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Eisenberg Y, Hofstra A, Twardzik E. Quantifying active travel among people with disabilities in the US. Disabil Health J 2024; 17:101615. [PMID: 38565481 PMCID: PMC11194152 DOI: 10.1016/j.dhjo.2024.101615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 03/08/2024] [Accepted: 03/08/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND People with disabilities have higher rates of physical inactivity than people without. Active travel (e.g., walking/wheeling to nearby destinations or transit) is a recommended approach to increasing total physical activity (PA) but limited research has examined active travel among people with disabilities. OBJECTIVE To describe active travel among a nationally representative sample of people with disabilities, analyze variation between sub-groups, and examine factors associated with active travel. METHODS Using the 2017 National Household Travel Survey, our cross-sectional analysis summarized counts and duration of walking/wheeling trips for people with four different types of disabilities. We examined which factors were associated with doing any active travel and the duration of active travel, using zero inflated negative binomial regression models. RESULTS Our analysis identified that 14.55% of people with disabilities took a mean of 2.56 (95%CI = 2.42-2.69) walking/wheeling trips per day. Compared to non-active travelers, a higher proportion of active travelers were low-income, lived alone, had no-vehicle, and were Black or Hispanic. For active travelers, daily walking minutes, on average, were 46.41 (95%CI = 40.25-52.57) among people who used ambulatory devices, 41.55 (95%CI = 24.61-58.49) among people who were blind/low-vision, 39.93 (95%CI = 35.41-44.45) among people who used no device, and 29.58 (95%CI = 23.53-35.64) among people who used chair devices. Our analysis identified individual, household, and community factors associated with the likelihood and duration of walking/wheeling for travel and variation across disability types. CONCLUSIONS Understanding the multiple identities of active travelers with disabilities can inform walking/wheeling intervention strategies. Infrastructure improvements that support less reliance on automobiles could increase active travel among people with disabilities.
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Affiliation(s)
- Yochai Eisenberg
- Department of Disability and Human Development, University of Illinois- Chicago, Chicago, IL, 1640 Roosevelt Road, Chicago, 60608, United States.
| | - Amy Hofstra
- Department of Disability and Human Development, University of Illinois- Chicago, Chicago, IL, 1640 Roosevelt Road, Chicago, 60608, United States; College of Urban Planning and Public Affairs, University of Illinois-Chicago, Chicago, IL, 412 S. Peoria St., Chicago, 60607, United States.
| | - Erica Twardzik
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, United States.
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Rahimi F, Sadeghisani M, Karimzadeh A. Efficacy of transcranial direct current stimulation in patients with knee osteoarthritis: A systematic review. Neurophysiol Clin 2023; 53:102918. [PMID: 37944293 DOI: 10.1016/j.neucli.2023.102918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 10/18/2023] [Accepted: 10/21/2023] [Indexed: 11/12/2023] Open
Abstract
OBJECTIVE Transcranial direct current stimulation (tDCS) has demonstrated its efficacy in alleviating pain among individuals with musculoskeletal disorders. This review focuses on the application of tDCS as a therapeutic intervention for managing knee osteoarthritis (OA), a prevalent musculoskeletal condition. The primary objective is to assess the effectiveness of tDCS(add-on tDCS and /or stand-alone tDCS), whether as an add-on to existing treatments or as a standalone therapy, in reducing pain and enhancing functional capacity in patients with knee OA. METHODS A comprehensive search was conducted across multiple databases, including PubMed, Science Direct, OVID, MEDLINE, CINAHL, EMBASE, ProQuest, and Google Scholar, and Web of Science. The search terms employed were "Transcranial direct current stimulation" or "tDCS" in combination with "Osteoarthritis" or "OA" and "knee." After eliminating duplicates and studies that did not meet the inclusion criteria, a total of 14 relevant articles were identified for review. RESULTS Among the included studies, twelve reported statistically significant improvements in pain levels when comparing the active tDCS group to the sham tDCS group. Only two studies reported no significant difference in pain intensity between the active tDCS and sham tDCS groups. Findings regarding functional abilities were diverse, with some studies demonstrating a significant enhancement in functional outcomes in the active tDCS group, while others observed no statistically significant differences. CONCLUSION The results of this review suggest that tDCS holds promise as a pain management intervention for individuals with knee OA. Notably, anodal tDCS applied over the primary motor cortex (M1) appears to be particularly effective in alleviating pain in patients with knee OA. However, the impact of tDCS on functional performance appears to be limited.
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Affiliation(s)
- Fatemeh Rahimi
- Department of Physiotherapy, School of Allied Medical Sciences, Social Determinants of Health Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran.
| | - Meissam Sadeghisani
- Department of Physiotherapy, School of Allied Medical Sciences, Social Determinants of Health Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Atefeh Karimzadeh
- Department of Physiotherapy, School of Allied Medical Sciences, Social Determinants of Health Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran; Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
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Kalu ME, Bello-Haas VD, Griffin M, Boamah S, Harris J, Zaide M, Rayner D, Khattab N, Abrahim S. A Scoping Review of Personal, Financial, and Environmental Determinants of Mobility Among Older Adults. Arch Phys Med Rehabil 2023; 104:2147-2168. [PMID: 37119957 DOI: 10.1016/j.apmr.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 04/04/2023] [Accepted: 04/06/2023] [Indexed: 05/01/2023]
Abstract
OBJECTIVE To synthesize available evidence of factors comprising the personal, financial, and environmental mobility determinants and their association with older adults' self-reported and performance-based mobility outcomes. DATA SOURCES PubMed, EMBASE, PsychINFO, Web of Science, AgeLine, Sociological Abstract, Allied and Complementary Medicine Database, and Cumulative Index to Nursing and Allied Health Literature databases search for articles published from January 2000 to December 2021. STUDY SECTION Using predefined inclusion and exclusion criteria, multiple reviewers independently screened 27,293 retrieved citations from databases, of which 422 articles underwent full-text screening, and 300 articles were extracted. DATA EXTRACTION The 300 articles' information, including study design, sample characteristics including sample size, mean age and sex, factors within each determinant, and their associations with mobility outcomes, were extracted. DATA SYNTHESIS Because of the heterogeneity of the reported associations, we followed Barnett et al's study protocol and reported associations between factors and mobility outcomes by analyses rather than by article to account for multiple associations generated in 1 article. Qualitative data were synthesized using content analysis. A total of 300 articles were included with 269 quantitative, 22 qualitative, and 9 mixed-method articles representing personal (n=80), and financial (n=1), environmental (n=98), more than 1 factor (n=121). The 278 quantitative and mixed-method articles reported 1270 analyses; 596 (46.9%) were positively and 220 (17.3%) were negatively associated with mobility outcomes among older adults. Personal (65.2%), financial (64.6%), and environmental factors (62.9%) were associated with mobility outcomes, mainly in the expected direction with few exceptions in environmental factors. CONCLUSIONS Gaps exist in understanding the effect of some environmental factors (eg, number and type of street connections) and the role of gender on older adults' walking outcomes. We have provided a comprehensive list of factors with each determinant, allowing the creation of core outcome set for a specific context, population, or other forms of mobility, for example, driving.
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Affiliation(s)
- Michael E Kalu
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Canada.
| | - Vanina Dal Bello-Haas
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Meridith Griffin
- Department of Health, Aging & Society, Faculty of Social Science, McMaster University, Hamilton, Canada
| | - Sheila Boamah
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Jocelyn Harris
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Mashal Zaide
- Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Daniel Rayner
- Department of Health Science, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Nura Khattab
- Department of Kinesiology, Faculty of Sciences, McMaster University, Hamilton, Canada
| | - Salma Abrahim
- Department of Kinesiology, Faculty of Sciences, McMaster University, Hamilton, Canada
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Katayama O, Lee S, Bae S, Makino K, Chiba I, Harada K, Shinkai Y, Shimada H. Differential effects of lifestyle activities on disability incidence based on neighborhood amenities. BMC Geriatr 2023; 23:483. [PMID: 37563564 PMCID: PMC10416387 DOI: 10.1186/s12877-023-04170-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 07/13/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND This study examined the effect of neighborhood amenities on disability risk among community-dwelling older adults in Japan, based on lifestyle activities. METHOD This was an observational prospective cohort study. Participants comprised 13,258 older adults from the National Center for Geriatrics and Gerontology-Study of Geriatric Syndromes. We calculated participants' Walk Score using their home addresses and divided them into three groups: "car-dependent," "somewhat walkable," and "very walkable." We then calculated the average value of lifestyle activities. We divided the neighborhood amenity groups into two groups, "fewer lifestyle activities" and "more lifestyle activities," for a total of six groups. After identifying interactions between neighborhood amenities and lifestyle activities, Cox proportional hazard models to calculate hazard ratios for incident disability risk, based on neighborhood amenities and lifestyle activities. RESULTS An interaction occurred between neighborhood amenities and lifestyle activities (p < 0.05). Survival probabilities for incident disability based on lifestyle activities were estimated for each neighborhood amenity group: car-dependent, 1.62 (95% CI 1.07 to 2.46); somewhat walkable, 1.08 (95% CI 0.84 to 1.40); and very walkable, 1.05 (95% CI 0.87 to 1.27). Those with fewer lifestyle activities in the car-dependent group exhibited the highest risk of incident disability in the unadjusted and adjusted models. CONCLUSION Given that the aging population is increasing steadily, considering older adults' neighborhood amenities and lifestyle activities in their day-to-day lives can help clinicians to deliver more older adult-centered care. Incorporating the lifestyle activities and neighborhood amenities of older adults into care planning will lead to the design and development of integrated clinical and community screening programs.
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Affiliation(s)
- Osamu Katayama
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu City, 474-8511, Aichi, Japan.
- Japan Society for the Promotion of Science, Tokyo, Japan.
- Columbia University Irving Medical Center, New York, USA.
| | - Sangyoon Lee
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu City, 474-8511, Aichi, Japan
| | - Seongryu Bae
- Department of Health Care and Science, Dong-A University, Busan, Korea
| | - Keitaro Makino
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu City, 474-8511, Aichi, Japan
- Japan Society for the Promotion of Science, Tokyo, Japan
| | - Ippei Chiba
- Tohoku Medical Megabank Organization (ToMMo), Tohoku University, Sendai, Japan
| | - Kenji Harada
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu City, 474-8511, Aichi, Japan
| | - Yohei Shinkai
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu City, 474-8511, Aichi, Japan
| | - Hiroyuki Shimada
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu City, 474-8511, Aichi, Japan
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Giroux C, Sogoloff B, Bergmans L, Bae M, Vannostrand M, Kasser SL. An Exploratory Study of Community Mobility in Adults With Multiple Sclerosis Across Different Ambulation Levels. Int J MS Care 2023; 25:145-151. [PMID: 37469334 PMCID: PMC10353691 DOI: 10.7224/1537-2073.2022-042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
BACKGROUND The purpose of this study was to identify differences in community mobility in adults with multiple sclerosis (MS) at various ambulation levels. METHODS Seventy-one adults with MS completed a survey about their mobility impairment and avoidance of challenging mobility tasks. Individuals were categorized as having mild, moderate, or severe gait impairment. RESULTS Participants across the different functional groups significantly differed in perceived ambulation disability, fatigue impact, falls efficacy, quality of life, challenges with dual-tasking, and self-efficacy for community mobility. There were no significant differences between the mild and moderate gait impairment groups in crossing a busy street or going out in different ambient conditions. Significant differences were found between those with mild impairment and those with severe impairment in avoidance of various terrain elements, heavy manual doors, postural transitions, attentional situations, and crowded places. The only environmental dimension that significantly differed across all 3 groups was carrying 2 or more items, in which avoidance increased as ambulation worsened. CONCLUSIONS Avoidance behavior for particular environmental features can begin relatively early in the disease process. This underscores the need to further study mobility differences, community ambulation, and participation restrictions in adults with MS.
