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Ringsten M, Ivanic B, Iwarsson S, Lexell EM. Interventions to improve outdoor mobility among people living with disabilities: A systematic review. CAMPBELL SYSTEMATIC REVIEWS 2024; 20:e1407. [PMID: 38882933 PMCID: PMC11177337 DOI: 10.1002/cl2.1407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 03/28/2024] [Accepted: 04/03/2024] [Indexed: 06/18/2024]
Abstract
Background Around 15% of the global population live with some form of disabilities and experience worse health outcomes, less participation in the community and are part of fewer activities outside the home. Outdoor mobility interventions aim to improve the ability to move, travel and orient outside the home and could influence the number of activities outside the home, participation and quality of life. However, outdoor mobility interventions may also lead to harm like falls or injuries or have unforeseen effects which could lead to mortality or hospitalization. Objectives To assess the efficacy of interventions aiming to improve outdoor mobility for adults living with disabilities and to explore if the efficacy varies between different conditions and different intervention components. Search Methods Standard, extensive Campbell search methods were used, including a total of 12 databases searched during January 2023, including trial registries. Selection Criteria Only randomized controlled trials were included, focusing on people living with disabilities, comparing interventions to improve outdoor mobility to control interventions as well as comparing different types of interventions to improve outdoor mobility. Data Collection and Analysis Standard methodological procedures expected by Campbell were used. The following important outcomes were 1. Activity outside the home; 2. Engagement in everyday life activities; 3. Participation; 4. Health-related Quality of Life; 5. Major harms; 6. Minor harms. The impact of the interventions was evaluated in the shorter (≤6 months) and longer term (≥7 months) after starting the intervention. Results are presented using risk ratios (RR), risk difference (RD), and standardized mean differences (SMD), with the associated confidence intervals (CI). The risk of bias 2-tool and the GRADE-framework were used to assess the certainty of the evidence. Main Results The screening comprised of 12.894 studies and included 22 studies involving 2.675 people living with disabilities and identified 12 ongoing studies. All reported outcomes except one (reported in one study, some concerns of bias) had overall high risk of bias. Thirteen studies were conducted in participants with disabilities due to stroke, five studies with older adults living with disabilities, two studies with wheelchair users, one study in participants with disabilities after a hip fracture, and one study in participants with cognitive impairments. Skill training interventions versus control interventions (16 studies) The evidence is very uncertain about the benefits and harms of skill training interventions versus control interventions not aimed to improve outdoor mobility among all people living with disabilities both in the shorter term (≤6 months) and longer term (≥7 months) for Activity outside the home; Participation; Health-related Quality of Life; Major harms; and Minor harms, based on very low certainty evidence. Skill training interventions may improve engagement in everyday life activities among people with disabilities in the shorter term (RR: 1.46; 95% CI: 1.16 to 1.84; I 2 = 7%; RD: 0.15; 95% CI: -0.02 to 0.32; I 2 = 71%; 692 participants; three studies; low certainty evidence), but the evidence is very uncertain in the longer term, based on very low certainty evidence. Subgroup analysis of skill training interventions among people living with disabilities due to cognitive impairments suggests that such interventions may improve activity outside the home in the shorter term (SMD: 0.44; 95% CI: 0.07 to 0.81; I 2 = NA; 118 participants; one study; low certainty evidence). Subgroup analysis of skill training interventions among people living with cognitive impairments suggests that such interventions may improve health-related quality of life in the shorter term (SMD: 0.49; 95% CI: 0.12 to 0.88; I 2 = NA; 118 participants; one study; low certainty evidence). Physical training interventions versus control interventions (five studies) The evidence is very uncertain about the benefits and harms of physical training interventions versus control interventions not aimed to improve outdoor mobility in the shorter term (≤6 months) and longer term (≥7 months) for: Engagement in everyday life activities; Participation; Health-related Quality of Life; Major harms; and Minor harms, based on very low certainty evidence. Physical training interventions may improve activity outside the home in the shorter (SMD: 0.35; 95% CI: 0.08 to 0.61; I 2 = NA; 228 participants; one study; low certainty evidence) and longer term (≥7 months) (SMD: 0.27; 95% CI: 0.00 to 0.54; I 2 = NA; 216 participants; one study; low certainty evidence). Comparison of different outdoor mobility interventions (one study) The evidence is very uncertain about the benefits and harms of outdoor mobility interventions of different lengths in the shorter term (≤6 months) and longer term (≥7 months) for Activity outside the home; Engagement in everyday life activities; Participation; Health-related Quality of Life; Major harms; and Minor harms, based on very low certainty evidence. No studies explored the efficacy of other types of interventions. Authors’ Conclusions Twenty-two studies of interventions to improve outdoor mobility for people living with disabilities were identified, but the evidence still remains uncertain about most benefits and harms of these interventions, both in the short- and long term. This is primarily related to risk of bias, small underpowered studies and limited reporting of important outcomes for people living with disabilities. For people with disabilities, skill training interventions may improve engagement in everyday life in the short term, and improve activity outside the home and health-related quality of life for people with cognitive impairments in the short term. Still, this is based on low certainty evidence from few studies and should be interpreted with caution. One study with low certainty evidence suggests that physical training interventions may improve activity outside the home in the short term. In addition, the effect sizes across all outcomes were considered small or trivial, and could be of limited relevance to people living with disabilities. The evidence is currently uncertain if there are interventions that can improve outdoor mobility for people with disabilities, and can improve other important outcomes, while avoiding harms. To guide decisions about the use of interventions to improve outdoor mobility, future studies should use more rigorous design and report important outcomes for people with disabilities to reduce the current uncertainty.
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Affiliation(s)
- Martin Ringsten
- Cochrane Sweden, Research and Development Skåne University Hospital Lund Sweden
- Department of Health Sciences Lund University Lund Sweden
| | | | | | - Eva Månsson Lexell
- Department of Health Sciences Lund University Lund Sweden
- Department of Neurology, Rehabilitation Medicine, Cognitive Medicine and Geriatrics Skåne University Hospital Lund-Malmö Sweden
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An Active Retirement Programme, a Randomized Controlled Trial of a Sensorimotor Training Programme for Older Adults: A Study Protocol. Healthcare (Basel) 2022; 11:healthcare11010086. [PMID: 36611545 PMCID: PMC9819127 DOI: 10.3390/healthcare11010086] [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: 11/17/2022] [Revised: 12/19/2022] [Accepted: 12/25/2022] [Indexed: 12/29/2022] Open
Abstract
Research shows that exercise training programmes lead to several improvements in older adults' health-related quality of life (HRQoL) and well-being. This study will examine the effects of an active retirement programme on Portuguese older adults, investigating its effects on body composition, physical fitness, HRQoL, and physical activity level (PAL). Therefore, a parallel-group randomised controlled trial will be conducted, including body composition (height and body weight), physical fitness (strength, flexibility, agility, postural control, and gait), HRQoL, and PAL assessments before and after the application of the programme. The programme will be carried out for six months, two days per week (45 min), plus a year of follow-up. The programme will consist of six circuits with eight physical exercises each. The circuits will change at the end of the four weeks (one monthly circuit). The exercises' difficulty will increase throughout the programme, with alternatives for all the participants. If the effectiveness of the programme is demonstrated, implementation in different services and municipalities could be advised, as the actors involved in health and social services should promote the well-being of their citizens through, among others, health-related physical activity and the prevention of diseases associated with inactivity.
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Hartley P, Keating JL, Jeffs KJ, Raymond MJ, Smith TO. Exercise for acutely hospitalised older medical patients. Cochrane Database Syst Rev 2022; 11:CD005955. [PMID: 36355032 PMCID: PMC9648425 DOI: 10.1002/14651858.cd005955.pub3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Approximately 30% of hospitalised older adults experience hospital-associated functional decline. Exercise interventions that promote in-hospital activity may prevent deconditioning and thereby maintain physical function during hospitalisation. This is an update of a Cochrane Review first published in 2007. OBJECTIVES To evaluate the benefits and harms of exercise interventions for acutely hospitalised older medical inpatients on functional ability, quality of life (QoL), participant global assessment of success and adverse events compared to usual care or a sham-control intervention. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was May 2021. SELECTION CRITERIA We included randomised or quasi-randomised controlled trials evaluating an in-hospital exercise intervention in people aged 65 years or older admitted to hospital with a general medical condition. We excluded people admitted for elective reasons or surgery. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our major outcomes were 1. independence with activities of daily living; 2. functional mobility; 3. new incidence of delirium during hospitalisation; 4. QoL; 5. number of falls during hospitalisation; 6. medical deterioration during hospitalisation and 7. participant global assessment of success. Our minor outcomes were 8. death during hospitalisation; 9. musculoskeletal injuries during hospitalisation; 10. hospital length of stay; 11. new institutionalisation at hospital discharge; 12. hospital readmission and 13. walking performance. We used GRADE to assess certainty of evidence for each major outcome. We categorised exercise interventions as: rehabilitation-related activities (interventions designed to increase physical activity or functional recovery, but did not follow a specified exercise protocol); structured exercise (interventions that included an exercise intervention protocol but did not include progressive resistance training); and progressive resistance exercise (interventions that included an element of progressive resistance training). MAIN RESULTS We included 24 studies (nine rehabilitation-related activity interventions, six structured exercise interventions and nine progressive resistance exercise interventions) with 7511 participants. All studies compared exercise interventions to usual care; two studies, in addition to usual care, used sham interventions. Mean ages ranged from 73 to 88 years, and 58% of participants were women. Several studies were at high risk of bias. The most common domain assessed at high risk of bias was measurement of the outcome, and five studies (21%) were at high risk of bias arising from the randomisation process. Exercise may have no clinically important effect on independence in activities of daily living at discharge from hospital compared to controls (16 studies, 5174 participants; low-certainty evidence). Five studies used the Barthel Index (scale: 0 to 100, higher scores representing greater independence). Mean scores at discharge in the control groups ranged from 42 to 96 points, and independence in activities of daily living was 1.8 points better (0.43 worse to 4.12 better) with exercise compared to controls. The minimally clinical important difference (MCID) is estimated to be 11 points. We are uncertain regarding the effect of exercise on functional mobility at discharge from the hospital compared to controls (8 studies, 2369 participants; very low-certainty evidence). Three studies used the Short Physical Performance Battery (SPPB) (scale: 0 to 12, higher scores representing better function) to measure functional mobility. Mean scores at discharge in the control groups ranged from 3.7 to 4.9 points on the SPPB, and the estimated effect of the exercise interventions was 0.78 points better (0.02 worse to 1.57 better). A change of 1 point on the SPPB represents an MCID. We are uncertain regarding the effect of exercise on the incidence of delirium during hospitalisation compared to controls (7 trials, 2088 participants; very low-certainty evidence). The incidence of delirium during hospitalisation was 88/1091 (81 per 1000) in the control group compared with 70/997 (73 per 1000; range 47 to 114) in the exercise group (RR 0.90, 95% CI 0.58 to 1.41). Exercise interventions may result in a small clinically unimportant improvement in QoL at discharge from the hospital compared to controls (4 studies, 875 participants; low-certainty evidence). Mean QoL on the EuroQol 5 Dimensions (EQ-5D) visual analogue scale (VAS) (scale: 0 to 100, higher scores representing better QoL) ranged between 48.9 and 64.7 in the control group at discharge from the hospital, and QoL was 6.04 points better (0.9 better to 11.18 better) with exercise. A change of 10 points on the EQ-5D VAS represents an MCID. No studies measured participant global assessment of success. Exercise interventions did not affect the risk of falls during hospitalisation (moderate-certainty evidence). The incidence of falls was 31/899 (34 per 1000) in the control group compared with 31/888 (34 per 1000; range 20 to 57) in the exercise group (RR 0.99, 95% CI 0.59 to 1.65). We are uncertain regarding the effect of exercise on the incidence of medical deterioration during hospitalisation (very low-certainty evidence). The incidence of medical deterioration in the control group was 101/1417 (71 per 1000) compared with 96/1313 (73 per 1000; range 44 to 120) in the exercise group (RR 1.02, 95% CI 0.62 to 1.68). Subgroup analyses by different intervention categories and by the use of a sham intervention were not meaningfully different from the main analyses. AUTHORS' CONCLUSIONS Exercise may make little difference to independence in activities of daily living or QoL, but probably does not result in more falls in older medical inpatients. We are uncertain about the effect of exercise on functional mobility, incidence of delirium and medical deterioration. Certainty of evidence was limited by risk of bias and inconsistency. Future primary research on the effect of exercise on acute hospitalisation could focus on more consistent and uniform reporting of participant's characteristics including their baseline level of functional ability, as well as exercise dose, intensity and adherence that may provide an insight into the reasons for the observed inconsistencies in findings.
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Affiliation(s)
- Peter Hartley
- Department of Physiotherapy, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | | | - Kimberley J Jeffs
- Department of Aged Care, Northern Health, Epping, Australia
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Australia
| | - Melissa Jm Raymond
- Physiotherapy Department, Caulfield Hospital, Alfred Health, Melbourne, Australia
- College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
| | - Toby O Smith
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
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Effects of a Physically Active Lifestyle Modification (PALM) Program for Independent Taiwanese Older Adults. TOPICS IN GERIATRIC REHABILITATION 2022. [DOI: 10.1097/tgr.0000000000000356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Postural Control in Older Adults During and Following a 12-Week Balance Training Intervention With Attentional Focus Instructions. JOURNAL OF MOTOR LEARNING AND DEVELOPMENT 2021. [DOI: 10.1123/jmld.2021-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Adults (N = 54, 80.78 ± 6.08 years) who reported falling during the previous 12 months participated in a 12-week wobble board training program with internal focus or external focus (EF) instructions. Verbal manipulation checks were performed after training sessions as a self-report of the attentional foci used. The percentage of sessions in which participants reported using an EF (EFSR) was subsequently calculated. Mean velocity and mean power frequency in the anterior–posterior (MVELOAP and MPFAP) and medial–lateral (MVELOML and MPFML) direction were assessed during a 35-s wobble board task at Weeks 0, 6, 12, 13, 16, and 20, with the latter three as retention tests. Piecewise linear growth models estimated treatment effects on individual growth trajectories of MVELOAP and ML and MPFAP and ML during intervention and retention periods. Regardless of condition, MVELOML significantly decreased (π = −.0019, p = .005) and MPFML increased (π = .025, p < .02) during the intervention period. In analyses including interaction terms, participants in the EF group who reported greater EFSR had superior progression of MPFAP during the intervention (π = .0013, p = .025). Verbal manipulation checks suggest a preference for and advantage of EF for facilitating postural control performance and automaticity.
