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Ringsten M, Ivanic B, Iwarsson S, Lexell EM. Interventions to improve outdoor mobility among people living with disabilities: A systematic review. CAMPBELL SYSTEMATIC REVIEWS 2024; 20:e1407. [PMID: 38882933 PMCID: PMC11177337 DOI: 10.1002/cl2.1407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 03/28/2024] [Accepted: 04/03/2024] [Indexed: 06/18/2024]
Abstract
Background Around 15% of the global population live with some form of disabilities and experience worse health outcomes, less participation in the community and are part of fewer activities outside the home. Outdoor mobility interventions aim to improve the ability to move, travel and orient outside the home and could influence the number of activities outside the home, participation and quality of life. However, outdoor mobility interventions may also lead to harm like falls or injuries or have unforeseen effects which could lead to mortality or hospitalization. Objectives To assess the efficacy of interventions aiming to improve outdoor mobility for adults living with disabilities and to explore if the efficacy varies between different conditions and different intervention components. Search Methods Standard, extensive Campbell search methods were used, including a total of 12 databases searched during January 2023, including trial registries. Selection Criteria Only randomized controlled trials were included, focusing on people living with disabilities, comparing interventions to improve outdoor mobility to control interventions as well as comparing different types of interventions to improve outdoor mobility. Data Collection and Analysis Standard methodological procedures expected by Campbell were used. The following important outcomes were 1. Activity outside the home; 2. Engagement in everyday life activities; 3. Participation; 4. Health-related Quality of Life; 5. Major harms; 6. Minor harms. The impact of the interventions was evaluated in the shorter (≤6 months) and longer term (≥7 months) after starting the intervention. Results are presented using risk ratios (RR), risk difference (RD), and standardized mean differences (SMD), with the associated confidence intervals (CI). The risk of bias 2-tool and the GRADE-framework were used to assess the certainty of the evidence. Main Results The screening comprised of 12.894 studies and included 22 studies involving 2.675 people living with disabilities and identified 12 ongoing studies. All reported outcomes except one (reported in one study, some concerns of bias) had overall high risk of bias. Thirteen studies were conducted in participants with disabilities due to stroke, five studies with older adults living with disabilities, two studies with wheelchair users, one study in participants with disabilities after a hip fracture, and one study in participants with cognitive impairments. Skill training interventions versus control interventions (16 studies) The evidence is very uncertain about the benefits and harms of skill training interventions versus control interventions not aimed to improve outdoor mobility among all people living with disabilities both in the shorter term (≤6 months) and longer term (≥7 months) for Activity outside the home; Participation; Health-related Quality of Life; Major harms; and Minor harms, based on very low certainty evidence. Skill training interventions may improve engagement in everyday life activities among people with disabilities in the shorter term (RR: 1.46; 95% CI: 1.16 to 1.84; I 2 = 7%; RD: 0.15; 95% CI: -0.02 to 0.32; I 2 = 71%; 692 participants; three studies; low certainty evidence), but the evidence is very uncertain in the longer term, based on very low certainty evidence. Subgroup analysis of skill training interventions among people living with disabilities due to cognitive impairments suggests that such interventions may improve activity outside the home in the shorter term (SMD: 0.44; 95% CI: 0.07 to 0.81; I 2 = NA; 118 participants; one study; low certainty evidence). Subgroup analysis of skill training interventions among people living with cognitive impairments suggests that such interventions may improve health-related quality of life in the shorter term (SMD: 0.49; 95% CI: 0.12 to 0.88; I 2 = NA; 118 participants; one study; low certainty evidence). Physical training interventions versus control interventions (five studies) The evidence is very uncertain about the benefits and harms of physical training interventions versus control interventions not aimed to improve