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Han J, Wang H, Ding Y, Li Q, Zhai H, He S. Effect of Otago exercise on fear of falling in older adults: a systematic review and meta-analysis. BMC Sports Sci Med Rehabil 2024; 16:132. [PMID: 38877578 PMCID: PMC11177432 DOI: 10.1186/s13102-024-00917-2] [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: 05/09/2024] [Accepted: 05/31/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND Approximately 40-70% of older adults who have experienced falls develop fear of falling (FOF), with the incidence rate in nursing home residents reaching as high as 79.4%. An increasing number of studies have focused on the effect of the Otago Exercise Programme (OEP) on reducing FOF among older adults, yet comprehensive analysis is lacking due to regional and demographic variations. Therefore, this study integrates the relevant literature to provide evidence supporting interventions aimed at alleviating FOF among older adults. OBJECTIVE To evaluate the impact of OEP on FOF in older adults through meta-analysis. METHODS We searched ten databases using computer systems, covering all records up to May 1, 2024. Two researchers independently conducted the literature screening, bias risk assessment, and data extraction. We performed data analysis using RevMan 5.3 and Stata 15.0 software, assessed result stability through sensitivity analysis, and examined publication bias with funnel plots and Egger's test. RESULTS Sixteen RCTs were included. Meta-analysis revealed that the OEP significantly reduced FOF among older adults [SMD = 0.96, 95%CI (0.68, 1.23), P < 0.00001]. Subgroup analysis revealed that interventions lasting more than 16 weeks [SMD = 1.12, 95%CI (0.75, 1.49), P < 0.00001], with a frequency of more than twice a week [SMD = 0.99, 95%CI (0.64, 1.35), P < 0.00001], and for older adults in community and nursing institutions [SMD = 1.03, 95%CI (0.50, 1.57), P = 0.0002] were more effective. A comparison of the 16-week and 24-week interventions revealed that the latter had better outcomes [SMD = 0.87, 95%CI (0.66, 1.08), P = 0.0004]. CONCLUSION Current evidence indicates that OEP effectively reduces FOF among older adults. It is recommended that interventions last for more than 24 weeks, occur more than twice a week, and suitable for application among older adults in community settings or elder care institutions.
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Affiliation(s)
| | | | | | - Qing Li
- Jiamusi University, Jiamusi, China
| | - Huanqie Zhai
- The Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Shuling He
- The First Affiliated Hospital of Jiamusi University, Jiamusi, China.
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Kim J, Foucher K. Fall experiences from the perspectives of people with osteoarthritis: in their own words. Disabil Rehabil 2024; 46:77-85. [PMID: 36519505 DOI: 10.1080/09638288.2022.2156629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 11/23/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE To explore real-life experiences of people with osteoarthritis (OA) to increase understanding of how they perceive contributing factors to falls, circumstances at time of falls, and consequences of falls. MATERIALS AND METHODS Four focus groups of 3-7 people with OA from the Chicago, IL, USA, and neighboring areas were conducted remotely via web-based videoconferencing. Inclusion criteria included history of falls in previous 12 months and hip and/or knee OA. Focus group transcripts were coded and analyzed using a modified grounded theory approach to identify themes. RESULTS Focus group participants (n = 17) described experiences associated with fall-related events that resulted in the identification of four themes: (1) perception of falls and fall risks can be influenced by OA symptoms, (2) ability to remember circumstances of falls are influenced by consequences, (3) behaviors and attitudes that address OA symptoms and avoidance of falls are similar and (4) OA symptoms and falls have common psychological impacts on lives. CONCLUSION Our study highlights how people with OA define falls, perceive contributing factors to falls, and describe general and OA-related factors that contributed to their fall experiences. The shared experiences contributed to the creation of themes that represented various aspects of the circumstances and impact of falls. Consideration for the identified themes may enhance recording and reporting of falls, contribute to development of improved fall risk assessment tools, and prioritize research into the biopsychosocial effects of falls in people with OA.IMPLICATIONS FOR REHABILITATIONInformation about circumstances of a fall such as location, activity, and symptoms of osteoarthritis may be beneficial in creating tailored fall prevention training and education.Falls are a common problem for people with lower limb osteoarthritis that can lead to negative changes in activity and quality of life.The psychological impact of osteoarthritis symptoms may be contributing to fear of falling and decrease participation in daily activities.Awareness of the perceptions people with osteoarthritis have about their symptoms may provide educational and training opportunities to address the benefits of different therapeutic treatments.Awareness of perceptions people with osteoarthritis have about their risk of falling may provide educational and training opportunities to address the benefits of different therapeutic treatments.
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Affiliation(s)
- Janis Kim
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, USA
| | - Kharma Foucher
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, USA
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Chan KOW, Yuen PP, Fong BYF, Law VTS, Ng FSF, Fung WCP, Ng TKC, Cheung IS. Effectiveness of telehealth in preventive care: a study protocol for a randomised controlled trial of tele-exercise programme involving older people with possible sarcopenia or at risk of fall. BMC Geriatr 2023; 23:845. [PMID: 38093219 PMCID: PMC10717497 DOI: 10.1186/s12877-023-04535-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 11/30/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Continuous loss of muscle mass and strength are the consequences of the ageing process, which increase the risk of falls among older people. Falls can lead to severe consequences such as bone fractures and hampered physical and psychological well-being. Regular exercise is the key to reversing muscle atrophy and relieving sarcopenia. However, the frailty of older people and the recent COVID-19 pandemic may affect their confidence to leave home to attend classes in the community. A feasible and effective alternative should be explored. METHODS The primary objective is to evaluate the effectiveness of tele-exercise (TE) in relation to physical functioning and exercise adherence among community-dwelling older people at risk of falls in comparison with a community-based group (CB). The secondary objective includes evaluating older people's experience with tele-exercise, emphasizing their psychological welfare, social well-being, and acceptance of the telehealth approach. The design, conduct, and report follow the SPIRIT guidelines (Standard Protocol Items: recommended items to address in a Clinical Trial Protocol and Related Documents). Older people will be recruited from 10 local community centres in Hong Kong and randomly allocated into two groups. All participants will attend the exercise training 3 days per week for 3 months but the mode of delivery will differ, either online as the tele-exercise group (TE) or face-to-face as the community-based group (CB). The outcome measures include muscle strength, physical function, exercise adherence and dropout rate, psychological and social well-being will be assessed at the baseline, and the 3rd, 6th and 12th month. Some participants will be invited to attend focus group interviews to evaluate their overall experience of the tele-exercise training. DISCUSSION Tele-exercise reduces the barriers to exercise, such as time constraints, inaccessibility to facilities, and the fear of frail older people leaving their homes. Promoting an online home-based exercise programme for older people can encourage them to engage in regular physical activity and increase their exercise adherence even when remaining at home. The use of telehealth can potentially result in savings in cost and time. The final findings will provide insights on delivering exercise via telehealth to older people and propose an exercise delivery and maintenance model for future practice. TRIAL REGISTRATION Chinese Clinical Trial Registry ( https://www.chictr.org.cn/hvshowprojectEN.html?id=219002&v=1.1 ), registration number: ChiCTR2200063370. Registered on 5 September 2022.
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Affiliation(s)
- Karly O W Chan
- College of Professional and Continuing Education, The Hong Kong Polytechnic University, PolyU Hung Hom Bay Campus, 8 Hung Lok Road, Hung Hom, Kowloon, Hong Kong SAR, China.
| | - Peter P Yuen
- College of Professional and Continuing Education, The Hong Kong Polytechnic University, PolyU Hung Hom Bay Campus, 8 Hung Lok Road, Hung Hom, Kowloon, Hong Kong SAR, China
| | - Ben Y F Fong
- College of Professional and Continuing Education, The Hong Kong Polytechnic University, PolyU Hung Hom Bay Campus, 8 Hung Lok Road, Hung Hom, Kowloon, Hong Kong SAR, China
| | - Vincent T S Law
- College of Professional and Continuing Education, The Hong Kong Polytechnic University, PolyU Hung Hom Bay Campus, 8 Hung Lok Road, Hung Hom, Kowloon, Hong Kong SAR, China
| | - Fowie S F Ng
- School of Management, Tung Wah College, Kowloon, Hong Kong SAR, China
| | - Wilson C P Fung
- Hong Kong Telemedicine Association, Hong Kong, Hong Kong SAR, China
| | - Tommy K C Ng
- College of Professional and Continuing Education, The Hong Kong Polytechnic University, PolyU Hung Hom Bay Campus, 8 Hung Lok Road, Hung Hom, Kowloon, Hong Kong SAR, China
| | - I S Cheung
- College of Professional and Continuing Education, The Hong Kong Polytechnic University, PolyU Hung Hom Bay Campus, 8 Hung Lok Road, Hung Hom, Kowloon, Hong Kong SAR, China
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Yi M, Zhang W, Zhang X, Zhou J, Wang Z. The effectiveness of Otago exercise program in older adults with frailty or pre-frailty: A systematic review and meta-analysis. Arch Gerontol Geriatr 2023; 114:105083. [PMID: 37390692 DOI: 10.1016/j.archger.2023.105083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 05/19/2023] [Accepted: 05/29/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND Frailty is a well-recognized risk factor for adverse health-related outcomes in aging population. However, little is known about the dynamic changing nature of frailty and the potential for it to be modified within the scope of exercise. Currently, there has not been a systematic review of the impact of Otago exercise program (OEP) implementation specifically for the frail or pre-frail older adults. OBJECTIVE To determine the effectiveness of Otago exercise program on the degree of frailty, physical balance ability, mobility, grip strength and health-related quality of life in older adults with frailty or pre-frailty. METHODS We conducted literature searching in seven electronic databases, as well as hand-search of reference of included studies from inception to December 2022. Eligible studies included clinical trials of pre-frail or frail elderly receiving OEP interventions reporting on the relevant outcomes. The effect size was evaluated using standardized mean differences (SMDs) and its 95% confidence interval with random effects models. Risk of bias was appraised independently by two authors. RESULTS 10 trials containing 8 RCTs and 2 non-RCTs studies were included. Five studies were evaluated with some concerns in the evidence quality. The results showed that the OEP intervention could possibly reduce the level of frailty (SMD=-1.14, 95% CI: -1.68∼-0.06, P < 0.01) and improve the mobility (SMD=-2.15, 95% CI: -3.35∼-0.94, P < 0.01) and physical balance ability (SMD=2.59, 95% CI: 1.07-4.11), P = 0.01), and enhance their grip strength (SMD=1.68, 95% CI=0.05∼3.31, P = 0.04). However, no statistically significant effect of OEP on quality of life (SMD=-1.517, 95% CI=-3.18∼0.15, P = 0.07) in frail elderly was found based on the current evidence. The subgroup analysis indicated that participant age, different intervention total duration and per min of each session have varying degrees of impact on frail or pre-frail older people. CONCLUSIONS The OEP intervention targeting older adults with frailty or pre-frailty are effective in reducing frailty, improving physical balance ability, mobility, and grip strength with low to moderate certainty. More rigorous and tailored research are still needed in the future to further enrich the evidence in these fields.
