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Alissa N, Shipper AG, Zilliox L, Westlake KP. A Systematic Review of the Effect of Physical Rehabilitation on Balance in People with Diabetic Peripheral Neuropathy Who are at Risk of Falling. Clin Interv Aging 2024; 19:1325-1339. [PMID: 39050517 PMCID: PMC11268776 DOI: 10.2147/cia.s459492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 05/25/2024] [Indexed: 07/27/2024] Open
Abstract
Background Falls are a significant issue in people with diabetic peripheral neuropathy. Balance interventions have been broadly administered in individuals with diabetic peripheral neuropathy, but the effects on static and dynamic balance in those who are at risk of falling have not yet been comprehensively reviewed. Objective To provide a synthesis of the literature regarding the effectiveness of physical rehabilitation interventions to improve balance in people with diabetic peripheral neuropathy who are at risk of falling. Methods Four databases (PubMed, Embase, the Cochrane Central Register of Controlled Trials, Cumulated Index in Nursing and Allied Health Literature) were systematically searched from inception to July 2022. Articles meeting the eligibility criteria (ie, participants with diabetic peripheral neuropathy and at risk of falling based on validated fall balance outcome risk cut off scores; inclusion of physical rehabilitation intervention) underwent a quality assessment using the Physiotherapy Evidence Database scale. Data regarding fall risk was extracted. Results Sixteen studies met the eligibility criteria. Participants in six studies improved balance such that their fall risk was reduced from a moderate-high risk of falls to no or low risk of falls from pre- to post-intervention. Interventions within these six studies were variable and included balance exercise, gait training, endurance, tai-chi with mental imagery, proprioceptive training, aerobic training, and yoga. Participants in seven of the remaining studies showed no improvement and participants in three studies showed mixed results regarding improved balance and reduced fall risk status by post-intervention. Conclusion While physical rehabilitation is sufficient to improve balance in individuals with diabetic peripheral neuropathy who are at risk of falling, few interventions led to improved balance and reduced fall risk. Interventions involving intentional weight shifting, manipulation of the base of support, and displacement of the center of mass such as tai-chi and yoga appear to provide the most consistent results in terms of decreasing fall risk. To better understand the effectiveness of rehabilitation on balance and fall risk, future studies should examine the impact of physical interventions on prospective fall rates.
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Affiliation(s)
- Nesreen Alissa
- University of Maryland School of Medicine, Department of Physical Therapy and Rehabilitation Science, Baltimore, MD, USA
| | | | - Lindsay Zilliox
- University of Maryland School of Medicine, Department of Neurology, Baltimore, ML, USA
| | - Kelly P Westlake
- University of Maryland School of Medicine, Department of Physical Therapy and Rehabilitation Science, Baltimore, MD, USA
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Fujinami Y, Nosaka H, Sato K, Kirita M. Decrease in Tongue Pressure in Frail Patients in the Sitting Position and Its Alleviation by Plantar Grounding. J Clin Med 2024; 13:3697. [PMID: 38999263 PMCID: PMC11242899 DOI: 10.3390/jcm13133697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 06/21/2024] [Accepted: 06/24/2024] [Indexed: 07/14/2024] Open
Abstract
PURPOSE The deterioration of oral function has received much attention, also being referred to as "Oral frailty". This study evaluated the change in tongue pressure, one of the objective items of oral frailty, to examine the relationship between body position and tongue pressure. METHODS This study was a prospective, observational study conducted in a single center. The participants were categorized by their Clinical Frailty Scale (CFS) scores. Tongue pressure was measured in the following positions: dorsal, sitting, and sitting with plantar grounding. Differences in tongue pressure between CFS and between body positions were statistically analyzed. RESULTS A significant decrease in tongue pressure was demonstrated in CFS4 compared to CFS3. Furthermore, in CFS5 and CFS6, tongue pressure decreased in the sitting position compared to that in the dorsal position, and tongue pressure recovered to the dorsal level with plantar grounding. CONCLUSIONS Tongue pressure decreased with the progression of frailty. It was decreased by sitting, and this decrease was alleviated by plantar grounding.
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Affiliation(s)
- Yoshihisa Fujinami
- Department of Emergency Medicine, Kakogawa Central City Hospital, Hyogo 675-8611, Japan; (H.N.); (K.S.); (M.K.)
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Lesch KJ, Tuomisto S, Tikkanen HO, Venojärvi M. Validity and Reliability of Dynamic and Functional Balance Tests in People Aged 19-54: A Systematic Review. Int J Sports Phys Ther 2024; 19:381-393. [PMID: 38699672 PMCID: PMC11065456 DOI: 10.26603/001c.94612] [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] [Received: 09/18/2023] [Accepted: 01/28/2024] [Indexed: 05/05/2024] Open
Abstract
Evaluating an impairment in an individual's capacity to maintain, achieve, or restore balance suggests a deficiency in postural control. For effective identification of individuals at risk for falls, balance assessment should exhibit reliability, validity, and ease of use. This systematic review concentrated on dynamic and functional balance assessment methods and their validity in healthy adults aged 19-54. The objective was to clarify the tools that health professionals can utilize to assess balance in this healthy population. Methods A systematic literature search conducted in August 2019 yielded nine articles meeting predefined selection criteria. Inclusion criteria required studies featuring healthy adult participants aged 19-54, published in English, and focusing on dynamic and functional balance testing. Exclusion criteria excluded studies involving participants with chronic diseases or musculoskeletal disorders, systematic reviews, professional athletes, and those lacking specific participant age information. The quality of the studies was evaluated using a modified PEDro scale. Results This review analyzed ten distinct postural balance tests. The Star Excursion Balance Test and Y-Balance Test exhibited moderate to high reliability, establishing them as dependable measures of dynamic balance. The Nintendo Wii Balance Board, Clever Balance Board, and Posturomed device also displayed excellent reliability for assessing dynamic postural balance. Comparing one-arm and two-arm functional reach tests, the one-arm reach test emerged as a more suitable option for evaluating dynamic balance among young adults. Moreover, an investigation comparing three dynamic balance tests (one-leg jump landing, Posturomed device, and stimulated forward fall) revealed a low correlation among these tests, indicating a measurement of different balance constructs. Discussion In conclusion, the Y-Balance Test stands out as the most practical dynamic balance assessment for clinical use, characterized by a standardized protocol, good repeatability, affordability, and ease of application. The Nintendo Wii Balance Board also presents itself as a cost-effective and reliable tool for dynamic balance evaluation in clinical settings. It is crucial to recognize that these tests appraise discrete postural skills, preventing direct comparisons between test outcomes. This review equips healthcare professionals with valuable insights into optimal balance assessment methods for the healthy, 19 to 54 aged population. Levels of evidence Level 3.
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Affiliation(s)
- Kim J Lesch
- Institute of Biomedicine, Sports and Exercise MedicineUniversity of Eastern Finland, Kuopio, Finland
| | - Sanni Tuomisto
- Institute of Biomedicine, Sports and Exercise MedicineUniversity of Eastern Finland, Kuopio, Finland
| | - Heikki O Tikkanen
- Institute of Biomedicine, Sports and Exercise MedicineUniversity of Eastern Finland, Kuopio, Finland
| | - Mika Venojärvi
- Institute of Biomedicine, Sports and Exercise MedicineUniversity of Eastern Finland, Kuopio, Finland
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de Oliveira MPB, Pereira DS, da Silva SLA, Alencar MA, Iunes DH, da Silva Alexandre T. Are assessment measures for components of the International Classification of Functioning, Disability and Health reproducible for use on pre-frail and frail older adults? A systematic review. Exp Gerontol 2023; 182:112300. [PMID: 37769825 DOI: 10.1016/j.exger.2023.112300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 12/06/2022] [Accepted: 09/25/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVE To analyze the internal consistency, reliability and measurement error of assessment measures for body structure and function (postural balance, muscle strength, cardiorespiratory function and physical fitness), activity (walking and mobility) and participation (quality of life and social reintegration) outcomes for use on pre-frail and frail older adults. METHODS Searches were performed in six databases (Medline, Embase, ScienceDirect, Web of Science, The Cochrane Library and Lilacs) and reproducibility studies were included. Cronbach's alpha and the classification proposed by Terwee et al. (2007) were used for the interpretation of internal consistency. The intraclass correlation coefficient (ICC) and the Munro classification were used for the determination of reliability. The standard error of measurement (SEM), minimal detectable change (MDC) as well as percentages of error (SEM%) and change (MDC%) were calculated. Methodological quality of the studies was appraised using Boxes 4, 6 and 7 of the COSMIN Risk of Bias checklist. RESULTS Six studies were included in the present systematic review, with a total of 835 (82.4 years; 582 women and 253 men) pre-frail and frail older adults analyzed. Seven measures were identified for the assessment of body structure and function, activity and participation outcomes (Hierarchical Assessment of Balance and Mobility, Self-Assessment of Physical Fitness, Sarcopenia Quality of Life, Reintegration to Normal Living Index, Two-Minute Walking test, Six-Minute Walking test and Ten-Meter Walking test). The following measurement properties were identified: internal consistency = 0.84 (mean Cronbach's alpha); reliability = 0.87 (mean ICC); SEM range = 0.06 to 10.10; MDC range = 0.13 to 28.10; SEM% range = 5.2 % to 9.5 %; and MDC% range = 10.7 % to 28.5 %. CONCLUSION The present systematic review found adequate internal consistency, high reliability and an acceptable measurement error for assessment measures of body structure and function, activity and participation outcomes for use on pre-frail and frail older adults.
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Affiliation(s)
| | - Daniele Sirineu Pereira
- Department of Physical Therapy, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Mariana Asmar Alencar
- Department of Physical Therapy, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Denise Hollanda Iunes
- Department of Physical Therapy, Federal University of Alfenas, Alfenas, Minas Gerais, Brazil.
| | - Tiago da Silva Alexandre
- Department of Gerontology and Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil; Department of Epidemiology and Public Health, University College London, London, United Kingdom.
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Can Virtual Reality-Assisted Therapy Offer Additional Benefits to Patients With Vestibular Disorders Compared With Conventional Vestibular Physical Therapy? A Meta-analysis. Arch Phys Med Rehabil 2023; 104:490-501. [PMID: 36265531 DOI: 10.1016/j.apmr.2022.08.972] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 08/10/2022] [Accepted: 08/16/2022] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To determine whether virtual reality-assisted therapy (VRAT) significantly improves the treatment of peripheral or central vestibular disorders when compared with conventional vestibular physical therapy (CVPT) alone. Indicators of vestibular symptoms are used to determine this. DATA SOURCES Two reviewers independently searched PubMed, EMBASE, ClinicalTrials.gov, Web of Science, and the Cochrane Collaboration database from January 2010 to January 2022 for studies reporting on VRAT in vestibular disorders. STUDY SELECTION Randomized controlled trials (RCTs) were included that mainly focused on the following measures: the Dizziness Handicap Inventory (DHI), Simulator Sickness Questionnaire, visual analog scale, and balance measures such as the Activities-specific Balance Confidence Scale (ABC), timed Up and Go test, sensory organization test, and center of pressure. The primary outcome was assessment of symptomatic changes before and after VRAT. DATA EXTRACTION Two authors independently conducted the literature search and selection. After screening, meta-analysis was performed on the RCTs using RevMan 5.3 software. DATA SYNTHESIS The results showed that VRAT produced significantly greater improvement than CVPT alone in scores of DHI-Total (standardized mean difference [SMD]: -7.09, 95% confidence interval [CI]: [-12.17, -2.00], P=.006), DHI-Functional (SMD=-3.66, 95% CI: [-6.34, -0.98], P=.007), DHI-Physical (SMD=-3.14, 95% CI: [-5.46, -0.83], P=.008), and DHI-Emotional (SMD=-3.10, 95% CI: [-5.13, -1.08], P=.003). ABC scores did not show improvement (SMD: 0.58, 95% CI: [-3.69, 4.85], P=.79). Subgroup analysis showed that DHI-Total between-group differences were insignificant for central vestibular disorders (SMD=-1.47, 95% CI: [-8.71, -5.78], P=.69), although peripheral disorders showed significant improvements (SMD=-9.58, 95% CI: [-13.92, -5.25], P<.0001). However, the included studies showed high heterogeneity (I2>75%). CONCLUSIONS VRAT may offer additional benefits for rehabilitation from vestibular diseases, especially peripheral disorders, when compared with CVPT alone. However, because of high heterogeneity and limited data, additional studies with a larger sample size and more sensitive and specific measurements are required to conclusively determine the evidence-based utility of virtual reality.
