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Gatenio-Hefling O, Tzemah-Shahar R, Asraf K, Dilian O, Gil E, Agmon M. Revisiting the "Timed Up and Go" test: a 12-s cut-off can predict Hospitalization Associated Functional Decline in older adults. GeroScience 2024:10.1007/s11357-024-01280-3. [PMID: 39014130 DOI: 10.1007/s11357-024-01280-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 07/02/2024] [Indexed: 07/18/2024] Open
Abstract
Early detection of functional decline, a major risk among hospitalized older adults, can facilitate interventions that could significantly reduce it. We aimed to examine the contribution of the Timed Up and Go (TUG) test in predicting Hospitalization Associated Functional Decline (HAFD) among older adults, able to independently ambulate before admission. We used a cross-sectional study design; a total of 310 older adults (age ≥ 65) hospitalized in internal medicine wards between December 2018 and August 2020 were included; exclusion criteria were inability to ambulate, a diagnosis restricting mobility, hospitalization for end-of-life care, or impaired cognition. The Modified Barthel Index was used to assess HAFD; it was administered at admission to evaluate patients' independence in activities of daily living 2 weeks prior hospitalization, and at discharge. The TUG test was performed on admission and to predict significant functional decline (defined by a reduction of three points or more in the Modified Barthel Index), while accounting for demographics, length of hospitalization, comorbidity burden (Charlson's comorbidity index), and cognitive function (ALFI-MMSE). Participants were divided into three groups according to their TUG score-under or over a cut-off score of 12 s, or inability to complete the test. Adjusting for age, comorbidity, cognitive ability, and duration of hospitalization, the group that performed the test in less than 12 s showed no statistically significant change in the Modified Barthel Index, therefore no significant HAFD. The other groups showed a statistically significant decline in function. Risk for significant HAFD is currently underestimated in clinical settings, limited to subjective assessment, and underused in the context of implementing early interventions to prevent HAFD. The TUG may support screening for those at risk of hospitalizing-associated functional decline and could help identify patients suitable for preventative interventions.
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Affiliation(s)
| | - Roy Tzemah-Shahar
- Faculty of Health and Social Welfare, University of Haifa, Haifa, Israel
| | - Kfir Asraf
- Max Stern Yezreel Valley College, Emek Yezreel, Israel
| | - Omer Dilian
- Faculty of Health and Social Welfare, University of Haifa, Haifa, Israel
| | - Efrat Gil
- HaEmek Medical Center, Afula, Israel
- Faculty of Medicine, Technion Institute of Technology, Haifa, Israel
| | - Maayan Agmon
- Faculty of Health and Social Welfare, University of Haifa, Haifa, Israel.
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Jones AE, Kennedy M, Hayden EM, Ouchi K, N Shankar K, Chary A, Li A, Loughlin KM, White B, Franco-Garcia E, Dellheim V, Liu SW. A protocol to determine the acceptability and feasibility of a pilot intervention emergency department virtual observation unit fall prevention program. Pilot Feasibility Stud 2024; 10:79. [PMID: 38762531 PMCID: PMC11102199 DOI: 10.1186/s40814-024-01502-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 04/30/2024] [Indexed: 05/20/2024] Open
Abstract
BACKGROUND As a third of all community dwellers aged 65+ fall each year, falls are common reasons for older adults to present to an Emergency Department (ED). Although EDs should assess patients' multifactorial fall risks to prevent future fall-related injuries, this frequently does not occur. We describe our protocol to determine the feasibility, acceptability, and safety of a pilot ED Virtual Observation Unit (VOU) Falls program. METHODS To ensure standardized conduct and reporting, the Standard Protocol Items for Intervention Trials (SPIRIT) guidelines will be used. The VOU is a program where patients are sent home from the ED but are part of a virtual observation unit in that they can call on-call ED physicians while they are being treated for conditions such as cellulitis, congestive heart failure, or pneumonia. A paramedic conducts daily visits with the patient and facilitates a telemedicine consult with an ED physician. VOU nursing staff conduct daily assessments of patients via telemedicine. The ED VOU Falls program is one of the VOU pathways and is a multi-component fall prevention program for fall patients who present after an ED visit. The paramedic conducts a home safety evaluation, a Timed Up and Go Test (TUG). During the VOU visit, the ED physician conducts a telemedicine visit, while the paramedic is visiting the home, to review patients' fall-risk-increasing drugs and their TUG test. We will determine feasibility by calculating rates of patient enrollment refusal, and adherence to fall-risk prevention recommendations using information from 3-month follow-up telephone calls, as well as qualitative interviews with the paramedics. We will determine the acceptability of the ED VOU Falls program based on patient and provider surveys using a Likert scale. We will ask VOU nursing staff to report any safety issues encountered while the patient is in the ED VOU Falls program (e.g., tripping hazards). We will use the chi-square test or Fisher's exact test for categorical variables, Student's t-test for continuous variables, and Mann-Whitney for nonparametric data. We will review interview transcripts and generate codes. Codes will then be extracted and organized into concepts to generate an overall theme following grounded theory methods. This is a pilot study; hence, results cannot be extrapolated. However, a definite trial would be the next step in the future to determine if such a program could be implemented as part of fall prevention interventions. DISCUSSION This study will provide insights into the feasibility and acceptability of a novel ED VOU Falls program with the aim of ultimately decreasing falls. In the future, such a program could be implemented as part of fall prevention interventions.
