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Lee Y, Shin S. Risk of using smartphones while walking for digital natives in realistic environments: Effects of cognitive-motor interference. Heliyon 2024; 10:e28901. [PMID: 38601574 PMCID: PMC11004577 DOI: 10.1016/j.heliyon.2024.e28901] [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: 12/18/2023] [Revised: 03/23/2024] [Accepted: 03/26/2024] [Indexed: 04/12/2024] Open
Abstract
The effect of using smartphones while walking on the cognitive and physical abilities of the "digital native" generation, i.e., individuals who have grown up in a digital media-centric environment, remains poorly understood. This study evaluated the effects of cognitive-motor interference on the use of smartphones while walking in children and young adults. The study involved 50 individuals from the digital age generation, including 24 children and 26 young adults. The study encompassed three experimental conditions, in which participants were instructed to traverse a distance of 60 m. The initial condition functioned as a control, wherein the participants walked without supplementary stimuli. In the second condition, the participants were provided with explicit instructions to grasp the smartphone device and position it in front of their chest by using both hands. This manipulation introduced a postural component into the experimental setup. The third condition required participants to be ambulatory while concurrently engaging in a cognitive task, namely, participating in a game that necessitated focused attention. Gait parameters were obtained by using inertial measurement unit sensors. Subsequently, the acquired gait characteristics were converted into dual-task costs (DTC). In the cognitive condition, children exhibited significantly greater DTC values for gait speed (76%), stride length (79%), stride time (102%), and stride length coefficient of variation (CV) than the young adults (p < 0.025). Moreover, as shown by the increased CV, a significant association exists between poor performance in smartphone games among children and increased variability in stride length. In children, the DTC of stride time CV decreased as smartphone game scores increased (R2 = 16.5%), and the DTC of stride length CV decreased more markedly as smartphone game scores increased (R2 = 28.2%). In conclusion, children are at a higher risk of pedestrian accidents when using smartphones while walking compared to young adults.
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Affiliation(s)
- Yungon Lee
- Department of Physical Education, Korea Military Academy, Nowon-gu, 01805, Seoul, Republic of Korea
| | - Sunghoon Shin
- Neuromuscular Control Laboratory, Yeungnam University, Gyeongsan-si, 38541, Gyungbuk, Republic of Korea
- Research Institute of Human Ecology, Yeungnam University, Gyeongsan-si, 38541, Gyungbuk, Republic of Korea
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Tai K, Mitsunaga T, Kawasumi M, Kurata T, Sato Y, Izumiyama K. Hemodialysis Treatment Influences Postoperative Activities of Daily Living Improvement for Patients with Hip Fractures. Prog Rehabil Med 2023; 8:20230031. [PMID: 37736257 PMCID: PMC10509464 DOI: 10.2490/prm.20230031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 08/09/2023] [Indexed: 09/23/2023] Open
Abstract
Objectives The aim of this study was to investigate the influences of hemodialysis (HD) on activities of daily living (ADL) in patients with hip fracture. Methods This study included 28 patients (14 HD and 14 non-HD patients) with acute hip fracture. The effects of variables such as age, sex, surgical procedure, length of hospital stay, serum albumin, C-reactive protein (CRP), number of physical therapy units, and functional independence measure (FIM) were assessed. For each factor, a two-group comparison was conducted between the HD and non-HD groups. Multiple regression analysis was used to examine the factors affecting FIM efficacy (E-FIM). Results For HD patients, total and motor FIM at discharge, E-FIM, and albumin level were significantly lower than in non-HD patients. Length of hospital stay was significantly longer for HD patients. Multiple regression analysis showed that HD had a negative effect on E-FIM. Conclusions The results suggest that rehabilitation for HD patients with hip fractures require intervention that not only provides standard rehabilitation but also addresses aspects of renal rehabilitation.
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Affiliation(s)
- Keita Tai
- Department of Rehabilitation, Association of EISEIKAI Medical and Healthcare Corporation Minamitama Hospital, Tokyo, Japan
| | - Toshiya Mitsunaga
- Department of Emergency Medicine, Association of EISEIKAI Medical and Healthcare Corporation Minamitama Hospital, Tokyo, Japan
| | - Moe Kawasumi
- Department of Rehabilitation, Association of EISEIKAI Medical and Healthcare Corporation Minamitama Hospital, Tokyo, Japan
| | - Takanori Kurata
- Department of Rehabilitation, Association of EISEIKAI Medical and Healthcare Corporation Minamitama Hospital, Tokyo, Japan
| | - Yuichi Sato
- Department of Nephrology, Association of EISEIKAI Medical and Healthcare Corporation Minamitama Hospital, Tokyo, Japan
| | - Ko Izumiyama
- Department of Orthopedics, Association of EISEIKAI Medical and Healthcare Corporation Minamitama Hospital, Tokyo, Japan
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Finco MG, Najafi B, Zhou H, Hamad A, Ibrahim R, Al-Ali F. Game-based intradialytic non-weight-bearing exercise training on gait speed and balance in older adults with diabetes: a single-blind randomized controlled trial. Sci Rep 2023; 13:14225. [PMID: 37648695 PMCID: PMC10469197 DOI: 10.1038/s41598-023-41290-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 08/24/2023] [Indexed: 09/01/2023] Open
Abstract
Older adults with diabetes receiving hemodialysis have impaired gait speed and balance compared to the general population, which have been associated with increased risks of falls and mortality. This study evaluated the effectiveness of a game-based intradialytic exercise training program (iExergame) on improving gait speed and balance. This was a single-blind randomized controlled trial. The intervention group (IG) received iExergame training using real-time audiovisual feedback with wearable inertial sensors. The control group (CG) received conventional training without any technology. Both trainings were intradialytic, non-weight-bearing, and used ankle range of motion. Gait and balance parameters were collected at baseline and 4-week follow-up. Data from 70 adults (age 64.2 ± 9.0 years) were analyzed. Compared to the CG, the IG showed greater changes between baseline and 4-week follow-up in several parameters. Gait parameters included faster speeds and longer stride lengths, particularly during dual task walking (p < 0.050). Balance parameters included reductions in center of mass (p = 0.004), ankle (p < 0.001), and hip (p = 0.010) sways during semi-tandem stance, particularly in users of assistive devices. iExergame training could improve gait speed and balance in this population and might be an option to increase intradialytic exercise adherence while reducing burdens of exercise administration.
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Affiliation(s)
- M G Finco
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Bijan Najafi
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
| | - He Zhou
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
- Shenzhen Mass Medical Co., Ltd., Shenzhen, China
- Shanghai Dengding BioAI Co., Ltd., Shanghai, China
| | - Abdullah Hamad
- Department of Nephrology, Fahad Bin Jassim Kidney Center, Hamad General Hospital, Doha, Qatar
| | - Rania Ibrahim
- Department of Nephrology, Fahad Bin Jassim Kidney Center, Hamad General Hospital, Doha, Qatar
| | - Fadwa Al-Ali
- Department of Nephrology, Fahad Bin Jassim Kidney Center, Hamad General Hospital, Doha, Qatar
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Jesus LADSD, Pinheiro BV, Lucinda LMF, de Oliveira GBGR, Haddad MFPD, Vidigal ABR, Maciel JM, Watanabe LD, Oliveira CC, Reboredo MM. Factors associated with postural balance in patients with end-stage renal disease on hemodialysis. Clin Biomech (Bristol, Avon) 2023; 107:106033. [PMID: 37352608 DOI: 10.1016/j.clinbiomech.2023.106033] [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: 01/14/2023] [Revised: 04/18/2023] [Accepted: 06/16/2023] [Indexed: 06/25/2023]
Abstract
BACKGROUND Patients with end-stage renal disease on hemodialysis have postural balance impairments due to uremic syndrome and hemodialysis complications. This study evaluated the factors associated with postural balance in patients on hemodialysis. METHODS This cross-sectional study included patients on hemodialysis [n = 93, 62.0 (16.0) years]. Postural balance was evaluated using a force plate in a static position with eyes opened and eyes closed on a firm surface and with eyes opened on a foam surface to register the center of pressure path length. Physical function was assessed by isometric handgrip force, the 5-repetition sit-to-stand test, and gait speed. The level of physical activity and quality of life were evaluated by accelerometry and the 36-Item Short Form Health Survey, respectively. FINDINGS After adjustment for potential confounders, the multiple linear regression analysis showed that the presence of diabetes mellitus and neurological disease and gait speed were significantly associated with the center of pressure path length in the eyes opened test (R2 = 0.263; p < 0.001). The center of pressure path length in the eyes closed test was significantly associated with the presence of neurological disease (R2 = 0.177; p = 0.002). The center of pressure path length in the eyes opened on a foam surface test was significantly associated with the presence of diabetes mellitus (R2 = 0.223; p < 0.001). INTERPRETATION Poor postural balance was associated with the presence of diabetes mellitus and neurological disease and a slower gait speed in patients on hemodialysis.