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Affiliation(s)
- Mo Yi
- School of Nursing, Peking University, China
| | | | - Xu Zhang
- School of Nursing, Peking University, China
| | - Jia Zhou
- School of Nursing, Peking University, China
| | - Zhiwen Wang
- School of Nursing, Peking University, China.
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Martinez-Calderon J, Flores-Cortes M, Morales-Asencio JM, Pineda-Galán C, García-Rios MC, Torrontegui-Duarte M, Luque-Suarez A. Is it Possible to Reduce Pain-Related Fear in Individuals with Knee Osteoarthritis? a Systematic Review of Randomised Clinical Trials. Physiother Theory Pract 2023; 39:1106-1132. [PMID: 35200089 DOI: 10.1080/09593985.2022.2038743] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 11/26/2021] [Accepted: 01/07/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of different interventions in reducing pain-related fear outcomes in people with knee osteoarthritis who have or have not had previous knee surgery, and to analyze whether included trials reported their interventions in full detail. METHODS Systematic searches were carried out in the Cochrane CENTRAL, CINAHL, EMBASE, PEDro, PsycINFO, PubMed, and SPORTDiscus from the inception of the database up to November 2019. Searches were manually updated to July 2021. We included randomized clinical trials that evaluated pain-related fear outcomes as a primary or secondary outcome in adults with knee osteoarthritis. The Cochrane Risk of Bias Tool 2 and the GRADE approach evaluated the risk of bias and the certainty of the evidence, respectively. RESULTS Eighteen trials were included. Four trials evaluated pain-related fear as a primary outcome and all evaluated kinesiophobia in samples that had previously undergone a knee surgical procedure. These trials found that interventions based primarily on cognitive aspects (e.g. cognitive-behavioral principles) can be effective in reducing kinesiophobia. Trials evaluating pain-related fear as the secondary outcome also found that interventions that included cognitive aspects (e.g. pain neuroscience education) decreased the levels of pain-related fear (e.g. fear of falling or kinesiophobia) in patients with or without a previous knee surgery. However, serious to very serious risk of bias and imprecisions were found in included trials. Thus, the certainty of the evidence was judged as low and very low using the GRADE approach. All trials reported insufficient details to allow a complete replication of their interventions. CONCLUSIONS Interventions that include cognitive aspects may be the best option to reduce pain-related fear in people with knee osteoarthritis. However, we found a general low and very low certainty of the evidence and the findings should be considered with caution.
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Affiliation(s)
- Javier Martinez-Calderon
- Department of Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Seville, Spain
| | - Mar Flores-Cortes
- Department of Physiotherapy, Faculty of Health Sciences, University of Malaga, Malaga, Spain
| | - Jose Miguel Morales-Asencio
- Biomedical Research Institute of Malaga (Ibima), Spain
- Department of Nursing, Faculty of Health Sciences, University of Malaga, Malaga, Spain
| | | | | | | | - Alejandro Luque-Suarez
- Department of Physiotherapy, Faculty of Health Sciences, University of Malaga, Malaga, Spain
- Biomedical Research Institute of Malaga (Ibima), Spain
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Gholami Z, Faezi ST, Letafatkar A, Madreseh E. Pain neuroscience education, blended exercises and booster sessions as an effective therapy for pain, functional and psychological factors in patients with knee osteoarthritis: a study protocol for a single-blind randomised controlled trial with 2 2 factorial design during 6-month follow-up. BMJ Open 2023; 13:e070336. [PMID: 37173101 PMCID: PMC10186447 DOI: 10.1136/bmjopen-2022-070336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 04/24/2023] [Indexed: 05/15/2023] Open
Abstract
INTRODUCTION This study aims to investigate whether a pain neuroscience education (PNE) combined with a blended exercises programme including aerobic, resistance, neuromuscular, breathing, stretching and balance exercises and diet education provides greater pain relief and improvement in functional and psychological factors than PNE and blended exercises alone and whether 'exercise booster sessions (EBS)' approach may improve outcomes and increase adherence in patients with knee osteoarthritis (KOA) (by telerehabilitation (TR)). METHODS AND ANALYSIS In this single-blind randomised controlled trial, 129 patients (both genders; age >40) diagnosed with KOA will be randomly assigned to one of the 22 treatment combinations as: (1) blended exercises alone (36 sessions over 12 weeks), (2) PNE alone (three sessions over 2 weeks), (3) combination of PNE with blended exercises (exercise three times a week for 12 weeks combined with three sessions of PNE) and (4) a control group. Outcome assessors will be blinded towards group allocation. The primary outcome variables are the visual analogue scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis index in knee osteoarthritis (WOMAC) score. Secondary outcomes include Pain Self-Efficacy Questionnaire (PSEQ), Depression, Anxiety and Stress Scale (DASS), Tampa Scale for Kinesiophobia (TSK), Short Falls Efficacy Scale International (FES-I), Pain Catastrophising Scale (PCS), Short Form Health Survey (SF-12) and Exercise Adherence Rating Scale (EARS), 30 s sit-to-stand test (30CST), Timed Up and Go (TUG), lower limbs' muscle strength and lower limb joints' active range of motion (AROM) will be performed at baseline, 3 and 6 months' postinterventions. The primary and secondary outcomes will assess at baseline, 3 months and 6 months postinterventions.The findings will be useful in establishing an effective treatment strategy covering multiple aspects behind KOA. The study protocol is conducted in clinical settings, thereby enhancing the possibility of future implementation of the treatments in the healthcare systems and self-care management. Results in comparison between groups will help to clarify the most effective of mixed-method TR (blended exercise, PNE, EBS with diet education) on more improvement in pain, functional and psychological factors in patients with KOA. This study will combine some of the most critical interventions, to be able to introduce a 'gold standard therapy' in the treatment of KOA. ETHICS AND DISSEMINATION The trial has been approved by the ethics committee for research involving human subjects of the Sport Sciences Research Institute of Iran (IR.SSRC.REC.1401.021). The study findings will be published in international peer-reviewed journals. TRIAL REGISTRATION NUMBER IRCTID: IRCT20220510054814N1.
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Affiliation(s)
- Zohreh Gholami
- Biomechanics and Sports Injuries, Kharazmi University - Karaj, Hesarak, Iran
| | | | - Amir Letafatkar
- Department of Biomechanics and Sport Injuries, Kharazmi University, Tehran, Iran
| | - Elham Madreseh
- Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, Iran
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Raizah A, Reddy RS, Alshahrani MS, Tedla JS, Dixit S, Gular K, Gautam AP, Ahmad I, Kandakurti PK. Investigating Knee Joint Proprioception and Its Impact on Limits of Stability Using Dynamic Posturography in Individuals with Bilateral Knee Osteoarthritis-A Cross-Sectional Study of Comparisons and Correlations. J Clin Med 2023; 12:jcm12082764. [PMID: 37109102 PMCID: PMC10146398 DOI: 10.3390/jcm12082764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/03/2023] [Accepted: 04/04/2023] [Indexed: 04/29/2023] Open
Abstract
(1) Background: Proprioception and limits of stability can significantly impact static and dynamic balance. Knee proprioception and limits of stability may be impaired in individuals with knee osteoarthritis (KOA). Impaired knee proprioception may impact the limits of stability, and understanding the associations between these factors is important for formulating treatment strategies in this population. The objectives of this study are to (a) compare the knee joint position error (JPE) and limits of stability between KOA and asymptomatic individuals and (b) assess the correlation between knee JPE and the limits of stability in KOA individuals. (2) Methods: This cross-sectional study included 50 individuals diagnosed with bilateral KOA and 50 asymptomatic individuals. Knee JPE was measured using a dual digital inclinometer at 25° and 45° of knee flexion (in the dominant and nondominant legs). The limits of stability variables, including reaction time (s), maximum excursion (%), and direction control (%), were evaluated using computerized dynamic posturography. (3) Results: The magnitude of the mean knee JPE is significantly larger in KOA individuals (p < 0.001) compared to asymptomatic individuals assessed at 25° and 45° of knee flexion in both the dominant and nondominant legs. The limits of stability test showed that KOA group individuals had a longer reaction time (1.64 ± 0.30 s) and reduced maximum excursion (4.37 ± 0.45) and direction control (78.42 ± 5.47) percentages compared to the asymptomatic group (reaction time = 0.89 ± 0.29, maximum excursion = 5.25 ± 1.34, direction control = 87.50 ± 4.49). Knee JPE showed moderate to strong correlations with the reaction time (r = 0.60 to 0.68, p < 0.001), maximum excursion (r = -0.28 to -0.38, p < 0.001) and direction control (r = -0.59 to -0.65, p < 0.001) parameters in the limits of stability test. (4) Conclusions: Knee proprioception and limits of stability are impaired in KOA individuals compared to asymptomatic individuals, and knee JPE showed significant relationships with the limits of stability variables. These factors and correlations may be considered when evaluating and developing treatment strategies for KOA patients.