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Rabelo LG, Bjornsdottir A, Jonsdottir AB, Einarsson SG, Karason S, Sigurdsson MI. Frailty assessment tools and associated postoperative outcomes in older patients undergoing elective surgery: A prospective pilot study. Acta Anaesthesiol Scand 2023; 67:150-158. [PMID: 36307919 DOI: 10.1111/aas.14162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 10/02/2022] [Accepted: 10/22/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND There is a need for a feasible tool to assess the risk of frailty prior to surgery. We aimed to identify the ratio of abnormal results for three clinically applicable screening tools to assess the risk of frailty, and their association with adverse outcomes in a cohort of elderly surgical patients. METHODS In this prospective pilot study, patients ≥65 years undergoing preoperative evaluation for elective surgery were included and subjected to three frailty screening tests; Program of Research to Integrate Services for the Maintenance of Autonomy 7-item questionnaire (PRISMA7), Timed Up and Go (TUG), and Clock Drawing Test (CDT). The primary outcome was the incidence of abnormal testing, and secondary outcomes were the association between abnormal tests and mortality, readmission, delirium, surgical complications and non-home discharge. RESULTS Out of 99 patients, 41%, 37%, and 43% had abnormal PRISMA7, TUG, and CDT screening, respectively. Postoperative delirium was more likely to occur in patients with abnormal TUG screening (19% vs. 3%, p = .011) and CDT (17% vs. 2%, p = .019). When analyzing screening tool combinations, patients with abnormal PRISMA7 and TUG had a higher rate of non-home discharge (38% vs. 17%, p = .029); and patients with abnormal TUG and CDT had a higher rate of postoperative delirium (25% vs. 3%, p = .006) and any surgical complication (58% vs. 38%, p = .037); and patients with abnormal results from all three tools had a higher rate of postoperative delirium (21% vs. 5%, p = .045) and non-home discharge (42% vs. 18%, p = .034). CONCLUSION Approximately 40% of elderly surgical patients have abnormal PRISMA7, TUG, and CDT screening tests for frailty, and they are associated individually or in combination with increased risk of adverse postoperative outcomes. The results will aid in designing studies to further risk-stratify patients at risk of frailty and attempt to modify associated outcomes.
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Affiliation(s)
- Luis G Rabelo
- Division of Anaesthesia and Intensive Care Medicine, Perioperative Services, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | | | - Anna B Jonsdottir
- Geriatric and Rehabilitation Services, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - Sveinn G Einarsson
- Division of Anaesthesia and Intensive Care Medicine, Perioperative Services, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - Sigurbergur Karason
- Division of Anaesthesia and Intensive Care Medicine, Perioperative Services, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - Martin I Sigurdsson
- Division of Anaesthesia and Intensive Care Medicine, Perioperative Services, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
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Leizerowitz GM, Gabai R, Plotnik M, Keren O, Karni A. Improving old tricks as new: Young adults learn from repeating everyday activities. PLoS One 2023; 18:e0285469. [PMID: 37167235 PMCID: PMC10174589 DOI: 10.1371/journal.pone.0285469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 04/24/2023] [Indexed: 05/13/2023] Open
Abstract
The notion that young healthy adults can substantially improve in activities that are part of their daily routine is often overlooked because it is assumed that such activities have come to be fully mastered. We followed, in young healthy adults, the effects of repeated executions of the Timed-Up-and-Go (TUG) task, a clinical test that assesses the ability to execute motor activities relevant to daily function-rising from a seated position, walking, turning and returning to a seated position. The participants (N = 15) performed 18 consecutive trials of the TUG in one session, and were retested on the following day and a week later. The participants were video recorded and wore inertial measurement units. Task execution times improved robustly; performance was well fitted by a power function, with large gains at the beginning of the session and nearing plateau in later trials, as one would expect in the learning of a novel task. Moreover, these gains were well retained overnight and a week later, with further gains accruing in the subsequent test-sessions. Significant intra-session and inter-session changes occurred in step kinematics as well; some aspects underwent inter-sessions recalibrations, but other aspects showed delayed inter-session changes, suggesting post-practice memory consolidation processes. Even common everyday tasks can be improved upon by practice; a small number of consecutive task repetitions can trigger lasting gains in young healthy individuals performing highly practiced routine tasks. This new learning in highly familiar tasks proceeded in a time-course characteristic of the acquisition of novel 'how to' (procedural) knowledge.
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Affiliation(s)
- Gil Meir Leizerowitz
- Sagol Department of Neurobiology, University of Haifa, Haifa, Israel
- The Rehabilitation Hospital, C. Sheba Medical Center, Ramat Gan, Israel
| | - Ran Gabai
- Technion-Israel Institute of Technology, Haifa, Israel
| | - Meir Plotnik
- Center of Advanced Technologies in Rehabilitation, C. Sheba Medical Center, Ramat Gan, Israel
- Faculty of Medicine & Sagol School of Neuroscience, Department of Physiology and Pharmacology, Tel Aviv University, Tel Aviv, Israel
| | - Ofer Keren
- The Rehabilitation Hospital, C. Sheba Medical Center, Ramat Gan, Israel
- Galilee Rehabilitation Center, Karmiel, Israel
| | - Avi Karni
- Sagol Department of Neurobiology, University of Haifa, Haifa, Israel
- The E. J. Safra Brain Research Center for the Study of Learning Disabilities, University of Haifa, Haifa, Israel
- Department of Diagnostic Imaging, C. Sheba Medical Center, Ramat Gan, Israel
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Asahina Y, Sakaguchi Y, Kajimoto S, Hattori K, Oka T, Kaimori JY, Kashihara N, Isaka Y. A Randomized Controlled Trial of Whole-Body Vibration on Gait Ability and Balance among Older Hemodialysis Patients. Clin J Am Soc Nephrol 2023; 18:84-90. [PMID: 36719160 PMCID: PMC10101606 DOI: 10.2215/cjn.0000000000000018] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 11/01/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND Gait abnormality is a serious problem among hemodialysis patients. Whole-body vibration is a simple exercise that induces sustained muscular contractions through mechanical vibrations. This training improved gait ability in older adults. We aimed to investigate the effect of whole-body vibration on balance and gait ability in older hemodialysis patients. METHODS We conducted a 12-week, open-label, multicenter, randomized controlled trial of 98 hemodialysis patients, who were aged ≥65 years, from three dialysis centers in Japan. Those who had difficulty walking alone or dementia were excluded. Patients were randomly allocated to the whole-body vibration group or control group. The training was performed for 3 minutes thrice a week on dialysis days. The primary outcome was the Timed Up and Go test. The secondary outcomes were the single-leg stand test and 30-second chair stand test. RESULTS The mean (SD) age of the participants was 76 (7) years. The mean (SD) Timed Up and Go test was 12.0 (6.6) and 11.8 (7.0) seconds in the whole-body vibration and control groups, respectively. During the 12-week study period, 6 (12%) of 49 patients in the whole-body vibration group and 3 (6%) of 49 patients in the control group dropped out. In the whole-body vibration group, 42 (86% of the randomly allocated patients) completed the training according to the protocol. The mean (SD) changes in the Timed Up and Go test were -1.1 (4.0) and -1.4 (4.4) seconds in the whole-body vibration and control groups, respectively (change, 0.3 seconds in the whole-body vibration group; 95% confidence interval, -1.4 to 2.0; P=0.71). The changes in the single-leg stand test and 30-second chair stand test did not differ significantly between groups. There were no musculoskeletal adverse events directly related to this training. CONCLUSIONS Whole-body vibration did not improve balance and gait ability. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER Effect of Whole Body Vibration on Walking Performance in Elderly Hemodialysis Patients NCT04774731.
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Affiliation(s)
- Yuta Asahina
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yusuke Sakaguchi
- Department of Inter-Organ Communication Research in Kidney Diseases, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Sachio Kajimoto
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Koki Hattori
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Tatsufumi Oka
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Jun-Ya Kaimori
- Department of Inter-Organ Communication Research in Kidney Diseases, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Naoki Kashihara
- Department of Nephrology and Hypertension, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Yoshitaka Isaka
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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Fong KNK, Chung RCK, Sze PPC, NG CKM. Factors associated with fall risk of community-dwelling older people: A decision tree analysis. Digit Health 2023; 9:20552076231181202. [PMID: 37325076 PMCID: PMC10262624 DOI: 10.1177/20552076231181202] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 05/24/2023] [Indexed: 06/17/2023] Open
Abstract
Objective To examine the predictive attributes for accidental falls in community-dwelling older people in Hong Kong using decision tree analysis. Methods We recruited 1151 participants with an average age of 74.8 years by convenience sampling from a primary healthcare setting to carry out the cross-sectional study over 6 months. The whole dataset was divided into two sets, namely training set and test set, which respectively occupied 70% and 30% of the whole dataset. The training dataset was used first; decision tree analysis was used to identify possible stratifying variables that could help to generate separate decision models. Results The number of fallers was 230 with 20% 1-year prevalence. There were significant differences in gender, use of walking aids, presence of chronic diseases, and co-morbidities including osteoporosis, depression, and previous upper limb fractures, and performance in the Timed Up and Go test and the Functional Reach test among the baselines between the faller and non-faller groups. Three decision tree models for the dependent dichotomous variables (fallers, indoor fallers, and outdoor fallers) were generated, with overall accuracy rates of the models of 77.40%, 89.44% and 85.76%, respectively. Timed Up and Go, Functional Reach, body mass index, high blood pressure, osteoporosis, and number of drugs taken were identified as stratifying variables in the decision tree models for fall screening. Conclusion The use of decision tree analysis for clinical algorithms for accidental falls in community-dwelling older people creates patterns for decision-making in fall screening, which also paves the way for utility-based decision-making using supervised machine learning in fall risk detection.
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Affiliation(s)
- Kenneth N K Fong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR
| | - Raymond C K Chung
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR
| | - Patrick P C Sze
- Elderly Resources Centre, Hong Kong Housing Society, Hong Kong SAR
| | - Carmen K M NG
- Elderly Resources Centre, Hong Kong Housing Society, Hong Kong SAR
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Braun T, Thiel C, Peter RS, Bahns C, Büchele G, Rapp K, Becker C, Grüneberg C. Association of clinical outcome assessments of mobility capacity and incident disability in community-dwelling older adults - a systematic review and meta-analysis. Ageing Res Rev 2022; 81:101704. [PMID: 35931411 DOI: 10.1016/j.arr.2022.101704] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/19/2022] [Accepted: 08/01/2022] [Indexed: 01/31/2023]
Abstract
The objective of the present review is to synthesize all available research on the association between mobility capacity and incident disability in non-disabled older adults. MEDLINE, EMBASE and CINAHL databases were searched without any limits or restrictions until February 2021. Published reports of longitudinal cohort studies that estimated a direct association between baseline mobility capacity, assessed with a standardized outcome assessment, and subsequent development of disability, including initially non-disabled older adults were included. The risk of bias was assessed using the Quality in Prognosis Studies (QUIPS) tool. Random-effect models were used to explore the objective. The certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. The main outcome measures were the pooled relative risks (RR) per one conventional unit per mobility assessment for incident disability. A total of 40 reports (85,515 participants at baseline) were included. For usual and fast gait speed, the RR per -0.1 m/s was 1.23 (95% CI: 1.18-1.28; 26,638 participants) and 1.28 (95% CI: 1.19-1.38; 8161 participants), respectively. Each point decrease in Short Physical Performance Battery score increased the risk of incident disability by 30% (RR = 1.30, 95% CI: 1.23-1.38; 9183 participants). The RR of incident disability by each second increase in Timed Up and Go test and Chair Rise Test performance was 1.15 (95% CI: 1.09-1.21; 30,426 participants) and 1.07 (95% CI: 1.04-1.10; 9450 participants), respectively. The review concludes that among community-dwelling non-disabled older adults, poor mobility capacity is a potent modifiable risk factor for incident disability. Mobility impairment should be mandated as a quality indicator of health for older people.