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Affiliation(s)
| | - Bruno Valle Pinheiro
- Pulmonary and Critical Care Division, University Hospital of Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil; School of Medicine, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - Leda Marília Fonseca Lucinda
- Pulmonary and Critical Care Division, University Hospital of Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil; Barbacena School of Medicine, Barbacena, Minas Gerais, Brazil; Department of Morphology, Institute of Biological Sciences, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | | | | | | | | | | | - Cristino Carneiro Oliveira
- Department of Physiotherapy, Federal University of Juiz de Fora - Governador Valadares, Governador Valadares, Minas Gerais, Brazil; School of Physical Education, Physical Therapy, and Occupational Therapy. Department of Physical Therapy, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Maycon Moura Reboredo
- Pulmonary and Critical Care Division, University Hospital of Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil; School of Medicine, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil.
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Kimura A, Paredes W, Pai R, Farooq H, Buttar RS, Custodio M, Munugoti S, Kotwani S, Randhawa LS, Dalezman S, Elters AC, Nam K, Ibarra JS, Venkataraman S, Abramowitz MK. Step length and fall risk in adults with chronic kidney disease: a pilot study. BMC Nephrol 2022; 23:74. [PMID: 35193493 PMCID: PMC8862327 DOI: 10.1186/s12882-022-02706-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 02/10/2022] [Indexed: 11/25/2022] Open
Abstract
Background Patients with chronic kidney disease commonly experience gait abnormalities, which predispose to falls and fall-related injuries. An unmet need is the development of improved methods for detecting patients at high risk of these complications, using tools that are feasible to implement in nephrology practice. Our prior work suggested step length could be such a marker. Here we explored the use of step length as a marker of gait impairment and fall risk in adults with chronic kidney disease. Methods We performed gait assessments in 2 prospective studies of 82 patients with stage 4 and 5 chronic kidney disease (n = 33) or end-stage renal disease (ESRD) (n = 49). Gait speed and step length were evaluated during the 4-m walk component of the Short Physical Performance Battery (SPPB). Falls within 6 months prior to or following enrollment were identified by questionnaire. Associations of low step length (≤47.2 cm) and slow gait speed (≤0.8 m/s) with falls were examined using logistic regression models adjusted for demographics and diabetes and peripheral vascular disease status. Results Assessments of step length were highly reproducible (r = 0.88, p < 0.001 for duplicate measurements at the same visit; r = 0.78, p < 0.001 between baseline and 3-month evaluations). Patients with low step length had poorer physical function, including lower SPPB scores, slower gait speed, and lower handgrip strength. Although step length and gait speed were highly correlated (r = 0.73, p < 0.001), one-third (n = 14/43) of patients with low step length did not have slow gait speed. Low step length and slow gait speed were each independently associated with the likelihood of falls (odds ratio (OR) 3.90 (95% confidence interval (CI) 1.05–14.60) and OR 4.25 (95% CI 1.24–14.58), respectively). Compared with patients who exhibited neither deficit, those with both had a 6.55 (95% CI 1.40–30.71) times higher likelihood of falls, and the number of deficits was associated with a graded association with falls (p trend = 0.02). Effect estimates were similar after further adjustment for ESRD status. Conclusions Step length and gait speed may contribute additively to the assessment of fall risk in a general adult nephrology population.
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Affiliation(s)
- Atsumi Kimura
- Department of Medicine, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Ullmann 615, Bronx, NY, USA
| | - William Paredes
- Department of Medicine, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Ullmann 615, Bronx, NY, USA
| | - Rima Pai
- Department of Medicine, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Ullmann 615, Bronx, NY, USA
| | - Hina Farooq
- Department of Medicine, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Ullmann 615, Bronx, NY, USA
| | - Rupinder S Buttar
- Department of Medicine, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Ullmann 615, Bronx, NY, USA
| | - Matthew Custodio
- Department of Medicine, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Ullmann 615, Bronx, NY, USA
| | - Samhitha Munugoti
- Department of Medicine, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Ullmann 615, Bronx, NY, USA
| | - Sonia Kotwani
- Department of Medicine, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Ullmann 615, Bronx, NY, USA
| | - Lovepreet S Randhawa
- Department of Medicine, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Ullmann 615, Bronx, NY, USA
| | - Solomon Dalezman
- Department of Medicine, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Ullmann 615, Bronx, NY, USA
| | - Antonio C Elters
- Department of Medicine, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Ullmann 615, Bronx, NY, USA
| | - Kate Nam
- Department of Medicine, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Ullmann 615, Bronx, NY, USA
| | - Jose S Ibarra
- Department of Medicine, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Ullmann 615, Bronx, NY, USA
| | - Sandheep Venkataraman
- Department of Medicine, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Ullmann 615, Bronx, NY, USA
| | - Matthew K Abramowitz
- Department of Medicine, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Ullmann 615, Bronx, NY, USA. .,Institute for Aging Research, Albert Einstein College of Medicine, Bronx, NY, USA. .,Diabetes Research Center, Albert Einstein College of Medicine, Bronx, NY, USA. .,Fleischer Institute for Diabetes and Metabolism, Albert Einstein College of Medicine, Bronx, NY, 10461, USA.
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Perez-Gurbindo I, María Álvarez-Méndez A, Pérez-García R, Arribas-Cobo P, Carrere MTA. Factors associated with falls in hemodialysis patients: a case-control study. Rev Lat Am Enfermagem 2021; 29:e3505. [PMID: 34816874 PMCID: PMC8616170 DOI: 10.1590/1518-8345.5300.3505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 09/06/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to identify possible associations between a higher probability of falls among hemodialysis patients and laboratory values, comorbidities, pharmacological treatment, hemodynamic changes, dialysis results and stabilometric alterations. METHOD this was a retrospective case-control study with hemodialysis patients. Patients in a hemodialysis unit who had suffered one or more falls were included in the case group. Patients from the same unit who had not suffered falls were the controls. Data were gathered from the patients' clinical history and also from the results of a balance test conducted six months before the study. RESULTS thirty-one patients were included (10 cases and 21 controls). Intradialytic body weight change was significantly greater among cases (p <0.05). Patients in the case group also presented greater lateral instability after dialysis (p <0.05). Other factors such as high blood pressure, antihypertensives, beta-blockers, and lower heart rates were also associated with falls. CONCLUSION a greater intradialytic weight change was associated with an increase in risk of falls. Nursing staff can control these factors to prevent the incidence of falls in dialysis patients.
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Affiliation(s)
- Ignacio Perez-Gurbindo
- Universidad Complutense de Madrid, Facultad de Enfermería,
Fisioterapia y Podología, Madrid, Madrid, Spain
| | - Ana María Álvarez-Méndez
- Universidad Complutense de Madrid, Facultad de Enfermería,
Fisioterapia y Podología, Madrid, Madrid, Spain
| | - Rafael Pérez-García
- Hospital Universitario Infanta Leonor, Servicio de Nefrología,
Madrid, Madrid, Spain
| | - Patricia Arribas-Cobo
- Hospital Universitario Infanta Leonor, Servicio de Nefrología,
Madrid, Madrid, Spain
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Varghese S, Kumar K, Kalaiah MK, Shastri U, Ebenezer A, Prabhu MV. Vestibular evoked myogenic potentials in chronic renal disease. Acta Otolaryngol 2021; 141:925-928. [PMID: 34622737 DOI: 10.1080/00016489.2021.1983212] [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: 10/20/2022]
Abstract
BACKGROUND There is limited evidence to provide an insight on the VEMP characteristics to explain the association between chronic renal disease (CRD) and its effect on otolith structures. OBJECTIVE To compare the otolithic function of individuals with CRD and individuals with no known CRD. To investigate the relationship between disease duration and VEMP and creatine level and VEMP among individuals with CRD. METHOD A cross-sectional study design using convenient sampling method was adapted for the present study. A total of 50 adults aged between 40 and 60 years participated in the study. Group 1 included 25 individuals with CRD undergoing hemodialysis and Group 2 included 25 individuals with no known CRD. cVEMP and oVEMP were recorded from participants in both groups. RESULTS cVEMP and oVEMP was absent in 28% and 44% of individuals with CRD respectively, while, both VEMPs were present among all participants in group 2. Further, peak-to-peak amplitude of VEMP was reduced in individuals with CRD suggesting abnormal otolith function. In addition, a negative correlation was found between disease duration and the peak-to-peak amplitude of VEMP. CONCLUSION The abnormal VEMP findings in individuals with CRD shows presence of otolithic dysfunction along with amplitude is found to decrease with an increase in the disease duration.
