technol 2024; 36:302-308. [PMID: 38381129 DOI: 10.1080/10400435.2024.2315412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2024] [Indexed: 02/22/2024] Open
Abstract
CLOSER is a computer-based exercise program that aims to improve older adults' health, fitness and social lives. This pilot study aimed to examine the effect of CLOSER, the first computer-based exercise program developed for older adults on a national scale, on those with a history of falls. Forty-eight older adults (71.33 ± 7.47) with a history of falling at least once in the last year were included in the study. Older adults performed CLOSER exercises for (balance maintenance, neck rotation, rhythmic walking, knee flexion and trunk rotation) 2 sessions per week for eight weeks. All individuals were evaluated at baseline and the end of the eighth week. The primary outcome measures were the 30-s Chair-Stand Test (p = 0.002), the Berg Balance Scale (p = 0.002), the Falls Efficacy Scale International (p = 0.003), the Timed Up and Go Test (p = 0.008) and the motivation level (p = 0.007) statistically significant improvements were observed. The results show that a CLOSER-computer-based exercise program effectively increases balance and reduces the risk and fear of falling. In the future, CLOSER could significantly contribute to the healthcare system as an alternative aid for home-based exercise.
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Affiliation(s)
- Medine Nur Özata Değerli
- Faculty of Health Sciences, Department of Occupational Therapy, Hacettepe University, Ankara, Turkey
| | - Sedef Şahİn
- Faculty of Health Sciences, Department of Occupational Therapy, Hacettepe University, Ankara, Turkey
| | - Onur Altuntaş
- Faculty of Health Sciences, Department of Occupational Therapy, Hacettepe University, Ankara, Turkey
| | - Mine Uyanık
- Faculty of Health Sciences, Department of Occupational Therapy, Hacettepe University, Ankara, Turkey
| | - Adem Ali Yılmaz
- Health Information Science and Systems, Tiga Information Technologies Inc, Ankara, Turkey
| | - Ali Yaşar Yiğit
- Health Information Science and Systems, Tiga Information Technologies Inc, Ankara, Turkey
| | - Alaettin Uçan
- Health Information Science and Systems, Tiga Information Technologies Inc, Ankara, Turkey
| | - I Lyas Yapar
- Health Information Science and Systems, Tiga Information Technologies Inc, Ankara, Turkey
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Sharma N, Kumar P, Kaur S, Sharma N. Effects of 8 Weeks of Balance Training, Virtual Training, and Combined Exercise on Lower Limb Muscle Strength Balance, and Functional Mobility Among Older Men: A Randomized Controlled Trial: Letter to the Editor. Sports Health 2024; 16:664-666. [PMID: 37246555 PMCID: PMC11195871 DOI: 10.1177/19417381231175478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
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Zhou M, Zhang G, Wang N, Zhao T, Liu Y, Geng Y, Zhang J, Wang N, Peng N, Huang L. A novel score for predicting falls in community-dwelling older people: a derivation and validation study. BMC Geriatr 2024; 24:491. [PMID: 38834944 DOI: 10.1186/s12877-024-05064-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 05/09/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND Early detection of patients at risk of falling is crucial. This study was designed to develop and internally validate a novel risk score to classify patients at risk of falls. METHODS A total of 334 older people from a fall clinic in a medical center were selected. Least absolute shrinkage and selection operator (LASSO) regression was used to minimize the potential concatenation of variables measured from the same patient and the overfitting of variables. A logistic regression model for 1-year fall prediction was developed for the entire dataset using newly identified relevant variables. Model performance was evaluated using the bootstrap method, which included measures of overall predictive performance, discrimination, and calibration. To streamline the assessment process, a scoring system for predicting 1-year fall risk was created. RESULTS We developed a new model for predicting 1-year falls, which included the FRQ-Q1, FRQ-Q3, and single-leg standing time (left foot). After internal validation, the model showed good discrimination (C statistic, 0.803 [95% CI 0.749-0.857]) and overall accuracy (Brier score, 0.146). Compared to another model that used the total FRQ score instead, the new model showed better continuous net reclassification improvement (NRI) [0.468 (0.314-0.622), P < 0.01], categorical NRI [0.507 (0.291-0.724), P < 0.01; cutoff: 0.200-0.800], and integrated discrimination [0.205 (0.147-0.262), P < 0.01]. The variables in the new model were subsequently incorporated into a risk score. The discriminatory ability of the scoring system was similar (C statistic, 0.809; 95% CI, 0.756-0.861; optimism-corrected C statistic, 0.808) to that of the logistic regression model at internal bootstrap validation. CONCLUSIONS This study resulted in the development and internal verification of a scoring system to classify 334 patients at risk for falls. The newly developed score demonstrated greater accuracy in predicting falls in elderly people than did the Timed Up and Go test and the 30-Second Chair Sit-Stand test. Additionally, the scale demonstrated superior clinical validity for identifying fall risk.
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Affiliation(s)
- Ming Zhou
- Department of Rehabilitation Medicine, The First Medical Center of Chinese PLA General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
| | - Gongzi Zhang
- Department of Rehabilitation Medicine, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Na Wang
- Department of Rehabilitation Medicine, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Tianshu Zhao
- Department of Rehabilitation Medicine, The First Medical Center of Chinese PLA General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
| | - Yangxiaoxue Liu
- Department of Rehabilitation Medicine, The First Medical Center of Chinese PLA General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
| | - Yuhan Geng
- Department of Rehabilitation Medicine, The First Medical Center of Chinese PLA General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
| | - Jiali Zhang
- Department of Rehabilitation Medicine, The First Medical Center of Chinese PLA General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
| | - Ning Wang
- Department of Rehabilitation Medicine, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Nan Peng
- Department of Rehabilitation Medicine, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China.
| | - Liping Huang
- Department of Rehabilitation Medicine, The First Medical Center of Chinese PLA General Hospital, Beijing, China.
- Department of Rehabilitation Medicine, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China.
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Zhang K, Yang Z, Zhang X, Li L. Comparison of falls and risk factors among older adults in urban villages, urban and rural areas of Shantou, China. Heliyon 2024; 10:e30536. [PMID: 38737229 PMCID: PMC11087945 DOI: 10.1016/j.heliyon.2024.e30536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 04/28/2024] [Accepted: 04/29/2024] [Indexed: 05/14/2024] Open
Abstract
Objective To investigate and compare the differences between the incidence of falls, balance and living environment among older persons in urban villages and other types of residential areas. Methods We surveyed 580 older adults living in different types of residential areas in Shantou, China, surveying basic information, fall incidence, balance ability testing of older persons, home environment safety assessment. Results The incidence of falls among older people in urban villages (19.54 %) was between urban areas(26.63 %) and rural areas(16.91 %). The influencing factors of falls in different residential types were different. Near-fall, abnormal bowel movement, and impaired balance ability were the risk factors of falls among older persons in urban villages. Divorce/single, fair and poor hearing loss and near-fall were the risk factors of falls in urban older adults. Frailty and impaired balance ability were the risk factors of falls in rural older people. Conclusions Risk factors for falls in older people vary according to the characteristics of their living areas and relevant interventions should be targeted according to the characteristics of falls occurring in different residential areas.
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Affiliation(s)
- Kaiting Zhang
- School of Public Health, Shantou University, Shantou, Guangdong Province, China
- Cancer Hospital of Shantou University Medical College, Shantou, Guangdong Province, China
- Injury Prevention Research Center, Shantou University Medical College, Shantou, Guangdong Province, China
| | - Zidan Yang
- School of Public Health, Shantou University, Shantou, Guangdong Province, China
- Injury Prevention Research Center, Shantou University Medical College, Shantou, Guangdong Province, China
- Shantou Central Hospital, Shantou, Guangdong Province, China
| | - Xiaowei Zhang
- School of Public Health, Shantou University, Shantou, Guangdong Province, China
- Injury Prevention Research Center, Shantou University Medical College, Shantou, Guangdong Province, China
| | - Liping Li
- School of Public Health, Shantou University, Shantou, Guangdong Province, China
- Injury Prevention Research Center, Shantou University Medical College, Shantou, Guangdong Province, China
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Alsaqer H, Rababah JA, Al-Hammouri MM, Barbarawi MM, Suliman M. The Effect of the Stopping Elderly Accidents, Deaths, and Injuries Program on Falls Prevention in Neurosurgical Patients. J Neurosci Nurs 2024; 56:92-98. [PMID: 38598842 DOI: 10.1097/jnn.0000000000000753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
ABSTRACT BACKGROUND: Despite the negative consequences of falls among neurosurgery patients in acute care settings, there is a lack of high-quality evidence for successful fall prevention programs. This study was conducted to evaluate the effectiveness of the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) program on falling prevention compared with routine falling protocol in neurosurgical patients in Jordan. METHODS: A prospective quasi-experimental design was used in this study. The sample comprised 70 neurosurgical patients from a major university-affiliated hospital in Jordan. The study sample was assigned into a control group (35 patients) and an intervention group (35 patients). A demographics questionnaire, and different fall risk screening tools and tests were used in this study as recommended by the STEADI program. RESULTS: Multivariate analysis of variance results showed a significant effect ( P = .001) of the STEADI program on the linear combination of outcome measures. Independent samples t tests further confirmed the program's effectiveness, with statistically significant mean differences in most outcome measures between the intervention and control groups post intervention. After implementing the study intervention, participants in the intervention group had a statistically significant lower risk for falls. CONCLUSION: The findings indicate potential effectiveness in improving neurosurgery patients' outcomes and reducing the risk of falls. Implementing the study recommendations can enhance patient safety and promote evidence-based fall prevention interventions in neurosurgery patients.
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Hager AGM, Mathieu N, Carrard S, Bridel A, Wapp C, Hilfiker R. Partially supervised exercise programmes for fall prevention improve physical performance of older people at risk of falling: a three-armed multi-centre randomised controlled trial. BMC Geriatr 2024; 24:311. [PMID: 38570773 PMCID: PMC10993430 DOI: 10.1186/s12877-024-04927-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 03/28/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Falls have a major impact on individual patients, their relatives, the healthcare system and related costs. Physical exercise programmes that include multiple categories of exercise effectively reduce the rate of falls and risk of falling among older adults. METHODS This 12-month, assessor-blinded, three-armed multicentre randomised clinical trial was conducted in adults aged ≥ 65 years identified as at risk of falling. Four hundred and five participants were randomly allocated into 3 groups: experimental group (n = 166) with the Test&Exercise partially supervised programme based on empowerment delivered with a tablet, illustrated manual and cards, reference group (n = 158) with the Otago partially supervised programme prescribed by a physiotherapist delivered with an illustrated manual and control group (n = 81) with the Helsana self-administrated programme delivered with cards. Experimental and reference groups received partially supervised programmes with 8 home sessions over 6 months. Control group received a self-administered program with a unique home session. The 3 groups were requested to train independently 3 times a week for 12 months. Primary outcome was the incidence rate ratio of self-reported falls over 12 months. Secondary outcomes were fear of falling, basic functional mobility and balance, quality of life, and exercise adherence. RESULTS A total of 141 falls occurred in the experimental group, 199 in the reference group, and 42 in the control group. Incidence rate ratios were 0.74 (95% CI 0.49 to 1.12) for the experimental group and 0.43 (95% CI 0.25 to 0.75) for the control group compared with the reference group. The Short Physical Performance Battery scores improved significantly in the experimental group (95% CI 0.05 to 0.86; P = 0.027) and in the reference group (95% CI 0.06 to 0.86; P = 0.024) compared with the control group. CONCLUSION The self-administered home-based exercise programme showed the lowest fall incidence rate, but also the highest dropout rate of participants at high risk of falling. Both partially supervised programmes resulted in statistically significant improvements in physical performance compared with the self-administered programme. TRIAL REGISTRATION NCT02926105. CLINICALTRIALS gov. Date of registration: 06/10/2016.
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Affiliation(s)
- Anne-Gabrielle Mittaz Hager
- School of Health Sciences, HES-SO Valais-Wallis, University of Applied Sciences and Arts Western Switzerland, Valais, Sion, Switzerland.
- School of Health Sciences, HES-SO Valais-Wallis, Rathaustrasse 25, 3941, Leukerbad, Switzerland.
| | - Nicolas Mathieu
- School of Health Sciences, HES-SO Valais-Wallis, University of Applied Sciences and Arts Western Switzerland, Valais, Sion, Switzerland
| | - Sophie Carrard
- School of Health Sciences, HES-SO Valais-Wallis, University of Applied Sciences and Arts Western Switzerland, Valais, Sion, Switzerland
| | - Alice Bridel
- Bern University of Applied Sciences, Department of Health Professions, Bern, Switzerland
| | - Christina Wapp
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Roger Hilfiker
- School of Health Sciences, HES-SO Valais-Wallis, University of Applied Sciences and Arts Western Switzerland, Valais, Sion, Switzerland
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Huang S, Wang Z, Wu Q, Fan J, Luo J. Combined effect of falling difficulty and cardiovascular diseases on the risk of all-cause and cardiovascular mortality in older adults: an analysis of the National Health and Nutrition Examination Survey. Eur Geriatr Med 2024; 15:345-357. [PMID: 38032478 DOI: 10.1007/s41999-023-00897-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 10/31/2023] [Indexed: 12/01/2023]
Abstract
PURPOSE Older adults with cardiovascular diseases (CVD) are prone to falls. This study aimed to analyze the combined effect of falling difficulty and CVD on the risk of all-cause- and CVD mortality in older adults. METHODS In this retrospective cohort study, people aged ≥60 years with information on falling difficulty and CVD from the 1999-2004 National Health and Nutrition Examination Survey (NHANES) were selected. Multivariable Cox proportional hazards regression model was used to assess the associations of falling difficulty and CVD with all-cause- and CVD mortality. RESULTS A total of 1409 participants were included, of whom 868 (58.1%) participants died, and 237 (15.0%) died of CVD. The mean age of participants was 72.1 (0.3) years and 825 (64.7%) were female. Older adults with falling difficulty or CVD were associated with an increased risk of all-cause- and CVD mortality. Older adults in the no falling difficulty & CVD group [hazard ratio (HR) = 1.45, 95% confidence interval (CI) 1.19-1.78], the falling difficulty & no CVD group (HR = 1.45, 95%CI 1.12-1.89), and the falling difficulty & CVD group (HR = 2.13, 95%CI 1.77-2.56) were related to a higher risk of all-cause mortality compared to those in the no falling difficulty & no CVD group. The combined effect of falling difficulty and CVD was positively correlated with the risk of all-cause mortality (HR = 1.26, 95%CI: 1.18-1.34; P-trend <0.001) and CVD mortality (HR = 1.36, 95%CI: 1.18-1.56; P-trend <0.001). CONCLUSION The combined effect of falling difficulty and CVD was positively associated with the risk of all-cause- and CVD mortality in older adults.
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Affiliation(s)
- Sheng Huang
- Department of Gerontology, Mindong Hospital Affiliated to Fujian Medical University, Fujian, 355000, People's Republic of China
| | - Zhigang Wang
- Department of Gerontology, Mindong Hospital Affiliated to Fujian Medical University, Fujian, 355000, People's Republic of China
| | - Qiaohong Wu
- Department of Gerontology, Mindong Hospital Affiliated to Fujian Medical University, Fujian, 355000, People's Republic of China
| | - Jinmao Fan
- Department of Gerontology, Mindong Hospital Affiliated to Fujian Medical University, Fujian, 355000, People's Republic of China
| | - Ji Luo
- Traditional Chinese Medicine Rheumatic Immunology Department, People's Hospital of Chongqing Banan District, No.659, Yunan Street, Banan District, Chongqing, 401320, People's Republic of China.
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Chen R, Guo Y, Kuang Y, Zhang Q. Effects of home-based exercise interventions on post-stroke depression: A systematic review and network meta-analysis. Int J Nurs Stud 2024; 152:104698. [PMID: 38290424 DOI: 10.1016/j.ijnurstu.2024.104698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 01/11/2024] [Accepted: 01/12/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND Post-stroke depression (PSD) is a common and persistent mental disorder that negatively impacts stroke outcomes. Exercise-based interventions have been shown to be an effective non-pharmacological treatment for improving depression in patients with mild stroke, but no reviews have yet synthesized the effects of home-based exercise on PSD. OBJECTIVE The purpose of this systematic review and network meta-analysis was to synthesize the available evidence to compare the effectiveness of different types of home-based exercise programs on PSD and identify the optimal home-based exercise modality to inform clinical decision-making for the treatment of PSD. METHODS PubMed, Embase, the Cochrane Library, CINAHL, and PsycINFO were systematically searched from their inception dates to March 7, 2023. We searched for randomized controlled trials (RCTs) of home-based exercise for PSD in adults aged 18 years and older. Only scores of depression retrieved directly post-treatment were included as the primary endpoint for the analysis. Version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB-2) was used to assess the quality of included studies. We conducted traditional pairwise meta-analysis for direct comparisons using Review Manager 5.4.1, followed by network meta-analysis using Stata 15.1 for both the network evidence plot and analysis. The surface under the cumulative ranking curve (SUCRA) was used to estimate the intervention hierarchy. The protocol was registered with PROSPERO under registration number CRD42022363784. RESULTS A total of 517 participants from nine RCTs were included. Based on the ranking probabilities, mind-body exercise was the most effective way in improving PSD (SUCRA: 90.4 %, Hedges' g: -0.59, 95 % confidence interval [CI]: -1.16 to -0.02), followed by flexibility/neuro-motor skills training (SUCRA: 42.9 %, Hedges' g: -0.10, 95 % CI: -0.70 to 0.49), and aerobic exercise (SUCRA: 39.3 %, Hedges' g: -0.07, 95 % CI: -0.81 to 0.67). We performed a subgroup analysis of mind-body exercise. In mind-body exercise interventions, Tai Chi was the most effective way to improve PSD (SUCRA: 99.4 %, Hedges' g: -0.94, 95 % CI: -1.28 to -0.61). CONCLUSIONS Our network meta-analysis that provides evidence with very low certainty indicates potential benefits of home-based exercise for alleviating PSD, with mind-body exercises, notably Tai Chi, showing promise as an effective treatment. However, further rigorous studies are needed to solidify these findings. Specifically, multicenter RCTs comparing specific exercises to no intervention are crucial, assessing not only efficacy but also dose, reach, fidelity, and long-term effects for real-world optimization.