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Affiliation(s)
- Abigail E Jones
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, USA
| | - Maura Kennedy
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Emily M Hayden
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Kei Ouchi
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, USA
| | - Kalpana N Shankar
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, USA
| | - Anita Chary
- Departments of Emergency Medicine and Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, TX, USA
| | - Angel Li
- Valley Health System, Las Vegas, NV, USA
| | | | - Benjamin White
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Esteban Franco-Garcia
- Department of Internal Medicine, Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, USA
| | | | - Shan W Liu
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Strauss DH, Davoodi NM, Resnik LJ, Keene S, Serina PT, Goldberg EM. Emergency Department-Based Physical Function Measures for Falls in Older Adults and Outcomes: A Secondary Analysis of GAPcare. J Geriatr Phys Ther 2024:00139143-990000000-00048. [PMID: 38656264 DOI: 10.1519/jpt.0000000000000403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
BACKGROUND AND PURPOSE Falls are the leading reason for injury-related emergency department (ED) visits for older adults. The Geriatric Acute and Post-acute Fall Prevention Intervention (GAPcare), an in-ED intervention combining a medication therapy management session delivered by a pharmacist and a fall risk assessment and plan by a physical therapist, reduced ED revisits at 6 months among older adults presenting after a fall. Our objective was to evaluate the relationship between measures of function obtained in the ED and clinical outcomes. METHODS This was a secondary analysis of data from GAPcare, a randomized controlled trial conducted from January 2018 to October 2019 at 2 urban academic EDs. Standardized measures of function (Timed Up and Go [TUG] test, Barthel Activity of Daily Living [ADL], Activity Measure for Post Acute Care [AM-PAC] 6 clicks) were collected at the ED index visit. We performed a descriptive analysis and hypothesis testing (chi square test and analysis of variance) to assess the relationship of functional measures with outcomes (ED disposition, ED revisits for falls, and place of residence at 6 months). Emergency department disposition status refers to discharge location immediately after the ED evaluation is complete (eg, hospital admission, original residence, skilled nursing facility). RESULTS AND DISCUSSION Among 110 participants, 55 were randomized to the GAPcare intervention and 55 received usual care. Of those randomized to the intervention, 46 received physical therapy consultation. Median age was 81 years; participants were predominantly women (67%) and White (94%). Seventy-three (66%) were discharged to their original residence, 14 (13%) were discharged to a skilled nursing facility and 22 (20%) were admitted. There was no difference in ED disposition status by index visit Barthel ADLs (P = .371); however, TUG times were faster (P = .016), and AM-PAC 6 clicks score was higher among participants discharged to their original residence (P ≤ .001). Participants with slower TUG times at the index ED visit were more likely to reside in nursing homes by six months (P = .002), while Barthel ADL and AM-PAC 6 clicks did not differ between those residing at home and other settings. CONCLUSIONS Measures of function collected at the index ED visit, such as the AM-PAC 6 clicks and TUG time, may be helpful at predicting clinical outcomes for older adults presenting for a fall. Based on our study findings, we suggest a novel workflow to guide the use of these clinical measures for ED patients with falls.
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Affiliation(s)
- Daniel H Strauss
- Department of Emergency Medicine, The Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Natalie M Davoodi
- Department of Emergency Medicine, The Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Linda J Resnik
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, Rhode Island
- Research Department, Providence VA Medical Center, Providence, Rhode Island
| | - Sarah Keene
- Department of Emergency Medicine, The Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Peter T Serina
- Department of Emergency Medicine, The Warren Alpert Medical School, Brown University, Providence, Rhode Island
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island
| | - Elizabeth M Goldberg
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado
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Wolf LA, Lo AX, Serina P, Chary A, Sri‐On J, Shankar K, Sano E, Liu SW. Frailty assessment tools in the emergency department: A geriatric emergency department guidelines 2.0 scoping review. J Am Coll Emerg Physicians Open 2024; 5:e13084. [PMID: 38162531 PMCID: PMC10755799 DOI: 10.1002/emp2.13084] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 11/20/2023] [Accepted: 11/22/2023] [Indexed: 01/03/2024] Open
Abstract
Objective Given the aging population and growing burden of frailty, we conducted this scoping review to describe the available literature regarding the use and impact of frailty assessment tools in the assessment and care of emergency department (ED) patients older than 60 years. Methods A search was made of the available literature using the Covidence system using various search terms. Inclusion criteria comprised peer-reviewed literature focusing on frailty screening tools used for a geriatric population (60+ years of age) presenting to EDs. An additional search of PubMed, EBSCO, and CINAHL for articles published in the last 5 years was conducted toward the end of the review process (January 2023) to search specifically for literature describing interventions for frailty, yielding additional articles for review. Exclusion criteria comprised articles focusing on an age category other than geriatric and care environments outside the emergency care setting. Results A total of 135 articles were screened for inclusion and 48 duplicates were removed. Of the 87 remaining articles, 20 were deemed irrelevant, leaving 67 articles for full-text review. Twenty-eight were excluded for not meeting inclusion criteria, leaving 39 full-text studies. Use of frailty screening tools were reported in the triage, care, and discharge decision-making phases of the ED care trajectory, with varying reports of usefulness for clinical decision-making. Conclusion The literature reports tools, scales, and instruments for identifying frailty in older patients at ED triage; multiple frailty scores or tools exist with varying levels of utilization. Interventions for frailty directed at the ED environment were scant. Further research is needed to determine the usefulness of frailty identification in the context of emergency care, the effects of care delivery interventions or educational initiatives for front-line medical professionals on patient-oriented outcomes, and to ensure these initiatives are acceptable for patients.
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Affiliation(s)
- Lisa A. Wolf
- Emergency Nurses AssociationSchaumburgIllinoisUSA
| | - Alexander X. Lo
- Department of Emergency MedicineNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Peter Serina
- Department of Emergency MedicineBrown UniversityProvidenceRhode IslandUSA
| | - Anita Chary
- Department of Emergency MedicineBaylor College of MedicineHoustonTexasUSA
| | - Jiraporn Sri‐On
- Department of Emergency MedicineVajira HospitalBangkokThailand
| | - Kalpana Shankar
- Department of Emergency MedicineBrigham and Women's HospitalBostonMassachusettsUSA
| | - Ellen Sano
- Department of Emergency MedicineColumbia University College of Physicians and SurgeonsNew YorkNew YorkUSA
| | - Shan W. Liu
- Department of Emergency MedicineMassachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
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Lewis A, Clout M, Benger J, Braude P, Turner N, Gagg J, Gendall E, Holloway S, Ingram J, Kandiyali R, Maskell N, Shipway D, Smith JE, Taylor J, Darweish-Medniuk A, Carlton E. The Randomised Evaluation of early topical Lidocaine patches In Elderly patients admitted to hospital with rib Fractures (RELIEF): feasibility trial protocol. NIHR OPEN RESEARCH 2023; 3:38. [PMID: 37881461 PMCID: PMC10593328 DOI: 10.3310/nihropenres.13438.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/22/2023] [Indexed: 10/27/2023]
Abstract
Background Topical lidocaine patches, applied over rib fractures, have been suggested as a non-invasive method of local anaesthetic delivery to improve respiratory function, reduce opioid consumption and consequently reduce pulmonary complications. Older patients may gain most benefit from improved analgesic regimens yet lidocaine patches are untested as an early intervention in the Emergency Department (ED). The aim of this trial is to investigate uncertainties around trial design and conduct, to establish whether a definitive randomised trial of topical lidocaine patches in older patients with rib fractures is feasible. Methods RELIEF is an open label, multicentre, parallel group, individually randomised, feasibility randomised controlled trial with economic scoping and nested qualitative study. Patients aged ≥ 65 years presenting to the ED with traumatic rib fracture(s) requiring admission will be randomised 1:1 to lidocaine patches (intervention), in addition to standard clinical management, or standard clinical management alone. Lidocaine patches will be applied immediately after diagnosis in ED and continued daily for 72 hours or until discharge. Feasibility outcomes will focus on recruitment, adherence and follow-up data with a total sample size of 100. Clinical outcomes, such as 30-day pulmonary complications, and resource use will be collected to understand feasibility of data collection. Qualitative interviews will explore details of the trial design, trial acceptability and recruitment processes. An evaluation of the feasibility of measuring health economics outcomes data will be completed. Discussion Interventions to improve outcomes in elderly patients with rib fractures are urgently required. This feasibility trial will test a novel early intervention which has the potential of fulfilling this unmet need. The Randomised Evaluation of early topical Lidocaine patches In Elderly patients admitted to hospital with rib Fractures (RELIEF) feasibility trial will determine whether a definitive trial is feasible. ISRCTN Registration ISRCTN14813929 (22/04/2021).