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Affiliation(s)
- Abdullah Raizah
- Department of Orthopaedics, College of Medicine, King Khalid University, Abha 61421, Saudi Arabia
| | - Ravi Shankar Reddy
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61421, Saudi Arabia
| | - Mastour Saeed Alshahrani
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61421, Saudi Arabia
| | - Jaya Shanker Tedla
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61421, Saudi Arabia
| | - Snehil Dixit
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61421, Saudi Arabia
| | - Kumar Gular
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61421, Saudi Arabia
| | - Ajay Prashad Gautam
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61421, Saudi Arabia
| | - Irshad Ahmad
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61421, Saudi Arabia
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Choma EA, Treat-Jacobson DJ, Keller-Ross ML, Wolfson J, Martin L, McMahon SK. Using the RE-AIM framework to evaluate physical activity-based fall prevention interventions in older adults with chronic conditions: A systematic review. Transl Behav Med 2023; 13:42-52. [PMID: 36394349 DOI: 10.1093/tbm/ibac072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Falls are a serious public health problem, especially for older adults with chronic conditions. The purpose of this systematic review was to evaluate the translational potential of physical activity-based balance interventions for older adults with common chronic conditions guided by the Reach, Effectiveness/Efficacy, Adoption, Implementation, and Maintenance (RE-AIM) framework. Databases were searched (2011-2021) to identify studies with physical activity-based fall prevention interventions for older adults with chronic conditions. Data were collected using the RE-AIM coding guide and Mixed Methods Appraisal Tool for evidence quality. The search yielded 122 articles, of which 14 distinct studies were included. The most reported RE-AIM dimensions across the studies were Reach (46.2%) and Implementation (40.5%), with Effectiveness/Efficacy (29.4%), Adoption (2.0%), and Maintenance (5.4%) being the least reported. Studies were largely conducted in controlled research environments with minimal staff involvement and without long-term follow-up periods. While studies found that physical activity-based programs were effective in improving balance, information on representativeness and adoption/maintenance of programs was lacking. Studies included sufficient details about the intervention (content, dosage, progression). External validity RE-AIM indicators were reported less frequently than internal validity indicators. The studies were of moderate quality overall. Studies often lacked information on indicators critical for understanding how to implement these programs. This review signals the need to investigate the translation of these interventions from controlled research settings to clinical settings to improve the public impact of fall prevention for this population.
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Affiliation(s)
- Elizabeth A Choma
- Department of Physical Therapy, College of Arts and Sciences, Whitworth University, Spokane, WA, USA
| | - Diane J Treat-Jacobson
- School of Nursing, Academic Health Center, University of Minnesota, Minneapolis, MN, USA
| | - Manda L Keller-Ross
- Division of Physical Therapy, Medical School, University of Minnesota, Minneapolis, MN, USA.,Division of Rehabilitation Science, Medical School, University of Minnesota, Minneapolis, MN, USA
| | - Julian Wolfson
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Lauren Martin
- School of Nursing, Academic Health Center, University of Minnesota, Minneapolis, MN, USA
| | - Siobhan K McMahon
- School of Nursing, Academic Health Center, University of Minnesota, Minneapolis, MN, USA
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Chopra S, Kodali RT, McHugh GA, Conaghan PG, Kingsbury SR. Home-Based Health Care Interventions for People Aged 75 Years and Above With Chronic, Noninflammatory Musculoskeletal Pain: A Scoping Review. J Geriatr Phys Ther 2023; 46:3-14. [PMID: 36525074 DOI: 10.1519/jpt.0000000000000334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND PURPOSE Chronic, noninflammatory musculoskeletal pain is common in the aged population and management can be challenging for older people due to multimorbidity, social isolation, and physical frailty. The aim of this scoping review is to summarize and discuss the evidence related to home-based health care interventions for older adults, with chronic, musculoskeletal pain. METHODS A review of the literature using 8 electronic databases (Embase, MEDLINE, CINAHL, PubMed, Cochrane Library, Physiotherapy Evidence Database [PEDro], Scopus, and Web of Science) was performed, following the PRISMA-ScR guidelines. English language published studies that assessed home-based health care intervention/s, in men and women 75 years and older, with chronic, noninflammatory musculoskeletal pain where included. Two authors independently reviewed the articles and extracted data into a preformulated chart. RESULTS AND DISCUSSION The database search identified 4722 studies of which 7 studies met the inclusion criteria. Six of the 7 studies were randomized controlled trials and 5 studies focused on a single-site pain. The type of home-based interventions in the included studies was physical therapy (n = 2), psychotherapy (n = 3), and multimodal therapy (combination of multiple therapies) (n = 2). Participation completion rate was more than 74% in 6 out of 7 studies. Most studies used pain and/or physical function as their primary outcome (n = 6). Music therapy showed a statistically significant reduction in visual analog scale score for pain, and there was a trend toward improvement of pain and function in the physical therapy studies. No significant differences in outcomes between intervention and control groups were observed in the multimodal studies. CONCLUSION This review highlights the scarcity of evidence related to home-based health interventions in older people 75 years and older, living with chronic, noninflammatory musculoskeletal pain. The findings were that physical, psychotherapeutic, and multimodal interventions are usually well tolerated and can be delivered as a safe self-management option. There remains a substantial need for more high-quality research with wider range of home-based interventions and comprehensive assessment of outcomes for this age group.
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Affiliation(s)
- Swati Chopra
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, and NIHR Leeds Biomedical Research Centre, University of Leeds, Leeds, England
| | - Rama T Kodali
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, and NIHR Leeds Biomedical Research Centre, University of Leeds, Leeds, England
| | - Gretl A McHugh
- School of Healthcare, University of Leeds, Leeds, England
| | - Philip G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, and NIHR Leeds Biomedical Research Centre, University of Leeds, Leeds, England
| | - Sarah R Kingsbury
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, and NIHR Leeds Biomedical Research Centre, University of Leeds, Leeds, England
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Zheng Z, Luo H, Xu W, Shi L, Wang F, Qiu Y, Wang L, Xu Y, Sun C, Xue Q. Association between Elevated Magnesium Intake and Reduced Risk of Recurrent Falls and Frailty in Osteoarthritis: Data from the Osteoarthritis Initiative. J Nutr Health Aging 2023; 27:775-784. [PMID: 37754218 DOI: 10.1007/s12603-023-1979-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 08/03/2023] [Indexed: 09/28/2023]
Abstract
OBJECTIVES The objective of this 8-year follow-up study was to investigate the relationship between magnesium intake and frailty, as well as recurrent falls, in individuals diagnosed with Osteoarthritis (OA) or those at a heightened risk for developing the condition. METHODS This study utilized data from the Osteoarthritis Initiative (OAI) database and conducted a prospective cohort study with a 8-year follow-up period. Total magnesium intake from both food sources and supplements was assessed using a food frequency questionnaire (FFQ), while frailty and recurrent falls were evaluated through established criteria and self-report, respectively. To account for potential confounding factors, various covariates were considered, and statistical analyses, including generalized additive mixed models (GAMMs), were employed to examine the associations. RESULTS Among the 4,667 participants with OA, those with lower total magnesium intake were characterized by younger age, a higher proportion of African American individuals, higher body mass index (BMI), and lower dietary fiber intake (P<0.001). Notably, this group exhibited higher odds of experiencing recurrent falls and frailty (P = 0.034 and 0.006, respectively). Controlling for various factors, the GAMMs consistently revealed negative correlations between magnesium intake and the likelihood of frailty and recurrent falls, with each 1 mg/1000 kcal increase in magnesium intake associated with a 0.5% reduced frailty risk (p < 0.001) and a 0.2% decreased risk of recurrent falls (p = 0.001). Subgroup analyses suggested that increased total magnesium intake from both food sources and supplements may exert a more pronounced preventive effect on recurrent falls and frailty in men, older adults, individuals with normal BMI, and those with higher dietary fiber intake. CONCLUSIONS Elevated total magnesium intake from both food sources and supplements was found to be associated with a decreased risk of recurrent falls and frailty in individuals diagnosed with OA or those at risk of developing the condition. These findings imply that increased total magnesium intake might be beneficial in managing the risk of these outcomes, particularly within specific subgroups, including men, older adults, those with a normal BMI, and those with higher dietary fiber intake.
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Affiliation(s)
- Z Zheng
- Qingyun Xue, M.D., Ph.D., Department of Orthopedics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, NO.1 Da Hua Road, DongDan, Beijing 100730, China, E-mail:
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Peng Y, Yi J, Zhang Y, Sha L, Jin S, Liu Y. The effectiveness of a group-based Otago exercise program on physical function, frailty and health status in older nursing home residents: A systematic review and meta-analysis. Geriatr Nurs 2023; 49:30-43. [PMID: 36413811 DOI: 10.1016/j.gerinurse.2022.10.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 10/19/2022] [Accepted: 10/21/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To explore the effects of a group-based Otago exercise program (OEP) on physical function (mobility, balance, lower limb strength), frailty and health status in older nursing home residents to determine the optimal scheme and format. METHODS This systematic review and meta-analysis was conducted to estimate group-based OEP effects. Subgroup analysis was performed to identify the influences of the participant and intervention characteristics on the effects. RESULTS Twelve studies met the eligibility criteria and were included in this meta-analysis, and the overall quality was relatively high. The results showed that the group-based OEP significantly improved physical function, including mobility [SMD=-0.64, 95% CI (-0.83,-0.45), Z=6.55, p<0.001], balance [MD=4.72, 95% CI (3.54, 5.90), Z=7.84, p<0.001], lower limb strength [SMD=-1.09, 95% CI (-1.40, -0.79), Z=7.01, p<0.001]; frailty [SMD=-0.73, 95% CI (-1.01, -0.45), Z=5.13, p<0.001] and health status [SMD=0.47, 95% CI (0.20, 0.74), Z=3.44, p=0.0006]. Subgroup analysis revealed that 30-minute sessions were more beneficial for improving balance than >30-minute sessions (p=0.0004). The training was coordinated with physiotherapists, who were more skilled at improving mobility than providing health training education (p=0.04). CONCLUSIONS Group-based OEP is helpful for improving physical function, frailty and health status in older nursing home residents. Specifically, 30-minute sessions and coordinating with physiotherapists may be the most appropriate and effective options.
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Affiliation(s)
- Yu Peng
- Department of Nursing, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Jing Yi
- Department of Nursing, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Yuhan Zhang
- Department of Nursing, School of Nursing, Shanxi Medical University, Taiyuan, Shanxi, China.
| | - Liyan Sha
- Department of Nursing, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China.
| | - Shixiao Jin
- Department of Nursing, School of Nursing, China Medical University, Shenyang, Liaoning, China
| | - Yang Liu
- Department of Nursing, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
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Yang Y, Wang K, Liu H, Qu J, Wang Y, Chen P, Zhang T, Luo J. The impact of Otago exercise programme on the prevention of falls in older adult: A systematic review. Front Public Health 2022; 10:953593. [PMID: 36339194 PMCID: PMC9631473 DOI: 10.3389/fpubh.2022.953593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 10/04/2022] [Indexed: 01/24/2023] Open
Abstract
Objective To improve the quality of life of older adult in their later years, by increasing the physical activity participation of older adult, the occurrence of falls accident scores in older adult can be prevented. This paper comprehensively summarizes the origin, development, participation forms, and fitness effects of the Otago exercise program (OEP). Methods Using PubMed, web of science, CNKI, dimensional spectrum, and other databases, search for research papers from 2005 to April 2021 by using keywords such as Otago project exercise; aged, Fall; Cognitive function, Balance ability, Lower limb strength, Fall efficiency, and so on. PEDro Scale was used to check the quality of the literatures. Results A total of 34 papers were included after searching for kinds of literature related to the subject of this paper and after careful review by researchers. Conclusions Otago exercise programme is beneficial to improve the cognitive function of older adult, enhance their lower limb muscle strength and dynamic and static balance ability, and then improve the gait stability and posture control ability of older adult, which has significant positive benefits for the prevention of falls in older adult. OEP is helpful to improve the falling efficiency of older adult, help older adult overcome the fear of falling, and form a positive emotion of "exercise improves exercise," to reduce the harm caused by sedentary behavior and the incidence of depression and improve their subjective wellbeing. Although OEP has significant positive effects on improving the health and physical fitness of older adult, preventing falls, and restoring clinical function, the corresponding neural mechanism for preventing falls is not very clear. At the same time, how OEP can be combined with emerging technologies to maximize its benefits needs to be further discussed in the future.