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Affiliation(s)
- Tobias Braun
- Department of Applied Health Sciences, Hochschule für Gesundheit (University of Applied Sciences), Bochum, Germany; Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany; HSD Hochschule Döpfer (University of Applied Sciences), Department of Health, Cologne, Germany.
| | - Christian Thiel
- Department of Applied Health Sciences, Hochschule für Gesundheit (University of Applied Sciences), Bochum, Germany; Faculty of Sports Science, Ruhr-University Bochum, Bochum, Germany
| | - Raphael Simon Peter
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Carolin Bahns
- Department of Therapy Science I, Brandenburg Technical University Cottbus - Senftenberg, Senftenberg, Germany
| | - Gisela Büchele
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Kilian Rapp
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Clemens Becker
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany; Digital Geriatric Medicine, Medical Clinic, Heidelberg University, Germany
| | - Christian Grüneberg
- Department of Applied Health Sciences, Hochschule für Gesundheit (University of Applied Sciences), Bochum, Germany
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Zhou X, Wang B, Demkowicz PC, Johnson JS, Chen Y, Spakowicz DJ, Zhou Y, Dorsett Y, Chen L, Sodergren E, Kuchel GA, Weinstock GM. Exploratory studies of oral and fecal microbiome in healthy human aging. FRONTIERS IN AGING 2022; 3:1002405. [PMID: 36338834 PMCID: PMC9631447 DOI: 10.3389/fragi.2022.1002405] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/26/2022] [Indexed: 11/05/2022]
Abstract
Growing evidence has linked an altered host fecal microbiome composition with health status, common chronic diseases, and institutionalization in vulnerable older adults. However, fewer studies have described microbiome changes in healthy older adults without major confounding diseases or conditions, and the impact of aging on the microbiome across different body sites remains unknown. Using 16S ribosomal RNA gene sequencing, we reconstructed the composition of oral and fecal microbiomes in young (23-32; mean = 25 years old) and older (69-94; mean = 77 years old) healthy community-dwelling research subjects. In both body sites, we identified changes in minor bacterial operational taxonomic units (OTUs) between young and older subjects. However, the composition of the predominant bacterial species of the healthy older group in both microbiomes was not significantly different from that of the young cohort, which suggests that dominant bacterial species are relatively stable with healthy aging. In addition, the relative abundance of potentially pathogenic genera, such as Rothia and Mycoplasma, was enriched in the oral microbiome of the healthy older group relative to the young cohort. We also identified several OTUs with a prevalence above 40% and some were more common in young and others in healthy older adults. Differences with aging varied for oral and fecal samples, which suggests that members of the microbiome may be differentially affected by aging in a tissue-specific fashion. This is the first study to investigate both oral and fecal microbiomes in the context of human aging, and provides new insights into interactions between aging and the microbiome within two different clinically relevant sites.
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Affiliation(s)
- Xin Zhou
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, United States
- Department of Genetics and Genome Sciences, University of Connecticut Health Center, Farmington, CT, United States
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, United States
| | - Baohong Wang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University School of Medicine, Hangzhou City, China
| | - Patrick C. Demkowicz
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, United States
- Yale University School of Medicine, New Haven, CT, United States
| | - Jethro S. Johnson
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, United States
- Oxford Centre for Microbiome Studies, Kennedy Institute of Rheumatology, University of Oxford, Oxford, United Kingdom
| | - Yanfei Chen
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, United States
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University School of Medicine, Hangzhou City, China
| | - Daniel J. Spakowicz
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, United States
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States
| | - Yanjiao Zhou
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, United States
- Department of Medicine, University of Connecticut Health Center, Farmington, CT, United States
| | - Yair Dorsett
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, United States
- Department of Medicine, University of Connecticut Health Center, Farmington, CT, United States
| | - Lei Chen
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, United States
- Shanghai Institute of Immunology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Erica Sodergren
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, United States
| | - George A. Kuchel
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, United States
- UConn Center on Aging, University of Connecticut Health Center, Farmington, CT, United States
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12
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Braun T, Wiegard A, Geritz J, Hansen C, Tan KE, Hildesheim H, Kudelka J, Maetzler C, Welzel J, Romijnders R, Maetzler W, Bergmann P. Association between heart failure severity and mobility in geriatric patients: an in-clinic study with wearable sensors. J Geriatr Cardiol 2022; 19:660-674. [PMID: 36284678 PMCID: PMC9548060 DOI: 10.11909/j.issn.1671-5411.2022.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Individuals with heart failure (HF) frequently experience limitations in mobility, but specific aspects of these limitations are not well understood. This study investigated the association of HF severity, based on the New York Heart Association (NYHA) classes, with digital mobility outcomes (DMOs) and handgrip strength in older inpatients with HF. METHODS For this explorative analysis, hospital admission and discharge data from an ongoing, prospective cohort study were used. The sample included older participants with HF and a sub-sample of heart-healthy individuals. Participants were equipped with a wearable inertial measurement unit (IMU) system during mobility performance (balancing, sit-to-stand transfer, walking). We analyzed the association between 17 DMOs and HF severity with multiple linear regression models. RESULTS The total sample included 61 older participants (65-97 years of age, 55.7% female). Of all DMOs, only sway path in a semi-tandem stance position (m/s²) showed a relevant association with NYHA classes (admission: β = -0.28, P = 0.09; discharge: β = -0.39, P = 0.02). Handgrip strength showed a trend towards a significant association (admission: β = -0.15, P = 0.10; discharge: β = -0.15, P = 0.19). CONCLUSIONS This is to our best knowledge the first analysis on the association of HF severity and IMU-based DMOs. Sway path and handgrip strength may be the most promising parameters for monitoring mobility aspects in treatment of HF.
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Affiliation(s)
- Tobias Braun
- Department of Neurology, Kiel University, Arnold-Heller-Straße 3, 24105 Kiel, Germany
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801 Bochum, Germany
- HSD Hochschule Döpfer (University of Applied Sciences), Waidmarkt 3 und 9, 50676 Cologne, Germany
| | - Anna Wiegard
- Department of Neurology, Kiel University, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - Johanna Geritz
- Department of Neurology, Kiel University, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - Clint Hansen
- Department of Neurology, Kiel University, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - Kim Eng Tan
- Department of Neurology, Kiel University, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - Hanna Hildesheim
- Department of Neurology, Kiel University, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - Jennifer Kudelka
- Department of Neurology, Kiel University, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - Corina Maetzler
- Department of Neurology, Kiel University, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - Julius Welzel
- Department of Neurology, Kiel University, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - Robbin Romijnders
- Department of Neurology, Kiel University, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - Walter Maetzler
- Department of Neurology, Kiel University, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - Philipp Bergmann
- Department of Internal Medicine I, Christian-Albrechts-University of Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany
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13
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Kostka J, Sosowska N, Guligowska A, Kostka T. A Proposed Method of Converting Gait Speed and TUG Test in Older Subjects. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12145. [PMID: 36231451 PMCID: PMC9564782 DOI: 10.3390/ijerph191912145] [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: 08/22/2022] [Revised: 09/18/2022] [Accepted: 09/22/2022] [Indexed: 06/16/2023]
Abstract
Sarcopenia is one of the most important health problems in advanced age. In 2019, the European Working Group of Sarcopenia in Older People (EWGSOP) updated the operational diagnostic criteria for identification of people with sarcopenia (EWGSOP2). Among the two proposed low performance measures of sarcopenia are gait speed and the Timed Up and Go (TUG) test. Usage of any of those tools requires recalculation for the second one for eventual comparisons. The simple linear regression has been used for such comparisons in several previous studies, but the appropriateness of such an approach has not been verified. The aim of this study is to find the most appropriate model describing the relationship between these two popular measures of physical function. The study was performed in 450 consecutive outpatients of the Geriatric Clinic of the Medical University of Lodz, Poland, aged 70 to 92 years who volunteered to participate in the study. The TUG test and gait speed at 4 m to assess physical function were used. Different alternative models were compared to obtain the highest R-squared values. A Reciprocal-Y model (R-squared = 71.9%) showed the highest performance, followed by a Logarithmic-Y square root-X model (R-squared = 69.3%) and a Reciprocal-Y square root-X model (R-squared = 69.1%). The R-squared for the linear model was 49.5%. For the selected reciprocal model, the correlation coefficient was 0.85 and the equation of the fitted model was: Gait speed (m/s) = 1/(-0.0160767 + 0.101386 × TUG). In conclusion, in independent community-dwelling older adults, the relationship between gait speed and the TUG test in older subjects is nonlinear. The proposed reciprocal model may be useful for recalculations of gait speed or TUG in future studies.
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Affiliation(s)
- Joanna Kostka
- Department of Gerontology, Medical University of Lodz, Milionowa 14, 93-113 Lodz, Poland
| | - Natalia Sosowska
- Department of Geriatrics, Healthy Ageing Research Centre, Medical University of Lodz, Hallera 1, 90-647 Lodz, Poland
| | - Agnieszka Guligowska
- Department of Geriatrics, Healthy Ageing Research Centre, Medical University of Lodz, Hallera 1, 90-647 Lodz, Poland
| | - Tomasz Kostka
- Department of Geriatrics, Healthy Ageing Research Centre, Medical University of Lodz, Hallera 1, 90-647 Lodz, Poland
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O’Brien MK, Shin SY, Khazanchi R, Fanton M, Lieber RL, Ghaffari R, Rogers JA, Jayaraman A. Wearable Sensors Improve Prediction of Post-Stroke Walking Function Following Inpatient Rehabilitation. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE 2022; 10:2100711. [PMID: 36304845 PMCID: PMC9592048 DOI: 10.1109/jtehm.2022.3208585] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/31/2022] [Accepted: 09/19/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE A primary goal of acute stroke rehabilitation is to maximize functional recovery and help patients reintegrate safely in the home and community. However, not all patients have the same potential for recovery, making it difficult to set realistic therapy goals and to anticipate future needs for short- or long-term care. The objective of this study was to test the value of high-resolution data from wireless, wearable motion sensors to predict post-stroke ambulation function following inpatient stroke rehabilitation. METHOD Supervised machine learning algorithms were trained to classify patients as either household or community ambulators at discharge based on information collected upon admission to the inpatient facility (N=33-35). Inertial measurement unit (IMU) sensor data recorded from the ankles and the pelvis during a brief walking bout at admission (10 meters, or 60 seconds walking) improved the prediction of discharge ambulation ability over a traditional prediction model based on patient demographics, clinical information, and performance on standardized clinical assessments. RESULTS Models incorporating IMU data were more sensitive to patients who changed ambulation category, improving the recall of community ambulators at discharge from 85% to 89-93%. CONCLUSIONS This approach demonstrates significant potential for the early prediction of post-rehabilitation walking outcomes in patients with stroke using small amounts of data from three wearable motion sensors. CLINICAL IMPACT Accurately predicting a patient's functional recovery early in the rehabilitation process would transform our ability to design personalized care strategies in the clinic and beyond. This work contributes to the development of low-cost, clinically-implementable prognostic tools for data-driven stroke treatment.
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Affiliation(s)
- Megan K. O’Brien
- Max Nader Laboratory for Rehabilitation Technologies and Outcomes ResearchShirley Ryan AbilityLabChicagoIL60611USA
- Department of Physical Medicine and RehabilitationNorthwestern UniversityChicagoIL60611USA
| | | | | | | | - Richard L. Lieber
- Max Nader Laboratory for Rehabilitation Technologies and Outcomes ResearchShirley Ryan AbilityLabChicagoIL60611USA
- Department of Physical Medicine and RehabilitationNorthwestern UniversityChicagoIL60611USA
- Department of Biomedical EngineeringNorthwestern UniversityEvanstonIL60208USA
| | - Roozbeh Ghaffari
- Querrey Simpson Institute for Bioelectronics, Northwestern UniversityEvanstonIL60208USA
| | - John A. Rogers
- Querrey Simpson Institute for Bioelectronics, Northwestern UniversityEvanstonIL60208USA
- Department of Materials Science and EngineeringNorthwestern UniversityEvanstonIL60208USA
- Department of ChemistryNorthwestern UniversityEvanstonIL60208USA
- Department of Mechanical EngineeringNorthwestern UniversityEvanstonIL60208USA
- Department of Electrical Engineering and Computer ScienceNorthwestern UniversityEvanstonIL60208USA
| | - Arun Jayaraman
- Max Nader Laboratory for Rehabilitation Technologies and Outcomes ResearchShirley Ryan AbilityLabChicagoIL60611USA
- Department of Physical Medicine and RehabilitationNorthwestern UniversityChicagoIL60611USA
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15
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Nakhostin-Ansari A, Naghshtabrizi N, Naghdi S, Ghafouri M, Khalifeloo M, Mohammadzadeh M, Vezvaei P, Nakhostin Ansari N. Normative values of functional reach test, single-leg stance test, and timed “UP and GO” with and without dual-task in healthy Iranian adults: A cross-sectional study. Ann Med Surg (Lond) 2022; 80:104053. [PMID: 36045774 PMCID: PMC9422043 DOI: 10.1016/j.amsu.2022.104053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 06/19/2022] [Accepted: 06/21/2022] [Indexed: 11/28/2022] Open
Abstract
Background Balance impairment is a common problem in all age groups. There are several tools to assess balance. Functional reach test (FRT), single-leg stance (SLS) test, timed up and go (TUG) test, and TUG with the cognitive dual-task (TUGcog) are commonly employed balance tests. The current study aimed to determine the normative values of FRT, SLST, TUG, and TUGcog across age groups and genders in healthy Iranian adults. Methods We designed a cross-sectional study, and 240 healthy adults (120 males and 120 females) in six age groups (18–29, 30–39, 40–49, 50–59, 60–69, ≥70 years) completed FRT, SLST, TUG, and TUGcog based on the Persian version of BESTest instructions. Results There were significant age-specific declines in balance performances. Gender had effects on 18–29 years and older adults (≥60 years), and males performed better than females. Male and females had similar performance on the TUG and TUGcog tests in 60–69 years (p > 0.05). Conclusions The normative values of FRT, SLS, TUG, and TUGcog provided for healthy Iranian adults increase the clinical utility of tests, and serve as a reference to estimating the individuals’ balance performance across age and gender groups. This study provided reference values of four balance tests for Iranian adults. Performance in balance tests declines with age among Iranian adults. In most age groups, there is no significant difference between males and females regarding their balance.