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Affiliation(s)
- Carley Giroux
- From the Department of Rehabilitation and Movement Science, University of Vermont, Burlington, VT, USA (CG, BS, LB, MB, MV, SLK)
| | - Barbara Sogoloff
- From the Department of Rehabilitation and Movement Science, University of Vermont, Burlington, VT, USA (CG, BS, LB, MB, MV, SLK)
| | - Lance Bergmans
- From the Department of Rehabilitation and Movement Science, University of Vermont, Burlington, VT, USA (CG, BS, LB, MB, MV, SLK)
| | - Myeongjin Bae
- From the Department of Rehabilitation and Movement Science, University of Vermont, Burlington, VT, USA (CG, BS, LB, MB, MV, SLK)
| | - Michael Vannostrand
- From the Department of Rehabilitation and Movement Science, University of Vermont, Burlington, VT, USA (CG, BS, LB, MB, MV, SLK)
| | - Susan L. Kasser
- From the Department of Rehabilitation and Movement Science, University of Vermont, Burlington, VT, USA (CG, BS, LB, MB, MV, SLK)
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Bramhankar M, Kundu S, Pandey M, Mishra NL, Adarsh A. An assessment of self-rated life satisfaction and its correlates with physical, mental and social health status among older adults in India. Sci Rep 2023; 13:9117. [PMID: 37277415 PMCID: PMC10241830 DOI: 10.1038/s41598-023-36041-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 05/28/2023] [Indexed: 06/07/2023] Open
Abstract
Life satisfaction refers to the assessment of one's own life in terms of self-perceived favourable qualities. It is an integral part of healthy and successful course of ageing. It is widely associated with the health status and social well-being. The present study attempted to determine the constructing factors of self-rated life satisfaction, such as socio-demographic, physical, social, and mental well-being of older adults. We analysed information from the Longitudinal Ageing Study in India (LASI-1), the initial phase conducted during 2017-18 for the population of older adults in India. We applied descriptive statistics for prevalence assessment and association was checked using chi-square test. Further, to determine the adjusted outcome of predictor covariates on the likelihood of an individual being satisfied from life estimated by applying hierarchical multiple logistic regression models. Several noteworthy affirmations on the relationship between the socio-demographic variables and health risk behaviours with life satisfaction were observed. The results were consistent with studies showing change in life satisfaction subject to the state of physical and mental health, presence of chronic diseases, friends and family relations, dependency, and events of trauma or abuse. While comparing respondents, we found varying degrees of life satisfaction by gender, education, marital status, expenditure and other socio-economic features. We also found that besides physical and mental health, social support and well-being play a pivotal role in achieving higher life satisfaction among older adults. Overall, this work contributes to the study of the subjective well-being of older adults in India based on self-reported levels of life satisfaction and further narrows the gap in knowledge about associated behaviour. Hence, with on-going ageing scenario, there is need for multi-sectorial policy-oriented approaches at individual, family, and community level, which helps to take care of older-adults' physical, social, and mental health for the betterment of healthy ageing.
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Affiliation(s)
- Mahadev Bramhankar
- Department of Bio-Statistics and Demography, International Institute for Population Sciences, Mumbai, India.
| | - Sampurna Kundu
- Centre of Social Medicine and Community Health, Jawaharlal Nehru University, New Delhi, India
| | - Mohit Pandey
- Department of Bio-Statistics and Demography, International Institute for Population Sciences, Mumbai, India
| | - Nand Lal Mishra
- Department of Bio-Statistics and Demography, International Institute for Population Sciences, Mumbai, India
- Department of Survey Research and Data Analytics, International Institute for Population Sciences, Mumbai, India
| | - Adarsh Adarsh
- Laboratory of Population Health, Max Planck Institute for Demographic Research, Rostock, Germany
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7
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Smail E, Alpert J, Mardini M, Kaufmann C, Bai C, Gill T, Fillingim R, Cenko E, Zapata R, Karnati Y, Marsiske M, Ranka S, Manini T. Feasibility of a Smartwatch Platform to Assess Ecological Mobility: Real-Time Online Assessment and Mobility Monitor. J Gerontol A Biol Sci Med Sci 2023; 78:821-830. [PMID: 36744611 PMCID: PMC10172974 DOI: 10.1093/gerona/glad046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Early detection of mobility decline is critical to prevent subsequent reductions in quality of life, disability, and mortality. However, traditional approaches to mobility assessment are limited in their ability to capture daily fluctuations that align with sporadic health events. We aim to describe findings from a pilot study of our Real-time Online Assessment and Mobility Monitor (ROAMM) smartwatch application, which uniquely captures multiple streams of data in real time in ecological settings. METHODS Data come from a sample of 31 participants (Mage = 74.7, 51.6% female) who used ROAMM for approximately 2 weeks. We describe the usability and feasibility of ROAMM, summarize prompt data using descriptive metrics, and compare prompt data with traditional survey-based questionnaires or other established measures. RESULTS Participants were satisfied with ROAMM's function (87.1%) and ranked the usability as "above average." Most were highly engaged (average adjusted compliance = 70.7%) and the majority reported being "likely" to enroll in a 2-year study (77.4%). Some smartwatch features were correlated with their respective traditional measurements (eg, certain GPS-derived life-space mobility features (r = 0.50-0.51, p < .05) and ecologically measured pain (r = 0.72, p = .01), but others were not (eg, ecologically measured fatigue). CONCLUSIONS ROAMM was usable, acceptable, and effective at measuring mobility and risk factors for mobility decline in our pilot sample. Additional work with a larger and more diverse sample is necessary to confirm associations between smartwatch-measured features and traditional measures. By monitoring multiple data streams simultaneously in ecological settings, this technology could uniquely contribute to the evolution of mobility measurement and risk factors for mobility loss.
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Affiliation(s)
- Emily J Smail
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida,USA
| | - Jordan M Alpert
- Department of Advertising, College of Journalism and Communications, University of Florida, Gainesville, Florida,USA
| | - Mamoun T Mardini
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida,USA
| | - Christopher N Kaufmann
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida,USA
| | - Chen Bai
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida,USA
| | - Thomas M Gill
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut,USA
| | - Roger B Fillingim
- Department of Community Dentistry & Behavioral Science, College of Dentistry, University of Florida, Gainesville, Florida,USA
| | - Erta Cenko
- Department of Epidemiology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida,USA
| | - Ruben Zapata
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida,USA
| | - Yashaswi Karnati
- Department of Computer & Information Science & Engineering, College of Liberal Arts and Sciences, University of Florida, Gainesville, Florida,USA
| | - Michael Marsiske
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida,USA
| | - Sanjay Ranka
- Department of Computer & Information Science & Engineering, College of Liberal Arts and Sciences, University of Florida, Gainesville, Florida,USA
| | - Todd M Manini
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida,USA
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Darekar A. Virtual Reality for Motor and Cognitive Rehabilitation. Curr Top Behav Neurosci 2023; 65:337-369. [PMID: 37041455 DOI: 10.1007/7854_2023_418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
Virtual Reality (VR) affords clinicians the ability to deliver safe, controlled, task-specific customised interventions that are enjoyable, motivating and engaging. Elements of training in VR comply with principles of learning implicated in new skill acquisition and re-learning skills post-neurological disorders. However, heterogeneity in the description of VR systems and the description and control of 'active' ingredients of interventions (like dosage, type of feedback, task specificity, etc.) have led to inconsistency in the synthesis and interpretation of evidence related to the effectiveness of VR-based interventions, particularly in post-stroke and Parkinson's Disease (PD) rehabilitation. This chapter attempts to describe VR interventions with respect to their compliance with principles of neurorehabilitation, with the goal of optimising interventions for effective training and facilitation of maximum functional recovery. This chapter also advocates using a uniform framework to describe VR systems to promote homogeneity in literature in order to help in the synthesis of evidence. An overview of the evidence revealed that VR systems are effective in mediating deficits in upper extremity, posture and gait function seen in people post-stroke and PD. Generally, interventions were more effective when they were delivered as an adjunct to conventional therapy and were customised for rehabilitation purposes, in addition to complying with principles of learning and neurorehabilitation. Although recent studies imply that their VR intervention is compliant with principles of learning, only a few explicitly describe how these principles are incorporated as 'active ingredients' of the intervention. Finally, VR interventions targeting community ambulation and cognitive rehabilitation are yet limited and therefore warrant attention.
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Criss MG, Chui KK, Gallichio J, Centra J, Canbek J. Reliability, responsiveness, and validity of slow walking speed in community dwelling older adults. Gait Posture 2023; 99:54-59. [PMID: 36327539 DOI: 10.1016/j.gaitpost.2022.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 09/20/2022] [Accepted: 10/23/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Independent ambulation requires adaptability. Self-selected and maximum walking speeds are often both assessed to demonstrate the ability to adapt speed to different tasks and environments. However, purposefully walking at a slow speed (slowWS) could also be an appropriate adaptation in certain situations but has rarely been investigated. RESEARCH QUESTION The purpose of this study was to assess the reliability, responsiveness, and concurrent validity of slowWS in community-dwelling older adults. METHODS This was an observational, cross-sectional study of 110 community-dwelling older adults. Test-retest and inter-rater reliabilities of slowWS were assessed with intra-class correlation coefficients. Standard error of measurement (SEM) and minimal detectable change (MDC95) were calculated to determine responsiveness. Concurrent validity was assessed with Spearman rank-order correlations between slowWS and a battery of tests previously shown to be related to walking speed. RESULTS Walking speed measurement for slowWS was shown to have excellent test-retest and interrater reliability (ICCs values of 0.971-0.997). Standard error of measurement value was small (0.015 m/sec) and MDC95 was 0.04 m/sec. SlowWS was not found to significantly correlate to any other study variable. SIGNIFICANCE Walking speed, whether self-selected, maximum, or slow, can be measured reliably with a stopwatch and specific verbal commands. While slowWS could be beneficial for certain tasks or environments, walking slowly was not associated with age, sex, comorbidity, or measures of cognition, depression, strength, balance, disability, or life-space in this sample.
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Affiliation(s)
- Michelle G Criss
- Doctor of Physical Therapy Program, Chatham University, Woodland Rd, Pittsburgh 15232, PA, USA.
| | - Kevin K Chui
- Department of Physical Therapy, Radford University, 101 Elm Avenue, 8th Floor, Roanoke 24013, VA, USA.
| | - Joann Gallichio
- Doctor of Physical Therapy Program, Nova Southeastern University, 3400 Gulf to Bay Blvd., Clearwater 33759, FL, USA.
| | - Jacob Centra
- ReMed Maryland, 5999 Harpers Ferry Road, Columbia 20144, MD, USA.
| | - Jennifer Canbek
- Doctor of Physical Therapy Program, Nova Southeastern University, 3200 South University Drive, Fort Lauderdale 33328, FL, USA.
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Balkman GS, Hafner BJ, Rosen RE, Morgan SJ. Mobility experiences of adult lower limb orthosis users: a focus group study. Disabil Rehabil 2022; 44:7904-7915. [PMID: 34807780 PMCID: PMC10111250 DOI: 10.1080/09638288.2021.2002437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 10/15/2021] [Accepted: 11/01/2021] [Indexed: 01/18/2023]
Abstract
PURPOSE People with lower limb impairments are often prescribed orthoses to preserve or enhance their mobility. Exploration of mobility experiences common among orthosis users may provide insights into how orthoses, and other mobility aids, are utilized and regarded. The objective of this study was to broadly explore how lower limb orthosis users describe their mobility. MATERIALS AND METHODS Four focus groups were held online with participants who lived in the U.S. or Canada. Participants had at least six months of experience using an ankle-foot- and/or a knee-ankle-foot-orthosis for one or both legs. All discussions were transcribed and coded. Thematic analysis was used to identify cross-cutting themes. RESULTS Participants included 29 orthosis users with a variety of health conditions. Inter-related themes, including personal factors, situational contexts, and assistance were identified as elements that influenced participants' mobility. Participants described a process of modifying their mobility through the use and non-use of one or more mobility aids. CONCLUSIONS The current study findings may assist clinicians in developing strategies to optimize orthosis users' mobility in different situations. Experiences described by participants in this study may also help researchers identify aspects of mobility most pertinent to orthosis users and inform the development of new outcome measures.Implications for RehabilitationPeople who use lower-limb orthoses share common mobility experiences, despite differences in health diagnoses.Orthosis users often have opportunities to modify their mobility by choosing to use or not use their brace(s) and/or handheld mobility aids.When providing mobility aid interventions, clinicians should consider how each patient's individual characteristics, including physical characteristics (e.g., the health condition and how it presents, pain, fatigue) and psychosocial characteristics (e.g., fear and confidence, self-motivation, emotional responses), can affect mobility.Clinicians may be able to help patients optimize their mobility by asking about environmental obstacles they regularly encounter and recommending strategies for utilization of mobility aids, including simultaneous use of multiple aids, use of one aid, or choosing not to use any aids, depending on the activity and situation.Clinicians should inquire about all mobility aids available to a patient at home and in the community, including fixed objects, and consider how new mobility aid interventions might affect the patient's mobility when used alone and in combination with other forms of assistance.
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Affiliation(s)
- Geoffrey S. Balkman
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Brian J. Hafner
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Rachael E. Rosen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Sara J. Morgan
- Gillette Children’s Specialty Healthcare, St. Paul, MN, USA
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Gill TM. Preserving community mobility in vulnerable older people. BMJ 2022; 377:o1084. [PMID: 35545267 DOI: 10.1136/bmj.o1084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Outdoor Community Ambulation Interventions to Improve Physical and Mental Health in Older Adults: A Systematic Review and Meta-Analysis. J Aging Phys Act 2022; 30:1061-1074. [PMID: 35418512 DOI: 10.1123/japa.2021-0151] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 01/19/2022] [Accepted: 02/01/2022] [Indexed: 11/18/2022]
Abstract
Limited community ambulation, defined as independent mobility outside the home, predicts adverse outcomes in older adults. We performed a systematic review and meta-analysis to examine outdoor community ambulation intervention effectiveness in older adults. We searched six databases until October 2021. Studies with an evaluative research objective, older adult population, and outdoor community ambulation interventions were eligible. After reviewing 23,172 records, five studies were included. The meta-analysis found no significant difference in walking endurance and depression outcomes between outdoor community ambulation and comparison interventions. For outcomes not suitable for meta-analysis, studies showed no significant difference in walking activity, anxiety, and general and health-related quality of life, and possible improvements in gait speed and lower extremity function and strength. Most evidence was of low to very low certainty. Considering the limited evidence base, the design, implementation, and evaluation of outdoor community ambulation interventions in older adults should be prioritized in primary research.