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Evaluating the Association Between Hearing Loss and Falls in Adults With Vestibular Dysfunction or Nonvestibular Dizziness. Ear Hear 2021; 43:1003-1012. [PMID: 34751678 PMCID: PMC9010359 DOI: 10.1097/aud.0000000000001156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Although emerging evidence suggests that hearing loss (HL) is an independent risk factor for falls, it is unclear how HL may impact falls risk in adults with vestibular dysfunction and nonvestibular dizziness. The purpose of this study was to characterize the impact of HL on falls in patients with vestibular dysfunction and nonvestibular dizziness relative to a group of patients without dizziness. In addition, this study aimed to evaluate whether there was an interactive effect between HL and vestibular dysfunction or nonvestibular dizziness on the odds of falling. DESIGN The authors conducted a retrospective cross-sectional study of 2,750 adult patients with dizziness evaluated at a tertiary care center vestibular clinic between June 1, 2015, and October 7, 2020. Only patients with available self-reported falls status, as extracted from the electronic medical record, were included. Patients were classified into the following diagnostic groups based on rotary chair testing and videonystagmography: benign paroxysmal positional vertigo (BPPV, n = 255), unilateral vestibular hypofunction (UVH, n = 456), bilateral vestibular hypofunction (BVH, n = 38), central dysfunction (n = 208), multiple diagnoses (n = 109), and dizzy, nonvestibular (n = 1,389). A control group of patients without dizziness (n = 295) was identified by a random sample of audiology patients. Degree of HL was characterized by the 4-frequency pure tone average (PTA) (0.5, 1, 2, and 4 kHz) of the better hearing ear. Demographic variables, comorbidities, cognitive impairment status, and falls-associated medications were extracted from the electronic medical record and included as covariates during analysis. Potential associations between PTA and falls status and possible interactions between diagnostic group and PTA were explored using multivariate logistic regression. RESULTS The BVH and central dysfunction groups had the highest rates of self-reported falls at 26.3% and 26.9%, respectively. The control group had the lowest rate of self-reported falls at 6.4%. With the exception of the multiple diagnoses group, all diagnostic groups had elevated odds of falling compared with the control group, when adjusting for demographics, comorbidities, cognitive impairment status, and falls-associated medications. There was no significant association between degree of HL and falls status (odds ratio [OR] = 1.02; 95% confidence interval [CI] = 0.93, 1.11; p = 0.713) when adjusting for diagnostic group and all other covariates. Furthermore, there were no significant interactions between diagnostic group and degree of HL on the odds of falling. CONCLUSIONS These results indicate that HL was not associated with falls in patients with vestibular dysfunction or nonvestibular dizziness, while adjusting for demographics, comorbidities, and falls-associated medications. There was no significant interactive effect observed between HL and vestibular dysfunction or nonvestibular dizziness on the odds of falling. As previously reported, vestibular dysfunction and nonvestibular dizziness were independently associated with falls relative to a group of patients without dizziness. A population-based study utilizing more robust falls data is needed to explore a potential association between HL and falls in those with vestibular dysfunction.
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Caristia S, Campani D, Cannici C, Frontera E, Giarda G, Pisterzi S, Terranova L, Payedimarri AB, Faggiano F, Dal Molin A. Physical exercise and fall prevention: A systematic review and meta-analysis of experimental studies included in Cochrane reviews. Geriatr Nurs 2021; 42:1275-1286. [PMID: 34555570 DOI: 10.1016/j.gerinurse.2021.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 05/31/2021] [Accepted: 06/02/2021] [Indexed: 01/04/2023]
Abstract
The aim of this systematic review (SR) and meta-analysis was to assess what type of exercise is associated with fall risk reduction among apparently healthy adults aged 50 and older. We conducted a SR by searching for randomized controlled trials (RCTs) included in Cochrane SRs published until October 2019. Five SRs that compared exercise versus any type of control included 32 RCTs. The outcomes examined were falls, fallers, fractures, and fear of falling. A random effects-based meta-analysis by type of exercise was performed. Almost all the interventions were effective for fall rate reduction, with a major effect for three-dimensional exercise, strength/resistance exercises, and mixed exercises. The number of fallers was reduced by three-dimensional exercise and mixed exercises. Fall-related fractures were generally reduced by all types of exercises considered all together, but none singly resulted in statistically effective fracture prevention. Fear of falling was slightly decreased with endurance exercises.
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Affiliation(s)
- Silvia Caristia
- Department of Translational Medicine, Università del Piemonte Orientale, Via G. Solaroli 17, Novara 28100, Italy
| | - Daiana Campani
- Department of Translational Medicine, Università del Piemonte Orientale, Via G. Solaroli 17, Novara 28100, Italy.
| | - Chiara Cannici
- Hematology Department, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Via Venezia, 16, Alessandria 15121, Italy
| | - Edoardo Frontera
- S. Andrea Hospital, Local Health Unit of Vercelli, Corso M. Abbiate 21, Vercelli 13100, Italy
| | - Giulia Giarda
- D.E.A. of Local Health Unit of Torino, Corso Galileo Ferraris 3, Chivasso 10034, Italy
| | - Sara Pisterzi
- Hospital of Local Health Unit of Biella, Via dei Ponderanesi 2, Ponderano 13875, Italy
| | - Luisa Terranova
- Hospital of Local Health Unit of Biella, Via dei Ponderanesi 2, Ponderano 13875, Italy
| | - Anil Babu Payedimarri
- Department of Translational Medicine, Università del Piemonte Orientale, Via G. Solaroli 17, Novara 28100, Italy
| | - Fabrizio Faggiano
- Department of Translational Medicine, Università del Piemonte Orientale, Via G. Solaroli 17, Novara 28100, Italy
| | - Alberto Dal Molin
- Department of Translational Medicine, Università del Piemonte Orientale, Via G. Solaroli 17, Novara 28100, Italy; Health Professions' Direction, Maggiore della Carità Hospital, Corso Mazzini 18, Novara 28100, Italy
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Kollock R, Thomas J, Hale D, Sanders G, Long A, Dawes J, Peveler W. The Effects of Firefighter Equipment and Gear on the Static and Dynamic Postural Stability of Fire Cadets. Gait Posture 2021; 88:292-296. [PMID: 34153807 DOI: 10.1016/j.gaitpost.2021.05.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 04/28/2021] [Accepted: 05/11/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Slips, trips, falls, and jumps were the second leading cause of injuries at the fireground. RESEARCH QUESTION The purpose of this study was to explore the effects of firefighter equipment and gear (EQG) on postural stability and determine if load per kg of body mass (L/BM) is associated with postural stability. METHODS 26 male fire cadets (26.15 ± 4.16 yr., 178.92 ± 6.92 cm, 86.61 ± 9.09 kg) were included in the analyses. Participants performed 3 single-leg landings (SLL) with and without EQG. The first 3 seconds of ground reaction forces following initial ground contact were used to calculate dynamic postural stability index (DPSI). Participants completed 2 static balance tasks (normal stability and limits of stability (LoS)) with and without EQG. Main outcome measures were overall LoS score (LoSS), direction-specific LoSS, and LoS distance (cm) of COP excursion (LoSD) in the anterior, posterior, right, and left directions. Separate paired-samples t-tests were run to determine the differences between load conditions for DPSI, overall LoSS, direction-specific LoSS, and LoSD in all directions. Bivariate correlations were conducted to determine the relationship of L/BM to DPSI, overall LoSS, and LoSS and LoSD in the anterior, posterior, right and left directions. RESULTS Due to the use of multiple statistical tests, a Bonferroni correction was used, and the alpha level of .05 was adjusted to .005. DPSI was significantly higher loaded than unloaded, t(25) = -13.965, p < .001, d = 7.032, 95% CI, -0.133 to -0.099. No other comparisons were significant. A significant strong positive correlation (r(24) = .665, p < .001) was observed between L/BM and DPSI. No other correlations were significant. SIGNIFICANCE This study demonstrates that firefighter EQG may significantly impact a cadet's ability to maintain postural stability while performing their duties.
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Affiliation(s)
- Roger Kollock
- The University of Tulsa, 800 S Tucker Drive, Tulsa, OK, 74104, USA.
| | - Jacob Thomas
- The University of Tulsa, 800 S Tucker Drive, Tulsa, OK, 74104, USA.
| | - Davis Hale
- The University of Tulsa, 800 S Tucker Drive, Tulsa, OK, 74104, USA.
| | - Gabriel Sanders
- Northern Kentucky University, Louie B Nunn Dr, Highland Heights, KY, 41099, USA.
| | - Alex Long
- The University of Tulsa, 800 S Tucker Drive, Tulsa, OK, 74104, USA.
| | - Jay Dawes
- Oklahoma State University, CRC 183, Stillwater, OK, 74078, USA.
| | - Will Peveler
- Liberty University, 1971 University Blvd, Lynchburg, VA, 24515, USA.
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Pothier K, Vrinceanu T, Intzandt B, Bosquet L, Karelis AD, Lussier M, Vu TTM, Nigam A, Li KZH, Berryman N, Bherer L. A comparison of physical exercise and cognitive training interventions to improve determinants of functional mobility in healthy older adults. Exp Gerontol 2021; 149:111331. [PMID: 33774144 DOI: 10.1016/j.exger.2021.111331] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/12/2021] [Accepted: 03/22/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Mobility is a complex but crucial clinical outcome in older adults. Past observational studies have highlighted that cardiorespiratory fitness (CRF), energy cost of walking (ECW), and cognitive switching abilities are associated with mobility performance, making these key determinants of mobility intervention targets to enhance mobility in older adults. The objective of this study was to compare, in the same design, the impact of three training methods - each known to improve either CRF, ECW, or cognitive switching abilities - on mobility in healthy older adults. METHODS Seventy-eight participants (69.28 ± 4.85yo) were randomly assigned to one of three twelve-week interventions: Aerobic Exercise (AE; n = 26), Gross Motor Abilities (GMA; n = 27), or Cognitive (COG; n = 25) training. Each intervention was designed to improve one of the three key determinants of mobility (CRF, ECW, and cognitive switching). Primary outcomes (usual gait speed, and TUG performance) and the three mobility determinants were measured before and after the intervention. RESULTS Repeated-measures ANOVAs showed a time effect for TUG performance (F(1,75) = 14.92, p < .001): all groups equally improved after the intervention (ΔTUGpost-pre, in seconds, with 95% CI: AE = -0.44 [-0.81 to -0.08]; GMA = -0.60 [-1.10 to -0.10]; COG = -0.33 [-0.71 to 0.05]). No significant between group differences were observed. CRF was improved in the AE group only (Hedges' G = 0.27, small effect), ECW and cognitive switching improved the most in the GMA (Hedges' G = -0.78, moderate effect) and COG groups (Hedges' G = -1.93, large effect) respectively. Smaller improvements in ECW were observed following AE and COG trainings (Hedges' G: AE = -0.39, COG = -0.36, both small effects) as well as in cognitive switching following AE and GMA training (Hedges' G: AE = -0.42, GMA = -0.21, both small effects). DISCUSSION This study provides further support to the notion that multiple interventional approaches (aerobic, gross motor exercise, or cognitive training) can be employed to improve functional mobility in older adults, giving them, and professionals, more options to promote healthy ageing.
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Affiliation(s)
- Kristell Pothier
- Research Centre, Institut Universitaire de Gériatrie de Montréal, Montréal, Canada; PERFORM Centre, Concordia University, Montréal, Canada; EA 2114, Psychologie des Âges de la Vie et Adaptation, University of Tours, Tours, France.
| | - Tudor Vrinceanu
- Research Centre, Institut Universitaire de Gériatrie de Montréal, Montréal, Canada; Research Centre, Montreal Heart Institute, Montréal, Canada; Department of Medicine, University of Montréal, Montréal, Canada
| | - Brittany Intzandt
- Research Centre, Institut Universitaire de Gériatrie de Montréal, Montréal, Canada; PERFORM Centre, Concordia University, Montréal, Canada; Research Centre, Montreal Heart Institute, Montréal, Canada
| | - Laurent Bosquet
- Laboratory MOVE (EA 6314), Faculty of Sport Sciences, University of Poitiers, Poitiers, France
| | - Antony D Karelis
- Research Centre, Institut Universitaire de Gériatrie de Montréal, Montréal, Canada; Département des Sciences de l'Activité Physique, Université du Québec à Montréal, Montréal, QC, Canada
| | - Maxime Lussier
- Research Centre, Institut Universitaire de Gériatrie de Montréal, Montréal, Canada; Rehabilitation Science, Faculty of Medicine, University of Montréal, Montréal, Canada
| | - T T Minh Vu
- Department of Medicine, University of Montréal, Montréal, Canada; Research Centre, Centre hospitalier de l'Université de Montréal, Montréal, Canada
| | - Anil Nigam
- Research Centre, Montreal Heart Institute, Montréal, Canada; Department of Medicine, University of Montréal, Montréal, Canada
| | - Karen Z H Li
- PERFORM Centre, Concordia University, Montréal, Canada; Department of Psychology, Concordia University, Montreal, QC, Canada; Centre for Research in Human Development, Concordia University, Montreal, QC, Canada
| | - Nicolas Berryman
- Research Centre, Institut Universitaire de Gériatrie de Montréal, Montréal, Canada; Laboratory MOVE (EA 6314), Faculty of Sport Sciences, University of Poitiers, Poitiers, France; Département des Sciences de l'Activité Physique, Université du Québec à Montréal, Montréal, QC, Canada; Department of Sports Studies, Bishop's University, Sherbrooke, Canada
| | - Louis Bherer
- Research Centre, Institut Universitaire de Gériatrie de Montréal, Montréal, Canada; PERFORM Centre, Concordia University, Montréal, Canada; Research Centre, Montreal Heart Institute, Montréal, Canada; Department of Medicine, University of Montréal, Montréal, Canada.