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Affiliation(s)
- Amanda Lewis
- Bristol Trials Centre (BTC), Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England, UK
| | - Madeleine Clout
- Bristol Trials Centre (BTC), Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England, UK
| | - Jonathan Benger
- Emergency Care, Faculty of Health and Applied Sciences, University of the West of England, Bristol, England, UK
| | - Philip Braude
- Department of Elderly Care Medicine, Southmead Hospital, North Bristol NHS Trust, Bristol, England, UK
| | - Nicholas Turner
- Bristol Trials Centre (BTC), Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England, UK
| | - James Gagg
- Department of Emergency Medicine, Musgrove Park Hospital, Taunton, England, UK
| | - Emma Gendall
- Research and Innovation, Southmead Hospital, North Bristol NHS Trust, Bristol, England, UK
| | - Simon Holloway
- Pharmacy Clinical Trials and Research, Southmead Hospital, North Bristol NHS Trust, Bristol, England, UK
| | - Jenny Ingram
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England, UK
| | - Rebecca Kandiyali
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Warwick, England, UK
| | - Nick Maskell
- Academic Respiratory Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, England, UK
| | - David Shipway
- Department of Elderly Care Medicine, Southmead Hospital, North Bristol NHS Trust, Bristol, England, UK
| | - Jason E Smith
- Emergency Department, Derriford Hospital, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Jodi Taylor
- Bristol Trials Centre (BTC), Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England, UK
| | - Alia Darweish-Medniuk
- Department of Anaesthesia and Pain Medicine, Southmead Hospital, North Bristol NHS Trust, Bristol, England, UK
| | - Edward Carlton
- Department of Emergency Medicine, Southmead Hospital, North Bristol NHS Trust, Bristol, England, UK
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, England, UK
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Santangelo I, Ahmad S, Liu S, Southerland LT, Carpenter C, Hwang U, Lesser A, Tidwell N, Biese K, Kennedy M. Examination of geriatric care processes implemented in level 1 and level 2 geriatric emergency departments. JOURNAL OF GERIATRIC EMERGENCY MEDICINE 2023; 3:10.17294/2694-4715.1041. [PMID: 36970655 PMCID: PMC10035774 DOI: 10.17294/2694-4715.1041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
Introduction Older adults constitute a large and growing proportion of the population and have unique care needs in the emergency department (ED) setting. The geriatric ED accreditation program aims to improve emergency care provided to older adults by standardizing care provided across accredited geriatric EDs (GED) and through implementation of geriatric-specific care processes. The purpose of this study was to evaluate select care processes at accredited level 1 and level 2 GEDs. Methods This was a cross-sectional analysis of a cohort of level 1 and level 2 GEDs that received accreditation between May 7, 2018 and March 1, 2021. We a priori selected five GED care processes for analysis: initiatives related to delirium, screening for dementia, assessment of function and functional decline, geriatric falls, and minimizing medication-related adverse events. For all protocols, a trained research assistant abstracted information on the tool used or care process, which patients received the interventions, and staff members were involved in the care process; additional information was abstracted specific to individual care processes. Results A total of 35 level 1 and 2 GEDs were included in this analysis. Among care processes studied, geriatric falls were the most common (31 GEDs, 89%) followed by geriatric pain management (25 GEDs, 71%), minimizing the use of potentially inappropriate medications (24 EDs, 69%), delirium (22 GEDs, 63%), medication reconciliation (21 GEDs, 60%), functional assessment (20 GEDs, 57%), and dementia screening (17 GEDs, 49%). For protocols related to delirium, dementia, function, and geriatric falls, sites used an array of different screening tools and there was heterogeneity in who performed the screening and which patients were assessed. Medication reconciliation protocols leveraged pharmacists, pharmacy technicians and/or nurses. Protocols on avoiding potentially inappropriate medication administration generally focused on ED administration of medications and used the BEERs criteria, and few sites indicated whether pain medications protocols had dosing modifications for age and/or renal function. Conclusion This study provides a snapshot of care processes implemented in level 1 and level 2 accredited GEDs and demonstrates significant heterogeny in how these care processes are implemented.
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Affiliation(s)
- Ilianna Santangelo
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | - Surriya Ahmad
- SUNY Downstate Medical Center / Kings County Hospital Center
| | - Shan Liu
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA; Department of Emergency Medicine, Harvard Medical School, Boston, MA
| | | | - Christopher Carpenter
- Department of Emergency Medicine and Emergency Care Research Core, Washington University in St. Louis School of Medicine, St. Louis, MO
| | - Ula Hwang
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT; Geriatric Research, Education and Clinical Center, James J. Peters VAMC, Bronx, NY
| | | | | | - Kevin Biese
- West Health Institute, La Jolla, CA; Division of Geriatric Emergency Medicine, University of North Carolina, Chapel Hill, NC
| | - Maura Kennedy
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA; Department of Emergency Medicine, Harvard Medical School, Boston, MA
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Albarrati AM, Gale NS, Munnery MM, Reid N, Cockcroft JR, Shale DJ. The Timed Up and Go test predicts frailty in patients with COPD. NPJ Prim Care Respir Med 2022; 32:24. [PMID: 35794130 PMCID: PMC9259691 DOI: 10.1038/s41533-022-00287-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 05/24/2022] [Indexed: 11/16/2022] Open
Abstract
The Timed Up and Go (TUG) is a global measure of mobility and has the ability to detect frail individuals. Frail patients with chronic obstructive pulmonary disease (COPD) are usually undiagnosed. We hypothesised that the TUG would identify frail patients with COPD. Frailty was assessed in 520 patients diagnosed with COPD and 150 controls using a Comprehensive Geriatric Assessment questionnaire and frailty index (FI) was derived. The TUG was used to assess physical mobility. All participants were assessed for lung function and body composition. A ROC curve was used to identify how well TUG discriminates between frail and non-frail patients with COPD. The patients with COPD and controls were similar in age, sex and BMI but the patients with COPD were more frail, mean ± SD FI 0.16 ± 0.08 than controls 0.05 ± 0.03, P < 0.001. Frail patients with COPD had a greater TUG time (11.55 ± 4.03 s) compared to non-frail patients (9.2 ± 1.6 sec), after controlling for age and lung function (F = 15.94, P < 0.001), and both were greater than the controls (8.3 ± 1.2 sec), P < 0.001. The TUG discriminated between frail and non-frail patients with COPD with an area under the curve of 72 (95% CI: 67–76), and a diagnostic odds ratio of 2.67 (95% CI:1.5–4.6), P < 0.001. The TUG showed the ability to discriminate between frail and non-frail patients with COPD, independent of age and severity of the airflow obstruction. The TUG is a simple, easy and quick measure that could be easily applied in restricted settings to screen for frailty in COPD.