outdoor mobility in the shorter term (≤6 months) and longer term (≥7 months) for: Engagement in everyday life activities; Participation; Health-related Quality of Life; Major harms; and Minor harms, based on very low certainty evidence. Physical training interventions may improve activity outside the home in the shorter (SMD: 0.35; 95% CI: 0.08 to 0.61; I 2 = NA; 228 participants; one study; low certainty evidence) and longer term (≥7 months) (SMD: 0.27; 95% CI: 0.00 to 0.54; I 2 = NA; 216 participants; one study; low certainty evidence). Comparison of different outdoor mobility interventions (one study) The evidence is very uncertain about the benefits and harms of outdoor mobility interventions of different lengths in the shorter term (≤6 months) and longer term (≥7 months) for Activity outside the home; Engagement in everyday life activities; Participation; Health-related Quality of Life; Major harms; and Minor harms, based on very low certainty evidence. No studies explored the efficacy of other types of interventions. Authors’ Conclusions Twenty-two studies of interventions to improve outdoor mobility for people living with disabilities were identified, but the evidence still remains uncertain about most benefits and harms of these interventions, both in the short- and long term. This is primarily related to risk of bias, small underpowered studies and limited reporting of important outcomes for people living with disabilities. For people with disabilities, skill training interventions may improve engagement in everyday life in the short term, and improve activity outside the home and health-related quality of life for people with cognitive impairments in the short term. Still, this is based on low certainty evidence from few studies and should be interpreted with caution. One study with low certainty evidence suggests that physical training interventions may improve activity outside the home in the short term. In addition, the effect sizes across all outcomes were considered small or trivial, and could be of limited relevance to people living with disabilities. The evidence is currently uncertain if there are interventions that can improve outdoor mobility for people with disabilities, and can improve other important outcomes, while avoiding harms. To guide decisions about the use of interventions to improve outdoor mobility, future studies should use more rigorous design and report important outcomes for people with disabilities to reduce the current uncertainty.
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Affiliation(s)
- Martin Ringsten
- Cochrane Sweden, Research and Development Skåne University Hospital Lund Sweden
- Department of Health Sciences Lund University Lund Sweden
| | | | | | - Eva Månsson Lexell
- Department of Health Sciences Lund University Lund Sweden
- Department of Neurology, Rehabilitation Medicine, Cognitive Medicine and Geriatrics Skåne University Hospital Lund-Malmö Sweden
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Kawasaki T, Ohira M, Endo R, Muto K, Sakai H, Goto K. Changes in the higher-level functional capacities for modern daily living in community-dwelling stroke survivors: A preliminary case series. Front Neurol 2022; 13:948494. [PMID: 36341119 PMCID: PMC9627274 DOI: 10.3389/fneur.2022.948494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 10/06/2022] [Indexed: 11/13/2022] Open
Abstract
Along with the development of modern technology, the variety of higher-level activities of daily living has steadily expanded. However, no reports have examined the capacities for the higher-level activities in stroke survivors. Moreover, the relationship between these capacities and executive functions has not been reported. This preliminary study longitudinally measured changes in the capacities for high-level activities of modern daily living in community-dwelling stroke survivors. In addition, we examined whether changes in these capacities were correlated with executive functions. The results showed no significant reduction in the capacities for high-level activities of modern daily living at 1 year after stroke. Significant improvements were observed in one aspect of executive functions: planning. The changes in the capacities for higher-level activities of modern daily living were significantly correlated with executive function. The results suggest that, in stroke survivors, (a) it is likely feasible to maintain the capacities for higher-level activities of modern daily living, and (b) these capacities are related to executive functions.