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10
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Brahms M, Heinzel S, Rapp M, Reisner V, Wahmkow G, Rimpel J, Schauenburg G, Stelzel C, Granacher U. Cognitive-Postural Multitasking Training in Older Adults - Effects of Input-Output Modality Mappings on Cognitive Performance and Postural Control. J Cogn 2021; 4:20. [PMID: 33748665 PMCID: PMC7954177 DOI: 10.5334/joc.146] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 12/31/2020] [Indexed: 11/20/2022] Open
Abstract
Older adults exhibit impaired cognitive and balance performance, particularly under multi-task conditions, which can be improved through training. Compatibility of modality mappings in cognitive tasks (i.e., match between stimulus modality and anticipated sensory effects of motor responses), modulates physical and cognitive dual-task costs. However, the effects of modality specific training programs have not been evaluated yet. Here, we tested the effects of cognitive-postural multi-tasking training on the ability to coordinate task mappings under high postural demands in healthy older adults. Twenty-one adults aged 65-85 years were assigned to one of two groups. While group 1 performed cognitive-postural triple-task training with compatible modality mappings (i.e., visual-manual and auditory-vocal dual n-back tasks), group 2 performed the same tasks with incompatible modality mappings (i.e., visual-vocal and auditory-manual n-back tasks). Throughout the 6-weeks balance training intervention, working-memory load was gradually increased while base-of-support was reduced. Before training (T0), after a 6-week passive control period (T1), and immediately after the intervention (T2), participants performed spatial dual one-back tasks in semi-tandem stance position. Our results indicate improved working-memory performance and reduced dual-task costs for both groups after the passive control period, but no training-specific performance gains. Furthermore, balance performance did not improve in response to training. Notably, the cohort demonstrated meaningful interindividual variability in training responses. Our findings raise questions about practice effects and age-related heterogeneity of training responses following cognitive-motor training. Following multi-modal balance training, neither compatible nor incompatible modality mappings had an impact on the observed outcomes.
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Affiliation(s)
- Markus Brahms
- Division of Training and Movement Sciences, Research Focus Cognition Sciences, University of Potsdam, Potsdam, Germany
| | - Stephan Heinzel
- Clinical Psychology and Psychotherapy, Freie Universität Berlin, Berlin, Germany
| | - Michael Rapp
- University of Potsdam, Research Focus Cognitive Sciences, Division of Social and Preventive Medicine, Potsdam, Germany
| | - Volker Reisner
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Gunnar Wahmkow
- Division of Training and Movement Sciences, Research Focus Cognition Sciences, University of Potsdam, Potsdam, Germany
| | - Jérôme Rimpel
- Division of Training and Movement Sciences, Research Focus Cognition Sciences, University of Potsdam, Potsdam, Germany
| | - Gesche Schauenburg
- Division of Training and Movement Sciences, Research Focus Cognition Sciences, University of Potsdam, Potsdam, Germany
| | | | - Urs Granacher
- Division of Training and Movement Sciences, Research Focus Cognition Sciences, University of Potsdam, Potsdam, Germany
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11
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Ditchburn JL, van Schaik P, Dixon J, MacSween A, Martin D. The effects of exergaming on pain, postural control, technology acceptance and flow experience in older people with chronic musculoskeletal pain: a randomised controlled trial. BMC Sports Sci Med Rehabil 2020; 12:63. [PMID: 33062284 PMCID: PMC7547415 DOI: 10.1186/s13102-020-00211-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 10/01/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Older people with chronic musculoskeletal pain are at risk of falls. This study aimed to investigate the effects of exergaming on pain and postural control in older people with chronic musculoskeletal pain. Secondary outcomes were technology acceptance, flow experience, perceived physical exertion, expended mental effort and heart rate. METHODS Fifty four older adults (age: 71 ± 5 years) with chronic musculoskeletal pain were randomised into 2 groups. Group 1 received exergaming training using the Interactive Rehabilitation and Exercise System (IREX®). Group 2 undertook traditional gym-based exercise (TGB). Both groups completed twice weekly 40-min exercise sessions for 6 weeks. Perceived pain was measured using a numeric pain rating scale and the Multidimensional Affect and Pain Survey questionnaire. Postural control was measured as sway using a Kistler™ force platform. Technology acceptance was measured with the Unified Theory of Acceptance and Use of Technology questionnaire and flow experience with the Flow State Scale. Physiological measures of perceived physical exertion, expended mental effort and heart rate were recorded during all sessions. RESULTS The exergaming group demonstrated significant reductions in pain intensity and thermal pain including a near significant approach in physical engagement in comparison to TGB group. Although no intervention effects on postural control were found, the exergaming group showed significant improvements in three sway measures (AP SD, ML SD and AP range) over time whereas significant improvements in ML range were found in the TGB group. Relating to technology acceptance, significant intervention effects on social influence and behavioural intention were found in the TGB group instead, although both groups demonstrated increases of acceptance over time. Regarding flow experience, concentration at task was significantly influenced in the TGB group and significant increases in flow variables over time were observed in both groups. Significant increases over time in perceived physical exertion and expended mental effort were found in both groups. CONCLUSION Our findings support the potential of exergaming to alleviate pain and improve balance in older people with chronic musculoskeletal pain. Both forms of exercise are acceptable, intrinsically motivating and show evidence of benefit to older people with chronic musculoskeletal pain. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04029285 (retrospectively registered, July 23, 2019).
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Affiliation(s)
- Jae-Llane Ditchburn
- Institute of Science, Natural Resources and Outdoor Studies, University of Cumbria, Fusehill Street, Carlisle, Cumbria, CA1 2HH UK
| | - Paul van Schaik
- School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, TS1 3BA UK
| | - John Dixon
- School of Health and Life Sciences, Teesside University, Middlesbrough, TS1 3BX UK
| | - Alasdair MacSween
- School of Health and Life Sciences, Teesside University, Middlesbrough, TS1 3BX UK
| | - Denis Martin
- School of Health and Life Sciences, Teesside University, Middlesbrough, TS1 3BX UK
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12
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Yang CM, Chen Hsieh J(S, Chen YC, Yang SY, Lin HCK. Effects of Kinect exergames on balance training among community older adults: A randomized controlled trial. Medicine (Baltimore) 2020; 99:e21228. [PMID: 32664177 PMCID: PMC7360267 DOI: 10.1097/md.0000000000021228] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 01/16/2020] [Accepted: 06/10/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Recent years have witnessed wide applications of exergames to balance training among the older adults. However, research concerning balance training with the use of Kinect for Xbox has remained scarce. While previous studies have shown the positive effects of exergames on improving balance and preventing falling among the older adults, there has been a paucity of empirical evidence supporting the superiority of Kinect exercise to conventional exercise over balance training among the older adults. Therefore, this study aimed to compare the feasibility, safety, and effectiveness of Kinect exercise against conventional exercise over balance training among the community older adults. METHOD A total of 20 participants were randomly assigned to the Kinect Exercise Group (N = 10) or the Conventional Exercise Group (N = 10) for a 5-week balance training (45 minutes a time, 2 times a week). Assessor blinding was employed to assess the participants' performance before and after the treatment, including 30-Second Chair Stand Test (30-sec CST), Timed Up and Go (TUG), Functional Reach Test (FRT), and One-Leg Stance Test (OLST) respectively with eyes open and closed. Subjective feeling of the intensity of pain and side effects were recorded throughout the investigation period. Nonparametric statistics was used for data analysis. RESULTS Within-group comparison between the pre-test and post-test indicated that significant differences existed in all of the 5 tests (30-sec CST, TUG, FRT, OLST with eyes open, and OLST with eyes closed) in the Kinect exercise group. To the Conventional exercise group, however, significant differences were only observed in 30-sec CST, FRT and OLST with eyes open. With regard to between-group comparison, significant differences were only found in FRT. CONCLUSION Such results indicated that both treatments were helpful in improving the participants' balance performance, that Kinect exercise was more effective in terms of overall balance ability, and that Kinect exercise was particularly beneficial to functional reach enhancement in comparison with traditional exercise. Kinect exercise could be a feasible, safe, and effective alternative for dynamic balance training among older adults.
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Affiliation(s)
- Chi-Min Yang
- Department of Physical Medicine and Rehabilitation, Chi-Mei Medical Center
- Department of Information and Learning Technology, National University of Tainan, Tainan
| | | | - Yi-Chen Chen
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan, ROC
| | - Shu-Yu Yang
- Department of Physical Medicine and Rehabilitation, Chi-Mei Medical Center
| | - Hao-Chiang Koong Lin
- Department of Information and Learning Technology, National University of Tainan, Tainan
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13
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Ayenigbara IO. The contributions of physical activity and fitness for the optimal health and wellness of the elderly people. JOURNAL OF GERONTOLOGY AND GERIATRICS 2020. [DOI: 10.36150/2499-6564-351] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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14
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Kuspinar A, Verschoor CP, Beauchamp MK, Dushoff J, Ma J, Amster E, Bassim C, Dal Bello-Haas V, Gregory MA, Harris JE, Letts L, Neil-Sztramko SE, Richardson J, Valaitis R, Vrkljan B. Modifiable factors related to life-space mobility in community-dwelling older adults: results from the Canadian Longitudinal Study on Aging. BMC Geriatr 2020; 20:35. [PMID: 32005107 PMCID: PMC6995110 DOI: 10.1186/s12877-020-1431-5] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 01/15/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The most common methods for measuring mobility in older adulthood include performance-based tests, such as the Timed-Up-and-Go and gait speed. While these measures have strong predictive validity for adverse outcomes, they are limited to assessing what older adults do in standardized settings, rather than what they do in their daily life. Life-space mobility, which is the ability to move within environments that expand from one's home to the greater community, has been proposed as a more comprehensive measure of mobility. The aim of this study was to determine the association between modifiable factors and life-space mobility in older adults enrolled in the Canadian Longitudinal Study on Aging (CLSA). METHODS Life-space mobility was measured using the Life Space Index (LSI). Explanatory factors included physical, psychosocial and cognitive determinants, as well as pain, fatigue, driving status, nutrition, body mass index, smoking status, and vision. To estimate the association between the LSI and explanatory variables, univariate and multivariable ordinary least squares regression analyses were performed. RESULTS All adults 65 years and older (n = 12,646) were included in the analysis. Fifty percent were women and the mean age was 73.0 (SD5.7). The mean LSI score was 80.5, indicating that, on average, the sample was able to move outside of their neighborhood independently. All explanatory variables were significantly associated with the LSI except for balance and memory. The top 3 variables that explained the most variation in the LSI were driving, social support and walking speed. CONCLUSION To our knowledge, this was the first study to examine the association between life-space mobility and a comprehensive set of modifiable factors that were selected based on a theoretical framework and existing research evidence. This study had two important messages. First, driving, social support and walking speed emerged as the most significant correlates of life-space mobility in older adults. Second, life-space mobility is multifactorial and interventions that are pragmatic in their design and testing are needed that consider the complexity involved. A multi-disciplinary approach to examining life-space mobility in older adults is needed to optimize opportunities for healthy aging and develop strategies that support mobility in older adulthood.
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Affiliation(s)
- A Kuspinar
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
| | - C P Verschoor
- Health Sciences North Research Institute, Sudbury, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - M K Beauchamp
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - J Dushoff
- Department of Biology, Faculty of Science, McMaster University, Hamilton, Ontario, Canada
| | - J Ma
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - E Amster
- Department of History, Faculty of Humanities, McMaster University, Hamilton, Ontario, Canada
| | - C Bassim
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - V Dal Bello-Haas
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - M A Gregory
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - J E Harris
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - L Letts
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - S E Neil-Sztramko
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - J Richardson
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - R Valaitis
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - B Vrkljan
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
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15
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Ng CACM, Fairhall N, Wallbank G, Tiedemann A, Michaleff ZA, Sherrington C. Exercise for falls prevention in community-dwelling older adults: trial and participant characteristics, interventions and bias in clinical trials from a systematic review. BMJ Open Sport Exerc Med 2019; 5:e000663. [PMID: 31908838 PMCID: PMC6936986 DOI: 10.1136/bmjsem-2019-000663] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2019] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION There is strong evidence that exercise prevents falls in community-dwelling older people. This review summarises trial and participant characteristics, intervention contents and study quality of 108 randomised trials evaluating exercise interventions for falls prevention in community-dwelling older adults. METHODS MEDLINE, EMBASE, CENTRAL and three other databases sourced randomised controlled trials of exercise as a single intervention to prevent falls in community-dwelling adults aged 60+ years to May 2018. RESULTS 108 trials with 146 intervention arms and 23 407 participants were included. Trials were undertaken in 25 countries, 90% of trials had predominantly female participants and 56% had elevated falls risk as an inclusion criterion. In 72% of trial interventions attendance rates exceeded 50% and/or 75% of participants attended 50% or more sessions. Characteristics of the trials within the three types of intervention programme that reduced falls were: (1) balance and functional training interventions lasting on average 25 weeks (IQR 16-52), 39% group based, 63% individually tailored; (2) Tai Chi interventions lasting on average 20 weeks (IQR 15-43), 71% group based, 7% tailored; (3) programmes with multiple types of exercise lasting on average 26 weeks (IQR 12-52), 54% group based, 75% tailored. Only 35% of trials had low risk of bias for allocation concealment, and 53% for attrition bias. CONCLUSIONS The characteristics of effective exercise interventions can guide clinicians and programme providers in developing optimal interventions based on current best evidence. Future trials should minimise likely sources of bias and comply with reporting guidelines.