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Affiliation(s)
- Yi Yang
- Research Centre for Exercise Detoxification, College of Physical Education, Southwest University, Chongqing, China
| | - Kun Wang
- Research Centre for Exercise Detoxification, College of Physical Education, Southwest University, Chongqing, China
| | - Hengxu Liu
- Research Centre for Exercise Detoxification, College of Physical Education, Southwest University, Chongqing, China
| | - Jiawei Qu
- Research Centre for Exercise Detoxification, College of Physical Education, Southwest University, Chongqing, China
| | - Yan Wang
- School of Physical Education, Sichuan Agricultural University, Yaan, China
| | - Peijie Chen
- Leisure College of Shanghai Institute of Physical Education, Shanghai, China
| | - TingRan Zhang
- Research Centre for Exercise Detoxification, College of Physical Education, Southwest University, Chongqing, China,*Correspondence: TingRan Zhang
| | - Jiong Luo
- Research Centre for Exercise Detoxification, College of Physical Education, Southwest University, Chongqing, China,Jiong Luo
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Ince B, Goksel Karatepe A, Akcay S, Kaya T. The efficacy of balance and proprioception exercises in female patients with knee osteoarthritis: A randomized controlled study. Clin Rehabil 2022; 37:60-71. [PMID: 35801287 DOI: 10.1177/02692155221111929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Loss of proprioception and balance disorders are commonly observed in patients with knee osteoarthritis. In this study, we aimed to investigate the effects of balance and proprioception exercises in patients with knee osteoarthritis. DESIGN A single-center randomized trial with three parallel arms. SETTING A tertiary health care facility in Turkey. PARTICIPANTS Female patients with knee osteoarthritis aged 40-70 years. INTERVENTIONS Ten-week exercise program in Biodex training, classical balance training and isometric strengthening groups. MAIN MEASURES Dynamic balance (overall stability index and the modified Clinical Test of Sensory Interaction and Balance), pain (visual analogue scale), physical function (30-s chair stand test and 40-meter fast-paced walk test) and quality of life (Knee Injury and Osteoarthritis Outcome Score). RESULTS Eighty-nine patients enrolled in the study. The Biodex training group, the classical training group, and the control group had overall stability index values of 1.0 ± 0.07, 1.4 ± 0.07 and 1.4 ± 0.07, and the Modified Clinical Test of Sensory Interaction and Balance - Condition-3 values of 0.7 ± 0.04, 0.9 ± 0.04 and 0.9 ± 0.04 respectively, at the end of treatment. In terms of pain scores on movement, each group showed significant improvement compared to their baseline, and the classical balance training group had better scores than the control group. No other significant difference was found between the groups. Physical function and quality of life outcomes showed significant main effects only in the time factor. CONCLUSIONS Balance and proprioception exercises may have positive effects on dynamic balance and pain. The effects on physical function and quality of life should be investigated in further studies with larger sample.
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Affiliation(s)
- Bugra Ince
- Department of Physical Medicine and Rehabilitation, 169317Izmir Bozyaka Education and Research Hospital, University of Health Sciences, Izmir, Turkey
| | - Altinay Goksel Karatepe
- Department of Physical Medicine and Rehabilitation, 169317Izmir Bozyaka Education and Research Hospital, University of Health Sciences, Izmir, Turkey
| | - Seniz Akcay
- Department of Physical Medicine and Rehabilitation, 169317Izmir Bozyaka Education and Research Hospital, University of Health Sciences, Izmir, Turkey
| | - Taciser Kaya
- Department of Physical Medicine and Rehabilitation, 169317Izmir Bozyaka Education and Research Hospital, University of Health Sciences, Izmir, Turkey
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Sedaghati P, Ahmadabadi S, Goudarzian M. Evaluation of the durable effects of corrective exercises on the postural alignment and stability in hyperkyphotic elderly with a history of falls. BMC Geriatr 2022; 22:545. [PMID: 35773652 PMCID: PMC9245289 DOI: 10.1186/s12877-022-03210-4] [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: 12/02/2021] [Accepted: 06/13/2022] [Indexed: 11/10/2022] Open
Abstract
Background This study aimed to investigate the durability of the effects of corrective exercises on the postural alignment and stability of hyperkyphotic elderly with a history of falls. Balance disturbance and recurrent falls are directly related to changes in the alignment of physical posture and function of the elderly, and effective methods with durable effects on improving the postural stability of the elderly have always been under the attention of researchers. Methods This study was a randomized clinical trial, and the statistical population included the elderly referred to neurology clinics. According to the research inclusion criteria (hyperkyphotic elderly with a history of falls during the last six months), 30 elderly aged 60 to 75 years old were purposefully selected and randomly divided into two groups of corrective exercises and control. The experimental group performed an exercise program based on the Alexander posture correction technique. Both groups were evaluated with forward head angle, kyphosis, the timed up and go test, postural stability, and fear of falling tests in three phases. Data analysis was conducted using SPSS 21 software and the MANCOVA test and repeated-measures analysis of variance. Results Data analysis showed significant improvements in the variables of forward head (p = 0.007), kyphosis(p = .001), balance(p = 0.002), postural stability(p = 0.001), and fear of falling(p = 0.001) in the experimental group. Post-test comparisons between the experimental and control groups showed significant differences in all variables except for kyphosis(p > .05), and follow-up analysis also revealed significant differences in all variables, except for the variables of forward head and kyphosis(p > .05). Conclusions Although the effects of corrective exercises in the elderly decreased regarding spinal alignment after three months, more lasting effects were seen in functional balance, postural stability, and fear of falling, suggesting this strategy as a stimulus for more mobility and a lower risk of falling in the elderly. Therefore, when using corrective exercises, it is possible to apply these exercises for a longer period of time to achieve more durable outcomes, especially regarding spinal alignment. Trial registration This research was registered in the Iranian Registry of Clinical Trials (IRCT2016081529373N1, Date of registration: 19/04/2017).
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Affiliation(s)
- Parisa Sedaghati
- Department of Sports Injuries and Corrective Exercise, Faculty of Physical Education and Sport Sciences, University of Guilan, Rasht, Iran.
| | - Somayeh Ahmadabadi
- Department of Physical Education and Sports Sciences, Farhangian University, Tehran, Iran
| | - Maryam Goudarzian
- Iranian Research Center On Healthy Aging, Sabzevar University of Medical Sciences, Sabzevar, Iran
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Effects of a modified Otago exercise program delivered through outpatient physical therapy to community-dwelling older adult fallers in Greece during the COVID-19 pandemic: a controlled, randomized, multicenter trial. Eur Geriatr Med 2022; 13:893-906. [PMID: 35606677 PMCID: PMC9126757 DOI: 10.1007/s41999-022-00656-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 05/03/2022] [Indexed: 11/05/2022]
Abstract
Aim To investigate the effectiveness of a video-supported OTAGO exercise program (OEP) in balance, functional ability, fear of falls and number of falls in Greek older adults with a history of falls. Findings A 6-month OEP helped older adults to improve their balance and functional ability test scores as well as reduce fear and number of falls, both after the intervention and at the 12-month follow-up. However, the adherence to the program remained unaffected. Message The OEP contributes to the well-being of older adults with a history of falls by improving all their relevant skills and scores. More long-term research under less adverse conditions is required to solidify these findings. Background The pandemic has led to the isolation and social exclusion of older adults and cut them off from any exercise activity. Thus, it is more than ever necessary to implement organized interventions to prevent falls in older people as they remain a global health problem associated with serious injuries, chronic disability, and high costs for the healthcare system. Otago exercise program (OEP) can effectively reduce the number of falls. Aim To study the effect of a 6 months modified video supported OEP in balance, functional ability, fear of falls and number of falls in Greek older people who have fallen. Method 150 fallers aged 65–80 years [Median age 70 (67–74), 88.7% women] were divided into two groups (intervention and control). Primary outcomes included changes in Short FES-I, CONFbal scale, 4-Stage Balance test, BBS, TUG test and number of falls, while the secondary outcome consists of the monthly adherence to exercise after the intervention. Analysis of variance with repeated measures was applied. Results There were statistically significant between groups differences after 6 months with the OEP group to shows improved values in TUG time score (17.8 vs 3.9%, p < 0.001, 95% CI), 4-Stage Balance Test (6.85 vs 1.09%, p < 0.05 95% CI), 30-Second Chair Stand Test 7.35 vs 2.93%, p < 0.001), BBS score (13.27 vs 3.89%, p < 0.001, 95% CI), Short FES-I (35.78 vs 13.01%, p < 0.001, 95% CI) and number of falls (69.12 vs 18.70%, p < 0.001, 95% CI). All the above differences remained statistically significant in the 12 months follow-up (p < 0.05), when differences in the CONFbal score were also observed (p < 0.001, 95% CI). No differences were found in adherence to OEP (p > 0.05). Conclusions A modified OEP decreases the number of falls, improves the balance and functional ability of older adults and reduces the fear of falling. However, it did not contribute to satisfactory adherence to exercise. Trial registration number/date of registration NCT04330053/April 1, 2020.
