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Zhou M, Zhang G, Wang N, Zhao T, Liu Y, Geng Y, Zhang J, Wang N, Peng N, Huang L. A novel score for predicting falls in community-dwelling older people: a derivation and validation study. BMC Geriatr 2024; 24:491. [PMID: 38834944 DOI: 10.1186/s12877-024-05064-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 05/09/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND Early detection of patients at risk of falling is crucial. This study was designed to develop and internally validate a novel risk score to classify patients at risk of falls. METHODS A total of 334 older people from a fall clinic in a medical center were selected. Least absolute shrinkage and selection operator (LASSO) regression was used to minimize the potential concatenation of variables measured from the same patient and the overfitting of variables. A logistic regression model for 1-year fall prediction was developed for the entire dataset using newly identified relevant variables. Model performance was evaluated using the bootstrap method, which included measures of overall predictive performance, discrimination, and calibration. To streamline the assessment process, a scoring system for predicting 1-year fall risk was created. RESULTS We developed a new model for predicting 1-year falls, which included the FRQ-Q1, FRQ-Q3, and single-leg standing time (left foot). After internal validation, the model showed good discrimination (C statistic, 0.803 [95% CI 0.749-0.857]) and overall accuracy (Brier score, 0.146). Compared to another model that used the total FRQ score instead, the new model showed better continuous net reclassification improvement (NRI) [0.468 (0.314-0.622), P < 0.01], categorical NRI [0.507 (0.291-0.724), P < 0.01; cutoff: 0.200-0.800], and integrated discrimination [0.205 (0.147-0.262), P < 0.01]. The variables in the new model were subsequently incorporated into a risk score. The discriminatory ability of the scoring system was similar (C statistic, 0.809; 95% CI, 0.756-0.861; optimism-corrected C statistic, 0.808) to that of the logistic regression model at internal bootstrap validation. CONCLUSIONS This study resulted in the development and internal verification of a scoring system to classify 334 patients at risk for falls. The newly developed score demonstrated greater accuracy in predicting falls in elderly people than did the Timed Up and Go test and the 30-Second Chair Sit-Stand test. Additionally, the scale demonstrated superior clinical validity for identifying fall risk.
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Affiliation(s)
- Ming Zhou
- Department of Rehabilitation Medicine, The First Medical Center of Chinese PLA General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
| | - Gongzi Zhang
- Department of Rehabilitation Medicine, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Na Wang
- Department of Rehabilitation Medicine, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Tianshu Zhao
- Department of Rehabilitation Medicine, The First Medical Center of Chinese PLA General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
| | - Yangxiaoxue Liu
- Department of Rehabilitation Medicine, The First Medical Center of Chinese PLA General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
| | - Yuhan Geng
- Department of Rehabilitation Medicine, The First Medical Center of Chinese PLA General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
| | - Jiali Zhang
- Department of Rehabilitation Medicine, The First Medical Center of Chinese PLA General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
| | - Ning Wang
- Department of Rehabilitation Medicine, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Nan Peng
- Department of Rehabilitation Medicine, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China.
| | - Liping Huang
- Department of Rehabilitation Medicine, The First Medical Center of Chinese PLA General Hospital, Beijing, China.
- Department of Rehabilitation Medicine, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China.