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Clark DJ, Hawkins KA, Winesett SP, Cox BA, Pesquera S, Miles JW, Fuller DD, Fox EJ. Enhancing Locomotor Learning With Transcutaneous Spinal Electrical Stimulation and Somatosensory Augmentation: A Pilot Randomized Controlled Trial in Older Adults. Front Aging Neurosci 2022; 14:837467. [PMID: 35309891 PMCID: PMC8924500 DOI: 10.3389/fnagi.2022.837467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 02/10/2022] [Indexed: 11/18/2022] Open
Abstract
This study investigated locomotor learning of a complex terrain walking task in older adults, when combined with two adjuvant interventions: transcutaneous spinal direct current stimulation (tsDCS) to increase lumbar spinal cord excitability, and textured shoe insoles to increase somatosensory feedback to the spinal cord. The spinal cord has a crucial contribution to control of walking, and is a novel therapeutic target for rehabilitation of older adults. The complex terrain task involved walking a 10-meter course consisting of nine obstacles and three sections of compliant (soft) walking surface. Twenty-three participants were randomly assigned to one of the following groups: sham tsDCS and smooth insoles (sham/smooth; control group), sham tsDCS and textured insoles (sham/textured), active tsDCS and smooth insoles (active/smooth), and active tsDCS and textured insoles (active/textured). The first objective was to assess the feasibility, tolerability, and safety of the interventions. The second objective was to assess preliminary efficacy for increasing locomotor learning, as defined by retention of gains in walking speed between a baseline visit of task practice, and a subsequent follow-up visit. Variability of the center of mass while walking over the course was also evaluated. The change in executive control of walking (prefrontal cortical activity) between the baseline and follow-up visits was measured with functional near infrared spectroscopy. The study results demonstrated feasibility based on enrollment and retention of participants, tolerability based on self-report, and safety based on absence of adverse events. Preliminary efficacy was supported based on trends showing larger gains in walking speed and more pronounced reductions in mediolateral center of mass variability at the follow-up visit in the groups randomized to active tsDCS or textured insoles. These data justify future larger studies to further assess dosing and efficacy of these intervention approaches. In conclusion, rehabilitation interventions that target spinal control of walking present a potential opportunity for enhancing walking function in older adults.
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Affiliation(s)
- David J. Clark
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, FL, United States
- Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, United States
- *Correspondence: David J. Clark,
| | - Kelly A. Hawkins
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, FL, United States
- Department of Physical Therapy, University of Florida, Gainesville, FL, United States
| | - Steven P. Winesett
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, FL, United States
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, United States
| | - Brigette A. Cox
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, FL, United States
| | - Sarah Pesquera
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, FL, United States
| | - Jon W. Miles
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, FL, United States
| | - David D. Fuller
- Department of Physical Therapy, University of Florida, Gainesville, FL, United States
| | - Emily J. Fox
- Department of Physical Therapy, University of Florida, Gainesville, FL, United States
- Brooks Rehabilitation, Jacksonville, FL, United States
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Ryder‐Burbidge C, Wieler M, Nykiforuk CI, Jones CA. Life-Space Mobility and Parkinson's Disease. A Multiple-Methods Study. Mov Disord Clin Pract 2022; 9:351-361. [PMID: 35402649 PMCID: PMC8974890 DOI: 10.1002/mdc3.13406] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 12/21/2021] [Accepted: 12/21/2021] [Indexed: 01/21/2023] Open
Abstract
Background Life-space mobility (LSM) captures a broad spectrum of mobility in physical and social environments; however, it has not been extensively studied in Parkinson's disease. Using a multiple-methods approach, individual, social and environmental factors that impact LSM were explored in PD. Methods Two hundred twenty-seven participants with PD (n = 113) and a comparative group without PD (n = 114) were recruited from the community. Within a cross-sectional survey, LSM (University of Alabama Birmingham Life-Space Assessment, LSA) was compared in the two groups. Using multiple linear regression, socio-demographics, lifestyle behaviors, medical, mobility and social factors were examined to identify factors that explained LSM. A qualitative narrative inquiry was completed to augment the findings from the survey; 10 participants with PD were interviewed regarding facilitators and barriers to mobility. Results The mean overall LSA-composite score for the PD group was 64.2 (SD = 25.8) and 70.3 (SD = 23.1) for the community comparative group (mean difference = 6 points, 95%CI:-0.4, 12.5) indicating most participants moved independently beyond their neighborhoods. A higher proportion of the PD group required assistance with mobility than the community comparison group. Not driving, receiving caregiving, lower social participation, and lower monthly family finances were associated with restricted LSM in the PD group. Data from qualitative interviews supported quantitative findings and offered insights into the features of the built environment that facilitate and restrict mobility. Conclusion Individual, social and environmental factors are associated with the LSM among persons with PD. Clinicians and policy-makers should include both individual and community-based factors when developing interventions to encourage the LSM of the PD population.
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Affiliation(s)
| | - Marguerite Wieler
- Department of Physical TherapyUniversity of AlbertaEdmontonAlbertaCanada
| | | | - C. Allyson Jones
- School of Public Health, University of AlbertaEdmontonAlbertaCanada,Department of Physical TherapyUniversity of AlbertaEdmontonAlbertaCanada
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Sugita Y, Hara T, Ohnuma T, Kogure E, Urano T. [Factors related to regional differences among home-visit rehabilitation users]. Nihon Ronen Igakkai Zasshi 2022; 59:49-57. [PMID: 35264534 DOI: 10.3143/geriatrics.59.49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
AIM The present study investigated the relationship between the type of residential area and each factor of the International Classification of Functioning, Disability and Health (ICF) framework among elderly subjects receiving home-visit rehabilitation. METHODS This was a cross-sectional study conducted at two institutions. A total 84 participants (46 men and 38 women, age: 79.1±7.8 years old) who were receiving home-visit rehabilitation in urban and rural areas were examined. The parameters measured included the modified Gait Efficacy Scale (mGES), grip strength, 30-seconds chair stand test (CS-30), Functional Independence Measure (FIM), Life-Space Assessment (LSA), Frenchay Activities Index (FAI), Ikigai-9, and Home and Community Environment (HACE), which is based on the ICF concepts of health status, physical structure, physical and mental functions, activities, participation, personal factors, and environmental factors respectively; these points were evaluated by physical or occupational therapists. The health status was based on the diagnosis obtained from the clinical record. RESULTS Receiving home-visit rehabilitation in a rural area was significantly associated with the LSA (odds ratio [OR]=1.075, p=0.028), optimistic and positive feelings for life (OR=0.698, p=0.040), and community mobility scores (OR=5.755, p=0.001). CONCLUSIONS Environmental factors, activities, and personal factors differed depending on the region where the elderly subject received home-visit rehabilitation. Thus, intervention methods concerning home-visit rehabilitation may need to be adjusted according to the region where the patient lives.
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Affiliation(s)
- Yuta Sugita
- Division of Physical Therapy, Doctoral Program in Health Science Graduate School of Medicine, International University of Health and Welfare
- Nishinasuno General Home Care Center
- Division of Rehabilitation, International University of Health and Welfare Hospital
| | - Tsuyoshi Hara
- Department of Physical Therapy, School of Health Science, International University of Health and Welfare
| | | | | | - Tomohiko Urano
- Department of Geriatric Medicine, School of Medicine, International University of Health and Welfare
- Nishinasuno General Home Care Center, Department of Day Rehabilitation, Care Facility for the Elderly "Maronie-en"
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Musselwhite C, Roberts K. Accessibility and informational barriers to an age friendly railway. QUALITY IN AGEING AND OLDER ADULTS 2021. [DOI: 10.1108/qaoa-02-2021-0015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Against a backdrop in an increase in the number of older people in the United Kingdom (UK) and an increase in the amount of travel per person for this age group, the number of older people using the railway is in decline. The purpose of this paper is to report on an investigation is a first step towards ascertaining why through audits of issues and problems on rolling stock and station platforms.
Design/methodology/approach
Rolling stock and station audits were carried out by older people across a rail network in the South West of the UK. A total of 72.2 hours of auditing took place across different sizes of station and different types of rolling stock.
Findings
Two main themes were found across both rolling stock and station audits: accessibility and information provision. With regards to accessibility, boarding and especially alighting from the train was the key issue. Across stations and in rolling stock luminance, was a key issue for older people with places being too dark or moving from places that were bright to dark. Use of stairs at stations between platforms, especially when the station is crowded was an issue. In terms of information, key issues were found with signage being too cluttered, small, hidden and inconsistent and audible announcements being difficult to decipher.
Practical implications
There must be improvements made to railways to help older people feel more safe and secure using them. It is suggested step free and level accessibility is found boarding and alighting from the train, but also from station entrance to carriage. Better signage is needed throughout the station and on trains, with large repeated fonts used. Lighting needs to be revisited throughout to ensure areas are bright and well-lit both on station platforms and onboard. Further research needs to look at these findings in relation to slip, trips and fall accident rates.
Originality/value
There is very little research on older people’s perceptions and barriers to railway use. This adds value in being one of the only studies to do so, especially from the perspective of older people themselves as co-researchers.
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Keshner EA, Lamontagne A. The Untapped Potential of Virtual Reality in Rehabilitation of Balance and Gait in Neurological Disorders. FRONTIERS IN VIRTUAL REALITY 2021; 2:641650. [PMID: 33860281 PMCID: PMC8046008 DOI: 10.3389/frvir.2021.641650] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Dynamic systems theory transformed our understanding of motor control by recognizing the continual interaction between the organism and the environment. Movement could no longer be visualized simply as a response to a pattern of stimuli or as a demonstration of prior intent; movement is context dependent and is continuously reshaped by the ongoing dynamics of the world around us. Virtual reality is one methodological variable that allows us to control and manipulate that environmental context. A large body of literature exists to support the impact of visual flow, visual conditions, and visual perception on the planning and execution of movement. In rehabilitative practice, however, this technology has been employed mostly as a tool for motivation and enjoyment of physical exercise. The opportunity to modulate motor behavior through the parameters of the virtual world is often ignored in practice. In this article we present the results of experiments from our laboratories and from others demonstrating that presenting particular characteristics of the virtual world through different sensory modalities will modify balance and locomotor behavior. We will discuss how movement in the virtual world opens a window into the motor planning processes and informs us about the relative weighting of visual and somatosensory signals. Finally, we discuss how these findings should influence future treatment design.
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Affiliation(s)
- Emily A. Keshner
- Department of Health and Rehabilitation Sciences, Temple University, Philadelphia, PA, United States
- Correspondence: Emily A. Keshner,
| | - Anouk Lamontagne
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
- Virtual Reality and Mobility Laboratory, CISSS Laval—Jewish Rehabilitation Hospital Site of the Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Laval, QC, Canada
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Clinical Practice Guideline to Improve Locomotor Function Following Chronic Stroke, Incomplete Spinal Cord Injury, and Brain Injury. J Neurol Phys Ther 2021; 44:49-100. [PMID: 31834165 DOI: 10.1097/npt.0000000000000303] [Citation(s) in RCA: 156] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Individuals with acute-onset central nervous system (CNS) injury, including stroke, motor incomplete spinal cord injury, or traumatic brain injury, often experience lasting locomotor deficits, as quantified by decreases in gait speed and distance walked over a specific duration (timed distance). The goal of the present clinical practice guideline was to delineate the relative efficacy of various interventions to improve walking speed and timed distance in ambulatory individuals greater than 6 months following these specific diagnoses. METHODS A systematic review of the literature published between 1995 and 2016 was performed in 4 databases for randomized controlled clinical trials focused on these specific patient populations, at least 6 months postinjury and with specific outcomes of walking speed and timed distance. For all studies, specific parameters of training interventions including frequency, intensity, time, and type were detailed as possible. Recommendations were determined on the basis of the strength of the evidence and the potential harm, risks, or costs of providing a specific training paradigm, particularly when another intervention may be available and can provide greater benefit. RESULTS Strong evidence indicates that clinicians should offer walking training at moderate to high intensities or virtual reality-based training to ambulatory individuals greater than 6 months following acute-onset CNS injury to improve walking speed or distance. In contrast, weak evidence suggests that strength training, circuit (ie, combined) training or cycling training at moderate to high intensities, and virtual reality-based balance training may improve walking speed and distance in these patient groups. Finally, strong evidence suggests that body weight-supported treadmill training, robotic-assisted training, or sitting/standing balance training without virtual reality should not be performed to improve walking speed or distance in ambulatory individuals greater than 6 months following acute-onset CNS injury to improve walking speed or distance. DISCUSSION The collective findings suggest that large amounts of task-specific (ie, locomotor) practice may be critical for improvements in walking function, although only at higher cardiovascular intensities or with augmented feedback to increase patient's engagement. Lower-intensity walking interventions or impairment-based training strategies demonstrated equivocal or limited efficacy. LIMITATIONS As walking speed and distance were primary outcomes, the research participants included in the studies walked without substantial physical assistance. This guideline may not apply to patients with limited ambulatory function, where provision of walking training may require substantial physical assistance. SUMMARY The guideline suggests that task-specific walking training should be performed to improve walking speed and distance in those with acute-onset CNS injury although only at higher intensities or with augmented feedback. Future studies should clarify the potential utility of specific training parameters that lead to improved walking speed and distance in these populations in both chronic and subacute stages following injury. DISCLAIMER These recommendations are intended as a guide for clinicians to optimize rehabilitation outcomes for persons with chronic stroke, incomplete spinal cord injury, and traumatic brain injury to improve walking speed and distance.
