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Sciamanna CN, Lemaster KA, Danilovich MK, Conroy DE, Schmitz KH, Silvis M, Ladwig M, Ballentine N. Accuracy of Self-Reported Physical Capacities as a Clinical Screening Test for Older Adults With Mobility Disability. Gerontol Geriatr Med 2023; 9:23337214231167979. [PMID: 37113797 PMCID: PMC10126779 DOI: 10.1177/23337214231167979] [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: 01/07/2023] [Revised: 03/10/2023] [Accepted: 03/17/2023] [Indexed: 04/29/2023] Open
Abstract
Background: Screening for poor physical performance has the potential to identify older adults at risk for loss of future independence, yet clinically feasible measures have yet to be identified. Methods: Using data from the National Health and Aging Trends Study, we evaluated the diagnostic utility of self-reported physical capacities of older adults (walking three blocks or six blocks, climbing 10 stairs or 20 stairs) compared to the objectively measured Short Physical Performance Battery (SPPB). Sensitivity, specificity, and likelihood ratio (LR) were calculated across three SPPB cut-points (≤8, ≤9, ≤10). Results: Sensitivity of single item-measures for detecting a low SBBP averaged 0.39 (range: 0.26-0.52), specific averaged 0.97 (range: 0.94-0.99) and likelihood ratio averaged 20.0 (range: 9.0-35.5). Among age and gender subgroups, all measures maintained clinically applicable LRs (minimum = 4.59). Conclusion: Single-item self-reported physical capacities are accurate for screening older adults with physical limitations, making them potentially useful in healthcare settings.
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Affiliation(s)
- Christopher N. Sciamanna
- Penn State College of Medicine, Hershey, PA, USA
- Christopher N. Sciamanna, Penn State College of Medicine, The Pennsylvania State University, 500 University Drive, Hershey, PA 17033, USA.
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Su C, Yang X, Wei S, Zhao R. Association of Cerebral Small Vessel Disease With Gait and Balance Disorders. Front Aging Neurosci 2022; 14:834496. [PMID: 35875801 PMCID: PMC9305071 DOI: 10.3389/fnagi.2022.834496] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 06/14/2022] [Indexed: 12/27/2022] Open
Abstract
Cerebral small vessel disease (CSVD) is a common cerebrovascular disease and an important cause of gait and balance disorders. Gait and balance disorders can further lead to an increased risk of falls and a decreased quality of life. CSVD can damage gait and balance function by affecting cognitive function or directly disrupting motor pathways, and different CSVD imaging features have different characteristics of gait and balance impairment. In this article, the correlation between different imaging features of sporadic CSVD and gait and balance disorders has been reviewed as follows, which can provide beneficial help for standardized management of CSVD.
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Affiliation(s)
| | | | | | - Renliang Zhao
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China
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Papp ME, Grahn-Kronhed AC, Rauch Lundin H, Salminen H. Changes in physical activity levels and relationship to balance performance, gait speed, and self-rated health in older Swedish women: a longitudinal study. Aging Clin Exp Res 2022; 34:775-783. [PMID: 34784017 PMCID: PMC9076716 DOI: 10.1007/s40520-021-02016-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 10/20/2021] [Indexed: 12/30/2022]
Abstract
Background and aim Physical activity levels in older people often decrease and may mean impaired physical functioning leading to an increased fall risk. The aim of this study was to investigate self-reported change in physical activity dose and deterioration in balance performance, gait speed, and self-rated health (SRH) in older women between two time points in a follow-up study. Methods A cohort of community-living women, aged 69–79 years (n = 351) were evaluated by questionnaire and clinical tests on balance, gait speed, and SRH at baseline. One hundred and eighty-six women were followed-up by these tests 8.5 years after inclusion. The non-parametric Wilcoxon signed-rank test and Mann–Whitney U test were used for the analysis. Results The greatest changes were seen in one-leg standing time (OLST) with eyes closed (− 60%) and eyes open (− 42%). The population was divided into high exercise (HE, n = 49) and low exercise (LE, n = 51) groups. At baseline the HE group had an OLST of 19 s with eyes open and 3 s with eyes closed. In the LE group, these values were 7.3 s and 2 s. At follow-up, differences between HE and LE concerning tandem walk forwards (steps) (HE = 8.5; LE = 2.5) and backwards (HE = 11; LE = 3.5) emerged. The HE group estimated SRH (VAS-scale) 30 mm higher at baseline and 17 mm higher at follow-up than the LE group. Conclusion Greater physical activity seems to be an important predictor for maintaining physical function and SRH in older women.
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Affiliation(s)
- Marian E Papp
- Division of Family Medicine and Primary Care, Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Alfred Nobels alle 23, 141 83, Huddinge, Sweden.
- Division of Physical Therapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Solna, Sweden.
| | - Ann Charlotte Grahn-Kronhed
- Rehab Väst, Local Health Care Services in the West of Östergötland, Motala, Sweden
- Division of Prevention, Rehabilitation, and Community Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Hans Rauch Lundin
- Division of Family Medicine and Primary Care, Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Alfred Nobels alle 23, 141 83, Huddinge, Sweden
- Academic Primary Healthcare Centre Stockholm, Stockholm, Sweden
| | - Helena Salminen
- Division of Family Medicine and Primary Care, Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Alfred Nobels alle 23, 141 83, Huddinge, Sweden
- Academic Primary Healthcare Centre Stockholm, Stockholm, Sweden
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Wright JR, Koch-Hanes T, Cortney C, Lutjens K, Raines K, Shan G, Young D. Planning for Safe Hospital Discharge by Identifying Patients Likely to Fall After Discharge. Phys Ther 2022; 102:6448020. [PMID: 34935968 DOI: 10.1093/ptj/pzab264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/15/2021] [Accepted: 09/28/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Acute care physical therapists recommend discharge locations and services in part to help prevent falls during post-discharge recovery. Therapists may use standardized tests to inform their recommendation decisions, but evidence linking test scores with fall risk after discharge is lacking. The primary purpose of this study was to explore the associations between Tinetti Performance-Oriented Mobility Assessment (POMA) and Activity Measure for Post-Acute Care Inpatient Mobility Short Form (AM-PAC IMSF) scores and falls in the first 30 days after hospital discharge. Anticipating that agreement between therapist recommendations and discharge locations and services (discharge agreement), age, and sex could impact those associations, these factors were included in this investigation. METHODS In this observational cohort study, 258 hospitalized patients consented to medical record data extraction and answered a phone survey 30 days after discharge to report whether they had experienced a fall since leaving the hospital. POMA and AM-PAC IMSF tests were administered for every patient. Participants' age, sex, diagnosis, last POMA score, last AM-PAC IMSF score, physical therapist discharge recommendations, actual discharge location and services, discharge date, and phone number were collected from their medical records. RESULTS When analyzed alone, higher POMA scores were associated with lower odds of falling, but the association was not significant after adjustment for other factors. Neither AM-PAC IMSF scores, age, nor sex were associated with falls. Discharge agreement, however, was associated with 59% lower odds of falling after adjustment for other factors. CONCLUSION Participants, who were discharged to the location with the services recommended by their physical therapist, were less likely to fall. Tinetti POMA and AM-PAC IMSF scores did not discriminate well participants who would fall. IMPACT Findings in this study inform those involved in discharge planning on the value of implementing physical therapist recommendations in reducing fall risk after hospital discharge. LAY SUMMARY If physical therapist discharge recommendations are implemented, patients are less likely to fall during the month after hospital discharge. Balance and mobility test scores may provide therapists valuable information, but they are limited in their ability to identify who will fall after discharge.
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Affiliation(s)
- Jonathan R Wright
- Doctor of Physical Therapy Program, Rocky Mountain University of Health Professions, Provo, Utah, USA
| | - Trisha Koch-Hanes
- Department of Physical Therapy, University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Ciera Cortney
- Department of Physical Therapy, University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Kathryn Lutjens
- Department of Physical Therapy, University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Kristopher Raines
- Physical Therapist Assistant Program, Carrington College, Las Vegas, Nevada, USA
| | - Guogen Shan
- Epidemiology and Biostatistics Program, School of Public Health, University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Daniel Young
- Department of Physical Therapy, University of Nevada Las Vegas, Las Vegas, Nevada, USA
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Omaña H, Bezaire K, Brady K, Davies J, Louwagie N, Power S, Santin S, Hunter SW. Functional Reach Test, Single-Leg Stance Test, and Tinetti Performance-Oriented Mobility Assessment for the Prediction of Falls in Older Adults: A Systematic Review. Phys Ther 2021; 101:6317705. [PMID: 34244801 DOI: 10.1093/ptj/pzab173] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 03/15/2021] [Accepted: 05/14/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The authors sought to systematically review the existing literature on the falls-related diagnostic test properties of the Functional Reach Test (FRT), single-leg stance test (SLST), and Tinetti Performance-Oriented Mobility Assessment (POMA) in older adults across settings and patient populations. METHODS The PubMed, EMBASE, and CINAHL databases were searched (inception-July 2020). Inclusion criteria were participants aged 60 years or more, prospectively recorded falls, and the reporting of falls-related predictive validity. Manuscripts not published in English were excluded. Methodological quality of reporting was assessed using the Tooth Scale. RESULTS Of 1071 studies reviewed, 21 met the inclusion criteria (12 POMA, 8 FRT, 6 SLST). Seven studies (58.3%) used a modified version of the POMA, and 3 (37.5%) used a modified FRT. For the outcome of any fall, the respective ranges of sensitivity and specificity were 0.076 to 0.615 and 0.695 to 0.97 for the POMA, 0.27 to 0.70 and 0.52 to 0.83 for the modified POMA, 0.73 and 0.88 for the FRT, 0.47 to 0.682 and 0.59 to 0.788 for the modified FRT, and 0.51 and 0.61 for the SLST in community-dwelling older adults. For the SLST, the sensitivity and specificity for recurrent falls in the community-dwelling setting were 0.33 and 0.712, respectively. CONCLUSION All the clinical tests of balance demonstrated an overall low diagnostic accuracy and a consistent inability to correctly identify fallers. None of these tests individually are able to predict future falls in older adults. Future research should develop a better understanding of the role that clinical tests of balance play in the comprehensive assessment of falls risk in older adults. IMPACT Neither the FRT, SLST, nor POMA alone shows consistent evidence of being able to correctly identify fallers across fall types, settings, or older adult subpopulations. These clinical tests of balance cannot substitute a comprehensive falls risk assessment and thus should be incorporated in practice solely to identify and track balance impairment in older adults.
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Affiliation(s)
- Humberto Omaña
- Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada
| | - Kari Bezaire
- School of Physical Therapy, University of Western Ontario, London, Ontario, Canada
| | - Kyla Brady
- School of Physical Therapy, University of Western Ontario, London, Ontario, Canada
| | - Jayme Davies
- School of Physical Therapy, University of Western Ontario, London, Ontario, Canada
| | - Nancy Louwagie
- School of Physical Therapy, University of Western Ontario, London, Ontario, Canada
| | - Sean Power
- School of Physical Therapy, University of Western Ontario, London, Ontario, Canada
| | - Sydney Santin
- School of Physical Therapy, University of Western Ontario, London, Ontario, Canada
| | - Susan W Hunter
- Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada.,School of Physical Therapy, University of Western Ontario, London, Ontario, Canada
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Fear of Falling, Recurrence of Falls, and Quality of Life in Patients with a Low Energy Fracture-Part II of an Observational Study. ACTA ACUST UNITED AC 2021; 57:medicina57060584. [PMID: 34200303 PMCID: PMC8226509 DOI: 10.3390/medicina57060584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/26/2021] [Accepted: 05/29/2021] [Indexed: 11/17/2022]
Abstract
Background and objective: Falls in elderly cause injury, mortality, and loss of independence, making Fear of Falling (FoF) a common health problem. FoF relates to activity restriction and increased fall risk. A voluntary intervention including fall risk assessment and prevention strategies was implemented to reduce falls in elderly patients with low energy fractures (LEF). The primary purpose of this study was to evaluate FoF and the number of subsequent falls in trauma patients one year after a LEF. The secondary aim was to examine how FoF affects patients' lives in terms of Quality of Life (QoL), mobility, and activity levels. Finally, participation in the voluntary fall prevention program (FPP) was evaluated. Materials and Methods: Observational cohort study in one Swiss trauma center. LEF patients, treated between 2012 and 2015, were analyzed one year after injury. Primary outcomes were Falls-Efficacy Score-International (FES-I) and number of subsequent falls. Secondary outcomes were EuroQoL-5-Dimensions-3-Levels (EQ5D-3L), mobility, activity levels, and participation in the FPP. Subgroup analysis was performed for different age categories. Results: 411 patients were included for analysis. Mean age was 72 ± 9.3, mean FES-I was 21.1 ± 7.7. Forty percent experienced FoF. A significant negative correlation between FoF and QoL (R = 0.64; p < 0.001) was found. High FoF correlated with lower activity levels (R= -0.288; p < 0.001). Six percent visited the FPP. Conclusions: At follow-up, 40% suffered from FoF which seems to negatively affect patients' QoL. Nevertheless, participation in the FPP was low. Simply informing patients about their susceptibility to falls and recommending participation in FPPs seems insufficient to motivate and recruit patients into FPPs. We suggest implementing repeated fall risk- and FoF screenings as standard procedures in the follow-up of LEF, especially in patients aged over 75 years.