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Affiliation(s)
- Christopher A C M Ng
- Medical School, University of Western Australia, Crawley, Western Australia, Australia
- The University of Sydney School of Public Health, Sydney, New South Wales, Australia
| | - Nicola Fairhall
- Institute for Musculoskeletal Health, The University of Sydney School of Public Health, Sydney, New South Wales, Australia
| | - Geraldine Wallbank
- Institute for Musculoskeletal Health, The University of Sydney School of Public Health, Sydney, New South Wales, Australia
| | - Anne Tiedemann
- Institute for Musculoskeletal Health, The University of Sydney School of Public Health, Sydney, New South Wales, Australia
| | - Zoe A Michaleff
- Institute for Musculoskeletal Health, The University of Sydney School of Public Health, Sydney, New South Wales, Australia
- Institute for Evidence-Based Healthcare, Bond University Faculty of Health Sciences and Medicine, Gold Coast, Queensland, Australia
| | - Catherine Sherrington
- Institute for Musculoskeletal Health, The University of Sydney School of Public Health, Sydney, New South Wales, Australia
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16
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Sherrington C, Fairhall NJ, Wallbank GK, Tiedemann A, Michaleff ZA, Howard K, Clemson L, Hopewell S, Lamb SE. Exercise for preventing falls in older people living in the community. Cochrane Database Syst Rev 2019; 1:CD012424. [PMID: 31789289 PMCID: PMC6360922 DOI: 10.1002/14651858.cd012424.pub2] [Citation(s) in RCA: 433] [Impact Index Per Article: 86.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND At least one-third of community-dwelling people over 65 years of age fall each year. Exercises that target balance, gait and muscle strength have been found to prevent falls in these people. An up-to-date synthesis of the evidence is important given the major long-term consequences associated with falls and fall-related injuries OBJECTIVES: To assess the effects (benefits and harms) of exercise interventions for preventing falls in older people living in the community. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, three other databases and two trial registers up to 2 May 2018, together with reference checking and contact with study authors to identify additional studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) evaluating the effects of any form of exercise as a single intervention on falls in people aged 60+ years living in the community. We excluded trials focused on particular conditions, such as stroke. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Our primary outcome was rate of falls. MAIN RESULTS We included 108 RCTs with 23,407 participants living in the community in 25 countries. There were nine cluster-RCTs. On average, participants were 76 years old and 77% were women. Most trials had unclear or high risk of bias for one or more items. Results from four trials focusing on people who had been recently discharged from hospital and from comparisons of different exercises are not described here.Exercise (all types) versus control Eighty-one trials (19,684 participants) compared exercise (all types) with control intervention (one not thought to reduce falls). Exercise reduces the rate of falls by 23% (rate ratio (RaR) 0.77, 95% confidence interval (CI) 0.71 to 0.83; 12,981 participants, 59 studies; high-certainty evidence). Based on an illustrative risk of 850 falls in 1000 people followed over one year (data based on control group risk data from the 59 studies), this equates to 195 (95% CI 144 to 246) fewer falls in the exercise group. Exercise also reduces the number of people experiencing one or more falls by 15% (risk ratio (RR) 0.85, 95% CI 0.81 to 0.89; 13,518 participants, 63 studies; high-certainty evidence). Based on an illustrative risk of 480 fallers in 1000 people followed over one year (data based on control group risk data from the 63 studies), this equates to 72 (95% CI 52 to 91) fewer fallers in the exercise group. Subgroup analyses showed no evidence of a difference in effect on both falls outcomes according to whether trials selected participants at increased risk of falling or not.The findings for other outcomes are less certain, reflecting in part the relatively low number of studies and participants. Exercise may reduce the number of people experiencing one or more fall-related fractures (RR 0.73, 95% CI 0.56 to 0.95; 4047 participants, 10 studies; low-certainty evidence) and the number of people experiencing one or more falls requiring medical attention (RR 0.61, 95% CI 0.47 to 0.79; 1019 participants, 5 studies; low-certainty evidence). The effect of exercise on the number of people who experience one or more falls requiring hospital admission is unclear (RR 0.78, 95% CI 0.51 to 1.18; 1705 participants, 2 studies, very low-certainty evidence). Exercise may make little important difference to health-related quality of life: conversion of the pooled result (standardised mean difference (SMD) -0.03, 95% CI -0.10 to 0.04; 3172 participants, 15 studies; low-certainty evidence) to the EQ-5D and SF-36 scores showed the respective 95% CIs were much smaller than minimally important differences for both scales.Adverse events were reported to some degree in 27 trials (6019 participants) but were monitored closely in both exercise and control groups in only one trial. Fourteen trials reported no adverse events. Aside from two serious adverse events (one pelvic stress fracture and one inguinal hernia surgery) reported in one trial, the remainder were non-serious adverse events, primarily of a musculoskeletal nature. There was a median of three events (range 1 to 26) in the exercise groups.Different exercise types versus controlDifferent forms of exercise had different impacts on falls (test for subgroup differences, rate of falls: P = 0.004, I² = 71%). Compared with control, balance and functional exercises reduce the rate of falls by 24% (RaR 0.76, 95% CI 0.70 to 0.81; 7920 participants, 39 studies; high-certainty evidence) and the number of people experiencing one or more falls by 13% (RR 0.87, 95% CI 0.82 to 0.91; 8288 participants, 37 studies; high-certainty evidence). Multiple types of exercise (most commonly balance and functional exercises plus resistance exercises) probably reduce the rate of falls by 34% (RaR 0.66, 95% CI 0.50 to 0.88; 1374 participants, 11 studies; moderate-certainty evidence) and the number of people experiencing one or more falls by 22% (RR 0.78, 95% CI 0.64 to 0.96; 1623 participants, 17 studies; moderate-certainty evidence). Tai Chi may reduce the rate of falls by 19% (RaR 0.81, 95% CI 0.67 to 0.99; 2655 participants, 7 studies; low-certainty evidence) as well as reducing the number of people who experience falls by 20% (RR 0.80, 95% CI 0.70 to 0.91; 2677 participants, 8 studies; high-certainty evidence). We are uncertain of the effects of programmes that are primarily resistance training, or dance or walking programmes on the rate of falls and the number of people who experience falls. No trials compared flexibility or endurance exercise versus control. AUTHORS' CONCLUSIONS Exercise programmes reduce the rate of falls and the number of people experiencing falls in older people living in the community (high-certainty evidence). The effects of such exercise programmes are uncertain for other non-falls outcomes. Where reported, adverse events were predominantly non-serious.Exercise programmes that reduce falls primarily involve balance and functional exercises, while programmes that probably reduce falls include multiple exercise categories (typically balance and functional exercises plus resistance exercises). Tai Chi may also prevent falls but we are uncertain of the effect of resistance exercise (without balance and functional exercises), dance, or walking on the rate of falls.
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Affiliation(s)
- Catherine Sherrington
- The University of SydneyInstitute for Musculoskeletal Health, School of Public Health, Faculty of Medicine and HealthPO Box 179Missenden RoadSydneyNSWAustralia2050
| | - Nicola J Fairhall
- The University of SydneyInstitute for Musculoskeletal Health, School of Public Health, Faculty of Medicine and HealthPO Box 179Missenden RoadSydneyNSWAustralia2050
| | - Geraldine K Wallbank
- The University of SydneyInstitute for Musculoskeletal Health, School of Public Health, Faculty of Medicine and HealthPO Box 179Missenden RoadSydneyNSWAustralia2050
| | - Anne Tiedemann
- The University of SydneyInstitute for Musculoskeletal Health, School of Public Health, Faculty of Medicine and HealthPO Box 179Missenden RoadSydneyNSWAustralia2050
| | - Zoe A Michaleff
- The University of SydneyInstitute for Musculoskeletal Health, School of Public Health, Faculty of Medicine and HealthPO Box 179Missenden RoadSydneyNSWAustralia2050
| | - Kirsten Howard
- The University of SydneySchool of Public HealthSydneyNSWAustralia2006
| | - Lindy Clemson
- The University of SydneyFaculty of Health SciencesEast St. LidcombeLidcombeNSWAustralia1825
| | - Sally Hopewell
- University of OxfordNuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS)Botnar Research Centre, Windmill RoadOxfordOxfordshireUKOX3 7LD
| | - Sarah E Lamb
- University of OxfordNuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS)Botnar Research Centre, Windmill RoadOxfordOxfordshireUKOX3 7LD
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Cameron ID, Dyer SM, Panagoda CE, Murray GR, Hill KD, Cumming RG, Kerse N. Interventions for preventing falls in older people in care facilities and hospitals. Cochrane Database Syst Rev 2018; 9:CD005465. [PMID: 30191554 PMCID: PMC6148705 DOI: 10.1002/14651858.cd005465.pub4] [Citation(s) in RCA: 169] [Impact Index Per Article: 28.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Falls in care facilities and hospitals are common events that cause considerable morbidity and mortality for older people. This is an update of a review first published in 2010 and updated in 2012. OBJECTIVES To assess the effects of interventions designed to reduce the incidence of falls in older people in care facilities and hospitals. SEARCH METHODS We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (August 2017); Cochrane Central Register of Controlled Trials (2017, Issue 8); and MEDLINE, Embase, CINAHL and trial registers to August 2017. SELECTION CRITERIA Randomised controlled trials of interventions for preventing falls in older people in residential or nursing care facilities, or hospitals. DATA COLLECTION AND ANALYSIS One review author screened abstracts; two review authors screened full-text articles for inclusion. Two review authors independently performed study selection, 'Risk of bias' assessment and data extraction. We calculated rate ratios (RaR) with 95% confidence intervals (CIs) for rate of falls and risk ratios (RRs) and 95% CIs for outcomes such as risk of falling (number of people falling). We pooled results where appropriate. We used GRADE to assess the quality of evidence. MAIN RESULTS Thirty-five new trials (77,869 participants) were included in this update. Overall, we included 95 trials (138,164 participants), 71 (40,374 participants; mean age 84 years; 75% women) in care facilities and 24 (97,790 participants; mean age 78 years; 52% women) in hospitals. The majority of trials were at high risk of bias in one or more domains, mostly relating to lack of blinding. With few exceptions, the quality of evidence for individual interventions in either setting was generally rated as low or very low. Risk of fracture and adverse events were generally poorly reported and, where reported, the evidence was very low-quality, which means that we are uncertain of the estimates. Only the falls outcomes for the main comparisons are reported here.Care facilitiesSeventeen trials compared exercise with control (typically usual care alone). We are uncertain of the effect of exercise on rate of falls (RaR 0.93, 95% CI 0.72 to 1.20; 2002 participants, 10 studies; I² = 76%; very low-quality evidence). Exercise may make little or no difference to the risk of falling (RR 1.02, 95% CI 0.88 to 1.18; 2090 participants, 10 studies; I² = 23%; low-quality evidence).There is low-quality evidence that general medication review (tested in 12 trials) may make little or no difference to the rate of falls (RaR 0.93, 95% CI 0.64 to 1.35; 2409 participants, 6 studies; I² = 93%) or the risk of falling (RR 0.93, 95% CI 0.80 to 1.09; 5139 participants, 6 studies; I² = 48%).There is moderate-quality evidence that vitamin D supplementation (4512 participants, 4 studies) probably reduces the rate of falls (RaR 0.72, 95% CI 0.55 to 0.95; I² = 62%), but probably makes little or no difference to the risk of falling (RR 0.92, 95% CI 0.76 to 1.12; I² = 42%). The population included in these studies had low vitamin D levels.Multifactorial interventions were tested in 13 trials. We are uncertain of the effect of multifactorial interventions on the rate of falls (RaR 0.88, 95% CI 0.66 to 1.18; 3439 participants, 10 studies; I² = 84%; very low-quality evidence). They may make little or no difference to the risk of falling (RR 0.92, 95% CI 0.81 to 1.05; 3153 participants, 9 studies; I² = 42%; low-quality evidence).HospitalsThree trials tested the effect of additional physiotherapy (supervised exercises) in rehabilitation wards (subacute setting). The very low-quality evidence means we are uncertain of the effect of additional physiotherapy on the rate of falls (RaR 0.59, 95% CI 0.26 to 1.34; 215 participants, 2 studies; I² = 0%), or whether it reduces the risk of falling (RR 0.36, 95% CI 0.14 to 0.93; 83 participants, 2 studies; I² = 0%).We are uncertain of the effects of bed and chair sensor alarms in hospitals, tested in two trials (28,649 participants) on rate of falls (RaR 0.60, 95% CI 0.27 to 1.34; I² = 0%; very low-quality evidence) or risk of falling (RR 0.93, 95% CI 0.38 to 2.24; I² = 0%; very low-quality evidence).Multifactorial interventions in hospitals may reduce rate of falls in hospitals (RaR 0.80, 95% CI 0.64 to 1.01; 44,664 participants, 5 studies; I² = 52%). A subgroup analysis by setting suggests the reduction may be more likely in a subacute setting (RaR 0.67, 95% CI 0.54 to 0.83; 3747 participants, 2 studies; I² = 0%; low-quality evidence). We are uncertain of the effect of multifactorial interventions on the risk of falling (RR 0.82, 95% CI 0.62 to 1.09; 39,889 participants; 3 studies; I² = 0%; very low-quality evidence). AUTHORS' CONCLUSIONS In care facilities: we are uncertain of the effect of exercise on rate of falls and it may make little or no difference to the risk of falling. General medication review may make little or no difference to the rate of falls or risk of falling. Vitamin D supplementation probably reduces the rate of falls but not risk of falling. We are uncertain of the effect of multifactorial interventions on the rate of falls; they may make little or no difference to the risk of falling.In hospitals: we are uncertain of the effect of additional physiotherapy on the rate of falls or whether it reduces the risk of falling. We are uncertain of the effect of providing bed sensor alarms on the rate of falls or risk of falling. Multifactorial interventions may reduce rate of falls, although subgroup analysis suggests this may apply mostly to a subacute setting; we are uncertain of the effect of these interventions on risk of falling.