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Fahey M, Brazg G, Henderson CE, Plawecki A, Lucas E, Reisman DS, Schmit BD, Hornby TG. The Value of High Intensity Locomotor Training Applied to Patients With Acute-Onset Neurologic Injury. Arch Phys Med Rehabil 2020; 103:S178-S188. [PMID: 33383032 DOI: 10.1016/j.apmr.2020.09.399] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 08/31/2020] [Accepted: 09/17/2020] [Indexed: 11/02/2022]
Abstract
Long-standing research in animal models and humans with stroke or incomplete spinal cord injury (iSCI) indicate that specific physical training variables, such as the specificity and amount of practice, may influence neurologic recovery and locomotor function. More recent data highlight the contributions of exercise intensity, as estimated indirectly by cardiovascular exertion, as potentially more important than previously considered. The effects of exercise intensity are well described in neurologically intact individuals, although confusion regarding the definitions of intensity and safety concerns have limited its implementation during physical rehabilitation of patients with neurologic injury. The purpose of this review is to delineate some of the evidence regarding the effects of exercise intensity during locomotor training in patients with stroke and iSCI. We provide specific definitions of exercise intensity used within the literature, describe methods used to ensure appropriate levels of exertion, and discuss potential adverse events and safety concerns during its application. Further details on the effects of locomotor training intensity on clinical outcomes, and on neuromuscular and cardiovascular function will be addressed as available. Existing literature across multiple studies and meta-analyses reveals that exercise training intensity is likely a major factor that can influence locomotor function after neurologic injury. To extend these findings, we describe previous attempts to implement moderate to high intensity interventions during physical rehabilitation of patients with neurologic injury, including the utility of specific strategies to facilitate implementation, and to navigate potential barriers that may arise during implementation efforts.
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Affiliation(s)
- Meghan Fahey
- Rehabilitation Institute of Chicago, Chicago, IL
| | | | - Christopher E Henderson
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, IN; Rehabilitation Hospital of Indiana, Indianapolis, IN
| | | | - Emily Lucas
- Rehabilitation Hospital of Indiana, Indianapolis, IN
| | - Darcy S Reisman
- Department of Physical Therapy, University of Delaware, Newark, DE
| | - Brian D Schmit
- Department of Biomedical Engineering, Marquette University, Milwaukee, WI
| | - T George Hornby
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, IN; Rehabilitation Hospital of Indiana, Indianapolis, IN.
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Bowden JL, Hunter DJ, Feng Y. How can neighborhood environments facilitate management of osteoarthritis: A scoping review. Semin Arthritis Rheum 2020; 51:253-265. [PMID: 33387921 DOI: 10.1016/j.semarthrit.2020.09.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/09/2020] [Accepted: 09/11/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The association between neighborhood environments and health outcomes has long been recognized, but the importance of environmental factors is less well examined in osteoarthritis (OA). We aimed to give an overview of the literature examining the role of neighborhood built environments in the context of OA self-management. MATERIAL AND METHODS A literature search between 2000 and 2019 was performed using a scoping methodology. Literature examining the influence of neighborhood built environments on health and other outcomes in people with OA, mixed or unspecified arthritis were screened by two independent reviewers. Seven domains were pre-determined based on the World Health Organization European Healthy Cities Framework. Sub-domains and themes were synthesized from the literature. RESULTS We included 27 studies across seven pre-determined domains, 23 sub-domains. We identified 6 key outcomes of physical activity, quality of life, community participation, resource use, psychological health, and other physical health. The majority of studies emphasized the importance of neighborhood built environment on supporting OA self-management, particularly for facilitating physical activity. The impacts on other outcomes were also considered important but were less well studied, especially access to healthy food. CONCLUSIONS This review highlights the potential of better using the built environment to support OA management to address many different outcomes. Understanding the impacts of different environments is the first step, and designing new and novel ways to utilize neighborhoods is needed. Implementing strategies and public policies at a neighborhood level may be a more viable way to curb further increases in the OA epidemic than addressing individual factors alone.
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Affiliation(s)
- Jocelyn L Bowden
- Institute of Bone and Joint Research, the Kolling Institute, The University of Sydney, and Rheumatology Department, Royal North Shore Hospital, Sydney, Australia.
| | - David J Hunter
- Institute of Bone and Joint Research, the Kolling Institute, The University of Sydney, and Rheumatology Department, Royal North Shore Hospital, Sydney, Australia
| | - Yingyu Feng
- Institute of Bone and Joint Research, The Kolling Institute, The University of Sydney, Australia
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21
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Interrater Reliability of Historical Virtual Audits Using Archived Google Street View Imagery. J Aging Phys Act 2020; 29:63-70. [PMID: 32702666 DOI: 10.1123/japa.2019-0331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 03/30/2020] [Accepted: 05/04/2020] [Indexed: 11/18/2022]
Abstract
Impaired mobility occurs in up to half of community-dwelling older adults and is associated with poor health outcomes and high health care costs. Although the built environment impacts mobility, most studies of older adults lack information about environmental-level factors. In-person observational audits can be utilized but cannot assess the historical environment. We applied a 78-item checklist to archived Google Street View imagery to assess historical residence access and neighborhood characteristics. Interrater reliability between two raters was tested on 50 addresses using prevalence-adjusted and bias-adjusted kappa (PABAK). The mean PABAK for all items was .75, with 81% of the items having substantial (PABAK ≥ .61) or almost perfect (PABAK ≥ .81) agreement. Environmental assessment using archived virtual imagery has excellent reliability for factors related to residence access and many neighborhood characteristics. Archived imagery can assess past neighborhood characteristics, facilitating the use of historical environment data within existing cohorts.
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Pahor M, Anton SD, Beavers DP, Cauley JA, Fielding RA, Kritchevsky SB, Leeuwenburgh C, Lewis KH, Liu CK, Lovato LC, Lu J, Manini TM, McDermott MM, Miller ME, Newman AB, Radziszewska B, Stowe CL, Tracy RP, Walkup MP, Wu SS, Ambrosius WT. Effect of Losartan and Fish Oil on Plasma IL-6 and Mobility in Older Persons. The ENRGISE Pilot Randomized Clinical Trial. J Gerontol A Biol Sci Med Sci 2019; 74:1612-1619. [PMID: 30541065 PMCID: PMC6748815 DOI: 10.1093/gerona/gly277] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Low-grade chronic inflammation, characterized by elevations in plasma Interleukin-6 (IL-6), is an independent risk factor of impaired mobility in older persons. Angiotensin receptor blockers and omega-3 polyunsaturated fatty acids (ω-3) may reduce IL-6 and may potentially improve physical function. To assess the main effects of the angiotensin receptor blocker losartan and ω-3 as fish oil on IL-6 and 400 m walking speed, we conducted the ENRGISE Pilot multicenter randomized clinical trial. METHODS The ENRGISE Pilot enrolled participants between April 2016 and June 2017, who participated for 12 months. Participants were aged ≥70 years with mobility impairment, had IL-6 between 2.5 and 30 pg/mL, and were able to walk 400 m at baseline. Participants were randomized in three strata 2 × 2 factorial to: (i) losartan 50-100 mg/d or placebo (n = 43), (ii) fish oil 1,400-2,800 mg/d or placebo (n = 180), and (iii) with both (n = 66). RESULTS Two hundred eighty-nine participants were randomized (mean age 78.3 years, 47.4% women, 17.0% black). There was no effect of losartan (difference of means = -0.065 ± 0.116 [SE], 95% confidence interval [CI]: -0.293-0.163, p = .58) or fish oil (-0.020 ± 0.077, 95% CI: -0.171-0.132, p = .80) on the log of IL-6. Similarly, there was no effect of losartan (-0.025 ± 0.026, 95% CI: -0.076-0.026, p = .34) or fish oil (0.010 ± 0.017, 95% CI: -0.025-0.044, p = .58) on walking speed (m/s). CONCLUSIONS These results do not support the use of these interventions to prevent mobility loss in older adults at risk of disability with low-grade chronic inflammation. REGISTRATION Clinicaltrials.gov NCT02676466.
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Affiliation(s)
- Marco Pahor
- Department of Aging and Geriatric Research, University of Florida, Gainesville
| | - Stephen D Anton
- Department of Aging and Geriatric Research, University of Florida, Gainesville
| | - Daniel P Beavers
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Jane A Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania
| | - Roger A Fielding
- Nutrition, Exercise Physiology, and Sarcopenia Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts
| | - Stephen B Kritchevsky
- Department of Internal Medicine, Section of Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | | | - Kristina H Lewis
- Departments of Epidemiology & Prevention, and Implementation Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Christine K Liu
- Section of Geriatrics, Department of Medicine, Boston University School of Medicine, Massachusetts
| | - Laura C Lovato
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Jane Lu
- Department of Aging and Geriatric Research, University of Florida, Gainesville
| | - Todd M Manini
- Department of Aging and Geriatric Research, University of Florida, Gainesville
| | - Mary M McDermott
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Michael E Miller
- Department of Aging and Geriatric Research, University of Florida, Gainesville
| | - Anne B Newman
- Department of Epidemiology, University of Pittsburgh, Pennsylvania
| | - Barbara Radziszewska
- Division of Geriatrics and Clinical Gerontology, National Institute on Aging, Bethesda, Maryland
| | - Cynthia L Stowe
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Russell P Tracy
- Departments of Pathology & Laboratory Medicine, and Biochemistry, Larner College of Medicine, University of Vermont, Burlington
| | - Michael P Walkup
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Samuel S Wu
- Department of Biostatistics, University of Florida, Gainesville
| | - Walter T Ambrosius
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Mobility Function and Recovery After Stroke: Preliminary Insights From Sympathetic Nervous System Activity. J Neurol Phys Ther 2019; 42:224-232. [PMID: 30138228 DOI: 10.1097/npt.0000000000000238] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND AND PURPOSE Poststroke hemiparesis increases the perceived challenge of walking. Perceived challenge is commonly measured by self-report, which is susceptible to measurement bias. A promising approach to objectively assess perceived challenge is measuring sympathetic nervous system (SNS) activity with skin conductance to detect the physiological stress response. We investigated the feasibility of using skin conductance measurements to detect task-related differences in the challenge posed by complex walking tasks in adults poststroke. METHODS Adults poststroke (n = 31) and healthy young adults (n = 8) performed walking tasks including typical walking, walking in dim lighting, walking over obstacles, and dual-task walking. Measures of skin conductance and spatiotemporal gait parameters were recorded. Continuous decomposition analysis was conducted to assess changes in skin conductance level (ΔSCL) and skin conductance response (ΔSCR). A subset of participants poststroke also underwent a 12-week rehabilitation intervention. RESULTS SNS activity measured by skin conductance (both ΔSCL and ΔSCR) was significantly greater for the obstacles task and dual-task walking than for typical walking in the stroke group. Participants also exhibited "cautious" gait behaviors of slower speed, shorter step length, and wider step width during the challenging tasks. Following the rehabilitation intervention, SNS activity decreased significantly for the obstacles task and dual-task walking. DISCUSSION AND CONCLUSIONS SNS activity measured by skin conductance is a feasible approach for quantifying task-related differences in the perceived challenge of walking tasks in people poststroke. Furthermore, reduced SNS activity during walking following a rehabilitation intervention suggests a beneficial reduction in the physiological stress response evoked by complex walking tasks.Video Abstract available for more insights from the authors (See Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A234).