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Affiliation(s)
- Tsubasa Kawasaki
- Department of Physical Therapy, School of Health Sciences, Tokyo International University, Kawagoe, Saitama, Japan
- *Correspondence: Tsubasa Kawasaki
| | - Masahiro Ohira
- Department of Rehabilitation, Faculty of Health Sciences, Uekusa Gakuen University, Chiba, Japan
| | - Ryu Endo
- Department of Rehabilitation, Yokohama Shin-midori General Hospital, Yokohama, Kanagawa, Japan
| | - Keita Muto
- Department of Rehabilitation, Yokohama Shin-midori General Hospital, Yokohama, Kanagawa, Japan
| | - Hiroki Sakai
- Department of Rehabilitation, Yokohama Shin-midori General Hospital, Yokohama, Kanagawa, Japan
| | - Keisuke Goto
- Department of Rehabilitation, Tokyo Women's Medical University Adachi Medical Center, Tokyo, Japan
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Chen YJ, Li XX, Pan B, Wang B, Jing GZ, Liu QQ, Li YF, Bing ZT, Yang KH, Han XM, Ge L. Non-pharmacological interventions for older adults with depressive symptoms: a network meta-analysis of 35 randomized controlled trials. Aging Ment Health 2021; 25:773-786. [PMID: 31880174 DOI: 10.1080/13607863.2019.1704219] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: To assess the effectiveness of non-pharmacological interventions for seniors with depressive symptoms.Methods: A comprehensive literature search was performed. We conducted network meta-analysis in two ways, intervention classes (psychosocial, psychotherapy, physical activity, combined, treatment as usual) and individual intervention (11 categories). Whenever included studies used different scales, the different instruments were converted to the units of the scale most frequently used (the Geriatric Depression Scale), such that the effect size was reported as a mean difference (MD) with 95% confidence interval (CI). The risk of bias of RCTs included in this review was assessed according to the Cochrane Handbook. Bayesian NMA was conducted using R-3.4.0 software.Results: A total of 35 RCTs with 3,797 enrolled patients were included. Compared to conventional treatment, physical activity and psychotherapy resulted in significant improvements in depressive symptoms (MD: 2.25, 95%CrI: 0.99-3.56; SUCRA = 86.07%; MD: 1.75, 95% CrI: 0.90-2.64; SUCRA = 66.44%, respectively). Similar results were obtained for music (MD: 2.6; 95% CrI: 0.84-4.35;SUCRA = 80.53%), life review (MD:1.92; 95% CrI:0.71-3.14; SUCRA = 65.62%), cognitive behavioral therapy (MD: 1.27; 95% CrI: 0.23-2.38; SUCRA = 45.4%), aerobic (MD: 1.84; 95% CrI: 0.39-3.36; SUCRA = 63%) and resistance training (MD: 1.72; 95% CrI: 0.06-3.42; SUCRA = 59.24%). Network meta-regression showed that there were no statistically significant subgroup effects.Conclusions: Physical activity and psychotherapy demonstrated statistically significant superiority over conventional treatment. Music and life review therapy proved the most promising individual interventions. However, conclusions are limited by the lack of sufficient sample size and consensus regarding intervention categories and so an adequately powered study is necessary to consolidate these findings.
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Affiliation(s)
- Ya-Jing Chen
- Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, China.,Evidence-Based Social Science Center, Lanzhou University, Lanzhou Gansu, China
| | - Xiu-Xia Li
- Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, China.,Evidence-Based Social Science Center, Lanzhou University, Lanzhou Gansu, China
| | - Bei Pan
- Gansu Provincial Hospital, Lanzhou, China
| | - Bangwei- Wang
- The First Clinical Medical College, Lanzhou University, Lanzhou, China
| | - Guang-Zhuang Jing
- Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, China
| | - Qian-Qian Liu
- Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, China
| | - Yan-Fei Li
- Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, China.,Evidence-Based Social Science Center, Lanzhou University, Lanzhou Gansu, China
| | - Zhi-Tong Bing
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.,Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Ke-Hu Yang
- Evidence-Based Social Science Center, Lanzhou University, Lanzhou Gansu, China.,Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.,Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Xue-Mei Han
- Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, China.,Evidence-Based Social Science Center, Lanzhou University, Lanzhou Gansu, China
| | - Long Ge
- Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, China.,Evidence-Based Social Science Center, Lanzhou University, Lanzhou Gansu, China
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Moore A, Motagh S, Sadeghirad B, Begum H, Riva JJ, Gaber J, Dolovich L. Volunteer Impact on Health-Related Outcomes for Seniors: a Systematic Review And Meta-Analysis. Can Geriatr J 2021; 24:44-72. [PMID: 33680263 PMCID: PMC7904324 DOI: 10.5770/cgj.24.434] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Volunteers are increasingly promoted to improve health-related outcomes for community-dwelling elderly without synthesized evidence for effectiveness. This systematic review and meta-analysis evaluates the effects of unpaid volunteer interventions on health-related outcomes for such seniors. METHODS MEDLINE, EMBASE and Cochrane (CENTRAL) were searched up to November 2018. We included English language, randomized trials. Two reviewers independently identified studies, extracted data, and assessed evidence certainty (using GRADE). Meta-analysis used random-effects models. Univariate meta-regressions investigated the relationship between volunteer intervention effects and trial participant age, percentage females, and risk of bias. RESULTS 28 included studies focussed on seniors with a variety of chronic conditions (e.g., dementia, diabetes) and health states (e.g., frail, palliative). Volunteers provided a range of roles (e.g., counsellors, educators and coaches). Low certainty evidence found that volunteers may improve both physical function (MD = 3.2 points on the 100-point SF-36 physical component score [PCS]; 95% CI: 1.09, 5.27) and physical activity levels (SMD = 0.5, 95% CI: 0.14 to 0.83). Adverse events were not increased. CONCLUSION Volunteers may increase physical activity levels and subjective ratings of physical function for seniors without apparent harm. These findings support the WHO call to action on evidence-based policies to align health systems in support of older adults.