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16
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Connelly DM. Recovery in Mobility by Community-Living Older Adults following Fragility Hip Fracture. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2022. [DOI: 10.1080/02703181.2021.2008086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Denise M. Connelly
- School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario London Ontario, Canada
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17
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Feldman PH, McDonald MV, Onorato N, Stein J, Williams O. Feasibility of deploying peer coaches to mentor frontline home health aides and promote mobility among individuals recovering from a stroke: pilot test of a randomized controlled trial. Pilot Feasibility Stud 2022; 8:22. [PMID: 35101133 PMCID: PMC8801561 DOI: 10.1186/s40814-022-00979-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 01/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Each year, approximately 100,000 individuals receive home health services after a stroke. Evidence has shown the benefits of home-based stroke rehabilitation, but little is known about resource-efficient ways to enhance its effectiveness, nor has anyone explored the value of leveraging low-cost home health aides (HHAs) to reinforce repetitive task training, a key component of home-based rehabilitation. We developed and piloted a Stroke Homehealth Aide Recovery Program (SHARP) that deployed specially trained HHAs as "peer coaches" to mentor frontline aides and help individuals recovering from stroke increase their mobility through greater adherence to repetitive exercise regimens. We assessed the feasibility of SHARP and its readiness for a full-scale randomized controlled trial (RCT). Specifically, we examined (1) the practicability of recruitment and randomization procedures, (2) program acceptability, (3) intervention fidelity, and (4) the performance of outcome measures. METHODS This was a feasibility study including a pilot RCT. Target enrollment was 60 individuals receiving post-stroke home health services, who were randomized to SHARP + usual home care or usual care only. The protocol specified a 30-day intervention with four planned in-home coach visits, including one joint coach/physical therapist visit. The primary participant outcome was 60-day change in mobility, using the performance-based Timed Up and Go and 4-Meter Walk Gait Speed tests. Interviews with participants, coaches, physical therapists, and frontline aides provided acceptability data. Enrollment figures, visit tracking reports, and audio recordings provided intervention fidelity data. Mixed methods included thematic analysis of qualitative data and quantitative analysis of structured data to examine the intervention feasibility and performance of outcome measures. RESULTS Achieving the 60-participant enrollment target required modifying participant eligibility criteria to accommodate a decline in the receipt of HHA services among individuals receiving home care after a stroke. This modification entailed intervention redesign. Acceptability was high among coaches and participants but lower among therapists and frontline aides. Intervention fidelity was mixed: 87% of intervention participants received all four planned coach visits; however, no joint coach/therapist visits occurred. Sixty-day follow-up retention was 78%. However, baseline and follow-up performance-based primary outcome mobility assessments could be completed for only 55% of participants. CONCLUSIONS The trial was not feasible in its current form. Before progressing to a definitive trial, significant program redesign would be required to address issues affecting enrollment, coach/HHA/therapist coordination, and implementation of performance-based outcome measures. TRIAL REGISTRATION ClinicalTrials.gov, NCT04840407 . Retrospectively registered on 9 April 2021.
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Affiliation(s)
- Penny H Feldman
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, 220 East 42nd Street, New York, NY, 10017, USA
| | - Margaret V McDonald
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, 220 East 42nd Street, New York, NY, 10017, USA.
| | - Nicole Onorato
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, 220 East 42nd Street, New York, NY, 10017, USA
| | - Joel Stein
- Department of Rehabilitation and Regenerative Medicine, Columbia University Vagelos College of Physicians and Surgeons, Department of Rehabilitation Medicine, Weill Cornell Medicine, New York-Presbyterian Hospital, 180 Ft. Washington Ave., Harkness Pavilion Room 1-165, New York, NY, 10032, USA
| | - Olajide Williams
- Department of Neurology, Columbia University, 710 West 168th Street, New York, NY, 10032, USA
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18
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Trautwein S. Personen mit Demenz – eine besondere Zielgruppe in der Sportwissenschaft. ZEITSCHRIFT FUR SPORTPSYCHOLOGIE 2022. [DOI: 10.1026/1612-5010/a000352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. In sportwissenschaftlichen Studien mit Personen mit Demenz ist es wichtig, die Besonderheiten der Zielgruppe zu berücksichtigen. Bisherige Studien weisen diesbezüglich Limitationen auf. Im Projekt Bewegung gegen Demenz wurde aufbauend auf einer Analyse des Forschungsstandes ein entsprechendes Studiendesign erarbeitet und in einer randomisierten kontrollierten Studie mit 319 Personen mit Demenz eingesetzt. Eine umfassende Betrachtung motorischer Tests unterstreicht die Bedeutung von angepassten Verfahren und gibt erste Empfehlungen. Die Überprüfung eines multimodalen Bewegungsprogrammes zeigt keine statistisch signifikanten Zeit*Gruppen-Effekte auf die motorische Leistung und den Gang. Explorative Analysen decken Unterschiede in der motorischen und kognitiven Ausgangsleistung zwischen Positiv-, Neutral- und Negativ-Respondern auf. Zudem erklären motorische und kognitive Leistungsänderungen bis zu 39.4 % der Varianz der Gangänderung. Die Ergebnisse und das erarbeitete Studiendesign bieten eine Grundlage für zukünftige Studien, verweisen aber gleichzeitig auf weiteren Forschungsbedarf. Außerdem unterstreichen die begrenzte Eignung eines standardisierten Bewegungsprogrammes sowie Hinweise auf zugrundeliegende Mechanismen die Bedeutung der Berücksichtigung des Individuums.
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Affiliation(s)
- Sandra Trautwein
- Institut für Sport und Sportwissenschaft, Karlsruher Institut für Technologie, Karlsruhe, Deutschland
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Takada Y, Tanaka S. Standard Error of the Mean and Minimal Detectable Change of Gait Speed in Older Adults Using Japanese Long-Term Care Insurance System. Gerontol Geriatr Med 2021; 7:23337214211048955. [PMID: 34692926 PMCID: PMC8531947 DOI: 10.1177/23337214211048955] [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: 06/04/2021] [Revised: 08/13/2021] [Accepted: 08/25/2021] [Indexed: 11/26/2022] Open
Abstract
Evaluation of motor function, such as gait ability, can accurately predict the
subsequent occurrence of disability in older adults. There are no reports of
standard error of the mean (SEM) or minimal detectable change (MDC) with respect
to gait in Japanese long-term care insurance-certified individuals. The purpose
of this study was to investigate the values of preferred gait, fast gait, and
the timed up and go (TUG) test. This study included 46 participants using the
Japanese long-term care insurance system. (age 86.5 ± 6.6 years, 12 men, 34
women). The duration of three gait were measured twice using a stopwatch. The
SEM was 0.07 for preferred gait, 0.09 for fast gait and 2.59 for TUG. The MDC
was 0.19 for preferred gait, 0.26 for fast gait, and 7.17 for TUG. The SEM and
MDC values of preferred gait, fast gait, and TUG in this study corroborated with
those of previous studies, whereas others were different. Considering that gait
speed differs with the country, it may be difficult to compare it among
different population groups. We obtained the results of gait speed of Japanese
long-term care insurance-certified individuals, which is a new finding
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Affiliation(s)
- Yui Takada
- Social Welfare Corporation Kowakai, Miyazaki, Japan
| | - Shigeharu Tanaka
- Faculty of Health and Social Services, Kanagawa University of Human Services, Yokosuka, Japan
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Laddu D, Kim H, Phillips SA, Jun M. INERTIA: A pilot study of the impact of progressive resistance training on blood pressure control in older adults with sarcopenia. Contemp Clin Trials 2021; 108:106516. [PMID: 34311098 DOI: 10.1016/j.cct.2021.106516] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 07/15/2021] [Accepted: 07/20/2021] [Indexed: 10/20/2022]
Abstract
Sarcopenia, and high blood pressure are highly prevalent, preventable conditions that pose significant burden for older adults and on the healthcare system. Current prevention and treatment of high blood pressure in sarcopenia, by non-pharmacological approaches remain limited and are far from optimal. Clinical trials and mechanistic studies provide encouraging evidence of a plausible therapeutic effect of progressive resistance training (PRT) on blood pressure in younger, and pre-hypertensive and hypertensive older adults. The impact of PRT on blood pressure has not been empirically tested in older adults with sarcopenia. This pilot study aims to provide effect size confidence intervals, clinical trial and intervention feasibility data, and procedural materials for a full-scale randomized controlled trial that will determine the efficacy of PRT intervention as a therapeutic strategy for blood pressure control in older adults with sarcopenia. Participants (N = 90) will be randomized to receive exercise educational materials or the PRT intervention consisting of 24 supervised exercise sessions over 12-weeks. Follow-up assessments will occur at 12-weeks and one-year later. The primary outcome is systolic blood pressure and diastolic blood pressure, analyzed separately. Microvascular mechanisms linking muscle (perfusion, strength, function) to changes in blood pressure will be explored at baseline and 12-weeks. This study will provide new evidence for the therapeutic effect of PRT as a non-pharmacological strategy for improving blood pressure. Insights gained may also inform of the potential role of muscle strength as a novel target for blood pressure control, and future exercise prescription guidelines related to muscle strengthening in high-risk older adults.
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Affiliation(s)
- Deepika Laddu
- University of Illinois at Chicago, Department of Physical Therapy, College of Applied Health Sciences, 1919 W. Taylor Street, Room 434 (MC 898), Chicago, IL 60612, United States of America.
| | - Hajwa Kim
- University of Illinois at Chicago, Center for Clinical and Translational Science, Biostatistics Core, 914 S. Wood Street, Room 233, Chicago, IL 60612, United States of America.
| | - Shane A Phillips
- University of Illinois at Chicago, Department of Physical Therapy, College of Applied Health Sciences, 1919 W. Taylor Street, Room 746 (MC 898), Chicago, IL 60612, United States.
| | - Ma Jun
- University of Illinois at Chicago, Department of Medicine, 1747 W. Roosevelt Rd, Room 586 (MC 275), Chicago, IL 60608, United States.