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Gade GV, Jørgensen MG, Ryg J, Riis J, Thomsen K, Masud T, Andersen S. Predicting falls in community-dwelling older adults: a systematic review of prognostic models. BMJ Open 2021; 11:e044170. [PMID: 33947733 PMCID: PMC8098967 DOI: 10.1136/bmjopen-2020-044170] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 02/24/2021] [Accepted: 04/16/2021] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To systematically review and critically appraise prognostic models for falls in community-dwelling older adults. ELIGIBILITY CRITERIA Prospective cohort studies with any follow-up period. Studies had to develop or validate multifactorial prognostic models for falls in community-dwelling older adults (60+ years). Models had to be applicable for screening in a general population setting. INFORMATION SOURCE MEDLINE, EMBASE, CINAHL, The Cochrane Library, PsycINFO and Web of Science for studies published in English, Danish, Norwegian or Swedish until January 2020. Sources also included trial registries, clinical guidelines, reference lists of included papers, along with contacting clinical experts to locate published studies. DATA EXTRACTION AND RISK OF BIAS Two authors performed all review stages independently. Data extraction followed the Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies checklist. Risk of bias assessments on participants, predictors, outcomes and analysis methods followed Prediction study Risk Of Bias Assessment Tool. RESULTS After screening 11 789 studies, 30 were eligible for inclusion (n=86 369 participants). Median age of participants ranged from 67.5 to 83.0 years. Falls incidences varied from 5.9% to 59%. Included studies reported 69 developed and three validated prediction models. Most frequent falls predictors were prior falls, age, sex, measures of gait, balance and strength, along with vision and disability. The area under the curve was available for 40 (55.6%) models, ranging from 0.49 to 0.87. Validated models' The area under the curve ranged from 0.62 to 0.69. All models had a high risk of bias, mostly due to limitations in statistical methods, outcome assessments and restrictive eligibility criteria. CONCLUSIONS An abundance of prognostic models on falls risk have been developed, but with a wide range in discriminatory performance. All models exhibited a high risk of bias rendering them unreliable for prediction in clinical practice. Future prognostic prediction models should comply with recent recommendations such as Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis. PROSPERO REGISTRATION NUMBER CRD42019124021.
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Affiliation(s)
- Gustav Valentin Gade
- Department of Geriatric Medicine, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | - Jesper Ryg
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Syddanmark, Denmark
| | - Johannes Riis
- Department of Geriatric Medicine, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Katja Thomsen
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Syddanmark, Denmark
| | - Tahir Masud
- Department of Healthcare for Older People, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Stig Andersen
- Department of Geriatric Medicine, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Mobility impact and well-being in later life: A multidisciplinary systematic review. RESEARCH IN TRANSPORTATION ECONOMICS 2021; 86:100975. [PMCID: PMC7547325 DOI: 10.1016/j.retrec.2020.100975] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 09/19/2020] [Accepted: 10/02/2020] [Indexed: 06/01/2023]
Abstract
In modern societies, the understanding of how active mobility affects the elderly's psycho-physical well-being is crucial to design ageing-friendly transport measures. From a multidisciplinary perspective, this systematic review points out the mobility impact on three elements of the EU Active Ageing Index: health, independence and social connectedness. By scanning four databases (Scopus, Web of Science, PubMed, and TRID), 3727 peer-reviewed papers published in the last decade were found, of which 57 met the inclusion criteria. The screening process was conducted following the PRISMA protocol and registered to the database PROSPERO, while the quality assessment was done using the Mixed Methods Appraisal Tool. More than 80% of the papers showed that an active mobility prevents psycho-physical harms, while only few papers study the relation of mobility with independence and social inclusion, to reduce the need for assistance and the related public expenditures. The findings of this review give important information both to transportation researchers and policymakers and companies, underlining the need for further research as well as investments in targeted age-friendly transport systems. The Covid-19 emergency has further underlined the importance of this issue, being the elderly one of the more disadvantaged and frailer social group.
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Wagner AR, Akinsola O, Chaudhari AMW, Bigelow KE, Merfeld DM. Measuring Vestibular Contributions to Age-Related Balance Impairment: A Review. Front Neurol 2021; 12:635305. [PMID: 33633678 PMCID: PMC7900546 DOI: 10.3389/fneur.2021.635305] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 01/18/2021] [Indexed: 12/16/2022] Open
Abstract
Aging is associated with progressive declines in both the vestibular and human balance systems. While vestibular lesions certainly contribute to imbalance, the specific contributions of age-related vestibular declines to age-related balance impairment is poorly understood. This gap in knowledge results from the absence of a standardized method for measuring age-related changes to the vestibular balance pathways. The purpose of this manuscript is to provide an overview of the existing body of literature as it pertains to the methods currently used to infer vestibular contributions to age-related imbalance.
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Affiliation(s)
- Andrew R. Wagner
- School of Health and Rehabilitation Science, The Ohio State University, Columbus, OH, United States
- Department of Otolaryngology—Head and Neck Surgery, The Ohio State University, Columbus, OH, United States
| | - Olaoluwa Akinsola
- Department of Mechanical and Aerospace Engineering, The Ohio State University, Columbus, OH, United States
| | - Ajit M. W. Chaudhari
- School of Health and Rehabilitation Science, The Ohio State University, Columbus, OH, United States
- Department of Mechanical and Aerospace Engineering, The Ohio State University, Columbus, OH, United States
| | - Kimberly E. Bigelow
- Department of Mechanical and Aerospace Engineering, University of Dayton, Dayton, OH, United States
| | - Daniel M. Merfeld
- School of Health and Rehabilitation Science, The Ohio State University, Columbus, OH, United States
- Department of Otolaryngology—Head and Neck Surgery, The Ohio State University, Columbus, OH, United States
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, United States
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Quijoux F, Bertin-Hugault F, Zawieja P, Lefèvre M, Vidal PP, Ricard D. Postadychute-AG, Detection, and Prevention of the Risk of Falling Among Elderly People in Nursing Homes: Protocol of a Multicentre and Prospective Intervention Study. Front Digit Health 2021; 2:604552. [PMID: 34713067 PMCID: PMC8521935 DOI: 10.3389/fdgth.2020.604552] [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: 09/09/2020] [Accepted: 12/15/2020] [Indexed: 12/02/2022] Open
Abstract
Introduction: While falls among the elderly is a public health issue, because of the social, medical, and economic burden they represent, the tools to predict falls are limited. Posturography has been developed to distinguish fallers from non-fallers, however, there is too little data to show how predictions change as older adults' physical abilities improve. The Postadychute-AG clinical trial aims to evaluate the evolution of posturographic parameters in relation to the improvement of balance through adapted physical activity (APA) programs. Methods: In this prospective, multicentre clinical trial, institutionalized seniors over 65 years of age will be followed for a period of 6 months through computer-assisted posturography and automatic gait analysis. During the entire duration of the follow-up, they will benefit from a monthly measurement of their postural and locomotion capacities through a recording of their static balance and gait thanks to a software developed for this purpose. The data gathered will be correlated with the daily record of falls in the institution. Static and dynamic balance measurements aim to extract biomechanical markers and compare them with functional assessments of motor skills (Berg Balance Scale and Mini Motor Test), expecting their superiority in predicting the number of falls. Participants will be followed for 3 months without APA and 3 months with APA in homogeneous group exercises. An analysis of variance will evaluate the variability of monthly measures of balance in order to record the minimum clinically detectable change (MDC) as participants improve their physical condition through APA. Discussion: Previous studies have stated the MDC through repeated measurements of balance but, to our knowledge, none appear to have implemented monthly measurements of balance and gait. Combined with a reliable measure of the number of falls per person, motor capacities and other precipitating factors, this study aims to provide biomechanical markers predictive of fall risk with their sensitivity to improvement in clinical status over the medium term. This trial could provide the basis for posturographic and gait variable values for these elderly people and provide a solution to distinguish those most at risk to be implemented in current practice in nursing homes. Trial Registration: ID-RCB 2017-A02545-48. Protocol Version: Version 4.2 dated January 8, 2020.
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Affiliation(s)
- Flavien Quijoux
- Centre Borelli UMR 9010/Université Paris-Saclay, ENS Paris-Saclay, CNRS, SSA, Université de Paris, Inserm, Paris, France
- ORPEA Group, Puteaux, France
| | | | | | | | - Pierre-Paul Vidal
- Centre Borelli UMR 9010/Université Paris-Saclay, ENS Paris-Saclay, CNRS, SSA, Université de Paris, Inserm, Paris, France
- Institute of Information and Control, Hangzhou Dianzi University, Hangzhou, China
| | - Damien Ricard
- Centre Borelli UMR 9010/Université Paris-Saclay, ENS Paris-Saclay, CNRS, SSA, Université de Paris, Inserm, Paris, France
- Service de Neurologie de l'Hôpital d'Instruction des Armées de Percy, Service de Santé des Armées, Clamart, France
- Ecole du Val-de-Grâce, Ecole de Santé des Armées, Paris, France
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Kozinc Ž, Löfler S, Hofer C, Carraro U, Šarabon N. Diagnostic Balance Tests for Assessing Risk of Falls and Distinguishing Older Adult Fallers and Non-Fallers: A Systematic Review with Meta-Analysis. Diagnostics (Basel) 2020; 10:E667. [PMID: 32899201 PMCID: PMC7554797 DOI: 10.3390/diagnostics10090667] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 09/01/2020] [Accepted: 09/02/2020] [Indexed: 01/02/2023] Open
Abstract
Falls are a major cause of injury and morbidity in older adults. To reduce the incidence of falls, a systematic assessment of the risk of falling is of paramount importance. The purpose of this systematic review was to provide a comprehensive comparison of the diagnostic balance tests used to predict falls and for distinguishing older adults with and without a history of falls. We conducted a systematic review of the studies in which instrumented (force plate body sway assessment) or other non-instrumented balance tests were used. We analyzed the data from 19 prospective and 48 retrospective/case-control studies. Among the non-instrumented tests, the single-leg stance test appears to be the most promising for discrimination between fallers and non-fallers. In terms of body sway measures, the center-of-pressure area was most consistently associated with falls. No evidence was found for increased benefit of the body sway test when cognitive tasks were added, or the vision was eliminated. While our analyses are limited due to the unbalanced representation of different test and outcome measures across studies, we can recommend the single-leg test for the assessment of the risk of falling, and the measurements of body sway for a more comprehensive assessment.
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Affiliation(s)
- Žiga Kozinc
- Faculty of Health Sciences, University of Primorska, Polje 42, SI-6310 Izola, Slovenia;
- Andrej Marušič Institute, University of Primorska, Muzejski trg 2, SI-6000 Koper, Slovenia
| | - Stefan Löfler
- Physiko- & Rheumatherapie, Institute for Physical Medicine and Rehabilitation, 3100 St. Pölten, Austria;
- Centre of Active Ageing—Competence Centre for Health, Prevention and Active Ageing, 3100 St. Pölten, Austria
- Ludwig Boltzmann Institute for Rehabilitation Research, Neugebäudeplatz 1, 3100 St. Pölten, Austria;
| | - Christian Hofer
- Ludwig Boltzmann Institute for Rehabilitation Research, Neugebäudeplatz 1, 3100 St. Pölten, Austria;
| | - Ugo Carraro
- Department of Biomedical Sciences, University of Padova, Via Ugo Bassi, 58/B, 35131 Padova, Italy;
- Interdepartmental Research Center of Myology, University of Padova, Via Ugo Bassi, 58/B, 35131 Padova, Italy
- A&C M-C Foundation for Translational Myology, Padova, Galleria Duomo 5, 35141 Padova, Italy
| | - Nejc Šarabon
- Faculty of Health Sciences, University of Primorska, Polje 42, SI-6310 Izola, Slovenia;
- InnoRenew CoE, Livade 6, SI6310 Izola, Slovenia
- Laboratory for Motor Control and Motor Behavior, S2P, Science to Practice, Ltd., Tehnološki park 19, SI-1000 Ljubljana, Slovenia
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Quijoux F, Vienne-Jumeau A, Bertin-Hugault F, Zawieja P, Lefèvre M, Vidal PP, Ricard D. Center of pressure displacement characteristics differentiate fall risk in older people: A systematic review with meta-analysis. Ageing Res Rev 2020; 62:101117. [PMID: 32565327 DOI: 10.1016/j.arr.2020.101117] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 06/07/2020] [Accepted: 06/15/2020] [Indexed: 12/31/2022]
Abstract
Falling is the second most prevalent cause of accidental death in the world. Currently available clinical tests to assess balance in older people are insufficiently sensitive to screen for fall risk in this population. Laboratory tests that record the center of pressure (COP) trajectory could overcome this problem but despite their widespread use, the choice of COP trajectory features for use as a biomarker of fall risk lacks consensus. This systematic review and meta-analysis aimed at identifying the best COP characteristics to predict risk of falling in older adults. More than 4000 articles were screened; 44 (7176 older adults) were included in this study. Several COP parameters emerged as good indices to discriminate fallers from non-fallers. From sensitivity analysis, Sway area per unit time, anteroposterior mean velocity, and radial mean velocity were the best traditional features. In this study, identification of older people with a high fall risk was demonstrated using quiet-standing recordings. Such screening would also be useful for routine follow-up of balance changes in older fallers in clinical practice.