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Affiliation(s)
- Rong Chen
- Sun Yat Sen University, School of Nursing, 74 Zhongshan 2nd Rd, Guangzhou 510080, Guangdong, China
| | - Yijia Guo
- Sun Yat Sen University, School of Nursing, 74 Zhongshan 2nd Rd, Guangzhou 510080, Guangdong, China
| | - Yashi Kuang
- Sun Yat Sen University, School of Nursing, 74 Zhongshan 2nd Rd, Guangzhou 510080, Guangdong, China
| | - Qi Zhang
- Sun Yat Sen University, School of Nursing, 74 Zhongshan 2nd Rd, Guangzhou 510080, Guangdong, China.
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Marmor S, Karaca-Mandic P, Adams ME. Physical Therapy And Risk of Falls Among Patients With Dizziness-Reply. JAMA Otolaryngol Head Neck Surg 2024; 150:356-357. [PMID: 38358769 DOI: 10.1001/jamaoto.2023.4693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Affiliation(s)
- Schelomo Marmor
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis
- Department of Surgery, University of Minnesota, Minneapolis
- Center for Clinical Quality & Outcomes Discovery and Evaluation (C-QODE), University of Minnesota, Minneapolis
| | - Pinar Karaca-Mandic
- Department of Finance, Carlson School of Management, University of Minnesota, Minneapolis
| | - Meredith E Adams
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis
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Wu HT, Tung CC, Chang R. Physical Therapy and Risk of Falls Among Patients With Dizziness. JAMA Otolaryngol Head Neck Surg 2024; 150:356. [PMID: 38358768 DOI: 10.1001/jamaoto.2023.4692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Affiliation(s)
- Hsin-Tien Wu
- Department of Otorhinolaryngology- Head& Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chung-Chu Tung
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Renin Chang
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Department of Emergency Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Department of Recreation and Sports Management, Tajen University, Pingtung, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
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van Dijk M, Allegaert P, Locus M, Saenen L, Breuls S, Michiels D, Vermeulen L, Jannes S, Van Kerckhoven Y, Tournoy J, Verheyden G, Flamaing J. In-hospital rehabilitation with the Geriatric Activation Program Pellenberg improves functional performance in a heterogeneous geriatric population. Physiother Theory Pract 2024; 40:755-766. [PMID: 36576257 DOI: 10.1080/09593985.2022.2162356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 12/19/2022] [Accepted: 12/19/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Regaining independent living can be challenging in patients undergoing inpatient geriatric rehabilitation. Given the paucity of evidence-based physiotherapy programs for this particular heterogeneous group, the Geriatric Activation Program Pellenberg (GAPP) was developed. PURPOSE Investigate the evolution of functional performance, and predict detectable changes throughout 4 weeks of GAPP. Methods: Participants in this observational study (2017-2019) followed GAPP as part of their rehabilitation program. Functional balance (Berg balance scale (BBS)) and independence (Katz scale) were the primary outcomes, with gait speed, elbow and knee extension strength, cognitive processing speed, and mood as secondary outcomes. All outcomes were assessed at baseline, 2 weeks and 4 weeks later. Prediction analysis was conducted using logistic regression modeling. Previously reported minimal detectable change with 95% confidence interval (MDC95) was used as detectable change. RESULTS We recruited 111 participants, with 83 completing 4 weeks of GAPP and all assessments. Over 4 weeks, all outcome measures showed a significant improvement (p ≤ .007). Detectable change was found for BBS (mean improvement of 12.8 points (95% CI: 10.9-14.8), MDC95 = 6.6) and gait speed (mean improvement of 0.24 m/s (95% CI: 0.19-0.29), MDC95 = 0.1 m/s). We found that baseline scores lower than 26 on the BBS (75% sensitivity, 65% specificity) and gait speed lower than 0.34 m/s (53% sensitivity, 81% specificity) were associated with participants achieving detectable change at 4 weeks on BBS and gait speed, respectively. CONCLUSION Functional performance of a heterogeneous group of geriatric inpatients improved notably after 4 weeks of GAPP. Baseline scores on BBS and gait speed can partially predict detectable changes in functional performance.
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Affiliation(s)
- Margaretha van Dijk
- Department of Physical Medicine and Rehabilitation, UZ Leuven, Campus Pellenberg, Pellenberg, Belgium
| | - Patsy Allegaert
- Department of Physical Medicine and Rehabilitation, UZ Leuven, Campus Pellenberg, Pellenberg, Belgium
| | - Marlies Locus
- Department of Physical Medicine and Rehabilitation, UZ Leuven, Campus Pellenberg, Pellenberg, Belgium
| | - Leen Saenen
- Department of Rehabilitation Sciences, KU Leuven, Gymnasium, Leuven, Belgium
| | - Sofie Breuls
- Department of Rehabilitation Sciences, KU Leuven, Gymnasium, Leuven, Belgium
| | - Demi Michiels
- Department of Rehabilitation Sciences, KU Leuven, Gymnasium, Leuven, Belgium
| | - Lien Vermeulen
- Department of Rehabilitation Sciences, KU Leuven, Gymnasium, Leuven, Belgium
| | - Stefanie Jannes
- Department of Rehabilitation Sciences, KU Leuven, Gymnasium, Leuven, Belgium
| | | | - Jos Tournoy
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
- Department of Geriatric Medicine, UZ Leuven, Leuven, Belgium
| | - Geert Verheyden
- Department of Physical Medicine and Rehabilitation, UZ Leuven, Campus Pellenberg, Pellenberg, Belgium
- Department of Rehabilitation Sciences, KU Leuven, Gymnasium, Leuven, Belgium
| | - Johan Flamaing
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
- Department of Geriatric Medicine, UZ Leuven, Leuven, Belgium
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13
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Lyu Z, Shen Q, Tian S, Gong L, Lou H, Bao G, Wu Z, Lu C, Zhang W, Huang R, Ji C, Zheng S, Pan W, Ying Y, Jin J, Liang Y. Effects of Patient-Controlled Transcutaneous Electrical Acupoint Stimulation on Cancer Induced Bone Pain Relief in Patients with Non-Small Cell Lung Cancer: Study Protocol for a Randomized Controlled Trial. J Pain Res 2024; 17:1285-1298. [PMID: 38560406 PMCID: PMC10981381 DOI: 10.2147/jpr.s437296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 03/04/2024] [Indexed: 04/04/2024] Open
Abstract
Background Transcutaneous Electrical Acupoint Stimulation (TEAS) therapy opens up the possibility for individuals with Cancer-induced bone pain (CIBP) to receive a home-based, patient-controlled approach to pain management. The aim of this study is designed to evaluate the efficacy of patient-controlled TEAS (PC-TEAS) for relieving CIBP in patients with non-small cell lung cancer (NSCLC). Methods/Design This is a study protocol for a prospective, triple-blind, randomized controlled trial. We anticipate enrolling 188 participants with NSCLC bone metastases who are also using potent opioid analgesics from 4 Chinese medical centers. These participants will be randomly assigned in a 1:1 ratio to either the true PC-TEAS or the sham PC-TEAS group. All participants will receive standard adjuvant oncology therapy. The true group will undergo patient-controlled TEAS intervention as needed, while the sham group will follow the same treatment schedule but with non-conductive gel patches. Each treatment course will span 7 days, with a total of 4 courses administered. There will be 4 assessment time points: baseline, the conclusion of weeks 4, 8, and 12. The primary outcome of this investigation is the response rate of the average pain on the Brief Pain Inventory (BPI) scale at week 4 after treatment. Secondary outcomes include pain related indicators, quality of life scale, mood scales, and routine blood counts on the assessment days. Any adverse events will be promptly addressed and reported if they occur. We will manage trial data using the EDC platform, with a data monitoring committee providing regular quality oversight. Discussion PC-TEAS interventions offer an attempt to achieve home-based acupuncture treatment and the feasibility of achieving triple blinding in acupuncture research. This study is designed to provide more rigorous trial evidence for the adjuvant treatment of cancer-related pain by acupuncture and to explore a safe and effective integrative medicine scheme for CIBP. Trial Registration ClinicalTrials.gov NCT05730972, registered February 16, 2023.
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Affiliation(s)
- Zhengyi Lyu
- The Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Qiongying Shen
- The Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Shuxin Tian
- The Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Liyan Gong
- Zhejiang Cancer Hospital, Hangzhou, Zhejiang, People’s Republic of China
| | - Haizhou Lou
- Department of Medical Oncology, Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, People’s Republic of China
| | - Guanai Bao
- Zhejiang Cancer Hospital, Hangzhou, Zhejiang, People’s Republic of China
| | - Zhuoxuan Wu
- Department of Medical Oncology, Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, People’s Republic of China
| | - Chao Lu
- Zhejiang Cancer Hospital, Hangzhou, Zhejiang, People’s Republic of China
| | - Weiping Zhang
- Department of Acupuncture, the Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Rui Huang
- Department of Acupuncture and Tuina, Wenzhou Central Hospital, Wenzhou, Zhejiang, People’s Republic of China
| | - Conghua Ji
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Siyi Zheng
- The Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Wei Pan
- The Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Yinyin Ying
- Department of Acupuncture, the Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Jianwei Jin
- Department of Acupuncture, the Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Yi Liang
- Department of Acupuncture, the Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
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14
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Wang J, Li Y, Yang GY, Jin K. Age-Related Dysfunction in Balance: A Comprehensive Review of Causes, Consequences, and Interventions. Aging Dis 2024:AD.2024.0124-1. [PMID: 38607735 DOI: 10.14336/ad.2024.0124-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 01/24/2024] [Indexed: 04/14/2024] Open
Abstract
This review delves into the multifaceted aspects of age-related balance changes, highlighting their prevalence, underlying causes, and the impact they have on the elderly population. Central to this discussion is the exploration of various physiological changes that occur with aging, such as alterations in the vestibular, visual, proprioceptive systems, and musculoskeletal degeneration. We examine the role of neurological disorders, cognitive decline, and medication side effects in exacerbating balance issues. The review underscores the significance of early detection and effective intervention strategies in mitigating the risks associated with balance problems, such as falls and reduced mobility. It discusses the effectiveness of diverse intervention strategies, including exercise programs, rehabilitation techniques, and technological advancements like virtual reality, wearable devices, and telemedicine. Additionally, the review stresses the importance of a holistic approach in managing balance disorders, encompassing medication review, addressing comorbidities, and environmental modifications. The paper also presents future research directions, emphasizing the need for a deeper understanding of the complex mechanisms underlying balance changes with aging and the potential of emerging technologies and interdisciplinary approaches in enhancing assessment and intervention methods. This comprehensive review aims to provide valuable insights for healthcare providers, researchers, and policymakers in developing targeted strategies to improve the quality of life and ensure the well-being of the aging population.
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Affiliation(s)
- Jixian Wang
- Department of Rehabilitation Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yongfang Li
- Department of Rehabilitation Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guo-Yuan Yang
- Neuroscience and Neuroengineering Research Center, Med-X Research Institute and School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Kunlin Jin
- Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
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15
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Gómez-Redondo P, Valenzuela PL, Martínez-de-Quel Ó, Sánchez-Martín C, Cerezo-Arroyo M, Moreno-Manzanaro D, Alegre LM, Guadalupe-Grau A, Ara I, Mañas A. The role of supervision and motivation during exercise on physical and mental health in older adults: a study protocol for a randomized controlled trial (PRO-Training project). BMC Geriatr 2024; 24:274. [PMID: 38509514 PMCID: PMC10953175 DOI: 10.1186/s12877-024-04868-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/04/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Although supervised exercise is frequently recommended for older adults, its superiority over unsupervised exercise remains uncertain. Furthermore, whether motivational techniques could help to enhance the effectiveness of the latter remains to be elucidated. The present randomized controlled trial aims to determine the role of supervision and motivational strategies on the safety, adherence, efficacy, and cost-effectiveness of different exercise programs for improving physical and mental health in older adults. METHODS Participants (n = 120, aged 60-75 years) will be randomly allocated into five groups: 1-Control (CON), 2-Supervised exercise without motivational intervention (SUP), 3- Supervised exercise with motivational intervention (SUP +), 4- Unsupervised exercise without motivational intervention (UNSUP) and 5- Unsupervised exercise with motivational intervention (UNSUP +). Over 24 weeks, all exercise groups will participate in a multicomponent exercise program three times/week (performed in group classes at a center for SUP and SUP + , or home without supervision but with the help of a mobile app for UNSUP and UNSUP +), while the CON group will maintain their usual lifestyle. The motivational intervention (for SUP + and UNSUP + groups) will be based on the self-determination theory, including strategies such as phone calls, interactive workshops, motivational messages, informative infographics and videos. Primary outcomes will include safety, adherence, costs, and lower-body muscular function using a leg press machine. Secondary outcomes will include upper-body muscular function, physical and cardiorespiratory function, blood pressure and heart rate, body composition, health-related quality of life, cognitive performance, anxiety, depression, physical activity levels, sleep and sedentarism, biochemical markers, motivators and barriers to exercise. Assessments will be conducted at baseline, mid-intervention (i.e., week 13), at the end of the intervention (i.e., week 25), and 24 weeks later (i.e., week 49). DISCUSSION The findings of this trial might provide valuable insights into the role of supervision and motivational strategies on the effectiveness of exercise programs for older adults. Additionally, the study could contribute to developing cost-effective interventions, supporting the design of future public policies for healthy aging. TRIAL REGISTRATION NCT05619250. Registered 16 November 2022.
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Affiliation(s)
- Paola Gómez-Redondo
- GENUD Toledo Research Group, Faculty of Sports Sciences, University of Castilla-La Mancha, Avda. Carlos III S/N, 45071, Toledo, Spain
- CIBER of Frailty and Healthy Aging, Instituto de Salud Carlos III, Madrid, Spain
- Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM), Junta de Comunidades de Castilla-La Mancha (JCCM), Toledo, Spain
| | - Pedro L Valenzuela
- Physical Activity and Health Research Group (PaHerg), Research Institute of Hospital, 12 de Octubre (imas12), Madrid, Spain
- Department of Systems Biology, University of Alcalá, Madrid, Spain
| | - Óscar Martínez-de-Quel
- Didactics of Languages, Arts and Physical Education Department, Faculty of Education, Complutense University of Madrid, 28040, Madrid, Spain
- Faculty of Sciences for Physical Activity and Sport (INEF), Polytechnic University of Madrid, 28040, Madrid, Spain
| | - Coral Sánchez-Martín
- GENUD Toledo Research Group, Faculty of Sports Sciences, University of Castilla-La Mancha, Avda. Carlos III S/N, 45071, Toledo, Spain
- CIBER of Frailty and Healthy Aging, Instituto de Salud Carlos III, Madrid, Spain
- Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM), Junta de Comunidades de Castilla-La Mancha (JCCM), Toledo, Spain
| | - Mónica Cerezo-Arroyo
- GENUD Toledo Research Group, Faculty of Sports Sciences, University of Castilla-La Mancha, Avda. Carlos III S/N, 45071, Toledo, Spain
- CIBER of Frailty and Healthy Aging, Instituto de Salud Carlos III, Madrid, Spain
- Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM), Junta de Comunidades de Castilla-La Mancha (JCCM), Toledo, Spain
| | - David Moreno-Manzanaro
- GENUD Toledo Research Group, Faculty of Sports Sciences, University of Castilla-La Mancha, Avda. Carlos III S/N, 45071, Toledo, Spain
- CIBER of Frailty and Healthy Aging, Instituto de Salud Carlos III, Madrid, Spain
- Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM), Junta de Comunidades de Castilla-La Mancha (JCCM), Toledo, Spain
| | - Luis M Alegre
- GENUD Toledo Research Group, Faculty of Sports Sciences, University of Castilla-La Mancha, Avda. Carlos III S/N, 45071, Toledo, Spain
- CIBER of Frailty and Healthy Aging, Instituto de Salud Carlos III, Madrid, Spain
- Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM), Junta de Comunidades de Castilla-La Mancha (JCCM), Toledo, Spain
| | - Amelia Guadalupe-Grau
- GENUD Toledo Research Group, Faculty of Sports Sciences, University of Castilla-La Mancha, Avda. Carlos III S/N, 45071, Toledo, Spain
- CIBER of Frailty and Healthy Aging, Instituto de Salud Carlos III, Madrid, Spain
- Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM), Junta de Comunidades de Castilla-La Mancha (JCCM), Toledo, Spain
| | - Ignacio Ara
- GENUD Toledo Research Group, Faculty of Sports Sciences, University of Castilla-La Mancha, Avda. Carlos III S/N, 45071, Toledo, Spain
- CIBER of Frailty and Healthy Aging, Instituto de Salud Carlos III, Madrid, Spain
- Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM), Junta de Comunidades de Castilla-La Mancha (JCCM), Toledo, Spain
| | - Asier Mañas
- GENUD Toledo Research Group, Faculty of Sports Sciences, University of Castilla-La Mancha, Avda. Carlos III S/N, 45071, Toledo, Spain.