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Affiliation(s)
- Ali M Albarrati
- School of Healthcare Sciences, Cardiff University, University Hospital of Wales, Cardiff, CF14 4XN, UK. .,College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia.
| | - Nichola S Gale
- School of Healthcare Sciences, Cardiff University, University Hospital of Wales, Cardiff, CF14 4XN, UK
| | - Margaret M Munnery
- School of Health Sciences, Cardiff Metropolitan University, Llandaff Campus, Western Avenue, Cardiff, CF5 2YB, UK
| | - Natasha Reid
- Centre for Health Services Research, Faculty of Medicine, Princess Alexandra Hospital, The University of Queensland, St Lucia, Australia
| | - John R Cockcroft
- School of Health Sciences, Cardiff Metropolitan University, Llandaff Campus, Western Avenue, Cardiff, CF5 2YB, UK
| | - Dennis J Shale
- School of Healthcare Sciences, Cardiff University, University Hospital of Wales, Cardiff, CF14 4XN, UK
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Telles LGDS, Billaut F, Cunha G, Ribeiro ADS, Monteiro ER, Barreto AC, Leitão L, Panza P, Vianna JM, Novaes JDS. Ischemic Preconditioning Improves Handgrip Strength and Functional Capacity in Active Elderly Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116628. [PMID: 35682213 PMCID: PMC9180149 DOI: 10.3390/ijerph19116628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 05/25/2022] [Accepted: 05/27/2022] [Indexed: 02/04/2023]
Abstract
Background: Aging decreases some capacities in older adults, sarcopenia being one of the common processes that occur and that interfered with strength capacity. The present study aimed to verify the acute effect of IPC on isometric handgrip strength and functional capacity in active elderly women. Methods: In a single-blind, placebo-controlled design, 16 active elderly women (68.1 ± 7.6 years) were randomly performed on three separate occasions a series of tests: (1) alone (control, CON); (2) after IPC (3 cycles of 5-min compression/5-min reperfusion at 15 mmHg above systolic blood pressure, IPC); and (3) after placebo compressions (SHAM). Testing included a handgrip isometric strength test (HIST) and three functional tests (FT): 30 s sit and stand up from a chair (30STS), get up and go time (TUG), and 6 min walk distance test (6MWT). Results: HIST significantly increased in IPC (29.3 ± 6.9 kgf) compared to CON (27.3 ± 7.1 kgf; 7.1% difference; p = 0.01), but not in SHAM (27.7 ± 7.9; 5.5%; p = 0.16). The 30STS increased in IPC (20.1 ± 4.1 repetitions) compared to SHAM (18.5 ± 3.5 repetitions; 8.7%; p = 0.01) and CON (18.5 ± 3.9 repetitions; 8.6%; p = 0.01). TUG was significantly lower in IPC (5.70 ± 1.35 s) compared to SHAM (6.14 ± 1.37 s; −7.2%; p = 0.01), but not CON (5.91 ± 1.45 s; −3.7%; p = 0.24). The 6MWT significantly increased in IPC (611.5 ± 93.8 m) compared to CON (546.1 ± 80.5 m; 12%; p = 0.02), but not in SHAM (598.7 ± 67.6 m; 2.1%; p = 0.85). Conclusions: These data suggest that IPC can promote acute improvements in handgrip strength and functional capacity in active elderly women.
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Affiliation(s)
- Luiz Guilherme da Silva Telles
- Physical Education and Sports Department, Federal University of Rio de Janeiro, Rio de Janeiro 21941-901, Brazil; (L.G.d.S.T.); (E.R.M.); (J.d.S.N.)
- Estácio de Sá University (UNESA), Rio de Janeiro 20261-063, Brazil;
| | - François Billaut
- Department of Kinesiology, Laval University, Quebec, QC G1V 0A6, Canada;
| | - Gélio Cunha
- Estácio de Sá University (UNESA), Rio de Janeiro 20261-063, Brazil;
| | - Aline de Souza Ribeiro
- Physical Education and Sports Department, Federal University of Juiz de Fora, São Pedro 36036-900, Brazil; (A.d.S.R.); (P.P.); (J.M.V.)
| | - Estêvão Rios Monteiro
- Physical Education and Sports Department, Federal University of Rio de Janeiro, Rio de Janeiro 21941-901, Brazil; (L.G.d.S.T.); (E.R.M.); (J.d.S.N.)
- Department of Physical Therapy, University Center of Augusto Motta of UNISUAM, Rio de Janeiro 21041-020, Brazil
| | | | - Luís Leitão
- Sciences and Technology Department, Superior School of Education of Polytechnic Institute of Setubal, 2910-761 Setúbal, Portugal
- Life Quality Research Centre, 2040-413 Rio Maior, Portugal
- Correspondence:
| | - Patrícia Panza
- Physical Education and Sports Department, Federal University of Juiz de Fora, São Pedro 36036-900, Brazil; (A.d.S.R.); (P.P.); (J.M.V.)
| | - Jeferson Macedo Vianna
- Physical Education and Sports Department, Federal University of Juiz de Fora, São Pedro 36036-900, Brazil; (A.d.S.R.); (P.P.); (J.M.V.)
| | - Jefferson da Silva Novaes
- Physical Education and Sports Department, Federal University of Rio de Janeiro, Rio de Janeiro 21941-901, Brazil; (L.G.d.S.T.); (E.R.M.); (J.d.S.N.)