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McCrary JM, Goldstein D, Trinh T, Timmins HC, Li T, Menant J, Friedlander M, Lewis CR, Hertzberg M, O'Neill S, King T, Bosco A, Harrison M, Park SB. Balance Deficits and Functional Disability in Cancer Survivors Exposed to Neurotoxic Cancer Treatments. J Natl Compr Canc Netw 2020; 17:949-955. [PMID: 31390588 DOI: 10.6004/jnccn.2019.7290] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 02/25/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Chemotherapy-induced peripheral neuropathy (CIPN) persists after treatment in up to 40% of cancer survivors and has been linked with increased balance deficits, disabilities, and fall occurrences. This study aimed to comprehensively assess the links between CIPN, balance deficits, and functional disability and to inform the development of clinical screening tools for patients at risk of these events. PATIENTS AND METHODS A total of 190 cancer survivors exposed to neurotoxic chemotherapies (age, 57 ± 13 years; average time from completion of neurotoxic therapy, 12 ± 11 months) attended a neurology research clinic for a single cross-sectional assessment of patient-reported and objective CIPN, standing balance in 4 conditions of increasing difficulty, and functional disability. RESULTS Most patients (68%) reported CIPN symptoms at assessment. Symptomatic patients displayed increased functional disability (F=39.4; P<.001) and balance deficits (F=34.5; P<.001), with degree of balance impairments consistent with a healthy elderly population (age ≥65 years) reporting multiple falls over the subsequent year. Increasing CIPN severity correlated with increasing functional disability (clinically assessed R2=0.46; patient-reported R2=0.49; P<.001) and balance deficits (clinically assessed R2=0.41; patient-reported R2=0.30; P<.001). A 5-factor model of key independent correlates-patient-reported numbness/tingling, weakness, and balance deficit; age; and vibration perception-was strongly linked to balance deficits (R2=0.46; P<.001) and functional disability (R2=0.56; P<.001). CONCLUSIONS This study confirms links between increasing CIPN severity and increasing balance deficits and functional disability using comprehensive CIPN assessment methodology. The extent of balance deficits in patients with CIPN underscores the functional consequences of neurotoxicity. A 5-factor model provides a foundation for clinical screening tools to assess balance deficits and functional disability in patients exposed to neurotoxic chemotherapies.
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Affiliation(s)
- J Matt McCrary
- Prince of Wales Clinical School, University of New South Wales, Kensington
| | - David Goldstein
- Prince of Wales Clinical School, University of New South Wales, Kensington.,Prince of Wales Hospital, Randwick
| | - Terry Trinh
- Prince of Wales Clinical School, University of New South Wales, Kensington
| | | | - Tiffany Li
- Brain and Mind Centre, The University of Sydney, Camperdown
| | | | - Michael Friedlander
- Prince of Wales Clinical School, University of New South Wales, Kensington.,Prince of Wales Hospital, Randwick
| | - Craig R Lewis
- Prince of Wales Clinical School, University of New South Wales, Kensington.,Prince of Wales Hospital, Randwick
| | - Mark Hertzberg
- Prince of Wales Clinical School, University of New South Wales, Kensington.,Prince of Wales Hospital, Randwick
| | | | - Tracy King
- Royal Prince Alfred Hospital, Camperdown.,Sydney Nursing School, The University of Sydney, Camperdown
| | - Annmarie Bosco
- Prince of Wales Hospital, Randwick.,School of Medical Sciences, University of New South Wales, Kensington; and
| | - Michelle Harrison
- School of Medical Sciences, University of New South Wales, Kensington; and.,School of Medical Sciences, University of New South Wales, Kensington; and
| | - Susanna B Park
- Prince of Wales Clinical School, University of New South Wales, Kensington.,Brain and Mind Centre, The University of Sydney, Camperdown
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Pacheco TBF, de Medeiros CSP, de Oliveira VHB, Vieira ER, de Cavalcanti FAC. Effectiveness of exergames for improving mobility and balance in older adults: a systematic review and meta-analysis. Syst Rev 2020; 9:163. [PMID: 32682439 PMCID: PMC7368979 DOI: 10.1186/s13643-020-01421-7] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 07/06/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Exergaming is a fun, engaging, and interactive form of exercising that may help overcome some of the traditional exercise barriers and help improve adherence on the part of older adults, providing therapeutic applications for balance recovery and functional mobility. The purpose of this systematic review is to summarize the effects of exergames on mobility and balance in older adults. METHODS The PRISMA guidelines for systematic reviews were followed. The following databases were searched from inception to August 2019: Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, PEDro, CINAHL, and INSPEC. We selected randomized controlled trials that assessed the effects of exergames on balance or mobility of older adults without neurological conditions, in comparison to no intervention or health education. Two review authors independently screened the trials' titles and abstracts and identified trials for inclusion according to the eligibility criteria. An almost perfect agreement between the authors was observed with respect to interrater reliability of trial selection (kappa = 0.84; P < 0.001). We performed descriptive analysis of the quantitative data to summarize the evidence. Meta-analysis was carried out using RevMan. A random effects model was used to compute the pooled prevalence with 95% confidence intervals. RESULTS After screening 822 records, 12 trials comparing exergames with no intervention were included. A total of 1520 older adults participated in the studies, with a mean age of 76 ± 6 years for the experimental group and 76 ± 5 years for the control group. Quantitative synthesis showed significant improvements in balance and mobility based on the center of pressure sway (SMD = - 0.89; 95%CI = - 1.26 to - 0.51; P = 0.0001; I2 = 58%), Berg Balance Scale (MD = 2.15; 95%CI = 1.77 to 2.56; P = 0.0001; I2 = 96%), and on Timed Up and Go test (MD = - 2.48; 95%CI = - 3.83 to - 1.12; P = 0.0003; I2 = 0). CONCLUSIONS Exergames improved balance and mobility in older adults without neurological disorders and motivate patients to keep performing balance exercises. High quality studies with standardized assessment protocols are necessary to improve the strength of the evidence.
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Affiliation(s)
- T B F Pacheco
- Department of Physical Therapy, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil.
| | - C S P de Medeiros
- Department of Physical Therapy, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
| | - V H B de Oliveira
- Department of Physical Therapy, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
| | - E R Vieira
- Department of Physical Therapy, Florida International University (FIU), Miami, USA
| | - F A C de Cavalcanti
- Department of Physical Therapy, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
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15
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Accuracy of modified 30-s chair-stand test for predicting falls in older adults. Ann Phys Rehabil Med 2020; 63:309-315. [DOI: 10.1016/j.rehab.2019.08.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 08/02/2019] [Accepted: 08/02/2019] [Indexed: 11/17/2022]
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Maier C, Trabue J, Farley K, Paz J, Walter A. Rehabilitation interventions to reduce the risk of falls in patients with chronic obstructive pulmonary disease: a systematic review of the literature. PHYSICAL THERAPY REVIEWS 2020. [DOI: 10.1080/10833196.2020.1784571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Claire Maier
- Physical Therapy, Walsh University, North Canton, OH, USA
| | - Jack Trabue
- Physical Therapy, Walsh University, North Canton, OH, USA
| | - Katie Farley
- Physical Therapy, Walsh University, North Canton, OH, USA
| | - Jaime Paz
- Physical Therapy, Walsh University, North Canton, OH, USA
| | - Alysha Walter
- Physical Therapy, Walsh University, North Canton, OH, USA
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Jehu DA, Davis JC, Liu-Ambrose T. Risk factors for recurrent falls in older adults: a study protocol for a systematic review with meta-analysis. BMJ Open 2020; 10:e033602. [PMID: 32376749 PMCID: PMC7223009 DOI: 10.1136/bmjopen-2019-033602] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Older adults who fall recurrently (i.e., >1 fall/year) are at risk for functional decline and mortality. Key risk factors for recurrent falls in community-dwelling older adults are not well established due to methodological limitations, such as recall bias. A better understanding of the risk factors for recurrent falls will aid in refining clinical practice guidelines for secondary fall prevention strategies. The primary objective of this systematic review with meta-analysis is to examine the risk factors for recurrent falls in prospective studies among community-dwelling older adults. METHODS AND ANALYSIS A comprehensive search for articles indexed in MEDLINE, EMBASE, PsycINFO and CINAHL databases as well as grey literature was conducted on April 25, 2019. We will use MeSH and keyword search terms around the following topics: falls, recurrence, fall-risk, ageing and prospective studies. Prospective studies with monthly falls monitoring for 12 months, investigating risk factors for recurrent falls in older adults will be included. One author will complete the search. Two authors will remove duplicates and screen the titles and abstracts for their potential inclusion against the eligibility criteria. Two authors will screen the full texts and extract the data using a piloted extraction sheet. Included studies will be evaluated for the risk of bias with the Joanna Briggs Institute Prevalence Critical Appraisal tools. The quality of reporting will be determined with the Strengthening the Reporting of OBservational studies in Epidemiology. The data extraction will include study characteristics as well as sociodemographic, balance and mobility, sensory and neuromuscular, psychological, medical, medication and environmental factors. The results will be presented via figures, summary tables, meta-analysis (when possible) and narrative summaries. ETHICS AND DISSEMINATION No ethics approval will be required. Findings will be disseminated through publication and media. PROSPERO REGISTRATION NUMBER CRD42019118888; Pre-results.
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Affiliation(s)
- Deborah A Jehu
- Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
- Aging, Mobility and Cognitive Neuroscience Laboratory, Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jennifer C Davis
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
- Social & Economic Change Laboratory, Faculty of Management, University of British Columbia - Okanagan Campus, Kelowna, British Columbia, Canada
| | - Teresa Liu-Ambrose
- Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
- Aging, Mobility and Cognitive Neuroscience Laboratory, Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
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18
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Reliability, validity, interpretability and responsiveness of the DEMMI mobility index for Brazilian older hospitalized patients. PLoS One 2020; 15:e0230047. [PMID: 32187212 PMCID: PMC7080236 DOI: 10.1371/journal.pone.0230047] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 02/20/2020] [Indexed: 11/19/2022] Open
Abstract
AIM To translate and adapt cross-culturally the De Morton Mobility Index from English to Brazilian Portuguese. Furthermore, to test the content validity, reliability, construct validity, interpretability and responsiveness for older hospitalized patients. METHODS After we carried out the translation and the cross-cultural adaptation of the De Morton Mobility Index and its administration instructions according to international guidelines, the content validity of De Morton Mobility Index was tested by experienced physiotherapists. In the sequence, the reliability, construct validity, interpretability and responsiveness were tested in a test-retest design with 93 older patients hospitalized in ward for clinical reasons. The reliability was tested by Cronbach's alpha coefficient (internal consistency), standard error measurement (agreement), and interclass correlation coefficients (intra and inter-examiner reliability). The construct validity was tested by Pearson's correlation between the De Morton Mobility Index score and the number of steps. Interpretability was analyzed by determining the minimum detectable change and the floor and ceiling effects (frequency of maximum and minimum scoring). Responsiveness was analyzed by effect size. RESULTS The Brazilian version of the De Morton Mobility Index was made and adapted. The internal consistency (α = 0.89), reliability intra-(ICC = 0.94) and inter-examiners (ICC = 0.82), agreement were all adequate. The De Morton Mobility Index is validity when correlated with number of steps (r = 0.46). Floor or ceiling effects (<15%) were not observed and the responsiveness was high (ES = 3.65). CONCLUSION The De Morton Mobility Index has shown adequate reliability, validity, interpretability and responsiveness for the evaluation of the mobility of older hospitalized patients.
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Knobe M, Rasche P, Rentemeister L, Bliemel C, Bücking B, Bollheimer LC, Pape HC. [Evaluation of a simple screening tool for ambulant fall prevention]. Unfallchirurg 2019; 121:901-910. [PMID: 29396590 DOI: 10.1007/s00113-018-0462-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND An individual's risk of falling is generally difficult to detect and it is likely to be underestimated. Thus, preventive measures are challenging and they demand sufficient integration and implementation into aftercare and outpatient management. The Aachen Falls Prevention Scale (AFPS) is a quick and easy tool for patient-driven fall risk assessment. Older adults' risk of falling is identified in a suitable manner and they then have the opportunity to independently assess and monitor their risk of falling. OBJECTIVES The aim of the current study was to evaluate the AFPS as a simple screening tool in geriatric trauma patients via the identification of influencing factors, e.g. objective or subjective fall risk, fear of falling (FOF) and demographic data. In this context, we investigated older adults' willingness to take part in special activities concerning fall prevention. METHODS Retrospectively, all patients over 70 years of age who received in-hospital fracture treatment between July 2014 and April 2016 were analyzed at a level I trauma center. After identification of 884 patients, participants completed a short questionnaire (47 questions, yes/no, Likert scale) comprising the AFPS. A history of falls in the past year was considered an indicator of a balance disorder. In addition, ambulant patients were invited to participate between July and August 2016. RESULTS In total, 201 patients (mean 80.4 years, range 63-97 years) performed a self-assessment based on the AFPS. After steps 1 and 2 of the AFPS had been completed, 95 (47%) participants rated their subjective risk of falling as high (more than 5 points). Of the participants 84 (42%) were objectively classified as "fallers" with significant effects on their AFPS evaluation and rating of their subjective risk of falling. Furthermore, 67% of the participants identified a general practitioner as their main contact person, and 43% of the respondents viewed the AFPS as a beneficial screening tool in fall risk evaluation (8% negative attitudes). Only 12% of the participants could imagine using the AFPS app version as a feasible option. CONCLUSION It would be advantageous to pretest at-risk individuals in their environment using a simple self-assessment approach, with the main purpose of identifying potential balance problems. With this approach, cost savings in the healthcare system are possible, combined with a higher health-related quality of life in the geriatric population.