- CIBER of Frailty and Healthy Aging, Instituto de Salud Carlos III, Madrid, Spain.
- Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM), Junta de Comunidades de Castilla-La Mancha (JCCM), Toledo, Spain.
- Didactics of Languages, Arts and Physical Education Department, Faculty of Education, Complutense University of Madrid, 28040, Madrid, Spain.
- Center UCM-ISCIII for Human Evolution and Behavior, 28029, Madrid, Spain.
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16
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Haag S, Kepros J. Head Protection Device for Individuals at Risk for Head Injury due to Ground-Level Falls: Single Trauma Center User Experience Investigation. JMIR Hum Factors 2024; 11:e54854. [PMID: 38502170 PMCID: PMC10988374 DOI: 10.2196/54854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 02/08/2024] [Accepted: 02/18/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Falls represent a large percentage of hospitalized patients with trauma as they may result in head injuries. Brain injury from ground-level falls (GLFs) in patients is common and has substantial mortality. As fall prevention initiatives have been inconclusive, we changed our strategy to injury prevention. We identified a head protection device (HPD) with impact-resistant technology, which meets head impact criteria sustained in a GLF. HPDs such as helmets are ubiquitous in preventing head injuries in sports and industrial activities; yet, they have not been studied for daily activities. OBJECTIVE We investigated the usability of a novel HPD on patients with head injury in acute care and home contexts to predict future compliance. METHODS A total of 26 individuals who sustained head injuries, wore an HPD in the hospital, while ambulatory and were evaluated at baseline and 2 months post discharge. Clinical and demographic data were collected; a usability survey captured HPD domains. This user experience design revealed patient perceptions, satisfaction, and compliance. Nonparametric tests were used for intragroup comparisons (Wilcoxon signed rank test). Differences between categorical variables including sex, race, and age (age group 1: 55-77 years; age group 2: 78+ years) and compliance were tested using the chi-square test. RESULTS Of the 26 patients enrolled, 12 (46%) were female, 18 (69%) were on anticoagulants, and 25 (96%) were admitted with a head injury due to a GLF. The median age was 77 (IQR 55-92) years. After 2 months, 22 (85%) wore the device with 0 falls and no GLF hospital readmissions. Usability assessment with 26 patients revealed positive scores for the HPD post discharge regarding satisfaction (mean 4.8, SD 0.89), usability (mean 4.23, SD 0.86), effectiveness (mean 4.69, SD 0.54), and relevance (mean 4.12, SD 1.10). Nonparametric tests showed positive results with no significant differences between 2 observations. One issue emerged in the domain of aesthetics; post discharge, 8 (30%) patients had a concern about device weight. Analysis showed differences in patient compliance regarding age (χ12=4.27; P=.04) but not sex (χ12=1.58; P=.23) or race (χ12=0.75; P=.60). Age group 1 was more likely to wear the device for normal daily activities. Patients most often wore the device ambulating, and protection was identified as the primary benefit. CONCLUSIONS The HPD intervention is likely to have reasonably high compliance in a population at risk for GLFs as it was considered usable, protective, and relevant. The feasibility and wearability of the device in patients who are at risk for GLFs will inform future directions, which includes a multicenter study to evaluate device compliance and effectiveness. Our work will guide other institutions in pursuing technologies and interventions that are effective in mitigating injury in the event of a fall in this high-risk population.
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Affiliation(s)
- Susan Haag
- Scottsdale Osborn Medical Center, Scottsdale, AZ, United States
| | - John Kepros
- Scottsdale Osborn Medical Center, Scottsdale, AZ, United States
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17
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Lee-Confer J. Strength in arms: empowering older adults against the risk of slipping and falling-a theoretical perspective. Front Sports Act Living 2024; 6:1371730. [PMID: 38523707 PMCID: PMC10957654 DOI: 10.3389/fspor.2024.1371730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 03/01/2024] [Indexed: 03/26/2024] Open
Abstract
Background Slips and falls are a serious health concern, particularly among older adults. Current physical therapy protocols strengthen the legs to improve balance. However, arm movements help maintain balance during a slip incident. Understanding how arm movements improve balance may help clinicians develop more comprehensive fall-prevention protocols to improve patient outcomes. Clinical question What limitations exist in current fall prevention protocols for reducing falls in older adults during slip incidents, and what new strategies can enhance these outcomes? Key results Slip incidents often result in a sideways loss of balance, leading to hip fractures in older adults. During a slip, the legs do not produce sideways motion and are less effective in regaining balance in this direction. Contrary, the arms produce 100 + degrees of abduction and this motion reduces falls by 200%+ during a slip incident. Notably, older adults exhibit 35.7% decreased arm abduction acceleration responses compared to younger adults during a slip incident. This delay may be attributed to age-related decreases in type II fibers of the deltoid. High-velocity and ballistic training have been shown to improve the proportion and size of type II fibers as well as improve fall outcomes when focused on the lower extremities. Clinical application Therefore, I propose incorporating arm abductor training, alongside leg exercises, as a cost-effective and low-risk intervention to enhance the slip responses in older adults. In light of its minimal risk and considerable potential benefits, starting arm abductor exercises with older adults is a sensible move.
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Affiliation(s)
- Jonathan Lee-Confer
- Department of Physical Therapy, University of Arizona, Tucson, AZ, United States
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18
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Martín-Vírgala J, Martín-Carro B, Fernández-Villabrille S, Ruiz-Torres MP, Gómez-Alonso C, Rodríguez-García M, Fernández-Martín JL, Alonso-Montes C, Panizo S, Cannata-Andía JB, Naves-Díaz M, Carrillo-López N. Soluble Klotho, a Potential Biomarker of Chronic Kidney Disease-Mineral Bone Disorders Involved in Healthy Ageing: Lights and Shadows. Int J Mol Sci 2024; 25:1843. [PMID: 38339121 PMCID: PMC10855561 DOI: 10.3390/ijms25031843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 01/23/2024] [Accepted: 01/31/2024] [Indexed: 02/12/2024] Open
Abstract
Shortly after the discovery of Klotho, interest grew in its potential role in chronic kidney disease (CKD). There are three isoforms of the Klotho protein: αKlotho, βKlotho and γKlotho. This review will focus on αKlotho due to its relevance as a biomarker in CKD. αKlotho is synthesized mainly in the kidneys, but it can be released into the bloodstream and urine as soluble Klotho (sKlotho), which undertakes systemic actions, independently or in combination with FGF23. It is usually accepted that sKlotho levels are reduced early in CKD and that lower levels of sKlotho might be associated with the main chronic kidney disease-mineral bone disorders (CKD-MBDs): cardiovascular and bone disease. However, as results are inconsistent, the applicability of sKlotho as a CKD-MBD biomarker is still a matter of controversy. Much of the inconsistency can be explained due to low sample numbers, the low quality of clinical studies, the lack of standardized assays to assess sKlotho and a lack of consensus on sample processing, especially in urine. In recent decades, because of our longer life expectancies, the prevalence of accelerated-ageing diseases, such as CKD, has increased. Exercise, social interaction and caloric restriction are considered key factors for healthy ageing. While exercise and social interaction seem to be related to higher serum sKlotho levels, it is not clear whether serum sKlotho might be influenced by caloric restriction. This review focuses on the possible role of sKlotho as a biomarker in CKD-MBD, highlighting the difference between solid knowledge and areas requiring further research, including the role of sKlotho in healthy ageing.
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Affiliation(s)
- Julia Martín-Vírgala
- Metabolismo Óseo, Vascular y Enfermedades Inflamatorias Crónicas, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain
- Redes de Investigación Cooperativa Orientadas a Resultados en Salud (RICORS2040, Kidney Disease), 28040 Madrid, Spain;
| | - Beatriz Martín-Carro
- Metabolismo Óseo, Vascular y Enfermedades Inflamatorias Crónicas, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain
- Redes de Investigación Cooperativa Orientadas a Resultados en Salud (RICORS2040, Kidney Disease), 28040 Madrid, Spain;
| | - Sara Fernández-Villabrille
- Metabolismo Óseo, Vascular y Enfermedades Inflamatorias Crónicas, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain
- Redes de Investigación Cooperativa Orientadas a Resultados en Salud (RICORS2040, Kidney Disease), 28040 Madrid, Spain;
| | - María Piedad Ruiz-Torres
- Redes de Investigación Cooperativa Orientadas a Resultados en Salud (RICORS2040, Kidney Disease), 28040 Madrid, Spain;
- Área 5—Fisiología y Fisiopatología Renal y Vascular del Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Physiology Unit, Department of Systems Biology, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, 28871 Alcalá de Henares, Spain
| | - Carlos Gómez-Alonso
- Metabolismo Óseo, Vascular y Enfermedades Inflamatorias Crónicas, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain
- Bone and Mineral Research Unit, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
| | - Minerva Rodríguez-García
- Metabolismo Óseo, Vascular y Enfermedades Inflamatorias Crónicas, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain
- Redes de Investigación Cooperativa Orientadas a Resultados en Salud (RICORS2040, Kidney Disease), 28040 Madrid, Spain;
- Nephrology Unit, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
| | - José Luis Fernández-Martín
- Metabolismo Óseo, Vascular y Enfermedades Inflamatorias Crónicas, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain
- Redes de Investigación Cooperativa Orientadas a Resultados en Salud (RICORS2040, Kidney Disease), 28040 Madrid, Spain;
- Bone and Mineral Research Unit, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
| | - Cristina Alonso-Montes
- Metabolismo Óseo, Vascular y Enfermedades Inflamatorias Crónicas, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain
- Redes de Investigación Cooperativa Orientadas a Resultados en Salud (RICORS2040, Kidney Disease), 28040 Madrid, Spain;
| | - Sara Panizo
- Metabolismo Óseo, Vascular y Enfermedades Inflamatorias Crónicas, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain
- Redes de Investigación Cooperativa Orientadas a Resultados en Salud (RICORS2040, Kidney Disease), 28040 Madrid, Spain;
| | - Jorge B. Cannata-Andía
- Redes de Investigación Cooperativa Orientadas a Resultados en Salud (RICORS2040, Kidney Disease), 28040 Madrid, Spain;
- Department of Medicine, Universidad de Oviedo, 33011 Oviedo, Spain
| | - Manuel Naves-Díaz
- Metabolismo Óseo, Vascular y Enfermedades Inflamatorias Crónicas, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain
- Redes de Investigación Cooperativa Orientadas a Resultados en Salud (RICORS2040, Kidney Disease), 28040 Madrid, Spain;
- Bone and Mineral Research Unit, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
| | - Natalia Carrillo-López
- Metabolismo Óseo, Vascular y Enfermedades Inflamatorias Crónicas, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain
- Redes de Investigación Cooperativa Orientadas a Resultados en Salud (RICORS2040, Kidney Disease), 28040 Madrid, Spain;
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19
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Gute L, Zimbudzi E. Interventions to reduce falls among dialysis patients: a systematic review. BMC Nephrol 2023; 24:382. [PMID: 38129770 PMCID: PMC10734056 DOI: 10.1186/s12882-023-03408-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 11/23/2023] [Indexed: 12/23/2023] Open
Abstract
INTRODUCTION Despite all available evidence regarding increased morbidity and mortality among dialysis patients due to falls and their complications, and an increase in risk factors for falls, relatively little attention has been focused on evidence-based interventions that can reduce falls. We evaluated the effectiveness of fall prevention interventions among dialysis patients. METHODS We searched Ovid-Medline, Ovid-Embase, PubMed, Cumulated Index to Nursing and Allied Health Literature and the Cochrane Central Register of Controlled Trials (Central) from inception to 19 July 2023 for studies that evaluated the effectiveness of fall prevention interventions among dialysis patients. The search, screening and extraction of data followed standardised processes and the methodological quality of studies was independently assessed by two reviewers. Data was analysed using a narrative synthesis approach. RESULTS Of the 18 studies that had full text review, five were eligible. Three studies were performed in the USA and one each in UK and Japan. Four studies were conducted in outpatient hemodialysis centres and one in a hospital-based nephrology unit. Reported sample sizes ranged from 51 to 96 participants per study with a follow-up period of 3 to 35 months. There was moderate-quality evidence that exercises reduce the rate of falls compared to usual care and low to moderate quality of evidence that multifactorial falls prevention interventions reduce the rate of falls. However, treatment effects could not be quantitatively estimated for all interventions due to substantial heterogeneity of included studies. CONCLUSIONS This systematic review reflects that there is insufficient evidence regarding falls prevention strategies specific to dialysis patients. Available data based on low to moderate quality studies, suggest that among dialysis patients, exercises may reduce falls and the effectiveness of multifactorial interventions such as staff and patient education still need to be explored using high-quality prospective studies.
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Affiliation(s)
- Lelise Gute
- Department of Nephrology, Monash Health, VIC, Australia
| | - Edward Zimbudzi
- Department of Nephrology, Monash Health, VIC, Australia.
- School of Public Health and Preventive Medicine, Monash University, VIC, Australia.
- School of Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Level 3, Building 13D, Rm D304, Clayton Campus, 35 Rainforest Walk, Clayton, VIC, 3800, Australia.
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20
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Chan KOW, Yuen PP, Fong BYF, Law VTS, Ng FSF, Fung WCP, Ng TKC, Cheung IS. Effectiveness of telehealth in preventive care: a study protocol for a randomised controlled trial of tele-exercise programme involving older people with possible sarcopenia or at risk of fall. BMC Geriatr 2023; 23:845. [PMID: 38093219 PMCID: PMC10717497 DOI: 10.1186/s12877-023-04535-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 11/30/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Continuous loss of muscle mass and strength are the consequences of the ageing process, which increase the risk of falls among older people. Falls can lead to severe consequences such as bone fractures and hampered physical and psychological well-being. Regular exercise is the key to reversing muscle atrophy and relieving sarcopenia. However, the frailty of older people and the recent COVID-19 pandemic may affect their confidence to leave home to attend classes in the community. A feasible and effective alternative should be explored. METHODS The primary objective is to evaluate the effectiveness of tele-exercise (TE) in relation to physical functioning and exercise adherence among community-dwelling older people at risk of falls in comparison with a community-based group (CB). The secondary objective includes evaluating older people's experience with tele-exercise, emphasizing their psychological welfare, social well-being, and acceptance of the telehealth approach. The design, conduct, and report follow the SPIRIT guidelines (Standard Protocol Items: recommended items to address in a Clinical Trial Protocol and Related Documents). Older people will be recruited from 10 local community centres in Hong Kong and randomly allocated into two groups. All participants will attend the exercise training 3 days per week for 3 months but the mode of delivery will differ, either online as the tele-exercise group (TE) or face-to-face as the community-based group (CB). The outcome measures include muscle strength, physical function, exercise adherence and dropout rate, psychological and social well-being will be assessed at the baseline, and the 3rd, 6th and 12th month. Some participants will be invited to attend focus group interviews to evaluate their overall experience of the tele-exercise training. DISCUSSION Tele-exercise reduces the barriers to exercise, such as time constraints, inaccessibility to facilities, and the fear of frail older people leaving their homes. Promoting an online home-based exercise programme for older people can encourage them to engage in regular physical activity and increase their exercise adherence even when remaining at home. The use of telehealth can potentially result in savings in cost and time. The final findings will provide insights on delivering exercise via telehealth to older people and propose an exercise delivery and maintenance model for future practice. TRIAL REGISTRATION Chinese Clinical Trial Registry ( https://www.chictr.org.cn/hvshowprojectEN.html?id=219002&v=1.1 ), registration number: ChiCTR2200063370. Registered on 5 September 2022.