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Affiliation(s)
- Ian D Cameron
- The University of SydneyJohn Walsh Centre for Rehabilitation Research, Sydney Medical School, Northern Clinical SchoolReserve RoadSt LeonardsNSWAustralia2065
| | - Suzanne M Dyer
- DHATR Consulting120 Robsart StreetParksideSouth AustraliaAustralia5063
| | - Claire E Panagoda
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Northern Sydney Local Health DistrictSt LeonardsNSWAustralia2065
| | - Geoffrey R Murray
- Illawarra Shoalhaven Local Health DistrictAged Care, Rehabilitation and Palliative CareWarrawongAustralia
| | - Keith D Hill
- Curtin UniversitySchool of Physiotherapy and Exercise Science, Faculty of Health SciencesGPO Box U1987PerthWestern AustraliaAustralia6845
| | - Robert G Cumming
- Sydney Medical School, University of SydneySchool of Public HealthRoom 306, Edward Ford Building (A27)Fisher RoadSydneyNSWAustralia2006
| | - Ngaire Kerse
- University of AucklandDepartment of General Practice and Primary Health CarePrivate Bag 92019AucklandNew Zealand
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18
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Maritz CA, Silbernagel KG. A Prospective Cohort Study on the Effect of a Balance Training Program, Including Calf Muscle Strengthening, in Community-Dwelling Older Adults. J Geriatr Phys Ther 2018; 39:125-31. [PMID: 26288238 DOI: 10.1519/jpt.0000000000000059] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Falls are the number 1 cause of injury, fractures, and death among the older population. In fact, one-third of adults older than 60 years will experience 1 or more falls annually. Factors including inactivity and decreased mobility are associated with overall declines in strength, balance, and functional mobility in older adults. PURPOSE The purpose of this study was to evaluate the effect of a balance training program, including calf muscle strengthening, in community-dwelling older adults and to evaluate how calf muscle strength correlates with risk factors for falls. METHODS Community-dwelling older adults from a local senior center were invited to participate in a 5-week (10 sessions), 1-on-1, balance training program, which included calf muscle strengthening. All the participants were evaluated before and after the intervention. The outcome measures were static balance, unilateral heel-rise test, Timed Up and Go test (TUG), the 30-second Chair Stand Test (30-sCST), and the Activity Balance Confidence Scale. RESULTS Twenty-eight participants (6 males and 22 females) mean (standard deviation) age of 78 years were included in the study and completed the baseline evaluation. Eight participants did not complete the study. Static balance with eyes closed, heel rise, TUG, 30-sCST, and the Activity Balance Confidence Scale improved significantly (P < .05) following treatment compared with the baseline evaluation. The heel-rise ability correlated significantly (P < .05) with TUG (r = -0.484 to -0.528) and 30-sCST (r = 0.501-0.595). Sixty-three percent of the participants performed 10 reps or less of the unilateral heel rise on the right side and 60% on the left side. None of the participants who performed 10 reps or more of the unilateral heel rise had a high risk of falls based on the TUG. CONCLUSIONS A balance training program that includes calf muscle strengthening performed twice a week for 5 weeks resulted in significant improvements in calf muscle strength, functional performance and balance, as well as a significant improvement in balance confidence. The results from this study identify the importance unilateral calf muscle strength has to falls risk among older adults.
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Affiliation(s)
- Carol A Maritz
- Department of Physical Therapy, Samson College of Health Sciences, University of the Sciences, Philadelphia, Pennsylvania
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19
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Shier V, Trieu E, Ganz DA. Implementing exercise programs to prevent falls: systematic descriptive review. Inj Epidemiol 2016; 3:16. [PMID: 27747553 PMCID: PMC4932138 DOI: 10.1186/s40621-016-0081-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 06/20/2016] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The United States Preventive Services Task Force recommends exercise to prevent falls in community-dwelling adults aged ≥ 65 years at increased fall risk. However, little is known about how best to implement exercise programs in routine care when a patient's need for exercise is identified within the healthcare system. METHODS Using a qualitative approach, we reviewed the literature to determine how exercise programs to prevent falls are implemented from the vantage point of a health care setting. We synthesized descriptive information about each program with data on program features and implementation difficulties and facilitators. RESULTS We found that programs sponsored by primary care providers (PCPs) or specialists may help with recruitment into exercise programs. PCPs have the opportunity to identify people at risk and promote participation since most older adults regularly visit, and inquire about exercise from, their physicians. In terms of referral options, both home-based and group-based exercise programs have been shown effective in preventing falls; however, each approach carries strengths and limitations. Home-based programs can include participants who are reluctant or unable to attend group classes and can be individually tailored, but provide less opportunity for supervision and socialization than classes. Adherence to programs can be encouraged, and attrition minimized, through positive reinforcement. Successful programs ranged in expense for exercise sessions: a weekly class combined with exercises at home cost < $2 per participant per week, while frequent individual sessions cost > $100 per participant per week. CONCLUSIONS With increasing attention to population-based health management in the United States, clinicians and health system leaders need a deeper understanding of how to link patients in their healthcare systems with appropriate community programs. This review identifies key characteristics of successful fall prevention exercise programs that can be used to determine which local options conform to clinical evidence. In addition, we highlight tradeoffs between program options, such as home versus group exercise programs, to allow referrals to be tailored to local conditions and patient preferences. Finally, our work highlights the key role of the PCP in recruiting patients to participate in exercise programs, and identifies options, such as registries, to support referrals to the community.
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Affiliation(s)
- Victoria Shier
- Pardee RAND Graduate School, RAND Corporation, 1776 Main St, Santa Monica, CA 90407 USA
| | - Eric Trieu
- Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048 USA
| | - David A. Ganz
- VA Greater Los Angeles Healthcare System, David Geffen School of Medicine at UCLA, RAND Corporation, 11301 Wilshire Blvd., Building 158, Room 128, Los Angeles, CA 90073 USA
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20
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Poulsen I, Hesselbo B, Pietersen I, Schroll M. Implementation of functional assessment scales in geriatric practice: A feasibility study. Scand J Public Health 2016; 33:292-9. [PMID: 16087492 DOI: 10.1080/14034940510005806] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Aim: A study was undertaken to evaluate the feasibility of functional assessment scales regarding completion rate and ability to document functional changes in geriatric rehabilitation patients. Methods: Five functional assessment scales were implemented, and used on admission and discharge as part of standard care. Results: Of 2,812 patients, 90 patients (3.2%) had no scales administered, 2,330 patients (82.9%) had between one and six scales administered and 392 (13.9%) had a complete data set (seven scales). The percentage of inpatients who were independent or almost independent in basic ADL functions improved from 30% to 60% during hospitalization; 53% had cognitive impairment, while 19% expressed depressive thoughts or depression on admission. Conclusion: Functional assessment scales were feasible in the clinical routine, gave important information on patients' functional status at baseline, and showed that patients improved their physical function considerably during hospitalization. Interdisciplinary teamwork and management affect the success of the implementation of assessment scales.
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Affiliation(s)
- Ingrid Poulsen
- Department of Geriatric Medicine, Copenhagen University Hospital, Bispebjerg, Denmark.
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21
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Covill LG, Utley C, Hochstein C. Comparison of Ai Chi and Impairment-Based Aquatic Therapy for Older Adults With Balance Problems: A Clinical Study. J Geriatr Phys Ther 2016; 40:204-213. [PMID: 27490823 DOI: 10.1519/jpt.0000000000000100] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE Older adults with balance deficits often fear falling and limit their mobility. Poor balance is multifactorial, influenced by medication interactions, musculoskeletal and sensory system changes, and poor neuromuscular response to changes in body positions. Aquatic physical therapy (APT) is an intervention used to improve balance and decrease falls. Ai Chi is a water-based exercise program. It incorporates slow movements of progressive difficulty utilizing the upper and lower extremities and trunk coordinated with deep breathing. It is used for relaxation, strengthening, and balance training. The purpose of this study was to determine whether Ai Chi provides better results than conventional impairment-based aquatic therapy (IBAT) for older adults with balance deficits. METHODS Thirty-two community-dwelling adults, 65 to 85 years old, were referred to 2 different community pools for APT. Fifteen participants received Ai Chi-based aquatic interventions and 17 participants received an IBAT program. Physical therapists trained in both programs completed interventions and determined discharge. Physical balance measures, which included the Berg Balance Scale (BBS) and Timed Up and Go (TUG), were collected pre- and posttherapy. Self-reported outcome measures, the Activities-Specific Balance Confidence Scale (ABC) and Numerical Pain Rating Scale (NPRS), were collected pre- and posttherapy and 3- and 6-month postdischarge. RESULTS A 2-way (group by time) mixed-model analysis of covariance with initial outcome scores as a covariate revealed no difference between groups in any of the outcome measures (BBS, P = .53; TUG, P = .39; ABC, P = .63; NPRS, P = .27). Repeated-measures analysis and dependent t tests showed significant improvements in the BBS (P = .00) and TUG (P = .03) after APT. The ABC and NPRS did not improve significantly (ABC, P = .27; NPRS, P = .77). CONCLUSIONS There were no significant differences found in balance measures, balance confidence, or pain levels for community-dwelling older adults between the Ai Chi and IBAT programs. Physical outcome measures improved with APT but patient-reported measures did not. Further study is indicated to determine the most effective treatment frequency and duration for this population.
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Affiliation(s)
- Laura G Covill
- 1Des Moines University, Des Moines, Iowa. 2Mercy Physical Therapy Clinics, Des Moines, Iowa
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22
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Potential analysis for research on occupational therapy-led physical exercise programmes and home environment adaptation programmes to prevent falls for elderly people living at home / Potenzialanalyse zu ergotherapeutischen körperlichen Trainingsprogrammen und Wohnraumanpassungen zur Vermeidung von Stürzen bei zu Hause lebenden älteren Menschen. INTERNATIONAL JOURNAL OF HEALTH PROFESSIONS 2016. [DOI: 10.1515/ijhp-2016-0018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
In Germany, four to five million community-dwelling people aged 65 years or older fall every year. The presented potential analysis evaluates the potential of occupational therapy-led physical exercise programs and home environment adaptations to reduce the frequency of falling and as well as intrinsic and extrinsic risk factors for falling of older people living at home.
Methods
The potential analysis was compiled according to a method guideline (p.11-22) available as follows: http://www.cochrane. de/news/leitfaden-f%C3%BCr-gesundheitsfachberufe-mai-2013. The research question of fall prevention was considered as very relevant for health care and specified according to the PICOS-system. A Cochrane review was systematically searched and the body of evidence was assessed using the GRADE-system. In addition, studies after the search period of the Cochrane review were identified using the search strategy of this review. Both the studies within and after the review were assessed regarding their transferability to the German health care context.
Corpus of evidence
A Cochrane review from 2012 revealed that occupational therapy-led physical exercise programs reduced the frequency of falling of older people living at home (7 studies, 951 participants, 0.68 RaR; 95%-KI [0.58-0.80]), the number of fallers (6 studies, 714 participants, 0.78 RaR, 95%-KI [0.64-0.94]) and the fractures (6 studies, 810 participants, 0.34 RaR, 95%-KI [0.18-0.63]). Further studies showed that home environment adaptation programs significantly reduced the number of falls (4 studies, 1443 participants, 0.69 RaR, 95%-KI [0.55-0.86]) and the number of fallers (5 studies, 1153 participants, 0.79 RaR, 95%-KI [0.70-0.91]). However, direct implementation into the German healthcare context is not recommendable.
Implication for research
It is recommended (1) to manualise identified home environment adaptation programmes for the German healthcare context and (2) to pilot-test the physical exercise programmes ‘LiFE’ with regard to theoretical framework, acceptance, applicability and feasibility and to examine both interventions as part of a feasibility study. If this trial results in a feasible treatment programme well accepted by patients and their treating occupational therapists, a large-scaled randomized clinical trial in terms of comparative effectiveness research may follow.
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23
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Donat H, Ozcan A. Comparison of the effectiveness of two programmes on older adults at risk of falling: unsupervised home exercise and supervised group exercise. Clin Rehabil 2016; 21:273-83. [PMID: 17329285 DOI: 10.1177/0269215506069486] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To compare the effectiveness of unsupervised home and supervised group exercise on parameters related to risk of falling among older adults. Design: Prospective, single-blind, randomized and controlled trial. Setting: Nursing home. Subjects: The subjects were selected from 535 independent individuals who resided in a nursing home. Forty-two older adults, aged > 65 years, with risk of falling were recruited, and 32 of them completed the study. Intervention: The 42 subjects were divided into two groups (unsupervised home exercise and supervised exercise group) randomly. Exercise sessions were performed three times a week for a period of eight weeks. Main measures: Measurements were taken at baseline and after the completion of the exercise programme. The fear of falling was evaluated using a visual analogue scale, quadriceps muscle strength was measured with a dynamometer, flexibility was assessed with the sit and reach test, functional mobility was determined using the Timed Up and Go Test, balance was evaluated using one-leg and tandem standing, and Berg Balance Scale and proprioception was assessed with knee position sense. Results: Thirty-two subjects (unsupervised home exercise n = 15, supervised group exercise n = 17) completed the exercise programme and all of the measurements. The unsupervised home exercise group showed significant improvement in balance, functional mobility and flexibility (P > 0.05). In addition to balance, functional mobility and flexibility, the supervised exercise group also showed significant improvements in both strength and proprioception (P > 0.05). Conclusions: Supervised group exercise is more effective at reducing the risk factors related to falling among older adults living in a nursing home than is unsupervised home exercise.
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Affiliation(s)
- Hülya Donat
- Republic of Turkey Emekli Sandigi Narlidere Nursing Home, Izmir, Turkey
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24
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Li J, Huang J, Zhang J, Li Y. A home-based, nurse-led health program for postoperative patients with early-stage cervical cancer: A randomized controlled trial. Eur J Oncol Nurs 2016; 21:174-80. [PMID: 26482004 DOI: 10.1016/j.ejon.2015.09.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Revised: 09/23/2015] [Accepted: 09/25/2015] [Indexed: 02/05/2023]
Abstract
PURPOSE To investigate the effect of a home-based, nurse-led health program on quality of life and family function for postoperative patients with early-stage cervical cancer. METHOD 226 cervical cancer patients, from two hospitals between December 2012 and April 2014, were randomly divided into intervention and control groups. Patients in the intervention group received an individual home-based, nurse-led health program (family-care team provision, physiological rehabilitation, emotion-release management, informal social support system, and follow-up monitoring), in addition to conventional nursing education. Patients in the control group only received conventional nursing education. The Functional Assessment Cancer Therapy-Cervix, Female Sexual Function Index, and the Family Adaptability and Cohesion Scale were used for assessment before and after the intervention. RESULTS After the intervention, significant improvements were found for the quality of life total scores (t=-7.650, p=0.000), sexual function scores (t=-6.465, p=0.000), cohesion scores (t=-8.417, p=0.001) and adaptability scores (t=-10.735, p=0.000) in the intervention group. Moreover, proportions of family types were also improved (χ2 = 17.77, p=0.000). However, for the control group, no significant differences were found except for a decrease in sexual function scores (t = -4.035, p=0.000). Significant differences in change scores between groups were also found for quality of life (F=41.980, p=0.000), Sexual function (F=37.380, p=0.000), cohesion (F=15.268, p=0.000) and adaptability (F=16.998, p=0.000). CONCLUSION A home-based, nurse-led health promotion program improves the quality of life, sexual function and family function in postoperative patients with early-stage cervical cancer.