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Sung PS, Lee D. A study on the effects of visual condition on postural stability in adults with and without chronic low back pain. J Biomech 2024; 171:112193. [PMID: 38885601 DOI: 10.1016/j.jbiomech.2024.112193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 04/12/2024] [Accepted: 06/10/2024] [Indexed: 06/20/2024]
Abstract
This study was conducted to compare postural stability during repeated unilateral standing tasks between adults with and without chronic low back pain (LBP) while considering visual input. The study involved 26 participants with LBP and 39 control participants. Each participant performed three trials of standing tasks on the dominant limb using a stable platform. The Falls Efficacy Scale was utilized to assess fall-related self-efficacy and fear of falling due to potential physical frailty. The center of pressure (COP) sway excursion was analyzed at 10 mm and 20 mm thresholds for the time-in-boundary (TIB). The results indicated a significant fear of falling difference in the LBP group compared to the control group (t = 3.27, p = 0.001). The LBP group demonstrated a significant interaction between visual condition and TIB (F = 8.45, p = 0.01), particularly in the LBP group, which demonstrated a notable decrease in TIB at 10 mm (54.02 % compared to the control group's 70.40 %) and 20 mm (70.93 % compared to the control group's 85.92 %) thresholds during the second trial and at 10 mm (59.73 % compared to the control group's 73.84 %) during the third trial in the eyes open condition. Overall, visual condition demonstrated significant interactions on thresholds (F = 15.80, p = 0.001, η2p = 0.21) as well as trials × thresholds (F = 4.21, p = 0.04, η2p = 0.07). These findings indicate a potential adaptation in postural control among the LBP group with visual feedback. Further research is warranted to explore group differences when considering visual conditions and sway excursion thresholds.
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Affiliation(s)
- Paul S Sung
- Doctor of Physical Therapy Program, Indiana Wesleyan University, 4201 South Washington Street, Marion, IN, USA.
| | - Dongchul Lee
- Nevro Inc., 1800 Bridge Parkway, Redwood City, CA, USA.
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Lee D, Sung PS. Normalized stability time analysis within the boundaries between adults with and without fear of falling. Aging Clin Exp Res 2024; 36:13. [PMID: 38281190 PMCID: PMC10822799 DOI: 10.1007/s40520-023-02651-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 10/29/2023] [Indexed: 01/30/2024]
Abstract
BACKGROUND The unilateral stance test, measured by the center of pressure (COP), has been widely used to identify balance deficits. However, there is a critical gap in understanding the specific COP thresholds on postural stability in adults with a fear of falling (FOF). AIMS To investigate the normalized stability time, which was defined as the ratio of time spent within stability boundaries to the total test duration, under different visual conditions and specific thresholds between adults with and without FOF. METHODS Twenty-one older adults with FOF and 22 control subjects completed the unilateral limb standing test in eyes-open and eyes-closed conditions. Normalized stability times were computed based on five pre-determined COP sway range thresholds: 10 mm, 15 mm, 20 mm, 25 mm, and 30 mm. RESULTS Receiver operating characteristic analysis determined the diagnostic accuracy of FOF. There were significant differences in the effects of both visual conditions (F = 46.88, p = 0.001) and threshold settings (F = 119.38, p = 0.001) on stability time between groups. The FOF group significantly reduced normalized stability time at the 10 mm COP threshold under eyes-closed conditions (t = - 1.95, p = 0.03). DISCUSSION The findings highlight the heightened sensitivity of the 10 mm COP threshold in identifying group variances in postural stability when eyes are closed. Moreover, the FOF group displayed a marked reduction in stability duration based on visual scenarios and normalized thresholds. CONCLUSION The study highlights the need to account for both COP boundaries and visual conditions in adults with FOF. When assessing postural control during unilateral stances, clinicians must also give attention to non-visual cues.
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Affiliation(s)
- Dongchul Lee
- Nevro Inc., 1800 Bridge Parkway, Redwood City, CA, USA
| | - Paul S Sung
- Doctor of Physical Therapy Program, Indiana Wesleyan University, 4201 South Washington Street, Marion, IN, 46953, USA.