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Affiliation(s)
- Karly O W Chan
- College of Professional and Continuing Education, The Hong Kong Polytechnic University, PolyU Hung Hom Bay Campus, 8 Hung Lok Road, Hung Hom, Kowloon, Hong Kong SAR, China.
| | - Peter P Yuen
- College of Professional and Continuing Education, The Hong Kong Polytechnic University, PolyU Hung Hom Bay Campus, 8 Hung Lok Road, Hung Hom, Kowloon, Hong Kong SAR, China
| | - Ben Y F Fong
- College of Professional and Continuing Education, The Hong Kong Polytechnic University, PolyU Hung Hom Bay Campus, 8 Hung Lok Road, Hung Hom, Kowloon, Hong Kong SAR, China
| | - Vincent T S Law
- College of Professional and Continuing Education, The Hong Kong Polytechnic University, PolyU Hung Hom Bay Campus, 8 Hung Lok Road, Hung Hom, Kowloon, Hong Kong SAR, China
| | - Fowie S F Ng
- School of Management, Tung Wah College, Kowloon, Hong Kong SAR, China
| | - Wilson C P Fung
- Hong Kong Telemedicine Association, Hong Kong, Hong Kong SAR, China
| | - Tommy K C Ng
- College of Professional and Continuing Education, The Hong Kong Polytechnic University, PolyU Hung Hom Bay Campus, 8 Hung Lok Road, Hung Hom, Kowloon, Hong Kong SAR, China
| | - I S Cheung
- College of Professional and Continuing Education, The Hong Kong Polytechnic University, PolyU Hung Hom Bay Campus, 8 Hung Lok Road, Hung Hom, Kowloon, Hong Kong SAR, China
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21
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Rice J, Li LC, Davis JC, Pahor M, Madden K, Wei N, Wong H, Skelton DA, McCormick S, Falck RS, Barha CK, Rhodes RE, Loomba S, Sadatsafavi M, Liu-Ambrose T. Supporting physical activity for mobility in older adults with mobility limitations (SuPA Mobility): study protocol for a randomized controlled trial. Trials 2023; 24:769. [PMID: 38017467 PMCID: PMC10685660 DOI: 10.1186/s13063-023-07798-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 11/09/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Limited mobility in older adults consistently predicts both morbidity and mortality. As individuals age, the rates of mobility disability increase from 1.0% in people aged 15-24 to 20.6% in adults over 65 years of age. Physical activity can effectively improve mobility in older adults, yet many older adults do not engage in sufficient physical activity. Evidence shows that increasing physical activity by 50 min of moderate intensity physical activity in sedentary older adults with mobility limitations can improve mobility and reduce the incidence of mobility disability. To maximize the healthy life span of older adults, it is necessary to find effective and efficient interventions that can be delivered widely to prevent mobility limitations, increase physical activity participation, and improve quality of life in older adults. We propose a randomized controlled trial to assess the effect of a physical activity health coaching intervention on mobility in older adults with mobility limitations. METHODS This randomized controlled trial among 290 (145 per group) community-dwelling older adults with mobility limitations, aged 70-89 years old, will compare the effect of a physical activity health coaching intervention versus a general healthy aging education program on mobility, as assessed with the Short Physical Performance Battery. The physical activity health coaching intervention will be delivered by exercise individuals who are trained in Brief Action Planning. The coaches will use evidence-based behavior change techniques including goal-setting, action planning, self-monitoring, and feedback to improve participation in physical activity by a known dose of 50 min per week. There will be a total of 9 health coaching or education sessions delivered over 26 weeks with a subsequent 26-week follow-up period, wherein both groups will receive the same duration and frequency of study visits and activities. DISCUSSION The consequences of limited mobility pose a significant burden on the quality of life of older adults. Our trial is novel in that it investigates implementing a dose of physical activity that is known to improve mobility in older adults utilizing a health coaching intervention. TRIAL REGISTRATION ClinicalTrials.gov Protocol Registration System: NCT05978336; registered on 28 July 2023.
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Affiliation(s)
- Jordyn Rice
- University of British Columbia, 2329 West Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Linda C Li
- University of British Columbia, 2329 West Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Jennifer C Davis
- University of British Columbia-Okanagan, 3333 University Way, Kelowna, BC, V1V 1V7, Canada
| | - Marco Pahor
- University of Florida, Gainesville, FL, 32611, USA
| | - Kenneth Madden
- University of British Columbia, 2329 West Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Nathan Wei
- University of British Columbia, 2329 West Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Hubert Wong
- University of British Columbia, 2329 West Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Dawn A Skelton
- Glasgow Caledonian University, Cowcaddens Rd, Glasgow, G4 0BA, UK
| | - Sioban McCormick
- University of British Columbia, 2329 West Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Ryan S Falck
- University of British Columbia, 2329 West Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Cindy K Barha
- University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
| | - Ryan E Rhodes
- University of Victoria, 3800 Finnerty Rd, Victoria, BC, V8P 5C2, Canada
| | - Sohail Loomba
- University of British Columbia, 2329 West Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Mohsen Sadatsafavi
- University of British Columbia, 2329 West Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Teresa Liu-Ambrose
- University of British Columbia, 2329 West Mall, Vancouver, BC, V6T 1Z4, Canada.
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22
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Hong QM, Wang HN, Liu XH, Zhou WQ, Zhang X, Luo XB. Home-based exercise program and Health education in patients with patellofemoral pain: a randomized controlled trial. BMC Musculoskelet Disord 2023; 24:896. [PMID: 37980477 PMCID: PMC10657019 DOI: 10.1186/s12891-023-07027-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 11/07/2023] [Indexed: 11/20/2023] Open
Abstract
BACKGROUND Patellofemoral pain (PFP) is one of the most common disorders of the knee joint. Home-based exercise is an effective intervention to achieve self-management for chronic diseases. This study evaluated the effects of home-based exercise and health education in patients with PFP. METHODS Patients who had PFP were randomly allocated to an intervention group (IG) or control group (CG). Patients in the IG received a 6-week tailored home-based exercise program with health education via remote support, while patients in the CG group only received health education. Clinical outcomes were compared using the Anterior Knee Pain Scale (AKPS) to measure function and the Visual Analog Scale (VAS) to measure "worst pain" and "pain with daily activity". Muscle strength was measured according to the peak torque of the knee muscles using an isokinetic system. RESULTS Among a total of 112 participants screened for eligibility, 38 were randomized and analyzed, including 19 participants in the intervention group and 19 participants in the control group. There were no significant differences in baseline characteristics between the groups. At 6-week follow-up, the intervention group showed a greater worst pain reduction (between-group difference, -19.3 [95%CI, -23.2 to -15.5]; P < 0.01) and pain with daily activity (between-group difference, -22.9 [95%CI, -28.3 to -17.4]; P < 0.01) than the control group. Similarly, the intervention group had better improvements in AKPS (between-group difference, 9.0 [95%CI, 4.1 to 13.9]; P < 0.01) and knee extensor strength (between-group difference, 20.1 [95%CI, 14.5 to 25.8]; P < 0.01), compared to the control group. No adverse events were reported. CONCLUSION Home-based exercise and health education resulted in less pain, better function, and higher knee muscle strength compared with no exercise in patients with PFP. A large randomized controlled trial with long-term follow-up is required to confirm these findings. TRIAL REGISTRATION Chinese Clinical Trial Registry, ChiCTR2200056224 ( https://www.chictr.org.cn/showproj.aspx?proj=135506 ). Registered on February 1, 2022.
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Affiliation(s)
- Qiao-Mei Hong
- Department of Sport Medicine, Sichuan Province Orthopedic Hospital, Chengdu, Sichuan Province, China
| | - Hao-Nan Wang
- Faculty of Sport Medicine and Rehabilitation, Beijing Sport University, Beijing, China
| | - Xi-Hui Liu
- Department of Sport Medicine, Sichuan Province Orthopedic Hospital, Chengdu, Sichuan Province, China
| | - Wen-Qi Zhou
- Department of Sport Medicine, Sichuan Province Orthopedic Hospital, Chengdu, Sichuan Province, China
| | - Xiao Zhang
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Xiao-Bing Luo
- Department of Sport Medicine, Sichuan Province Orthopedic Hospital, Chengdu, Sichuan Province, China.
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23
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Cardozo-Stolberg S, Szydziak E, Angus LDG, Blake R, Marsden D, Venkatesh S, Mon NO. Geospatial Mapping to Target Injury Prevention for Older Adult Ground-Level Falls: A Feasibility Study. J Trauma Nurs 2023; 30:340-345. [PMID: 37937875 DOI: 10.1097/jtn.0000000000000753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
BACKGROUND Trauma centers target injury prevention efforts based on trauma registry and local epidemiological data. Identifying geographic patterns of injury through geospatial mapping has emerged as a technology to help identify at-risk individuals. Yet, the feasibility of using spatial analysis to target injury prevention efforts remains unknown. OBJECTIVE This study aims to demonstrate the use of geospatial mapping of older adult ground-level falls to target injury prevention efforts. METHODS This retrospective cohort analysis of ground-level falls among older adults was conducted from 2017 to 2020 at a Level I trauma center and safety net hospital. Trauma admissions, U.S. census median income, Hispanic percentage, and population density by zip codes were combined to create choropleth and heat maps to identify injury hot spots to target fall prevention classes. RESULTS A total of 5,629 patients were reviewed, of which 3,002 (53%) were fall cases. Low-level falls (<10 ft) accounted for 2,224 cases; 1,449 were among older adults centered around the study hospital. Ground-level falls accounted for 1,663 patients, of whom 1,182 were older adults clustering around senior housing, assisted living facilities, nursing homes, and rehabilitation centers. As a result, our fall prevention classes are now targeted at these newly identified locations. CONCLUSION Geospatial analysis provided powerful visualization of fall injury locations to target our fall prevention efforts. Geospatial analysis is a feasible tool for trauma centers to guide injury prevention strategies that effectively target the populations most in need.
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Affiliation(s)
- Sara Cardozo-Stolberg
- Division of Trauma, Department of Surgery, Nassau University Medical Center, East Meadow, New York
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24
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Pu A, Paul S, Luke B, Bhattacharyya T. Better Mobility Is Associated With Higher Incomes and Longer Working Years Among Older Adults. Clin Orthop Relat Res 2023; 482:00003086-990000000-01388. [PMID: 37878467 PMCID: PMC10723861 DOI: 10.1097/corr.0000000000002886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 09/12/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Robust physical mobility is the key to healthy independent aging. Although the association between socioeconomic status and health is well documented, it is unclear whether there is a relationship between mobility and income, because income data are not readily available. QUESTIONS/PURPOSES (1) Do individuals with better mobility have higher incomes? (2) Does maintaining mobility over time allow individuals to keep working? (3) Is exercise associated with higher mobility over time? METHODS We obtained longitudinal income and health data from the nationally representative Health and Retirement Study. Three cohorts were used. First, we studied the relationship between household income and mobility (on a 6-point index of walking impairment) in 19,430 adults who were assessed in 2016 (representing 93% of the 20,805-person total cohort). We measured the association of mobility and household income in a multivariate linear regression analysis of age, gender, health conditions, and education. We then identified a second group of 1094 individuals with unrestricted mobility in the year 2000 and compared differences in income and working rates between those who maintained mobility and those who lost mobility after 10 years. Finally, we identified a third group of 7063 individuals who were 60 to 80 years old in 2012, divided the group by how often they engaged in exercise, and observed differences in mobility after 4 years. RESULTS After adjusting for covariates, a drop of one level of mobility was associated with a USD 3410 reduction in annual household income (95% CI USD 2890 to USD 3920; p < 0.001). After 10 years, individuals who maintained their mobility had incomes that were USD 6500 higher than that of individuals who were not working (95% CI USD 2300 to USD 10,300; p < 0.001) and were more likely to be working (40% versus 34.5%; p < 0.001). Exercising at least once per week was associated with better mobility 4 years later (mobility score 4.46 ± 0.08 versus 3.66 ± 0.08; p < 0.001). CONCLUSION Better mobility was associated with more than USD 3000 in annual income. Regular exercise and other interventions that improve mobility may have meaningful returns on investment. CLINICAL RELEVANCE Because greater mobility is strongly associated with higher income, orthopaedic interventions may be undervalued.
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Affiliation(s)
- Alex Pu
- Clinical Trials and Outcomes Branch, National Institute for Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Subrata Paul
- Integrated Data Sciences Section, Research Technologies Branch, NIADH/NIH, Bethesda, MD, USA
| | - Brian Luke
- Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Timothy Bhattacharyya
- Clinical Trials and Outcomes Branch, National Institute for Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA
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25
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Thakur B, Ayers GD, Atem F, DeClercq JJ, Jain NB. Statistical and Methodological Considerations for Randomized Controlled Trial Design in Physical Medicine and Rehabilitation. Am J Phys Med Rehabil 2023; 102:855-860. [PMID: 36882301 PMCID: PMC10471787 DOI: 10.1097/phm.0000000000002225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
ABSTRACT Well-designed randomized controlled clinical trials assessing treatments in the field of physical medicine and rehabilitation are essential for evidence-based patient care. However, there are challenges unique to clinical trials in physical medicine and rehabilitation due to complex health interventions in this field. We highlight routinely encountered empirical challenges and provide evidence-based recommendations on statistical and methodological approaches for the design and conduct of randomized controlled trials. Some of the issues addressed include challenges with blinding treatment groups in a rehabilitation setting, heterogeneity in treatment therapy, heterogeneity of treatment effects, uniformity in patient-reported outcome measures, and effect on power with varying scales of information. Furthermore, we discuss challenges with estimation of sample size and power, adaption to poor compliance with treatment and missing outcomes, and preferred statistical approaches for longitudinal data analysis. TO CLAIM CME CREDITS Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME. CME OBJECTIVES Upon completion of this article, the reader should be able to: (1) Appraise the complexities of interventions in physical medicine and rehabilitation and how these challenges impact the conduct of clinical trials; (2) Develop an analytical strategy for poor treatment compliance and missing outcomes that can compromise the causal effect sought in a randomized clinical trial; and (3) Recognize the role of a data and safety monitoring board in a clinical trial. LEVEL Advanced. ACCREDITATION The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s) ™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
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Affiliation(s)
- Bhaskar Thakur
- From the Department of Physical Medicine and Rehabilitation, Family and Community Medicine, and Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, Texas (BT); Center for Quantitative Sciences, Department of Biostatistics, Vanderbilt School of Medicine, Nashville, Tennessee (GDA); Department of Biostatistics and Data Science, University of Texas Health Science Center-Houston, Dallas, Texas (FA); Department of Biostatistics, Vanderbilt School of Medicine, Nashville, Tennessee (JD); Department of Physical Medicine and Rehabilitation, and Orthopedics, University of Texas Southwestern, Dallas, Texas (NBJ); and Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee (NBJ)
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Delaire L, Courtay A, Humblot J, Aubertin-Leheudre M, Mourey F, Racine AN, Gilbert T, Niasse-Sy Z, Bonnefoy M. Implementation and Core Components of a Multimodal Program including Exercise and Nutrition in Prevention and Treatment of Frailty in Community-Dwelling Older Adults: A Narrative Review. Nutrients 2023; 15:4100. [PMID: 37836384 PMCID: PMC10574358 DOI: 10.3390/nu15194100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/08/2023] [Accepted: 09/18/2023] [Indexed: 10/15/2023] Open
Abstract
Increasing disability-free life expectancy is a crucial issue to optimize active ageing and to reduce the burden of evitable medical costs. One of the main challenges is to develop pragmatic and personalized prevention strategies in order to prevent frailty, counteract adverse outcomes such as falls and mobility disability, and to improve quality of life. Strong evidence reports the effectiveness of exercise interventions to improve various physical parameters and muscle function that are cornerstones of frailty. Other findings also suggest that the interactions between nutrition and physical exercise with or without health behavior promotion prevent the development of frailty. Multimodal programs, including structured exercise, adequate dietary intervention and health behavior promotion, appear increasingly consensual. However, in order for implementation in real-life settings, some pitfalls need to be addressed. In this perspective, structuring and tailoring feasible, acceptable and sustainable interventions to optimize exercise training responses are essential conditions to warrant short, medium and long-term individual benefits. The different components of exercise programs appear to be fairly consensual and effective. However, specific composition of the programs proposed (frequency, intensity, type, time, volume and progressiveness) have to be tailored to individual characteristics and objectives in order to improve exercise responses. The intervention approaches, behavioral strategies and indications for these programs also need to be refined and framed. The main objective of this work is to guide the actions of healthcare professionals and enable them to widely and effectively implement multimodal programs including exercise, nutrition and behavioral strategies in real-life settings.
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Affiliation(s)
- Leo Delaire
- Service de Médecine du Vieillissement, Hôpital Lyon Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France; (A.C.); (J.H.); (T.G.); (Z.N.-S.); (M.B.)
- Programme «Bien sur ses Jambes», Hôpital Lyon Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France
| | - Aymeric Courtay
- Service de Médecine du Vieillissement, Hôpital Lyon Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France; (A.C.); (J.H.); (T.G.); (Z.N.-S.); (M.B.)
- Programme «Bien sur ses Jambes», Hôpital Lyon Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France
| | - Joannès Humblot
- Service de Médecine du Vieillissement, Hôpital Lyon Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France; (A.C.); (J.H.); (T.G.); (Z.N.-S.); (M.B.)
- Programme «Bien sur ses Jambes», Hôpital Lyon Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France
| | - Mylène Aubertin-Leheudre
- Centre de Recherche de L’Institut Universitaire de Gériatrie de Montréal (CRIUGM), Montréal, QC H3W 1W5, Canada;
- Groupe de Recherche en Activité Physique Adaptée, Département des Sciences de l’Activité Physique, Université du Québec à Montréal (UQÀM), Montréal, QC H2L 2C4, Canada
| | - France Mourey
- Laboratoire CAPS (Cognition, Action, et Plasticité Sensorimotrice), Inserm U1093, UFR STAPS, Université de Bourgogne, Campus Universitaire, BP 27877, 21078 Dijon, France;
| | | | - Thomas Gilbert
- Service de Médecine du Vieillissement, Hôpital Lyon Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France; (A.C.); (J.H.); (T.G.); (Z.N.-S.); (M.B.)
- Programme «Bien sur ses Jambes», Hôpital Lyon Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France
- RESHAPE Research on Healthcare Professionals and Performance, Inserm U1290, Université Claude Bernard Lyon 1, 69008 Lyon, France
| | - Zeinabou Niasse-Sy
- Service de Médecine du Vieillissement, Hôpital Lyon Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France; (A.C.); (J.H.); (T.G.); (Z.N.-S.); (M.B.)
- Programme «Bien sur ses Jambes», Hôpital Lyon Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France
| | - Marc Bonnefoy
- Service de Médecine du Vieillissement, Hôpital Lyon Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France; (A.C.); (J.H.); (T.G.); (Z.N.-S.); (M.B.)