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Stasi S, Papathanasiou G, Diochnou A, Polikreti B, Chalimourdas A, Macheras GA. Modified Harris Hip Score as patient-reported outcome measure in osteoarthritic patients: psychometric properties of the Greek version. Hip Int 2021; 31:516-525. [PMID: 31984798 DOI: 10.1177/1120700020901682] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION This study explored the psychometric properties of the modified Harris Hip Score-Greek version (mHHS-Gr) as a patient-reported outcome (PRO) measure in osteoarthritic hip patients. METHODS Internal consistency, test-retest reliability and reproducibility were evaluated in 90 patients aged >55 years. Construct validity was tested against Greek versions of the Lower Extremity Functional Scale (LEFS-Greek) and WOMAC Index (WOMAC-Gr), and the Timed Up and Go (TUG) and 9-stairs-ascend/descend (9S-A/D) tests. Known-groups validity was examined using TUG score (cut-off 13.5 s) as an estimate variable. Responsiveness was examined before and 4 weeks after direct anterior minimal invasive surgery. RESULTS Reliability: Internal consistency was moderate (Cronbach's a = 0.614, p < 0.001). Test-retest reliability was excellent (ICC = 0.881, 95% CI, 0.824-0.920). Reproducibility: Floor and ceiling effects were both 1.1%; measurement error was 3.54 (p < 0.05); minimal important change was lower than minimal detectable change.Validity: mHHS-Gr correlated strongly with both LEFS-Greek and WOMAC-Gr (Pearson's r 0.801 and -0.783, respectively; p < 0.001). The questionnaire's correlations with TUG and 9S-A/D were also significant but moderate (Spearman's ρ: -0.547 and -0.575, respectively; p < 0.001). Known-groups validity showed that mHHS-Gr scores were significantly higher in participants with TUG < 13.5 seconds than in those with TUG > 13.5 seconds (p < 0.001). In ROC analysis, the cut-off point of 52.5 yielded sensitivity 81% and specificity 71%.Responsiveness: Standardised response mean and Guyatt's responsiveness statistic were greater than 0.8. DISCUSSION mHHS-Gr showed significant moderate to excellent reliability, significant moderate to strong validity properties and excellent responsiveness. Overall, mHHS-Gr could be a reliable and valid PRO measure for assessing patients with osteoarthritis of the hip.
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Affiliation(s)
- Sophia Stasi
- Laboratory of Neuromuscular and Cardiovascular Study of Motion, Physiotherapy Department, Faculty of Health and Care Sciences, University of West Attica, Egaleo, Attica, Greece
| | - George Papathanasiou
- Laboratory of Neuromuscular and Cardiovascular Study of Motion, Physiotherapy Department, Faculty of Health and Care Sciences, University of West Attica, Egaleo, Attica, Greece
| | - Afroditi Diochnou
- Laboratory of Neuromuscular and Cardiovascular Study of Motion, Physiotherapy Department, Faculty of Health and Care Sciences, University of West Attica, Egaleo, Attica, Greece
| | - Basiliki Polikreti
- Laboratory of Neuromuscular and Cardiovascular Study of Motion, Physiotherapy Department, Faculty of Health and Care Sciences, University of West Attica, Egaleo, Attica, Greece
| | - Antonios Chalimourdas
- Laboratory of Neuromuscular and Cardiovascular Study of Motion, Physiotherapy Department, Faculty of Health and Care Sciences, University of West Attica, Egaleo, Attica, Greece
| | - George A Macheras
- Laboratory of Neuromuscular and Cardiovascular Study of Motion, Physiotherapy Department, Faculty of Health and Care Sciences, University of West Attica, Egaleo, Attica, Greece.,4th Orthopaedic Department, "KAT" General Hospital of Attica, Kifissia, Attica, Greece
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22
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Beauchamp MK, Hao Q, Kuspinar A, D'Amore C, Scime G, Ma J, Mayhew A, Bassim C, Wolfson C, Kirkland S, Griffith L, Raina P. Reliability and minimal detectable change values for performance-based measures of physical functioning in the Canadian Longitudinal Study on Aging (CLSA). J Gerontol A Biol Sci Med Sci 2021; 76:2030-2038. [PMID: 34170316 PMCID: PMC8514069 DOI: 10.1093/gerona/glab175] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The aim of this study was to determine the relative and absolute reliabilities of five key performance-based measures of physical function in the Canadian Longitudinal Study on Aging (CLSA). METHODS An age-stratified sub-sample of 147 participants from the CLSA who were undergoing their 3-year data collection visit participated in two repeat visits (within one week). Participants underwent tests of grip strength, 4-metre gait speed, Timed Up and Go (TUG), chair-rise and single-leg stance (left, right, mean, maximum). Intra-class correlation coefficients (ICC), standard error of measurement (SEM) and minimal detectable change (MDC) values were calculated. RESULTS The relative reliability for grip strength was excellent (ICC = 0.95); the TUG and single-leg stance tests had good reliability (ICC = 0.80 or 0.78-0.82, respectively); gait speed and the chair-rise test had moderate reliability (ICC=0.64 for both) for participants overall. For participants between 50 and 64 years, TUG and gait speed had poor reliabilities (ICC = 0.38 or 0.33, respectively). For participants aged 75+ years, the single-leg stance had poor reliability (ICC=0.30-0.39). The MDC90 was about 6 kg for grip strength, 2.3 seconds for TUG, 0.2 metres/second for gait speed, 5.2 seconds for chair-rise, and ranged from 22.8 to 26.2 seconds for the single-leg stance. CONCLUSIONS Among community-dwelling Canadians >50 years old, the reliabilities of the CLSA measures were moderate to excellent. The TUG and gait speed in the youngest age group, and the single-leg stance in oldest age group, showed poor reliability. MDC values can be used to interpret changes over time.
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Affiliation(s)
- Marla K Beauchamp
- McMaster University Faculty of Health Sciences, Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Qiukui Hao
- McMaster University Faculty of Health Sciences, Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada.,The Center of Gerontology and Geriatrics/ National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Ayse Kuspinar
- McMaster University Faculty of Health Sciences, Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Cassandra D'Amore
- McMaster University Faculty of Health Sciences, Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Giulia Scime
- Canadian Longitudinal Study on Aging, Hamilton Data Collection Site, Hamilton, Ontario, Canada
| | - Jinhui Ma
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Alexandra Mayhew
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Carol Bassim
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Christina Wolfson
- Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, McGill University, Montreal, Quebec, Canada.,Research Institute of the McGill University Health Centre. , Montreal, Quebec, Canada
| | - Susan Kirkland
- Department of Community Health and Epidemiology and Division of Geriatric Medicine, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Lauren Griffith
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Parminder Raina
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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Normative scores for the Timed Up & Go in a Spanish sample of community-dweller adults with preserved functionality. Aten Primaria 2021; 53:102065. [PMID: 33901769 PMCID: PMC8094903 DOI: 10.1016/j.aprim.2021.102065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 11/18/2020] [Accepted: 02/26/2021] [Indexed: 11/24/2022] Open
Abstract
Our aim was to calculate the 'Timed Up & Go' (TUG) normative scores in a Spanish sample composed of functional older adults. The TUG test provides a measure of global ambulation skills and its total score has been successfully related with functionality and other important health variables in older adults. Reliable norms are needed for adults 50 years and older that allow the early identification and intervention in motor disturbances. The study was carried out with adults from Galicia and Valencia living in the community. A total of 314 Spanish community-living participants, aged from 50 to 90 years and functionality preserved were assessed through the implementation of a cross-sectional design. Health, comorbidity, physical activity, cognitive status, functionality measures and TUG test scores were obtained. TUG scores were successfully predicted by age and gender, and significantly correlated with cognitive status and comorbidity. TUG norms were calculated by age-group for women and men. TUG normative scores were below 13s and slightly lower in men. Normative scores for women and men were lower than those proposed in studies carried-out in our context. Our norms showed risk reference scores close to those obtained by meta-analytical procedures.
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24
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Chan WLS, Cheung YT, Lee YW, Teo AM, Wo HK, Wong Y. Reliability, Validity, and Minimal Detectable Change of Backward Walk Test in Older Adults With Dementia. J Geriatr Phys Ther 2021; 45:145-153. [PMID: 33782361 DOI: 10.1519/jpt.0000000000000306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE The backward walk test (BWT) has been used to evaluate the balance, gait, and fall risk for older adults, but its psychometric properties in older adults with dementia have not been investigated. This study aims at examining the test-retest and interrater reliability, construct and known-group validity, and absolute and relative minimal detectable changes at the 95% level of confidence (MDC95) of the BWT in older adults with dementia. METHODS This study was a cross-sectional study with repeated measures. Thirty older adults with a mean age of 83.3 years and a diagnosis of dementia who were able to walk backward independently for at least 3 m were recruited from day care and residential care units. The BWT was conducted on 3 separate testing occasions within 2 weeks under 2 independent raters using a modified progressive cueing system. The 10-m walk test (10MWT), Berg Balance Scale (BBS), and Timed Up and Go test (TUG) were used to assess the gait, balance, and mobility performances of the participants. RESULTS AND DISCUSSION The BWT had excellent test-retest reliability-intraclass correlation coefficient (ICC) = 0.96-and interrater reliability (ICC = 0.97-0.97) in the participants. Moderate correlations between the BWT and BBS (Spearman's ρ = 0.60) and strong correlations between the BWT and 10MWT (ρ = 0.84) and TUG (ρ = -0.82) were found. The BWT could distinguish between the participants who ambulated with walking aids and those who did not (P = .005). The participants who had experienced a fall in the past year did not differ significantly in the BWT compared with those who had not fallen (P = .36). The absolute and relative MDC95 of the BWT in the participants were 0.10 m/s and 39.3%, respectively. CONCLUSIONS The BWT is reliable and valid in assessing balance and gait performances in older adults with dementia. Further investigation is needed to determine whether the BWT can identify those with an increased risk of falls.
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Affiliation(s)
- Wayne L S Chan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
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25
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Suzuki T, Hashisdate H, Fujisawa Y, Yatsunami M, Ota T, Shimizu N, Betsuyaku T. Reliability of measurement using Image J for reach distance and movement angles in the functional reach test. J Phys Ther Sci 2021; 33:112-117. [PMID: 33642684 PMCID: PMC7897527 DOI: 10.1589/jpts.33.112] [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] [Received: 09/14/2020] [Accepted: 11/02/2020] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to examine the test-retest reliability and
minimal detectable change (MDC) of reach distance and movement angle analyses using Image
J. [Participants and Methods] Thirty-eight healthy young males performed the functional
reach test (FRT) twice, and their reach movements were recorded using a digital video
camera. Image J was used to combine the digital photographs taken at the start position
and maximum reach and to measure each movement. The measurements recorded were the
movement distance of the third metacarpal bone (reach distance), anterior-superior iliac
spine, and trochanter major, and the angles recorded were the acromion-malleolus
lateralis, acromion-trochanter major, and trochanter major-malleolus lateralis. The
reliability of all the measurements was analyzed using intraclass correlation coefficients
(ICCs), Bland-Altman plots, and MDCs. [Results] The ICCs (1, 1) were >0.80 for all the
outcomes. The Bland-Altman analysis revealed no systematic bias in any outcome. The MDC of
reach distance was 18.3 mm. [Conclusion] Measurement using Image J for reach distance and
movement angles in the FRT showed acceptable high test-retest reliability. Measurement of
the FRT and the MDC calculated in this study could be used as a reference for further
research.
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Affiliation(s)
- Takayuki Suzuki
- Department of Rehabilitation, Tokyo Tenshi Hospital: 50-1 Kamiichibukata-cho, Hachioji-city, Tokyo 193-0811, Japan.,Department of Rehabilitation Science, Graduate School of Health Sciences, Kyorin University, Japan
| | - Hiroyuki Hashisdate
- Department of Rehabilitation Science, Graduate School of Health Sciences, Kyorin University, Japan
| | - Yuhki Fujisawa
- Department of Rehabilitation Science, Graduate School of Health Sciences, Kyorin University, Japan
| | - Mitsunobu Yatsunami
- Department of Rehabilitation Science, Graduate School of Health Sciences, Kyorin University, Japan
| | - Tomohiro Ota
- Department of Rehabilitation, Hatsudai Rehabilitation Hospital, Japan
| | - Natsuki Shimizu
- Department of Rehabilitation, Hatsudai Rehabilitation Hospital, Japan
| | - Tetsuo Betsuyaku
- Department of Rehabilitation, Tokyo Tenshi Hospital: 50-1 Kamiichibukata-cho, Hachioji-city, Tokyo 193-0811, Japan
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26
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Responsiveness and interpretability of commonly used outcome assessments of mobility capacity in older hospital patients with cognitive spectrum disorders. Health Qual Life Outcomes 2021; 19:68. [PMID: 33648508 PMCID: PMC7923341 DOI: 10.1186/s12955-021-01690-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 01/25/2021] [Indexed: 02/06/2023] Open
Abstract
Background In older hospital patients with cognitive spectrum disorders (CSD), mobility should be monitored frequently with standardised and psychometrically sound measurement instruments. This study aimed to examine the responsiveness, minimal important change (MIC), floor effects and ceiling effects of commonly used outcome assessments of mobility capacity in older patients with dementia, delirium or other cognitive impairment. Methods In a cross-sectional study that included acute older hospital patients with CSD (study period: 02/2015–12/2015), the following mobility assessments were applied: de Morton Mobility Index (DEMMI), Hierarchical Assessment of Balance and Mobility (HABAM), Performance Oriented Mobility Assessment, Short Physical Performance Battery, 4-m gait speed test, 5-times chair rise test, 2-min walk test, Timed Up and Go test, Barthel Index mobility subscale, and Functional Ambulation Categories. These assessments were administered shorty after hospital admission (baseline) and repeated prior to discharge (follow-up). Global rating of mobility change scales and a clinical anchor of functional ambulation were used as external criteria to determine the area under the curve (AUC). Construct- and anchor-based approaches determined responsiveness. MIC values for each instrument were established from different anchor- and distribution-based approaches. Results Of the 63 participants (age range: 69–94 years) completing follow-up assessments with mild (Mini Mental State Examination: 19–24 points; 67%) and moderate (10–18 points; 33%) cognitive impairment, 25% were diagnosed with dementia alone, 13% with delirium alone, 11% with delirium superimposed on dementia and 51% with another cognitive impairment. The follow-up assessment was performed 10.8 ± 2.5 (range: 7–17) days on average after the baseline assessment. The DEMMI was the most responsive mobility assessment (all AUC > 0.7). For the other instruments, the data provided conflicting evidence of responsiveness, or evidence of no responsiveness. MIC values for each instrument varied depending on the method used for calculation. The DEMMI and HABAM were the only instruments without floor or ceiling effects. Conclusions Most outcome assessments of mobility capacity seem insufficiently responsive to change in older hospital patients with CSD. The significant floor effects of most instruments further limit the monitoring of mobility alterations over time in this population. The DEMMI was the only instrument that was able to distinguish clinically important changes from measurement error. Trial registration German Clinical Trials Register (DRKS00005591). Registered February 2, 2015.
