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Choudhury R, Park JH, Banarjee C, Coca MG, Fukuda DH, Xie R, Stout JR, Thiamwong L. Associations between monitor-independent movement summary (MIMS) and fall risk appraisal combining fear of falling and physiological fall risk in community-dwelling older adults. FRONTIERS IN AGING 2024; 5:1284694. [PMID: 38660534 PMCID: PMC11040232 DOI: 10.3389/fragi.2024.1284694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 03/20/2024] [Indexed: 04/26/2024]
Abstract
Introduction: Fall Risk Appraisal (FRA), a process that integrates perceived and objective fall risk measures, serves as a crucial component for understanding the incongruence between fear of falling (FOF) and physiological fall risk in older adults. Despite its importance, scant research has been undertaken to investigate how habitual physical activity (PA) levels, quantified in Monitor-Independent Movement Summary (MIMS), vary across FRA categories. MIMS is a device-independent acceleration summary metric that helps standardize data analysis across studies by accounting for discrepancies in raw data among research-grade and consumer devices. Objective: This cross-sectional study explores the associations between MIMS (volume and intensity) and FRA in a sample of older adults in the United States. Methods: We assessed FOF (Short Falls Efficacy Scale-International), physiological fall risk (balance: BTrackS Balance, leg strength: 30-s sit-to-stand test) and 7-day free-living PA (ActiGraph GT9X) in 178 community-dwelling older adults. PA volume was summarized as average daily MIMS (MIMS/day). PA intensity was calculated as peak 30-min MIMS (average of highest 30 non-consecutive MIMS minutes/day), representing a PA index of higher-intensity epochs. FRA categorized participants into following four groups: Rational (low FOF-low physiological fall risk), Irrational (high FOF-low physiological fall risk), Incongruent (low FOF-high physiological fall risk) and Congruent (high FOF-high physiological fall risk). Results: Compared to rational group, average MIMS/day and peak 30-min MIMS were, respectively, 15.8% (p = .025) and 14.0% (p = .004) lower in irrational group, and 16.6% (p = .013) and 17.5% (p < .001) lower in congruent group. No significant differences were detected between incongruent and rational groups. Multiple regression analyses showed that, after adjusting for age, gender, and BMI (reference: rational), only irrational FRA was significantly associated with lower PA volume (β = -1,452.8 MIMS/day, p = .034); whereas irrational and congruent FRAs were significantly associated with lower "peak PA intensity" (irrational: β = -5.40 MIMS/day, p = .007; congruent: β = -5.43 MIMS/day, p = .004). Conclusion: These findings highlight that FOF is a significant barrier for older adults to participate in high-intensity PA, regardless of their balance and strength. Therefore, PA programs for older adults should develop tailored intervention strategies (cognitive reframing, balance and strength exercises, or both) based on an individual's FOF and physiological fall risk.
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Affiliation(s)
- Renoa Choudhury
- Department of Mechanical Engineering, University of Central Florida, Orlando, FL, United States
| | - Joon-Hyuk Park
- Department of Mechanical Engineering, University of Central Florida, Orlando, FL, United States
- Disability, Aging and Technology Cluster, University of Central Florida, Orlando, FL, United States
| | - Chitra Banarjee
- College of Medicine, University of Central Florida, Orlando, FL, United States
| | - Miguel Grisales Coca
- Department of Mechanical Engineering, University of Central Florida, Orlando, FL, United States
| | - David H. Fukuda
- School of Kinesiology and Rehabilitation Sciences, College of Health Professions and Sciences, University of Central Florida, Orlando, FL, United States
| | - Rui Xie
- Department of Statistics and Data Science, University of Central Florida, Orlando, FL, United States
- College of Nursing, University of Central Florida, Orlando, FL, United States
| | - Jeffrey R. Stout
- Disability, Aging and Technology Cluster, University of Central Florida, Orlando, FL, United States
- School of Kinesiology and Rehabilitation Sciences, College of Health Professions and Sciences, University of Central Florida, Orlando, FL, United States
| | - Ladda Thiamwong
- Disability, Aging and Technology Cluster, University of Central Florida, Orlando, FL, United States
- College of Nursing, University of Central Florida, Orlando, FL, United States
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Leinert C, Fotteler M, Kocar TD, Dallmeier D, Kestler HA, Wolf D, Gebhard F, Uihlein A, Steger F, Kilian R, Mueller-Stierlin AS, Michalski CW, Mihaljevic A, Bolenz C, Zengerling F, Leinert E, Schütze S, Hoffmann TK, Onder G, Andersen-Ranberg K, O’Neill D, Wehling M, Schobel J, Swoboda W, Denkinger M. Supporting SURgery with GEriatric Co-Management and AI (SURGE-Ahead): A study protocol for the development of a digital geriatrician. PLoS One 2023; 18:e0287230. [PMID: 37327245 PMCID: PMC10275448 DOI: 10.1371/journal.pone.0287230] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 05/22/2023] [Indexed: 06/18/2023] Open