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Phillips CB, Freed SA, Ross LA. Older Adult Lifespace Varies by Driving Status and Residential Population Density. TRANSPORTATION RESEARCH RECORD 2019; 2673:586-595. [PMID: 32773923 PMCID: PMC7413609 DOI: 10.1177/0361198119846092] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Individual- and environmental-level factors may explain differential trajectories in lifespace mobility in older adults. The current study tested whether driving status was associated with lifespace, whether lifespace change varied by driving status, and whether residential context moderated the relationship between driving status and lifespace. Participants were older adults ages 65 to 94 (mean = 73.6 + 5.9) enrolled in the Advanced Cognitive Training for Independent and Vital Elderly Study (N = 2,792). Lifespace and driving status were assessed at baseline and first, second, third, and fifth annual follow-up visits. Residential population density was measured as the population density for participants' enrollment site counties. Two sites were categorized as low density (< 600 per square mile) and four sites were categorized as high density (> 1,200 per square mile). Multilevel longitudinal models tested relationships between driving status, residential population density, and lifespace over five years. After controlling for potential confounders, results indicated that non-drivers had smaller mean lifespace than drivers across five years. Rates of lifespace declines did not differ between drivers and non-drivers. Non-drivers at baseline residing in low population density areas had smaller lifespace than non-drivers in high population density areas and all drivers regardless of population density. The findings suggest that residential context plays a role in older adults' travel behaviors and choices. Further research is needed to understand what residential characteristics support or hinder lifespace maintenance for older adult non-drivers, such as availability and usability of transportation and walkability.
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Affiliation(s)
- Christine B Phillips
- Arizona State University College of Health Solutions Mail Code: 9020 550 N. 3 Street Phoenix, AZ 85004
| | - Sara A Freed
- The Pennsylvania State University 119 Health and Human Development Building University Park, PA 16802
| | - Lesley A Ross
- The Pennsylvania State University 119 Health and Human Development Building University Park, PA 16802
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Souza Silva W, McFadyen B, Kehayia E, Azevedo N, Fung J, Lamontagne A. Phone messages affect the detection of approaching pedestrians in healthy young and older adults immersed in a virtual community environment. PLoS One 2019; 14:e0217062. [PMID: 31141549 PMCID: PMC6541266 DOI: 10.1371/journal.pone.0217062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 05/04/2019] [Indexed: 11/18/2022] Open
Abstract
Background Mobile phones are increasingly associated with accidents while walking. Little is known, however, about the impact of phone messaging on the actual perception of other pedestrians. This study aimed to investigate the extent to which the detection of approaching pedestrians is affected by the sensory modality (text or audio) of phone messages in young vs. older adults. Methods Eighteen healthy young (24 ± 2.9 years) and 15 older adults (68 ± 4.2 years) performed a phone message deciphering task, an obstacle detection task, and a dual-task condition combining both tasks. Participants were tested while seated and viewing a virtual subway station (VE) in a helmet mounted display. As they were passively moved within the VE one of three virtual pedestrians randomly approached them from the center (0°), right (+40°) or left (+40°). When present, phone message conditions were delivered at obstacle movement onset and presented either as (1) text messages on the screen of a virtual phone or (2) audio messages delivered through earphones. Participants were instructed to press a joystick button as soon as they detected the approaching virtual pedestrian and to report the message content at the end of the trials. Results Young and older participants showed delayed obstacle detection times with vs. without text messages. Older adults further showed reduced accuracy of message report for texts compared to audio messages. In both groups, audio messages yielded no difference in obstacle detection time or accuracy of message report compared to the no message condition. Conclusions Findings indicate that text messages prolong the detection of approaching pedestrians, suggesting that they compromise safe ambulation in community environments. Older adults, who show larger deteriorations on the obstacle detection and message deciphering tasks, may be at even greater risk of collision. Audio messages could be a safer alternative for on-the-go communication.
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Affiliation(s)
- Wagner Souza Silva
- School of Physical & Occupational Therapy, McGill University, Montreal, QC, Canada.,Feil and Oberfeld Research Center, Jewish Rehabilitation Hospital (CISSS-Laval), Research site of CRIR, Laval, QC, Canada
| | - Bradford McFadyen
- Department of Rehabilitation, Université Laval, Quebec City, QC, Canada.,Centre Interdisciplinaire de recherche en réadaptation et intégration sociale (CIUSSS-CN), Quebec City, QC, Canada
| | - Eva Kehayia
- School of Physical & Occupational Therapy, McGill University, Montreal, QC, Canada.,Feil and Oberfeld Research Center, Jewish Rehabilitation Hospital (CISSS-Laval), Research site of CRIR, Laval, QC, Canada
| | - Nancy Azevedo
- Feil and Oberfeld Research Center, Jewish Rehabilitation Hospital (CISSS-Laval), Research site of CRIR, Laval, QC, Canada
| | - Joyce Fung
- School of Physical & Occupational Therapy, McGill University, Montreal, QC, Canada.,Feil and Oberfeld Research Center, Jewish Rehabilitation Hospital (CISSS-Laval), Research site of CRIR, Laval, QC, Canada
| | - Anouk Lamontagne
- School of Physical & Occupational Therapy, McGill University, Montreal, QC, Canada.,Feil and Oberfeld Research Center, Jewish Rehabilitation Hospital (CISSS-Laval), Research site of CRIR, Laval, QC, Canada
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Souza Silva W, McFadyen B, Fung J, Lamontagne A. Effects of Age on Obstacle Avoidance while Walking and Deciphering Text versus Audio Phone Messages. Gerontology 2019; 65:524-536. [PMID: 31085916 DOI: 10.1159/000499067] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 02/21/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Widely popular among young, and more recently older adults, mobile phones are increasingly used while walking. Knowledge of the impact of phone message modality (e.g., text vs. audio) on the ability to avoid collisions with other pedestrians, however, remains limited. OBJECTIVES This study aimed to investigate the extent to which the circumvention of an approaching pedestrian is affected by text versus audio phone messages in healthy young and older adults. METHOD Sixteen young (aged 24 ± 3 years) and 14 older adults (aged 68 ± 4.5 years) were tested while walking and viewing a virtual environment depicted as a subway station in a helmet-mounted display. As they walked, one of three virtual humans randomly approached from the center (0°), right (+40°), or left (+40°). Phone messages, when present, were delivered at obstacle displacement onset and presented either as text messages on a virtual phone or as audio messages delivered through earphones. Participants were instructed to avoid collisions with pedestrians and to fully report the message content at the end of trials. RESULTS Both groups showed decreased accuracy of message report (AMR), slower walking speed, and more collisions in response to text versus audio messages. Compared to young adults, older adults showed greater reduction in AMR, more collisions, and similar speed adaptation in the presence of text messages. In both age groups, no significant differences in walking speed emerged between the audio message and the no-message condition, but only older adults experienced collisions and reduced AMR with the audio messages. Obstacle clearance and the onset time of avoidance strategy were not affected by message condition. CONCLUSIONS Results suggest that coping with text messages while walking leads to greater risk of collision and alters message deciphering accuracy, while audio messages stand out as a safer and more efficient alternative for on-the-go communication. In general, older adults experienced larger motor-cognitive interference than younger adults, resulting in reduced AMR and more collisions without further changes in gait adaptation. Consequently, older adults failed to prioritize their safety when attending to phone messages while walking.
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Affiliation(s)
- Wagner Souza Silva
- School of Physical & Occupational Therapy, McGill University, Montreal, Québec, Canada, .,Feil and Oberfeld Research Center, Jewish Rehabilitation Hospital (CISSS-Laval), Research Site of CRIR, Laval, Québec, Canada,
| | - Bradford McFadyen
- Department of Rehabilitation, Université Laval, Quebec City, Québec, Canada.,Centre Interdisciplinaire de recherche en réadaptation et intégration sociale (CIUSSS-CN), Quebec City, Québec, Canada
| | - Joyce Fung
- School of Physical & Occupational Therapy, McGill University, Montreal, Québec, Canada.,Feil and Oberfeld Research Center, Jewish Rehabilitation Hospital (CISSS-Laval), Research Site of CRIR, Laval, Québec, Canada
| | - Anouk Lamontagne
- School of Physical & Occupational Therapy, McGill University, Montreal, Québec, Canada.,Feil and Oberfeld Research Center, Jewish Rehabilitation Hospital (CISSS-Laval), Research Site of CRIR, Laval, Québec, Canada
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Kujala UM, Hautasaari P, Vähä-Ypyä H, Waller K, Lindgren N, Iso-Markku P, Heikkilä K, Rinne J, Kaprio J, Sievänen H. Chronic diseases and objectively monitored physical activity profile among aged individuals - a cross-sectional twin cohort study. Ann Med 2019; 51:78-87. [PMID: 30626223 PMCID: PMC7857471 DOI: 10.1080/07853890.2019.1566765] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION High physical activity (PA) at old age indicates good functional capacity enabling independent living. We investigated how different disease conditions are associated with measured PA indicators in old women and men, and whether they recognize this association. MATERIALS AND METHODS This cross-sectional twin cohort study in Finland comprised 779 individuals (276 complete twin pairs, including 117 monozygotic pairs), who participated in hip-worn accelerometer monitoring of PA and responded to questions on diseases and mobility limitations at mean age of 73 (range 71-75). RESULTS Of the participants, 23.2% reported having a disease restricting mobility. With sex and age in the regression model, the reported disease restricting mobility explained 11.8% of the variation in moderate-to-vigorous PA (MVPA) and 10.4% of the variation in daily steps. Adding stepwise other self-reported diseases and body mass index to the model increased the explanatory power for MVPA up to 18.5% and 25.5%, and for daily steps up to 16.0% and 20.7%, respectively. In the co-twin control analysis the PA differences were smaller in disease-discordant monozygotic than dizygotic pairs. CONCLUSIONS Chronic disease conditions are associated with low PA, which individuals may not always recognize. Shared genetic factors may explain part of the associations. Key messages Among community-dwelling older men and women one-fourth of the variation in objectively measured moderate-to-vigorous physical activity is accounted for by age, sex, body mass index and self-reported diseases. Occurrence of chronic diseases is associated with low physical activity and individuals do not always recognize this. Healthcare professionals should pay attention to the low physical activity and mobility of individuals with chronic disease conditions before these result in limitations in independent living.
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Affiliation(s)
- Urho M Kujala
- a Faculty of Sport and Health Sciences , University of Jyväskylä , Jyväskylä , Finland
| | - Pekka Hautasaari
- a Faculty of Sport and Health Sciences , University of Jyväskylä , Jyväskylä , Finland
| | - Henri Vähä-Ypyä
- b The UKK Institute for Health Promotion Research , Tampere , Finland
| | - Katja Waller
- a Faculty of Sport and Health Sciences , University of Jyväskylä , Jyväskylä , Finland
| | - Noora Lindgren
- c Turku PET Centre , Turku University Hospital, University of Turku , Turku , Finland
| | - Paula Iso-Markku
- d Department of Clinical Physiology and Nuclear Medicine, HUS Medical Imaging Center , Helsinki University Central Hospital, University of Helsinki , Helsinki , Finland
| | - Kauko Heikkilä
- e Institute for Molecular Medicine Finland , Helsinki , Finland
| | - Juha Rinne
- c Turku PET Centre , Turku University Hospital, University of Turku , Turku , Finland.,f Clinical Neurology , University of Turku , Turku , Finland
| | - Jaakko Kaprio
- e Institute for Molecular Medicine Finland , Helsinki , Finland.,g Department of Public Health , University of Helsinki , Helsinki , Finland
| | - Harri Sievänen
- b The UKK Institute for Health Promotion Research , Tampere , Finland
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Buhler MA, Lamontagne A. Circumvention of Pedestrians While Walking in Virtual and Physical Environments. IEEE Trans Neural Syst Rehabil Eng 2018; 26:1813-1822. [PMID: 30130232 DOI: 10.1109/tnsre.2018.2865907] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Virtual environments (VEs) are increasingly used in the context of scientific inquiries and rehabilitation for tasks that are otherwise difficult to control or perform safely in physical environments (PEs), such as avoiding other pedestrians during locomotion. The usefulness of VEs, however, remains constrained by the extent to which they can elicit natural responses. The objectives of the study were to examine circumvention strategies in response to pedestrians approaching from different directions in the VE versus PE and to determine the effects of repeated practice on the circumvention strategies. Twelve participants were assessed over five blocks of eight trials that consisted of walking toward a target while circumventing pedestrians approaching from different directions (0°, ± 30° right or left or none) in the VE and the PE. Similar onset distances of circumvention strategy and preferred side of circumvention were observed between the two environments. Participants, however, maintained enlarged minimum distances from the interferer (13%) and walked slower (11.5%) in the VE. Repeated practice resulted in walking speed increments of 7.4% over the entire session that were similar in the VE versus PE. While the changes observed in VE may reflect the use of more cautious circumvention strategies, the similarities in strategies between the two environments and the advantages of VEs (e.g., controlled exposure, reproduction of ecologically valid conditions, and safety) suggest that virtual reality is a valuable tool to study visually guided locomotor tasks, such as pedestrian circumvention, and shows great potential for assessment and intervention in physical rehabilitation.