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Yano T, Fujishiro T, Obo T, Nakano A, Nakaya Y, Hayama S, Mori K, Baba I, Neo M. The Effects of Surgery on Postural Instability in Patients With Cervical Compressive Myelopathy: Evaluating Subjective Perceptions and Objective Measurements. Clin Spine Surg 2022; 35:E298-E305. [PMID: 34039889 DOI: 10.1097/bsd.0000000000001195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 04/14/2021] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN A retrospective study. OBJECTIVE To investigate the effects of surgery on the subjective perception of bodily unsteadiness and the objective measurements of postural instability in patients with cervical compressive myelopathy (CCM). SUMMARY OF BACKGROUND DATA Several studies have demonstrated that CCM patients have impaired postural stability and investigated its surgical outcomes. However, these studies have only objectively measured postural stability by using a stabilometer or three-dimensional motion capture system. There have been no studies examining the subjective perception of postural instability in CCM patients. MATERIALS AND METHODS We retrospectively reviewed patients who underwent decompressive surgery for CCM. The Fall Efficacy Scale-International (FES-I) and a self-prepared questionnaire were used to evaluate subjective perception of bodily unsteadiness. To objectively assess postural instability, a stabilometric analysis was performed with the following parameters: sway area (SwA, cm2), sway velocity (SwV, cm/s), and sway density (SwD, /cm). The evaluations were performed preoperatively, during the early postoperative period (3-6 mo postoperatively), and at 1-year postoperatively in patients with CCM. The evaluation results were compared with age-matched, sex-matched, and body mass index-matched healthy subjects. RESULTS We included 70 CCM patients and 36 healthy subjects in this study. In both the FES-I and self-prepared questionnaire, CCM patients reported significantly milder postoperative bodily unsteadiness. The stabilometric parameters were significantly improved during the postoperative period when compared with preoperative values. Nevertheless, neither the self-reported outcome measures nor stabilometric parameters of CCM patients reached the levels of those in healthy controls in the postoperative period. CONCLUSION This was the first study to examine CCM surgical outcomes in terms of both subjective perception and objective postural instability. While both objective postural stability and subjective perception improved following decompressive surgery, they did not reach the levels seen in healthy participants. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Toma Yano
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
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Jardim RAC, de Sousa TS, Dos Santos WNN, Matos AP, Iosimuta NCR. Blood flow restriction with different load levels in patients with knee osteoarthritis: protocol of a randomized controlled trial. Trials 2022; 23:41. [PMID: 35033169 PMCID: PMC8761307 DOI: 10.1186/s13063-022-05998-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 01/03/2022] [Indexed: 11/10/2022] Open
Abstract
Background The effectiveness of blood flow restriction training (BFR) in elderly with knee osteoarthritis (OA) is comparable to performing high-intensity protocols (70 to 80% of 1 RM [repetition maximum]) that are known to be effective for improving the muscle strength of knee extensors, with the advantage of generating less particular rating of perceived exertion and pain immediately after training. However, despite being a promising alternative, little is known about the best way to apply the BFR, such as level of pressure and combination or not with other therapeutic modalities. The purpose of this study is to evaluate whether different levels of blood flow restriction with low load (BFR + LL) and no load (BFR + rest) are non-inferior to high-intensity resistance exercise (HIRE+BFRplacebo) for pain reduction in patients with knee OA. Methods/design This clinical trial is a non-inferiority, five-arm, randomized, active-controlled, single trial which will be carried out in 165 patients of both sexes with knee OA, aged 50 years and older. Participants will be randomly allocated into 5 exercise groups (40% of BFR + LL; 80% of BFR + LL; 40% of BFR + rest; 80% BFR + rest, and HIRE+BFR placebo). A mixed linear model will be used to examine the effect of group-by-time interaction on pain intensity on the WOMAC subscale (primary outcome) and on disease severity, physical functional data, balance data, quality of life, global perceived effect scale, and muscle strength (secondary outcomes). Participants will be analyzed for intention-to-treat, and the statistical assessor blinded to the groups. The collection of outcomes 72 h after completion of the 16 weeks of interventions will be the primary measurement point. Follow-up secondary timepoints will be collected at 20, 28, 40, 52, and 64 weeks after the end of interventions, except for pain during the training, which will be measured immediately at the end of each session. Only the comparison of the primary outcome between the HIRE group with each BFR group will be analyzed in the non-inferiority framework, the other comparisons between the BFR groups for the primary outcome, and all secondary outcomes will be interpreted in the superiority framework. Discussion The results of this clinical trial can point out more clearly to ways to optimize the BFR training with the minimum of pain immediately after training, which will allow the offer of an effective and more adherent strengthening training to patients with knee OA. Trial registration Registro Brasileiro de Ensaios Clínicos, RBR-93rx9q. Registered on 23 July 2020. Version 1.0. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-05998-3.
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Affiliation(s)
- Roger Andrey Carvalho Jardim
- Postgraduate Program of Health Sciences, Department of Biological Sciences and Health, Federal University of Amapá - UNIFAP, Macapá, AP, Brazil.
| | - Tamara Silva de Sousa
- Postgraduate Program of Health Sciences, Department of Biological Sciences and Health, Federal University of Amapá - UNIFAP, Macapá, AP, Brazil
| | | | - Areolino Pena Matos
- Postgraduate Program of Health Sciences, Department of Biological Sciences and Health, Federal University of Amapá - UNIFAP, Macapá, AP, Brazil
| | - Natália Camargo Rodrigues Iosimuta
- Postgraduate Program of Health Sciences, Department of Biological Sciences and Health, Federal University of Amapá - UNIFAP, Macapá, AP, Brazil
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Ángeles CMM, Laura AM, Consuelo CSM, Manuel RR, Eva AC, Covadonga GPA. The effect that the Otago Exercise Programme had on fear of falling in community dwellers aged 65-80 and associated factors. Arch Gerontol Geriatr 2022; 99:104620. [PMID: 34999543 DOI: 10.1016/j.archger.2022.104620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/28/2021] [Accepted: 12/31/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Falls are a major public health problem. Fear of falling is highly prevalent amongst community-dwelling older adults who have already fallen and it is also a risk factor for recurrent falls. There has been limited research about the impact that exercises programs have on the fear of falling. The aim of this study was to evaluate whether the Otago Exercise Programme (OEP) reduced the fear of falling in non-institutionalised people aged 65-80 years in Spain. It also evaluated the factors associated with the fear of falling. METHODS This was a quasi-experimental study that focused on people aged 65-80 who attended 21 primary healthcare centres, lived in the community, were able to walk independently and provided written, informed consent. They were recruited from September 2017 to December 2019. The OEP sessions took place at the primary healthcare centres and were provided on an individual or group basis by trained OEP instructors. The participants attended five weekly sessions, where they were given exercises to develop their strength, balance and endurance. They then continued the programme at home. The subjects were followed up 12 months after baseline and the analyses included a bivariate analysis and a multivariate analysis with logistic regression. RESULTS We enroled 498 patients (67.07% female) with an average age of 71.81 years. More than two-thirds (65.06%) lived with a partner and 42.37% were overweight. Significant reductions were observed in the mean level of fear of falling between baseline and 12 months (p = 0.000). A number of factors associated with fear of falling also showed significant differences. These were: age (p = 0.033), sex (p = 0.000), living alone (p = 0.000), body mass index (p = 0.003) and whether psychotropic drugs were used (p = 0.000). The multivariate analysis showed a moderate to high fear of falling amongst participants who were female (p = 0.000), 72-80 years of age (p = 0.017), obese (p = 0.045) and used psychotropic drugs (p = 0.021). CONCLUSIONS Taking part in the OEP reduced the overall fear of falling. There were significant associations between fear of falling and being female, taking psychotic drugs and having a history of falls. This study is a quasi-experimental sign nested an experimental study (randomized controlled trial previously published and registered on ClinicalTrials.org (NCT03320668)). Retrospectively registered on 25/10/2017.
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Affiliation(s)
- Cidoncha-Moreno Maria Ángeles
- IIS Bioaraba, General Head Office of Osakidetza, Basque Health Service, Subdirection of Nursing, Instituto de Salud Carlos III, Madrid, Spain.
| | - Albornos-Muñoz Laura
- Instituto de Salud Carlos III, Nursing and Healthcare Research Unit (Investén-isciii), Spain
| | | | - Rich-Ruiz Manuel
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba (UCO), Spain
| | - Abad-Corpa Eva
- Professor, University of Murcia-SMS-IMIB-Arrixaca. Spain
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Kechichian A, Lafrance S, Matifat E, Dubé F, Lussier D, Benhaim P, Perreault K, Filiatrault J, Rainville P, Higgins J, Rousseau J, Masse J, Desmeules F. Multimodal Interventions Including Rehabilitation Exercise for Older Adults With Chronic Musculoskeletal Pain: A Systematic Review and Meta-analyses of Randomized Controlled Trials. J Geriatr Phys Ther 2021; 45:34-49. [PMID: 34928239 DOI: 10.1519/jpt.0000000000000279] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND PURPOSE Musculoskeletal disorders (MSKDs) are the most common causes of disabilities for older adults. The aim of this systematic review and meta-analysis is to assess the effectiveness of multimodal interventions including exercise rehabilitation for older adults with chronic MSKDs. METHODS A literature search was conducted up to February 2019 in 5 bibliographical databases to identify randomized controlled trials (RCTs) that compared multimodal interventions including exercise rehabilitation with usual medical care or no intervention. Randomized controlled trials were assessed with the Cochrane risk-of-bias tool. Meta-analyses were performed and pooled mean differences (MDs) or standardized mean differences (SMDs) were calculated. RESULTS Sixteen RCTs (n = 2322 participants) were included. One RCT was considered at low risk of bias, 8 had some concerns of bias, and 7 had a high risk of bias. Participants suffered from hip or knee osteoarthritis (OA) (n = 12 RCTs), low back pain (LBP) (n = 2 RCTs) and generalized chronic pain (GCP) (n = 2 RCTs). Multimodal interventions were significantly more effective than usual care to decrease pain (visual analog scale, out of 10 points) in the short term, MD: -0.71 (95% confidence interval [CI] -1.08 to -0.34, n = 900), and in the long term: MD: -0.52 (95% CI -0.98 to -0.05, n = 575), but these differences are not considered clinically important. In terms of disabilities, multimodal interventions were also significantly more effective than usual care. The SMDs were -0.47 (95% CI -0.61 to -0.34, n = 903) and -0.29 (95% CI -0.46 to -0.13, n = 568) for OA trials in the short and long terms, respectively, and -0.47 (95% CI -0.81 to -0.12, n = 211) for LBP and GCP trials in the short term. The magnitude of these effects may be considered as small to moderate. CONCLUSION Multimodal intervention including exercise rehabilitation combined with usual medical care is an efficacious therapeutic option to reduce disabilities in older adults with chronic MSKDs. A significant but not clinically important effect was observed for pain. The most beneficial component of the multimodal interventions in terms of education, exercises, or medication remains to be determined.