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Affiliation(s)
- Ainsley Moore
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Shahrzad Motagh
- The Michael G. DeGroote Institute of Pain Research and Care, McMaster University, Hamilton, ON, Canada
| | - Behnam Sadeghirad
- The Michael G. DeGroote Institute of Pain Research and Care, McMaster University, Hamilton, ON, Canada
| | - Housne Begum
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - John J. Riva
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
- Health Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Jessica Gaber
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Lisa Dolovich
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
- Health Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
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Goehner A, Kricheldorff C, Bitzer EM. Trained volunteers to support chronically ill, multimorbid elderly between hospital and domesticity - a systematic review of one-on-one-intervention types, effects, and underlying training concepts. BMC Geriatr 2019; 19:126. [PMID: 31046693 PMCID: PMC6498473 DOI: 10.1186/s12877-019-1130-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 04/05/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND New approaches are needed to address the challenges of demographic change, staff shortages, and societal change in the care of the elderly. While volunteering has barely been established as a pillar of the welfare state in several countries, legislators and nonprofit or community-based organizations in some countries favor the increased integration of volunteers, as they can rely on many dedicated people. When caring for the multimorbid elderly, the transition from hospital to domesticity involves certain risks. Currently, no systematic knowledge exists on whether and how elderly benefit from volunteer support after a hospital stay. Objectives of this systematic review were to (1) identify evaluated approaches with trained volunteers supporting chronically ill, multimorbid elderly one-on-one at the interface between hospital and domesticity; (2) investigate the patient-related effectiveness of the approaches; (3) present the characteristics of the supporting volunteers; and (4) present the underlying teaching and training concepts for the volunteers. METHODS A systematic search of the following online databases was conducted in April 2017: the Cochrane Library, Medline (PubMed), CINAHL, and PsycINFO (Ebscohost). We included (cluster/quasi-) randomized controlled trials, controlled clinical trials and single-group pre-post design. An institutional search was conducted on eight national institutions from research and practice in Germany. Screening was conducted by one researcher, risk of bias was assessed. Study authors were contacted for study and training details. RESULTS We identified a total of twelve studies, eight of which evaluated treatment following hospital stay: psychosocial-coordinative support (n = 2), physical-cognitive activation (n = 4), and assistance with medication intake (n = 2). We saw short-term effects with small and medium effect sizes. Most volunteers were women aged between 45 and 61 years. Their training lasted 12-26 h and took place prior to first patient contact. During the intervention, volunteers could rely on permanent supporting structures. CONCLUSIONS Few studies exist that have evaluated one-on-one-volunteer support following hospitalization, and the effects are inconsistent. As such, further, well-designed studies are needed. The suitability and transferability of the interventions in country-specific settings should be examined in feasibility studies. Furthermore, an international discussion on the appropriate theoretical backgrounds of volunteer training is needed.