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Callahan MK, Cowan RE. Relationship of Fitness and Wheelchair Mobility With Encounters, Avoidances, and Perception of Environmental Barriers Among Manual Wheelchair Users With Spinal Cord Injury. Arch Phys Med Rehabil 2018; 99:2007-2014.e3. [PMID: 29981312 DOI: 10.1016/j.apmr.2018.06.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 05/04/2018] [Accepted: 06/07/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To assess (1) if fitness and mobility are related to behavior and perception of physical barriers and (2) if behavior and physical barrier perception are related. DESIGN Cross-sectional case series. SETTING Academic Medical Laboratory. PARTICIPANTS Manual wheelchair users (N=50) with chronic spinal cord injury (62% paraplegia). INTERVENTION None. MAIN OUTCOME MEASURES Participants completed the following assessments: (1) fitness: graded exercise test (aerobic) and Wingate (anaerobic); (2) mobility: 6-minute push test and 30-second sprint test; (3) physical barrier behavior: Encounters of Environmental Features in the Environmental Aspects of Mobility Questionnaire (EAMQ); (4) physical barrier perception: Craig Hospital Inventory of Environmental Factor (CHIEF) Environmental Barriers domain. RESULTS Individuals with paraplegia had higher fitness, mobility, and environmental barrier encounter rates and lower avoidance per encounter rates vs tetraplegia (all P≤.05). For individuals with tetraplegia only, as mobility and fitness increased, frequencies of (1) encounters increased; (2) avoidances per encounter decreased, in multiple EAMQ domains (all P≤.05). Perception of barriers did not differ between lesion levels (P=.79). Mobility and fitness were not related to environmental barriers perception in both groups (all P>.17). CONCLUSIONS Fitness and mobility are associated with barrier behaviors (ie, encounters and avoidances) among individuals with tetraplegia, but not paraplegia. Despite a greater barrier avoidance rate, persons with tetraplegia do not perceive more physical barriers than persons with paraplegia. Surprisingly, fitness and mobility were not related to perception of barriers in either group. More research is required on if barrier perception, behavior, or both influence participation, to enable rehabilitation programs to tailor interventions to enhance participation.
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Affiliation(s)
- Morgan K Callahan
- Shirley Ryan Ability Lab, Northwestern University Feinberg School of Medicine, Chicago, IL.
| | - Rachel E Cowan
- Departments of Neurosurgery and Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL
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Abstract
Top themes of international research on disability in the past three decades are discussed: disability dynamics, buffers and barriers for disability, disability trends, and disability among very old persons. Each theme is highlighted by research examples. Turning to measurement, I discuss traditional measures of disability, new longer and shorter ones, and composites like disability-free life expectancy, noting their merits. Contemporary models of disability are presented, ranging from visual images to formal theories. The article ends on how scientists can facilitate movement of disability science into health care practice and policy.
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Clark DJ, Chatterjee SA, McGuirk TE, Porges EC, Fox EJ, Balasubramanian CK. Sympathetic nervous system activity measured by skin conductance quantifies the challenge of walking adaptability tasks after stroke. Gait Posture 2018; 60:148-153. [PMID: 29216598 PMCID: PMC5911926 DOI: 10.1016/j.gaitpost.2017.11.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Revised: 08/25/2017] [Accepted: 11/29/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Walking adaptability tasks are challenging for people with motor impairments. The construct of perceived challenge is typically measured by self-report assessments, which are susceptible to subjective measurement error. The development of an objective physiologically-based measure of challenge may help to improve the ability to assess this important aspect of mobility function. The objective of this study to investigate the use of sympathetic nervous system (SNS) activity measured by skin conductance to gauge the physiological stress response to challenging walking adaptability tasks in people post-stroke. METHODS Thirty adults with chronic post-stroke hemiparesis performed a battery of seventeen walking adaptability tasks. SNS activity was measured by skin conductance from the palmar surface of each hand. The primary outcome variable was the percent change in skin conductance level (ΔSCL) between the baseline resting and walking phases of each task. Task difficulty was measured by performance speed and by physical therapist scoring of performance. Walking function and balance confidence were measured by preferred walking speed and the Activities-specific Balance Confidence Scale, respectively. RESULTS There was a statistically significant negative association between ΔSCL and task performance speed and between ΔSCL and clinical score, indicating that tasks with greater SNS activity had slower performance speed and poorer clinical scores. ΔSCL was significantly greater for low functioning participants versus high functioning participants, particularly during the most challenging walking adaptability tasks. CONCLUSION This study supports the use of SNS activity measured by skin conductance as a valuable approach for objectively quantifying the perceived challenge of walking adaptability tasks in people post-stroke.
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Affiliation(s)
- David J. Clark
- Brain Rehabilitation Research Center of Excellence, North Florida/South Georgia Veterans Health System, 1601 SW Archer Rd, Gainesville, FL, 32608 USA,Department of Aging and Geriatric Research, University of Florida, 2004 Mowry Rd, Gainesville, FL, 32611, USA
| | - Sudeshna A. Chatterjee
- Brain Rehabilitation Research Center of Excellence, North Florida/South Georgia Veterans Health System, 1601 SW Archer Rd, Gainesville, FL, 32608 USA,Department of Physical Therapy, University of Florida, 1225 Center Drive, HPNP Building Room 1142, Gainesville FL, 32610, USA
| | - Theresa E. McGuirk
- Brain Rehabilitation Research Center of Excellence, North Florida/South Georgia Veterans Health System, 1601 SW Archer Rd, Gainesville, FL, 32608 USA
| | - Eric C. Porges
- Department of Clinical and Health Psychology, University of Florida, 1225 Center Drive, HPNP Building, Gainesville, FL, 32610, USA
| | - Emily J. Fox
- Department of Physical Therapy, University of Florida, 1225 Center Drive, HPNP Building Room 1142, Gainesville FL, 32610, USA,Clinical Research Center, Brooks Rehabilitation, 3599 University Blvd S, Jacksonville, FL, 32216, USA
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Kostadinović M, Nikolić D, Šantrić-Milićević M. The role of gender and comorbidity on function and movement in elderly population: Importance of physical activity. MEDICINSKI PODMLADAK 2018. [DOI: 10.5937/mp69-16796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Shafrin J, Sullivan J, Goldman DP, Gill TM. The association between observed mobility and quality of life in the near elderly. PLoS One 2017; 12:e0182920. [PMID: 28827806 PMCID: PMC5572211 DOI: 10.1371/journal.pone.0182920] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 07/26/2017] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Chronic diseases associated with aging, such as arthritis, frequently cause reduced mobility, pain and diminished quality of life. To date, research on the association between mobility and quality of life has primarily focused in the elderly; hence, much less is known about this association in the near elderly. This cross-sectional study aimed to assess the association between mobility and quality of life measures in the near elderly. METHODS A prospective observational study of persons aged 50-69 years was conducted. The primary endpoint was quality of life measured by EQ-5D-5L, and the primary explanatory variable was observed mobility assessed using the 6-minute walk distance (6MWD). We applied regression models controlling for demographic, health status and other factors to evaluate the association between 6MWD and EQ-5D-5L. RESULTS Of the 183 participants analyzed in the study, 37% were male and the average age was 59.8 years. After adjusting for differences in demographic characteristics and health status, EQ-5D-5L-based utility values were 0.046 points (p<0.001), or 5.2% (95% CI: 2.7% to 7.8%), higher on average for individuals with 100 meters longer 6MWD. Holding constant the mobility-specific component of EQ-5D-5L, we still found that walking an additional 100 meters was associated with an EQ-5D-5L utility value that was 0.029 points (p<0.001), or 3.5% (95% CI: 1.7% to 5.5%), higher than the average participant. Among persons with arthritis, the association between 6MWD and EQ-5D-5L was slightly stronger. CONCLUSIONS Near elderly persons with better mobility had higher quality of life. Diseases that decrease mobility, such as arthritis, are likely to have a significant impact on quality of life.
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Affiliation(s)
- Jason Shafrin
- Precision Health Economics, Los Angeles, California, United States of
America
| | - Jeff Sullivan
- Precision Health Economics, Los Angeles, California, United States of
America
| | - Dana P. Goldman
- Schaeffer Center for Health Policy and Economics, University of Southern
California, Los Angeles, California, United States of America
| | - Thomas M. Gill
- Department of Internal Medicine, Yale School of Medicine, New Haven,
Connecticut, United States of America
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Rantakokko M, Wilkie R. The role of environmental factors for the onset of restricted mobility outside the home among older adults with osteoarthritis: a prospective cohort study. BMJ Open 2017; 7:e012826. [PMID: 28667194 PMCID: PMC5734218 DOI: 10.1136/bmjopen-2016-012826] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The study examines how environmental factors contribute to the onset of restricted mobility outside the home among older adults with osteoarthritis. METHODS This is a prospective cohort study of adults aged 50 years and older with osteoarthritis (n=1802). Logistic regression tested the association between the onset of restricted mobility outside the home and health, sociodemographic and perceived environmental barriers (hills and steep slopes, inaccessible public buildings, poor pavement condition, lack of access to public parks or sport facilities, heavy traffic or speeding cars and poor weather). The potential moderating role of environmental barriers on the association between health factors and onset was examined using interaction terms and stratified analysis. RESULTS Of 1802 participants, 13.5% (n=243) reported the onset of restricted mobility outside the home at 3-year follow-up. Walking disability, anxiety, depression, cognitive impairment and obesity and all environmental barriers were associated with onset after adjustment for confounders. Environmental barriers had an added contribution to the effect of the health conditions on onset of restricted mobility, which was attenuated when adjusted for confounders. The added contribution remained only for walking disability and the presence of hills and steep slopes; in the presence of both, the association with onset of restricted mobility was stronger (OR 7.66, 95% CI 4.64 to 12.64) than in the presence of walking disability (3.60, 2.43 to 5.32) or the presence of hills and steep slopes alone (4.55, 2.89 to 7.16). CONCLUSION For older adults with osteoarthritis, environmental barriers are associated and add a contribution to that of morbidities and walking disability on the onset of restricted mobility outside the home. Awareness of environmental barriers is important when aiming to maintain mobility and activities outside the home despite health conditions in older adults.
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Affiliation(s)
- Merja Rantakokko
- Faculty of Sport and Health Sciences, Gerontology Research Center, University of Jyvaskyla, Jyvaskyla, Finland
| | - Ross Wilkie
- Research Institute for Primary Care Sciences, Keele University, Keele, UK
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Clarke P, Hirsch JA, Melendez R, Winters M, Sims Gould J, Ashe M, Furst S, McKay H. Snow and Rain Modify Neighbourhood Walkability for Older Adults. Can J Aging 2017; 36:159-169. [PMID: 28390449 PMCID: PMC5423849 DOI: 10.1017/s071498081700006x] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
The literature has documented a positive relationship between walkable built environments and outdoor mobility in older adults. Yet, surprisingly absent is any consideration of how weather conditions modify the impact of neighbourhood walkability. Using archived weather data linked to survey data collected from a sample of older adults in Vancouver, Canada, we found that car-dependent neighbourhoods (featuring longer block lengths, fewer intersections, and greater distance to amenities) became inaccessible in snow. Even older adults who lived in very walkable neighbourhoods walked to 25 per cent fewer destinations in snow. It is crucial to consider the impact of weather in the relationship between neighbourhood walkability and older adult mobility.
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Affiliation(s)
- Philippa Clarke
- Institute for Social Research,Department of Epidemiology,University of Michigan
| | - Jana A Hirsch
- Carolina Population Center,University of North Carolina at Chapel Hill
| | | | | | - Joanie Sims Gould
- Centre for Hip Health and Mobility and Department of Family Practice,University of British Columbia
| | - Maureen Ashe
- Centre for Hip Health and Mobility and Department of Family Practice,University of British Columbia
| | - Sarah Furst
- Centre for Hip Health and Mobility,University of British Columbia
| | - Heather McKay
- Centre for Hip Health and Mobility and Department of Family Practice,University of British Columbia
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Lamont RM, Morris ME, Menz HB, McGinley JL, Brauer SG. Falls in people with Parkinson's disease: A prospective comparison of community and home-based falls. Gait Posture 2017; 55:62-67. [PMID: 28419875 DOI: 10.1016/j.gaitpost.2017.04.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 02/27/2017] [Accepted: 04/02/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Falls are common and debilitating in people with Parkinson's disease (PD) and restrict participation in daily activities. Understanding circumstances of falls in the community and at home may assist clinicians to target therapy more effectively. OBJECTIVE To compare the characteristics of community and home fallers and the circumstances that contribute to falls in people living with PD. METHODS People with mild-moderately severe PD (n=196) used a daily falls diary and telephone hotline to report prospectively the occurrence, location and circumstances of falls over 14 months. RESULTS 62% of people with PD fell, with most falling at least once in the community. Compared to people who fell at home, the community-only fallers had shorter durations of PD (p=0.012), less severe disease (p=0.008) and reported fewer falls in the year prior to the study (p=0.003). Most falls occurred while people were ambulant, during postural transitions and when medication was working well. Community-based falls were frequently attributed to environmental factors such as challenging terrains (p<0.001), high attention demands (p=0.029), busy or cluttered areas (p<0.001) and tasks requiring speed (p=0.020). Physical loads were more often present in home than community-based falls (p=0.027). CONCLUSION Falls that occur in the community typically affect people with earlier PD and less severe disease than home-based falls. Individuals experiencing community-based falls may benefit from physiotherapy to manage challenging environments and high attention demands.