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27
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Dulfikar A, Koh ES, Lwin Z, Hovey E, Dhillon H, Arundell J, Pinkham E, Pinkham MB, Holland J, Trajano G, Naumann F. Physical functional capacity of patients with glioma prior to adjuvant radiation: preliminary descriptive study. Neurooncol Pract 2021; 8:290-298. [PMID: 34055376 DOI: 10.1093/nop/npab015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background Few studies have assessed physical functioning in glioma patients with grade II, III, and IV glioma prior to undergoing adjuvant radiation with or without chemotherapy. The aim of this study was to describe the baseline physical functioning capacity of patients with glioma prior to adjuvant therapy compared to validated cutoffs required to maintain independence. Methods This study is a cross-sectional study that recruited patients with grade II, III, and IV glioma (n = 33) undergoing adjuvant radiation with or without chemotherapy. The six-minute walk, thirty-second sit-to-stand, and timed "Up & Go" assessments were used to describe baseline physical functioning. Perceived quality of life from the European Organisation for Research and Treatment of Cancer (EORTC) quality of life questionnaire (QLQ-C30) version 3.0 was used to quantify the quality of life. Results Mean distance walked in the six-minute walk test was 416.2 m (SD 137.6 m) with a mean of 12.2 stands (SD 3.4 stands) achieved during the thirty-second sit-to-stand. Median time to complete the timed "Up & Go" assessment was 7 s (interquartile range: 3 s). One-sample t tests suggest walking distance and chair stands were significantly lower than cutoff criterions to maintain independent living, t(32) = -5.96, P < .001, bias-corrected accelerated 95% CI [370.7-460.4], and t(32) = -4.60, P < .01, bias-corrected accelerated 95% CI [11.0-13.4], respectively. Wilcoxon signed-rank test identified significantly shorter median time taken to complete the timed "Up & Go" test compared to the cutoff criterion (z = -4.43, n = 33, P < .01). Conclusion This study suggests glioma patient's aerobic endurance and lower limb strength are below criterion cutoffs recommended to maintain independent living. Timed "Up & Go" scores did not exceed the criterion cutoff, indicating respectable levels of mobility.
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Affiliation(s)
- Ali Dulfikar
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Kelvin Grove, Australia
| | - Eng-Siew Koh
- Radiation oncology, Liverpool Hospital, Liverpool, Australia.,University of New South Wales, Randwick, Australia
| | - Zarnie Lwin
- Department of Medical Oncology, Royal Brisbane and Womens Hospital, Herston, Australia.,School of Medicine, University of Queensland, St Lucia, Australia
| | - Elizabeth Hovey
- Department of Medical Oncology, Nelune Comprehensive Cancer Centre, Prince of wales Hospital, Randwick, Australia.,University of New South Wales, Randwick, Australia
| | - Haryana Dhillon
- Centre for Medical Psychology & Evidence-Based Decision-Making, School of Psychology Faculty of Science, The University of Sydney, Camperdown, Australia
| | - Jesica Arundell
- Radiation oncology, Liverpool Hospital, Liverpool, Australia
| | - Elizabeth Pinkham
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Kelvin Grove, Australia.,Physiotherapy, Clinical Support Services, Princess Alexandra Hospital, Woollongabba, Australia
| | - Mark B Pinkham
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Kelvin Grove, Australia.,Radiation Oncology, Cancer Services, Princess Alexandra Hospital, Woolloongabba, Australia
| | - Justin Holland
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Kelvin Grove, Australia
| | - Gabriel Trajano
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Kelvin Grove, Australia
| | - Fiona Naumann
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Kelvin Grove, Australia
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Piau A, Mattek N, Crissey R, Beattie Z, Dodge H, Kaye J. When Will My Patient Fall? Sensor-Based In-Home Walking Speed Identifies Future Falls in Older Adults. J Gerontol A Biol Sci Med Sci 2021; 75:968-973. [PMID: 31095283 DOI: 10.1093/gerona/glz128] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Although there are known clinical measures that may be associated with risk of future falls in older adults, we are still unable to predict when the fall will happen. Our objective was to determine whether unobtrusive in-home assessment of walking speed can detect a future fall. METHOD In both ISAAC and ORCATECH Living Laboratory studies, a sensor-based monitoring system has been deployed in the homes of older adults. Longitudinal mixed-effects regression models were used to explore trajectories of sensor-based walking speed metrics in those destined to fall versus controls over time. Falls were captured during a 3-year period. RESULTS We observed no major differences between those destined to fall (n = 55) and controls (n = 70) at baseline in clinical functional tests. There was a longitudinal decline in median daily walking speed over the 3 months before a fall in those destined to fall when compared with controls, p < .01 (ie, mean walking speed declined 0.1 cm s-1 per week). We also found prefall differences in sensor-based walking speed metrics in individuals who experienced a fall: walking speed variability was lower the month and the week just before the fall compared with 3 months before the fall, both p < .01. CONCLUSIONS While basic clinical tests were not able to differentiate who will prospectively fall, we found that significant variations in walking speed metrics before a fall were measurable. These results provide evidence of a potential sensor-based risk biomarker of prospective falls in community living older adults.
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Affiliation(s)
- Antoine Piau
- Oregon Center for Aging & Technology (ORCATECH), Oregon Health & Science University, Portland.,Internal Medicine and Gerontology, University Hospital of Toulouse, France
| | - Nora Mattek
- Oregon Center for Aging & Technology (ORCATECH), Oregon Health & Science University, Portland
| | - Rachel Crissey
- Oregon Center for Aging & Technology (ORCATECH), Oregon Health & Science University, Portland
| | - Zachary Beattie
- Oregon Center for Aging & Technology (ORCATECH), Oregon Health & Science University, Portland
| | - Hiroko Dodge
- Oregon Center for Aging & Technology (ORCATECH), Oregon Health & Science University, Portland
| | - Jeffrey Kaye
- Oregon Center for Aging & Technology (ORCATECH), Oregon Health & Science University, Portland
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Backåberg S, Hellström A, Fagerström C, Halling A, Lincke A, Löwe W, Ekstedt M. Evaluation of the Skeleton Avatar Technique for Assessment of Mobility and Balance Among Older Adults. FRONTIERS IN COMPUTER SCIENCE 2020. [DOI: 10.3389/fcomp.2020.601271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Mobility and balance is essential for older adults' well-being and independence and the ability to maintain physically active. Early identification of functional impairment may enable early risk-of-fall assessments and preventive measures. There is a need to find new solutions to assess functional ability in easy, efficient, and accurate ways, which can be clinically used frequently and repetitively. Therefore, we need to understand how functional tests and expert assessments (EAs) correlate with new techniques.Objective: To explore whether the skeleton avatar technique (SAT) can predict the results of functional tests (FTs) of mobility and balance: Timed Up and Go (TUG), the 30-s chair stand test (30sCST), the 4-stage balance test (4SBT), and EA scoring of movement quality.Methods: Fifty-four older adults (+65 years) were recruited through pensioners' associations. The test procedure contained three standardized FTs: TUG, 30sCST, and 4SBT. The test performances were recorded using a three-dimensional SAT camera. EA scoring was performed based on the video recordings of the 30sCST. Functional ability scores were aggregated from balance and mobility scores. Probability theory-based statistical analyses were used on the data to aggregate sets of individual variables into scores, with correlation analysis used to assess the dependency between variables and between scores. Machine learning techniques were used to assess the appropriateness of easily observable variables/scores as predictors of the other variables included.Results: The results indicate that SAT data of the fourth 4SBT stage could be used to predict the aggregated results of all stages of 4SBT (with 7.82% mean absolute error), the results of the 30sCST (11.0%), the TUG test (8.03%), and the EA of the sit-to-stand movement (8.79%). There is a moderate (significant) correlation between the 30sCST and the 4SBT (0.31, p = 0.03), but not between the EA and the 30sCST.Conclusion: SAT can predict the results of the 4SBT, the 30sCST (moderate accuracy), and the TUG test and might add important qualitative information to the assessment of movement performance in active older adults. SAT might in the future provide the means for a simple, easy, and accessible assessment of functional ability among older adults.
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Bozhilov K, Vo KB, Wong LL. Can the Timed Up & Go Test and Montreal Cognitive Assessment predict outcomes in patients waitlisted for renal transplant? Clin Transplant 2020; 35:e14161. [PMID: 33217080 DOI: 10.1111/ctr.14161] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 11/04/2020] [Accepted: 11/10/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE Frail patients who undergo renal transplantation (RT) have more complications; however, little is known if these patients can sustain the wait to RT. We used the Timed Up and Go Test (TUGT) and Montreal Cognitive Assessment (MoCA) to determine outcomes of RT candidates. METHODS In this retrospective study, 526 RT candidates underwent TUGT and MoCA (2015-2019) and were divided into "favorable" (transplanted or remained on the list) or "unfavorable" (not listed, removed from list, or died) outcome. Demographics, education, language, comorbidities, dialysis type, use of a walking device, TUGT, and MoCA were compared by outcome. RESULTS Overall, 230 patients (43.7%) passed TUG, 268 (51%) passed MoCA, 133 (25.3%) passed both, and 161 (30.6%) failed both tests. Multivariate analysis demonstrated age ≥ 65 (OR 1.58, CI 1.03-2.43), cardiac disease (OR 3.09, CI 2.02-4.72), ≥36 months on dialysis (OR 1.80, CI 1.24-2.69), EPTS < 20% at time of MoCA (OR 0.26, CI 0.07-0.98), and failing TUGT (OR 2.14, CI 1.43-3.19) were associated with unfavorable outcome. Failing MoCA was not associated with outcome. CONCLUSIONS MoCA test results were not associated with RT waitlist outcomes; however, passing the TUGT was associated with receiving RT or remaining on the list. Additional studies are needed to validate this and determine outcome after RT.