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Affiliation(s)
- Anne Goehner
- Center for Geriatric Medicine and Gerontology Freiburg, Medical Center, Faculty of Medicine, University of Freiburg, Lehener Str. 88, 79106 Freiburg, Germany
- University of Education Freiburg, Public Health & Health Education, Kunzenweg 21, 79117 Freiburg, Germany
| | - Cornelia Kricheldorff
- Catholic University of Applied Sciences Freiburg, Karlstr. 63, 79104 Freiburg, Germany
| | - Eva Maria Bitzer
- University of Education Freiburg, Public Health & Health Education, Kunzenweg 21, 79117 Freiburg, Germany
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Rantanen T, Pynnönen K, Saajanaho M, Siltanen S, Karavirta L, Kokko K, Karvonen A, Kauppinen M, Rantalainen T, Rantakokko M, Portegijs E, Hassandra M. Individualized counselling for active aging: protocol of a single-blinded, randomized controlled trial among older people (the AGNES intervention study). BMC Geriatr 2019; 19:5. [PMID: 30616537 PMCID: PMC6323746 DOI: 10.1186/s12877-018-1012-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 12/11/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Active aging has been established as a policy goal for aging societies. We define active aging at the individual level as striving for elements of well-being through activities in relation to a person's goals, functional capacities and opportunities. Increasing evidence suggests that any meaningful activity is beneficial for different aspects of well-being in older people. The aim of the present randomized controlled trial is to test the feasibility and effectiveness of a one-year community-based intervention on active aging. The AGNES intervention aims at increasing older peoples' participation in self-selected valued activities. METHODS The proposed study is a two-arm single-blinded randomized controlled trial. The intervention group receives individually tailored counselling for an active life (one face-to-face session, four phone calls and supportive written material) and the control group written general health information only. Two hundred older adults aged 75- and 80- year old, with intermediate mobility function and without cognitive impairment, living independently in the municipality of Jyväskylä, Finland, are recruited and randomized with a 1:1 allocation to the intervention and control group. Randomization is computer-generated stratified by sex and age. The primary outcome is active aging and secondary outcomes are well-being, depressive symptoms, quality of life, personal goals, mobility and physical activity. Measures are administered at pre-trial, mid-trial (at 6 months) and post-trial (12 months after baseline). DISCUSSION The AGNES intervention study will provide new knowledge on the effects of individualized counselling on active aging and the potential of older people to promote their own well-being. TRIAL REGISTRATION The trial is registered at ISRCTN - ISRCTN16172390 : Promoting well-being through active aging.
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Affiliation(s)
- Taina Rantanen
- Gerontology Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, P.O. Box 35 (L335), 40014 Jyväskylä, Finland
| | - Katja Pynnönen
- Gerontology Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, P.O. Box 35 (L335), 40014 Jyväskylä, Finland
| | - Milla Saajanaho
- Gerontology Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, P.O. Box 35 (L335), 40014 Jyväskylä, Finland
| | - Sini Siltanen
- Gerontology Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, P.O. Box 35 (L335), 40014 Jyväskylä, Finland
| | - Laura Karavirta
- Gerontology Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, P.O. Box 35 (L335), 40014 Jyväskylä, Finland
| | - Katja Kokko
- Gerontology Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, P.O. Box 35 (L335), 40014 Jyväskylä, Finland
| | - Anu Karvonen
- Gerontology Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, P.O. Box 35 (L335), 40014 Jyväskylä, Finland
| | - Markku Kauppinen
- Gerontology Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, P.O. Box 35 (L335), 40014 Jyväskylä, Finland
| | - Timo Rantalainen
- Gerontology Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, P.O. Box 35 (L335), 40014 Jyväskylä, Finland
| | - Merja Rantakokko
- Gerontology Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, P.O. Box 35 (L335), 40014 Jyväskylä, Finland
| | - Erja Portegijs
- Gerontology Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, P.O. Box 35 (L335), 40014 Jyväskylä, Finland
| | - Mary Hassandra
- Gerontology Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, P.O. Box 35 (L335), 40014 Jyväskylä, Finland
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The interrelationship between balance, Tai Chi and depression in Latino older adults. Aging Clin Exp Res 2017; 29:395-401. [PMID: 27318946 DOI: 10.1007/s40520-016-0593-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 05/19/2016] [Indexed: 10/21/2022]
Abstract
Falls and associated injuries are the most serious medical problem affecting the functional independence among both White non-Hispanics and Latino older adults. Studies have shown the effectiveness of Tai Chi exercise in reducing falls but have primarily focused on White non-Hispanic older adults. There is limited research that examines the effectiveness of this exercise on balance among different racial/ethnic minority older adults. This study focused on the interrelationship between functional status (balance performance) and psychosocial status (depression) before and after a 12-week Tai Chi program among Latinos in a Midwestern metropolitan city. Results indicated that at baseline, prior to the start of the Tai Chi program, participants who were more depressed had poorer functional status. Participants who had higher depression at baseline, experienced greater improvement in functional status, following the 12-week Tai Chi exercise program, compared with those who had lower levels of depression.
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