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Affiliation(s)
- Shibi Varghese
- Department of Audiology and Speech Language Pathology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Kaushlendra Kumar
- Department of Audiology and Speech Language Pathology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Mohan Kumar Kalaiah
- Department of Audiology and Speech Language Pathology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Usha Shastri
- Department of Audiology and Speech Language Pathology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Anupriya Ebenezer
- Department of Audiology and Speech Language Pathology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Mayoor Vasant Prabhu
- Department of Nephrology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
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Li Y, Zhang D, Ma Q, Diao Z, Liu S, Shi X. The Impact of Frailty on Prognosis in Elderly Hemodialysis Patients: A Prospective Cohort Study. Clin Interv Aging 2021; 16:1659-1667. [PMID: 34552324 PMCID: PMC8450604 DOI: 10.2147/cia.s329665] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 09/08/2021] [Indexed: 01/02/2023] Open
Abstract
Purpose To explore the impact of frailty on adverse outcomes in elderly hemodialysis (HD) patients. Patients and Methods An observational and prospective cohort study was conducted in elderly patients (≥60) with HD, with an average 12-month follow-up. Fried frailty phenotype (FFP) was used to define frailty. Negative binomial regression was used to estimate the impact of frailty on the incidence of emergency visits, hospitalizations, acute cardiovascular events, and falls within a year. Cox regression analysis was used to assess the influence of frailty on all-cause mortality in elderly HD patients. Results Our study enrolled 150 elderly HD patients, and the prevalence of frailty was 34.7%. After adjustment, frailty was independently associated with increased all-cause mortality [hazard ratio (HR)=4.10, 95% CI: 1.09-15.43, p=0.037] and emergency visits [incidence rate ratio (IRR)=2.78 95% CI: 1.70-4.60, p<0.001]. Gait speed was an independent risk factor for all-cause deaths (HR=5.56 95% CI: 1.41-22.00, p=0.014), emergency visits (IRR=2.52 95% CI: 1.48-4.33, p<0.001), and hospitalizations (IRR=2.24, 95% CI: 1.19-4.21, p=0.010) in elderly HD patients. Conclusion Frailty was an independent indicator of all-cause mortality and emergency visits in elderly patients with HD.
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Affiliation(s)
- Yuanyuan Li
- Department of Geriatrics, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Dai Zhang
- Department of Geriatrics, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Qing Ma
- Department of Geriatrics, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Zongli Diao
- Department of Nephrology, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Sha Liu
- Department of Nephrology, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Xiaotian Shi
- Department of Geriatrics, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
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Liu CK, Seo J, Lee D, Wright K, Tamura MK, Moye JA, Bean JF, Weiner DE. Mobility in Older Adults Receiving Maintenance Hemodialysis: A Qualitative Study. Am J Kidney Dis 2021; 79:539-548.e1. [PMID: 34419517 DOI: 10.1053/j.ajkd.2021.07.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 07/10/2021] [Indexed: 12/13/2022]
Abstract
RATIONALE & OBJECTIVE For older adults, maintaining mobility is a major priority, especially for those with advanced chronic diseases like kidney failure. However, our understanding of the factors affecting mobility in older adults receiving maintenance hemodialysis is limited. STUDY DESIGN Descriptive qualitative study. SETTING AND PARTICIPANTS Using purposive sampling, we recruited 1) persons aged ≥ 60 years receiving maintenance hemodialysis and 2) care partners (≥ 18 years) providing regular support to an older adult receiving hemodialysis. During a single in-person home visit, we assessed mobility using the Short Physical Performance Battery (SPPB) and conducted individual one-on-one interviews regarding important personal factors related to mobility. ANALYTIC APPROACH Descriptive statistics were used for demographic and SPPB data. Transcripts underwent thematic coding, informed by the International Classification of Function framework of mobility. We used conceptual content analysis to inductively extract themes and subthemes. RESULTS We enrolled 31 older adults receiving hemodialysis (42% female, 68% Black) with mean age of 73±8 years and mean dialysis duration of 4.6±3.5 years; mean SPPB was 3.6±2.8 points. Among 12 care partners (75% female, 33% Black), mean age was 54±16 years and mean SPPB was 10.1±2.4 points. Major themes extracted were: 1) mobility represents independence; 2) mobility is precarious; 3) limitations in mobility cause distress; 4) sources of encouragement and motivation are critical; and 5) adaptability is key. LIMITATIONS Modest sample from single geographic area. CONCLUSIONS For older adults receiving hemodialysis, mobility is severely limited and is often precarious in nature, causing distress. Older adults receiving hemodialysis and their care partners have identified sources of encouragement and motivation for mobility, and cite an adaptable mindset as important. Future studies should conceptualize mobility as a variable condition, and build upon this outlook of adaptability in the development of interventions.
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Affiliation(s)
- Christine K Liu
- Section of Geriatrics, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts; Jean Mayer United States Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts; Section of Geriatrics, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California; Geriatric Research and Education Clinical Center, Veteran Affairs Palo Alto Health Care System, Palo Alto, California.
| | - Janet Seo
- Section of Geriatrics, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts; Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Dayeun Lee
- Section of Geriatrics, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts; Section of Pediatric Infectious Diseases, Boston University School of Medicine and Boston Medical Center, Boston, MD
| | - Kristen Wright
- Section of Geriatrics, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts
| | - Manjula Kurella Tamura
- Geriatric Research and Education Clinical Center, Veteran Affairs Palo Alto Health Care System, Palo Alto, California; Division of Nephrology, Stanford University School of Medicine, Stanford, California
| | - Jennifer A Moye
- New England Geriatric Research Education and Clinical Center, Veterans Affairs Boston Healthcare System, Boston, MA; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Jonathan F Bean
- New England Geriatric Research Education and Clinical Center, Veterans Affairs Boston Healthcare System, Boston, MA; Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts
| | - Daniel E Weiner
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
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Instrumented and Standard Measures of Physical Performance in Adults With Chronic Kidney Disease. JOURNAL OF ACUTE CARE PHYSICAL THERAPY 2021. [DOI: 10.1097/jat.0000000000000179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Factors associated with fear of falling in hemodialysis patients. Int Urol Nephrol 2021; 53:2159-2166. [PMID: 33881702 DOI: 10.1007/s11255-021-02856-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 04/11/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE Fear of falling (FOF) has important clinical and psychological consequences. This study evaluated the factors associated with FOF in hemodialysis patients and compared with the FOF reported by age-gender matched individuals without chronic kidney disease. METHODS This cross sectional study included hemodialysis group (n = 60, 55.4 ± 7.6 years, 55.0% male) and control group (n = 40, 55.1 ± 7.5 years, 52.5% male). FOF was assessed by the Falls Efficacy Scale International (FES-I). Physical function was evaluated using the Mini-Balance Evaluation Systems Test (Mini-BESTest), Timed Up and Go test, 4-m gait speed, isometric handgrip force and 10-repetition sit-to-stand test. The physical and mental components of quality of life was evaluated by 36-Item Short Form Health Survey. RESULTS The FES-I score was higher in the hemodialysis group compared to the control group (28.2 ± 9.7 vs. 23.3 ± 5.1, p = 0.020). In addition, the prevalence of individuals with a higher concern about falling was greater in the hemodialysis group (41.7 vs. 17.5%, p = 0.033). Multiple linear regression showed that the FES-I score was associated with the Mini-BESTest score and the physical component summary of quality of life (coefficient of determination of 0.51 and an adjusted coefficient of determination of 0.46). CONCLUSION FOF was associated with poor postural balance and reduced physical component of quality of life in patients on hemodialysis and these patients showed higher FOF compared to individuals without chronic kidney disease.