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Affiliation(s)
- Jue Li
- Department of Nursing Teaching and Research, Shantou University Medical College, Shantou, Guangdong, PR China.
| | - Jiliang Huang
- Reproductive Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital, Shantou University, Shantou, Guangdong, PR China.
| | - Jun Zhang
- Department of Obstetrics and Gynecology, Nanfang Hospital, South Medical University, Guangzhou, Guangdong, PR China.
| | - Yajie Li
- Department of Nursing Teaching and Research, Nanfang Hospital, South Medical University, Guangzhou, Guangdong, PR China.
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25
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Kim SE, Hong J, Cha JY, Park JM, Eun D, Yoo J, Jee YS. Relative appendicular skeletal muscle mass is associated with isokinetic muscle strength and balance in healthy collegiate men. J Sports Sci 2016; 34:2114-20. [PMID: 26930152 DOI: 10.1080/02640414.2016.1151922] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
There are few studies on the relationship between skeletal muscle mass and balance in the young ages. We investigated the relationship between appendicular skeletal muscle mass, isokinetic muscle strength of lower extremity, and balance among healthy young men using relative skeletal muscle index. Thirty men were grouped according to relative appendicular skeletal muscle mass index: higher skeletal muscle group (n = 15) and lower skeletal muscle group (n = 15). Static and dynamic balance abilities were measured using the following: a test where participants stood on one leg with eyes closed, a modified Clinical Test of Sensory Interaction on Balance (mCTSIB) with eyes open and eyes closed, a stability test, and limits of stability test. The muscle strength of lower extremities was measured with an isokinetic analyser in hip, knee, and ankle joints. Participants with higher appendicular skeletal muscle mass were significantly more stable in maintaining dynamic balance than those with lower appendicular skeletal muscle mass. Moreover, appendicular skeletal muscle mass index was positively correlated with dynamic balance ability. Participants with higher appendicular skeletal muscle mass had stronger strength in the lower extremity, and there were significant differences in the isokinetic torque ratios between groups. From these results, it can be inferred that higher appendicular skeletal muscle mass relates to muscle strength and the alteration in the peak torque ratio of the lower extremity, contributing to the maintenance of balance.
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Affiliation(s)
- Sung-Eun Kim
- a Department of Physiology , College of Medicine, Kyung Hee University , Seoul , Republic of Korea
| | - Ju Hong
- b Department of Exercise Physiology and Prescription, Graduate School of Health Promotion , Hanseo University , Seosan , Republic of Korea
| | - Jun-Youl Cha
- c Department of Physical Education , Graduate School of Chungnam National University , Daejeon , Republic of Korea
| | - Jung-Min Park
- c Department of Physical Education , Graduate School of Chungnam National University , Daejeon , Republic of Korea
| | - Denny Eun
- b Department of Exercise Physiology and Prescription, Graduate School of Health Promotion , Hanseo University , Seosan , Republic of Korea
| | - Jaehyun Yoo
- d Department of Health Management , Sahmyook University , Seoul , Republic of Korea
| | - Yong-Seok Jee
- b Department of Exercise Physiology and Prescription, Graduate School of Health Promotion , Hanseo University , Seosan , Republic of Korea
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Dadgari A, Aizan Hamid T, Hakim MN, Chaman R, Mousavi SA, Poh Hin L, Dadvar L. Randomized Control Trials on Otago Exercise Program (OEP) to Reduce Falls Among Elderly Community Dwellers in Shahroud, Iran. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016; 18:e26340. [PMID: 27478629 PMCID: PMC4948256 DOI: 10.5812/ircmj.26340] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 01/09/2015] [Accepted: 02/10/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Fall is a worldwide health problem among elderly people and a known leading cause of disabilities. Fall prevention programs have been implemented in various forms. The Otago exercise program (OEP) is one of the most recent home-base exercise training program. OBJECTIVES This study was conducted to examine the effectiveness of OEP to reduce falls among elderly people in Shahroud, IR Iran. MATERIALS AND METHODS This randomised control trial was conducted among the elderly community dwellers in Shahroud city of the Semnan province, IR Iran, with experience of falls in the last 12 months. Subjects of the study (n = 317) were recruited from elderly senior citizens at public health centers. Block systematic random sampling was applied to categorize the subjects in experimental and control groups. The experimental group (n = 160) received OEP for six months and was compared with the control group (n = 157) who received general health training. This study was registered with the following ID, IRCT2014012016285N1. RESULTS The findings of the study showed that OEP improved physical performance (Berg-Balance-Score with P > 0.025, and Timed-Up-Go-Test with P > 0.017) and functional capacity (Arm-Curl-Test with P > 0.00 and Chair-Stand-Test with P > 0.01). In addition, OEP significantly reduced the incidence of falls (P ≤ 0.00) among senior citizens in the experimental group. DISCUSSION The OEP as a home-based exercise is effective for the reduction of the incidence of falls among senior citizens with a history of falls. The OEP can be recommended for elderly homebound people who do not have access to facilities.
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Affiliation(s)
- Ali Dadgari
- School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, IR Iran
- Malaysian Research Institute on Ageing, University of Putra Malaysia, Selangor, Malaysia
- Corresponding Author: Ali Dadgari, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, IR Iran. Tel: +98-9123733539, Fax: +98-982332395054, E-mail:
| | - Tengku Aizan Hamid
- Malaysian Research Institute on Ageing, University of Putra Malaysia, Selangor, Malaysia
| | - Mohammad Nazrul Hakim
- Faculty of Medicine and Health Sciences, University of Putra Malaysia. Darul Ehsan, Selangor, Malaysia
| | - Reza Chaman
- School of Medicine, Yasooj University of Medical Sciences, Yasojj, IR Iran
| | - Seyed Abbas Mousavi
- Health Related Social and Behavioral Sciences Research Center, Shahroud University of Medical Sciences, Shahroud, IR Iran
| | - Lim Poh Hin
- Faculty of Medicine and Health Sciences, University of Putra Malaysia. Darul Ehsan, Selangor, Malaysia
| | - Leila Dadvar
- Imam Hossein Education Research and Treatment Center, Shahroud University of Medical Sciences, Shahroud, IR Iran
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Wai AAP, Duc PD, Syin C, Zhang H. iBEST: intelligent Balance assessment and Stability Training system using smartphone. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2015; 2014:3683-6. [PMID: 25570790 DOI: 10.1109/embc.2014.6944422] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Patients with postural instability could lead to falls and injuries while walking due to balance disorders. So those patients need regular balance training and evaluation to improve and examine balance deficiencies. But many do not notice such balance issues; resulting lack of timely preventive measures. This shows the needs of affordable and accessible solution for balance training and assessment. So iBEST (intelligent Balance assessment and Stability Training) is proposed enabling to train and assess balance conveniently anywhere anytime. Moreover, therapists can remotely evaluate and manage their recovery progress. These benefits can be realized leveraging sensors from smartphone, cloud-based data analytics and web applications. iBEST employs sensorised automated balance assessment in digitizing Berg Balance Scale (BBS) clinical risk assessment tool. The initial feasibility study showed average accuracy of 90.22% using smartphone in classifying the specified BBS test items.
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Choi JH, Kim NJ. The effects of balance training and ankle training on the gait of elderly people who have fallen. J Phys Ther Sci 2015; 27:139-42. [PMID: 25642058 PMCID: PMC4305545 DOI: 10.1589/jpts.27.139] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 07/24/2014] [Indexed: 12/03/2022] Open
Abstract
[Purpose] The aim of this study was to examine the effects of balance training and muscle
training around the ankle joints on the gait of elderly people who have experienced a
fall. [Subjects] Twenty-six elderly people with a risk of falling and a Berg Balance Scale
score of 37 to 50 points who had experienced a fall in the last year were randomly and
equally assigned to either a balance training group or an ankle training group. The
balance training group received training on a hard floor, training while maintaining
balance on a cushion ball in a standing position, and training while maintaining balance
on an unstable platform in a standing position; the ankle training group received training
to strengthen the muscles around the ankle joints and conducted stretch exercise for the
muscles around the ankle joints. [Results] There were significant changes in gait
velocity, step length, and stride length in the balance training group after the
intervention; there were significant changes in gait velocity, cadence, step time, cycle
time, step length, and stride length in the ankle training group after the intervention.
In a between-group comparison, the gait velocity of the balance training group showed a
significant improvement compared with the ankle training group. [Conclusion] Both balance
training and ankle joint training are effective in enhancing the gait ability of elderly
people with a risk of falling; in particular, balance training is effective in improving
the gait velocity of elderly people who have experienced a fall compared with ankle joint
training.
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Affiliation(s)
- Jung-Hyun Choi
- Department of Physical Therapy, Namseoul University, Republic of Korea
| | - Nyeon-Jun Kim
- Department of Physical Therapy, Faculty of Medical and Health, Pohang College: Pohang-si, Gyeongsangbuk-do, Republic of Korea
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Laufer Y, Dar G, Kodesh E. Does a Wii-based exercise program enhance balance control of independently functioning older adults? A systematic review. Clin Interv Aging 2014; 9:1803-13. [PMID: 25364238 PMCID: PMC4211857 DOI: 10.2147/cia.s69673] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Exercise programs that challenge an individual’s balance have been shown to reduce the risk of falls among older adults. Virtual reality computer-based technology that provides the user with opportunities to interact with virtual objects is used extensively for entertainment. There is a growing interest in the potential of virtual reality-based interventions for balance training in older adults. This work comprises a systematic review of the literature to determine the effects of intervention programs utilizing the Nintendo Wii console on balance control and functional performance in independently functioning older adults. Methods Studies were obtained by searching the following databases: PubMed, CINAHL, PEDro, EMBASE, SPORTdiscus, and Google Scholar, followed by a hand search of bibliographic references of the included studies. Included were randomized controlled trials written in English in which Nintendo Wii Fit was used to enhance standing balance performance in older adults and compared with an alternative exercise treatment, placebo, or no treatment. Results Seven relevant studies were retrieved. The four studies examining the effect of Wii-based exercise compared with no exercise reported positive effects on at least one outcome measure related to balance performance in older adults. Studies comparing Wii-based training with alternative exercise programs generally indicated that the balance improvements achieved by Wii-based training are comparable with those achieved by other exercise programs. Conclusion The review indicates that Wii-based exercise programs may serve as an alternative to more conventional forms of exercise aimed at improving balance control. However, due to the great variability between studies in terms of the intervention protocols and outcome measures, as well as methodological limitations, definitive recommendations as to optimal treatment protocols and the potential of such an intervention as a safe and effective home-based treatment cannot be made at this point.
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Affiliation(s)
- Yocheved Laufer
- Physical Therapy Department, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Gali Dar
- Physical Therapy Department, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Einat Kodesh
- Physical Therapy Department, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
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Alves LV, Taguchi CK, Oliveira ILD, Sousa MDGCD. Avaliação da tendência à quedas em idosos de Sergipe. REVISTA CEFAC 2014. [DOI: 10.1590/1982-0216201425312] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJETIVOS:analisar o desempenho de idosos no teste Dynamic Gait Index e Timed Up and Go Testpara avaliar a tendência para quedas e verificar a interferência das variáveis idade, gênero e relato de eventos de quedas pregressas.MÉTODOS:trata-se de uma pesquisa clínica, descritiva, de caráter qualitativo e quantitativo para analisar os resultados obtidos da aplicação do Dynamic Gait Index e Timed Up and Go Test- versão brasileira, em 60 voluntários, de ambos os gêneros e idade entre 60 e 83 anos (média= 68,57 ± 5,94). O projeto de pesquisa foi apreciado pelo Comitê de Ética da instituição e seguiu as recomendações do parecer 196/96 da Legislação Brasileira para pesquisa com seres humanos. Para a análise dos dados utilizou-se testes descritivos, teste de Mann-Whitney e Qui-Quadrado (X²), sendo que foi adotado o p<0,05.RESULTADOS: verificou-se que 37 (61,7%) dos 60 voluntários pontuaram com índices inferiores ao padrão de normalidade no Timed Up and Go Test, enquanto, no Dynamic Gait Index 19 (31,7%) voluntários apresentaram índices inferiores ao ponto de corte. Ocorreu associação estatisticamente significante entre Dynamic Gait Index e as variáveis idade e quedas. Neste estudo o Timed Up and Go Test apresentou associação estatisticamente significante com as variáveis quedas e gênero. Encontraram-se valores estatisticamente significantes na comparação entre as variáveis.CONCLUSÃO:foi frequente a constatação de alteração funcional de equilíbrio e de marcha, e a maioria da amostra apresentou tendência para quedas. A idade associou-se com alterações de marcha e equilíbrio, o gênero com tendência para quedas, e os relatos de eventos de quedas pregressas com os dois instrumentos aplicados. Os resultados aqui apresentados reforçam a necessidade da formação científica e profissional voltada para a atenção primária e secundária da população idosa.
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Asmidawati A, Hamid TA, Hussain RM, Hill KD. Home based exercise to improve turning and mobility performance among community dwelling older adults: protocol for a randomized controlled trial. BMC Geriatr 2014; 14:100. [PMID: 25196930 PMCID: PMC4166017 DOI: 10.1186/1471-2318-14-100] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 08/14/2014] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Turning is a common activity for older people, and is one of the activities commonly associated with falls during walking. Falls that occur while walking and turning have also been associated with an increased risk of hip fracture in older people. Despite the importance of stability during turning, there has been little focus on identifying this impairment in at risk older people, or in evaluating interventions aiming to improve this outcome. This study will evaluate the effectiveness of a 16 week tailored home based exercise program in older adults aged (50 years and above) who were identified as having unsteadiness during turning. METHODS/DESIGN A single blind randomized controlled trial will be conducted, with assessors blind to group allocation. Study participants will be aged 50 years and above, living in the community and have been identified as having impaired turning ability [outside of age and gender normal limits on the Step Quick Turn (180 degree turn) task on the Neurocom® Balance Master with long plate]. After a comprehensive baseline assessment, those classified as having balance impairment while turning will be randomized to intervention or control group. The intervention group will receive a 16 week individualized balance and strength home exercise program, based on the Otago Exercise Program with additional exercises focused on improving turning ability. Intervention group will attend four visit to the assessment centre over 16 weeks period, for provision, monitoring, modification of the exercise and encourage ongoing participation. Participants in the control group will continue with their usual activities. All participants will be re-assessed on completion of the 16 week program. Primary outcome measures will be the Step Quick Turn Test and Timed-Up and Go test. Secondary outcomes will include other clinical measures of balance, psychological aspects of falls, incidence of falls and falls risk factors. DISCUSSION Results of this study will provide useful information for clinicians on the types of exercises to improve turning ability in older people with increased falls risk and the effectiveness of these exercises in improving outcomes. TRIAL REGISTRATION ACTRN12613000855729.