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Affiliation(s)
- Kliment Bozhilov
- Department of Surgery, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii, USA
| | - Kristine B Vo
- Department of Surgery, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii, USA
| | - Linda L Wong
- Department of Surgery, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii, USA
- Transplant Center, Queen's Medical Center, Honolulu, Hawaii, USA
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Grant D, Tomlinson D, Tsintzas K, Kolić P, Onambélé-Pearson G. Minimizing sedentary behavior (without increasing medium-to-vigorous exercise) associated functional improvement in older women is somewhat dependent on a measurable increase in muscle size. Aging (Albany NY) 2020; 12:24081-24100. [PMID: 33276345 PMCID: PMC7762509 DOI: 10.18632/aging.202265] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 10/19/2020] [Indexed: 12/17/2022]
Abstract
The optimal pattern of sedentarism displacement and mechanisms underlying its health effects are poorly understood. Therefore, the aim of this study was to quantify muscle-tendon adaptation in response to two different sedentarism displacement interventions and relate any adaptations to functional outcomes. Thirty-four older women (73±5yrs) underwent skeletal muscle-tendon size and functional assessments. Participants were randomly allocated to: Sedentary behavior fragmentation (SBF), Light intensity physical activity (LIPA), or Control groups. Measures were taken at weeks 0 and 8. Gait speed significantly increased (p=0.003), in both experimental groups (SBF: 0.06 ± 0.08m/s, 6±10%, LIPA: 0.06 ± 0.07m/s, 6±6%), but not control (-0.02 ± 0.12m/s, -2±9%). Accordingly, the relative change in Vastus Lateralis muscle volume, accounted for 30% (p=0.027), and 45% (p=0.0006) of the explained variance in the relative change in gait speed, for SBF and LIPA respectively. Gastrocnemius Medialis fascicle length changes were positively associated with gait speed changes, following LIPA exclusively (R2= 0.50, p=0.009). This is the first study to show SBF and LIPA are adequate loading in older women, with related muscle adaptation and clinically relevant gait speed improvements. Such adaptations appear similar irrespective of whether sedentarism displacement is prescribed in a single bout (LIPA) or in frequent micro-bouts (SBF).
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Affiliation(s)
- Dale Grant
- Research Centre for Musculoskeletal Science and Sports Medicine, Department of Sports and Exercise Sciences, Manchester Metropolitan University, Manchester, UK
| | - David Tomlinson
- Research Centre for Musculoskeletal Science and Sports Medicine, Department of Sports and Exercise Sciences, Manchester Metropolitan University, Manchester, UK
| | - Kostas Tsintzas
- MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, School of Life Sciences, Faculty of Medicine and Health Sciences, The University of Nottingham Medical School, Queen's Medical Centre, Nottingham, UK
| | - Petra Kolić
- Research Centre for Musculoskeletal Science and Sports Medicine, Department of Sports and Exercise Sciences, Manchester Metropolitan University, Manchester, UK
| | - Gladys Onambélé-Pearson
- Research Centre for Musculoskeletal Science and Sports Medicine, Department of Sports and Exercise Sciences, Manchester Metropolitan University, Manchester, UK
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Johnson C, Hallemans A, Verbecque E, Vestel CD, Herssens N, Vereeck L. Aging and the Relationship between Balance Performance, Vestibular Function and Somatosensory Thresholds. J Int Adv Otol 2020; 16:328-337. [PMID: 33136012 DOI: 10.5152/iao.2020.8287] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES The objective of this study was two-fold: (1) To evaluate the impact of the physiological aging process on somatosensory, vestibular, and balance functions, and (2) To examine the extent to which age and somatosensory and vestibular functions can predict balance performance. MATERIALS AND METHODS In this cross-sectional study, 141 asymptomatic subjects were assessed for touch pressure thresholds (TPT) with Semmes-Weinstein monofilaments (SWF), vibration thresholds (VT) with a neurothesiometer (NT) and a Rydel-Seiffer tuning fork 128Hz (RSTF). Horizontal vestibulo-ocular reflexes (HVOR gain and asymmetry) were assessed using the video Head Impulse Test (vHIT). A modified version of the Romberg test was used to assess standing balance and the Timed Up and Go test (TUG) and tandem gait (TG) to evaluate dynamic balance. RESULTS Significant age effects were found for TPT, VT, and balance but not for HVOR gain or asymmetry. Standing balance was explained for 47.2% by age, metatarsal 1 (MT1) (NT), and heel (SWF). The variance in TUG performance was explained for 47.0% by age, metatarsal 5 (MT5) (SWF), and medial malleolus (MM) (NT). Finally, the variance in TG performance was predicted for 43.1% by age, MT1 (NT), HVOR gain, and heel (SWF). CONCLUSION Among asymptomatic adult population, both somatosensation and balance performance deteriorate with aging. In contrast, HVOR remains rather constant with age, which is possibly explained by the process of vestibular adaptation. Furthermore, this study provides evidence that the VT, TPT, HVOR gain, and age partly predict balance performance. Still, further research is needed, especially with bigger samples in decades 8 and 9.
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Affiliation(s)
- Charlotte Johnson
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Wilrijk, Belgium
| | - Ann Hallemans
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Wilrijk, Belgium
| | - Evi Verbecque
- Hasselt University, Faculty of Rehabilitation Sciences, Diepenbeek, Belgium
| | - Charlotte De Vestel
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Wilrijk, Belgium
| | - Nolan Herssens
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Wilrijk, Belgium
| | - Luc Vereeck
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Wilrijk, Belgium
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Trumpf R, Morat T, Zijlstra W, Haussermann P, Fleiner T. Assessment of Functional Performance in Acute Geriatric Psychiatry - Time for New Strategies? J Geriatr Psychiatry Neurol 2020; 33:316-323. [PMID: 31635520 DOI: 10.1177/0891988719882098] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES The aim of this study was to investigate the feasibility and reliability of functional performance tests in people living with dementia and depression. METHOD A cross-sectional study was conducted in a geriatric psychiatry hospital. People living with dementia, depression, and healthy older adults were included. Feasibility of the timed up and go test (TUG), the short physical performance battery (SPPB), and the multisurface obstacle test for older adults (MSOT) was assessed based on valid test executions. Test-retest reliability was evaluated by mean difference (MD), coefficient of variation (CV), standardized MD, intraclass correlation coefficient (ICC), and correlation coefficient (rs). RESULTS A total of 53 people in acute geriatric psychiatry and 21 healthy older adults were included. In people living with dementia (n = 23), feasibility was 65.2% (MSOT), 8.7% (TUG), and 8.7% (SPPB). In people living with depression (n = 30), feasibility was 83.3% (MSOT), 80.0% (TUG), and 46.7% (SPPB). Intraclass correlation coefficients and rs for the MSOT were high (ICC > 0.70) in both groups. Coefficient of variations of the MSOT were between 10.7% and 18.0% (dementia) and 7.1% and 17.0% (depression). Reliability of the TUG and SPPB was not analyzed in people living with dementia, due to low feasibility. In people living with depression, ICCs and rs were between 0.86 and 0.87 with CVs of 7.2% (TUG) and 0.69 and 0.95 with CVs of 7.8% and 15.1% (SPPB). CONCLUSION Feasibility and reliability of established functional performance tests in acute geriatric psychiatry are limited, especially in people living with dementia. New strategies, for example, sensor-based approaches, may allow measurement of functional performance apart from standardized instruction-based test procedures in this clinical population.
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Affiliation(s)
- Rieke Trumpf
- Institute of Movement and Sport Gerontology, 14926German Sport University Cologne, Cologne, Germany.,Department of Geriatric Psychiatry & Psychotherapy, 27183LVR-Hospital Cologne, Cologne, Germany
| | - Tobias Morat
- Institute of Movement and Sport Gerontology, 14926German Sport University Cologne, Cologne, Germany
| | - Wiebren Zijlstra
- Institute of Movement and Sport Gerontology, 14926German Sport University Cologne, Cologne, Germany
| | - Peter Haussermann
- Department of Geriatric Psychiatry & Psychotherapy, 27183LVR-Hospital Cologne, Cologne, Germany.,Peter Haussermann and Tim Fleiner equally contributed to the article
| | - Tim Fleiner
- Institute of Movement and Sport Gerontology, 14926German Sport University Cologne, Cologne, Germany.,Department of Geriatric Psychiatry & Psychotherapy, 27183LVR-Hospital Cologne, Cologne, Germany.,Peter Haussermann and Tim Fleiner equally contributed to the article
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Coleman G, Dobson F, Hinman RS, Bennell K, White DK. Measures of Physical Performance. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:452-485. [PMID: 33091270 DOI: 10.1002/acr.24373] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 07/01/2020] [Indexed: 12/11/2022]
Affiliation(s)
| | - Fiona Dobson
- University of Melbourne, Melbourne, Victoria, Australia
| | - Rana S Hinman
- University of Melbourne, Melbourne, Victoria, Australia
| | - Kim Bennell
- University of Melbourne, Melbourne, Victoria, Australia
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Salas MQ, Atenafu EG, Bascom O, Wilson L, Lam W, Law AD, Pasic I, Kim DDH, Michelis FV, Al-Shaibani Z, Gerbitz A, Viswabandya A, Lipton JH, Mattsson J, Alibhai SMH, Kumar R. Pilot prospective study of Frailty and Functionality in routine clinical assessment in allogeneic hematopoietic cell transplantation. Bone Marrow Transplant 2020; 56:60-69. [PMID: 32606454 DOI: 10.1038/s41409-020-0979-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 06/01/2020] [Accepted: 06/11/2020] [Indexed: 12/14/2022]
Abstract
A Frailty and Functionality evaluation for alloHCT was implemented using existing resources. We describe the implementation of this evaluation across all ages and at first consultation, and correlate results with posttransplant outcomes in 168 patients. The evaluation consists of: Clinical Frailty Scale (CFS), Instrumental Activities of Daily Living (IADL), grip strength (GS), timed up and go test (TUGT), self-rated health question (SRH), Single question of Falls, albumin and C-Reactive Protein (CRP) levels. Median time to perform the evaluation was 5-6 min. Median age was 58 years (range: 19-77) and median follow-up was 5.3 months. TUGT > 10 s (HR 2.92; p = 0.003), raised CRP (HR 4.40; p < 0.001), and hypoalbuminemia (HR 2.10; p = 0.043) were significant risk factors for worse overal survival (OS). CFS ≥ 3 (HR 3.11; p = 0.009), TUGT > 10 s (HR 3.47; p = 0.003), GS (HR 2.56; p = 0.029), SRH (<excellent) (HR 3.8 × 106; p < 0.001), elevated CRP (HR 11.8; p < 0.001), and hypoalbuminemia (HR 4.6; p < 0.001), were significant predictors for worse non relapse mortality (NRM). On multivariable analysis, TUGT > 10 s and raised CRP were significant predictors for worse OS and NRM. SRH (<excellent) was a significant predictor for higher NRM. Frailty and Functionality can be assessed in routine clinical practice in alloHCT and may be predictive of short-term outcomes.
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Affiliation(s)
- Maria Queralt Salas
- Department of Medicine, Section of Medical Oncology and Hematology, University of Toronto, Toronto, ON, Canada.,Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Hematology Department, Institut Català d'Oncologia-Hospitalet, IDIBELL, Barcelona, Spain
| | - Eshetu G Atenafu
- Department of Biostatistics, Princes Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Ora Bascom
- Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Leeann Wilson
- Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Wilson Lam
- Department of Medicine, Section of Medical Oncology and Hematology, University of Toronto, Toronto, ON, Canada.,Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Arjun Datt Law
- Department of Medicine, Section of Medical Oncology and Hematology, University of Toronto, Toronto, ON, Canada.,Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Ivan Pasic
- Department of Medicine, Section of Medical Oncology and Hematology, University of Toronto, Toronto, ON, Canada.,Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Dennis Dong Hwan Kim
- Department of Medicine, Section of Medical Oncology and Hematology, University of Toronto, Toronto, ON, Canada.,Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Fotios V Michelis
- Department of Medicine, Section of Medical Oncology and Hematology, University of Toronto, Toronto, ON, Canada.,Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Zeyad Al-Shaibani
- Department of Medicine, Section of Medical Oncology and Hematology, University of Toronto, Toronto, ON, Canada.,Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Armin Gerbitz
- Department of Medicine, Section of Medical Oncology and Hematology, University of Toronto, Toronto, ON, Canada.,Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Auro Viswabandya
- Department of Medicine, Section of Medical Oncology and Hematology, University of Toronto, Toronto, ON, Canada.,Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Jeffrey Howard Lipton
- Department of Medicine, Section of Medical Oncology and Hematology, University of Toronto, Toronto, ON, Canada.,Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Jonas Mattsson
- Department of Medicine, Section of Medical Oncology and Hematology, University of Toronto, Toronto, ON, Canada.,Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | | | - Rajat Kumar
- Department of Medicine, Section of Medical Oncology and Hematology, University of Toronto, Toronto, ON, Canada. .,Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
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The Relationship between ECOG-PS, mGPS, BMI/WL Grade and Body Composition and Physical Function in Patients with Advanced Cancer. Cancers (Basel) 2020; 12:cancers12051187. [PMID: 32397102 PMCID: PMC7281405 DOI: 10.3390/cancers12051187] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 04/28/2020] [Accepted: 05/04/2020] [Indexed: 12/31/2022] Open
Abstract
Cancer remains one of the leading causes of mortality worldwide and the associated reduction in physical function has a marked impact on both quality of life and survival. The aim of the present study was to examine the relationship between Eastern Cooperative Oncology Group-Performance status (ECOG-PS), modified Glasgow Prognostic Score (mGPS), Body Mass Index/ Weight Loss grade (BMI/WL grade), and Computerised Tomography (CT)-derived body composition measurement and physical function in patients with advanced cancer. Nine sites contributed prospective data on patient demographics, ECOG-PS, mGPS, physical function tests, and CT-derived body composition. Categorical variables were analysed using χ2 test for linear-by-linear association, or χ2 test for 2-by-2 tables. Associations were analysed using binary logistic regression. A total of 523 cancer patients (266 males, 257 females) were included in the final analysis and most had metastatic disease (83.2%). The median overall survival was 5.6 months. On multivariate binary logistic regression analysis, a high ECOG-PS remained independently associated with a low skeletal muscle index (p < 0.001), low skeletal muscle density (p < 0.05), and timed up and go test failure (p < 0.001). A high mGPS remained independently associated with a low skeletal muscle density (p < 0.05) and hand grip strength test failure (p < 0.01). A high BMI/WL grade remained independently associated with a low subcutaneous fat index (p < 0.05), low visceral obesity (p < 0.01), and low skeletal muscle density (p < 0.05). In conclusion, a high ECOG-PS and a high mGPS as outlined in the ECOG-PS/mGPS framework were consistently associated with poorer body composition and physical function in patients with advanced cancer.