- Programme «Bien sur ses Jambes», Hôpital Lyon Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France
- Inserm U1060-CarMeN, Université Claude Bernard Lyon 1, 69100 Villeurbanne, France
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Shi L, Zhou X, Gao Y, Li X, Fang R, Deng X. Evaluation of the correlation between depression and physical activity among older persons with osteoporosis: a cross-sectional study. Front Psychiatry 2023; 14:1193072. [PMID: 37711420 PMCID: PMC10499236 DOI: 10.3389/fpsyt.2023.1193072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 08/16/2023] [Indexed: 09/16/2023] Open
Abstract
Background Osteoporosis is a common chronic disease in older persons. Physical activity can prevent chronic diseases as well as many diseases associated with aging. Older persons often suffer from depression and other psychological problems. However, there are few studies on the correlation between depression and physical activity in older persons with osteoporosis in China. Methods This cross-sectional study was conducted from June 1 to December 28, 2021. A total of 207 subjects who met the inclusion and were exclusion criteria were selected from the outpatient department of West China Hospital and evaluated using a self-designed demographic data questionnaire, the Self-rating Depression Scale (SDS), and the Physical Activity Scale for the Elderly (PASE). Multivariate linear regression was performed to analyze the factors affecting physical activity, and multivariate logistic regression analysis was performed to analyze the factors affecting depression. Spearman's correlation coefficients were calculated to analyze the correlation between depression and physical activity in older persons with osteoporosis. Results A total of 173 valid questionnaires were statistically analyzed. A total of 122 (70.5%) participants were identified as having depression (SDS ≥ 50 points). The median depression score was 62.5 (24.38), and the median PASE score was 69.29 (116.64). Multivariate logistic regression model results showed that physical activity and pain were the main risk factors for depression in older persons with osteoporosis (p < 0.05). Multivariate linear regression model results showed that gender, participation in social activities, activities of daily living status (ADLs), and depression status were the main risk factors associated with physical activity in older persons with osteoporosis (p < 0.05). The results of the correlation analysis showed that physical activity was negatively correlated with depression (R = -0.510, p = 0.000). Conclusion We found that depression was negatively correlated with physical activity in older persons with osteoporosis in China. This means that the less physical activity there is, the more serious the depression status and having depression may result in reduced physical activity in older persons with osteoporosis. To better help older persons with osteoporosis, medical staff should give more attention to influencing factors of depression and physical activity.
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Affiliation(s)
- Linjun Shi
- West China School of Nursing/General Practice Ward, International Medical Center Ward, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoping Zhou
- West China School of Nursing/General Practice Ward, International Medical Center Ward, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yueshan Gao
- West China School of Nursing, Sichuan University, Chengdu, China
| | - Xia Li
- West China School of Nursing/General Practice Ward, International Medical Center Ward, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, China
| | - Ronghua Fang
- West China School of Nursing/General Practice Ward, International Medical Center Ward, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xuexue Deng
- West China School of Nursing/Department of Nursing, West China Hospital, Sichuan University, Chengdu, China
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Lamichhane P, Sukralia S, Alam B, Shaikh S, Farrukh S, Ali S, Ojha R. Augmented reality-based training versus standard training in improvement of balance, mobility and fall risk: a systematic review and meta-analysis. Ann Med Surg (Lond) 2023; 85:4026-4032. [PMID: 37554880 PMCID: PMC10406051 DOI: 10.1097/ms9.0000000000000986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 06/10/2023] [Indexed: 08/10/2023] Open
Abstract
UNLABELLED Augmented reality (AR) technology is being used recently in healthcare, especially for rehabilitation purposes, owing to its ability for repetition, rapid feedback, and motivation for patients. This systematic review and meta-analysis aims to compare the efficacy of AR-based interventions to conventional physical interventions in improving balance, mobility, and fall risk. MATERIAL AND METHODS PubMed, Google Scholar, Scopus, and the Cochrane Central Register of Controlled Trials were systematically searched from inception to January 2023. Randomized trials and observational cohort studies comparing the effects of AR-based exercises with conventional training in patients 18 years and older were included in the analysis. Studies using virtual reality, case reports and series, reviews, meta-analyses, letters, and editorials were excluded. Post-intervention data on the Berg Balance Scale (BBS) and Timed Up and Go (TUG) Test were extracted and studied. The fixed-effects inverse variance model was utilized to pool the extracted data. RESULTS Out of 438 articles, seven articles (199 participants) comparing AR-based exercise with the standard training were included in the systematic review. Six articles with sufficient data on the parameters were included in the meta-analysis. AR-based exercises resulted in a significantly higher BBS score than conventional exercise (Hedge's g=0.48, 95% CI=0.19-0.77, P<0.001). The BBS value was significantly higher in AR-based training of 8 weeks or more (Hedge's g=0.88, 95% CI=0.46-1.31) when compared with trainings conducted for less than 8 weeks (Hedge's g=0.11, 95% CI=-0.30 to 0.52), P=0.01). Likewise, the TUG Test score was found to be to be significantly lower in ARgroup than the controls (Hedge's g= -0.54, 95% CI=-0.85 to -0.23, P<0.01). CONCLUSION In comparison to conventional methods, AR-based exercises had higher improvements in balance, mobility, and fall risk parameters. The use of AR technology in elderly patients can promote independence while preventing falls and associated morbidity and mortality. There is a need for a larger randomized controlled trial to provide a more accurate comparison on efficacy and safety of different modalities of training.
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Affiliation(s)
| | | | - Benish Alam
- Karachi Medical and Dental College, Karachi, Pakistan
| | - Shawn Shaikh
- Department of Computer Science, University of Texas, Austin, TX, USA
| | | | - Shahid Ali
- Lady Reading Hospital, Peshawar, Pakistan
| | - Rajeev Ojha
- Department of Neurology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
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29
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Yang K, Yang S, Chen Y, Cao G, Xu R, Jia X, Hou L, Li J, Bi C, Wang X. Multimorbidity Patterns and Associations with Gait, Balance and Lower Extremity Muscle Function in the Elderly: A Cross-Sectional Study in Northwest China. Int J Gen Med 2023; 16:3179-3192. [PMID: 37533839 PMCID: PMC10392815 DOI: 10.2147/ijgm.s418015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 07/13/2023] [Indexed: 08/04/2023] Open
Abstract
Purpose Fall is a common geriatric syndrome leading to various adverse outcomes in the elderly. Gait and balance disorders and decreased lower extremity muscle function are the major intrinsic risk factors of falls, and studies suggested that they were closely related to the underlying chronic conditions. This study aimed to explore the patterns of multimorbidity and determine the associations of these multimorbidity patterns with gait, balance and lower extremity muscle function. Patients and Methods A cross-sectional survey of 4803 participants aged ≥60 years in Shaanxi Province, China was conducted and the self-reported chronic conditions were investigated. The 6-m walk test, timed-up-and-go test (TUG) and 5-sit-to-stand test (5-STS) were conducted to evaluate gait, balance, and lower extremity muscle function respectively. Latent class analysis was used to explore patterns of multimorbidity, and multivariate regression analysis was used to determine the associations of multimorbidity patterns with gait, balance, and lower extremity muscle function. Results Five multimorbidity patterns were identified: Degenerative Disease Class, Cardio-metabolic Class, Stroke-Respiratory-Depression Class, Gastrointestinal Class, and Very sick Class, and they were differently associated with gait and balance disorders and decreased lower extremity muscle function. In particular, the multimorbidity patterns of Degenerative Disease Class and Stroke-Respiratory-Depression Class were closely associated with all the three risk factors of falls. Conclusion There are significant differences in the impact of different multimorbidity patterns on the major intrinsic risk factors of falls in the elderly population, and appropriate multimorbidity patterns are closely related to the prediction of falls and can help to develop fall prevention strategies in the elderly.
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Affiliation(s)
- Kaikai Yang
- Department of Geriatrics, Xijing Hospital, Air Force Medical University, Xi’an, 710032, People’s Republic of China
| | - Shanru Yang
- Department of Geriatrics, Xijing Hospital, Air Force Medical University, Xi’an, 710032, People’s Republic of China
| | - Yang Chen
- Department of Geriatrics, Xijing Hospital, Air Force Medical University, Xi’an, 710032, People’s Republic of China
| | - Guihua Cao
- Department of Geriatrics, Xijing Hospital, Air Force Medical University, Xi’an, 710032, People’s Republic of China
| | - Rong Xu
- Department of Geriatrics, Xijing Hospital, Air Force Medical University, Xi’an, 710032, People’s Republic of China
| | - Xin Jia
- Department of Geriatrics, Xijing Hospital, Air Force Medical University, Xi’an, 710032, People’s Republic of China
| | - Liming Hou
- Department of Geriatrics, Xijing Hospital, Air Force Medical University, Xi’an, 710032, People’s Republic of China
| | - Jinke Li
- Department of Geriatrics, Xijing Hospital, Air Force Medical University, Xi’an, 710032, People’s Republic of China
| | - Chenting Bi
- Department of Geriatrics, Xijing Hospital, Air Force Medical University, Xi’an, 710032, People’s Republic of China
| | - Xiaoming Wang
- Department of Geriatrics, Xijing Hospital, Air Force Medical University, Xi’an, 710032, People’s Republic of China
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Wu Z, Kuang Y, Wan Y, Shi J, Li S, Xia R, Wan M, Chen S. Effect of a Baduanjin intervention on the risk of falls in the elderly individuals with mild cognitive impairment: a study protocol for a randomized controlled trial. BMC Complement Med Ther 2023; 23:233. [PMID: 37442990 DOI: 10.1186/s12906-023-04050-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 06/22/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Falls are a global public problem and may be an important cause of death in older adults. However, older adults with mild cognitive impairment(MCI) are more likely to fall and suffer more damage than older adults with normal cognitive function, which shows the importance of preventing falls. More and more evidence shows that Baduanjin can improve the balance function of the elderly and reduce the risk of falls in the elderly with MCI, but the mechanism is still unclear. The main purpose of this study is to verify the intervention effect of Baduanjin training on the risk of falls in elderly people with MCI and to elucidate the underlying mechanism of Baduanjin training in reducing the risk of falls in MCI patients. METHODS In this prospective study, outcome assessor-blind, three-arm randomized controlled trial, a total of 72 eligible participants will be randomly allocated (1:1:1) into the 12-week Baduanjin exercise intervention (60 min per session, three sessions per week), the 12-week brisk walking group(60 min per session, three sessions per week) or the 12-week health education group. Primary outcome is the Fall-Risk Self-Assessment Questionnaire(FRQ), and secondary outcomes are fall efficacy index, gait assessment, balance function, lower limb muscle strength, cognitive function, activities of daily living(ADL) and MRI scans. In addition to the MRI scans, which will be measured before and after the intervention,other primary and secondary outcomes will be assessed at baseline, 6 weeks, and 12 weeks (at the end of the intervention) and after an additional 12-week follow-up period. The mixed linear model will be conducted to observe the intervention effects. DISCUSSION This trial will investigate the effect of Baduanjin exercise on the prevention of falls in elderly individuals with MCI, explore the imaging mechanism of Baduanjin exercise to reduce the risk of falls in elderly individuals with MCI from the perspective of vestibular neural network, and provide strong evidence for Baduanjin exercise to reduce the risk of falls in elderly individuals with MCI, as well as provide new ideas and approaches for the central mechanism of Traditional Chinese Medicine(TRC) rehabilitation methods to intervene in falls in elderly. TRIAL REGISTRATION Chictr.org.cn, ID: ChiCTR2200057520. Registered on 14 March 2022, https://www.chictr.org.cn/showproj.html?proj=146592 .
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Affiliation(s)
- Ziyi Wu
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China
- Department of Rehabilitation,The People's Hospital of Baoan Shenzhen, The Second School of Clinical Medicine, Southern Medical University, Shenzhen, 518101, China
| | - Yuxing Kuang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China
- Department of Rehabilitation,The People's Hospital of Baoan Shenzhen, The Second School of Clinical Medicine, Southern Medical University, Shenzhen, 518101, China
| | - Yiwen Wan
- Department of Rehabilitation,The People's Hospital of Baoan Shenzhen, The Second School of Clinical Medicine, Southern Medical University, Shenzhen, 518101, China
| | - Jiao Shi
- Department of Rehabilitation,The People's Hospital of Baoan Shenzhen, The Second School of Clinical Medicine, Southern Medical University, Shenzhen, 518101, China
| | - Shuqian Li
- Department of Rehabilitation,The People's Hospital of Baoan Shenzhen, The Second School of Clinical Medicine, Southern Medical University, Shenzhen, 518101, China
| | - Rui Xia
- Department of Rehabilitation,The People's Hospital of Baoan Shenzhen, The Second School of Clinical Medicine, Southern Medical University, Shenzhen, 518101, China.
- Shunde Maternal and Children's Hospital, Guangdong Medical University, Foshan, 528300, China.
| | - Mingyue Wan
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China.
| | - Shangjie Chen
- Department of Rehabilitation,The People's Hospital of Baoan Shenzhen, The Second School of Clinical Medicine, Southern Medical University, Shenzhen, 518101, China.
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Mather H, Kleijwegt H, Bollens-Lund E, Liu B, Garrido MM, Kelley AS, Leff B, Ritchie CS, Ornstein KA. The heterogeneity of the homebound: A latent class analysis of a national sample of homebound older adults. J Am Geriatr Soc 2023; 71:2163-2171. [PMID: 36876755 DOI: 10.1111/jgs.18295] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 01/25/2023] [Accepted: 01/27/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Homebound status is a final common pathway for people with a variety of diseases and conditions. There are 7 million homebound older adults in the United States. Despite concerns regarding their high healthcare costs and utilization and limited access to care, the unique subsets within the homebound population are understudied. Better understanding of distinct homebound groups may enable more targeted and tailored approaches to care delivery. Therefore, in a nationally representative sample of homebound older adults we used latent class analysis (LCA) to examine distinct homebound subgroups based on clinical and sociodemographic characteristics. MATERIALS AND METHODS Using data from the National Health and Aging Trends Study (NHATS) 2011-2019, we identified 901 newly homebound persons (defined as never/rarely leaving home or leaving home only with assistance and/or difficulty). Sociodemographic, caregiving context, health and function, and geographic covariates were derived from NHATS via self-report. LCA was used to identify the existence of distinct subgroups within the homebound population. Indices of model fit were compared for models testing 1-5 latent classes. Association between latent class membership and 1 year mortality was examined using a logistic regression. RESULTS We identified four classes of homebound individuals differentiated by their health, function, sociodemographic characteristics, and caregiving context: (i) Resource constrained (n = 264); (ii) Multimorbid/high symptom burden (n = 216); (iii) Dementia/functionally impaired (n = 307); (iv) Older/assisted living (n = 114). One year mortality was highest among the older/assisted living subgroup (32.4%) and lowest among the resource constrained (8.2%). CONCLUSIONS This study identifies subgroups of homebound older adults characterized by distinct sociodemographic and clinical characteristics. These findings will support policymakers, payers, and providers in targeting and tailoring care to the needs of this growing population.
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Affiliation(s)
- Harriet Mather
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Hannah Kleijwegt
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Evan Bollens-Lund
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Bian Liu
- Department of Population Health Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Melissa M Garrido
- Partnered Evidence-based Policy Resource Center, Boston VA Healthcare System, Boston, Massachusetts, USA
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Amy S Kelley
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Bruce Leff
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Center for Transformative Geriatrics Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Community and Public Health, Johns Hopkins School of Nursing, Baltimore, Maryland, USA
| | - Christine S Ritchie
- Division of Palliative Care and Geriatric Medicine, Mongan Institute Center for Aging and Serious Illness, Massachusetts General Hospital, Boston, Massachusetts, USA
- Center for Palliative Care, Harvard Medical School, Boston, Massachusetts, USA
| | - Katherine A Ornstein
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Community and Public Health, Johns Hopkins School of Nursing, Baltimore, Maryland, USA
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32
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Elahi FM, Alladi S, Black SE, Claassen JAHR, DeCarli C, Hughes TM, Moonen J, Pajewski NM, Price BR, Satizabal C, Shaaban CE, Silva NCBS, Snyder HM, Sveikata L, Williamson JD, Wolters FJ, Hainsworth AH. Clinical trials in vascular cognitive impairment following SPRINT-MIND: An international perspective. Cell Rep Med 2023; 4:101089. [PMID: 37343515 PMCID: PMC10314118 DOI: 10.1016/j.xcrm.2023.101089] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 08/19/2022] [Accepted: 05/24/2023] [Indexed: 06/23/2023]
Abstract
A large interventional trial, the Systolic Blood Pressure Intervention Trial sub-study termed Memory and Cognition in Decreased Hypertension (SPRINT-MIND), found reduced risk of cognitive impairment in older adults with intensive, relative to standard, blood-pressure-lowering targets (systolic BP < 120 vs. <140 mm Hg). In this perspective, we discuss key questions and make recommendations for clinical practice and for clinical trials, following SPRINT-MIND. Future trials should embody cognitive endpoints appropriate to the participant group, ideally with adaptive designs that ensure robust answers for cognitive and cardiovascular endpoints. Reliable data from diverse populations, including the oldest-old (age > 80 years), will maximize external validity and global implementation of trial findings. New biomarkers will improve phenotyping to stratify patients to optimal treatments. Currently no antihypertensive drug class stands out for dementia risk reduction. Multi-domain interventions, incorporating lifestyle change (exercise, diet) alongside medications, may maximize global impact. Given the low cost and wide availability of antihypertensive drugs, intensive BP reduction may be a cost-effective means to reduce dementia risk in diverse, aging populations worldwide.