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Beauchet O, Matskiv J, Rolland Y, Schott AM, Allali G. ER 2 risk levels and their association with incident falls, their recurrence and post-fall fractures in older women: Results of the EPIDOS study. Maturitas 2023; 178:107838. [PMID: 37659130 DOI: 10.1016/j.maturitas.2023.107838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 06/12/2023] [Accepted: 08/18/2023] [Indexed: 09/04/2023]
Abstract
BACKGROUND "Emergency Room Evaluation and Recommendations" (ER2) is a validated clinical tool which stratifies the risk of the occurrence of adverse outcomes in three levels (i.e., low, moderate and high) in older people attending emergency departments. This study examines the association of ER2 risk levels with incident falls, their recurrence and post-fall fractures in older community women. METHODS 7147 participants of the EPIDémiologie de l'OStéoporose (EPIDOS) study - an observational population-based cohort study - were selected. ER2 low, moderate and high risk levels were determined at baseline. Incident fall outcomes (i.e., one incident fall without fracture, one incident fall with fracture, ≥2 falls without fracture and ≥ 2 falls with fracture) were collected prospectively every 4 months over a 4-year follow-up period. RESULTS The overall incidence of falls was 26.4.%, regardless of their characteristics. ER2 low risk level (hazard ratio (HR) ≤0.80 with P ≤ 0.001) and high risk (HR ≥ 1.26 with P ≤ 0.001) were associated respectively with low and high incident fall outcomes, except for recurrent falls without fracture. CONCLUSIONS ER2 low and high risk levels were associated with incident falls outcomes in EPIDOS participants, suggesting that the ER2 tool may be useful for stratifying the risk of falls in the older population.
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Affiliation(s)
- Olivier Beauchet
- Departments of Medicine and Geriatrics, University of Montreal, Montreal, Quebec, Canada; Research Centre of the Geriatric University Institute of Montreal, Montreal, Quebec, Canada; Department of Medicine, Division of Geriatric Medicine, Sir Mortimer B. Davis Jewish General Hospital, Lady Davis Institute for Medical Research, McGill University, Montreal, Quebec, Canada.
| | - Jacqueline Matskiv
- Research Centre of the Geriatric University Institute of Montreal, Montreal, Quebec, Canada
| | - Yves Rolland
- Gerontopole of Toulouse, CERPOP (Centre d'Epidémiologie et de Recherche en santé des POPulations) UPS/INSERM UMR 1295, Toulouse, France
| | - Anne-Marie Schott
- Université Claude Bernard Lyon1, Unité INSERM 1290 RESHAPE, Hospices Civils de Lyon, Pôle de Santé Publique, Lyon, France
| | - Gilles Allali
- Leenaards Memory Center, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Lee D, Sung PS. Postural adaptations within normalized stability between older adults with and without chronic low back pain. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:4420-4427. [PMID: 37718340 DOI: 10.1007/s00586-023-07939-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 08/26/2023] [Accepted: 08/30/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND Adaptations of dynamic balance performance are related to sway excursions in older adults with chronic low back pain (LBP). However, there is a lack of understanding on postural control within different thresholds of radius from the center of pressure (COP). PURPOSE This study was conducted to compare the normalized stability based on the time-in-boundary (TIB) during repeated unilateral limb standing trials between subjects with and without chronic LBP. METHODS There were 26 older adults with LBP and 39 control subjects who completed three trials of repeated unilateral limb standing on a force plat. RESULTS The TIB based on the seven thresholds was analyzed, and the groups demonstrated a significant interaction on thresholds for TIB (F = 8.76, p = 0.01). The TIB was significantly different in the 10 mm (F = 4.01, p = 0.04), 15 mm (F = 5.21, p = 0.03), and 20 mm (F = 4.48, p = 0.04) radius of thresholds only in the second trial. However, there was no group difference on TIB at the first and third trials due to potential compensatory and/or adaptive reactions to avoid fall risks. CONCLUSION The LBP group lacked postural stability within the thresholds less than a 20 mm radius at the second trial of unilateral standing. The significant group interaction with the thresholds indicates an adaptation strategy on sway thresholds. This postural reaction from repeated trials should be considered with sway excursion adjustments and fall prevention in older adults with LB.
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Affiliation(s)
| | - Paul S Sung
- Doctor of Physical Therapy Program, Indiana Wesleyan University, 4201 South Washington Street, Marion, IN, 46953, USA.