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Affiliation(s)
- Robyn M Lamont
- School of Health and Rehabilitation Sciences, University of Queensland, St Lucia, 4072, Australia.
| | - Meg E Morris
- School of Allied Health, La Trobe University, Melbourne, 3086, Australia; Northpark Private Hospital Healthscope, Melbourne, Australia.
| | - Hylton B Menz
- School of Allied Health, La Trobe University, Melbourne, 3086, Australia.
| | - Jennifer L McGinley
- Melbourne School of Health Sciences, The University of Melbourne, 3010, Melbourne, Australia.
| | - Sandra G Brauer
- School of Health and Rehabilitation Sciences, University of Queensland, St Lucia, 4072, Australia.
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Abstract
We provide an in-depth description of the mobility (capacity and enacted function, i.e., physical activity and travel behaviour) of community-dwelling older adults of low socioeconomic status. Participants [n = 161, mean age (range) = 74 (65-96) years] completed interviewer-administered questionnaires and objective measures of mobility. Our findings did not generally indicate that older adults of low socioeconomic status have a reduced capacity to be mobile. Participants presented with positive profiles across physical, psychosocial, and social environment domains that influence the capacity to be mobile. They also made a high proportion of trips by foot, although these did not together serve to meet physical activity guidelines for most. We challenge future researchers to focus on innovative strategies to recruit this difficult-to-access population, to consider the influence of socioeconomic status across the lifespan, and the role of behaviour-driven agency when investigating the association between the person, environment, and older adult mobility.
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Physical Limitations, Walkability, Perceived Environmental Facilitators and Physical Activity of Older Adults in Finland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14030333. [PMID: 28327543 PMCID: PMC5369168 DOI: 10.3390/ijerph14030333] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 03/17/2017] [Accepted: 03/17/2017] [Indexed: 11/17/2022]
Abstract
The aim was to study objectively assessed walkability of the environment and participant perceived environmental facilitators for outdoor mobility as predictors of physical activity in older adults with and without physical limitations. 75–90-year-old adults living independently in Central Finland were interviewed (n = 839) and reassessed for self-reported physical activity one or two years later (n = 787). Lower-extremity physical limitations were defined as Short Physical Performance Battery score ≤9. Number of perceived environmental facilitators was calculated from a 16-item checklist. Walkability index (land use mix, street connectivity, population density) of the home environment was calculated from geographic information and categorized into tertiles. Accelerometer-based step counts were registered for one week (n = 174). Better walkability was associated with higher numbers of perceived environmental facilitators (p < 0.001) and higher physical activity (self-reported p = 0.021, step count p = 0.010). Especially among those with physical limitations, reporting more environmental facilitators was associated with higher odds for reporting at least moderate physical activity (p < 0.001), but not step counts. Perceived environmental facilitators only predicted self-reported physical activity at follow-up. To conclude, high walkability of the living environment provides opportunities for physical activity in old age, but among those with physical limitations especially, awareness of environmental facilitators may be needed to promote physical activity.
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Public Open Space Development for Elderly People by Using the DANP-V Model to Establish Continuous Improvement Strategies towards a Sustainable and Healthy Aging Society. SUSTAINABILITY 2017. [DOI: 10.3390/su9030420] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Timmermans EJ, van der Pas S, Schaap LA, Cooper C, Edwards MH, Gale CR, Deeg DJH, Dennison EM. Associations between perceived neighbourhood problems and quality of life in older adults with and without osteoarthritis: Results from the Hertfordshire Cohort Study. Health Place 2017; 43:144-150. [PMID: 28061391 DOI: 10.1016/j.healthplace.2016.11.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 10/03/2016] [Accepted: 11/28/2016] [Indexed: 11/26/2022]
Abstract
This study examined whether the association of quality of life (QoL) with perceived neighbourhood problems is stronger in older adults with osteoarthritis (OA) than in those without OA. Of all 294 participants, 23.8% had OA. More perceived neighbourhood problems were associated with a stronger decrease in QoL over time in participants with OA (B=-0.018; p=0.02) than in those without OA (B=-0.004; p=0.39). Physical activity did not mediate this relationship. Older adults with OA may be less able to deal with more challenging environments.
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Affiliation(s)
- Erik J Timmermans
- Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands.
| | - Suzan van der Pas
- Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Laura A Schaap
- Department of Health Sciences, Faculty of Earth and Life Sciences, VU University Amsterdam, Amsterdam, The Netherlands
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, United Kingdom; NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Mark H Edwards
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, United Kingdom
| | - Catharine R Gale
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, United Kingdom; Centre for Cognitive Ageing & Cognitive Epidemiology, Department of Psychology, University of Edinburgh, Edinburgh, United Kingdom
| | - Dorly J H Deeg
- Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Elaine M Dennison
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, United Kingdom; School of Biological Sciences, Victoria University of Wellington, New Zealand
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Gill TM, Guralnik JM, Pahor M, Church T, Fielding RA, King AC, Marsh AP, Newman AB, Pellegrini CA, Chen SH, Allore HG, Miller ME. Effect of Structured Physical Activity on Overall Burden and Transitions Between States of Major Mobility Disability in Older Persons: Secondary Analysis of a Randomized Trial. Ann Intern Med 2016; 165:833-840. [PMID: 27669457 PMCID: PMC5476905 DOI: 10.7326/m16-0529] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The total time a patient is disabled likely has a greater influence on his or her quality of life than the initial occurrence of disability alone. OBJECTIVE To compare the effect of a long-term, structured physical activity program with that of a health education intervention on the proportion of patient assessments indicating major mobility disability (MMD) (that is, MMD burden) and on the risk for transitions into and out of MMD. DESIGN Single-blinded, parallel-group, randomized trial. (ClinicalTrials.gov: NCT01072500). SETTING 8 U.S. centers between February 2010 and December 2013. PARTICIPANTS 1635 sedentary persons, aged 70 to 89 years, who had functional limitations but could walk 400 m. INTERVENTION Physical activity (n = 818) and health education (n = 817). MEASUREMENTS MMD, defined as the inability to walk 400 m, was assessed every 6 months for up to 3.5 years. RESULTS During a median follow-up of 2.7 years, the proportion of assessments showing MMD was substantially lower in the physical activity (0.13 [95% CI, 0.11 to 0.15]) than the health education (0.17 [CI, 0.15 to 0.19]) group, yielding a risk ratio of 0.75 (CI, 0.64 to 0.89). In a multistate model, the hazard ratios for comparisons of physical activity with health education were 0.87 (CI, 0.73 to 1.03) for the transition from no MMD to MMD; 0.52 (CI, 0.10 to 2.67) for no MMD to death; 1.33 (CI, 0.99 to 1.77) for MMD to no MMD; and 1.92 (CI, 1.15 to 3.20) for MMD to death. LIMITATION The intention-to-treat principle was maintained for MMD burden and first transition out of no MMD, but not for subsequent transitions. CONCLUSION A structured physical activity program reduced the MMD burden for an extended period, in part through enhanced recovery after the onset of disability and diminished risk for subsequent disability episodes. PRIMARY FUNDING SOURCE National Institute on Aging, National Institutes of Health.
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Affiliation(s)
- Thomas M Gill
- From Yale School of Medicine, New Haven, Connecticut; University of Maryland School of Medicine, Baltimore, Maryland; University of Florida, Gainesville, Florida; Pennington Biomedical Research Center, Baton Rouge, Louisiana; Tufts University, Boston, Massachusetts; Stanford School of Medicine, Stanford, California; Wake Forest University and Wake Forest School of Medicine, Winston-Salem, North Carolina; University of Pittsburgh, Pittsburgh, Pennsylvania; and Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jack M Guralnik
- From Yale School of Medicine, New Haven, Connecticut; University of Maryland School of Medicine, Baltimore, Maryland; University of Florida, Gainesville, Florida; Pennington Biomedical Research Center, Baton Rouge, Louisiana; Tufts University, Boston, Massachusetts; Stanford School of Medicine, Stanford, California; Wake Forest University and Wake Forest School of Medicine, Winston-Salem, North Carolina; University of Pittsburgh, Pittsburgh, Pennsylvania; and Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Marco Pahor
- From Yale School of Medicine, New Haven, Connecticut; University of Maryland School of Medicine, Baltimore, Maryland; University of Florida, Gainesville, Florida; Pennington Biomedical Research Center, Baton Rouge, Louisiana; Tufts University, Boston, Massachusetts; Stanford School of Medicine, Stanford, California; Wake Forest University and Wake Forest School of Medicine, Winston-Salem, North Carolina; University of Pittsburgh, Pittsburgh, Pennsylvania; and Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Timothy Church
- From Yale School of Medicine, New Haven, Connecticut; University of Maryland School of Medicine, Baltimore, Maryland; University of Florida, Gainesville, Florida; Pennington Biomedical Research Center, Baton Rouge, Louisiana; Tufts University, Boston, Massachusetts; Stanford School of Medicine, Stanford, California; Wake Forest University and Wake Forest School of Medicine, Winston-Salem, North Carolina; University of Pittsburgh, Pittsburgh, Pennsylvania; and Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Roger A Fielding
- From Yale School of Medicine, New Haven, Connecticut; University of Maryland School of Medicine, Baltimore, Maryland; University of Florida, Gainesville, Florida; Pennington Biomedical Research Center, Baton Rouge, Louisiana; Tufts University, Boston, Massachusetts; Stanford School of Medicine, Stanford, California; Wake Forest University and Wake Forest School of Medicine, Winston-Salem, North Carolina; University of Pittsburgh, Pittsburgh, Pennsylvania; and Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Abby C King
- From Yale School of Medicine, New Haven, Connecticut; University of Maryland School of Medicine, Baltimore, Maryland; University of Florida, Gainesville, Florida; Pennington Biomedical Research Center, Baton Rouge, Louisiana; Tufts University, Boston, Massachusetts; Stanford School of Medicine, Stanford, California; Wake Forest University and Wake Forest School of Medicine, Winston-Salem, North Carolina; University of Pittsburgh, Pittsburgh, Pennsylvania; and Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Anthony P Marsh
- From Yale School of Medicine, New Haven, Connecticut; University of Maryland School of Medicine, Baltimore, Maryland; University of Florida, Gainesville, Florida; Pennington Biomedical Research Center, Baton Rouge, Louisiana; Tufts University, Boston, Massachusetts; Stanford School of Medicine, Stanford, California; Wake Forest University and Wake Forest School of Medicine, Winston-Salem, North Carolina; University of Pittsburgh, Pittsburgh, Pennsylvania; and Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Anne B Newman
- From Yale School of Medicine, New Haven, Connecticut; University of Maryland School of Medicine, Baltimore, Maryland; University of Florida, Gainesville, Florida; Pennington Biomedical Research Center, Baton Rouge, Louisiana; Tufts University, Boston, Massachusetts; Stanford School of Medicine, Stanford, California; Wake Forest University and Wake Forest School of Medicine, Winston-Salem, North Carolina; University of Pittsburgh, Pittsburgh, Pennsylvania; and Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Christine A Pellegrini
- From Yale School of Medicine, New Haven, Connecticut; University of Maryland School of Medicine, Baltimore, Maryland; University of Florida, Gainesville, Florida; Pennington Biomedical Research Center, Baton Rouge, Louisiana; Tufts University, Boston, Massachusetts; Stanford School of Medicine, Stanford, California; Wake Forest University and Wake Forest School of Medicine, Winston-Salem, North Carolina; University of Pittsburgh, Pittsburgh, Pennsylvania; and Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Shyh-Huei Chen
- From Yale School of Medicine, New Haven, Connecticut; University of Maryland School of Medicine, Baltimore, Maryland; University of Florida, Gainesville, Florida; Pennington Biomedical Research Center, Baton Rouge, Louisiana; Tufts University, Boston, Massachusetts; Stanford School of Medicine, Stanford, California; Wake Forest University and Wake Forest School of Medicine, Winston-Salem, North Carolina; University of Pittsburgh, Pittsburgh, Pennsylvania; and Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Heather G Allore
- From Yale School of Medicine, New Haven, Connecticut; University of Maryland School of Medicine, Baltimore, Maryland; University of Florida, Gainesville, Florida; Pennington Biomedical Research Center, Baton Rouge, Louisiana; Tufts University, Boston, Massachusetts; Stanford School of Medicine, Stanford, California; Wake Forest University and Wake Forest School of Medicine, Winston-Salem, North Carolina; University of Pittsburgh, Pittsburgh, Pennsylvania; and Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Michael E Miller
- From Yale School of Medicine, New Haven, Connecticut; University of Maryland School of Medicine, Baltimore, Maryland; University of Florida, Gainesville, Florida; Pennington Biomedical Research Center, Baton Rouge, Louisiana; Tufts University, Boston, Massachusetts; Stanford School of Medicine, Stanford, California; Wake Forest University and Wake Forest School of Medicine, Winston-Salem, North Carolina; University of Pittsburgh, Pittsburgh, Pennsylvania; and Northwestern University Feinberg School of Medicine, Chicago, Illinois
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The impact of measures taken in the outdoor environment on an ageing population: a panel study over a ten-year period. AGEING & SOCIETY 2016. [DOI: 10.1017/s0144686x16001082] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
ABSTRACTFor older people mobility and participation in activities can be restricted both by individual factors and by the environment. The aim of this paper was to examine the longitudinal impact of measures taken in the outdoor environment on an ageing population. The following factors were examined on three occasions over a nine-year period: frequency of walking; differences in report on environmental barriers; and reported valuation of the outdoor environment; and how these relate to different characteristics. At the second follow-up, the respondents experienced more functional limitations and more were using mobility devices than at baseline. At the first and second follow-up, the respondents did not experience as many environmental barriers in their outdoor environment compared to baseline. However, frequency of walking and evaluation of the outdoor environment decreased in general between baseline and first- and second follow-up. A quite promising result from the study is that compared to people not using mobility devices, mobility device users were more likely to be frequent walkers at first- and second follow-up than at baseline. Likewise, at second follow-up respondents having functional limitations were less likely to experience traffic barriers than at baseline. In terms of accessibility, usability and mobility for an ageing population, the results are promising, showing that measures in the outdoor environment can possibly facilitate walking for those who are more fragile, even in a longitudinal perspective.