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Wogksch MD, Finch ER, Nolan VG, Smeltzer MP, Mzayek F, Goodenough CG, Pui CH, Inaba H, Mulrooney DA, Kaste SC, Brinkman TM, Lanctot JQ, Srivastava DK, Jefferies JL, Armstrong GT, Robison LL, Hudson MM, Ness KK. Energy cost of walking in obese survivors of acute lymphoblastic leukemia: A report from the St. Jude Lifetime Cohort. Front Pediatr 2022; 10:976012. [PMID: 36389386 PMCID: PMC9650430 DOI: 10.3389/fped.2022.976012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 10/10/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose Adult survivors of childhood acute lymphoblastic leukemia (ALL) have impaired adaptive physical function and poor health-related quality of life (HRQoL). Obesity may contribute to these impairments by increasing the physiological cost of walking. Due to treatment exposures during ALL therapy, survivors' cost of walking may be more impacted by obesity than the general population. Therefore, we examined associations between obesity, persistent motor neuropathy, and energy cost of walking; and examined associations between energy cost of walking, adaptive physical function, and HRQoL, in adult survivors of childhood ALL vs. community controls. Methods Obesity was measured via body mass index (BMI) and body fat percentage. The physiological cost index (PCI) was calculated from the six-minute walk test. Adaptive physical functioning was measured using two tests: the timed up and go (TUG) test and the physical performance test. Persistent motor neuropathy was measured using the modified total neuropathy score; HRQoL was measured using the Short-Form-36 questionnaire. The associations between obesity and PCI were evaluated using multivariable linear regressions in adult survivors of childhood ALL (n = 1,166) and community controls (n = 491). Then, the associations between PCI, adaptive physical functioning and peripheral neuropathy were examined using multivariable linear regressions. Finally, to determine the association between obesity, and neuropathy on PCI, while accounting for potential lifestyle and treatment confounders, a three model, sequential linear regression was used. Results Obese individuals (BMI > 40 kg/m2 and excess body fat percentage [males: >25%; females: >33%]) had higher PCI compared to those with normal BMI and body fat percentage (0.56 ± 0.01 vs. 0.49 ± 0.009 beats/meter p < .01; and 0.51 ± 0.007 vs. 0.48 ± .0006 beats/meter p < .01, respectively). Treatment exposures did not attenuate this association. Increased PCI was associated with longer TUG time in survivors, but not community controls (6.14 ± 0.02 s vs. 5.19 ± 0.03 s, p < .01). Survivors with PCI impairment >95th percentile of community controls had lower HRQoL compared to un-impaired ALL survivors: 46.9 ± 0.56 vs. 50.4 ± 1.08, respectively (p < .01). Conclusion Obesity was associated with increased PCI. Survivors with high PCI had disproportionately worse adaptive physical function and HRQoL compared to controls. Survivors with increased energy costs of walking may benefit from weight loss interventions.
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Affiliation(s)
- Matthew D. Wogksch
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Emily R. Finch
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Vikki G. Nolan
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, TN, United States
| | - Matthew P. Smeltzer
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, TN, United States
| | - Fawaz Mzayek
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, TN, United States
| | - Chelsea G. Goodenough
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Ching-Hon Pui
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Hiroto Inaba
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Daniel A. Mulrooney
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, United States
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Sue C. Kaste
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, United States
- Department of Diagnostic Imaging, St. Jude Children’s Research Hospital, Memphis, TN, United States
- Department of Radiology, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Tara M. Brinkman
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, United States
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Jennifer Q. Lanctot
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Deo Kumar Srivastava
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - John L. Jefferies
- Division of Cardiovascular Diseases, Institute for Cardiovascular Science, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Gregory T. Armstrong
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, United States
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Leslie L. Robison
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Melissa M. Hudson
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, United States
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Kirsten K. Ness
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, United States
- Correspondence: Kirsten K. Ness
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10
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Kim SH, Higuchi M, Ishigami Y, Makishi G, Tada M, Hibino S, Gottlieb M, Lee S. Five Key Papers About Emergency Department Fall Evaluation: A Curated Collection for Emergency Physicians. Cureus 2021; 13:e17717. [PMID: 34650891 PMCID: PMC8489554 DOI: 10.7759/cureus.17717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2021] [Indexed: 11/24/2022] Open
Abstract
The evaluation of patients who have experienced a fall has been an integral part of geriatric emergency care. All physicians who engage in the care of the geriatric population in acute settings need to familiarize themselves with the current literature on this topic. However, it can be challenging to navigate the large body of literature on this topic. The purpose of this article is to identify and summarize the key studies that can be helpful for faculty interested in an evidence-based fall evaluation. The authors compiled a list of key papers on emergency department (ED) based upon a structured literature search supplemented with suggestions by key informants and an open call on social media; 32 studies on ED evaluation were identified. Our authorship group then engaged in a modified Delphi technique to develop consensus on the most important studies about fall evaluation for emergency physicians. This process eventually resulted in the selection of the top five articles on fall evaluation. Additionally, we summarize these studies with regard to their relevance to emergency medicine (EM) trainees and junior faculty. Evaluation of older patients with a history of falls is a challenging but crucial component of EM training. We believe our review will be educational for junior and senior EM faculty to better understand these patients' care and to design an evidence-based practice.
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Affiliation(s)
- Sung-Ho Kim
- Emergency Medicine, Rinku General Hospital, Osaka, JPN.,Trauma and Critical Care, Senshu Trauma and Critical Care Center, Osaka, JPN
| | - Masaya Higuchi
- Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, USA
| | | | - Go Makishi
- Emergency Medicine, Seirei Mikatahara General Hospital, Shizuoka, JPN
| | - Masafumi Tada
- Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, JPN.,Neurology-Emergency Medicine, Nagoya City University East Medical Center, Nagoya, JPN
| | - Seikei Hibino
- Emergency Medicine, University of Minnesota, Minneapolis, USA
| | - Michael Gottlieb
- Emergency Medicine, Rush University Medical Center, Chicago, USA
| | - Sangil Lee
- Emergency Medicine, University of Iowa Carver College of Medicine, Iowa, USA
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11
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Nielsen LM, Oestergaard LG, Kirkegaard H, Maribo T. Construct Validity and Clinical Utility of World Health Organization Disability Assessment Schedule 2.0 in Older Patients Discharged From Emergency Departments. FRONTIERS IN REHABILITATION SCIENCES 2021; 2:710137. [PMID: 36188825 PMCID: PMC9397984 DOI: 10.3389/fresc.2021.710137] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 07/26/2021] [Indexed: 11/13/2022]
Abstract
Introduction: The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) is designed to measure functioning and disability in six domains. It is included in the International Classification of Diseases 11th revision (ICD-11). The objective of the study was to examine the construct validity of WHODAS 2.0 and describe its clinical utility for the assessment of functioning and disability among older patients discharged from emergency departments (EDs). Material and Methods: This cross-sectional study is based on data from 129 older patients. Patients completed the 36-item version of WHODAS 2.0 together with the Barthel-20, the Assessment of Motor and Process Skills (AMPS), Timed Up and Go (TUG), and the 30-Second Chair Stand Test (30 s-CST). Construct validity was examined through hypothesis testing by correlating the WHODAS with the other instruments and specifically the mobility domain in WHODAS 2.0 with the TUG and 30 s-CST tests. The clinical utility of WHODAS 2.0 was explored through floor/ceiling effect and missing item responses. Results: WHODAS 2.0 correlated fair with Barthel-20 (r = -0.49), AMPS process skills (r = -0.26) and TUG (r=0.30) and correlated moderate with AMPS motor skills (r = -0.58) and 30s-CST (r = -0.52). The WHODAS 2.0 mobility domain correlated fair with TUG (r = 0.33) and moderate with 30s-CST (r = -0.60). Four domains demonstrated floor effect: D1 "Cognition," D3 "Self-care," D4 "Getting along," and D5 "Household." Ceiling effect was not identified. The highest proportion of missing item responses were present for Item 3.4 (Staying by yourself for a few days), Item 4.4 (Making new friends), and Item 4.5 (Sexual activities). Conclusion: WHODAS 2.0 had fair-to-moderate correlations with Barthel-20, AMPS, TUG, and 30s-CST and provides additional aspects of disability compared with commonly used instruments. However, the clinical utility of WHODAS 2.0 applied to older patients discharged from EDs poses some challenges due to floor effect and missing item responses. Accordingly, patient and health professional perspectives need further investigation.