Abstract
INTRODUCTION Geriatric co-management is known to improve treatment of older adults in various clinical settings, however, widespread application of the concept is limited due to restricted resources. Digitalization may offer options to overcome these shortages by providing structured, relevant information and decision support tools for medical professionals. We present the SURGE-Ahead project (Supporting SURgery with GEriatric co-management and Artificial Intelligence) addressing this challenge. METHODS A digital application with a dashboard-style user interface will be developed, displaying 1) evidence-based recommendations for geriatric co-management and 2) artificial intelligence-enhanced suggestions for continuity of care (COC) decisions. The development and implementation of the SURGE-Ahead application (SAA) will follow the Medical research council framework for complex medical interventions. In the development phase a minimum geriatric data set (MGDS) will be defined that combines parametrized information from the hospital information system with a concise assessment battery and sensor data. Two literature reviews will be conducted to create an evidence base for co-management and COC suggestions that will be used to display guideline-compliant recommendations. Principles of machine learning will be used for further data processing and COC proposals for the postoperative course. In an observational and AI-development study, data will be collected in three surgical departments of a University Hospital (trauma surgery, general and visceral surgery, urology) for AI-training, feasibility testing of the MGDS and identification of co-management needs. Usability will be tested in a workshop with potential users. During a subsequent project phase, the SAA will be tested and evaluated in clinical routine, allowing its further improvement through an iterative process. DISCUSSION The outline offers insights into a novel and comprehensive project that combines geriatric co-management with digital support tools to improve inpatient surgical care and continuity of care of older adults. TRIAL REGISTRATION German clinical trials registry (Deutsches Register für klinische Studien, DRKS00030684), registered on 21st November 2022.
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Affiliation(s)
- Christoph Leinert
- Institute for Geriatric Research at AGAPLESION Bethesda Ulm, Ulm University Medical Center, Ulm, Germany
- Geriatric Center Ulm, Ulm, Germany
| | - Marina Fotteler
- Institute for Geriatric Research at AGAPLESION Bethesda Ulm, Ulm University Medical Center, Ulm, Germany
- Geriatric Center Ulm, Ulm, Germany
- DigiHealth Institute, Neu-Ulm University of Applied Sciences, Neu-Ulm, Germany
| | - Thomas Derya Kocar
- Institute for Geriatric Research at AGAPLESION Bethesda Ulm, Ulm University Medical Center, Ulm, Germany
- Geriatric Center Ulm, Ulm, Germany
| | - Dhayana Dallmeier
- Institute for Geriatric Research at AGAPLESION Bethesda Ulm, Ulm University Medical Center, Ulm, Germany
- Geriatric Center Ulm, Ulm, Germany
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States of America
| | - Hans A. Kestler
- Institute for Medical Systems Biology, Ulm University, Ulm, Germany
| | - Dennis Wolf
- Institute for Medical Systems Biology, Ulm University, Ulm, Germany
| | - Florian Gebhard
- Department for Orthopedic Trauma, Ulm University Medical Center, Ulm, Germany
| | - Adriane Uihlein
- Department for Orthopedic Trauma, Ulm University Medical Center, Ulm, Germany
| | - Florian Steger
- Institute of the History, Philosophy and Ethics of Medicine, Ulm University, Ulm, Germany
| | - Reinhold Kilian
- Department of Psychiatry and Psychiatry II, Section of Health Economics and Health Services Research, Ulm University, Guenzburg, Germany
| | - Annabel S. Mueller-Stierlin
- Department of Psychiatry and Psychiatry II, Section of Health Economics and Health Services Research, Ulm University, Guenzburg, Germany
- Institute for Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | | | - André Mihaljevic
- Department of General and Visceral Surgery, Ulm University Hospital, Ulm, Germany
| | | | | | - Elena Leinert
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Sabine Schütze
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Thomas K. Hoffmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Hospital, Ulm, Germany
| | - Graziano Onder
- Department of Cardiovascular, Endocrine-metabolic Diseases and Aging, Instituto Superiore di Sanità, Rome, Italy
| | - Karen Andersen-Ranberg
- Geriatric Research Unit, Department of Clinical Research, Faculty of Health, University of Southern Denmark, Odense, Denmark
| | - Desmond O’Neill
- Centre for Ageing, Neuroscience and the Humanities, Trinity College Dublin, Dublin, Ireland
| | - Martin Wehling
- Working Group FORTA, Faculty of Medicine Mannheim, Ruprecht-Karls-University of Heidelberg, Mannheim, Germany
| | - Johannes Schobel
- DigiHealth Institute, Neu-Ulm University of Applied Sciences, Neu-Ulm, Germany
