Lower-limb muscle strength, static and dynamic postural stabilities, risk of falling and fear of falling in polio survivors and healthy subjects

Measurement properties of the Falls Efficacy Scale-International (FES-I) in persons with late effects of polio: a cross-sectional study

BACKGROUND

Fear of falling (FoF) is very common in persons with late effects of polio (LEoP). An internationally recognized rating scale to assess FoF is the Falls Efficacy Scale-International (FES-I). Yet, there is limited knowledge about its measurement properties in persons with LEoP.

OBJECTIVE

To investigate the measurement properties of FES-I (16-item version) and short FES-I (7-item version) in persons with LEoP.

DESIGN

Explorative factor analysis and Rasch model analysis of cross-sectional data.

SETTING

University Hospital.

PARTICIPANTS

A total of 321 persons with LEoP (mean age 70 ± 10 years, 173 women).

MAIN OUTCOME MEASUREMENT

The FES-I and short FES-I, comprising four response options about concerns of falling ranging from 1 (not at all concerned) to 4 (very concerned).

METHODS

Data were collected by a postal survey. First, a factor analysis was performed to investigate unidimensionality of the scale. Thereafter, a Rasch model analysis was used to further analyze the measurement properties of FES-I and short FES-I, such as local dependency, targeting, hierarchical order of items, Differential Item Functioning (DIF), response category functioning and reliability (Person Separation Index, PSI). Raw score transformation to interval measurements was also performed.

RESULTS

The factor analysis revealed that FES-I was unidimensional, even though the Rasch analysis showed some misfit to the Rasch model and local dependency. Targeting for FES-I and short FES-I was somewhat suboptimal as the participants on average reported less FoF than expected. A negligible gender DIF was found for two items in FES-I and for one item in short FES-I. Reliability was high (PSI >0.86), and the response category thresholds worked as intended for both FES-I, and short FES-I.

CONCLUSION

The FES-I and the short FES-I have sufficient measurement properties in persons with LEoP. Both versions can be used to assess fear of falling in this population. This article is protected by copyright. All rights reserved.

Fall-Related Activity Avoidance among Persons with Late Effects of Polio and Its Influence on Daily Life: A Mixed-Methods Study

Falls are common among persons with late effects of polio (LEoP), which may lead to fear of falling and activity avoidance in everyday life. Here, we assessed the occurrence of fall-related activity avoidance among persons with LEoP and explored how these experiences influenced daily life. Fourteen ambulatory persons (seven women; mean age 70 years) with LEoP participated. They responded to the modified Survey of Activities and Fear of Falling in the Elderly (mSAFFE) and participated in individual interviews, which were analysed by systematic text condensation. Each quotation was deductively analysed from its representation with regard to mSAFFE. We found that many persons often avoided activities related to standing and walking, for example, taking a bath, performing household chores, walking outdoors, attending social events if there were stairs in the building and travelling by public transport, due to fear of falling, increased pain and fatigability. To facilitate the performance of daily activities participants expressed that strategic thinking and aids were important to use. In conclusion, fall-related activity avoidance is common in persons with LEoP, which negatively influence daily life and social participation. To increase daily functioning in this population, fall-related activity avoidance should be included in a multifaceted fall management program.

Microprocessor Controlled Knee Ankle Foot Orthosis (KAFO) vs Stance Control vs Locked KAFO: A Randomized Controlled Trial

OBJECTIVE

To evaluate the potential of a microprocessor swing and stance controlled knee-ankle-foot orthosis (MPO) to improve balance, functional mobility, and quality of life in individuals with lower-extremity impairments as compared to a stance-control-orthosis (SCO) and conventional knee-ankle-foot orthosis (KAFO) over a use-period of a month.

DESIGN

Randomized crossover study.

SETTING

Ambulatory research laboratory and home and community for community-dwelling adults.

PARTICIPANTS

Persons (N=18) who actively used a unilateral KAFO or SCO for impairments due to neurologic or neuromuscular disease, orthopedic disease, or trauma.

INTERVENTION

Participants were trained to acclimate and use SCO and MPO.

MAIN OUTCOME MEASURES

The 6-minute walk test (6MWT), 10-m walk test, Berg Balance Scale (BBS), functional gait assessment (FGA), hill assessment index, stair assessment index (SAI), Five Times Sit to Stand Test, crosswalk test, Modified Falls Efficacy Scale, Orthotic and Prosthetic User's Survey (OPUS), and World Health Organization Quality of Life (WHQOL)-BREF Scale.

RESULTS

Significant changes were observed in participants' self-selected gait speed (P=.023), BBS (P=.01), FGA (P=.002), and SAI (P<.001) between baseline and post-MPO assessment. Similar significant differences were seen when comparing post-MPO with post-SCO data. During the 6MWT, persons using the MPO walked significantly longer (P=.013) than when using their baseline device. Participants reported higher quality of life scores in the OPUS (P=.02) and physical health domain of the WHOQOL-BREF (P=.037) after using the MPO. Participants reported fewer falls when wearing the MPO (5) versus an SCO (38) or locked KAFO (15).

CONCLUSIONS

The MPO may contribute to improved quality of life and health status of persons with lower-extremity impairments by providing the ability to have better walking speed, endurance, and functional balance.

Postural Control Adaptation and Habituation During Vibratory Proprioceptive Stimulation: An HD-EEG Investigation of Cortical Recruitment and Kinematics

The objective of the present work is to measure postural kinematics and power spectral variation from HD-EEG to assess changes in cortical activity during adaptation and habituation to postural perturbation. To evoke proprioceptive postural perturbation, vibratory stimulation at 85 Hz was applied to the calf muscles of 33 subjects over four 75-second stimulation periods. Stimulation was performed according to a pseudorandom binary sequence. Vibratory impulses were synchronized to high-density electroencephalography (HD-EEG, 256 channels). Changes in absolute spectral power (ASP) were analyzed over four frequency bands ( ∆ : 0.5-3.5 Hz; θ : 3.5-7.5 Hz; α : 7.5-12.5 Hz; β : 12.5-30 Hz). A force platform recorded torque actuated by the feet, and normalized sway path length (SPL) was computed as a construct for postural performance during each period. SPL values indicated improvement in postural performance over the trial periods. Significant variation in absolute power values (ASP) was found in assessing postural adaptation: an increase in θ band ASP in the frontal-central region for closed-eyes trials, an increase in θ and β band ASP in the parietal region for open-eyes trials. In habituation, no significant variations in ASP were observed during closed-eyes trials, whereas an increase in θ , α , and β band ASP was observed with open eyes. Furthermore, open-eyed trials generally yielded a greater number of significant ASP differences across all bands during both adaptation and habituation, suggesting that following cortical activity during postural perturbation may be up-regulated with the availability of visual feedback. These results altogether provide deeper insight into pathological postural control failure by exploring the dynamic changes in both cortical activity and postural kinematics during adaptation and habituation to proprioceptive postural perturbation.