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Yang YF, Huang CC, Chang CM, Lin HC. Effect of Whole-Body Vibration Training on Physical Fitness and Postural Control in Working-Age Patients on Haemodialysis. JOURNAL OF REHABILITATION MEDICINE. CLINICAL COMMUNICATIONS 2021; 4:1000045. [PMID: 33884147 PMCID: PMC8054743 DOI: 10.2340/20030711-1000045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/26/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate the effect of whole-body vibration training on working-age people on haemodialysis. DESIGN Consecutive case series study. SUBJECTS Seventeen working-age participants on maintenance haemodialysis were enrolled. METHODS A 12-week whole-body vibration training programme, including different postures, was designed. The study evaluated and compared physical fitness, including a list of tests such as the 5-repetition sit-to-stand test, hand grip test, 2-min step test, and 8-foot up-and-go test; modified Berg balance scale; static and dynamic balance function; and quality of life, using a quality of life questionnaire before and after the training. RESULTS All physical fitness parameters, except grip strength on the left side, improved after whole-body vibration training. For balance, the modified Berg balance scale demonstrated enhanced scores for equilibrium, with eyes closed on a stable surface and eyes open on an unstable surface, and movement velocity under the fast condition along the left and right directions (p=0.011). No significant improvements in quality of life were found. CONCLUSION Whole-body vibration exercise training enhanced physical fitness and static and dynamic balance control in working-age participants on haemodialysis.
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Affiliation(s)
- Ya-Fei Yang
- Department of Nephrology, China Medical University Hospital, Taichung, Taiwan, ROC
- Department of Medicine, China Medical University, Taichung, Taichung, Taiwan, ROC
| | - Chiu-Ching Huang
- Department of Nephrology, China Medical University Hospital, Taichung, Taiwan, ROC
- Department of Medicine, China Medical University, Taichung, Taichung, Taiwan, ROC
| | - Chia-Ming Chang
- Department of Physical Therapy and Graduate Institute of Rehabilitation Science, China Medical University, Taichung, Taiwan, ROC
| | - Hsiu-Chen Lin
- Department of Physical Therapy and Graduate Institute of Rehabilitation Science, China Medical University, Taichung, Taiwan, ROC
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Zanotto T, Mercer TH, Linden MLVD, Traynor JP, Doyle A, Chalmers K, Allan N, Shilliday I, Koufaki P. Association of postural balance and falls in adult patients receiving haemodialysis: A prospective cohort study. Gait Posture 2020; 82:110-117. [PMID: 32911095 DOI: 10.1016/j.gaitpost.2020.08.128] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 08/25/2020] [Accepted: 08/27/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Static postural balance performance is often impaired in people receiving haemodialysis (HD) for the treatment of stage-5 chronic kidney disease (CKD-5). However, the question as to whether lower postural balance is associated with adverse clinical outcomes such as falls has not been addressed yet. RESEARCH QUESTION We conducted a prospective cohort study to explore the association between static postural balance and falls in people receiving HD. We hypothesised that higher postural sway would be associated with increased odds of falling. METHODS Seventy-five prevalent CKD-5 patients receiving HD (age: 61.8 ± 13.4 years) from three Renal Units were enrolled in this prospective cohort study. At baseline, postural balance was assessed with a force platform in eyes open (EO) and eyes closed (EC) conditions. Centre of pressure (CoP) measures of range, velocity and area were taken for the analysis. Falls experienced by study participants were prospectively recorded during 12 months of follow-up. Secondary outcomes included timed-up and go, five-repetition sit-to-stand test and the Tinetti falls efficacy scale (FES). RESULTS In multivariable logistic regression analysis, higher CoP range in medial-lateral direction during EC was associated with increased odds of falling (OR: 1.04, 95 %CI: 1.00-1.07, p = 0.036). In ROC curve analysis, CoP velocity in EO exhibited the greatest prognostic accuracy (AUC: 0.69, 95 %CI: 0.55-0.82), however this was not statistically different from CoP measures of area and range. None of the postural balance measures exceeded the prognostic accuracy of the FES (AUC: 0.70, 95 %CI: 0.58-0.83, p = 0.005). SIGNIFICANCE This prospective cohort study showed that higher postural sway in medial-lateral direction was associated with increased odds of falling in people receiving HD. CoP measures of range, velocity and area displayed similar prognostic value in discriminating fallers from non-fallers. The overall utility of static posturography to detect future fall-risk may be limited in a clinical setting.
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Affiliation(s)
- Tobia Zanotto
- Centre of Health, Activity and Rehabilitation Research, Queen Margaret University, Edinburgh, United Kingdom.
| | - Thomas H Mercer
- Centre of Health, Activity and Rehabilitation Research, Queen Margaret University, Edinburgh, United Kingdom
| | - Marietta L van der Linden
- Centre of Health, Activity and Rehabilitation Research, Queen Margaret University, Edinburgh, United Kingdom
| | - Jamie P Traynor
- Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Arthur Doyle
- Renal Unit, Victoria Hospital, Kirkcaldy, United Kingdom
| | - Karen Chalmers
- Renal Unit, Victoria Hospital, Kirkcaldy, United Kingdom
| | - Nicola Allan
- Renal Unit, Victoria Hospital, Kirkcaldy, United Kingdom
| | | | - Pelagia Koufaki
- Centre of Health, Activity and Rehabilitation Research, Queen Margaret University, Edinburgh, United Kingdom
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Pérez-Gurbindo I, Angulo Carrere MT, Arribas Cobo P, Puerta M, Ortega M, Jaldo MT, de Sequera P, Alcázar R, Pérez-García R, Álvarez-Méndez AM. Haemodialysis patients have worse postural balance with an associated risk of falls. Nefrologia 2020; 40:655-663. [PMID: 32651084 DOI: 10.1016/j.nefro.2020.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 02/07/2020] [Accepted: 04/03/2020] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION Postural balance is the result of a complex interaction of sensory input which keeps us upright. Haemodialysis patients have alterations which can lead to postural instability and a risk of falls. Our objective was to analyse postural stability and its relationship with the risk of falls in haemodialysis patients using a force platform. MATERIAL AND METHODS This was a prospective cross-sectional study. Postural balance was recorded using a force platform in prevalent haemodialysis patients. We collected epidemiological, dialysis, analytical and treatment data. The incidence of falls was recorded over the 6 months following the tests. The postural stability analysis was performed with a portable strain gauge platform (AMTI AccuGait®) and a specific software unit for stabilometry (Balance Trainer® program). We measured 31 balance parameters; the balance variables used were: Area95; AreaEffect; VyMax; Xrange and Yrange. The stabilometry studies were performed in 3 situations: with eyes open; with eyes closed; and with the patient performing a simultaneous task. We performed one study at the start of the dialysis session, and a second study at the end. Stabilometry was measured in a control group under similar conditions. RESULTS We studied 32 patients with a mean age of 68 years old; of this group, 20 subjects were male and 12 were female. Their mean weight was 74kg, with a mean BMI of 27.6kg/m2. In the controls, there were no significant differences in the stabilometry between the 3 situations studied. Both pre- and post-haemodialysis, patients with closed eyes showed greater imbalance, and there were significant differences with the other situations and controls. We found a significant increase in instability after the haemodialysis session, and greater instability in the 13 patients with diabetes (P<.05). The 4 patients with hyponatraemia (Na<136mmol/l) had worse balance in the simultaneous task situation (P=.038). Various drugs, such as insulin (P=.022), antiplatelet agents (P=.036) and beta-blockers (P=.029), were associated with imbalance. The 10 patients who suffered falls had greater imbalance, Yrange, Xrange, Area95 and AreaEffect, both pre- and post-haemodialysis (P<.05) than those without falls. CONCLUSIONS Haemodialysis patients have alterations which can lead to postural instability and a risk of falls. Prevention programmes which include specific exercises to improve balance could be beneficial in reducing the risk of falls in this population.