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Affiliation(s)
- Amélie Kechichian
- Maisonneuve-Rosemont Hospital Research Center, University of Montreal Affiliated Research Center, Montreal, Quebec, Canada.,Pierre and Marie Curie University, Sorbonne University, Paris, France
| | - Simon Lafrance
- Maisonneuve-Rosemont Hospital Research Center, University of Montreal Affiliated Research Center, Montreal, Quebec, Canada.,School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Eveline Matifat
- Maisonneuve-Rosemont Hospital Research Center, University of Montreal Affiliated Research Center, Montreal, Quebec, Canada
| | - François Dubé
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada.,Institut Universitaire de Gériatrie de Montréal, CIUSSS Centre-Sud-de-l'Ile-de-Montréal, Montreal, Quebec, Canada
| | - David Lussier
- Institut Universitaire de Gériatrie de Montréal, CIUSSS Centre-Sud-de-l'Ile-de-Montréal, Montreal, Quebec, Canada.,Department of Medicine, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Patrick Benhaim
- Institut Universitaire de Gériatrie de Montréal, CIUSSS Centre-Sud-de-l'Ile-de-Montréal, Montreal, Quebec, Canada.,Department of Medicine, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Kadija Perreault
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, Quebec, Canada.,Department of Rehabilitation, Faculty of Medicine, University of Laval, Quebec, Canada
| | - Johanne Filiatrault
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada.,Institut Universitaire de Gériatrie de Montréal, CIUSSS Centre-Sud-de-l'Ile-de-Montréal, Montreal, Quebec, Canada
| | - Pierre Rainville
- Institut Universitaire de Gériatrie de Montréal, CIUSSS Centre-Sud-de-l'Ile-de-Montréal, Montreal, Quebec, Canada.,Departement of Stomatology, Faculty of Dental Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Johanne Higgins
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada.,Center for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Quebec, Canada
| | - Jacqueline Rousseau
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada.,Institut Universitaire de Gériatrie de Montréal, CIUSSS Centre-Sud-de-l'Ile-de-Montréal, Montreal, Quebec, Canada
| | - Julie Masse
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - François Desmeules
- Maisonneuve-Rosemont Hospital Research Center, University of Montreal Affiliated Research Center, Montreal, Quebec, Canada.,School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
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20
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Yaşar MF, Yakşi E, Kurul R, Balcı M. Comparison of outpatient and inpatient spa therapy in knee osteoarthritis. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2021; 65:1675-1682. [PMID: 33851246 DOI: 10.1007/s00484-021-02122-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 03/25/2021] [Indexed: 06/12/2023]
Abstract
Osteoarthritis (OA) is a common condition that impacts many people worldwide and involves weight-bearing joints, resulting in chronic pain. In this study, we aimed to compare the effectiveness of inpatient and outpatient physical therapy modalities and spa combination treatments on pain and functional status in patients with knee osteoarthritis. Seventy-four patients diagnosed with primary knee osteoarthritis were included in this study. The patients were randomized into two groups, inpatient (n = 37) and outpatient (n = 37) physical therapy. All patients received a physical therapy program (superficial heater + deep heater + transcutaneous electrical nerve stimulation) for 2 weeks and spa therapy. All cases were evaluated clinically, laboratory, and radiographically. In order to evaluate pain and functional status, the Visual Analogue Scale (VAS), Western Ontario and McMaster Universities osteoarthritis index (WOMAC), and Timed Up and Go (TUG) test were used before and after treatment. There was no significant difference between the two groups in the TUG test and WOMAC scores (p > 0.05). However, a significant difference was found in VAS scores in favor of the outpatient group (p < 0.05). As a result, although there was a significant improvement in pain scores in the outpatient group, multicenter studies with larger patient groups may provide more evidence.
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Affiliation(s)
- Mustafa Fatih Yaşar
- Medical Faculty, Department of Physical Medicine and Rehabilitation, Bolu Abant Izzet Baysal University, 14020, Bolu, Turkey.
| | - Elif Yakşi
- Medical Faculty, Department of Physical Medicine and Rehabilitation, Bolu Abant Izzet Baysal University, 14020, Bolu, Turkey
| | - Ramazan Kurul
- Department of Physical Therapy and Rehabilitation, Faculty of Health Sciences, Bolu Abant Izzet Baysal University, Bolu, Turkey
| | - Muhammed Balcı
- Medical Faculty, Department of Physical Medicine and Rehabilitation, Bolu Abant Izzet Baysal University, 14020, Bolu, Turkey
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21
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Mañas A, Gómez-Redondo P, Valenzuela PL, Morales JS, Lucía A, Ara I. Unsupervised home-based resistance training for community-dwelling older adults: A systematic review and meta-analysis of randomized controlled trials. Ageing Res Rev 2021; 69:101368. [PMID: 34022464 DOI: 10.1016/j.arr.2021.101368] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 05/07/2021] [Accepted: 05/17/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND We aimed to summarize evidence on the safety, adherence and effectiveness of home-based resistance training (UHBRT) for improving health-related endpoints in community-dwelling older adults. METHODS Randomized controlled trials of UHBRT in older adults (≥60yrs) were included after a systematic search (PubMed, CINAHL, PsycInfo, SPORTDiscus, Web of Science, MEDLINE, Cochrane Central Register of Controlled Trials) until 02/19/2021. Adverse events and adherence rates were assessed as indicators of feasibility. Other endpoints included physical (muscle strength, muscle power, balance, physical performance) and mental-related measures (cognition, quality of life [QoL]) as well as other health-related variables (body composition, physical activity levels, falls). RESULTS 21 studies (N = 4,053) were included. No major adverse events were reported, with adherence averaging 67 % (range 47-97 %). UHBRT significantly improved lower-limb muscle strength (Hedges' g = 0.33; 95 % confidence interval [CI] = 0.11-0.57), muscle power measured through the sit-to-stand test (g = 0.44; 95 %CI = 0.06-0.84), and balance (assessed with the postural sway, g = 0.32; 95 %CI = 0.16-0.49). No benefits were found for other strength indices (handgrip strength), balance (single leg stance and functional reach test), physical performance (walking speed, TUG and SPPB), QoL, nor for the risk or rate of falls (all p > 0.05, g<0.61). No meta-analysis could be performed for the remaining endpoints. CONCLUSIONS Although efforts are needed to increase adherence, preliminary evidence suggests that UHBRT can be safe and modestly effective for improving some measures of lower-limb muscle strength, balance, and muscle power in community-dwelling older adults. However, no benefits were found for other physical fitness measures, QoL or falls. More evidence is therefore needed to draw definite conclusions.
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22
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Yeap SS, Abu Amin SR, Baharuddin H, Koh KC, Lee JK, Lee VKM, Mohamad Yahaya NH, Tai CC, Tan MP. A Malaysian Delphi consensus on managing knee osteoarthritis. BMC Musculoskelet Disord 2021; 22:514. [PMID: 34088302 PMCID: PMC8178929 DOI: 10.1186/s12891-021-04381-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 05/18/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The 2013 Malaysian Clinical Practice Guidelines on the Management of Osteoarthritis (OA) recommend a linear step-up approach to manage knee OA. However, patients with knee OA often require a multimodal approach to address OA-related pain symptoms and functional limitations. This consensus aimed to provide doctors with an updated set of evidence-based, clinical experience-guided recommendations to manage knee OA. METHODS A multi-speciality expert panel consisting of nine Malaysian physicians from different healthcare settings who manage a diverse OA patient population was convened. Using a combination of the ADAPTE process and modified Delphi method, the panel reviewed current evidence on the management of knee OA and synthesised a set of nine recommendations on the management of knee OA, supported by an algorithm that summarises the consensus' core messages. RESULTS A multimodal intervention strategy is the mainstay of OA management and the choice of any single or multimodal intervention may vary over the course of the disease. Overall, a non-pharmacological core treatment set of patient education, weight loss and exercise is recommended for all patients. When pharmacotherapy is indicated, symptomatic slow-acting drugs for osteoarthritis are recommended at the early stage of disease, and they can be paired with physical therapy as background treatment. Concurrent advanced pharmacotherapy that includes non-steroidal anti-inflammatory drugs, intraarticular injections and short-term weak opioids can be considered if patients do not respond sufficiently to background treatment. Patients with severe symptomatic knee OA should be considered for knee replacement surgery. Management should begin with specific treatments with the least systemic exposure or toxicity, and the choice of treatment should be determined as a shared decision between patients and their team of healthcare providers. CONCLUSIONS This consensus presents nine recommendations that advocate an algorithmic approach in the management of patients living with knee OA. They are applicable to patients receiving treatment from primary to tertiary care providers in Malaysia as well as other countries.
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Affiliation(s)
- Swan Sim Yeap
- Department of Medicine, Subang Jaya Medical Centre, No. 1, Jalan SS12/1A, 47500, Subang Jaya, Selangor, Malaysia.
| | | | - Hazlyna Baharuddin
- Department of Internal Medicine, Universiti Teknologi MARA, Kampus Sungai Buloh, Jalan Hospital, 47000, Sungai Buloh, Selangor, Malaysia
| | - Kar Chai Koh
- Poliklinik Kepong Baru, Jalan Ambong Kiri Satu, Kepong Baru, 52100, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Joon Kiong Lee
- Department of Orthopaedic Surgery, Beacon Hospital, Jalan Templer, Section 51, 46050, Petaling Jaya, Selangor, Malaysia
| | - Verna Kar Mun Lee
- Department of Family Medicine, School of Medicine, International Medical University, No. 126, Jalan Jalil Perkasa 19, Bukit Jalil, 57000, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Nor Hamdan Mohamad Yahaya
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, 56000, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Cheh Chin Tai
- Department of Orthopaedic Surgery, Ara Damansara Medical Centre, Jalan Lapangan Terbang Subang, Seksyen U2, 40150, Shah Alam, Selangor, Malaysia
| | - Maw Pin Tan
- Department of Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
- Department of Medical Sciences, Faculty of Healthcare and Medical Sciences, Sunway University, 47500, Bandar Sunway, Selangor, Malaysia
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23
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Xie C, Wang W, Pei J, Wang H, Lv H. Effect of otago exercise on falls in patients with osteoarthritis: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e23559. [PMID: 33327309 PMCID: PMC7738029 DOI: 10.1097/md.0000000000023559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 11/06/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Osteoarthritis (OA) is considered as an established risk factor for falls, while exercise can effectively prevent falls. However, whether otago exercise can prevent falls in OA patients is still controversial. Based on sufficient clinical studies, this study aimed to apply meta-analysis to evaluate the effectiveness of otago exercise on preventing falls in OA patients with. METHODS PubMed, EMbase, Web of Science and Cochrane Library were searched to collect randomized controlled trial (RCT) of the effect of Otago exercise on falls in OA patients. The search time limit was from the establishment of the database to September 2020. After the 2 researchers independently screened the literature, the data was extracted and the bias risk included in the study was evaluated. Meta-analysis was carried out with RevMan 5.3software. RESULTS The results of our meta-analysis could be published in peer-reviewed journals. CONCLUSION This study provided high-quality evidence to support the effect of Otago exercise on falls in OA patients. OSF REGISTRATION NUMBER DOI 10.17605/OSF.IO/Z5XGV.