| | - Walter Swoboda
- DigiHealth Institute, Neu-Ulm University of Applied Sciences, Neu-Ulm, Germany
| | - Michael Denkinger
- Institute for Geriatric Research at AGAPLESION Bethesda Ulm, Ulm University Medical Center, Ulm, Germany
- Geriatric Center Ulm, Ulm, Germany
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Mejía ST, Su TT, Washington FC, Golinski S, Sosnoff JJ. Everyday Experiences of Physical Function and Awareness of Fall Risk in Older Adulthood. Innov Aging 2023; 7:igad037. [PMID: 37273259 PMCID: PMC10237285 DOI: 10.1093/geroni/igad037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Indexed: 06/06/2023] Open
Abstract
Background and Objectives Falls, the leading cause of death and disability among older adults, occur in daily life when the demands of daily activities surpass the ability to maintain balance. An estimated 30% of older adults misestimate their physical function, placing them at greater risk of falling. This study examined how experiences of physical function are linked to awareness of fall risk in daily life. Research Design and Methods For 30 consecutive days following a fall-risk assessment, 41 older adults (observations = 1,135; 56% women; age: 65-91) self-assessed objective and subjective fall risk using a custom smartphone application. Alignment of objective and subjective fall risk was indexed as awareness of fall risk. Postural sway was measured by the application. Physical and mobility symptoms and fear of falling were reported daily. Results At baseline, 49% of participants misestimated their fall risk. Awareness of fall risk varied from day to day and fall risk was misestimated on 40% of days. Multilevel multinomial models showed individual differences in the level of daily symptoms to increase the tendency to misestimate fall risk. Daily symptoms and fear of falling increased awareness of high fall risk, but daily symptoms threatened awareness of low fall risk. Discussion and Implications Findings suggest that misestimation of fall risk is common in older adulthood and informed by appraisals of physical function. Fall prevention strategies could support older adults in understanding their everyday physical function and provide tools to adjust the demands of activities in daily life.
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Affiliation(s)
- Shannon T Mejía
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois Urbana-Champaign, Champaign, Illinois, USA
| | - Tai-Te Su
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois Urbana-Champaign, Champaign, Illinois, USA
| | - Faith C Washington
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois Urbana-Champaign, Champaign, Illinois, USA
| | - Sean Golinski
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois Urbana-Champaign, Champaign, Illinois, USA
| | - Jacob J Sosnoff
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, School of Health Professions, Landon Center on Aging, University of Kansas Medical Center, Kansas City, Kansas, USA
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Hewage K, Fosker S, Leckie T, Venn R, Gonçalves AC, Koulouglioti C, Hodgson LE. The Hospital to Home study (H2H): smartwatch technology-enabled rehabilitation following hip fracture in older adults, a feasibility non-randomised trial. Future Healthc J 2023; 10:14-20. [PMID: 37786494 PMCID: PMC10538690 DOI: 10.7861/fhj.2022-0101] [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: 04/03/2023]
Abstract
Introduction Hip fractures are associated with significant morbidity and mortality. This study assessed the feasibility of smartwatches supporting rehabilitation post-surgical fixation. Methods This UK-based non-randomised intervention study recruited patients who had sustained a hip fracture (age ≥65 and Abbreviated Mental Test Score ≥8/10), following surgical fixation, at one hospital to the intervention group, and at a second hospital to a usual care group. The intervention group received a smartwatch (Fitbit Charge 4) and app (CUSH Health©). Feasibility measures included retention and completion of outcome measures. Results Between November 2020 and November 21, 66 participants were recruited (median age 78 (IQR 74-84)). The intervention cohort were younger, with no significant differences in frailty or multi-morbidity between the cohorts. Hospital stay was shorter in the intervention cohort (10 days (7-16) versus 12 (10-18), p=0.05). There were 15 falls-related readmissions in the control cohort, including 11 fractures, with none in the intervention cohort (p=0.016). In the intervention group, median daily step counts increased from 477 (320-697) in hospital, to 931 (505-1238) 1 week post-discharge, to 5,352 (3,552-7,944) at 12-weeks (p=0.001). Of the intervention cohort, 12 withdrew. Conclusion This study found that smartwatch-supported rehabilitation was feasible in this cohort. A significant proportion of patients either chose not to participate or withdrew; such a decrease in participants must be addressed to avoid digital exclusion. Falls and fracture-related readmissions were more frequent at the control site compared with the intervention site.