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Affiliation(s)
- Louise Moeldrup Nielsen
- Department of Occupational Therapy, Research Centre for Health and Welfare Technology, VIA University College, Aarhus, Denmark
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Lisa Gregersen Oestergaard
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
- DEFACTUM Central Denmark Region, Aarhus, Denmark
| | - Hans Kirkegaard
- Research Centre for Emergency Medicine, Emergency Department, Department of Clinical Medicine, Aarhus University Hospital, Aarhus University, Aarhus, Denmark
| | - Thomas Maribo
- Department of Public Health, Aarhus University, Aarhus, Denmark
- DEFACTUM Central Denmark Region, Aarhus, Denmark
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12
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Williams JM, Nyman SR. Age Moderates Differences in Performance on the Instrumented Timed Up and Go Test Between People With Dementia and Their Informal Caregivers. J Geriatr Phys Ther 2021; 44:E150-E157. [PMID: 32175993 PMCID: PMC7611094 DOI: 10.1519/jpt.0000000000000265] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE The instrumented Timed Up and Go test (iTUG) affords quantification of the subelements of the Timed Up and Go test to assess fall risk and physical performance. A miniature sensor applied to the back is able to capture accelerations and velocities from which the subelements of the iTUG can be quantified. This study is the first to compare iTUG performance between people with dementia (PWD) and their age-matched caregivers. The aims of this study were to explore how age moderates the differences in performance on the iTUG between PWD and their informal caregivers. METHODS Eight-three community-dwelling older PWD and their informal caregivers were recruited for this cross-sectional, observational study. Participants were grouped by age: younger than 70 years, 70 to 79 years, and 80 years and older. Participants wore an inertial sensor while performing the iTUG in their home. The performance of the subelements sit-to-stand, walking, and turning were captured through an algorithm converting accelerations and velocities into performance metrics such as duration and peak velocity. Performance for PWD was compared with caregivers for each age-matched group, and multiple regression models incorporating age, gender, and presence or absence of dementia were computed. RESULTS People with dementia took longer to turn in the younger than 70-year group, suggesting this may be an early indicator of functional decline in this age group. People with dementia took longer to complete the whole iTUG compared with caregivers in the 70- to 79-year-old group. In the 80+-year-old group, PWD took longer to complete both walking phases, sit-to-stand, and the full iTUG along with displaying slower turning velocity. Multiple regression models illustrated that gender failed to contribute significantly to the model, but age and presence of dementia explained around 30% of the variance of time to complete walking phases, total iTUG, and turning velocity. CONCLUSIONS Differences were evident in performance of the iTUG between PWD and caregivers even after controlling for age. Age moderates the differences observed in performance.
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Affiliation(s)
- Jonathan M Williams
- Department of Human Sciences and Public Health, Faculty of Health and Social Sciences, Bournemouth University, England
| | - Samuel R Nyman
- Department of Psychology and Ageing and Dementia Research Centre, Faculty of Science and Technology, Bournemouth University, England
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13
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Robinson-Papp J, Gensler G, Navis A, Sherman S, Ellis RJ, Gelman BB, Kolson DL, Letendre SL, Singer EJ, Valdes-Sueiras M, Morgello S. Characteristics of Motor Dysfunction in Longstanding Human Immunodeficiency Virus. Clin Infect Dis 2021; 71:1532-1538. [PMID: 31587032 DOI: 10.1093/cid/ciz986] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 10/03/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Cognitive dysfunction in human immunodeficiency virus (HIV) has decreased, but milder forms of HIV-associated neurocognitive disorders (HAND) persist along with motor dysfunction. The HIV Motor Scale (HMS) is a validated tool that captures motor abnormalities on routine neurologic examination and which is associated with cognitive impairment in HIV. In this study, we applied a modified HMS (MHMS) to a nationwide cohort of people with longstanding HIV to characterize and understand the factors contributing to motor dysfunction. METHODS The National NeuroAIDS Tissue Consortium is a nationwide longitudinal cohort study. Participants undergo regular assessments including neurological examination, neuropsychological testing, and immunovirologic data collection. Data from examinations were used to calculate the MHMS score, which was then correlated with history of AIDS-related central nervous system (CNS) disorders (ARCD; eg, prior CNS opportunistic infection), cerebrovascular disease (CVD), and HAND. RESULTS Sixty-nine percent of participants showed an abnormality on the MHMS, with 27% classified as severe. Results did not vary based on demographic or immunologic variables. The most common abnormalities seen were gait (54%), followed by coordination (39%) and strength (25%), and these commonly co-occurred. CVD (P = .02), history of ARCD (P = .001), and HAND (P = .001) were all associated with higher (ie, worse) HMS in univariate analyses; CVD and ARCD persisted in multivariate analyses. CVD was also marginally associated with symptomatic HAND. CONCLUSIONS Complex motor dysfunction remains common in HIV and is associated with CVD, ARCD, and to a lesser extent, HAND. Future studies are needed to understand the longitudinal trajectory of HIV-associated motor dysfunction, its neural substrates, and impact on quality of life.