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Timmermans EJ, van der Pas S, Cooper C, Schaap LA, Edwards MH, Deeg DJH, Gale CR, Dennison EM. The neighbourhood environment and use of neighbourhood resources in older adults with and without lower limb osteoarthritis: results from the Hertfordshire Cohort Study. Clin Rheumatol 2016; 35:2797-2805. [PMID: 27567628 PMCID: PMC5063902 DOI: 10.1007/s10067-016-3388-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 08/16/2016] [Accepted: 08/17/2016] [Indexed: 12/03/2022]
Abstract
This study aimed to examine the associations of perceptions of neighbourhood cohesion and neighbourhood problems and objectively measured neighbourhood deprivation with the use of neighbourhood resources by older adults with and without lower limb osteoarthritis (LLOA), and to assess whether these relationships are stronger in older persons with LLOA than in those without the condition. Data from the Hertfordshire Cohort Study were used. American College of Rheumatology classification criteria were used to diagnose clinical LLOA (knee and/or hip osteoarthritis). Use of neighbourhood resources was assessed using the Home and Community Environment instrument. Participants were asked about their perceptions of neighbourhood cohesion and neighbourhood problems. Objective neighbourhood deprivation was assessed using the Index of Multiple Deprivation score based on 2010 census data. Of the 401 participants (71–80 years), 74 (18.5 %) had LLOA. The neighbourhood measures were not significantly associated with use of resources in the full sample. A trend for a negative association between use of public transport and perceived neighbourhood problems was observed in participants with LLOA (OR = 0.77, 99 % CI = 0.53–1.12), whereas a trend for a positive association between perceived neighbourhood problems and use of public transport was found in participants without LLOA (OR = 1.18, 99 % CI = 1.00–1.39). The perception of more neighbourhood problems seems only to hinder older adults with LLOA to make use of public transport. Older adults with LLOA may be less able to deal with neighbourhood problems and more challenging environments than those without the condition.
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Affiliation(s)
- Erik J Timmermans
- Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Centre, De Boelelaan 1089A, 1081 HV, Amsterdam, The Netherlands.
| | - Suzan van der Pas
- Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Centre, De Boelelaan 1089A, 1081 HV, Amsterdam, The Netherlands
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
- NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Laura A Schaap
- Department of Health Sciences, Faculty of Earth and Life Sciences, VU University Amsterdam, Amsterdam, the Netherlands
| | - Mark H Edwards
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Dorly J H Deeg
- Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Centre, De Boelelaan 1089A, 1081 HV, Amsterdam, The Netherlands
| | - Catharine R Gale
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
- Centre for Cognitive Ageing & Cognitive Epidemiology, Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Elaine M Dennison
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
- School of Biological Sciences, Victoria University of Wellington, Wellington, New Zealand
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Keysor JJ, Dunn JE, Link CL, Badlissi F, Felson DT. Are Foot Disorders Associated With Functional Limitation and Disability Among Community-Dwelling Older Adults? J Aging Health 2016; 17:734-52. [PMID: 16377770 DOI: 10.1177/0898264305280998] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The objectives of this study are to examine whether specific foot disorders and ankle weakness and foot pain are related to functional limitations or disabilities in elders. Community-dwelling adults 65 and older were enrolled in a population-based, cross-sectional study of foot disorders and health outcomes. Demographics, health status, comorbidities, self-reported foot and knee pain, function and disability, and observed structural foot disorders, body mass index, and ankle muscle strength were assessed on 717 participants. The associations of foot disorders, foot pain, and ankle muscle weakness with function and disability were examined with regression analyses. Foot disorders were not associated with functional outcomes or disability. Ankle weakness was associated with performance-based function ( p = .005), self-report function ( p < .001), and disability ( p = .009). Foot pain was associated with self-report function ( p = .01) and disability ( p = .007). Foot pain and ankle weakness seem to be related to important health outcomes among older adults.
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Affiliation(s)
- Julie J Keysor
- Department of Rehabilitation Science, Programs in Physical Therapy, Sargent College of Health and Rehabilitation Science, Boston University, 635 Commonwealth Ave., Boston, MA 02215, USA.
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Maidan I, Nieuwhof F, Bernad-Elazari H, Reelick MF, Bloem BR, Giladi N, Deutsch JE, Hausdorff JM, Claassen JAH, Mirelman A. The Role of the Frontal Lobe in Complex Walking Among Patients With Parkinson's Disease and Healthy Older Adults: An fNIRS Study. Neurorehabil Neural Repair 2016; 30:963-971. [PMID: 27221042 DOI: 10.1177/1545968316650426] [Citation(s) in RCA: 194] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Gait is influenced by higher order cognitive and cortical control mechanisms. Functional near infrared spectroscopy (fNIRS) has been used to examine frontal activation during walking in healthy older adults, reporting increased oxygenated hemoglobin (HbO2) levels during dual task walking (DT), compared with usual walking. OBJECTIVE To investigate the role of the frontal lobe during DT and obstacle negotiation, in healthy older adults and patients with Parkinson's disease (PD). METHODS Thirty-eight healthy older adults (mean age 70.4 ± 0.9 years) and 68 patients with PD (mean age 71.7 ± 1.1 years,) performed 3 walking tasks: (a) usual walking, (b) DT walking, and (c) obstacles negotiation, with fNIRS and accelerometers. Linear-mix models were used to detect changes between groups and within tasks. RESULTS Patients with PD had higher activation during usual walking (P < .030). During DT, HbO2 increased only in healthy older adults (P < .001). During obstacle negotiation, HbO2 increased in patients with PD (P = .001) and tended to increase in healthy older adults (P = .053). Higher DT and obstacle cost (P < .003) and worse cognitive performance were observed in patients with PD (P = .001). CONCLUSIONS A different pattern of frontal activation during walking was observed between groups. The higher activation during usual walking in patients with PD suggests that the prefrontal cortex plays an important role already during simple walking. However, higher activation relative to baseline during obstacle negotiation and not during DT in the patients with PD demonstrates that prefrontal activation depends on the nature of the task. These findings may have important implications for rehabilitation of gait in patients with PD.
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Affiliation(s)
- Inbal Maidan
- Neurological Institute, Tel Aviv Medical Center, Israel Rutgers Biomedical and Health Sciences, Newark, NJ, USA
| | - Freek Nieuwhof
- Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Miriam F Reelick
- Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands Radboud University Medical Center, Nijmegen, Netherlands
| | - Bas R Bloem
- Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands Radboud University Medical Center, Nijmegen, Netherlands
| | - Nir Giladi
- Neurological Institute, Tel Aviv Medical Center, Israel Tel Aviv University, Tel Aviv, Israel
| | | | - Jeffery M Hausdorff
- Neurological Institute, Tel Aviv Medical Center, Israel Tel Aviv University, Tel Aviv, Israel
| | - Jurgen A H Claassen
- Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands Radboud University Medical Center, Nijmegen, Netherlands
| | - Anat Mirelman
- Neurological Institute, Tel Aviv Medical Center, Israel Tel Aviv University, Tel Aviv, Israel
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47
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Sakari R, Rantakokko M, Portegijs E, Iwarsson S, Sipilä S, Viljanen A, Rantanen T. Do Associations Between Perceived Environmental and Individual Characteristics and Walking Limitations Depend on Lower Extremity Performance Level? J Aging Health 2016; 29:640-656. [DOI: 10.1177/0898264316641081] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: The aim of this study was to analyze whether the associations between perceived environmental and individual characteristics and perceived walking limitations in older people differ between those with intact and those with poorer lower extremity performance. Method: Persons aged 75 to 90 ( N = 834) participated in interviews and performance tests in their homes. Standard questionnaires were used to obtain walking difficulties; environmental barriers to and, facilitators of, mobility; and perceived individual hindrances to outdoor mobility. Lower extremity performance was tested using Short Physical Performance Battery (SPPB). Results: Among those with poorer lower extremity performance, the likelihood for advanced walking limitations was, in particular, related to perceived poor safety in the environment, and among those with intact performance to perceived social issues, such as lack of company, as well as to long distances. Discussion: The environmental correlates of walking limitations seem to depend on the level of lower extremity performance.
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48
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Hau C, Reid KF, Wong KF, Chin RJ, Botto TJ, Eliasziw M, Bermudez OI, Fielding RA. Collaborative Evaluation of the Healthy Habits Program: An Effective Community Intervention to Improve Mobility and Cognition of Chinese Older Adults Living in the U.S. J Nutr Health Aging 2016; 20:391-7. [PMID: 26999238 DOI: 10.1007/s12603-015-0623-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES There is a growing demand to reduce ethnic health disparities. The Healthy Habits Program (HHP) was implemented to provide a community-based physical activity and education intervention for Chinese older adults living in Boston, Massachusetts. This study evaluated the HHP by assessing outcomes that are critical for maintaining independence of older persons. DESIGN, SETTING AND PARTICIPANTS Quantitative evaluation was performed on 50 Chinese older adults enrolled in the HHP. The community members were trained in data collection and management. MEASUREMENTS Cognition (Mini Mental State Examination (MMSE), Trail Making Test and Complex Walking Task), mobility (Short Physical Performance Battery (SPPB) and maximal gait speed), depressive symptoms (Patient Health Questionnaire-9), perceived disability (World Health Organization Disability Assessment 2.0), nutritional status (Mini Nutrition Assessment®), and strength (grip and leg strength) were assessed at baseline and at 6 months. All tests were translated into Chinese. RESULTS Of the 50 participants (mean age 68.4 years; 68% female), 78% achieved the goal of performing exercise ≥3 times/week. After 6 months, clinically meaningful improvements were observed in mobility (mean SPPB score changed from 10.3 to 11.1 points; p=0.01) and cognition (mean MMSE score changed from 26.0 to 27.8 points; p=0.001). There were also statistically significant improvements in executive function, depressive symptoms and perceived disability (p<0.05). CONCLUSION Culturally sensitive community interventions, such as the HHP, are effective for improving mobility and cognition of Chinese older adults. This reveals the potential of promoting successful aging in minority populations through community settings, and should be advocated to reduce ethnic health disparities in the U.S.
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Affiliation(s)
- C Hau
- Roger A. Fielding, PhD, Nutrition, Exercise Physiology and Sarcopenia Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, 711 Washington Street, Boston, MA 02111, USA, Phone: +1-617-556-3016, Fax: +1-617-556-3083, E-mail:
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49
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van der Pas S, Schaap L, Castell M, Cooper C, Denkinger M, Edwards M, Herbolsheimer F, Maggi S, Sánchez-Martinez M, Pedersen N, Peter R, Zambon S, Wiegersma S, Dekker J, Dennison E, Deeg D. Availability and use of neighborhood resources by older people with osteoarthritis: Results from the European Project on OSteoArthritis. Health Place 2016; 37:1-7. [DOI: 10.1016/j.healthplace.2015.10.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 09/28/2015] [Accepted: 10/11/2015] [Indexed: 11/15/2022]
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50
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Smith AR, Chen C, Clarke P, Gallagher NA. Trajectories of Outdoor Mobility in Vulnerable Community-Dwelling Elderly: The Role of Individual and Environmental Factors. J Aging Health 2015; 28:796-811. [PMID: 26486782 DOI: 10.1177/0898264315611665] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Outdoor mobility is critical for healthy aging, yet little is known about the factors influencing mobility in the frail elderly. We investigated the role of individual and community risk factors on trajectories of mobility in a population of vulnerable community-dwelling elderly. METHOD Using data from 1,188 older adults in Detroit, MI, who qualify for federally funded home care, a latent class growth analysis was used to model the frequency of going outside over a 15-month period. RESULTS Four latent trajectories were found: those with a low, high, and declining frequency of going outdoors over time, and those who do not go outdoors on a regular basis. Risk factors for membership in the homebound and infrequent mobility groups were older age, more severe mobility impairment, and fear of falling. Barriers at the entry to the home were associated with being homebound. DISCUSSION Declining health status and functional limitations are risk factors that pose a threat to outdoor mobility in the frail elderly, while housing barriers and community accessibility also merit attention.
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