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Affiliation(s)
- Chao Xie
- Department of Spinal Surgery, Yantai Yuhuangding Hospital
| | - Weini Wang
- Department of Pediatrics, Women and children's branch Hospital of Muping District Hospital of Traditional Chinese Medicine
| | | | - Haiyan Wang
- Central Laboratory, Yantai Yuhuangding Hospital, Yantai, Shandong, China
| | - Honglin Lv
- Department of Spinal Surgery, Yantai Yuhuangding Hospital
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24
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Truszczyńska-Baszak A, Dadura E, Drzał-Grabiec J, Tarnowski A. Static balance assessment in patients with severe osteoarthritis of the knee. Knee 2020; 27:1349-1356. [PMID: 33010747 DOI: 10.1016/j.knee.2020.06.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 06/04/2020] [Accepted: 06/30/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Pain related to severe knee osteoarthritis may lead to static balance disorders. Patients with severe knee arthrosis with arthroplasty indication should be aware of the postoperative rehabilitation menu because their balance ability has decreased. METHODS The study involved 33 patients with unilateral severe osteoarthritis (the study group) and 33 healthy subjects (the control group). We conducted the measurements of static balance with the CQStab2P platform. Functional disability was assessed using the Knee Society Score (KSS). RESULTS In the study group, balance distribution asymmetry between lower limbs was higher. Patients unloaded the painful joints due to pain and knee instability. We observed statistically significant differences both with eyes open and with eyes closed only for balance symmetry. The study group had mean results of 53.9 (±19.1 SD) points in the KSS scales and 52.1 (±24.1) in the KSS function. There were statistically significant positive correlations regarding KSS and body height (0.270; P < 0.05), and negative correlations for body mass index (0.329; P < 0.01). In measurements with open eyes, patients' KSS correlated with mean amplitude of sways (-0,227; P < 0.01) and max anteroposterior (-0.279; P < 0.01). In measurements with eyes closed, KSS function correlated with number of sways in the sagittal plane (0.331; P < 0.01). CONCLUSIONS Patients with severe osteoarthritis suffered from balance disorders regarding limbs' asymmetrical loading both under visual control and without visual control.
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Affiliation(s)
- A Truszczyńska-Baszak
- Faculty of Rehabilitation, Józef Piłsudski University of Physical Education in Warsaw, Warsaw, Poland; Professor A. Gruca Independent Public Research Hospital, Otwock Department of Orthopaedic Surgery, Centre of Postgraduate Medical Education, Poland.
| | - E Dadura
- Faculty of Rehabilitation, Józef Piłsudski University of Physical Education in Warsaw, Warsaw, Poland
| | | | - Adam Tarnowski
- Psychology Department, Warsaw University, Warsaw, Poland
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25
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Scronce G, Zhang W, Smith ML, Mercer VS. Characteristics Associated with Improved Physical Performance among Community-Dwelling Older Adults in a Community-Based Falls Prevention Program. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072509. [PMID: 32268621 PMCID: PMC7212756 DOI: 10.3390/ijerph17072509] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 03/25/2020] [Accepted: 04/03/2020] [Indexed: 01/01/2023]
Abstract
This was a retrospective analysis of quasi-longitudinal data from an ongoing, community-based falls prevention program. The purpose was to identify participant characteristics predicting improvement on physical performance measures associated with falls risk. Community-dwelling older adults ≥60 years old participated in a community-based implementation of the Otago Exercise Program (OEP). Participants with increased falls risk (n = 353) were provided with individualized exercises from OEP and were invited to return for monthly follow-up. One hundred twenty-eight participants returned for at least two follow-up visits within 6 months of their initial visit (mean time to second follow-up = 93 days with standard deviation = 43 days). Outcome measures assessed at initial and all follow-up visits included Four Stage Balance Test (4SBT), Timed Up and Go test (TUG), and Chair Rise Test (CRT). Distributions were examined, and results were categorized to depict improvement from initial visit (IVT) to second follow-up visit (F2). Key predictor variables were included in multivariable linear or logistic regression models. Improved 4SBT performance was predicted by greater balance confidence. Better TUG performance at F2 was predicted by no use of assistive device for walking, higher scores on cognitive screening, and better IVT TUG performance. Improvement on CRT was predicted by younger age and lower scores on cognitive screening. While improvements on each of the three measures were predicted by a unique combination of variables, these variables tended to be associated with less frailty.
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Affiliation(s)
- Gabrielle Scronce
- Curriculum in Human Movement Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Correspondence: ; Tel.: +1-919-451-1753
| | - Wanqing Zhang
- Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA;
| | - Matthew Lee Smith
- Center for Population Health and Aging, Texas A&M University, College Station, TX 77843, USA;
- Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, TX 77843, USA
- Department of Health Promotion and Behavior, College of Public Health, The University of Georgia, Athens, GA 30602, USA
| | - Vicki Stemmons Mercer
- Division of Physical Therapy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA;
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26
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Peultier-Celli L, Lion A, Chary-Valckenaere I, Loeuille D, Zhang Z, Rat AC, Gueguen R, Paysant J, Perrin PP. Comparison of high-frequency intensive balneotherapy with low-frequency balneotherapy combined with land-based exercise on postural control in symptomatic knee osteoarthritis: a randomized clinical trial. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2019; 63:1151-1159. [PMID: 31065841 DOI: 10.1007/s00484-019-01727-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 04/24/2019] [Accepted: 04/25/2019] [Indexed: 05/19/2023]
Abstract
Knee osteoarthritis (KOA) can generate postural control impairments which can increase fall risk. Land-based exercise (LBE) and balneotherapy are two modalities currently prescribed, but the impact of the latter on balance control has not been studied. This study aimed to compare two programs of balneotherapy with or without LBE to improve postural control, looking at frequency and duration of treatment. A total of 236 KOA patients (mean age = 64 years) were included in this prospective and randomized study: 122 patients went through 3 weeks of standardized continuous balneotherapy (high frequency/short duration) program (Gr1) and 114 went through 3 weeks of discontinuous (low frequency) balneotherapy program followed by 3 weeks of LBE (Gr2). The total number of treatment sessions was the same for both groups. Posturography was carried out before balneotherapy (W0) and at 3 (W3), 6 (W6), and 12 (W12) weeks after the beginning of treatment. Postural control increased in Gr1 from W0 to W3 and from W0 to W12 and in Gr2 from W0 to W6 and from W3 to W6. The improvement was greater in Gr1 from W0 to W3 and from W6 to W12 and in Gr2 from W3 to W6. High-frequency intensive balneotherapy improved posture control at 3 weeks, while low-frequency balneotherapy did not. This improvement persisted over a 12-week assessment period at the same level. LBE generated an improvement that did not persist over time. Sustained improvement of postural control requires high-frequency repetition of consecutive balneotherapy sessions.
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Affiliation(s)
- Laetitia Peultier-Celli
- EA 3450, Development, Adaptation and Handicap, Faculty of Medicine and UFR STAPS, University of Lorraine, F-54600 Villers-lès-Nancy, Nancy, France
- Laboratory for the Analysis of Posture, Equilibrium and Motor Function (LAPEM), University Hospital of Nancy, F-54500 Vandoeuvre-lès-Nancy, Nancy, France
| | - Alexis Lion
- EA 3450, Development, Adaptation and Handicap, Faculty of Medicine and UFR STAPS, University of Lorraine, F-54600 Villers-lès-Nancy, Nancy, France
- Laboratory for the Analysis of Posture, Equilibrium and Motor Function (LAPEM), University Hospital of Nancy, F-54500 Vandoeuvre-lès-Nancy, Nancy, France
- Fédération Luxembourgeoise des Associations de Sport de Santé, L-1445, Strassen, Luxembourg
| | - Isabelle Chary-Valckenaere
- Department of Rheumatology, University Hospital of Nancy, F-54511, Vandoeuvre-lès-Nancy, Nancy, France
- UMR-CNRS 7365, Ingénierie Moléculaire et Physiopathologie Articulaire-IMoPA, F-54500 Vandoeuvre-lès-Nancy, Nancy, France
| | - Damien Loeuille
- Department of Rheumatology, University Hospital of Nancy, F-54511, Vandoeuvre-lès-Nancy, Nancy, France
- UMR-CNRS 7365, Ingénierie Moléculaire et Physiopathologie Articulaire-IMoPA, F-54500 Vandoeuvre-lès-Nancy, Nancy, France
| | - Zheng Zhang
- EA 3450, Development, Adaptation and Handicap, Faculty of Medicine and UFR STAPS, University of Lorraine, F-54600 Villers-lès-Nancy, Nancy, France
- Department of Orthopaedics, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Anne-Christine Rat
- Department of Rheumatology, University Hospital of Nancy, F-54511, Vandoeuvre-lès-Nancy, Nancy, France
- INSERM, CIC-EC, CIE6, F-54000, Nancy, France
| | - René Gueguen
- EA 3450, Development, Adaptation and Handicap, Faculty of Medicine and UFR STAPS, University of Lorraine, F-54600 Villers-lès-Nancy, Nancy, France
| | - Jean Paysant
- EA 3450, Development, Adaptation and Handicap, Faculty of Medicine and UFR STAPS, University of Lorraine, F-54600 Villers-lès-Nancy, Nancy, France
- Regional Institute of Physical Medicine and Rehabilitation, F-54042, Nancy Cedex, France
| | - Philippe P Perrin
- EA 3450, Development, Adaptation and Handicap, Faculty of Medicine and UFR STAPS, University of Lorraine, F-54600 Villers-lès-Nancy, Nancy, France.
- Laboratory for the Analysis of Posture, Equilibrium and Motor Function (LAPEM), University Hospital of Nancy, F-54500 Vandoeuvre-lès-Nancy, Nancy, France.