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Affiliation(s)
- Fanny M Elahi
- Friedman Brain Institute, Ronald M. Loeb Center for Alzheimer's Disease, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Suvarna Alladi
- National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka 560030, India
| | - Sandra E Black
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Jurgen A H R Claassen
- Department of Geriatric Medicine and Donders Institute for Medical Neuroscience, Radboud University Medical Center, 6525 EN Nijmegen, the Netherlands
| | - Charles DeCarli
- Department of Neurology and Center for Neuroscience, University of California at Davis, Sacramento, CA 95817, USA
| | - Timothy M Hughes
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27101, USA
| | - Justine Moonen
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, 1081 HZ Amsterdam, the Netherlands
| | - Nicholas M Pajewski
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC 27154, USA
| | | | - Claudia Satizabal
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, Department of Population Health Sciences, UT Health San Antonio, San Antonio, TX 78229, USA
| | - C Elizabeth Shaaban
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Nárlon C B S Silva
- Djavad Mowafaghian Centre for Brain Health, Department of Physical Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Heather M Snyder
- Alzheimer's Association, 225 N Michigan Avenue, Chicago, IL 60603, USA
| | - Lukas Sveikata
- J.P. Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA; Division of Neurology, Department of Clinical Neurosciences, Geneva University Hospitals, 1205 Genève, Switzerland; Institute of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Jeff D Williamson
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27101, USA; Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27154, USA
| | - Frank J Wolters
- Departments of Epidemiology and Radiology & Nuclear Medicine, Erasmus MC, University Medical Centre Rotterdam, 3015 GD Rotterdam, the Netherlands
| | - Atticus H Hainsworth
- Neurology, St George's University Hospitals NHS Foundation Trust, London SW17 0QT, UK; Molecular and Clinical Sciences Research Institute, St George's University of London, London SW17 0RE, UK.
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Peng J, Ye P, Zhang J, Zhang X, Peng K, He J, Wen L, Wang X, Shi Z, Hu S, Sun F, Gong Z, Sun M, Liu T, Liu X, Ma R, Zhu S, Wu X, Ivers R, Yang M, Tian M. Characteristics of falls among older hip fracture patients from six Chinese hospitals: a post-hoc descriptive analysis. BMC Geriatr 2023; 23:284. [PMID: 37170210 PMCID: PMC10176772 DOI: 10.1186/s12877-023-03971-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 04/13/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND There is well-established evidence to understand the characteristics of falls among the older patients with hip fracture in many countries, but very little knowledge existed in China. This study described the characteristics of falls in older patients with hip fractures from six Chinese hospitals. METHODS This cross-sectional study is a post-hoc descriptive analysis of a recently completed trial. Eligible patients were aged 65 years and older, with confirmed hip fractures due to falls, and were admitted to the hospital within 21 days of the fracture. All patients were consecutively enrolled and screened within one year (November 15, 2018, to November 14, 2019). The collected data included patient demographics and fall-related information. RESULTS A total of 1,892 patients' fall-related information were described. Most patients with hip fractures caused by falls were in the oldest old age group (60.4% in age group ≥ 80), with an overall average age of 80.7 (7.6) years. There were more females (n = 1,325, 70.0%) than males (n = 567, 30.0%). The majority lived in urban (n = 1,409, 74.5%). Most falls (n = 1,237, 67.3%) occurred during the daytime (6:01-18:00). There were 1,451 patients had their falls occurring at home (76.7%). Lost balance (n = 1,031, 54.5%) was reported as the primary reason to cause falls. The most common activity during a fall was walking (n = 1,079, 57.0%). CONCLUSIONS Although the incidence of fall-related hip fractures in China is unclear, preventing falls and fall-related hip fractures in older people remains an urgent health concern as the ageing society increases. Studies with larger sample size and diverse population are needed to robustly understand this growing epidemic.
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Affiliation(s)
- Junyi Peng
- School of Public Health, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150081, China
| | - Pengpeng Ye
- National Centre for Non-Communicable Disease Control and Prevention, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Jing Zhang
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - Xinyi Zhang
- School of Public Health, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150081, China
| | - Ke Peng
- National Clinical Research Centre for Cardiovascular Diseases, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, China
| | - Jiusheng He
- Department of Orthopaedics, Beijing Shunyi District Hospital, Beijing, China
| | - Liangyuan Wen
- Department of Orthopaedics, Beijing Hospital, Institute of Geriatric Medicine, National Centre of Gerontology, Chinese Academy of Medical Sciences, Beijing, China
| | - Xianhai Wang
- Department of Orthopaedics, Beijing Changping District Hospital, Beijing, China
| | - Zongxin Shi
- Department of Orthopaedics, Beijing Liangxiang Hospital, Beijing, China
| | - Sanbao Hu
- Department of Orthopaedics, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Fengpo Sun
- Department of Orthopaedics, Beijing Hospital, Institute of Geriatric Medicine, National Centre of Gerontology, Chinese Academy of Medical Sciences, Beijing, China
| | - Zishun Gong
- Department of Orthopaedics, Beijing Liangxiang Hospital, Beijing, China
| | - Mingyao Sun
- Department of Orthopaedics, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Tingzhuo Liu
- School of Public Health, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150081, China
| | - Xinyan Liu
- School of Public Health, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150081, China
| | - Ruofei Ma
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Peking University Fourth School of Clinical Medicine, 31 Xinjiekou E Street, Xicheng District, Beijing, 100035, China
| | - Shiwen Zhu
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Peking University Fourth School of Clinical Medicine, 31 Xinjiekou E Street, Xicheng District, Beijing, 100035, China
| | - Xinbao Wu
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Peking University Fourth School of Clinical Medicine, 31 Xinjiekou E Street, Xicheng District, Beijing, 100035, China
| | - Rebecca Ivers
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - Minghui Yang
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Peking University Fourth School of Clinical Medicine, 31 Xinjiekou E Street, Xicheng District, Beijing, 100035, China.
| | - Maoyi Tian
- School of Public Health, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150081, China.
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia.
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González-Pisano AC, Company-Sancho MC, Abad-Corpa E, Solé-Agusti MC, Cidoncha-Moreno MÁ, González MMP. Relationship between Falls and the Use of Medications and Diseases in an Otago Exercise Programme in Old People Living in the Community in Spain. Healthcare (Basel) 2023; 11:healthcare11070998. [PMID: 37046925 PMCID: PMC10093805 DOI: 10.3390/healthcare11070998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/16/2023] [Accepted: 03/17/2023] [Indexed: 04/03/2023] Open
Abstract
(1) Background: Falls are a significant health problem among older adults, and can result in severe injuries, disability, and even death. In Spain, the prevalence of falls is lower if the person lives in the community than if they are institutionalized. Research has shown that exercise is an effective strategy for reducing the risk of falls among older adults. The objective of this study was to study the influence of a multicomponent exercise intervention on falls in people between 65 and 80 years of age despite the presence of diseases and drug use that are risk factors for falls; (2) Methods: This is a quasi-experimental study that focuses on people aged 65–80 who attended 21 primary healthcare centres. Target: Inclusion criteria were people between 65 and 80 years of age, living in the community with independent ambulation, and who were served by the healthcare centre of their region. Variables analysed: The number and characteristics of falls, sociodemographic, drug use, and previous diseases; (3) Results: The drugs associated with falls are benzodiazepines (OR 2.58), vasodilators (OR = 2.51), and psychotropics (OR = 1.61). For one of the years, a relationship was found between the consumption of antidepressants and falls (OR = 1.83). The associated diseases were mental and behavioural (OR = 2.53); (4) Discussion: The intervention has been related to the reduction in falls in people who consumed benzodiazepines, vasodilators, and psychotropics and in people with mental disorders; (5) Conclusion: This research concludes the importance of the implementation of the Otago Exercise Programme in the prevention of falls in the elderly.
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Affiliation(s)
- Ana Covadonga González-Pisano
- Research Group “Community Health and Active Aging”, Biosanitary Research Institute of the Principality of Asturias, Primary Care, Ministry of Health, Asturias, 33006 Oviedo, Spain
| | - Maria Consuelo Company-Sancho
- Health Promotion Service, Directorate General for Public Health, Canary Islands Health Service, 35003 Las Palmas de Gran Canaria, Spain
| | - Eva Abad-Corpa
- Nursing and Healthcare Research Unit (Investén-Isciii), CIBER of Frailty and Healthy Aging (CIBER-FES), 30011 Murcia, Spain
| | | | | | - Marta M Pisano González
- General Direction of Care, Humanization and Social and Health Care, Principado de Asturias, Biosanitary Research Institute of the Principality of Asturias, Ministry of Health, 33006 Oviedo, Spain
- Correspondence:
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Association of Sonographic Sarcopenia and Falls in Older Adults Presenting to the Emergency Department. J Clin Med 2023; 12:jcm12041251. [PMID: 36835787 PMCID: PMC9968231 DOI: 10.3390/jcm12041251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/22/2023] [Accepted: 01/30/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND AND OBJECTIVE To determine the association between point-of-care-ultrasonography (POCUS)-measured sarcopenia and grip strength, as well as the history of prior-year falls among older adults admitted to the emergency department observation unit (EDOU). MATERIALS AND METHODS This cross-sectional observational study was conducted over 8 months at a large urban teaching hospital. A consecutive sample of patients who were 65 years or older and admitted to the EDOU were enrolled in the study. Using standardized techniques, trained research assistants and co-investigators measured patients' biceps brachii and thigh quadriceps muscles via a linear transducer. Grip strength was measured using a Jamar Hydraulic Hand Dynamometer. Participants were surveyed regarding their history of falls in the prior year. Logistic regression analyses assessed the relationship of sarcopenia and grip strength to a history of falls (the primary outcome). RESULTS Among 199 participants (55% female), 46% reported falling in the prior year. The median biceps thickness was 2.22 cm with an Interquartile range [IQR] of 1.87-2.74, and the median thigh muscle thickness was 2.91 cm with an IQR of 2.40-3.49. A univariate logistic regression analysis demonstrated a correlation between higher thigh muscle thickness, normal grip strength, and history of prior-year falling, with an odds ratio [OR] of 0.67 (95% conference interval [95%CI] 0.47-0.95) and an OR of 0.51 (95%CI 0.29-0.91), respectively. In multivariate logistic regression, only higher thigh muscle thickness was correlated with a history of prior-year falls, with an OR of 0.59 (95% CI 0.38-0.91). CONCLUSIONS POCUS-measured thigh muscle thickness has the potential to identify patients who have fallen and thus are at high risk for future falls.
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Wiedenmann T, Held S, Rappelt L, Grauduszus M, Spickermann S, Donath L. Exercise based reduction of falls in communitydwelling older adults: a network meta-analysis. Eur Rev Aging Phys Act 2023; 20:1. [PMID: 36707758 PMCID: PMC9883964 DOI: 10.1186/s11556-023-00311-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 01/16/2023] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Traditional meta-analyses with pairwise direct comparison revealed that a variety of exercise-based training interventions can prevent falls in community-dwelling older adults. This network meta-analysis adds value by comparing and ranking different exercise training strategies based on their effects on fall risk reductions determined by analysis of direct and indirect comparisons. METHODS The studies included in this network meta-analysis were identified through a comprehensive search in five biomedical databases (PubMed, SportDiscus, CINAHL, Web of Science and EMBASE). We included (randomized) controlled trials (RCTs) that compared the occurance of fall events in older adults who received different interventional treatments. RESULTS Seventy six comparisons from 66 RCTs with 47.420 (61% male / 39% female) participants aged 77 ± 4 (68 - 88) years were included in this network meta-analysis. The network model revealed low heterogeneity (I2 = 28.0, 95%CI 1.0 to 47.7%) and inconsistency (Q between designs = 15.1, p = 0.37). Postural control training was found to be most effective in preventing falls (Postural Control Training: (home): Risk Ratio (RR) = 0.66, 95%-CI [0.49; 0.88], P-score = 0.97;Postural Control Training: RR = 0.82, 95%-CI [0.75; 0.91], P-score = 0.82). Combined and multifactorial interventions also display a robust but smaller effect (RR = 0.88-0.93, P-score = 0.65-0.47). CONCLUSION Physical activity that includes balance training presents itself to be the most effective. Multifactorial approaches are well investigated but could be slightly less effective than isolated postural control training.
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Affiliation(s)
- Tim Wiedenmann
- grid.27593.3a0000 0001 2244 5164Department of Intervention Research in Exercise Training, Institute of Exercise Training and Sport Informatics, Am Sportpark Müngersdorf 6, 50933 Cologne, German Sport University Cologne, Cologne, Germany
| | - Steffen Held
- grid.27593.3a0000 0001 2244 5164Department of Intervention Research in Exercise Training, Institute of Exercise Training and Sport Informatics, Am Sportpark Müngersdorf 6, 50933 Cologne, German Sport University Cologne, Cologne, Germany
| | - Ludwig Rappelt
- grid.27593.3a0000 0001 2244 5164Department of Intervention Research in Exercise Training, Institute of Exercise Training and Sport Informatics, Am Sportpark Müngersdorf 6, 50933 Cologne, German Sport University Cologne, Cologne, Germany
| | - Martin Grauduszus
- grid.27593.3a0000 0001 2244 5164Department of Intervention Research in Exercise Training, Institute of Exercise Training and Sport Informatics, Am Sportpark Müngersdorf 6, 50933 Cologne, German Sport University Cologne, Cologne, Germany
| | - Sofie Spickermann
- grid.27593.3a0000 0001 2244 5164Department of Intervention Research in Exercise Training, Institute of Exercise Training and Sport Informatics, Am Sportpark Müngersdorf 6, 50933 Cologne, German Sport University Cologne, Cologne, Germany
| | - Lars Donath
- grid.27593.3a0000 0001 2244 5164Department of Intervention Research in Exercise Training, Institute of Exercise Training and Sport Informatics, Am Sportpark Müngersdorf 6, 50933 Cologne, German Sport University Cologne, Cologne, Germany
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Kulkarni S, Nagarkar A. Effect of a video-assisted fall prevention program on fall incidence in community-dwelling older adults during COVID. Geriatr Nurs 2023; 50:31-37. [PMID: 36640516 DOI: 10.1016/j.gerinurse.2022.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 12/23/2022] [Accepted: 12/26/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND The study evaluated the effectiveness of a video-assisted exercise intervention program on fall incidence, activities of daily living, and fear of falling in community-dwelling older adults. METHODS A video-assisted 16-week exercise intervention consisting of stretching, strengthening, balance, and dual-task training was delivered to randomly selected 95 older adults with a high risk of falls. The fidelity of implementation was assessed for three areas; exercise program delivery, participant receipt, and enactment. RESULTS The fall incidence reduced significantly by 45% (IRR 0.55, (95% CI, 0.13-0.86) and difficulty in daily activities decreased (OR: 0.74, 95% CI, 0.16 - 0.96) among participants in the intervention group. Fear of falls did not show any significant difference in the groups at the 12-month follow-up. CONCLUSION The video-assisted exercise program was found to be effective in reducing fall incidence among older adults at a higher risk of falls.
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Affiliation(s)
- Snehal Kulkarni
- School of Health Sciences, Savitribai Phule Pune University, India
| | - Aarti Nagarkar
- School of Health Sciences, Savitribai Phule Pune University, India.
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Campos-Mesa MDC, Rosendo M, Morton K, DelCastillo-Andrés Ó. Effects of the Implementation of an Intervention Based on Falls Education Programmes on an Older Adult Population Practising Pilates-A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1246. [PMID: 36673985 PMCID: PMC9859372 DOI: 10.3390/ijerph20021246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/06/2023] [Accepted: 01/07/2023] [Indexed: 06/17/2023]
Abstract
Age brings consequent physical deterioration of body balance, strength, flexibility and agility. It has been demonstrated that daily physical activity (PA), managed by professionals, is fundamental to ageing with increased quality and to reducing the number of falls, which are a consequence of factors highlighted above. This has been most evident during the COVID-19 pandemic. The aim of this study is to determine and analyse the effects of a multidisciplinary intervention based on the Safe Fall, Safe Schools, adapted utilitarian judo (JUA) and Pilates programmes in a population of older people. After an intervention of 60 min, 2 days a week for 12 weeks, the changes produced in variables such as quality of life, balance, lower body strength, flexibility and agility were analysed. A p-value ≤ 0.05 is accepted. The data show that the intervention can help to improve quality of life, especially two of its dimensions: pain (increases 12 points) and health transition (increases 13 points). It also helped to improve balance, lower body strength, flexibility and agility to a lesser extent. It is concluded that this type of intervention has positive effects for the sample in all the variables mentioned above.
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Affiliation(s)
| | - Marta Rosendo
- Physical Education and Sport Department, University of Seville, 41013 Seville, Spain
| | - Kevin Morton
- School of Sport and Health Sciences, University of Brighton, Eastbourne BN20, UK
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Chen J, Romero R, Thompson LA. Motion Analysis of Balance Pre and Post Sensorimotor Exercises to Enhance Elderly Mobility: A Case Study. APPLIED SCIENCES (BASEL, SWITZERLAND) 2023; 13:889. [PMID: 38501123 PMCID: PMC10947499 DOI: 10.3390/app13020889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
Quantitative assessment of movement using motion capture provides insights on mobility which are not evident from clinical evaluation. Here, in older individuals that were healthy or had suffered a stroke, we aimed to investigate their balance in terms of changes in body kinematics and muscle activity. Our research question involved determining the effects on post- compared to pre-sensorimotor training exercises on maintaining or improving balance. Our research hypothesis was that training would improve the gait and balance by increasing joint angles and extensor muscle activities in lower extremities and spatiotemporal measures of stroke and elderly people. This manuscript describes a motion capture-based evaluation protocol to assess joint angles and spatiotemporal parameters (cadence, step length and walking speed), as well as major extensor and flexor muscle activities. We also conducted a case study on a healthy older participant (male, age, 65) and an older participant with chronic stroke (female, age, 55). Both participants performed a walking task along a path with a rectangular shape which included tandem walking forward, right side stepping, tandem walking backward, left side stepping to the starting location. For the stroke participant, the training improved the task completion time by 19 s. Her impaired left leg had improved step length (by 0.197 m) and cadence (by 10 steps/min) when walking forward, and cadence (by 12 steps/min) when walking backward. The non-impaired right leg improved cadence when walking forward (by 15 steps/min) and backward (by 27 steps/min). The joint range of motion (ROM) did not change in most cases. However, the ROM of the hip joint increased significantly by 5.8 degrees (p = 0.019) on the left leg side whereas the ROMs of hip joint and knee joint increased significantly by 4.1 degrees (p = 0.046) and 8.1 degrees (p = 0.007) on the right leg side during backward walking. For the healthy participant, the significant changes were only found in his right knee joint ROM having increased by 4.2 degrees (p = 0.031) and in his left ankle joint ROM having increased by 5.5 degrees (p = 0.006) during the left side stepping.