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Uematsu A, Tsuchiya K, Fukushima H, Hortobágyi T. Effects of Motor-Cognitive Dual-Task Standing Balance Exergaming Training on Healthy Older Adults' Standing Balance and Walking Performance. Games Health J 2023. [PMID: 36944151 DOI: 10.1089/g4h.2022.0203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
Objective: This study examined the effects of motor-cognitive dual-task exergaming standing balance training on healthy older adults' static, dynamic, and walking balance. Methods: Twenty-four adults older than 70 years (control group: n = 9, males = 6, balance training group: n = 15, males = 8) completed the experiment. Dual-tasking standing balance training comprised the accurate control of a ping-pong ball on a tray held with both hands, while standing on one leg (analog training) and three modules of Wii Fit™ exergaming (digital training). The duration of balance training was ∼15 minutes per day, 2 days per week for 8 weeks, in total 16 sessions. We measured one-leg standing time, functional reach distance, walking balance evaluated by the distance walked on a narrow beam (4-cm long, 4-cm wide, and 2-cm high) with single and dual tasking, habitual and maximal walking speed, and muscle strength of the hip extensor, hip abductor, hip adductor, knee extensor, and plantarflexor muscle groups in the right leg at baseline and after 8 weeks. Results: Control group decreased, but balance training group increased one-leg standing time. Only the balance training group improved functional reach distance and hip and knee extensor strength. There was no change in walking speed and walking balance in either group. In the balance training group, changes in maximal speed correlated with changes in dual-tasking walking balance and changes in one-leg standing time correlated with changes in single-tasking walking balance. Conclusion: These results suggest that 16 sessions of motor-cognitive dual-task standing exergaming balance training substantially improved healthy older adults' static and dynamic balance and leg muscle strength but failed to improve walking speed and walking balance. Balance exercises specific to walking balance need to be included in balance training to improve walking balance.
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Affiliation(s)
- Azusa Uematsu
- Faculty of Sociology, Otemon Gakuin University, Ibaraki, Japan
| | - Kazushi Tsuchiya
- Department of Rehabilitation Medicine, Yoshioka Hospital, Tendo, Japan
| | | | - Tibor Hortobágyi
- Department of Kinesiology, Hungarian University of Sports Science, Budapest, Hungary
- Institute of Sport Sciences and Physical Education, University of Pécs, Pécs, Hungary
- Somogy Country Kaposi Mór Teaching Hospital, Káposvar, Hungary
- Center for Human Movement Sciences, University of Groningen, Groningen, The Netherlands
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Blodgett JM, Hardy R, Davis DHJ, Peeters G, Hamer M, Kuh D, Cooper R. Prognostic accuracy of the one-legged balance test in predicting falls: 15-years of midlife follow-up in a British birth cohort study. Front Sports Act Living 2023; 4:1066913. [PMID: 36699981 PMCID: PMC9869374 DOI: 10.3389/fspor.2022.1066913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 12/06/2022] [Indexed: 01/11/2023] Open
Abstract
Introduction The one-legged balance test is a common screening tool for fall risk. Yet, there is little empirical evidence assessing its prognostic ability. The study aims were to assess the prognostic accuracy of one-legged balance performance in predicting falls and identify optimal cut-points to classify those at greater risk. Methods Data from up to 2,000 participants from a British birth cohort born in 1,946 were used. The times an individual could stand on one leg with their eyes open and closed were recorded (max: 30 s) at ages 53 and 60-64. Number of falls in the past year was self-reported at ages 53, 60-64 and 68; recurrent falls (0-1 vs. 2+) and any fall (0 vs. 1+) were considered binary outcomes. Four longitudinal associations between balance times and subsequent falls were investigated (age 53 → 60-64; age 53 → 68; age 60-64 → 68; age 53 & 60-64 → 68). For each temporal association, areas under the curve (AUC) were calculated and compared for a base sex-only model, a sex and balance model, a sex and fall history model and a combined model of sex, balance and fall history. The Liu method was used to identify optimal cut-points and sensitivity, specificity, and AUC at corresponding cut-points. Results Median eyes open balance time was 30 s at ages 53 and 60-64; median eyes closed balance times were 5 s and 3 s, respectively. The predictive ability of balance tests in predicting either fall outcome was poor (AUC range for sex and balance models: 0.577-0.600). Prognostic accuracy consistently improved by adding fall history to the model (range: 0.604-0.634). Optimal cut-points ranged from 27 s to 29 s for eyes open and 3 s to 5 s for eyes closed; AUC consistently indicated that using "optimal" cut-points to dichotomise balance time provided no discriminatory ability (AUC range:0.42-0.47), poor sensitivity (0.38-0.61) and poor specificity (0.23-0.56). Discussion Despite previous observational evidence showing associations between better one-legged balance performance and reduced fall risk, the one-legged balance test had limited prognostic accuracy in predicting recurrent falls. This contradicts ongoing translation of this test into clinical screening tools for falls and highlights the need to consider new and existing screening tools that can reliably predict fall risk.