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27
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Amano T, Suzuki N. Derivation of a clinical prediction rule to determine fall risk in community-dwelling individuals with knee osteoarthritis: a cross-sectional study. Arch Osteoporos 2019; 14:90. [PMID: 31420746 DOI: 10.1007/s11657-019-0641-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 08/06/2019] [Indexed: 02/03/2023]
Abstract
UNLABELLED We derived a clinical prediction rule (CPR) to determine fall risk. The probability of falls increased, with positive likelihood ratio being 17.8 and post-test probability (positive predictive value) being 88.2%, in cases where the CPR score was 2 points. Our CPR could be a useful screening test to detect fall risk probability. PURPOSE We aimed to examine the risk factors for falls in individuals with knee osteoarthritis (OA) and derive a clinical prediction rule (CPR) to determine fall risk. METHODS Eighty-one individuals with medial compartment knee OA were included. The outcome was whether the participants had a self-reported fall within the past 1 year of this study being conducted. The collected data included sex, age, body mass index, Kellgren-Lawrence grade, lesion type (bilateral or unilateral knee OA), pain (rated using the visual analog scale), muscle strength test of the quadriceps femoris, one-leg standing test (OLST), five times sit-to-stand test (FTSST), and 5-m walk test, which were used in binomial logistic regression analysis. The outcome measure of the analysis was whether the study participants belonged to a fall or non-fall group. Receiver operating characteristic (ROC) analysis was performed for the outcome measurements, and the factors were selected by binomial logistic regression analysis. Then, a CPR to determine fall risk was extracted, and its diagnostic characteristics were calculated. RESULTS Binomial logistic regression analysis showed that the OLST and FTSST were significant. ROC analysis showed that the cut-off values of the OLST and FTSST were 5.3 s and 7.9 s, respectively. The post-test probability (positive predictive value) increased to 88.2% (positive likelihood ratio = 17.8) when the OLST and FTSST were both positive (the CPR score was 2 points). CONCLUSION The CPR obtained from this study would be useful as a screening test to detect the fall risk probability in individuals with knee OA.
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Affiliation(s)
- Tetsuya Amano
- Department of Physical Therapy, Faculty of Health and Medical Sciences, Tokoha University, 1230 Miyakoda-cho, Kita-ku, Hamamatsu, Shizuoka, 431-2102, Japan.
| | - Nobuharu Suzuki
- Department of Physical Therapy, Faculty of Health and Medical Sciences, Tokoha University, 1230 Miyakoda-cho, Kita-ku, Hamamatsu, Shizuoka, 431-2102, Japan
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28
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Collins NJ, Hart HF, Mills KAG. Osteoarthritis year in review 2018: rehabilitation and outcomes. Osteoarthritis Cartilage 2019; 27:378-391. [PMID: 30529739 DOI: 10.1016/j.joca.2018.11.010] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 11/14/2018] [Accepted: 11/29/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Conduct a systematic review of systematic reviews and randomised controlled trials (RCTs) from the past year evaluating rehabilitation for people with osteoarthritis, and provide narrative synthesis of findings focused on core recommended treatments for osteoarthritis (exercise, education, biomechanical interventions, weight loss). DESIGN A comprehensive search strategy was used to search PubMed, EMBASE and Cochrane databases (16th May 2017 to 22nd March 2018). Search terms included 'osteoarthritis', 'rehabilitation', 'systematic review', and 'randomised controlled trial'. Inclusion criteria were: (1) RCT, or systematic review of randomised clinical trials (RCTs); (2) human participants with osteoarthritis (any joint); (3) evaluation of rehabilitation intervention; and (4) at least one patient-reported measure. Methodological quality was evaluated using the Assessment of Multiple Systematic Reviews (AMSTAR) tool (systematic reviews) and PEDro rating scale (RCTs). Narrative synthesis mapped findings to core recommendations from existing osteoarthritis clinical guidelines. RESULTS From 1994 records, 13 systematic reviews and 36 RCTs were included. 73% of these evaluated knee osteoarthritis (36 studies). The remaining studies evaluated hand osteoarthritis (6 studies), hip, hip/knee and general osteoarthritis (each 2 studies), and neck osteoarthritis (1 study). Exercise was the most common intervention evaluated (31%). Updated recommendations for exercise prescription and preliminary guidance for psychological interventions are provided. CONCLUSION Level 1 and 2 osteoarthritis rehabilitation literature continues to be dominated by knee osteoarthritis studies. Consistent with current clinical guidelines, exercise should be a core treatment for osteoarthritis, but future studies should ensure that exercise programs follow published dose guidelines. There is a clear need for research on rehabilitation for hip, hand, foot/ankle, shoulder and spine osteoarthritis.
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Affiliation(s)
- N J Collins
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia; La Trobe Sport and Exercise Medicine Research Centre, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia.
| | - H F Hart
- La Trobe Sport and Exercise Medicine Research Centre, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia; School of Physical Therapy and Bone and Joint Institute, The University of Western Ontario, London, Ontario, Canada
| | - K A G Mills
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
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Tan PJ, Khoo EM, Chinna K, Saedon NI, Zakaria MI, Ahmad Zahedi AZ, Ramli N, Khalidin N, Mazlan M, Chee KH, Zainal Abidin I, Nalathamby N, Mat S, Jaafar MH, Khor HM, Khannas NM, Majid LA, Tan KM, Chin AV, Kamaruzzaman SB, Poi P, Morgan K, Hill KD, MacKenzie L, Tan MP. Individually-tailored multifactorial intervention to reduce falls in the Malaysian Falls Assessment and Intervention Trial (MyFAIT): A randomized controlled trial. PLoS One 2018; 13:e0199219. [PMID: 30074996 PMCID: PMC6075745 DOI: 10.1371/journal.pone.0199219] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Accepted: 06/02/2018] [Indexed: 11/25/2022] Open
Abstract
Objective To determine the effectiveness of an individually-tailored multifactorial intervention in reducing falls among at risk older adult fallers in a multi-ethnic, middle-income nation in South-East Asia. Design Pragmatic, randomized-controlled trial. Setting Emergency room, medical outpatient and primary care clinic in a teaching hospital in Kuala Lumpur, Malaysia. Participants Individuals aged 65 years and above with two or more falls or one injurious fall in the past 12 months. Intervention Individually-tailored interventions, included a modified Otago exercise programme, HOMEFAST home hazards modification, visual intervention, cardiovascular intervention, medication review and falls education, was compared against a control group involving conventional treatment. Primary and secondary outcome measures The primary outcome was any fall recurrence at 12-month follow-up. Secondary outcomes were rate of fall and time to first fall. Results Two hundred and sixty-eight participants (mean age 75.3 ±7.2 SD years, 67% women) were randomized to multifactorial intervention (n = 134) or convention treatment (n = 134). All participants in the intervention group received medication review and falls education, 92 (68%) were prescribed Otago exercises, 86 (64%) visual intervention, 64 (47%) home hazards modification and 51 (38%) cardiovascular intervention. Fall recurrence did not differ between intervention and control groups at 12-months [Risk Ratio, RR = 1.037 (95% CI 0.613–1.753)]. Rate of fall [RR = 1.155 (95% CI 0.846–1.576], time to first fall [Hazard Ratio, HR = 0.948 (95% CI 0.782–1.522)] and mortality rate [RR = 0.896 (95% CI 0.335–2.400)] did not differ between groups. Conclusion Individually-tailored multifactorial intervention was ineffective as a strategy to reduce falls. Future research efforts are now required to develop culturally-appropriate and affordable methods of addressing this increasingly prominent public health issue in middle-income nations. Trial registration ISRCTN Registry no. ISRCTN11674947
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Affiliation(s)
- Pey June Tan
- Ageing and Age-Associated Disorders Research Group, University of Malaya, Kuala Lumpur, Malaysia
- Geriatric Education and Research Institute, Singapore
| | - Ee Ming Khoo
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Karuthan Chinna
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Nor I’zzati Saedon
- Ageing and Age-Associated Disorders Research Group, University of Malaya, Kuala Lumpur, Malaysia
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mohd Idzwan Zakaria
- Department of Trauma and Emergency Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Norlina Ramli
- Department of Ophthalmology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Nurliza Khalidin
- Department of Ophthalmology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mazlina Mazlan
- Department of Rehabilitation Medicine, Faculty of Medicine, University of Malaya, Kuala Limpur, Malaysia
| | - Kok Han Chee
- Division of Cardiology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Imran Zainal Abidin
- Division of Cardiology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Nemala Nalathamby
- Ageing and Age-Associated Disorders Research Group, University of Malaya, Kuala Lumpur, Malaysia
| | - Sumaiyah Mat
- Ageing and Age-Associated Disorders Research Group, University of Malaya, Kuala Lumpur, Malaysia
| | - Mohamad Hasif Jaafar
- Ageing and Age-Associated Disorders Research Group, University of Malaya, Kuala Lumpur, Malaysia
| | - Hui Min Khor
- Ageing and Age-Associated Disorders Research Group, University of Malaya, Kuala Lumpur, Malaysia
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Norfazilah Mohamad Khannas
- Department of Rehabilitation Medicine, Kuala Lumpur, University of Malaya Medical Centre, Kuala Limpur, Malaysia
| | - Lokman Abdul Majid
- Department of Rehabilitation Medicine, Kuala Lumpur, University of Malaya Medical Centre, Kuala Limpur, Malaysia
| | - Kit Mun Tan
- Ageing and Age-Associated Disorders Research Group, University of Malaya, Kuala Lumpur, Malaysia
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ai-Vyrn Chin
- Ageing and Age-Associated Disorders Research Group, University of Malaya, Kuala Lumpur, Malaysia
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Shahrul Bahyah Kamaruzzaman
- Ageing and Age-Associated Disorders Research Group, University of Malaya, Kuala Lumpur, Malaysia
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Philip Poi
- Ageing and Age-Associated Disorders Research Group, University of Malaya, Kuala Lumpur, Malaysia
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Karen Morgan
- Department Psychology and Behavioural Science, Perdana University-RCSI School of Medicine, Serdang, Selangor, Malaysia
| | - Keith D. Hill
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Lynette MacKenzie
- Department of Occupational Therapy, Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - Maw Pin Tan
- Ageing and Age-Associated Disorders Research Group, University of Malaya, Kuala Lumpur, Malaysia
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- * E-mail:
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Affiliation(s)
- J E Morley
- John E. Morley, MB,BCh, Division of Geriatric Medicine, Saint Louis University School of Medicine, 1402 S. Grand Blvd., M238, St. Louis, MO 63104,
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