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Affiliation(s)
- Ji Chen
- Biomedical Engineering Program, Department of Mechanical Engineering, University of the District of Columbia, Washington, DC 20008, USA
| | - Roni Romero
- Biomedical Engineering Program, Department of Mechanical Engineering, University of the District of Columbia, Washington, DC 20008, USA
| | - Lara A. Thompson
- Biomedical Engineering Program, Department of Mechanical Engineering, University of the District of Columbia, Washington, DC 20008, USA
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Pernes M, Agostinho I, Bernardes RA, Belo Fernandes J, Baixinho CL. Documenting fall episodes: a scoping review. Front Public Health 2023; 11:1067243. [PMID: 37200991 PMCID: PMC10187064 DOI: 10.3389/fpubh.2023.1067243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 02/27/2023] [Indexed: 05/20/2023] Open
Abstract
Documentation is an important measure for the management of fall risk because it concentrates the attention of professionals, raises awareness of the existence of fall risk factors, and promotes action to eliminate or minimize them. This study aimed to map the evidence on information to document episodes of falls in older adults. We opted for a scoping review, which followed the Joanna Briggs Institute protocol for this kind of study. The research question that guided the research strategy was "What recommendations emerge from the research on the documentation of falls of the older person?" The inclusion criteria defined were older adults who had at least one fall; nursing documentation after a fall has occurred; and nursing homes, hospitals, community, and long-term care. The search was performed on the following platforms: MEDLINE, CINAHL, Scopus, and Cochrane Database of Systematic Reviews in January 2022 and allowed the identification of 854 articles, which after analysis resulted in a final sample of six articles. The documentation of fall episodes should answer the following questions: Who? What? When? Where? How? Doing what? What was said? What were the consequences? and What has been done? Despite the recommendations for the documentation of fall episodes as a preventive measure for their recurrence, there are no studies evaluating the cost-effectiveness of this measure. Future studies should explore the association between fall documentation, fall recurrence prevention programs, and their impact on the prevalence rate of the second and subsequent falls, as well as the severity of injuries and fear of falling.
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Affiliation(s)
| | | | - Rafael A. Bernardes
- The Health Sciences Research Unit, Nursing (UICISA:E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
| | - Júlio Belo Fernandes
- Escola Superior de Saúde Egas Moniz, Caparica, Almada, Portugal
- Grupo de Patologia Médica, Nutrição e Exercício Clínico (PaMNEC)—Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Almada, Portugal
| | - Cristina Lavareda Baixinho
- Nursing School of Lisbon, Lisbon, Portugal
- Nursing Research, Innovation and Development Cetre of Lisbon (CIDNUR), Lisbon, Portugal
- *Correspondence: Cristina Lavareda Baixinho
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de Araújo TB, de Luca Corrêa H, de Deus LA, Neves RVP, Reis AL, Honorato FS, da S Barbosa JM, Palmeira TRC, Aguiar SS, Sousa CV, Santos CAR, Neto LSS, Amorim CEN, Simões HG, Prestes J, Rosa TS. The effects of home-based progressive resistance training in chronic kidney disease patients. Exp Gerontol 2023; 171:112030. [PMID: 36423855 DOI: 10.1016/j.exger.2022.112030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 11/09/2022] [Accepted: 11/11/2022] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Faced with lockdowns, it was mandatory the development of supervised home-based RT protocols to keep patients with chronic kidney disease engaged in programs. Nonetheless, there is a lack of scientific literature regarding its effects on patients. PURPOSE To investigate the effects of a supervised home-based progressive resistance training program on functional performance, bone mineral density, renal function, endothelial health, inflammation, glycemic homeostasis, metabolism, redox balance, and the modulation of exerkines in patients with CKD in stage 2. METHODS Patients (n = 31) were randomized and allocated into the control group (CTL; n = 15; 58.07 ± 5.22 yrs) or resistance training group (RT; n = 16; 57.94 ± 2.74 yrs). RT group performed 22 weeks of supervised progressive home-based resistance exercises. Bone mineral density, anthropometric measurements, and functional performance were assessed. Venous blood samples were collected at baseline and after the intervention for the analysis of markers of renal function, endothelial health, inflammation, glycemic homeostasis, metabolism, and redox balance. RESULTS Twenty-two weeks of home-based RT were effective in improving (P < 0.05) functional performance, bone mineral density, uremic profile, ADMA, inflammatory markers, the Klotho-FGF23 axis, glycemic homeostasis markers, and exerkines. These improvements were accompanied by higher concentrations of exerkines and anti-inflammatory cytokines. RT group displayed a decrease in cases of osteopenia after the intervention (RT: 50 % vs. CTL: 86.7 %; X2 = 4.763; P = 0.029). CONCLUSION Results provide new evidence that supervised home-based progressive RT may be a relevant intervention to attenuate the progression of CKD and improve functional capacity, bone mineral density, and the immunometabolic profile. These improvements are associated with positive modulation of several exerkines.
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Affiliation(s)
- Thaís B de Araújo
- Graduate Program in Physical Education, Catholic University of Brasília, Brasília, DF, Brazil
| | - Hugo de Luca Corrêa
- Graduate Program in Physical Education, Catholic University of Brasília, Brasília, DF, Brazil
| | - Lysleine A de Deus
- Graduate Program in Physical Education, Catholic University of Brasília, Brasília, DF, Brazil
| | - Rodrigo V P Neves
- Graduate Program in Physical Education, Catholic University of Brasília, Brasília, DF, Brazil
| | - Andrea L Reis
- Graduate Program in Physical Education, Catholic University of Brasília, Brasília, DF, Brazil
| | - Fernando S Honorato
- Graduate Program in Physical Education, Catholic University of Brasília, Brasília, DF, Brazil
| | - Jessica M da S Barbosa
- Graduate Program in Physical Education, Catholic University of Brasília, Brasília, DF, Brazil
| | - Thalyta R C Palmeira
- Graduate Program in Physical Education, Catholic University of Brasília, Brasília, DF, Brazil
| | - Samuel S Aguiar
- Graduate Program in Physical Education, Federal University of Mato Grosso, Cuiabá, Brazil
| | - Caio V Sousa
- Health Technology Lab, College of Arts, Media and Design, Bouvé College of Health Sciences, Northeastern University, Boston 02115, MA, USA
| | | | - Luiz S S Neto
- Federal University of Tocantins, Medicine Department, Tocantins, Brazil
| | - Carlos E N Amorim
- Federal University of Maranhão, Physical Education Department, Maranhão, Brazil
| | - Herbert G Simões
- Graduate Program in Physical Education, Catholic University of Brasília, Brasília, DF, Brazil
| | - Jonato Prestes
- Graduate Program in Physical Education, Catholic University of Brasília, Brasília, DF, Brazil
| | - Thiago S Rosa
- Graduate Program in Physical Education, Catholic University of Brasília, Brasília, DF, Brazil.
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The feasibility of a multimodal exercise program for sedentary postmenopausal women with urinary incontinence: A pilot randomized controlled trial. Maturitas 2023; 167:90-98. [DOI: 10.1016/j.maturitas.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 08/12/2022] [Accepted: 10/19/2022] [Indexed: 11/06/2022]
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Zemp DD, Baschung Pfister P, Knols R, Quadri P, Bianchi G, Giunzioni D, Lavorato S, Giannini O, de Bruin E. A blended e-health intervention for improving functional capacity in elderly patients on haemodialysis: A feasibility study. Front Digit Health 2022; 4:1054932. [PMID: 36561924 PMCID: PMC9763896 DOI: 10.3389/fdgth.2022.1054932] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction Physical exercise showed to be beneficial for frail older adults on haemodialysis (HD). However, there are several obstacles hindering the regular practice of exercise, such as transportation difficulties, lack of time, fatigue and comorbidities. E-health in this regard has many potential advantages and could be useful for motivating HD patients to increase their level of physical activity. The aim of this study was to evaluate the feasibility of a blended e-health intervention for elderly HD patients who individually exercise at home while under remote supervision of a physiotherapist. Material and methods Patients over 60 years of age with sufficient cognitive and motoric resources to perform a simple physical test battery and to use a tablet-computer were recruited from four HD outpatient facilities. Following baseline assessment at home, the participants were visited by a physiotherapist (PT). The PT set an individual exercise programme and explained how to use the web-based interface. During the 12 weeks of training, the PTs remotely supervised the patients' progress. At 12 weeks follow-up a second assessment took place. Results Twenty-two patients were recruited to participate in the study. Seven patients dropped out of the blended programme and 15 patients concluded the programme. The average training frequency of the 15 participants concluding the study was 1.5 times a week [range 0.2-5.8]. The duration of a training session was between 20 and 40 min. The usability of the system was deemed positive. Regarding the efficacy of the intervention, no significant improvement of any measured parameter was found, and effect sizes were small to medium. Conclusion A blended e-health intervention supported by a web-based application for exercising at home under remote supervision of a PT is feasible in a HD population including older patients. However, before planning a randomized controlled trial, strategies to increase the recruitment rate and the adherence to such a blended intervention should be further developed, e.g., to improve the recruitment procedures and lower the expectable drop-out rate. Furthermore, the dosage of the blended programme should be adapted to the patients' physical performance levels in future trials.The study was registered on the website clinicaltrials.gov with ID NCT04076488.
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Affiliation(s)
- Damiano D. Zemp
- Geriatric Service, Ospedale Regionale di Mendrisio, EOC, Mendrisio, Switzerland,Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Pierrette Baschung Pfister
- Directorate of Research and Education, Physiotherapy Occupational Therapy Research Center, University Hospital Zurich, Zurich, Switzerland,Department of Physiotherapy and Occupational Therapy, University Hospital Zurich, ZurichSwitzerland
| | - Ruud H. Knols
- Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland,Directorate of Research and Education, Physiotherapy Occupational Therapy Research Center, University Hospital Zurich, Zurich, Switzerland,Department of Physiotherapy and Occupational Therapy, University Hospital Zurich, ZurichSwitzerland
| | - Pierluigi Quadri
- Geriatric Service, Ospedale Regionale di Mendrisio, EOC, Mendrisio, Switzerland,Department of Internal Medicine, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Giorgia Bianchi
- Division of Nephrology, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Davide Giunzioni
- Division of Nephrology, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Soraya Lavorato
- Division of Nephrology, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Olivier Giannini
- Department of Internal Medicine, Ente Ospedaliero Cantonale, Bellinzona, Switzerland,Faculty of Biomedical Sciences, Università Della Svizzera Italiana, Lugano, Switzerland
| | - Eling D. de Bruin
- Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland,Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden,OST – Eastern Swiss University of Applied Sciences, Department of Health, St. Gallen, Switzerland,Correspondence: Eling de Bruin
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Cheng H, Wang Z, Gu WJ, Yang X, Song S, Huang T, Lyu J. Impact of Falls Within 3 Months on the Short-Term Prognoses of Elderly Patients in Intensive Care Units: A Retrospective Cohort Study Using Stabilized Inverse Probability Treatment Weighting. Clin Interv Aging 2022; 17:1779-1792. [PMID: 36506850 PMCID: PMC9733442 DOI: 10.2147/cia.s387148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 11/10/2022] [Indexed: 12/12/2022] Open
Abstract
Background Falls are a major public health problem in the older adults that can lead to poor clinical outcomes. There have been few reports on the short-term prognoses of older critically ill patients, and so we sought to determine the impact of falls on elderly patients in intensive care units (ICUs). Patients and Methods This retrospective study of 4503 patients (aged 65 years or older) analyzed data in the Medical Information Mart for Intensive Care-III critical care database. Of those, 2459 (54.6%) older adults are males, and 2044 (45.4%) older adults are females. Based on information from the medical care record assessment forms, patients were classified into the following two groups based on whether they had a fall within the previous 3 months: falls (n=1142) and nonfalls (n=3361). The primary outcomes of this study were 30- and 90-day mortality. Associations between the results of the Kaplan-Meier (KM) survival analysis, Cox proportional-hazards regression models, and subgroup analysis and its outcomes were analyzed using stabilized inverse probability treatment weighting (IPTW). Results KM survival curves with stabilized IPTW indicated that 30- and 90-day survival rates were significantly lower in elderly critically ill patients with a history of falls within the previous 3 months than in those patients without a history of falls (all p<0.001). Multivariate Cox proportional-hazards regression analysis indicated that 30- and 90-day mortality rates were 1.35 times higher (95% confidence interval [CI]=1.16-1.57, p<0.001) and 1.36 times higher (95% CI=1.19-1.55, p<0.001), respectively, in elderly critically ill patients with a history of falls within the previous 3 months than in those patients without a history of falls. Conclusion Experience of falls within the previous 3 months prior to ICU admission increased the risk of short-term mortality and affected the prognoses of elderly patients. Falls should therefore receive adequate attention from clinical healthcare providers and management decision-makers.