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Affiliation(s)
- Ignacio Pérez-Gurbindo
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutenese de Madrid, Madrid, España.
| | | | | | - Marta Puerta
- Servicio de Nefrología, Hospital Universitario Infanta Leonor, Madrid, España
| | - Mayra Ortega
- Servicio de Nefrología, Hospital Universitario Infanta Leonor, Madrid, España
| | - Maria Teresa Jaldo
- Servicio de Nefrología, Hospital Universitario Infanta Leonor, Madrid, España
| | - Patricia de Sequera
- Servicio de Nefrología, Hospital Universitario Infanta Leonor, Madrid, España
| | - Roberto Alcázar
- Servicio de Nefrología, Hospital Universitario Infanta Leonor, Madrid, España
| | - Rafael Pérez-García
- Servicio de Nefrología, Hospital Universitario Infanta Leonor, Madrid, España
| | - Ana María Álvarez-Méndez
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutenese de Madrid, Madrid, España
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Tekkarismaz N, Doruk Analan P, Ozelsancak R, Torun D, Caliskan K, Haberal M. Effect of Kidney Transplant on Balance and Fall Risk. EXP CLIN TRANSPLANT 2020; 18:73-77. [PMID: 32008501 DOI: 10.6002/ect.tond-tdtd2019.p19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Kidney transplant offers an improved quality of life and prolonged survival for patients with end-stage renal disease. This study aimed to compare balance and fall risk between kidney transplant recipients and healthy adults and to determine the relationship between biochemical parameters and fall risk and balance in kidney transplant recipients. As far as we know, this is the first study in the literature that evaluated whether balance changes occur in kidney transplant recipients using the Tetrax Interactive Balance System (Sunlight Medical Ltd., Ramat Gan, Israel). MATERIALS AND METHODS Our study included 131 kidney transplant recipients (80 male/53 female; mean age of 39 ± 12 y) and 158 healthy volunteers (86 male/69 female; mean age of 40 ± 15 y). Groups were statistically matched in age, male/female patients, and body mass index. Fall index percentages were calculated using the Tetrax posturography device. Risk of falling was compared between kidney transplant recipients and healthy participants. Kidney transplant recipients were divided into 3 groups based on risk of falling. Demographic and clinical characteristics of kidney transplant recipients were recorded, and statistical analyses were performed to analyze these parameters versus balance measurements. RESULTS Risk of falling was not significantly different between groups according to Tetrax measurements (32.4 ± 23.4 vs 31.6 ± 21.7; P = .08). Serum creatinine levels were significantly higher in kidney transplant recipients with a higher risk of falling (1.17 ± 0.37 vs 1.63 ± 1.18 mg/dL; P = .01). The use of oral antidiabetic drugs was shown to increase the risk of falling (P = .02). CONCLUSIONS Although patients with end-stage renal disease are thought to have balance impairments, kidney transplant recipients in our study had balance control similar to that shown in the healthy population. Graft function in kidney transplant recipients is important for the balance system.
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Affiliation(s)
- Nihan Tekkarismaz
- From the Nephrology Department, Baskent University Adana Dr Turgut Noyan Research and Training Center, Adana, Turkey
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Zanotto T, Gobbo S, Bullo V, Vendramin B, Roma E, Duregon F, Bocalini DS, Di Blasio A, Cugusi L, Furian L, Di Bella C, Neunhaeuserer D, Battista F, Bergamin M, Ermolao A. Postural balance, muscle strength, and history of falls in end-stage renal disease patients living with a kidney transplant: A cross-sectional study. Gait Posture 2020; 76:358-363. [PMID: 31901763 DOI: 10.1016/j.gaitpost.2019.12.031] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 12/16/2019] [Accepted: 12/23/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND End-stage renal disease patients living with a kidney transplant (KT) often present with frailty, functional disability, and mobility impairments that may result in a high risk of falls. Postural balance and muscle strength are implicated in the etiology of falls in the geriatric population, and both may be impaired in KT patients. RESEARCH QUESTION We conducted a cross-sectional investigation to estimate the prevalence of falls, as well as to explore the association between postural balance, muscle strength and history of falls in end-stage renal disease patients living with a KT. METHODS Fifty-nine prevalent KT patients (age = 53.2 ± 11 years) were enrolled in this cross-sectional study. Participants were classified as fallers/non-fallers and underwent an objectively-measured assessment of postural balance on a stabilometric platform in eyes open (EO), eyes closed (EC), and dual-task (DT) conditions. Center of pressure (CoP) variables were taken for the analysis. In addition, participants underwent isometric (IM) and isokinetic (IK) assessments of lower limb muscle strength on a multi-joint evaluation system. RESULTS Thirty-four percent of the study participants reported at least one fall in the previous 12 months. In logistic regression analysis, CoP velocity in EO (OR: 1.23, 95 % CI: 1.06-1.43, p = .007), and IK ankle dorsiflexion strength (OR: 0.87, 95 % CI: 0.77-0.99, p = .034) were independently associated with increased odds of falling. SIGNIFICANCE This cross-sectional study indicates that patients living with a KT presented with a prevalence of falls indicative of a high risk of falling. Postural balance and muscle strength are exercise-modifiable factors and further research is warranted to establish to what extent these measures may be implicated in the etiology of falling in this patient group.
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Affiliation(s)
- Tobia Zanotto
- Centre of Health, Activity and Rehabilitation Research, Queen Margaret University, Edinburgh, EH21 6UU, United Kingdom
| | - Stefano Gobbo
- Sport and Exercise Medicine Division, Department of Medicine, University of Padova, Via Giustiniani, 2, 35128, Padova, Italy
| | - Valentina Bullo
- Sport and Exercise Medicine Division, Department of Medicine, University of Padova, Via Giustiniani, 2, 35128, Padova, Italy
| | - Barbara Vendramin
- Sport and Exercise Medicine Division, Department of Medicine, University of Padova, Via Giustiniani, 2, 35128, Padova, Italy
| | - Enrico Roma
- Sport and Exercise Medicine Division, Department of Medicine, University of Padova, Via Giustiniani, 2, 35128, Padova, Italy
| | - Federica Duregon
- Sport and Exercise Medicine Division, Department of Medicine, University of Padova, Via Giustiniani, 2, 35128, Padova, Italy
| | - Danilo Sales Bocalini
- Laboratorio de Fisiologia e Bioquimica Experimental, Centro de Educacao Fisica e Deportos, Universidade Federal do Espirito Santo (UFES), Vitoria, ES, Rua Vergueiro, 235, Liberdade, Sao Paulo, SP, 01504-00, Brazil
| | - Andrea Di Blasio
- Department of Medicine and Sciences of Aging, G. d'Annunzio University of Chieti-Pescara IT, Italy
| | - Lucia Cugusi
- Department of Medical Sciences 'M. Aresu', University of Cagliari IT, SS 554 - 09042, Monserrato, CA, Italy
| | - Lucrezia Furian
- Kidney and Pancreas Transplant Unit, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
| | - Caterina Di Bella
- Kidney and Pancreas Transplant Unit, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
| | - Daniel Neunhaeuserer
- Sport and Exercise Medicine Division, Department of Medicine, University of Padova, Via Giustiniani, 2, 35128, Padova, Italy
| | - Francesca Battista
- Sport and Exercise Medicine Division, Department of Medicine, University of Padova, Via Giustiniani, 2, 35128, Padova, Italy
| | - Marco Bergamin
- Sport and Exercise Medicine Division, Department of Medicine, University of Padova, Via Giustiniani, 2, 35128, Padova, Italy.