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Affiliation(s)
- Joanna M. Blodgett
- Institute of Sport, Exercise & Health, Division of Surgery & Interventional Science, University College London, London, UK
| | - Rebecca Hardy
- School of Sport, Exercise and Health Sciences,Loughborough University, Loughborough, UK
- Social Research Institute, University College London, London, UK
| | | | - Geeske Peeters
- Department of Geriatric Medicine, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Mark Hamer
- Institute of Sport, Exercise & Health, Division of Surgery & Interventional Science, University College London, London, UK
| | - Diana Kuh
- MRC Unit for Lifelong Health and Ageing, UCL, London, UK
| | - Rachel Cooper
- Department of Sport and Exercise Sciences, Musculoskeletal Science and Sports Medicine Research Centre, Manchester Metropolitan University Institute of Sport, Manchester, UK
- AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
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Blodgett JM, Cooper R, Pinto Pereira SM, Hamer M. Stability of Balance Performance From Childhood to Midlife. Pediatrics 2022; 150:188250. [PMID: 35670126 DOI: 10.1542/peds.2021-055861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/05/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Balance ability underlies most physical movement across life, with particular importance for older adults. No study has investigated if balance ability is established in childhood nor if associations are independent of adult factors. We investigated associations between balance performance in early (age 10) and midlife (age 46), and whether associations were independent of contributors to adult balance. METHODS Up to 6024 individuals from the 1970 British Cohort Study were included. At age 10, static (1-legged stand) and dynamic (backward toe-to-heel walk) balance were categorized as poor, medium, or high. Eyes open and closed 1-legged balance performance (max: 30 seconds) was assessed at age 46 with 5 categories. RESULTS Poor static balance at age 10 was strongly associated with worse balance ability at age 46. Relative to the highest balance group at age 46 (ie, eyes open and closed for 30 seconds), those with poor static balance had a 7.07 (4.92-10.16) greater risk of being in the poorest balance group (ie, eyes open <15 seconds). Associations were robust to adjustment for childhood illness, cognition, and socioeconomic position and adult measures of height, BMI, education, exercise, word recall, and grip strength (adjusted relative risk: 5.04 [95% confidence interval: 3.46-7.37]). Associations between dynamic balance at age 10 and balance at age 46 were weaker (adjusted relative risk) of the poorest balance group: 1.84 [1.30-2.62]). CONCLUSIONS Early childhood may represent an important period for maturation of postural strategies involved in balance, indicating the potential for early intervention and policy changes alongside existing interventions that currently target older adults.
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Affiliation(s)
- Joanna M Blodgett
- Institute of Sport Exercise & Health, Division of Surgery & Interventional Science, University College London, London, United Kingdom
| | - Rachel Cooper
- Department of Sport and Exercise Sciences, Musculoskeletal Science and Sports Medicine Research Centre, Manchester Metropolitan University, Manchester, United Kingdom
| | - Snehal M Pinto Pereira
- Institute of Sport Exercise & Health, Division of Surgery & Interventional Science, University College London, London, United Kingdom
| | - Mark Hamer
- Institute of Sport Exercise & Health, Division of Surgery & Interventional Science, University College London, London, United Kingdom
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