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Affiliation(s)
- M Knobe
- Klinik für Unfall- und Wiederherstellungschirurgie, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland.
| | - P Rasche
- Lehrstuhl und Institut für Arbeitswissenschaft (IAW), RWTH Aachen, Aachen, Deutschland
| | - L Rentemeister
- Klinik für Unfall- und Wiederherstellungschirurgie, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland
| | - C Bliemel
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Gießen und Marburg GmbH, Marburg, Deutschland
| | - B Bücking
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Gießen und Marburg GmbH, Marburg, Deutschland
| | - L C Bollheimer
- Lehrstuhl für Altersmedizin der RWTH Aachen mit Klinik für Innere Medizin und Geriatrie, Franziskushospital Aachen, Aachen, Deutschland
| | - H-C Pape
- Klinik für Traumatologie, Universitätsspital Zürich, Zürich, Schweiz
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Jahantabi-Nejad S, Azad A. Predictive accuracy of performance oriented mobility assessment for falls in older adults: A systematic review. Med J Islam Repub Iran 2019; 33:38. [PMID: 31456962 PMCID: PMC6708086 DOI: 10.34171/mjiri.33.38] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Indexed: 11/05/2022] Open
Abstract
Background: Performance Oriented Mobility Assessment (POMA) is a commonly used screening tool for identifying patients at risk of falling. The purpose of this systematic review was to determine the overall predictive accuracy of POMA for falls in community-dwelling older adults. This review could provide useful information to use POMA in both research and clinical settings.
Methods: In this study, PubMed, EMBASE, CINHAL, Cochrane Library, EBSCO, and SCOPUS were searched to identify studies published from 1987 to 2017 that aimed at validating POMA and reporting predictive value with sufficient data to calculate sensitivity and specificity. The methodological quality of the selected studies was assessed using the Quality Assessment of Diagnostic Accuracy studies (QUADAS-2).
Results: Of the 121 identified studies, 12 met the inclusion criteria and were entered in the final analysis. Fall rate ranged from 5% to 61% in the included studies. The POMA cutoff point for discriminating fallers from non-fallers varied from 15 to 26. Sensitivity and specificity of the POMA ranged from 24-91 to 37-97, respectively.
Conclusion: Due to heterogeneity of the type of studies, participants, the definition of fall, and use of different versions of POMA, it was not possible to determine a specific cutoff point for POMA. In addition, using the same version and scoring method of POMA and controlling the significant potential confounders (eg, age, gender, and comorbidities) would provide better information about the predictive accuracy of POMA for falls in older adults.
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Affiliation(s)
- Seifollah Jahantabi-Nejad
- Musculoskeletal Rehabilitation Research Center, Ahvaz University of Medical Sciences, Ahvaz, Iran, & University of Medical Sciences, Tehran, Iran
| | - Akram Azad
- Rehabilitation Research Center, Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
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Rasche P, Nitsch V, Rentemeister L, Coburn M, Buecking B, Bliemel C, Bollheimer LC, Pape HC, Knobe M. The Aachen Falls Prevention Scale: Multi-Study Evaluation and Comparison. JMIR Aging 2019; 2:e12114. [PMID: 31518273 PMCID: PMC6715018 DOI: 10.2196/12114] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 11/16/2018] [Accepted: 01/23/2019] [Indexed: 01/13/2023] Open
Abstract
Background Fall risk assessment is a time-consuming and resource-intensive activity. Patient-driven self-assessment as a preventive measure might be a solution to reduce the number of patients undergoing a full clinical fall risk assessment. Objective The aim of this study was (1) to analyze test accuracy of the Aachen Falls Prevention Scale (AFPS) and (2) to compare these results with established fall risk assessment measures identified by a review of systematic reviews. Methods Sensitivity, specificity, and receiver operating curves (ROC) of the AFPS were calculated based on data retrieved from 2 independent studies using the AFPS. Comparison with established fall risk assessment measures was made by conducting a review of systematic reviews and corresponding meta-analysis. Electronic databases PubMed, Web of Science, and EMBASE were searched for systematic reviews and meta-analyses that reviewed fall risk assessment measures between the years 2000 and 2018. The review of systematic reviews was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. The Revised Assessment of Multiple SysTemAtic Reviews (R-AMSTAR) was used to assess the methodological quality of reviews. Sensitivity, specificity, and ROC were extracted from each review and compared with the calculated values of the AFPS. Results Sensitivity, specificity, and ROC of the AFPS were evaluated based on 2 studies including a total of 259 older adults. Regarding the primary outcome of the AFPS subjective risk of falling, pooled sensitivity is 57.0% (95% CI 0.467-0.669) and specificity is 76.7% (95% CI 0.694-0.831). If 1 out of the 3 subscales of the AFPS is used to predict a fall risk, pooled sensitivity could be increased up to 90.0% (95% CI 0.824-0.951), whereas mean specificity thereby decreases to 50.0% (95% CI 0.42-0.58). A systematic review for fall risk assessment measures produced 1478 articles during the study period, with 771 coming from PubMed, 530 from Web of Science, and 177 from EMBASE. After eliminating doublets and assessing full text, 8 reviews met the inclusion criteria. All were of sufficient methodological quality (R-AMSTAR score ≥22). A total number of 9 functional or multifactorial fall risk assessment measures were extracted from identified reviews, including Timed Up and Go test, Berg Balance Scale, Performance-Oriented Mobility Assessment, St Thomas’s Risk Assessment Tool in Falling Elderly, and Hendrich II Fall Risk Model. Comparison of these measures with pooled sensitivity and specificity of the AFPS revealed a sufficient quality of the AFPS in terms of a patient-driven self-assessment tool. Conclusions It could be shown that the AFPS reaches a test accuracy comparable with that of the established methods in this initial investigation. However, it offers the advantage that the users can perform the self-assessment independently at home without involving trained health care professionals.
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Affiliation(s)
- Peter Rasche
- Institute of Industrial Engineering and Ergonomics, Department of Mechanical Engineering, RWTH Aachen University, Aachen, Germany
| | - Verena Nitsch
- Institute of Industrial Engineering and Ergonomics, Department of Mechanical Engineering, RWTH Aachen University, Aachen, Germany
| | - Lars Rentemeister
- Department of Orthopaedic Trauma, University of Aachen Medical Center, RWTH Aachen University, Aachen, Germany
| | - Mark Coburn
- Klinik für Anästhesiologie, University of Aachen Medical Center, RWTH Aachen University, Aachen, Germany
| | - Benjamin Buecking
- Center for Orthopaedics and Trauma Surgery, University Hospital of Giessen and Marburg, Marburg, Germany
| | - Christopher Bliemel
- Center for Orthopaedics and Trauma Surgery, University Hospital of Giessen and Marburg, Marburg, Germany
| | - Leo Cornelius Bollheimer
- Department of Geriatrics, University of Aachen Medical Center, RWTH Aachen University, Aachen, Germany
| | - Hans-Christoph Pape
- Department of Orthopaedic Trauma, University of Zurich Medical Center, University of Zurich, Zurich, Switzerland
| | - Matthias Knobe
- Department of Orthopaedic Trauma, University of Aachen Medical Center, RWTH Aachen University, Aachen, Germany
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Freeman L, Gera G, Horak FB, Blackinton MT, Besch M, King L. Instrumented Test of Sensory Integration for Balance: A Validation Study. J Geriatr Phys Ther 2019; 41:77-84. [PMID: 27893564 DOI: 10.1519/jpt.0000000000000110] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND PURPOSE Abnormal postural sway is associated with an increase in risk of falls but is difficult for clinicians to accurately quantify without access to laboratory equipment. Instrumenting clinical outcome measures using body-worn movement monitors is a low-cost alternative. This is the first study to compare the modified Clinical Test of Sensory Integration for Balance (i-mCTSIB) to the laboratory test of the Sensory Organization Test (SOT) with dynamic posturography in a group of participants with Parkinson's disease (PD) and subtle balance limitations. The purpose of this study was to (1) determine the concurrent validity of the i-mCTSIB with the SOT (6 and 4 conditions) and (2) compare the i-mCTSIB and the SOT to differentiate between individuals with and without recent falls within the previous 6 months. METHODS This cross-sectional study examined 26 participants with idiopathic PD who had a Motor Unified Parkinson's Disease Rating Scale score of 32.7 (13.5) out of 108. RESULTS The composite and conditions 1 and 4 of the i-mCTSIB and SOT scores were significantly correlated: composite scores r = -0.64 (P ≤ .001), C1 r = -0.43 (P = .03), C3 r = -0.60 (P ≤ .01), and C4 r = -0.54 (P ≤ .001). A significant difference was observed in mean i-mCTSIB composite scores between fallers and nonfallers (P = .04). In contrast, the SOT composite was not significantly different between fallers and nonfallers (P = 0.31). DISCUSSION The results suggest that the i-mCTSIB may be a valid and clinically meaningful measure of sensory organization in persons with PD, even those with mild postural instability as measured by the median Hoehn and Yahr score (2.0). Future research should evaluate predictive validity of the i-mCTSIB for prospective falls. CONCLUSION The instrumented mCTSIB with portable, body-worn movement allows clinicians to quantify abnormal postural sway without the ceiling effects of clinical balance testing or the expense and importability of force plate technology in the SOT. Instrumenting mCTSIB may also distinguish between fallers and nonfallers.
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Affiliation(s)
- Lynn Freeman
- Aegis Therapies, Plano, Texas.,PATH Clinical Research Institute, USA
| | | | - Fay B Horak
- Oregon Health & Science University, Portland
| | | | | | - Laurie King
- Oregon Health & Science University, Portland
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Groessl EJ, Maiya M, Schmalzl L, Wing D, Jeste DV. Yoga to prevent mobility limitations in older adults: feasibility of a randomized controlled trial. BMC Geriatr 2018; 18:306. [PMID: 30541474 PMCID: PMC6291934 DOI: 10.1186/s12877-018-0988-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 11/21/2018] [Indexed: 12/19/2022] Open
Abstract
Background The loss of mobility during aging impacts independence and leads to further disability, morbidity, and reduced life expectancy. Our objective was to examine the feasibility and safety of conducting a randomized controlled trial of yoga for older adults at risk for mobility limitations. Methods Sedentary older adults (n = 46; age 60–89) were recruited and randomized to either yoga or a health education comparison group. Yoga sessions (60-min) occurred 2x weekly, and 90-min health education sessions occurred weekly, for 10 weeks. The primary outcomes were recruitment rate, intervention attendance, and retention at assessments. Adverse event rates and participant satisfaction were also measured. Physical performance measures of gait, balance, and strength and self-report outcome measures were administered at baseline and 10-weeks. Results Recruitment lasted 6 months. Retention of participants at the 10-week follow-up was high (89% - performance measures; 98% - self-report questionnaires). Attendance was good with 82% of yoga and 74% of health education participants attending at least 50% of the sessions. No serious adverse events were reported. Patient satisfaction with the interventions was high. The mean effect size for the physical performance measures was 0.35 with some over 0.50. The mean effect size for self-report outcome measures was 0.36. Conclusions Results indicate that it is feasible to conduct a larger RCT of yoga for sedentary older adults at risk for mobility problems. The yoga and comparison interventions were safe, well accepted, and well attended. Effect sizes suggest yoga may have important benefits for this population and should be studied further. Trial Registration ClinicalTrials # NCT03544879; Retrospectively registered 4 June, 2018.
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Affiliation(s)
- Erik J Groessl
- Department of Family Medicine and Public Health, University of California San Diego, 9500 Gilman Dr. #0994, La Jolla, CA, 92093, USA. .,HSR&D, VA San Diego Healthcare System, San Diego, CA, USA. .,UCSD Stein Institute for Research on Aging, La Jolla, CA, USA.
| | - Meghan Maiya
- Department of Family Medicine and Public Health, University of California San Diego, 9500 Gilman Dr. #0994, La Jolla, CA, 92093, USA
| | - Laura Schmalzl
- Department of Family Medicine and Public Health, University of California San Diego, 9500 Gilman Dr. #0994, La Jolla, CA, 92093, USA.,College of Science and Integrative Health, Southern California University of Health Sciences, Whittier, CA, USA
| | - David Wing
- Department of Family Medicine and Public Health, University of California San Diego, 9500 Gilman Dr. #0994, La Jolla, CA, 92093, USA.,UCSD Exercise and Physical Activity Resource Center (EPARC), La Jolla, CA, USA
| | - Dilip V Jeste
- UCSD Stein Institute for Research on Aging, La Jolla, CA, USA.,Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
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Bohannon RW, Wolfson LI, White WB. Timed mobility: description of measurement, performance, and dimensionality among older adults. Disabil Rehabil 2018; 40:2011-2014. [PMID: 28475411 PMCID: PMC6134395 DOI: 10.1080/09638288.2017.1323028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 03/21/2017] [Accepted: 04/21/2017] [Indexed: 01/07/2023]
Abstract
PURPOSE To describe the measurement, performance, and dimensionality of five timed mobility activities completed by older adults. MATERIALS AND METHODS Cross-sectional observational study using correlational and factor analysis to examine the dimensionality of five timed mobility activities performed by 189 older adults in an outpatient setting. RESULTS The times to complete supine-to-sit, five repetition sit-to-stand, 8 m comfortable gait, four step ascent, and four step descent were correlated significantly with one another (r = 0.294-0.827, p < 0.001). The times were also internally consistent (α = 0.71) and loaded highly on a single factor (0.587-0.888). CONCLUSION The timed measurements of this study were easily obtained. They can be viewed as unidimensional and representative of a single construct of the international classification of functioning, disability, and health -timed mobility. Implications for rehabilitation For patients who are independent in mobility, timing offers a means of differentiating the performance of individual patients. As the times to complete five mobility activities are interrelated, mobility is supported as a rehabilitation construct and patients who are faster at one activity should be expected to be faster at another.