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Affiliation(s)
| | | | | | | | - Anna-Carolina Gonçalves
- University Hospitals Sussex, Worthing, UK, and lecturer, University of Portsmouth, Portsmouth, UK
| | - Christina Koulouglioti
- University Hospitals Sussex, Worthing, UK, and senior research fellow, University of Middlesex, London, UK
| | - Luke E Hodgson
- University Hospitals Sussex, Worthing, UK and honorary clinical reader, Brighton and Sussex Medical School, Brighton, UK
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Howell DF, Malmgren Fänge A, Rogmark C, Ekvall Hansson E. Rehabilitation Outcomes Following Hip Fracture of Home-Based Exercise Interventions Using a Wearable Device-A Randomized Controlled Pilot and Feasibility Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3107. [PMID: 36833801 PMCID: PMC9967499 DOI: 10.3390/ijerph20043107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/07/2023] [Accepted: 02/09/2023] [Indexed: 06/18/2023]
Abstract
Although hip fractures are common and severe, there is insufficient evidence concerning which type of rehabilitation is most beneficial. The primary aim of this three-armed pilot study was to investigate any difference in outcome after hip fractures between and within groups in terms of balance, everyday activities, and health-related quality of life (HRQoL) following different home rehabilitation interventions. Further aims were to study feasibility and to suggest, if necessary, adjustments to the protocol for a future full randomized controlled trial (RCT). In total, 32 persons were included in this study. The intervention groups underwent the HIFE program with or without an inertial measurement unit, while the control group underwent standard rehabilitation. Within- and between-groups differences in outcomes and feasibility outcomes in terms of recruitment and retention rates were analyzed, and the ability to collect primary and secondary outcomes was assessed. Balance, measured as postural sway, showed no significant improvement in any group. All three groups improved in functional balance (p = 0.011-0.028), activity of daily living (p = 0.012-0.027), and in HRQoL (p = 0.017-0.028). There were no other significant changes within or between the groups. The recruitment rate was 46%, the retention rate was 75%, and the ability to collect outcome measures was 80% at baseline and 64% at follow-up. Based on the results, it is possible to, after adjusting the protocol, conduct a full RCT.
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Affiliation(s)
| | - Agneta Malmgren Fänge
- Department of Health Sciences, Faculty of Medicine, Lund University, P.O. Box 157, 22100 Lund, Sweden
| | - Cecilia Rogmark
- Department of Orthopedics, Skane University Hospital, Lund University, 21428 Malmö, Sweden
| | - Eva Ekvall Hansson
- Department of Health Sciences, Faculty of Medicine, Lund University, P.O. Box 157, 22100 Lund, Sweden
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Assessing the Outcome of Rehabilitation after Hip Fracture with a Wearable Device-A Study Protocol for a Randomized Control Trial in Community Healthcare. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910165. [PMID: 34639466 PMCID: PMC8508243 DOI: 10.3390/ijerph181910165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND The increase of the aging population is a challenge to society, as age is related to dependence. Injuries such as hip fractures cause morbidity, loss of independent life, and mortality. The purpose of this protocol is to describe a randomized control trial, with three intervention arms, aiming at investigating if there are any differences in outcomes after hip fracture between different rehabilitation interventions including (1) High-Intensity Functional Exercise (HIFE), (2) HIFE with the addition of continuous measures of movement and body positions with a wearable device, or (3) standard rehabilitation. A secondary aim is to evaluate physiotherapists' satisfaction with using the wearable device in rehabilitation. METHOD Patients with hip fracture that require rehabilitation at home will be invited to participate and randomly assigned to one intervention arm. The primary outcome is balance, measured by postural sway using an Inertial Measurement Unit and by Functional Balance test for Geriatric patients. Secondary outcomes are functional independence in everyday activities, measured with the Barthel Index, and health-related quality of life measured with EuroQol 5 Dimension questionnaire and EuroQol Visual Analogue Scale for health and user satisfaction measured by the User Satisfaction Evaluation Questionnaire. DISCUSSION This study protocol is the first step in securing the research process before performing a full randomized controlled trial. The next step will be a pilot- and feasibility study.
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