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Affiliation(s)
- Ashari Asmidawati
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, Western Australia 6845, Australia
- Institute of Gerontology, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Tengku Aizan Hamid
- Institute of Gerontology, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Rizal M Hussain
- Institute of Gerontology, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Keith D Hill
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, Western Australia 6845, Australia
- Health Promotion Division, National Ageing Research Institute, The Royal Melbourne Hospital, PO Box 2127, Parkville, Melbourne, Victoria 3050, Australia
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Ni M, Mooney K, Richards L, Balachandran A, Sun M, Harriell K, Potiaumpai M, Signorile JF. Comparative Impacts of Tai Chi, Balance Training, and a Specially-Designed Yoga Program on Balance in Older Fallers. Arch Phys Med Rehabil 2014; 95:1620-1628.e30. [DOI: 10.1016/j.apmr.2014.04.022] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 04/14/2014] [Accepted: 04/18/2014] [Indexed: 11/25/2022]
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Victor LGV, Oliveira MRD, Teixeira DDC, Paes MA, Fujisawa DS, Bispo NDNDC, Silva Junior RAD. Postural control during one-leg stance in active and sedentary older people. MOTRIZ: REVISTA DE EDUCACAO FISICA 2014. [DOI: 10.1590/s1980-65742014000300014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
Physical inactivity and aging are functional disability factors for older individuals, causing loss of balance and increasing the risk of falls. The purpose of this study was to compare the balance of physically independent older individuals, both participants and non-participants in a regular exercise program. Fifty six physically independent older participants were divided into G1ACTIVE = 28 individuals who participate in a regular exercise program and G2SEDENTARY = 28 individuals who did not participate in any physical exercise program. All participants underwent an eyes-open during one-leg balance test on a force platform. The postural oscillation parameters included center of pressure (COP); sway mean velocity and frequency of COP oscillations. G2 SEDENTARY showed higher postural instability than G1ACTIVE. Significant differences were observed for the main balance parameters. The results of this study support the concept that participation in regular physical activity is beneficial for postural balance of older individuals.
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Rogan S, Hilfiker R, Schenk A, Vogler A, Taeymans J. Effects of Whole-body Vibration with Stochastic Resonance on Balance in Persons with Balance Disability and Falls History – A Systematic Review. Res Sports Med 2014; 22:294-313. [DOI: 10.1080/15438627.2014.919504] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Slavko Rogan
- Bern University of Applied Sciences, Department of Health, Bern, Switzerland
- Akademie für integrative Physiotherapie und Trainingslehre, Grenzach-Wyhlen, Germany
| | - Roger Hilfiker
- School of Health Sciences, HES-SO Valais-Wallis, Sion, Switzerland
| | - Adrian Schenk
- Bern University of Applied Sciences, Department of Health, Bern, Switzerland
| | - Aldo Vogler
- Bern University of Applied Sciences, Department of Health, Bern, Switzerland
| | - Jan Taeymans
- Bern University of Applied Sciences, Department of Health, Bern, Switzerland
- Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
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Too sick not to exercise: using a 6-week, home-based exercise intervention for cancer-related fatigue self-management for postsurgical non-small cell lung cancer patients. Cancer Nurs 2014; 36:175-88. [PMID: 23051872 DOI: 10.1097/ncc.0b013e31826c7763] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Two prevalent unmet supportive care needs reported by the non-small cell lung cancer (NSCLC) population include the need to manage fatigue and attain adequate exercise to meet the physical demands of daily living. Yet, there are no guidelines for routine rehabilitative support to address fatigue and exercise for persons with NSCLC during the critical transition from hospital to home after thoracotomy. OBJECTIVE The objective of this study was to evaluate the feasibility, acceptability, safety, and changes in study end points of a home-based exercise intervention to enhance perceived self-efficacy for cancer-related fatigue (CRF) self-management for persons after thoracotomy for NSCLC transitioning from hospital to home. INTERVENTIONS/METHODS Guided by the principles of the Transitional Care Model and the Theory of Symptom Self-management, a single-arm design composed of 7 participants with early-stage NSCLC performed light-intensity walking and balance exercises in a virtual reality environment with the Nintendo Wii Fit Plus. Exercise started the first week after hospitalization for thoracotomy and continued for 6 weeks. RESULTS The intervention positively impacted end points such as CRF severity; perceived self-efficacy for fatigue self-management, walking, and balance; CRF self-management behaviors (walking and balance exercises); and functional performance (number of steps taken per day). CONCLUSIONS A home-based, light-intensity exercise intervention for patients after thoracotomy for NSCLC is feasible, safe, well tolerated, and highly acceptable showing positive changes in CRF self-management. IMPLICATIONS FOR PRACTICE Beginning evidence suggests that a light-intensity in-home walking and balance intervention after hospitalization for thoracotomy for NSCLC is a potentially effective rehabilitative CRF self-management intervention. Next steps include testing of this health-promoting self-management intervention in a larger-scale randomized controlled trial.
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Rocha Júnior PR, da Silva Peres A, Garbi FP, Frizzo ACF, Valenti VE. Effects of physiotherapy on balance and unilateral vestibular hypofunction in vertiginous elderly. Int Arch Med 2014; 7:8. [PMID: 24576350 PMCID: PMC3938970 DOI: 10.1186/1755-7682-7-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Accepted: 02/15/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We aimed to analyze the effect of a physical therapy protocol on unilateral vestibular hypofunction and overall balance in elderly with vertigo. METHODS The study included nine subjects, four male subjects (68.5 ± 11.09 years old) and five females (72.4 ± 7.09 years old). It was used the performance-oriented Mobility Assessment (POMA), to evaluate the balance and the Unterberger - Fukuda test for analysis of unilateral vestibular dysfunction through rotations and displacements of the body. We developed and applied a structured physical therapy protocol, consisting of group exercises. RESULTS It was observed that after the protocol, all participants improved balance (33.9 ± 5.1 vs. 47.3 ± 7.6, p < 0.0001) and displacement (111.1 ± 38.0 vs. 53.3 ± 34.6, p = 0.0001). However, it was not found significant differences for rotation. CONCLUSION The proposed protocol has contributed to an improvement in balance and vestibular dysfunction of the aged.
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Affiliation(s)
- Paulo Roberto Rocha Júnior
- Faculdades Adamantinenses Integradas, Via de Acesso Francisco Bellusci, 1000, Adamantina, SP 17800-000, Brazil
| | - Amanda da Silva Peres
- Faculdades Adamantinenses Integradas, Via de Acesso Francisco Bellusci, 1000, Adamantina, SP 17800-000, Brazil
| | - Fernando Pereira Garbi
- Faculdades Adamantinenses Integradas, Via de Acesso Francisco Bellusci, 1000, Adamantina, SP 17800-000, Brazil
| | - Ana CF Frizzo
- Departamento de Fonoaudiologia, Faculdade de Filosofia e Ciências, UNESP, Av. Hygino Muzzi Filho, 737, Marília, SP 17525-900, Brazil
| | - Vitor E Valenti
- Departamento de Fonoaudiologia, Faculdade de Filosofia e Ciências, UNESP, Av. Hygino Muzzi Filho, 737, Marília, SP 17525-900, Brazil
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Yamamoto S, Matsunaga A, Wang G, Hoshi K, Kamiya K, Noda C, Kimura M, Yamaoka-Tojo M, Masuda T. Effect of Balance Training on Walking Speed and Cardiac Events in Elderly Patients With Ischemic Heart Disease. Int Heart J 2014; 55:397-403. [DOI: 10.1536/ihj.14-017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
| | - Atsuhiko Matsunaga
- Graduate School of Medical Sciences, Kitasato University
- School of Allied Health Sciences, Kitasato University
| | - Guoqin Wang
- Kitasato Clinical Research Center, Kitasato University
| | - Keika Hoshi
- Kitasato Clinical Research Center, Kitasato University
- Department of Preventive Medicine, Kitasato University
| | - Kentaro Kamiya
- Graduate School of Medical Sciences, Kitasato University
| | | | | | | | - Takashi Masuda
- Graduate School of Medical Sciences, Kitasato University
- School of Allied Health Sciences, Kitasato University
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Exercise Interventions, Gait, and Balance in Older Subjects with Distal Symmetric Polyneuropathy. Am J Phys Med Rehabil 2014; 93:1-12; quiz 13-6. [DOI: 10.1097/phm.0000000000000052] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kristinsdottir EK, Baldursdottir B. Effect of multi-sensory balance training for unsteady elderly people: pilot study of the “Reykjavik model”. Disabil Rehabil 2013; 36:1211-8. [DOI: 10.3109/09638288.2013.835452] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Aveiro MC, Driusso P, Santos JGD, Kiyoto VD, Oishi J. Effects of a physical therapy program on quality of life among community-dwelling elderly women: randomized-controlled trial. FISIOTERAPIA EM MOVIMENTO 2013. [DOI: 10.1590/s0103-51502013000300004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION: Health promotion policies for encouraging elderly to remain active, independent and, effectively have a positive effect on their quality of life. OBJECTIVE: To verify the effects of a low-intensity group-based physical therapy program on quality of life among community-dwelling elderly women. MATERIALS AND METHODS: It was carried out a randomized controlled trial. Seventeen women (67.8 ± 4.9 years old) that completed 12-week training program and 10 women (68.9 ± 5.7 years old) that were included in control group answered the abbreviated version for World Health Organization Quality of life Questionnaire - WHOQOL-bref at baseline and after 12 weeks. Exercise group performed stretching, resistance and balance training. Intragroup and intergroup analysis was made using Wilcoxon and Mann-Whitney U tests, respectively. The level of significance used for all comparisons was 5%. Furthermore, it was determined the Reliable Change Index (RCI) as part of JT Method. RESULTS: Exercise group presented a significant improvement for Psychological domain (p = 0.047) after 12-week physical therapy program. Otherwise, control group presented a significant worsening for overall (p = 0.01), physical (p = 0.01) and psychological (p = 0.008) domains. Exercise group presented two participants with positive reliable change (PRC) for social domain, two participants with PRC for Environment domain. Overall and Physical domain presented three participants with PRC. Psychological domain presented four participants with PRC and one with negative reliable change. CONCLUSION: A low-intensity group-based physical therapy program may contribute in order to maintain quality of life and improve some psychological aspects among community-dwelling elderly women.
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Disparate Health Implications Stemming From the Propensity of Elderly and Medically Fragile Populations to Shelter in Place During Severe Storm Events. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2013; 19 Suppl 2:S55-62. [DOI: 10.1097/phh.0b013e318297226a] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Aveiro MC, Driusso P, Santos JGD, Kiyoto VD, Oishi J. Effects of a group-based exercise program on muscle strength and postural control among community-dwelling elderly women: a randomized-controlled trial. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2013. [DOI: 10.1590/s1809-98232013000300011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES: Verify if a group-based low intensity exercise training program could significantly improve physical variables related to muscle strength and postural control among community-dwelling elderly women. METHODS: This study was a non-blinded randomized-controlled trial. Thirty-seven women were allocated according a computer generated randomization list in two groups: Control (n=18; mean age 68.9(5.7)) and Exercise (n=19; mean age 67.8(4.9)). Main outcome measures were body sway during quiet stance, and knee and ankle isometric peak torque and isokinetic peak torque, power and time acceleration. Exercise group performed a group-based training program on two days per week for 12 weeks. Each training session consisted of stretching exercises, ankle and knee muscle strengthening and balance training. Control group did not undergo any training. RESULTS: Control group did not present significant differences for variables analyzed. Effect size to peak torque and power for non-dominant knee flexors at 60º/s (0.85 and 0.8, respectively), peak torque and power for non-dominant knee flexors and time acceleration for non-dominant knee extensors at 120º/s (0.8, -0.9 and 1.19, respectively) may be considered large after training. CONCLUSION: Low-intensity group-based exercise training program may be effective to improve knee isometric peak torque and knee and ankle isokinetic peak torque, power and time acceleration. Trial registration: ACTRN12610000042044.
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Harling A, Simpson JP. A systematic review to determine the effectiveness of Tai Chi in reducing falls and fear of falling in older adults. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/174328808x309241] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Relative efficacy of various strategies for visual feedback in standing balance activities. Exp Brain Res 2013; 230:117-25. [DOI: 10.1007/s00221-013-3634-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 06/24/2013] [Indexed: 10/26/2022]
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Nakano H, Nozaki M, Ueta K, Osumi M, Kawami S, Morioka S. Effect of a plantar perceptual learning task on walking stability in the elderly: a randomized controlled trial. Clin Rehabil 2013; 27:608-15. [PMID: 23405022 DOI: 10.1177/0269215512471062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To determine whether the plantar perceptual learning task, using a hardness discrimination training, efficiently improves walking stability in the elderly. DESIGN A randomized controlled trial. SETTING Elder day-care center. PARTICIPANTS Eighty-six elderly people (73.84 SD 5.98 years) who went to an elder day-care center were randomly assigned evenly to either an intervention or a control group. INTERVENTION The intervention group performed a task to discriminate hardness differences while standing on sponge mats of different levels of hardness. The control group underwent the same task except that they were not instructed to discriminate hardness levels of the mats. The tasks were carried out over a four-week period for 10 days for both groups. OUTCOME MEASURES Outcome was assessed by determining root mean squares of trunk acceleration during walking. RESULTS Plantar perception was significantly improved in the intervention group after training (F = 26.24, p < 0.01). In addition, changes in root mean square values of acceleration were significantly greater after training in the intervention group (medial-lateral, 0.36 SD 0.26; vertical, 0.32 SD 0.24; anterio-posterior, 0.26 SD 0.24) than in the control group (medial-lateral, 0.14 SD 0.28, vertical, 0.16 SD 0.35, anterio-posterior, 0.12 SD 0.29) (p < 0.05). Changes in walking speed were not significantly different (p = 0.13) between the intervention (0.06 SD 0.13) and control groups (0.02 SD 0.14). CONCLUSION The plantar perceptual learning task might efficiently stabilize postural control during walking in the elderly.