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Affiliation(s)
- Jessica Robinson-Papp
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Allison Navis
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Ronald J Ellis
- Department of Neurosciences, University of California, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, California, USA
| | - Benjamin B Gelman
- Department of Pathology, University of Texas Medical Branch, Galveston, Texas, USA
| | - Dennis L Kolson
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Scott L Letendre
- Department of Psychiatry, University of California, San Diego, California, USA.,Department of Medicine, University of California, San Diego, California, USA
| | - Elyse J Singer
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Miguel Valdes-Sueiras
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Susan Morgello
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York.,Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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14
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Fudickar S, Kiselev J, Stolle C, Frenken T, Steinhagen-Thiessen E, Wegel S, Hein A. Validation of a Laser Ranged Scanner-Based Detection of Spatio-Temporal Gait Parameters Using the aTUG Chair. SENSORS 2021; 21:s21041343. [PMID: 33668682 PMCID: PMC7918763 DOI: 10.3390/s21041343] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/02/2021] [Accepted: 02/04/2021] [Indexed: 12/15/2022]
Abstract
This article covers the suitability to measure gait-parameters via a Laser Range Scanner (LRS) that was placed below a chair during the walking phase of the Timed Up&Go Test in a cohort of 92 older adults (mean age 73.5). The results of our study demonstrated a high concordance of gait measurements using a LRS in comparison to the reference GAITRite walkway. Most of aTUG's gait parameters demonstrate a strong correlation coefficient with the GAITRite, indicating high measurement accuracy for the spatial gait parameters. Measurements of velocity had a correlation coefficient of 99%, which can be interpreted as an excellent measurement accuracy. Cadence showed a slightly lower correlation coefficient of 96%, which is still an exceptionally good result, while step length demonstrated a correlation coefficient of 98% per leg and stride length with an accuracy of 99% per leg. In addition to confirming the technical validation of the aTUG regarding its ability to measure gait parameters, we compared results from the GAITRite and the aTUG for several parameters (cadence, velocity, and step length) with results from the Berg Balance Scale (BBS) and the Activities-Specific Balance Confidence-(ABC)-Scale assessments. With confidence coefficients for BBS and velocity, cadence and step length ranging from 0.595 to 0.798 and for ABC ranging from 0.395 to 0.541, both scales demonstrated only a medium-sized correlation. Thus, we found an association of better walking ability (represented by the measured gait parameters) with better balance (BBC) and balance confidence (ABC) overall scores via linear regression. This results from the fact that the BBS incorporates both static and dynamic balance measures and thus, only partly reflects functional requirements for walking. For the ABC score, this effect was even more pronounced. As this is to our best knowledge the first evaluation of the association between gait parameters and these balance scores, we will further investigate this phenomenon and aim to integrate further measures into the aTUG to achieve an increased sensitivity for balance ability.
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Affiliation(s)
- Sebastian Fudickar
- Assistance Systems and Medical Device Technology, Carl von Ossietzky University Oldenburg, 26129 Oldenburg, Germany; (C.S.); (A.H.)
- Correspondence:
| | - Jörn Kiselev
- Geriatrics Research Group, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, D-10117 Berlin, Germany; (J.K.); (E.S.-T.); (S.W.)
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, D-10117 Berlin, Germany
| | - Christian Stolle
- Assistance Systems and Medical Device Technology, Carl von Ossietzky University Oldenburg, 26129 Oldenburg, Germany; (C.S.); (A.H.)
| | - Thomas Frenken
- IT Services Thomas Frenken, Loyerweg 62a, 26180 Rastede, Germany;
| | - Elisabeth Steinhagen-Thiessen
- Geriatrics Research Group, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, D-10117 Berlin, Germany; (J.K.); (E.S.-T.); (S.W.)
- Divison of Lipid Metabolism of the Department of Endocrinology and Metabolic Medicine, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, D-10117 Berlin, Germany
| | - Sandra Wegel
- Geriatrics Research Group, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, D-10117 Berlin, Germany; (J.K.); (E.S.-T.); (S.W.)
- Department of Surgery (CCM, CVK), Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, D-10117 Berlin, Germany
| | - Andreas Hein
- Assistance Systems and Medical Device Technology, Carl von Ossietzky University Oldenburg, 26129 Oldenburg, Germany; (C.S.); (A.H.)
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15
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Auvinen K, Voutilainen A, Jyrkkä J, Lönnroos E, Mäntyselkä P. Interprofessional medication assessment among home care patients: any impact on functioning? Results from a randomised controlled trial. BMC Geriatr 2020; 20:390. [PMID: 33023497 PMCID: PMC7539372 DOI: 10.1186/s12877-020-01796-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 09/28/2020] [Indexed: 11/15/2022] Open
Abstract
Background Multimorbidity and polypharmacy are related to the use of potentially inappropriate medicines and negative clinical outcomes including drug-related adverse events and functional declines. Home care clients are a vulnerable patient group often exposed to these risks. The aim of this study was to examine whether an interprofessional medication assessment can influence the functioning of home care patients. Methods The FIMA study was a randomised controlled intervention study comparing a general practitioner-led interprofessional medication assessment conducted at the baseline of the study with usual care with a six-month follow-up. We used linear mixed models (LMM) with a random subject effect to detect differences between the usual care and intervention groups in the following outcome measures; Katz index of Activities of Daily Living (ADL), Lawton and Brody scale of Instrumental Activities of Daily Living, Timed up and go-test (TUG), Mini-Mental State Examination, Geriatric Depression Scale and the 3-level version of EQ-5D. Results Home care patients (n = 512) had major disease burdens and functional limitations. Regarding TUG times, the LMM detected a one second improvement in the FIMA group and 2.4 s worsening in the usual care group. However, the result was not statistically significant. The ADL revealed an interaction across time, treatment and sex (p = 0.026). The ADL score decreased in both groups; the decline being the steepest among women in the intervention group. Conclusions In general, medication assessments may have limited impact on functioning of older people. Nonetheless, the FIMA intervention may prevent worsening of mobility among older home care patients. Trial registration The Interprofessional Medication Assessment for Older Patients, Clinical Trials.gov. NCT02398812. First registration, 26 March 2015. Retrospectively registered.
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Affiliation(s)
- K Auvinen
- The East Savo Hospital District, BOX 111, FI-57101, Savonlinna, Finland. .,Institute of Public Health and Clinical Nutrition, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.
| | - A Voutilainen
- Institute of Public Health and Clinical Nutrition, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - J Jyrkkä
- Assessment of Pharmacotherapies, Finnish Medicines Agency, Kuopio, Finland
| | - E Lönnroos
- Institute of Public Health and Clinical Nutrition, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - P Mäntyselkä
- Institute of Public Health and Clinical Nutrition, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.,Kuopio University Hospital, Primary Heath Care Unit, Kuopio, Finland
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16
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Nielsen LM, Maribo T, Kirkegaard H, Bjerregaard MK, Oestergaard LG. Identifying elderly patients at risk of readmission after discharge from a short-stay unit in the emergency department using performance-based tests of daily activities. BMC Geriatr 2020; 20:217. [PMID: 32571229 PMCID: PMC7310017 DOI: 10.1186/s12877-020-01591-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 05/21/2020] [Indexed: 11/21/2022] Open
Abstract
Background Readmission is a serious and adverse event for elderly patients. Despite efforts, predicting the risk of readmission remains imprecise. The objective of this study is to examine if performance-based tests of daily activities can identify elderly patients at risk of readmission within 26 weeks after discharge from a short-stay unit in the emergency department. Methods The current study is an observational study based on data from 144 elderly patients included in a previous non-randomised controlled trial. Before discharge, patients were assessed for limitations in performing daily activities using three performance-based tests with predetermined cut-off values: the Assessment of Motor and Process Skills, Timed Up and Go and the 30s-Chair Stand Test. Outcome was risk of readmission within 26 weeks after discharge. Results Limitations in performing daily activities were associated with risk of readmission as measured by the Assessment of Motor and Process Skills motor scale (Crude OR = 4.38 [1.36; 14.12]), (Adjusted OR = 4.17 [1.18; 14.75]) and the 30s-Chair Stand Test (Adjusted OR = 3.36 [1.42; 7.93]). No significant associations were found in regards to other measures. Conclusion The Assessment of Motor and Process Skills motor scale and the age, gender and comorbidity adjusted 30s-Chair Stand Test can identify elderly patients at increased risk of readmission after discharge from the emergency department. The results were limited by one-third of the patients did not perform the Assessment of Motor and Process Skills and the association between 30s-Chair Stand Test and risk of readmission were only positive when adjusted for age, gender and comorbidity.