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Affiliation(s)
- Richard W. Bohannon
- College of Pharmacy and Health Sciences, Campbell University, Lillington, North Carolina, USA
| | - Leslie I. Wolfson
- Department of Neurology, University of Connecticut School of Medicine, Farmington, CT, USA
| | - William B. White
- Cardiology Center, University of Connecticut School of Medicine, Farmington, Connecticut, USA
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Lusardi MM, Fritz S, Middleton A, Allison L, Wingood M, Phillips E, Criss M, Verma S, Osborne J, Chui KK. Determining Risk of Falls in Community Dwelling Older Adults: A Systematic Review and Meta-analysis Using Posttest Probability. J Geriatr Phys Ther 2018; 40:1-36. [PMID: 27537070 PMCID: PMC5158094 DOI: 10.1519/jpt.0000000000000099] [Citation(s) in RCA: 317] [Impact Index Per Article: 52.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/30/2022]
Abstract
BACKGROUND Falls and their consequences are significant concerns for older adults, caregivers, and health care providers. Identification of fall risk is crucial for appropriate referral to preventive interventions. Falls are multifactorial; no single measure is an accurate diagnostic tool. There is limited information on which history question, self-report measure, or performance-based measure, or combination of measures, best predicts future falls. PURPOSE First, to evaluate the predictive ability of history questions, self-report measures, and performance-based measures for assessing fall risk of community-dwelling older adults by calculating and comparing posttest probability (PoTP) values for individual test/measures. Second, to evaluate usefulness of cumulative PoTP for measures in combination. DATA SOURCES To be included, a study must have used fall status as an outcome or classification variable, have a sample size of at least 30 ambulatory community-living older adults (≥65 years), and track falls occurrence for a minimum of 6 months. Studies in acute or long-term care settings, as well as those including participants with significant cognitive or neuromuscular conditions related to increased fall risk, were excluded. Searches of Medline/PubMED and Cumulative Index of Nursing and Allied Health (CINAHL) from January 1990 through September 2013 identified 2294 abstracts concerned with fall risk assessment in community-dwelling older adults. STUDY SELECTION Because the number of prospective studies of fall risk assessment was limited, retrospective studies that classified participants (faller/nonfallers) were also included. Ninety-five full-text articles met inclusion criteria; 59 contained necessary data for calculation of PoTP. The Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS) was used to assess each study's methodological quality. DATA EXTRACTION Study design and QUADAS score determined the level of evidence. Data for calculation of sensitivity (Sn), specificity (Sp), likelihood ratios (LR), and PoTP values were available for 21 of 46 measures used as search terms. An additional 73 history questions, self-report measures, and performance-based measures were used in included articles; PoTP values could be calculated for 35. DATA SYNTHESIS Evidence tables including PoTP values were constructed for 15 history questions, 15 self-report measures, and 26 performance-based measures. Recommendations for clinical practice were based on consensus. LIMITATIONS Variations in study quality, procedures, and statistical analyses challenged data extraction, interpretation, and synthesis. There was insufficient data for calculation of PoTP values for 63 of 119 tests. CONCLUSIONS No single test/measure demonstrated strong PoTP values. Five history questions, 2 self-report measures, and 5 performance-based measures may have clinical usefulness in assessing risk of falling on the basis of cumulative PoTP. Berg Balance Scale score (≤50 points), Timed Up and Go times (≥12 seconds), and 5 times sit-to-stand times (≥12) seconds are currently the most evidence-supported functional measures to determine individual risk of future falls. Shortfalls identified during review will direct researchers to address knowledge gaps.
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Affiliation(s)
- Michelle M Lusardi
- 1Department of Physical Therapy and Human Movement Science, College of Health Professions, Sacred Heart University, Fairfield, Connecticut 2Department of Physical Therapy, Arnold School of Public Health, University of South Carolina, Columbia 3Division of Rehabilitation Sciences and Center for Recovery, Physical Activity and Nutrition, University of Texas Medical Branch, Galveston 4Department of Physical Therapy, Winston Salem State University, Winston Salem, North Carolina 5University of Vermont Medical Center, Colchester 6University of North Carolina Memorial Hospitals, Chapel Hill 7Physical Therapy Program, Chatham University, Pittsburgh, Pennsylvania 8Care One at the Highlands, Edison, New Jersey 9Geriatric Residency Program, Brooks Rehabilitation Institute of Higher Learning, Jacksonville, Florida 10School of Physical Therapy, Pacific University, Hillsboro, Oregon
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Watt AA, Clark C, Williams JM. Differences in sit-to-stand, standing sway and stairs between community-dwelling fallers and non-fallers: a review of the literature. PHYSICAL THERAPY REVIEWS 2018. [DOI: 10.1080/10833196.2018.1470748] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Andrew A. Watt
- Faculty of Health and Social Sciences, Department of Human Sciences and Public Health, Bournemouth University, Bournemouth, UK
| | - Carol Clark
- Faculty of Health and Social Sciences, Department of Human Sciences and Public Health, Bournemouth University, Bournemouth, UK
| | - Jonathan M. Williams
- Faculty of Health and Social Sciences, Department of Human Sciences and Public Health, Bournemouth University, Bournemouth, UK
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27
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Vottis CT, Mitsiokapa E, Igoumenou VG, Megaloikonomos PD, Galanopoulos IP, Georgoudis G, Koulouvaris P, Papagelopoulos PJ, Mavrogenis AF. Fall Risk Assessment Metrics for Elderly Patients With Hip Fractures. Orthopedics 2018; 41:142-156. [PMID: 29738597 DOI: 10.3928/01477447-20180501-07] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 02/09/2018] [Indexed: 02/03/2023]
Abstract
The most common surgery performed by orthopedic surgeons likely involves that for hip fractures. The incidence of hip fractures is anticipated to rise in the coming decades. Hip fractures most commonly occur in elderly women with osteoporosis after a fall from standing position. In an effort to reduce the incidence, improve the postoperative care, and accelerate the rehabilitation of hip fractures, it is important to evaluate the fall risk of these patients, as it is an objective indication of their level of physical activity. Metrics currently available for the evaluation of fall risk in the elderly vary widely, with each having been designed to assess a specific patient population. However, their applicability has often proved to be much broader than expected. This review summarizes the metrics available for fall risk assessment of elderly patients with hip fractures, describes their individual features and efficacy, and highlights those that seem to be more reliable for the assessment of rehabilitation of these patients after hip fracture surgery. [Orthopedics. 2018; 41(3):142-156.].
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28
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Rasche P, Mertens A, Brandl C, Liu S, Buecking B, Bliemel C, Horst K, Weber CD, Lichte P, Knobe M. Satisfying Product Features of a Fall Prevention Smartphone App and Potential Users' Willingness to Pay: Web-Based Survey Among Older Adults. JMIR Mhealth Uhealth 2018; 6:e75. [PMID: 29588268 PMCID: PMC5893889 DOI: 10.2196/mhealth.9467] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 02/16/2018] [Accepted: 02/23/2018] [Indexed: 01/15/2023] Open
Abstract
Background Prohibiting falls and fall-related injuries is a major challenge for health care systems worldwide, as a substantial proportion of falls occur in older adults who are previously known to be either frail or at high risk for falls. Hence, preventive measures are needed to educate and minimize the risk for falls rather than just minimize older adults’ fall risk. Health apps have the potential to address this problem, as they enable users to self-assess their individual fall risk. Objective The objective of this study was to identify product features of a fall prevention smartphone app, which increase or decrease users’ satisfaction. In addition, willingness to pay (WTP) was assessed to explore how much revenue such an app could generate. Methods A total of 96 participants completed an open self-selected Web-based survey. Participants answered various questions regarding health status, subjective and objective fall risk, and technical readiness. Seventeen predefined product features of a fall prevention smartphone app were evaluated twice: first, according to a functional (product feature is implemented in the app), and subsequently by a dysfunctional (product feature is not implemented in the app) question. On the basis of the combination of answers from these 2 questions, the product feature was assigned to a certain category (must-be, attractive, one-dimensional, indifferent, or questionable product feature). This method is widely used in user-oriented product development and captures users’ expectations of a product and how their satisfaction is influenced by the availability of individual product features. Results Five product features were identified to increase users’ acceptance, including (1) a checklist of typical tripping hazards, (2) an emergency guideline in case of a fall, (3) description of exercises and integrated workout plans that decrease the risk of falling, (4) inclusion of a continuous workout program, and (5) cost coverage by health insurer. Participants’ WTP was assessed after all 17 product features were rated and revealed a median monthly payment WTP rate of €5.00 (interquartile range 10.00). Conclusions The results show various motivating product features that should be incorporated into a fall prevention smartphone app. Results reveal aspects that fall prevention and intervention designers should keep in mind to encourage individuals to start joining their program and facilitate long-term user engagement, resulting in a greater interest in fall risk prevention.
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Affiliation(s)
- Peter Rasche
- Institute of Industrial Engineering and Ergonomics, Department of Mechanical Engineering, RWTH Aachen University, Aachen, Germany
| | - Alexander Mertens
- Institute of Industrial Engineering and Ergonomics, Department of Mechanical Engineering, RWTH Aachen University, Aachen, Germany
| | - Christopher Brandl
- Institute of Industrial Engineering and Ergonomics, Department of Mechanical Engineering, RWTH Aachen University, Aachen, Germany
| | - Shan Liu
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Benjamin Buecking
- Hand and Reconstructive Surgery, Department of Trauma, University Hospital of Giessen and Marburg, Marburg, Germany
| | - Christopher Bliemel
- Hand and Reconstructive Surgery, Department of Trauma, University Hospital of Giessen and Marburg, Marburg, Germany
| | - Klemens Horst
- Department of Orthopaedic Trauma, University of Aachen Medical Center, RWTH Aachen University, Aachen, Germany
| | - Christian David Weber
- Department of Orthopaedic Trauma, University of Aachen Medical Center, RWTH Aachen University, Aachen, Germany
| | - Philipp Lichte
- Department of Orthopaedic Trauma, University of Aachen Medical Center, RWTH Aachen University, Aachen, Germany
| | - Matthias Knobe
- Department of Orthopaedic Trauma, University of Aachen Medical Center, RWTH Aachen University, Aachen, Germany
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Simões MDSMP, Garcia IFF, Costa LDCM, Lunardi AC. Life-Space Assessment questionnaire: Novel measurement properties for Brazilian community-dwelling older adults. Geriatr Gerontol Int 2018; 18:783-789. [DOI: 10.1111/ggi.13263] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/15/2017] [Accepted: 12/10/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Maria do Socorro MP Simões
- Departament of Speech, Physical Therapy and Occupational Therapy, School of Medicine; University of Sao Paulo; Sao Paulo Brazil
| | - Isabel FF Garcia
- Master's and Doctoral Programs in Physical Therapy; University Cidade de Sao Paulo; Sao Paulo Brazil
| | - Lucíola da CM Costa
- Master's and Doctoral Programs in Physical Therapy; University Cidade de Sao Paulo; Sao Paulo Brazil
| | - Adriana C Lunardi
- Departament of Speech, Physical Therapy and Occupational Therapy, School of Medicine; University of Sao Paulo; Sao Paulo Brazil
- Master's and Doctoral Programs in Physical Therapy; University Cidade de Sao Paulo; Sao Paulo Brazil
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30
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Lubetzky AV, Kary EE, Harel D, Hujsak B, Perlin K. Feasibility and reliability of a virtual reality oculus platform to measure sensory integration for postural control in young adults. Physiother Theory Pract 2018; 34:935-950. [PMID: 29364733 DOI: 10.1080/09593985.2018.1431344] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Using Unity for the Oculus Development-Kit 2, we have developed an affordable, portable virtual reality platform that targets the visuomotor domain, a missing link in current clinical assessments of postural control. Here, we describe the design and technical development as well as report its feasibility with regards to cybersickness and test-retest reliability in healthy young adults. METHOD Our virtual reality paradigm includes two functional scenes ('City' and 'Park') and four moving dots scenes. Twenty-one healthy young adults were tested twice, one to two weeks apart. They completed a simulator sickness questionnaire several times per session. Their postural sway response was recorded from a forceplate underneath their feet while standing on the floor, stability trainers, or a Both Sides Up (BOSU) ball. Sample entropy, postural displacement, velocity, and excursion were calculated and compared between sessions given the visual and surface conditions. RESULTS Participants reported slight-to-moderate transient side effects. Intra-Class Correlation values mostly ranged from 0.5 to 0.7 for displacement and velocity, were above 0.5 (stability trainer conditions) and above 0.4 (floor mediolateral conditions) for sample entropy, and minimal for excursion. CONCLUSION Our novel portable VR platform was found to be feasible and reliable in healthy young adults.