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Affiliation(s)
- Hideki Nakano
- Department of Neurorehabilitation, Graduate School of Health Science, Kio University, Nara, Japan.
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Cameron ID, Gillespie LD, Robertson MC, Murray GR, Hill KD, Cumming RG, Kerse N. Interventions for preventing falls in older people in care facilities and hospitals. Cochrane Database Syst Rev 2012; 12:CD005465. [PMID: 23235623 DOI: 10.1002/14651858.cd005465.pub3] [Citation(s) in RCA: 254] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Falls in care facilities and hospitals are common events that cause considerable morbidity and mortality for older people. This is an update of a review first published in 2010. OBJECTIVES To assess the effectiveness of interventions designed to reduce falls by older people in care facilities and hospitals. SEARCH METHODS We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (March 2012); The Cochrane Library 2012, Issue 3; MEDLINE, EMBASE, and CINAHL (all to March 2012); ongoing trial registers (to August 2012), and reference lists of articles. SELECTION CRITERIA Randomised controlled trials of interventions to reduce falls in older people in residential or nursing care facilities or hospitals. DATA COLLECTION AND ANALYSIS Two review authors independently assessed risk of bias and extracted data. We used a rate ratio (RaR) and 95% confidence interval (CI) to compare the rate of falls (e.g. falls per person year) between intervention and control groups. For risk of falling we used a risk ratio (RR) and 95% CI based on the number of people falling (fallers) in each group. We pooled results where appropriate. MAIN RESULTS We included 60 trials (60,345 participants), 43 trials (30,373 participants) in care facilities, and 17 (29,972 participants) in hospitals.Results from 13 trials testing exercise interventions in care facilities were inconsistent. Overall, there was no difference between intervention and control groups in rate of falls (RaR 1.03, 95% CI 0.81 to 1.31; 8 trials, 1844 participants) or risk of falling (RR 1.07, 95% CI 0.94 to 1.23; 8 trials, 1887 participants). Post hoc subgroup analysis by level of care suggested that exercise might reduce falls in people in intermediate level facilities, and increase falls in facilities providing high levels of nursing care.In care facilities, vitamin D supplementation reduced the rate of falls (RaR 0.63, 95% CI 0.46 to 0.86; 5 trials, 4603 participants), but not risk of falling (RR 0.99, 95% CI 0.90 to 1.08; 6 trials, 5186 participants).For multifactorial interventions in care facilities, the rate of falls (RaR 0.78, 95% CI 0.59 to 1.04; 7 trials, 2876 participants) and risk of falling (RR 0.89, 95% CI 0.77 to 1.02; 7 trials, 2632 participants) suggested possible benefits, but this evidence was not conclusive.In subacute wards in hospital, additional physiotherapy (supervised exercises) did not significantly reduce rate of falls (RaR 0.54, 95% CI 0.16 to 1.81; 1 trial, 54 participants) but achieved a significant reduction in risk of falling (RR 0.36, 95% CI 0.14 to 0.93; 2 trials, 83 participants).In one trial in a subacute ward (54 participants), carpet flooring significantly increased the rate of falls compared with vinyl flooring (RaR 14.73, 95% CI 1.88 to 115.35) and potentially increased the risk of falling (RR 8.33, 95% CI 0.95 to 73.37).One trial (1822 participants) testing an educational session by a trained research nurse targeting individual fall risk factors in patients at high risk of falling in acute medical wards achieved a significant reduction in risk of falling (RR 0.29, 95% CI 0.11 to 0.74).Overall, multifactorial interventions in hospitals reduced the rate of falls (RaR 0.69, 95% CI 0.49 to 0.96; 4 trials, 6478 participants) and risk of falling (RR 0.71, 95% CI 0.46 to 1.09; 3 trials, 4824 participants), although the evidence for risk of falling was inconclusive. Of these, one trial in a subacute setting reported the effect was not apparent until after 45 days in hospital. Multidisciplinary care in a geriatric ward after hip fracture surgery compared with usual care in an orthopaedic ward significantly reduced rate of falls (RaR 0.38, 95% CI 0.19 to 0.74; 1 trial, 199 participants) and risk of falling (RR 0.41, 95% CI 0.20 to 0.83). More trials are needed to confirm the effectiveness of multifactorial interventions in acute and subacute hospital settings. AUTHORS' CONCLUSIONS In care facilities, vitamin D supplementation is effective in reducing the rate of falls. Exercise in subacute hospital settings appears effective but its effectiveness in care facilities remains uncertain due to conflicting results, possibly associated with differences in interventions and levels of dependency. There is evidence that multifactorial interventions reduce falls in hospitals but the evidence for risk of falling was inconclusive. Evidence for multifactorial interventions in care facilities suggests possible benefits, but this was inconclusive.
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Affiliation(s)
- Ian D Cameron
- Rehabilitation Studies Unit, SydneyMedical School Northern, The University of Sydney, Ryde, Australia.
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Oh DH, Park JE, Lee ES, Oh SW, Cho SI, Jang SN, Baik HW. Intensive exercise reduces the fear of additional falls in elderly people: findings from the Korea falls prevention study. Korean J Intern Med 2012; 27:417-25. [PMID: 23269883 PMCID: PMC3529241 DOI: 10.3904/kjim.2012.27.4.417] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Revised: 04/03/2012] [Accepted: 04/23/2012] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS Falls among older people are a major public health problem and may result in fracture, medical complications that require hospitalization, and fear of additional falls. Given the prevalence and impact of the fear of falling again, reducing the incidence of falls is important to prevent additional falls. This study analyzed whether exercise programs decrease the fear of future falls in elderly patients who have fallen previously. METHODS A randomized controlled study was performed that included 65 elderly community-dwelling subjects who had fallen in the previous year. Subjects were randomized into two groups: an exercise group (EG, n = 36) and a control group (CG, n = 29). The EG participated in three exercise sessions per week for 12 weeks. Muscle strength, balance, agility, flexibility, and muscular endurance were measured at baseline and after 12 weeks. RESULTS After the 12-week exercise program, the subjects in the EG demonstrated remarkable improvement in their walking speed, balance (p = 0.003), back strength (p = 0.08), lower extremity strength (p = 0.004), and flexibility (p < 0.001). When asked whether they were afraid of falling, more participants in the EG than in the CG responded "not at all" or "a little." CONCLUSIONS The 12-week exercise program described here reduced the fear of falling (p = 0.02). It also improved the balance, flexibility, and muscle strength of the participants and was associated with improved quality of life.
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Affiliation(s)
- Dong Hyun Oh
- Department of Internal Medicine, Bundang Jesaeng General Hospital, Seongnam, Korea
| | - Ji Eun Park
- Department of Internal Medicine, Bundang Jesaeng General Hospital, Seongnam, Korea
| | - Eon Sook Lee
- Department of Family Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Sang Woo Oh
- Department of Family Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Sung Il Cho
- Seoul National University School of Public Health, Seoul, Korea
| | - Soong Nang Jang
- Department of Nursing, Chung-Ang University Red Cross College of Nursing, Seoul, Korea
| | - Hyun Wook Baik
- Department of Internal Medicine, Bundang Jesaeng General Hospital, Seongnam, Korea
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Gillespie LD, Robertson MC, Gillespie WJ, Sherrington C, Gates S, Clemson LM, Lamb SE. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev 2012; 2012:CD007146. [PMID: 22972103 PMCID: PMC8095069 DOI: 10.1002/14651858.cd007146.pub3] [Citation(s) in RCA: 1255] [Impact Index Per Article: 104.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Approximately 30% of people over 65 years of age living in the community fall each year. This is an update of a Cochrane review first published in 2009. OBJECTIVES To assess the effects of interventions designed to reduce the incidence of falls in older people living in the community. SEARCH METHODS We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (February 2012), CENTRAL (The Cochrane Library 2012, Issue 3), MEDLINE (1946 to March 2012), EMBASE (1947 to March 2012), CINAHL (1982 to February 2012), and online trial registers. SELECTION CRITERIA Randomised trials of interventions to reduce falls in community-dwelling older people. DATA COLLECTION AND ANALYSIS Two review authors independently assessed risk of bias and extracted data. We used a rate ratio (RaR) and 95% confidence interval (CI) to compare the rate of falls (e.g. falls per person year) between intervention and control groups. For risk of falling, we used a risk ratio (RR) and 95% CI based on the number of people falling (fallers) in each group. We pooled data where appropriate. MAIN RESULTS We included 159 trials with 79,193 participants. Most trials compared a fall prevention intervention with no intervention or an intervention not expected to reduce falls. The most common interventions tested were exercise as a single intervention (59 trials) and multifactorial programmes (40 trials). Sixty-two per cent (99/159) of trials were at low risk of bias for sequence generation, 60% for attrition bias for falls (66/110), 73% for attrition bias for fallers (96/131), and only 38% (60/159) for allocation concealment.Multiple-component group exercise significantly reduced rate of falls (RaR 0.71, 95% CI 0.63 to 0.82; 16 trials; 3622 participants) and risk of falling (RR 0.85, 95% CI 0.76 to 0.96; 22 trials; 5333 participants), as did multiple-component home-based exercise (RaR 0.68, 95% CI 0.58 to 0.80; seven trials; 951 participants and RR 0.78, 95% CI 0.64 to 0.94; six trials; 714 participants). For Tai Chi, the reduction in rate of falls bordered on statistical significance (RaR 0.72, 95% CI 0.52 to 1.00; five trials; 1563 participants) but Tai Chi did significantly reduce risk of falling (RR 0.71, 95% CI 0.57 to 0.87; six trials; 1625 participants).Multifactorial interventions, which include individual risk assessment, reduced rate of falls (RaR 0.76, 95% CI 0.67 to 0.86; 19 trials; 9503 participants), but not risk of falling (RR 0.93, 95% CI 0.86 to 1.02; 34 trials; 13,617 participants).Overall, vitamin D did not reduce rate of falls (RaR 1.00, 95% CI 0.90 to 1.11; seven trials; 9324 participants) or risk of falling (RR 0.96, 95% CI 0.89 to 1.03; 13 trials; 26,747 participants), but may do so in people with lower vitamin D levels before treatment.Home safety assessment and modification interventions were effective in reducing rate of falls (RR 0.81, 95% CI 0.68 to 0.97; six trials; 4208 participants) and risk of falling (RR 0.88, 95% CI 0.80 to 0.96; seven trials; 4051 participants). These interventions were more effective in people at higher risk of falling, including those with severe visual impairment. Home safety interventions appear to be more effective when delivered by an occupational therapist.An intervention to treat vision problems (616 participants) resulted in a significant increase in the rate of falls (RaR 1.57, 95% CI 1.19 to 2.06) and risk of falling (RR 1.54, 95% CI 1.24 to 1.91). When regular wearers of multifocal glasses (597 participants) were given single lens glasses, all falls and outside falls were significantly reduced in the subgroup that regularly took part in outside activities. Conversely, there was a significant increase in outside falls in intervention group participants who took part in little outside activity.Pacemakers reduced rate of falls in people with carotid sinus hypersensitivity (RaR 0.73, 95% CI 0.57 to 0.93; three trials; 349 participants) but not risk of falling. First eye cataract surgery in women reduced rate of falls (RaR 0.66, 95% CI 0.45 to 0.95; one trial; 306 participants), but second eye cataract surgery did not.Gradual withdrawal of psychotropic medication reduced rate of falls (RaR 0.34, 95% CI 0.16 to 0.73; one trial; 93 participants), but not risk of falling. A prescribing modification programme for primary care physicians significantly reduced risk of falling (RR 0.61, 95% CI 0.41 to 0.91; one trial; 659 participants).An anti-slip shoe device reduced rate of falls in icy conditions (RaR 0.42, 95% CI 0.22 to 0.78; one trial; 109 participants). One trial (305 participants) comparing multifaceted podiatry including foot and ankle exercises with standard podiatry in people with disabling foot pain significantly reduced the rate of falls (RaR 0.64, 95% CI 0.45 to 0.91) but not the risk of falling.There is no evidence of effect for cognitive behavioural interventions on rate of falls (RaR 1.00, 95% CI 0.37 to 2.72; one trial; 120 participants) or risk of falling (RR 1.11, 95% CI 0.80 to 1.54; two trials; 350 participants).Trials testing interventions to increase knowledge/educate about fall prevention alone did not significantly reduce the rate of falls (RaR 0.33, 95% CI 0.09 to 1.20; one trial; 45 participants) or risk of falling (RR 0.88, 95% CI 0.75 to 1.03; four trials; 2555 participants).No conclusions can be drawn from the 47 trials reporting fall-related fractures.Thirteen trials provided a comprehensive economic evaluation. Three of these indicated cost savings for their interventions during the trial period: home-based exercise in over 80-year-olds, home safety assessment and modification in those with a previous fall, and one multifactorial programme targeting eight specific risk factors. AUTHORS' CONCLUSIONS Group and home-based exercise programmes, and home safety interventions reduce rate of falls and risk of falling.Multifactorial assessment and intervention programmes reduce rate of falls but not risk of falling; Tai Chi reduces risk of falling.Overall, vitamin D supplementation does not appear to reduce falls but may be effective in people who have lower vitamin D levels before treatment.
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Affiliation(s)
- Lesley D Gillespie
- Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
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Crownover J, Galang GNF, Wagner A. Rehabilitation Considerations for Traumatic Brain Injury in the Geriatric Population: Epidemiology, Neurobiology, Prognosis, and Management. ACTA ACUST UNITED AC 2012. [DOI: 10.1007/s13670-012-0021-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Aoki M, Nishihori T, Jiang Y, Nagasaki S, Wakaoka T, Ito Y. Damping control of balance in the medial/lateral direction and the risk of falling in the elderly. Geriatr Gerontol Int 2012; 13:182-9. [DOI: 10.1111/j.1447-0594.2012.00884.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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