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Affiliation(s)
- Louise Moeldrup Nielsen
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Arhus, Denmark. .,Department of Occupational Therapy, VIA University College, Aarhus, Denmark.
| | - Thomas Maribo
- Department of Public Health, Aarhus University, Aarhus, Denmark.,DEFACTUM, Central Denmark Region, Aarhus, Denmark
| | - Hans Kirkegaard
- Research Centre for Emergency Medicine, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
| | | | - Lisa Gregersen Oestergaard
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Arhus, Denmark.,Department of Public Health, Aarhus University, Aarhus, Denmark.,DEFACTUM, Central Denmark Region, Aarhus, Denmark.,The Research Initiative for Activity Studies and Occupational Therapy, General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
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17
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Montgomery G, McPhee J, Pääsuke M, Sipilä S, Maier AB, Hogrel JY, Degens H. Determinants of Performance in the Timed Up-and-Go and Six-Minute Walk Tests in Young and Old Healthy Adults. J Clin Med 2020; 9:E1561. [PMID: 32455757 PMCID: PMC7290512 DOI: 10.3390/jcm9051561] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/13/2020] [Accepted: 05/15/2020] [Indexed: 12/16/2022] Open
Abstract
The aim of this study was to assess associations between performance in the timed up-and-go (TUG) and six-minute walk distance (6MWD) with physiological characteristics in young and old healthy adults. Thereto, we determined TUG, 6MWD, normalised jump power, centre of pressure displacement during 1-leg standing, forced expiratory volume in 1 s, percentage of age-predicted maximal heart rate (HR%) and height in 419 healthy young (men: 23.5 ± 2.8 years, women: 23.2 ± 2.9 years) and old (men: 74.6 ± 3.2 years, women: 74.1 ± 3.2 years) adults. Normalised jump power explained 8% and 19% of TUG in young (p = 0.025) and older men (p < 0.001), respectively. When fat mass percentage and age were added to normalised jump power, 30% of TUG was explained in older men (R2adj = 0.30, p < 0.001 to 0.106). Appendicular lean muscle mass percentage (ALM%) and age were the best determinants of TUG for older women (R2adj = 0.16, p < 0.001 to 0.01). HR% explained 17-39% of 6MWD across all groups (R2adj = 0.17 to 39, p < 0.001). In conclusion, in men, jump power was a key determinant for TUG, while in old women only it was the ALM%. As HR% was the most important determinant of 6MWD, motivational bias needs to be considered in the interpretation of this test.
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Affiliation(s)
- Gallin Montgomery
- Musculoskeletal Science and Sports Medicine, Department of Sport and Exercise Sciences, Manchester Metropolitan University, Manchester M15 6BH, UK;
| | - Jamie McPhee
- Musculoskeletal Science and Sports Medicine, Department of Sport and Exercise Sciences, Manchester Metropolitan University, Manchester M15 6BH, UK;
| | - Mati Pääsuke
- Institute of Sport Sciences and Physiotherapy, Faculty of Medicine, University of Tartu, 51014 Tartu, Estonia;
| | - Sarianna Sipilä
- Gerontology Research Center, Faculty of Sport and Health Sciences, University of Jyvsäkylä, FI-40014 Jyvsäkylä, Finland;
| | - Andrea B Maier
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, 1081 BT Amsterdam, The Netherlands;
- Department of Medicine and Aged Care, The Royal Melbourne Hospital, The University of Melbourne, Victoria 3010, Australia
| | - Jean-Yves Hogrel
- Neuromuscular Investigation Center, Institute of Myology, Pitié-Salpêtrière Hospital, 73013 Paris, France;
| | - Hans Degens
- Musculoskeletal Science and Sports Medicine, School of Healthcare Science, Manchester Metropolitan University, Manchester M1 5GD, UK;
- Institute of Sport Science and Innovations, Lithuanian Sports University, LT-44221 Kaunas, Lithuania
- University of Medicine and Pharmacy of Targu Mures, 540142 Targu Mures, Romania
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Khant N, Dani VB, Patel P, Rathod R. Establishing the reference value for "timed up-and-go" test in healthy adults of Gujarat, India. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2018; 7:62. [PMID: 29922691 PMCID: PMC5963216 DOI: 10.4103/jehp.jehp_12_18] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 02/06/2018] [Indexed: 05/27/2023]
Abstract
CONTEXT Timed up-and-go (TUG) test is a valid, reliable, and an objective test for quantifying functional mobility and assessing the fall risk in all age groups. The analysis of patient scores on TUG test is limited by lack of data, having a wide range of performance scores among people without disabilities. AIM The objective of the study was to provide the reference value for TUG test in healthy individuals of Gujarat, India. SUBJECTS AND METHODS It was a cross-sectional observational study. Five hundred and twenty healthy individuals, aged 40-70 years, were recruited from various regions of Gujarat based on convenient sampling. All the participants were made to perform TUG test in a controlled environment in community. Three readings of the actual test were obtained and averaged. RESULTS Data were analyzed with mean, standard deviation, confidence intervals (CIs 95%) and Pearson's correlation coefficient (r) with α = 0.05 by age groups (40-50, 51-60, and 61-70 years) and gender. The mean (CI 95%) TUG time for healthy adults of Gujarat was 8.46 (8.35-8.57) s and demonstrated age-related decline for both male and female participants. TUG time also demonstrated strong correlation with the height of individuals. CONCLUSION This preliminary data can be used as a reference only for specific population with specific age groups due to variability in test results among the different population due to age, gender, anthropometric measures such as height, weight, and body mass index, geographical variation, nutritional support, and cognitive status.
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Affiliation(s)
- Nency Khant
- Physiotherapy Department, B N Patel College of Physiotherapy, Anand, Gujarat, India
| | - Vyoma Bharat Dani
- Physiotherapy Department, KM Patel Institute of Physiotherapy, Shree Krishna Hospital, Anand, Gujarat, India
| | - Purvi Patel
- Physiotherapist, NCD Cell, CHC-Charada, Mansa, Gandhinagar, Gujarat, India
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