| | - Andrea Ermolao
- Sport and Exercise Medicine Division, Department of Medicine, University of Padova, Via Giustiniani, 2, 35128, Padova, Italy
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Tran J, Ayers E, Verghese J, Abramowitz MK. Gait Abnormalities and the Risk of Falls in CKD. Clin J Am Soc Nephrol 2019; 14:983-993. [PMID: 31235462 PMCID: PMC6625617 DOI: 10.2215/cjn.13871118] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 05/04/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND OBJECTIVES Older adults with CKD are at high risk of falls and disability. It is not known whether gait abnormalities contribute to this risk. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Quantitative and clinical gait assessments were performed in 330 nondisabled community-dwelling adults aged ≥65 years. CKD was defined as an eGFR <60 ml/min per 1.73 m2. Cox proportional hazards models were created to examine fall risk. RESULTS A total of 41% (n=134) of participants had CKD. In addition to slower gait speed, participants with CKD had gait cycle abnormalities including shorter stride length and greater time in the stance and double-support phases. Among people with CKD, lower eGFR was independently associated with the severity of gait cycle abnormalities (per 10 ml/min per 1.73 m2 lower eGFR: 3.6 cm [95% confidence interval (95% CI), 1.4 to 5.8] shorter stride length; 0.7% [95% CI, 0.3 to 1.0] less time in swing phase; 1.1% [95% CI, 0.5 to 1.7] greater time in double-support phase); these abnormalities mediated the association of lower eGFR with slower gait speed. On clinical gait exam, consistent with the quantitative abnormalities, short steps and marked swaying or loss of balance were more common among participants with CKD, yet most had no identifiable gait phenotype. A gait phenotype defined by any of these abnormal signs was associated with higher risk of falls among participants with CKD: compared with people without CKD and without the gait phenotype, the adjusted hazard ratio was 1.72 (95% CI, 1.06 to 2.81) for those with CKD and the phenotype; in comparison, the adjusted hazard ratio was 0.71 (95% CI, 0.40 to 1.25) for people with CKD but without the phenotype (P value for interaction of CKD status and gait phenotype =0.01). CONCLUSIONS CKD in older adults is associated with quantitative gait abnormalities, which clinically manifest in a gait phenotype that is associated with fall risk.
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Affiliation(s)
| | - Emmeline Ayers
- Neurology, Albert Einstein College of Medicine, Bronx, New York
| | - Joe Verghese
- Departments of Medicine and.,Neurology, Albert Einstein College of Medicine, Bronx, New York
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Wilkinson TJ, Nixon DGD, Smith AC. Postural stability during standing and its association with physical and cognitive functions in non-dialysis chronic kidney disease patients. Int Urol Nephrol 2019; 51:1407-1414. [PMID: 31214955 PMCID: PMC6660492 DOI: 10.1007/s11255-019-02192-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 06/04/2019] [Indexed: 01/05/2023]
Abstract
PURPOSE Chronic kidney disease (CKD) is characterised by poor physical function. A possible factor may be aberrant changes to balance and postural stability (i.e. ability to maintain centre of pressure (COP)). Previous research has exclusively focused on patients undergoing renal replacement therapy (RRT). The current study investigated postural stability in a group of CKD patients not requiring RRT. METHODS 30 CKD patients (aged 57.0 ± 17.8 years, 47% female, mean eGFR 42.9 ± 27.2 ml/kg/1.73 m2) underwent a series of physical function assessments including the sit-to-stand-5 and -60, incremental shuttle walk test, gait speed, and short physical performance battery. Postural stability (defined as total COP ellipse (mm2) displacement) was measured using the Fysiometer board. Control reference data were provided by the manufacture. Cognitive function was assessed using the 'Montreal Cognitive Assessment-Basic' (MOCA-B)'. RESULTS CKD patients had poorer postural stability during quiet standing than reference values across all age categories (≤ 39 years, 24.9 ± 11.3 vs. 10.4 ± 1.8 mm2; 40-59 years, 34.3 ± 19.0 vs. 17.7 ± 6.2 mm2; ≥ 60 years, 39.7 ± 21.2 vs. 16.8 ± 2.9 mm2, all comparisons P < 0.001). Reductions in postural stability were associated with both physical and cognitive functioning. In females only, postural stability worsened with declining renal function (r = - 0.790, P < 0.01). CONCLUSIONS To our knowledge, this is the first and largest experimental report concerning measurement of postural stability of CKD patients not requiring RRT. Our findings suggest that postural stability is associated with worse physical and cognitive functioning in this patient group.
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Affiliation(s)
- Thomas J Wilkinson
- Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester, Leicester, LE1 7RH, UK. .,NIHR Leicester Biomedical Research Centre, Leicester, LE5 4PW, UK.
| | - Daniel G D Nixon
- Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester, Leicester, LE1 7RH, UK.,NIHR Leicester Biomedical Research Centre, Leicester, LE5 4PW, UK
| | - Alice C Smith
- Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester, Leicester, LE1 7RH, UK.,NIHR Leicester Biomedical Research Centre, Leicester, LE5 4PW, UK
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Kistler BM, Khubchandani J, Wiblishauser M, Wilund KR, Sosnoff JJ. Epidemiology of falls and fall-related injuries among middle-aged adults with kidney disease. Int Urol Nephrol 2019; 51:1613-1621. [PMID: 31165398 DOI: 10.1007/s11255-019-02148-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 04/10/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE Comorbidities, such as kidney disease (CKD), increase the likelihood of falls and fall-related injuries. Despite the focus of most research in this population on older adults, falls are a significant cause of injury throughout adulthood. Therefore, we aimed to describe the epidemiology of falls in middle-aged adults with kidney diseases. METHODS We analyzed falls and fall-related injuries among middle-aged adults (45-65 years old) with and without CKD included in the 2014 Behavioral Risk Factor Surveillance System (BRFSS) utilizing multivariate logistic regression and complex sample survey data analysis procedures. RESULTS Middle-aged adults with CKD were more likely to suffer a fall (2.30, 95% CI 2.07-2.55) and a fall-related injury (1.54, 95% CI 1.32-1.80) compared to those without CKD. However, only the increased likelihood for falls remained significant after correction for multiple demographic, health, lifestyle, and comorbid conditions (AOR 1.22, 95% CI 1.08-1.39). Among adults with CKD, general health status, smoking, and total comorbidity scores were significant predictors of falls and fall-related injuries (p < 0.05 for all). Furthermore, individual comorbidities such as COPD, asthma, depressive disorders, stroke, and arthritis also predicted falls and fall-related injuries (p < 0.05 for all). CONCLUSION Middle-aged adults with CKD were more likely than those without CKD to fall and suffer a fall-related injury. However, injury risk did not remain elevated after accounting for differences between groups. The presence of comorbidities, especially depressive disorders, was associated with increased odds for falls and fall-related injuries. Given the high prevalence of depression among adults with CKD, the relationship between depression and falls warrants further examination.
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Affiliation(s)
- Brandon M Kistler
- Department of Nutrition and Health Science, Ball State University, 2000 W University Avenue, Muncie, Indiana, USA.
| | - Jagdish Khubchandani
- Department of Nutrition and Health Science, Ball State University, 2000 W University Avenue, Muncie, Indiana, USA
| | - Michael Wiblishauser
- School of Education, Health Professions and Human Development, University of Houston-Victoria, Victoria, Texas, USA
| | - Kenneth R Wilund
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, Illinois, USA
| | - Jacob J Sosnoff
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, Illinois, USA
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Abstract
BACKGROUND Vestibular, neurological and musculoskeletal functions are affected in patients with renal failure. These problems can in turn affect the balance system in peritoneal dialysis (PD) patients. Previously, postural balance changes were shown in hemodialysis patients. This is the first study that evaluates whether there are similar changes in patients with PD. OBJECTIVE This study aimed to compare balance and fall risk between patients undergoing PD treatment and healthy subjects, and aimed to determine the correlation between biochemical parameters and fall risk and balance assessments in PD patients. METHODS This controlled study included 58 patients receiving PD treatment (PD Group) and 75 healthy subjects (Control Group). The Berg Balance Scale (BBS) and Tetrax® Interactive Balance System were used for the comparison of balance between groups. For patients in the PD Group, duration of PD, blood pressure, Kt/Vurea (actual mass of urea removed via peritoneal dialysis), and serum biochemical parameters were recorded and correlation analysis was performed between these parameters and balance measurements. RESULTS There were no statistically significant differences between groups in terms of demographics or BBS scores (p> 0.05). The fall risk of patients in the PD Group was significantly higher than those in the Control Group (p< 0.0001) according to Tetrax measurements. Female gender, older age, higher BMI, and higher blood glucose levels were negatively correlated with balance parameters of PD patients (r> 0.3). There was no statistically significant correlation between duration of PD, blood pressure, and Kt/Vurea with balance parameters or fall risk. CONCLUSIONS Balance was impaired in patients undergoing PD in comparison to healthy subjects. Fall risk may be evaluated using the Tetrax® instead of BBS for this population. Serum glucose level, BMI and age appear to affect balance and fall risk. Therefore, optimization of body weight and normalization of serum glucose levels are important factors for improving balance. The duration of PD, blood pressure, and Kt/Vurea do not affect balance system.