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Affiliation(s)
- Anat V Lubetzky
- a Department of Physical Therapy, Steinhardt School of Culture Education and Human Development , New York University , New York , NY , USA
| | - Erinn E Kary
- a Department of Physical Therapy, Steinhardt School of Culture Education and Human Development , New York University , New York , NY , USA
| | - Daphna Harel
- b Center for the Promotion of Research Involving Innovative Statistical Methodology, Steinhardt School of Culture Education and Human Development , New York University , New York , NY , USA
| | - Bryan Hujsak
- c Vestibular Rehabilitation, The Ear Institute, Hearing and Balance Center , The New York Eye and Ear Infirmary of Mount Sinai , New York , NY , USA
| | - Ken Perlin
- d Computer Science Department, Courant Institute of Mathematical Sciences , New York University , New York , NY , USA
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31
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Park J, Koh SB, Kim HJ, Oh E, Kim JS, Yun JY, Kwon DY, Kim Y, Kim JS, Kwon KY, Park JH, Youn J, Jang W. Validity and Reliability Study of the Korean Tinetti Mobility Test for Parkinson's Disease. J Mov Disord 2018; 11:24-29. [PMID: 29381888 PMCID: PMC5790627 DOI: 10.14802/jmd.17058] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 10/16/2017] [Accepted: 10/30/2017] [Indexed: 11/30/2022] Open
Abstract
Objective
Postural instability and gait disturbance are the cardinal symptoms associated with falling among patients with Parkinson’s disease (PD). The Tinetti mobility test (TMT) is a well-established measurement tool used to predict falls among elderly people. However, the TMT has not been established or widely used among PD patients in Korea. The purpose of this study was to evaluate the reliability and validity of the Korean version of the TMT for PD patients. Methods
Twenty-four patients diagnosed with PD were enrolled in this study. For the interrater reliability test, thirteen clinicians scored the TMT after watching a video clip. We also used the test-retest method to determine intrarater reliability. For concurrent validation, the unified Parkinson’s disease rating scale, Hoehn and Yahr staging, Berg Balance Scale, Timed-Up and Go test, 10-m walk test, and gait analysis by three-dimensional motion capture were also used. We analyzed receiver operating characteristic curve to predict falling. Results
The interrater reliability and intrarater reliability of the Korean Tinetti balance scale were 0.97 and 0.98, respectively. The interrater reliability and intra-rater reliability of the Korean Tinetti gait scale were 0.94 and 0.96, respectively. The Korean TMT scores were significantly correlated with the other clinical scales and three-dimensional motion capture. The cutoff values for predicting falling were 14 points (balance subscale) and 10 points (gait subscale). Conclusion
We found that the Korean version of the TMT showed excellent validity and reliability for gait and balance and had high sensitivity and specificity for predicting falls among patients with PD.
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Affiliation(s)
- Jinse Park
- Department of Neurology, Haeundae Paik Hospital, Inje University, Busan, Korea
| | - Seong-Beom Koh
- Department of Neurology & Parkinson's Disease Centre, Guro Hospital, Korea University, Seoul, Korea
| | - Hee Jin Kim
- Department of Neurology, Konkuk University School of Medicine, Seoul, Korea
| | - Eungseok Oh
- Department of Neurology, Chungnam National University Hospital, Daejeon, Korea
| | - Joong-Seok Kim
- Department of Neurology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Ji Young Yun
- Ewha Womans University School of Medicine, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Do-Young Kwon
- Department of Neurology, Korea University College of Medicine, Ansan Hospital, Ansan, Korea
| | - Younsoo Kim
- Department of Neurology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Ji Seon Kim
- Department of Neurology, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Kyum-Yil Kwon
- Department of Neurology, College of Medicine, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Jeong-Ho Park
- Department of Neurology, College of Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Jinyoung Youn
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea
| | - Wooyoung Jang
- Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
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Campanini I, Mastrangelo S, Bargellini A, Bassoli A, Bosi G, Lombardi F, Tolomelli S, Lusuardi M, Merlo A. Feasibility and predictive performance of the Hendrich Fall Risk Model II in a rehabilitation department: a prospective study. BMC Health Serv Res 2018; 18:18. [PMID: 29325560 PMCID: PMC5765700 DOI: 10.1186/s12913-017-2815-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 12/20/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Falls are a common adverse event in both elderly inpatients and patients admitted to rehabilitation units. The Hendrich Fall Risk Model II (HIIFRM) has been already tested in all hospital wards with high fall rates, with the exception of the rehabilitation setting. This study's aim is to address the feasibility and predictive performances of HIIFRM in a hospital rehabilitation department. METHODS A 6 months prospective study in a Italian rehabilitation department with patients from orthopaedic, pulmonary, and neurological rehabilitation wards. All admitted patients were enrolled and assessed within 24 h of admission by means of the HIIFRM. The occurrence of falls was checked and recorded daily. HIIFRM feasibility was assessed as the percentage of successful administrations at admission. HIIFRM predictive performance was determined in terms of area under the Receiver Operating Characteristic (ROC) curve (AUC), best cutoff, sensitivity, specificity, positive and negative predictive values, along with their asymptotic 95% confidence intervals (95% CI). RESULTS One hundred ninety-one patents were admitted. HIIFRM was feasible in 147 cases (77%), 11 of which suffered a fall (7.5%). Failures in administration were mainly due to bedridden patients (e.g. minimally conscious state, vegetative state). AUC was 0.779(0.685-0.873). The original HIIFRM cutoff of 5 led to a sensitivity of 100% with a mere specificity of 49%(40-57%), thus suggesting using higher cutoffs. Moreover, the median score for non-fallers at rehabilitation units was higher than that reported in literature for geriatric non fallers. The best trade-off between sensitivity and specificity was obtained by using a cutoff of 8. This lead to sensitivity = 73%(46-99%), specificity = 72%(65-80%), positive predictive value = 17% and negative predictive value = 97%. These results support the use of the HIIFRM as a predictive tool. CONCLUSIONS The HIIFRM showed satisfactory feasibility and predictive performances in rehabilitation wards. Based on both available literature and these results, the prediction of falls among all hospital wards, with high risk of falling, could be achieved by means of a unique tool and two different cutoffs: a standard cutoff of 5 in geriatric wards and an adjusted higher cutoff in rehabilitation units, with predictive performances similar to those of the best-preforming pathology specific tools for fall-risk assessment.
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Affiliation(s)
- Isabella Campanini
- Department of Rehabilitation, LAM-Motion Analysis Laboratory, AUSL of Reggio Emilia, S. Sebastiano Hospital, Via Mandriolo Superiore 11, 42015, Correggio, RE, Italy.
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy.
| | | | - Annalisa Bargellini
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Agnese Bassoli
- Department of Rehabilitation, LAM-Motion Analysis Laboratory, AUSL of Reggio Emilia, S. Sebastiano Hospital, Via Mandriolo Superiore 11, 42015, Correggio, RE, Italy
| | - Gabriele Bosi
- Department of Rehabilitation, LAM-Motion Analysis Laboratory, AUSL of Reggio Emilia, S. Sebastiano Hospital, Via Mandriolo Superiore 11, 42015, Correggio, RE, Italy
| | - Francesco Lombardi
- Neurological Rehabilitation Unit, AUSL of Reggio Emilia, S. Sebastiano Hospital, Correggio, Italy
| | - Stefano Tolomelli
- Neurological Rehabilitation Unit, AUSL of Reggio Emilia, S. Sebastiano Hospital, Correggio, Italy
- Orthopaedic Rehabilitation Unit, AUSL of Reggio Emilia, S. Sebastiano Hospital, Correggio, Italy
| | - Mirco Lusuardi
- Respiratory Rehabilitation Unit, AUSL of Reggio Emilia, S. Sebastiano Hospital, Correggio, Italy
| | - Andrea Merlo
- Department of Rehabilitation, LAM-Motion Analysis Laboratory, AUSL of Reggio Emilia, S. Sebastiano Hospital, Via Mandriolo Superiore 11, 42015, Correggio, RE, Italy
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Park SH. Tools for assessing fall risk in the elderly: a systematic review and meta-analysis. Aging Clin Exp Res 2018; 30:1-16. [PMID: 28374345 DOI: 10.1007/s40520-017-0749-0] [Citation(s) in RCA: 227] [Impact Index Per Article: 37.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 03/10/2017] [Indexed: 12/01/2022]
Abstract
The prevention of falls among the elderly is arguably one of the most important public health issues in today's aging society. The aim of this study was to assess which tools best predict the risk of falls in the elderly. Electronic searches were performed using Medline, EMBASE, the Cochrane Library, CINAHL, etc., using the following keywords: "fall risk assessment", "elderly fall screening", and "elderly mobility scale". The QUADAS-2 was applied to assess the internal validity of the diagnostic studies. Selected studies were meta-analyzed with MetaDisc 1.4. A total of 33 studies were eligible out of the 2,321 studies retrieved from selected databases. Twenty-six assessment tools for fall risk were used in the selected articles, and they tended to vary based on the setting. The fall risk assessment tools currently used for the elderly did not show sufficiently high predictive validity for differentiating high and low fall risks. The Berg Balance scale and Mobility Interaction Fall chart showed stable and high specificity, while the Downton Fall Risk Index, Hendrich II Fall Risk Model, St. Thomas's Risk Assessment Tool in Falling elderly inpatients, Timed Up and Go test, and Tinetti Balance scale showed the opposite results. We concluded that rather than a single measure, two assessment tools used together would better evaluate the characteristics of falls by the elderly that can occur due to a multitude of factors and maximize the advantages of each for predicting the occurrence of falls.
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Affiliation(s)
- Seong-Hi Park
- Department of Nursing, Soonchunhyang University, 22 Soonchunhyang-ro, Sinchang-myen, Asan-si, Chungcheongnam-do, 31538, South Korea.
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Cerebellar transcranial direct current stimulation improves adaptive postural control. Clin Neurophysiol 2017; 129:33-41. [PMID: 29136550 DOI: 10.1016/j.clinph.2017.09.118] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 09/11/2017] [Accepted: 09/28/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Rehabilitation interventions contribute to recovery of impaired postural control, but it remains a priority to optimize their effectiveness. A promising strategy may involve transcranial direct current stimulation (tDCS) of brain areas involved in fine-tuning of motor adaptation. This study explored the effects of cerebellar tDCS (ctDCS) on postural recovery from disturbance by Achilles tendon vibration. METHODS Twenty-eight healthy volunteers participated in this sham-ctDCS controlled study. Standing blindfolded on a force platform, four trials were completed: 60 s quiet standing followed by 20 min active (anodal-tDCS, 1 mA, 20 min, N = 14) or sham-ctDCS (40 s, N = 14) tDCS; three quiet standing trials with 15 s of Achilles tendon vibration and 25 s of postural recovery. Postural steadiness was quantified as displacement, standard deviation and path derived from the center of pressure (COP). RESULTS Baseline demographics and quiet standing postural steadiness, and backwards displacement during vibration were comparable between groups. However, active-tDCS significantly improved postural steadiness during vibration and reduced forward displacement and variability in COP derivatives during recovery. CONCLUSIONS We demonstrate that ctDCS results in short-term improvement of postural adaptation in healthy individuals. SIGNIFICANCE Future studies need to investigate if multisession ctDCS combined with training or rehabilitation interventions can induce prolonged improvement of postural balance.
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Rasche P, Mertens A, Bröhl C, Theis S, Seinsch T, Wille M, Pape HC, Knobe M. The "Aachen fall prevention App" - a Smartphone application app for the self-assessment of elderly patients at risk for ground level falls. Patient Saf Surg 2017; 11:14. [PMID: 28503199 PMCID: PMC5422970 DOI: 10.1186/s13037-017-0130-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 05/03/2017] [Indexed: 12/04/2022] Open
Abstract
Background Fall incidents are a major problem for patients and healthcare. The “Aachen Fall Prevention App” (AFPA) represents the first mobile Health (mHealth) application (app) empowering older patients (persons 50+ years) to self-assess and monitor their individual fall risk. Self-assessment is based on the “Aachen Fall Prevention Scale,” which consists of three steps. First, patients answer ten standardized yes–no questions (positive criterion ≥ 5 “Yes” responses). Second, a ten-second test of free standing without compensatory movement is performed (positive criterion: compensatory movement). Finally, during the third step, patients rate their subjective fall risk on a 10-point Likert scale, based on the results of steps one and two. The purpose of this app is (1) to offer a low-threshold service through which individuals can independently monitor their individual fall risk and (2) to collect data about how a patient-centered mHealth app for fall risk assessment is used in the field. Results The results represent the first year of an ongoing field study. From December 2015 to December 2016, 197 persons downloaded the AFPA (iOS™ and Android™; free of charge). N = 111 of these persons voluntarily shared their data and thereby participated in the field study. Data from a final number of n = 79 persons were analyzed due to exclusion criteria (age, missing objective fall risk, missing self-assessment). The objective fall risk and the self-assessed subjective risk measured by the AFPA showed a significant positive relationship. Conclusions The “Aachen Fall Prevention App” (AFPA) is an mHealth app released for iOS and Android. This field study revealed the AFPA as a promising tool to raise older adults’ awareness of their individual fall risk by means of a low-threshold patient-driven fall risk assessment tool.