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Affiliation(s)
- Hongtao Cheng
- School of Nursing, Jinan University, Guangzhou, People’s Republic of China
| | - Zichen Wang
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, People’s Republic of China
| | - Wan-Jie Gu
- Department of Intensive Care Unit, The First Affiliated Hospital of Jinan University, Guangzhou, People’s Republic of China
| | - Xin Yang
- School of Nursing, Jinan University, Guangzhou, People’s Republic of China
| | - Simeng Song
- School of Nursing, Jinan University, Guangzhou, People’s Republic of China
| | - Tao Huang
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, People’s Republic of China
| | - Jun Lyu
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, People’s Republic of China,Guangdong Provincial Key Laboratory of Traditional Chinese Medicine Informatization, Guangzhou, People’s Republic of China,Correspondence: Jun Lyu, Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, People’s Republic of China, Tel +86-20-38680061, Email
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Hoffmann I, Shojaa M, Kohl M, von Stengel S, Becker C, Gosch M, Jakob F, Kerschan-Schindl K, Kladny B, Clausen J, Lange U, Middeldorf S, Peters S, Schoene D, Sieber C, Tholen R, Thomasius F, Bischoff-Ferrari HA, Uder M, Kemmler W. Exercise Reduces the Number of Overall and Major Osteoporotic Fractures in Adults. Does Supervision Make a Difference? Systematic Review and Meta-Analysis. J Bone Miner Res 2022; 37:2132-2148. [PMID: 36082625 DOI: 10.1002/jbmr.4683] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 07/14/2022] [Accepted: 08/14/2022] [Indexed: 11/07/2022]
Abstract
The purpose of this systematic review and meta-analysis (PROSPERO ID: CRD42021250467) was to evaluate the effects of exercise on low-trauma overall and major osteoporotic fractures (hip, spine, forearm, or humerus fractures) and to determine the corresponding effect of supervision of the exercise program. Our systematic search of six literature databases according to the PRISMA guideline was conducted from January 1, 2013 (ie, date of our last search) to May 22, 2021, and included controlled clinical exercise trials with (i) individuals aged ≥45 years, (ii) cohorts without therapies/diseases related to fractures, (iii) observation periods of ≥3 months, and (iv) the number of low-trauma fractures listed separately for the exercise (EG) and control (CG) groups. We included 20 intervention studies with 21 EGs and 20 CGs comprising a pooled number of participant-years of n = 11.836 in the EG and n = 11.275 in the CG. The mixed-effects conditional Poisson regression revealed significant effects of exercise on low-trauma overall incidence (rate) ratio (IR 0.67, 95% confidence interval [95% CI] 0.51-0.87) and major osteoporotic fractures IR (0.69, 95% CI 0.52-0.92). Heterogeneity between the trials was moderate for low-trauma overall (I2 = 40%) and negligible (I2 < 1%) for major osteoporotic fractures. Supervision of the exercise program plays a significant role in the reductions of overall and major osteoporotic fractures with IR about twice as favorable in the predominately supervised (IR 0.44; 95% CI 0.27-0.73 and 0.38; 0.19-0.76) versus the predominately non-supervised exercise trials (IR 0.83; 95% CI 0.60-1.14 and 0.82; 0.64-1.05). In summary, the present study provides evidence for the positive effect of exercise on low-trauma overall and major osteoporotic fractures in middle aged to older adults. Supervision of the exercise program is a crucial aspect in exercise programs on fracture reduction. Thus, home-based exercise protocols should increasingly implement online classes to ensure widely consistent supervision and monitoring of the exercise program. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Isabelle Hoffmann
- Institute of Medical Physics, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Mahdieh Shojaa
- Institute of Medical Physics, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany.,Institute of Health Science, Department of Population-Based Medicine, University Hospital Tübingen, Tübingen, Germany
| | - Matthias Kohl
- Department of Medical and Life Sciences, University of Furtwangen, Schwenningen, Germany
| | - Simon von Stengel
- Institute of Medical Physics, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Clemens Becker
- Robert-Bosch-Hospital, Geriatrics and Geriatric Rehabilitation, Stuttgart, Germany
| | - Markus Gosch
- Paracelsus Medical University Nürnberg and General Hospital Nürnberg, Nuremberg, Germany
| | - Franz Jakob
- Bernhard Heine Centre of Movement Science, University of Würzburg, Würzburg, Germany
| | | | - Bernd Kladny
- German Society for Orthopaedics and Trauma, Frankfurt, Germany
| | | | - Uwe Lange
- German Society for Physical and Rehabilitative Medicine, Ulm, Germany
| | | | - Stefan Peters
- German Association for Health-Related Fitness and Exercise Therapy (DVGS) e.V, Hürth-Efferen, Germany
| | - Daniel Schoene
- Institute of Medical Physics, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Cornel Sieber
- European Geriatric Medicine Society (EuGMS), Institute for Biomedicine of Aging, FAU Erlangen-Nürnberg, Nürnberg, Germany
| | - Reina Tholen
- Deutscher Verband für Physiotherapie (ZVK) e.V, Köln, Germany
| | | | - Heike A Bischoff-Ferrari
- Department of Geriatrics and Aging Research, University Hospital of Zurich, City Hospital of Zurich-Waid and University of Zurich, Centre on Aging and Mobility, University of Zurich, Zürich, Switzerland
| | - Michael Uder
- Institute of Radiology, University Hospital Erlangen, Erlangen, Germany
| | - Wolfgang Kemmler
- Institute of Medical Physics, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany.,Institute of Radiology, University Hospital Erlangen, Erlangen, Germany
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46
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Ferreira CR, Mascarenhas-Melo F, Rodrigues AR, Lima MJR, Pinheiro JP, Chaves C, Teixeira-Lemos E, Bell V. Characterisation of institutionalised Portuguese older adult fallers: is there a place for pharmacist intervention? A preliminary study. Pharm Pract (Granada) 2022; 20:2717. [PMID: 36793917 PMCID: PMC9891778 DOI: 10.18549/pharmpract.2022.4.2717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 08/17/2022] [Indexed: 12/14/2022] Open
Abstract
Background Falls are a major public health issue, given their prevalence and social impact. Older adults living in long-term care facilities (LTCF) are at greater risk of injury resulting from a fall due to multiple factors, such as nutritional, functional/cognitive impairment, postural instability, polypharmacy, and the presence of potentially inappropriate medications (PIMs). Medication management in LTCF is complex and often sub-optimal and might be crucial for falls. Pharmacist intervention is important, since they have a unique knowledge of medication. However, studies mapping the impact of pharmaceutical activities in Portuguese LTC settings are scarce. Objective This study aims to assess the characteristics of older adult fallers living in LTFCs and examine the relationship between falling and several factors in this population. We also intend to explore the prevalence of PIMs and their relationship with the occurrence of falls. Methods The study was conducted in two long-term care facilities for elderly people, in the central region of Portugal. We included patients aged 65 and older with no reduced mobility or physical weakness and with the ability to understand spoken and written Portuguese. The following information was assessed: sociodemographic characteristics, comorbidities, polypharmacy, fear of falling, functional, nutritional and cognitive status. PIMs were evaluated according to the Beers criteria (2019). Results A total of 69 institutionalised older adults, 45 women and 24 men, with a mean age of 83.14 ± 8.87 years were included. The prevalence of falls was 21.74% Out of these, 46.67% (n=7) fell once, 13.33% (n=2) fell twice, and 40% (n=6) fell 3 or more times. Fallers were mainly women, had lower levels of education, were well nourished, had moderate to severe levels of dependence, and displayed moderate cognitive impairment. All adult fallers had a fear of falling. The main comorbidities of this population were related to the cardiovascular system. Polypharmacy was present in every patient, and at least one PIM was identified in 88.41% of the subjects. Fear of falling (FOF) and cognitive impairment (in subjects with 1 to 11 years of education) showed statistically significant associations with the occurrence of falls (p=0.005 and p=0.05, respectively). No significant differences were found between fallers and non-fallers for any other factors. Conclusions This present study is a preliminary contribution to characterise a group of older adult fallers living in Portuguese LTCFs and demonstrated that fear of falling and cognitive impairment are associated with the occurrence of falls in this population. The high prevalence of polypharmacy and PIMs emphasises the need for tailored interventions featuring the collaboration of a pharmacist to optimise medication management in this population.
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Affiliation(s)
- Carina Ramos Ferreira
- Pharmacist, Laboratory of Social Pharmacy and Public Health, Faculty of Pharmacy of the University of Coimbra, University of Coimbra, Coimbra, Portugal.
| | - Filipa Mascarenhas-Melo
- Pharmacist, PhD, Drug Development and Technology Laboratory, Faculty of Pharmacy of the University of Coimbra, University of Coimbra, Coimbra, Portugal; REQUIMTE/LAQV, Group of Pharmaceutical Technology, Faculty of Pharmacy of the University of Coimbra, University of Coimbra, Coimbra, Portugal.
| | - Ana Rita Rodrigues
- Pharmacist, PhD student, Laboratory of Social Pharmacy and Public Health, Faculty of Pharmacy of the University of Coimbra, University of Coimbra, Coimbra, Portugal.
| | - Maria João Reis Lima
- Pharmacist, PhD, ESAV, CERNAS-IPV Research Centre, Polytechnic Institute of Viseu, Portugal.
| | - João Páscoa Pinheiro
- MD, PhD, Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal.
| | - Claúdia Chaves
- ND, MSN, PhD, Nursing Department, ESSV, Centre for Studies in Education and Innovation (CI&DEI), Polytechnic Institute of Viseu, Portugal.
| | - Edite Teixeira-Lemos
- Pharmacist, MSc, PhD, CERNAS-IPV Research Centre, Polytechnic Institute of Viseu, Portugal.
| | - Victoria Bell
- Pharmacist, MSc, PhD, Laboratory of Social Pharmacy and Public Health, Faculty of Pharmacy of the University of Coimbra, University of Coimbra, Coimbra, Portugal.
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LeBoff MS, Greenspan SL, Insogna KL, Lewiecki EM, Saag KG, Singer AJ, Siris ES. The clinician's guide to prevention and treatment of osteoporosis. Osteoporos Int 2022; 33:2049-2102. [PMID: 35478046 PMCID: PMC9546973 DOI: 10.1007/s00198-021-05900-y] [Citation(s) in RCA: 253] [Impact Index Per Article: 126.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 02/19/2021] [Indexed: 12/16/2022]
Abstract
Osteoporosis is the most common metabolic bone disease in the USA and the world. It is a subclinical condition until complicated by fracture(s). These fractures place an enormous medical and personal burden on individuals who suffer from them and take a significant economic toll. Any new fracture in an adult aged 50 years or older signifies imminent elevated risk for subsequent fractures, particularly in the year following the initial fracture. What a patient perceives as an unfortunate accident may be seen as a sentinel event indicative of bone fragility and increased future fracture risk even when the result of considerable trauma. Clinical or subclinical vertebral fractures, the most common type of osteoporotic fractures, are associated with a 5-fold increased risk for additional vertebral fractures and a 2- to 3-fold increased risk for fractures at other sites. Untreated osteoporosis can lead to a vicious cycle of recurrent fracture(s), often resulting in disability and premature death. In appropriate patients, treatment with effective antifracture medication prevents fractures and improves outcomes. Primary care providers and medical specialists are critical gatekeepers who can identify fractures and initiate proven osteoporosis interventions. Osteoporosis detection, diagnosis, and treatment should be routine practice in all adult healthcare settings. The Bone Health and Osteoporosis Foundation (BHOF) - formerly the National Osteoporosis Foundation - first published the Clinician's Guide in 1999 to provide accurate information on osteoporosis prevention and treatment. Since that time, significant improvements have been made in diagnostic technologies and treatments for osteoporosis. Despite these advances, a disturbing gap persists in patient care. At-risk patients are often not screened to establish fracture probability and not educated about fracture prevention. Most concerning, the majority of highest risk women and men who have a fracture(s) are not diagnosed and do not receive effective, FDA-approved therapies. Even those prescribed appropriate therapy are unlikely to take the medication as prescribed. The Clinician's Guide offers concise recommendations regarding prevention, risk assessment, diagnosis, and treatment of osteoporosis in postmenopausal women and men aged 50 years and older. It includes indications for bone densitometry as well as fracture risk thresholds for pharmacologic intervention. Current medications build bone and/or decrease bone breakdown and dramatically reduce incident fractures. All antifracture therapeutics treat but do not cure the disease. Skeletal deterioration resumes sooner or later when a medication is discontinued-sooner for nonbisphosphonates and later for bisphosphonates. Even if normal BMD is achieved, osteoporosis and elevated risk for fracture are still present. The diagnosis of osteoporosis persists even if subsequent DXA T-scores are above - 2.5. Ongoing monitoring and strategic interventions will be necessary if fractures are to be avoided. In addition to pharmacotherapy, adequate intake of calcium and vitamin D, avoidance of smoking and excessive alcohol intake, weight-bearing and resistance-training exercise, and fall prevention are included in the fracture prevention armamentarium. Where possible, recommendations in this guide are based on evidence from RCTs; however, relevant published data and guidance from expert clinical experience provides the basis for recommendations in those areas where RCT evidence is currently deficient or not applicable to the many osteoporosis patients not considered for RCT participation due to age and morbidity.
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Affiliation(s)
- M. S. LeBoff
- grid.38142.3c000000041936754XBrigham and Women’s Hospital, Harvard Medical School, 221 Longwood Ave, Boston, MA 02115 USA
| | - S. L. Greenspan
- grid.412689.00000 0001 0650 7433University of Pittsburgh Medical Center, 1110 Kaufmann Building, 3471 Fifth Ave, Pittsburgh, PA 15213 USA
| | - K. L. Insogna
- grid.47100.320000000419368710Yale School of Medicine, 333 Cedar St, New Haven, CT 06520 USA
| | - E. M. Lewiecki
- grid.266832.b0000 0001 2188 8502University of New Mexico Health Sciences Center, 300 Oak St NE, Albuquerque, NM 87106 USA
| | - K. G. Saag
- grid.265892.20000000106344187University of Alabama at Birmingham, 1720 2nd Avenue South, FOT 820, Birmingham, AL 35294 USA
| | - A. J. Singer
- grid.411663.70000 0000 8937 0972MedStar Georgetown University Hospital and Georgetown University Medical Center, 3800 Reservoir Road NW, 3rd Floor, Washington, DC 20007 USA
| | - E. S. Siris
- grid.21729.3f0000000419368729Columbia University Irving Medical Center, 180 Fort Washington Ave, Suite 9-903, New York, NY 10032 USA
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Cao YT, Wang JJ, Yang YT, Zhu SJ, Zheng LD, Lu WW, Zhu R, Wu T. Effect of home-based exercise programs with e-devices on falls among community-dwelling older adults: a meta-analysis. J Comp Eff Res 2022; 11:1201-1217. [PMID: 36148921 DOI: 10.2217/cer-2022-0130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To explore the effectiveness of home-based exercise programs with e-devices (HEPEs) on falls among community-dwelling older adults. Methods: Twelve randomized controlled trials were included in the meta-analysis considering four fall-related outcomes. Results: HEPEs significantly reduced the rate of falls (risk ratio: 0.82; 95% CI: 0.72-0.95; p = 0.006) and improved lower extremity strength (mean difference: -0.94; 95% CI: -1.71 to -0.47; p < 0.001). There was a significant improvement favoring HEPEs on balance if the participants were aged >75 years (mean difference: -0.55; 95% CI: -1.05 to -0.05; p = 0.03), or the intervention duration was at least 16 weeks (mean difference: -0.81; 95% CI: -1.58 to -0.05; p = 0.04). Conclusion: HEPEs demonstrated an overall positive effect on falls among community-dwelling older adults.
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Affiliation(s)
- Yu-Ting Cao
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, 200092, China.,Key Laboratory of Spine & Spinal Cord Injury Repair & Regeneration of the Ministry of Education, Tongji Hospital, School of Medicine, Tongji University, 389 Xincun Road, Shanghai, 200065, China
| | - Jian-Jie Wang
- Key Laboratory of Spine & Spinal Cord Injury Repair & Regeneration of the Ministry of Education, Tongji Hospital, School of Medicine, Tongji University, 389 Xincun Road, Shanghai, 200065, China
| | - Yi-Ting Yang
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, 200092, China.,Key Laboratory of Spine & Spinal Cord Injury Repair & Regeneration of the Ministry of Education, Tongji Hospital, School of Medicine, Tongji University, 389 Xincun Road, Shanghai, 200065, China
| | - Shi-Jie Zhu
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, 200092, China.,Key Laboratory of Spine & Spinal Cord Injury Repair & Regeneration of the Ministry of Education, Tongji Hospital, School of Medicine, Tongji University, 389 Xincun Road, Shanghai, 200065, China
| | - Liang-Dong Zheng
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, 200092, China.,Key Laboratory of Spine & Spinal Cord Injury Repair & Regeneration of the Ministry of Education, Tongji Hospital, School of Medicine, Tongji University, 389 Xincun Road, Shanghai, 200065, China
| | - Wei-Wei Lu
- Zhongshan Hospital, Fudan University, Shanghai, 200030, China
| | - Rui Zhu
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, 200092, China.,Key Laboratory of Spine & Spinal Cord Injury Repair & Regeneration of the Ministry of Education, Tongji Hospital, School of Medicine, Tongji University, 389 Xincun Road, Shanghai, 200065, China
| | - Tao Wu
- Shanghai University of Medicine & Health Sciences, Shanghai, 201318, China
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Rodrigues GD, Lima LS, da Silva NCS, Telles PGL, da Mota Silva Rocha TM, de Aragão Porto VQ, Cardoso VV, da Silva Soares PP. Are home-based exercises effective to reduce blood pressure in hypertensive adults? A systematic review. Clin Hypertens 2022; 28:28. [PMID: 36104807 PMCID: PMC9474275 DOI: 10.1186/s40885-022-00211-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 05/31/2022] [Indexed: 11/12/2022] Open
Abstract
Sedentarism and chronic non-communicable diseases have been a worldwide health problem that is drastically exacerbated by the COVID-19 pandemic social impacts. Home-based exercises are widely encouraged during social isolation to counterbalance the physical inactive impacts. Although, in the context of hypertension, are home-based exercises effective in blood pressure controlling? Our objective is to conduct a systematic review of high-quality controlled trials comparing the possible effects of different types of home-based exercises in hypertensive patients. The literature search was carried out in three scientific databases: Medline, Europe PMC, and Lilacs. Articles were included following three criteria: analyzing the effect of home-based exercise programs on blood pressure in treated and untreated hypertensive patients; exercises must perform at home and on the frequency, intensity, time, and type (FITT) principle, and the articles were published in English. From the qualitative analysis of 27 original trials screened through 451 identified studies, the main results are the following: 1) both endurance, isometric strength, and respiratory home-based exercise programs were efficient to decrease blood pressure in hypertensive patients; 2) differences in methodological approaches regarding FITT components, distinct blood pressure values at baseline and specific underlying mechanisms must be considered as a potential bias of each home-based interventions. In conclusion, endurance, isometric strength, and breathing home-based programs seems to be effective to reduce blood pressure in hypertensive patients. However, further randomized controlled trials and mechanistic studies must be performing to guide evidence-based recommendations of home-based exercises as antihypertensive therapy.
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Establishing the minimal clinically important difference of the EQ-5D-3L in older adults with a history of falls. Qual Life Res 2022; 31:3293-3303. [PMID: 35999431 DOI: 10.1007/s11136-022-03231-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE Establish the minimal clinically important difference (MCID) of a health-related quality of life (HRQoL) measure-the EuroQol EQ-5 Dimensions-3 Level (EQ-5D-3L)-in older adults with a history of falls. METHODS This study is a secondary analysis of 255 complete cases who were enrolled in a 12-month randomized controlled trial (NCT01029171; NCT00323596); participants were randomized to the Otago Exercise Program (OEP; n = 126/172; Age:81.2 ± 6.2 years; 60.3% Female) or control (CON; n = 129/172; Age:81.7 ± 5.7 years; 70.5% Female). Participants completed the EQ-5D-3L and Visual Analogue Scale (VAS) at baseline and 1-year. The VAS was associated with HRQoL and was the health status anchor (VAS minimal improvement = 7 to 17, maximal improvement ≥ 18, minimal decline = - 7 to - 17, maximal decline ≤ - 18 points). We used four distinct approaches to estimate MCID ranges: (1) anchor-based change differences of the EQ-5D-3L (1-year minus baseline); (2) anchor-based beta coefficients from ordinary least squares regressions (OLS); (3) anchor-based receiver operating characteristic (ROC), and 4) distribution-based standard deviation and standardized effect size of 0.5. RESULTS EQ-5D-3L MCID ranges for minimal improvements (OEP = 0.028 to 0.059; CON = 0.007 to 0.051), maximal improvements (OEP = 0.059 to 0.090; CON = 0.051 to 0.090), minimal declines (OEP = - 0.029 to - 0.105; CON = - 0.015 to - 0.051), and maximal declines (OEP = - 0.018 to - 0.072; CON = - 0.018 to - 0.082) were established using change difference, OLS, and distribution-based methods. The ROC area under the curve was poor, thus, it was not used to estimate the MCID. CONCLUSIONS Our results will assist in the interpretation of changes in HRQoL, as measured by the EQ-5D-3L, in older adults with a history of falls.
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