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Affiliation(s)
- Pınar Doruk Analan
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Rüya Özelsancak
- Department of Nephrology, Faculty of Medicine, Baskent University, Ankara, Turkey
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Johansen KL, Delgado C, Kaysen GA, Chertow GM, Chiang J, Dalrymple LS, Segal MR, Grimes BA. Frailty Among Patients Receiving Hemodialysis: Evolution of Components and Associations With Mortality. J Gerontol A Biol Sci Med Sci 2019; 74:380-386. [PMID: 30192916 PMCID: PMC6376100 DOI: 10.1093/gerona/gly206] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Understanding how components of frailty change over time and how they can be modeled as time-dependent predictors of mortality could lead to better risk prediction in the dialysis population. METHODS We measured frailty at baseline, 12 months, and 24 months among 727 patients receiving hemodialysis in Northern California and Atlanta. We examined the likelihood of meeting frailty components (weight loss, exhaustion, low physical activity, weak grip strength, and slow gait speed) as a function of time in logistic regression analysis and association of frailty components with mortality in time-updated multivariable Cox models. RESULTS Physical activity and gait speed declined, exhaustion and grip strength did not change, and the odds of meeting the weight loss criterion declined with time. All five components were associated with higher mortality in multivariable analyses, but gait speed was the strongest individual predictor. All frailty components except physical inactivity were independently associated with mortality when all five components were included in the same model. The number of frailty components met was associated with mortality in a gradient that ranged from a hazard ratio of 2.73 for one component to 10.07 for five components met; the model including all five components was the best model based on Akaike information criterion. CONCLUSIONS Measurement of all frailty components was necessary for optimal mortality prediction, and the number of components met was strongly associated with mortality in this cohort.
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Affiliation(s)
- Kirsten L Johansen
- Division of Nephrology, University of California, San Francisco
- Nephrology Section, San Francisco Veterans Affairs Medical Center, California
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Cynthia Delgado
- Division of Nephrology, University of California, San Francisco
- Nephrology Section, San Francisco Veterans Affairs Medical Center, California
| | - George A Kaysen
- Department of Biochemistry and Molecular Medicine
- Department of Medicine, University of California, Davis
- Division of Nephrology, University of California, Davis
| | - Glenn M Chertow
- Division of Nephrology, School of Medicine, Stanford University, California
| | - Janet Chiang
- Division of Endocrinology, University of California, San Francisco
| | | | - Mark R Segal
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Barbara A Grimes
- Department of Epidemiology and Biostatistics, University of California, San Francisco
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22
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Erdoğanoğlu Y, Yalçin B, Külah E, Kaya D. Is there a relationship between plantar foot sensation and static balance, physical performance, fear of falling, and quality of life in hemodialysis patients? Hemodial Int 2019; 23:273-278. [PMID: 30740855 DOI: 10.1111/hdi.12724] [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] [Received: 07/18/2018] [Revised: 10/27/2018] [Indexed: 12/18/2022]
Abstract
INTRODUCTION This study was conducted to investigate the relationship between plantar foot sensation and static balance, physical performance, fear of falling, and quality of life in hemodialysis patients. MATERIALS AND METHODS The study involved 24 hemodialysis patients and 20 healthy volunteers. Light touch-pressure sensation (Semmes Weinstein Monofilament test kit), two-point discrimination sensation (esthesiometer) and vibration sensation (128 Hz diapason) were used to evaluate plantar foot sensation. Static balance was assessed by the one-leg standing balance test, physical performance by the Timed Up and Go test, fear of falling with the Fall Efficacy Scale, and quality of life with the Ferrans and Powers Quality of Life Index Dialysis Version. FINDINGS There was a significant difference in plantar foot sensation, static balance, and physical performance of the patients compared to the healthy controls (P < 0.05). There was a strong correlation between static balance and physical performance with foot sensation in the hemodialysis patients (P < 0.05). There was also a strong correlation between static balance, physical performance, and fear of falling in hemodialysis patients (P < 0.05). The correlation between static balance, physical performance, and quality of life in the hemodialysis patients was strong (P < 0.05). DISCUSSION The most important result of this study is that light touch-pressure sensation, vibration sensation, two-point discrimination sensation, static balance, and physical performance, all of which involve the activity of cutaneous sensory receptors on the sole of the foot, are reduced in individuals who undergo hemodialysis. The findings of this study suggest potential rehabilitation strategies that could be applied to this patient group.
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Affiliation(s)
- Yıldız Erdoğanoğlu
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Uskudar University, Istanbul, Turkey
| | - Berna Yalçin
- Department of Physiotherapy and Rehabilitation, Başkent University Istanbul Health Practice and Research Center, Istanbul, Turkey
| | - Eyyüp Külah
- Department of Nephrology, Başkent University Istanbul Health Practice and Research Center, Istanbul, Turkey
| | - Defne Kaya
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Uskudar University, Istanbul, Turkey
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23
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Mochizuki T, Matsuo Y, Sasaki M, Morihisa K, Tabata S, Fukuda T, Yajima I. Hemodynamic response to orthostatic stress immediately after dialysis session in chronic hemodialysis patients. RENAL REPLACEMENT THERAPY 2018. [DOI: 10.1186/s41100-018-0189-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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24
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Zhou H, Al-Ali F, Rahemi H, Kulkarni N, Hamad A, Ibrahim R, Talal TK, Najafi B. Hemodialysis Impact on Motor Function beyond Aging and Diabetes-Objectively Assessing Gait and Balance by Wearable Technology. SENSORS 2018; 18:s18113939. [PMID: 30441843 PMCID: PMC6263479 DOI: 10.3390/s18113939] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 10/25/2018] [Accepted: 11/09/2018] [Indexed: 12/13/2022]
Abstract
Motor functions are deteriorated by aging. Some conditions may magnify this deterioration. This study examined whether hemodialysis (HD) process would negatively impact gait and balance beyond diabetes condition among mid-age adults (48–64 years) and older adults (65+ years). One hundred and ninety-six subjects (age = 66.2 ± 9.1 years, body-mass-index = 30.1 ± 6.4 kg/m2, female = 56%) in 5 groups were recruited: mid-age adults with diabetes undergoing HD (Mid-age HD+, n = 38) and without HD (Mid-age HD−, n = 40); older adults with diabetes undergoing HD (Older HD+, n = 36) and without HD (Older HD−, n = 37); and non-diabetic older adults (Older DM−, n = 45). Gait parameters (stride velocity, stride length, gait cycle time, and double support) and balance parameters (ankle, hip, and center of mass sways) were quantified using validated wearable platforms. Groups with diabetes had overall poorer gait and balance compared to the non-diabetic group (p < 0.050). Among people with diabetes, HD+ had significantly worsened gait and balance when comparing to HD− (Cohen’s effect size d = 0.63–2.32, p < 0.050). Between-group difference was more pronounced among older adults with the largest effect size observed for stride length (d = 2.32, p < 0.001). Results suggested that deterioration in normalized gait speed among HD+ was negatively correlated with age (r = −0.404, p < 0.001), while this correlation was diminished among HD−. Interestingly, results also suggested that poor gait among Older HD− is related to poor ankle stability, while no correlation was observed between poor ankle stability and poor gait among Older HD+. Using objective assessments, results confirmed that the presence of diabetes can deteriorate gait and balance, and this deterioration can be magnified by HD process. Among HD− people with diabetes, poor ankle stability described poor gait. However, among people with diabetes undergoing HD, age was a dominate factor describing poor gait irrespective of static balance. Results also suggested feasibility of using wearable platforms to quantify motor performance during routine dialysis clinic visit. These objective assessments may assist in identifying early deterioration in motor function, which in turn may promote timely intervention.