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Affiliation(s)
- Peter Rasche
- Chair and Institute of Industrial Engineering and Ergonomics of RWTH Aachen, Bergdriesch 27, 52072 Aachen, Germany
| | - Alexander Mertens
- Chair and Institute of Industrial Engineering and Ergonomics of RWTH Aachen, Bergdriesch 27, 52072 Aachen, Germany
| | - Christina Bröhl
- Chair and Institute of Industrial Engineering and Ergonomics of RWTH Aachen, Bergdriesch 27, 52072 Aachen, Germany
| | - Sabine Theis
- Chair and Institute of Industrial Engineering and Ergonomics of RWTH Aachen, Bergdriesch 27, 52072 Aachen, Germany
| | - Tobias Seinsch
- Chair and Institute of Industrial Engineering and Ergonomics of RWTH Aachen, Bergdriesch 27, 52072 Aachen, Germany
| | - Matthias Wille
- Chair and Institute of Industrial Engineering and Ergonomics of RWTH Aachen, Bergdriesch 27, 52072 Aachen, Germany
| | - Hans-Christoph Pape
- Division of Orthopaedic Trauma, Department of Surgery, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Matthias Knobe
- Department of Orthopaedic Trauma, University of Aachen Medical Center, Pauwelsstraße 30, 52074 Aachen, Germany
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Lubetzky AV, McCoy SW, Price R, Kartin D. Response to Tendon Vibration Questions the Underlying Rationale of Proprioceptive Training. J Athl Train 2017; 52:97-107. [PMID: 28125270 DOI: 10.4085/1062-6050-52.1.06] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
CONTEXT Proprioceptive training on compliant surfaces is used to rehabilitate and prevent ankle sprains. The ability to improve proprioceptive function via such training has been questioned. Achilles tendon vibration is used in motor-control research as a form of proprioceptive stimulus. Using measures of postural steadiness with nonlinear measures to elucidate control mechanisms, tendon vibration can be applied to investigate the underlying rationale of proprioceptive training. OBJECTIVE To test whether the effect of vibration on young adults' postural control depended on the support surface. DESIGN Descriptive laboratory study. SETTING Research laboratory. PATIENTS OR OTHER PARTICIPANTS Thirty healthy adults and 10 adults with chronic ankle instability (CAI; age range = 18-40 years). INTERVENTION(S) With eyes open, participants stood in bilateral stance on a rigid plate (floor), memory foam, and a Both Sides Up (BOSU) ball covering a force platform. We applied bilateral Achilles tendon vibration for the middle 20 seconds in a series of 60-second trials and analyzed participants' responses from previbration to vibration (pre-vib) and from vibration to postvibration (vib-post). MAIN OUTCOME MEASURE(S) We calculated anterior-posterior excursion of the center of pressure and complexity index derived from the area under multiscale entropy curves. RESULTS The excursion response to vibration differed by surface, as indicated by a significant interaction of P < .001 for the healthy group at both time points and for the CAI group vib-post. Although both groups demonstrated increased excursion from pre-vib and from vib-post, a decrease was observed on the BOSU. The complexity response to vibration differed by surface for the healthy group (pre-vib, P < .001). The pattern for the CAI group was similar but not significant. Complexity changes vib-post were the same on all surfaces for both groups. CONCLUSIONS Participants reacted less to ankle vibration when standing on the BOSU as compared with the floor, suggesting that proprioceptive training may not be occurring. Different balance-training paradigms to target proprioception, including tendon vibration, should be explored.
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Affiliation(s)
- Anat Vilnai Lubetzky
- Department of Physical Therapy, Steinhardt School of Culture Education and Human Performance, New York University
| | | | - Robert Price
- Department of Rehabilitation Medicine, University of Washington, Seattle
| | - Deborah Kartin
- Department of Rehabilitation Medicine, University of Washington, Seattle
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Yingyongyudha A, Saengsirisuwan V, Panichaporn W, Boonsinsukh R. The Mini-Balance Evaluation Systems Test (Mini-BESTest) Demonstrates Higher Accuracy in Identifying Older Adult Participants With History of Falls Than Do the BESTest, Berg Balance Scale, or Timed Up and Go Test. J Geriatr Phys Ther 2017; 39:64-70. [PMID: 25794308 DOI: 10.1519/jpt.0000000000000050] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE Balance deficits a significant predictor of falls in older adults. The Balance Evaluation Systems Test (BESTest) and the Mini-Balance Evaluation Systems Test (Mini-BESTest) are tools that may predict the likelihood of a fall, but their capabilities and accuracies have not been adequately addressed. Therefore, this study aimed at examining the capabilities of the BESTest and Mini-BESTest for identifying older adult with history of falls and comparing the participants with history of falls identification accuracy of the BESTest, Mini-BESTest, Berg Balance Scale (BBS), and the Timed Up and Go Test (TUG) for identifying participants with a history of falls. METHODS Two hundred healthy older adults with a mean age of 70 years were classified into participants with and without history of fall groups on the basis of their 12-month fall history. Their balance abilities were assessed using the BESTest, Mini-BESTest, BBS, and TUG. An analysis of the resulting receiver operating characteristic curves was performed to calculate the area under the curve (AUC), sensitivity, specificity, cutoff score, and posttest accuracy of each. RESULTS The Mini-BESTest showed the highest AUC (0.84) compared with the BESTest (0.74), BBS (0.69), and TUG (0.35), suggesting that the Mini-BESTest had the highest accuracy in identifying older adult with history of falls. At the cutoff score of 16 (out of 28), the Mini-BESTest demonstrated a posttest accuracy of 85% with a sensitivity of 85% and specificity of 75%. The Mini-BESTest had the highest posttest accuracy, with the others having results of 76% (BESTest), 60% (BBS), and 65% (TUG). CONCLUSION The Mini-BESTest is the most accurate tool for identifying older adult with history of falls compared with the BESTest, BBS, and TUG.
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Affiliation(s)
- Anyamanee Yingyongyudha
- 1Division of Physical Therapy, Faculty of Health Science, Srinakharinwirot University, Nakhonnayok, Thailand. 2Department of Physiology, Faculty of Science, Mahidol University, Bangkok, Thailand
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Luque-Siles C, Gallego-Izquierdo T, Jímenez-Rejano JJ, de-la-Orden SG, Plaza-Manzano G, López-Illescas-Ruiz A, Ferragut-Garcías A, Romero-Franco N, Martín-Casas P, Pecos-Martín D. Reliability and minimal detectable change of three functional tests: forward-lunge, step-up-over and sit-to-stand. J Phys Ther Sci 2016; 28:3384-3389. [PMID: 28174457 PMCID: PMC5276766 DOI: 10.1589/jpts.28.3384] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 08/20/2016] [Indexed: 12/02/2022] Open
Abstract
[Purpose] To examine the intrasession and intersession reliability and the absolute
reliability of three functional dynamic tests—forward-lunge, step-up-over and sit-to-stand
tests—using computerized dynamic posturography. [Subjects and Methods] An intra-test and
test-retest, repeated measure study was designed. Forty-five healthy subjects twice
carried out the forward-lunge test, step-up-over test, and sit-to-stand test on two days,
one week apart. The intrasession and intersession reliabilities as judged by the
intraclass correlation coefficient (ICC) and the minimal detectable change of the three
functional tests were calculated. [Results] Excellent to very good intrasession
reliability of the forward-lunge test (ICC range of 0.9–0.8) was found. Very good to good
intrasession reliability of the step-up-over test (ICC range of 0.9–0.5) was found and
very good intrasession reliability of the sit-to-stand test (ICC range of 0.8–0.7) was
found. The minimal detectable change at the 95% confidence level of most of the measures
was lower than 30%. [Conclusion] The forward-lunge, step-up-over and sit-to-stand tests
are reliable measurement tools.
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Affiliation(s)
- Carmen Luque-Siles
- High Performance Sports Medicine Center of the High Council for Sports, Spain
| | | | | | | | - Gustavo Plaza-Manzano
- Departamento de Medicina Física y Rehabilitación, Facultad de Medicina, Universidad Complutense de Madrid. Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Spain
| | | | | | | | | | - Daniel Pecos-Martín
- Physiotherapy Department, University of Alcalá, Spain; Departamento de Medicina Física y Rehabilitación, Facultad de Enfermería, Fisioterapiay Podología, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Spain
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Sharp KG, Gramer R, Page SJ, Cramer SC. Increased Brain Sensorimotor Network Activation after Incomplete Spinal Cord Injury. J Neurotrauma 2016; 34:623-631. [PMID: 27528274 DOI: 10.1089/neu.2016.4503] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
After complete spinal cord injury (SCI), activation during attempted movement of paralyzed limbs is sharply reduced, but after incomplete SCI-the more common form of human injury-it is unknown how attempts to move voluntarily are accompanied by activation of brain motor and sensory networks. Here, we assessed brain activation during ankle movement in subjects with incomplete SCI, among whom voluntary motor function is partially preserved. Adults with incomplete SCI (n = 20) and healthy controls (n = 15) underwent functional magnetic resonance imaging that alternated rest with 0.3-Hz right ankle dorsiflexion. In both subject groups, ankle movement was associated with bilateral activation of primary and secondary sensory and motor areas, with significantly (p < 0.001) greater activation in subjects with SCI within right hemisphere areas, including primary sensorimotor cortex and pre-motor cortex. This result was further evaluated using linear regression analysis with respect to core clinical variables. Poorer locomotor function correlated with larger activation within several right hemisphere areas, including pre- and post-central gyri, possibly reflecting increased movement complexity and effort, whereas longer time post-SCI was associated with larger activation in left post-central gyrus and bilateral supplementary motor area, which may reflect behaviorally useful adaptations. The results indicate that brain adaptations after incomplete SCI differ sharply from complete SCI, are related to functional behavioral status, and evolve with increasing time post-SCI. The results suggest measures that might be useful for understanding and treating incomplete SCI in human subjects.
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Affiliation(s)
- Kelli G Sharp
- 1 Reeve-Irvine Research Center, University of California , Irvine, Irvine, California.,2 Department of Dance, University of California , Irvine, Irvine, California
| | - Robert Gramer
- 3 Departments of Neurology, Anatomy & Neurobiology, and Physical Medicine & Rehabilitation, University of California , Irvine, Irvine, California
| | - Stephen J Page
- 4 Division of Occupational Therapy, The Ohio State University Medical Center , Columbus, Ohio
| | - Steven C Cramer
- 1 Reeve-Irvine Research Center, University of California , Irvine, Irvine, California.,3 Departments of Neurology, Anatomy & Neurobiology, and Physical Medicine & Rehabilitation, University of California , Irvine, Irvine, California.,5 The Sue and Bill Gross Stem Cell Research Center, University of California , Irvine, Irvine, California
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Alin KK, Grahn Kronhed AC, Salminen H. The association between spinal curvature and balance in elderly women at high risk of osteoporotic fractures in primary health care. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2016. [DOI: 10.1080/21679169.2016.1185151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Knobe M, Giesen M, Plate S, Gradl-Dietsch G, Buecking B, Eschbach D, van Laack W, Pape HC. The Aachen Mobility and Balance Index to measure physiological falls risk: a comparison with the Tinetti POMA Scale. Eur J Trauma Emerg Surg 2016; 42:537-545. [DOI: 10.1007/s00068-016-0693-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 05/30/2016] [Indexed: 11/29/2022]
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Rajendran V, Jeevanantham D. Assessment of physical function in geriatric oncology based on International Classification of Functioning, Disability and Health (ICF) framework. CURRENT GERIATRICS REPORTS 2016. [DOI: 10.1007/s13670-016-0162-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Nagar VR, Sawyer SF, James CR, Brismée JM, Hooper TL, Sizer PS. The Effects of Volitional Preemptive Abdominal Contraction on Postural Control Responses in Healthy Subjects. PM R 2015; 7:1142-1151. [PMID: 26003873 DOI: 10.1016/j.pmrj.2015.05.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Revised: 04/14/2015] [Accepted: 05/10/2015] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To investigate the effect of volitional preemptive abdominal contraction by using an abdominal bracing maneuver (ABM) on postural control responses. DESIGN A within-subjects, repeated-measure, experimental design. SETTING Laboratory. PARTICIPANTS Sixty-five healthy subjects between 18 and 50 years of age. METHODS Subjects performed ABM alternating with No-ABM during 2 rounds of 2 Neurocom computed dynamic posturography tests: the Motor Control Test (MCT) and conditions 1 (eyes open), 2 (eyes closed), and 5 (eyes closed, sway-referenced support) of the Sensory Organization Test (SOT). MAIN OUTCOME MEASUREMENTS (1) MCT Response Latency (milliseconds) and Response Scaling (magnitude of active postural correction) and (2) SOT Equilibrium Scores and 2-Dimensional Sway (°/second), and SOT Movement Strategy, which measure postural sway and movement strategies (ankle versus hip strategy), respectively. RESULTS The use of ABM (versus No-ABM) produced: (1) a small but statistically significant decrease in SOT Equilibrium Score for condition 2 (-1.0%; P = .004); (2) an increase in SOT 2-Dimensional Sway (°/second) during conditions 1 (16.9%; P = .0001) and 2 (15.0%; P = .0001); (3) a small decrease in SOT Movement Strategy scores during condition 1 (-0.5%; P = .001) and condition 2 (-1.0%; P = .017); and (4) a reduction of MCT Response Latency by 3 milliseconds (-2.1%; P = .005) and reduction of Response Scaling by 0.33°/second (-9.2%; P = .001). CONCLUSION Individuals can incorporate the ABM without substantively altering postural control. Although selected SOT and MCT scores exhibited small decreases in postural response integrity, those outcomes did not reflect functionally meaningful changes. These findings can enhance clinicians' confidence in prescribing the ABM as a means to protectively stabilize the spine and potentially prevent injury in healthy subjects without concern for reducing postural control, especially during more complex postural perturbations that introduce sensory conflict.
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Affiliation(s)
- Vittal R Nagar
- Department of Rehabilitation Sciences and the Center for Rehabilitation Research, Texas Tech University Health Sciences Center, Lubbock, TX
| | - Steven F Sawyer
- Department of Rehabilitation Sciences and the Center for Rehabilitation Research, Texas Tech University Health Sciences Center, Lubbock, TX
| | - C Roger James
- Department of Rehabilitation Sciences and the Center for Rehabilitation Research, Texas Tech University Health Sciences Center, Lubbock, TX
| | - Jean-Michel Brismée
- Department of Rehabilitation Sciences and the Center for Rehabilitation Research, Texas Tech University Health Sciences Center, Lubbock, TX
| | - Troy L Hooper
- Department of Rehabilitation Sciences and the Center for Rehabilitation Research, Texas Tech University Health Sciences Center, Lubbock, TX
| | - Phillip S Sizer
- Department of Rehabilitation Sciences and the Center for Rehabilitation Research, Texas Tech University Health Sciences Center, Lubbock, TX
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Croarkin E, Eisenfeld R, Zampieri C, Rekant J. Custom Orthotics to Mitigate Effects of Chemotherapy-induced Peripheral Neuropathy. REHABILITATION ONCOLOGY 2015; 33:43-50. [PMID: 38405036 PMCID: PMC10888503 DOI: 10.1097/01893697-201533030-00006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background Chemotherapy-induced peripheral neuropathy (CIPN) is a complication commonly involving extremities characterized by dysthesias. Given the predilection towards diminished proprioceptive feedback, balance and gait deficits often result, leading to an increase in falls risk. To date there is no published evidence to support the use of orthotics in the treatment of balance dysfunction secondary to CIPN. Purpose This report describes custom foot orthotics with a closed cell foam overlay to improve postural stability and mobility in CIPN. Case Description An individual experiencing progressive balance dysfunction was provided orthotics when standard interventions were not effective. Expectations were that improved joint contact via midfoot compression and improved bony alignment would alter proprioceptive feedback throughout the kinetic chain and result in greater postural stability. Finding a cosmetically appealing shoe to provide sufficient tactile cues and support, without undue pressure challenged clinical decision making. Outcome Measures Computerized dynamic posturography and accelerometry were used to measure postural sway. Three conditions (barefoot, shoes only, and shoe plus orthotics) were tested to differentiate effects of orthotics and shoes. With orthotic use measures of sway velocity and area improved as did his ability to stand unassisted. Timed Up and Go and gait speed measures also improved.
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Affiliation(s)
- Earllaine Croarkin
- Mark O. Hatfield Clinical Research Center, National Institutes of Health, Bethesda, MD
| | - Rachel Eisenfeld
- Mark O. Hatfield Clinical Research Center, National Institutes of Health, Bethesda, MD
| | - Cris Zampieri
- Mark O. Hatfield Clinical Research Center, National Institutes of Health, Bethesda, MD
| | - Julie Rekant
- Mark O. Hatfield Clinical Research Center, National Institutes of Health, Bethesda, MD
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Phadke CP, Ismail F, Boulias C, Gage W, Mochizuki G. The impact of post-stroke spasticity and botulinum toxin on standing balance: a systematic review. Expert Rev Neurother 2014; 14:319-27. [DOI: 10.1586/14737175.2014.887443] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Lane RA, Mazari F, Mockford KA, Vanicek N, Chetter IC, Coughlin PA. Fear of falling in claudicants and its relationship to physical ability, balance, and quality of life. Vasc Endovascular Surg 2014; 48:297-304. [PMID: 24444769 DOI: 10.1177/1538574413519711] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Intermittent claudication is associated with poor physical function, quality of life (QoL), and balance impairment. Fear of falling (FoF) is a recognized contributing factor to poor physical ability. Any link between claudication and FoF is yet to be determined. This study aimed to explore the prevalence of FoF in claudicants and its relationship with physical function and QoL. METHODS A prospective observational study was performed. Fear of falling was determined using the Activities-specific Balance Confidence (ABC) questionnaire and the categorical question "Are you afraid of falling?" Physical ability and QoL (Short Form 36 and Vascular QoL) were determined. RESULTS A total of 161 claudicants (118 men, median age of 69 years) were assessed; 83 answered the categorical question "Are you afraid of falling?" By receiver-operating characteristic curve analysis, an ABC threshold <74% denoted a FoF, which was associated with poorer physical function and QoL. CONCLUSION Fear of falling is associated with poor physical, social, and psychological function, addressing this may improve all aspects of health.
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Affiliation(s)
- Risha A Lane
- Academic Vascular Surgical Unit, Hull Royal Infirmary, Hull, Hull York Medical School, University of Hull, United Kingdom
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Engelhart D, Pasma JH, Schouten AC, Meskers CGM, Maier AB, Mergner T, van der Kooij H. Impaired standing balance in elderly: a new engineering method helps to unravel causes and effects. J Am Med Dir Assoc 2013; 15:227.e1-227.e6. [PMID: 24220138 DOI: 10.1016/j.jamda.2013.09.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Revised: 09/09/2013] [Accepted: 09/11/2013] [Indexed: 11/18/2022]
Abstract
Deteriorated balance control is the most frequent cause of falls and injuries in the elderly. Balance control comprises a complex interplay of several underlying systems (ie, the sensory systems, the motor system, and the nervous system). Available clinical balance tests determine the patient's ability to maintain standing balance under defined test conditions and aim to describe the current state of this ability. However, these tests do not reveal which of the underlying systems is deteriorated and to what extent, so that the relation between cause and effect often remains unclear. Especially detection of early-stage balance control deterioration is difficult, because the balance control system is redundant and elderly may use compensation strategies. This article describes a new method that is able to identify causal relationships in deteriorated balance control, called CLSIT (Closed Loop System Identification Technique). Identification of impaired balance with CLSIT is a base for development of tailored interventions and compensation strategies to reduce the often serious consequences of deteriorated balance control in the elderly.
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Affiliation(s)
- Denise Engelhart
- Laboratory of Biomechanical Engineering, Institute for Biomedical Technology and Technical Medicine (MIRA), University of Twente, Enschede, The Netherlands.
| | - Jantsje H Pasma
- Department of Rehabilitation Medicine, Leiden University Medical Centre, Leiden, The Netherlands
| | - Alfred C Schouten
- Laboratory of Biomechanical Engineering, Institute for Biomedical Technology and Technical Medicine (MIRA), University of Twente, Enschede, The Netherlands; Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - Carel G M Meskers
- Department of Rehabilitation Medicine, Leiden University Medical Centre, Leiden, The Netherlands
| | - Andrea B Maier
- Section of Geriatrics and Gerontology, Department of Internal Medicine, VU University Medical Centre, Amsterdam, The Netherlands
| | | | - Herman van der Kooij
- Laboratory of Biomechanical Engineering, Institute for Biomedical Technology and Technical Medicine (MIRA), University of Twente, Enschede, The Netherlands; Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
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Tuunainen E, Rasku J, Jäntti P, Pyykkö I. Risk factors of falls in community dwelling active elderly. Auris Nasus Larynx 2013; 41:10-6. [PMID: 23763793 DOI: 10.1016/j.anl.2013.05.002] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 04/30/2013] [Accepted: 05/10/2013] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To search for measures to describe and relate to accidental falls in community dwelling elderly. METHOD A EuroQol EQ-5D questionnaire based on a patient's otoneurological case history provided a general health related quality of life measure, a fall history for the last 3 months and force platform measures for 96 active elderly from a pensioner organization. RESULTS On average, the elderly experienced 0.3 falls over the preceding three months. A fall was seen to cause a significant deterioration in the quality of life and vertigo and caused fear of falling. The postural instability correlated with falls. Vertigo was present among 42% and was most commonly characterized as episodic and rotatory in factorial analysis items relating to vertigo correlated to falls and balance complaints. Four factors were identified and three of these correlated with falls. Vestibular failure correlated to a fall occurring when a person was rising up; Movement intolerance correlated with falls due to slips and trips, and Near-syncope factor correlated to falls for other reasons. In posturography, the variable measuring critical time describing the memory based "closed loop" control of postural stability carried a risk for accidental fall with an odds ratio of 6. The variable measuring zero crossing velocity showed a high rate of velocity change around the neutral position of stance. CONCLUSION Vertigo and poor postural stability were the major reasons for falls in the active elderly. In ageing, postural control is shifted towards open loop control (visual, proprioception, exteroception and vestibular) instead of closed loop control and is a factor that contributes to a fall.
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Affiliation(s)
- Eeva Tuunainen
- Department of Otolaryngology, University Central Hospital of Tampere and University of Tampere, Medical School, Finland
| | - Jyrki Rasku
- Department of Otolaryngology, University Central Hospital of Tampere and University of Tampere, Medical School, Finland
| | - Pirkko Jäntti
- Department of Geriatric Medicine, Hatanpää City Hospital, Tampere, Finland
| | - Ilmari Pyykkö
- Department of Otolaryngology, University Central Hospital of Tampere and University of Tampere, Medical School, Finland.
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Cavallari M, Moscufo N, Skudlarski P, Meier D, Panzer VP, Pearlson GD, White WB, Wolfson L, Guttmann CRG. Mobility impairment is associated with reduced microstructural integrity of the inferior and superior cerebellar peduncles in elderly with no clinical signs of cerebellar dysfunction. NEUROIMAGE-CLINICAL 2013; 2:332-40. [PMID: 24179787 PMCID: PMC3777843 DOI: 10.1016/j.nicl.2013.02.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Revised: 02/21/2013] [Accepted: 02/22/2013] [Indexed: 11/29/2022]
Abstract
While the cerebellum plays a critical role in motor coordination and control no studies have investigated its involvement in idiopathic mobility impairment in community-dwelling elderly. In this study we tested the hypothesis that structural changes in the cerebellar peduncles not detected by conventional magnetic resonance imaging are associated with reduced mobility performance. The analysis involved eighty-five subjects (age range: 75–90 years) who had no clinical signs of cerebellar dysfunction. Based on the short physical performance battery (SPPB) score, we defined mobility status of the subjects in the study as normal (score 11–12, n = 26), intermediate (score 9–10, n = 27) or impaired (score < 9, n = 32). We acquired diffusion tensor imaging data to obtain indices of white matter integrity: fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD) and radial diffusivity (RD). Using a parcellation atlas, regional indices within the superior, middle, and inferior cerebellar peduncles (ICP, MCP, SCP) were calculated and their associations with mobility performance were analyzed. Subjects with impaired mobility showed reduced FA and AD values in the ICP and SCP but not in the MCP. The ICP-FA, ICP-AD and SCP-FA indices showed a significant association with the SPPB score. We also observed significant correlation between ICP-FA and walk time (r = − 0.311, p = 0.004), as well as between SCP-AD and self-paced maximum walking velocity (r = 0.385, p = 0.003) and usual walking velocity (r = 0.400, p = 0.002). In logistic regression analysis ICP-FA and ICP-AD together explained 51% of the variability in the mobility status of a sample comprising the normal and impaired subgroups, and correctly classified more than three-quarters of those subjects. Our findings suggest that presence of microstructural damage, likely axonal, in afferent and efferent connections of the cerebellum contributes to the deterioration of motor performance in older people. DTI study of the cerebellar peduncles and mobility in elderly. Fractional anisotropy and axial diffusivity of inferior peduncle predict mobility. Decreased anisotropy in the peduncles in the absence of T2 lesions. Findings likely reflect axonal degeneration of proprioceptive afferent fibers. Abnormalities in infratentorial white matter are novel findings in the field.
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Affiliation(s)
- Michele Cavallari
- Center for Neurological Imaging, Department of Radiology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA ; Dipartimento di Neuroscienze, Salute Mentale e Organi di Senso (NESMOS), Università La Sapienza, Rome, Italy
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Guevara CR, Lugo LH. Validez y confiabilidad de la Escala de Tinetti para población colombiana. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/s0121-8123(12)70017-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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