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Affiliation(s)
- He Zhou
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA.
| | - Fadwa Al-Ali
- Fahad Bin Jassim Kidney Center, Department of Nephrology, Hamad General Hospital, PO Box 3050 Doha, Qatar.
| | - Hadi Rahemi
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA.
| | - Nishat Kulkarni
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA.
| | - Abdullah Hamad
- Fahad Bin Jassim Kidney Center, Department of Nephrology, Hamad General Hospital, PO Box 3050 Doha, Qatar.
| | - Rania Ibrahim
- Fahad Bin Jassim Kidney Center, Department of Nephrology, Hamad General Hospital, PO Box 3050 Doha, Qatar.
| | - Talal K Talal
- Diabetic Foot and Wound Clinic, Hamad Medical Co, PO Box 3050 Doha, Qatar.
| | - Bijan Najafi
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA.
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25
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Zanotto T, Gobbo S, Bullo V, Vendramin B, Duregon F, Cugusi L, Di Blasio A, Furian L, Silvestre C, Neunhaeuserer D, Zaccaria M, Bergamin M, Ermolao A. Balance impairment in kidney transplant recipients without concurrent peripheral neuropathy. Gait Posture 2017; 55:116-120. [PMID: 28437758 DOI: 10.1016/j.gaitpost.2017.04.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 04/04/2017] [Accepted: 04/13/2017] [Indexed: 02/02/2023]
Abstract
Kidney transplant recipients (KTRs) present with compromised functional capacity, low levels of physical activity, muscle atrophy, and peripheral nerve dysfunction that may result in high postural instability. This study aimed to compare the static balance control of 19 KTRs with 19 healthy adults (HA). All participants completed the Romberg test on a stabilometric platform with eyes open (EO), eyes closed (EC) and during a dual task (DT) condition. Centre of pressure (COP) measures (COP velocity (COPv) and sway area (SA)), as well as position-based outcomes such as anterior-posterior (AP) and medio-lateral (ML) ranges of COP displacements were recorded. Independent ANCOVA revealed an overall lower performance of KTRs compared to HA (p<0.05) with the EC condition exhibiting the worst relative performance for KTRs, suggesting a poorer capacity of relying on proprioceptive information when maintaining the upright posture. The addition of a cognitive task did not further worsen balance performance in KTRs. As impaired postural control is one of the main predictors of falls in elderly subjects, these data might also indicate that this constitutes an equivalent risk factor for falling in middle-aged KTRs.
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Affiliation(s)
- T Zanotto
- School of Health Sciences, Queen Margaret University, Edinburgh, EH21 6UU, United Kingdom.
| | - S Gobbo
- Sport and Exercise Medicine Division, University of Padova, Via Giustiniani 2, 35128 Padova, Italy.
| | - V Bullo
- Sport and Exercise Medicine Division, University of Padova, Via Giustiniani 2, 35128 Padova, Italy.
| | - B Vendramin
- Sport and Exercise Medicine Division, University of Padova, Via Giustiniani 2, 35128 Padova, Italy.
| | - F Duregon
- Sport and Exercise Medicine Division, University of Padova, Via Giustiniani 2, 35128 Padova, Italy.
| | - L Cugusi
- Department of Medical Sciences 'M. Aresu', University of Cagliari, SS 554-09042, Monserrato, CA, Italy.
| | - A Di Blasio
- Department of Medicine and Sciences of Aging, University G. d'Annunzio of Chieti-Pescara, Via dei Vestini 31, 66013 Chieti, Italy.
| | - L Furian
- Kidney an Pancreas Transplant Unit, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Via Giustiniani 2, 35128 Padova, Italy.
| | - C Silvestre
- Kidney an Pancreas Transplant Unit, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Via Giustiniani 2, 35128 Padova, Italy.
| | - D Neunhaeuserer
- Sport and Exercise Medicine Division, University of Padova, Via Giustiniani 2, 35128 Padova, Italy.
| | - M Zaccaria
- Sport and Exercise Medicine Division, University of Padova, Via Giustiniani 2, 35128 Padova, Italy.
| | - M Bergamin
- Sport and Exercise Medicine Division, University of Padova, Via Giustiniani 2, 35128 Padova, Italy.
| | - A Ermolao
- Sport and Exercise Medicine Division, University of Padova, Via Giustiniani 2, 35128 Padova, Italy.
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26
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Fitschen PJ, Biruete A, Jeong J, Wilund KR. Efficacy of beta-hydroxy-beta-methylbutyrate supplementation in maintenance hemodialysis patients. Hemodial Int 2016; 21:107-116. [DOI: 10.1111/hdi.12440] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Peter J. Fitschen
- Division of Nutritional Sciences; University of Illinois; Urbana Illinois USA
| | - Annabel Biruete
- Division of Nutritional Sciences; University of Illinois; Urbana Illinois USA
| | - Jinny Jeong
- Department of Kinesiology and Community Health; University of Illinois; Urbana Illinois USA
| | - Kenneth R. Wilund
- Division of Nutritional Sciences; University of Illinois; Urbana Illinois USA
- Department of Kinesiology and Community Health; University of Illinois; Urbana Illinois USA
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27
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Magnard J, Lardy J, Testa A, Hristea D, Deschamps T. The effect of hemodialysis session on postural strategies in older end-stage renal disease patients. Hemodial Int 2015; 19:553-61. [DOI: 10.1111/hdi.12307] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Justine Magnard
- Laboratory “Motricité, Interactions, Performance” (UPRES EA 4334); University of Nantes; Nantes France
| | - Julien Lardy
- Laboratory “Motricité, Interactions, Performance” (UPRES EA 4334); University of Nantes; Nantes France
| | - Angelo Testa
- Dialysis Unit; ECHO Nantes Dialysis Association; Nantes France
| | - Dan Hristea
- Dialysis Unit; ECHO Nantes Dialysis Association; Nantes France
| | - Thibault Deschamps
- Laboratory “Motricité, Interactions, Performance” (UPRES EA 4334); University of Nantes; Nantes France
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28
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Magnard J, Hristea D, Lefrancois G, Testa A, Paris A, Deschamps T. Implicit postural control strategies in older hemodialysis patients: an objective hallmark feature for clinical balance assessment. Gait Posture 2014; 40:723-6. [PMID: 25103778 DOI: 10.1016/j.gaitpost.2014.07.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 07/08/2014] [Accepted: 07/11/2014] [Indexed: 02/02/2023]
Abstract
Elderly patients with end stage renal diseases (ESRD) undergoing hemodialyis (HD) present poorer physical function and higher accident falls than healthy elderly population. Therefore, the aim of this study was to examine the HD-related changes in postural sway in ESRD patients, as an objective hallmark of their functional abilities. We hypothesized that the ESRD symptoms (i.e. uremic syndrome) and the HD therapy affected the postural control, evidenced by higher bounding limits of center-of-pressure (COP) velocity dynamics. Fifty-five participants, including 28 HD patients and 27 age, body mass index and gender-matched healthy participants HS (70.42 ± 13.69 years; 23.46 ± 4.67 kg/m(2); 35.7% women vs. 73.62 ± 6.59 years; 25.09 ± 3.54 kg/m(2); 37% women), were asked to maintain quiet stance on force platform, with eyes open and eyes closed. COP parameters were mean and standard deviation (SD) of position, velocity and average absolute maximal velocity (AAMV) in antero-posterior and medio-lateral directions. The results revealed a significant main effect of group on velocity-based variables, highlighting that mean velocity, SD velocity and AAMV (p<0.01) were higher for HD as compared to HS. These findings identified the bounding limits of COP velocity as an objective hallmark feature of HD-related changes in postural sway. The clinical assessment of this active control of COP velocity dynamics could be useful to examine the effects of targeted intradialytic exercise programs on functional performances and for early detection of increased fall risk in HD patients.
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Affiliation(s)
- Justine Magnard
- University of Nantes, Laboratory "Motricité, Interactions, Performance" (UPRES EA 4334), F-44000 Nantes, France
| | - Dan Hristea
- Dialysis Unit, ECHO Nantes Dialysis Association, France
| | | | - Angelo Testa
- Dialysis Unit, ECHO Nantes Dialysis Association, France
| | - Anne Paris
- Dialysis Unit, ECHO Nantes Dialysis Association, France
| | - Thibault Deschamps
- University of Nantes, Laboratory "Motricité, Interactions, Performance" (UPRES EA 4334), F-44000 Nantes, France.
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