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Parfitt G, Post D, Penington A, Davison K, Corlis M. Challenges associated with physical assessments for people living with dementia: Modifying standard assessment protocols. SAGE Open Med 2020; 8:2050312120910359. [PMID: 32166030 PMCID: PMC7052450 DOI: 10.1177/2050312120910359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 02/04/2020] [Indexed: 11/17/2022] Open
Abstract
Objectives: Regular physical activity for older adults as they age is important for
maintaining not only physical function but also independence and self-worth.
To be able to monitor changes in physical function, appropriate validated
measures are required. Reliability of measures such as the timed-up-and-go,
five-repetition sit-to-stand, handgrip strength, two-minute walk, 30-second
sit-to-stand, and four-metre walk has been demonstrated; however, the
appropriateness of such measures in a population of adults living with
dementia, who may be unable to follow instructions or have diminished
physical capacity, is not as well quantified. This study sought to test
modified standard protocols for these measures. Methods: Modification to the standard protocols of the timed-up-and-go,
five-repetition sit-to-stand, handgrip strength, two-minute walk, 30-second
sit-to-stand, and four-metre walk was trialled. This occurred through
modification of procedural components of the assessment, such as encouraging
participants to use their hands to raise themselves from a seated position,
or the incorporation of staged verbal cueing, demonstration, or physical
guidance where required. The test–retest reliability of the modified
protocols was assessed using Pearson’s correlation, and performance
variances were assessed using the %coefficient of variation. Intraclass
correlations were included for comparisons to previous research and to
examine measurement consistency within three trials. Results: At least 64% of the population were able to complete all measures. Good
test–retest reliability was indicated for the modified measures
(timed-up-and-go = 0.87; five-repetition sit-to-stand = 0.75; handgrip
strength = 0.94; two-minute walk = 0.87; the 30-second sit-to-stand = 0.93;
and the four-metre walk = 0.83), and the %coefficient of variation
(7.2%–14.8%) and intraclass correlation (0.77–0.98) were acceptable to
good. Conclusion: This article describes the methodology of the modified assessments, presents
the test–retest statistics, and reports how modification of the current
protocols for common measures of physical function enabled more older adults
living with dementia in a residential aged care facility to participate in
assessments, with high reliability demonstrated for the measures.
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Affiliation(s)
- Gaynor Parfitt
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), School of Health Sciences, University of South Australia, Adelaide, SA, Australia.,NHMRC Cognitive Decline Partnership Centre, The University of Sydney, Sydney, NSW, Australia
| | - Dannielle Post
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), School of Health Sciences, University of South Australia, Adelaide, SA, Australia.,NHMRC Cognitive Decline Partnership Centre, The University of Sydney, Sydney, NSW, Australia
| | | | - Kade Davison
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), School of Health Sciences, University of South Australia, Adelaide, SA, Australia.,NHMRC Cognitive Decline Partnership Centre, The University of Sydney, Sydney, NSW, Australia
| | - Megan Corlis
- NHMRC Cognitive Decline Partnership Centre, The University of Sydney, Sydney, NSW, Australia.,Helping Hand Organisation, North Adelaide, SA, Australia
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Alqahtani BA, Sparto PJ, Whitney SL, Greenspan SL, Perera S, Brach JS. Psychometric properties of instrumented postural sway measures recorded in community settings in independent living older adults. BMC Geriatr 2020; 20:82. [PMID: 32111166 PMCID: PMC7048114 DOI: 10.1186/s12877-020-1489-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 02/24/2020] [Indexed: 11/09/2022] Open
Abstract
Background In the last few decades, research related to balance in older adults has been conducted in lab-based settings. The lack of portability and high cost that is associated with the current gold standard methods to quantify body balance limits their application to community settings such as independent living facilities. The purpose of the study was to examine the relative and absolute reliability and the convergent validity of static standing balance performance using an accelerometer device. Methods A total of 131 participants (85% female, mean age 80 ± 8 years) were included for the validity aim, and a subsample of 38 participants were enrolled in the reliability testing (89% female, mean age 76 ± 7 years). The root-mean-square (RMS) and normalized path length (NPL) for sway in antero-posterior (AP) and medio-lateral (ML) directions were calculated for different standing balance conditions. Test-retest reliability was assessed over two testing visits occurring 1 week apart using the intraclass correlation coefficient (ICC) for relative reliability, and the minimal detectable change (MDC) was calculated for the absolute reliability. Spearman’s rank correlation coefficient was used to test convergent validity at baseline between balance measurements and related mobility measures. Results Reliability of balance performance using accelerometers was good to excellent with ICC values ranging from 0.41 to 0.83 for RMS sway and from 0.49 to 0.82 for NPL sway. However, the ICC during semi-tandem stance in A-P direction was 0.35, indicating poor reliability. The MDC of the sway measurements ranged from 2.4 to 9.4 for the RMS and 5.2 to 13.8 for the NPL. Balance measurements were correlated with mobility measurements. Conclusions Using a portable accelerometer to quantify static standing postural control provides reliable measurements in community settings.
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Affiliation(s)
- Bader A Alqahtani
- Department of Health and Rehabilitation sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, 11942, Kingdom of Saudi Arabia.
| | - Patrick J Sparto
- Department of Physical Therapy, University of Pittsburgh, Bridgeside Point 1, 100 Technology Drive, Suite 210, Pittsburgh, PA, 15219, USA
| | - Susan L Whitney
- Department of Physical Therapy, University of Pittsburgh, Bridgeside Point 1, 100 Technology Drive, Suite 210, Pittsburgh, PA, 15219, USA
| | - Susan L Greenspan
- Department of Medicine, University of Pittsburgh, 3471 Fifth Avenue, Kaufmann Medical Building, Suite 500, Pittsburgh, PA, 15213, USA
| | - Subashan Perera
- Department of Medicine, University of Pittsburgh, 3471 Fifth Avenue, Kaufmann Medical Building, Suite 500, Pittsburgh, PA, 15213, USA
| | - Jennifer S Brach
- Department of Physical Therapy, University of Pittsburgh, Bridgeside Point 1, 100 Technology Drive, Suite 210, Pittsburgh, PA, 15219, USA
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Abstract
Differences in immune function and responses contribute to health- and life-span disparities between sexes. However, the role of sex in immune system aging is not well understood. Here, we characterize peripheral blood mononuclear cells from 172 healthy adults 22-93 years of age using ATAC-seq, RNA-seq, and flow cytometry. These data reveal a shared epigenomic signature of aging including declining naïve T cell and increasing monocyte and cytotoxic cell functions. These changes are greater in magnitude in men and accompanied by a male-specific decline in B-cell specific loci. Age-related epigenomic changes first spike around late-thirties with similar timing and magnitude between sexes, whereas the second spike is earlier and stronger in men. Unexpectedly, genomic differences between sexes increase after age 65, with men having higher innate and pro-inflammatory activity and lower adaptive activity. Impact of age and sex on immune phenotypes can be visualized at https://immune-aging.jax.org to provide insights into future studies.
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Harper KJ, Riley V, Petta A, Jacques A, Spendier N, Ingram K. Occupational therapist use of the 'Timed Up and Go' test in a Memory Clinic to compare performance between cognitive diagnoses and screen for falls risk. Aust Occup Ther J 2019; 67:13-21. [PMID: 31609001 DOI: 10.1111/1440-1630.12617] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Occupational therapists assess older patients attending Memory Clinics to address multiple facets, including memory, activities of daily living function, mobility and falls risk. Identifying deficits in motor and functional abilities represents a crucial and necessary component of cognitive diagnosis. The aim of this research was to compare performance on the TUG between patients with normal (NC), mild cognitive impairment (MCI) and dementia. METHODS A prospective single-blind single-centre cohort study was conducted in a Memory Clinic. Patients underwent comprehensive medical assessment, including the Mini Mental Status Examination (MMSE) to determine a cognitive diagnosis. The occupational therapist, blinded to any diagnosis, completed the TUG. RESULTS A total of 158 patients aged 60 years and older were recruited. The average TUG was 15.4 s, which was similar between men and women (p = .87). A TUG greater than ≥14 s was significantly associated with the use of a walking aid (p ≤ .001). The TUG increased with age and a slower TUG was associated with a greater number of previous falls (p = .023). The TUG did not significantly differ between patients with dementia, MCI and NC (p = .095). However, there was a significant difference comparing patients with NC and MCI (14.3 s) to those with dementia (16.4 s) (p = .048). There was a significant weak negative correlation between the MMSE and the TUG of -0.253 (p = .003). Univariate models showed that a patient's ability to ambulate independently contributed to 33% of the variance in the TUG, whereas previous falls contributed to 4%, highlighting the importance of physical function and intervention to target this. CONCLUSION A simple TUG test should be considered for use by occupational therapists in a Memory Clinic to screen patients at risk of falling. Patients diagnosed with dementia have a significantly slower TUG. However, this tool cannot assist with the early detection of patients with MCI.
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Affiliation(s)
- Kristie J Harper
- Occupational Therapy Department, Sir Charles Gairdner Hospital, Nedlands, Perth, WA, Australia
| | - Vera Riley
- Department of Rehabilitation and Aged Care, Sir Charles Gairdner Hospital, Nedlands, Perth, WA, Australia
| | - Antonio Petta
- Department of Rehabilitation and Aged Care, Sir Charles Gairdner Hospital, Nedlands, Perth, WA, Australia
| | - Angela Jacques
- Department of Research, Institute for Health Research, The University of Notre Dame Australia, Fremantle, WA, Australia
| | - Nicholas Spendier
- Department of Rehabilitation and Aged Care, Sir Charles Gairdner Hospital, Nedlands, Perth, WA, Australia
| | - Katharine Ingram
- Department of Rehabilitation and Aged Care, Sir Charles Gairdner Hospital, Nedlands, Perth, WA, Australia
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Tedla JS, Asiri F, Alshahrani MS, Sangadala DR, Gular K, Rengaramanujam K, Mukherjee D. Reference Values of Functional and Lateral Reach Test Among the Young Saudi Population: Their Psychometric Properties and Correlation with Anthropometric Parameters. Med Sci Monit 2019; 25:5683-5689. [PMID: 31365521 PMCID: PMC6686713 DOI: 10.12659/msm.916443] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background Due to lack of normal reference values of forward and lateral reach tests for Saudi young adults, this study aimed to formulate normative values of the forward reach test and lateral reach test and to assess the correlation between the demographic variables and the reach test results. Material/Methods We randomly assigned 240 normal young Saudi adults ages 20–23 years to assess reach test scores in forward and lateral directions. All the subjects had been measured for distance reached in forward and lateral direction on graph paper fixed to a white board. Results The mean and standard deviation of forward and lateral reach distances were 25±8.14 cm and 19.78±5.70 cm, respectively. Significant differences were found between males and females for forward reach and lateral reach scores (p<0.001). Forward reach and lateral reach values showed a moderate correlation with height, lower limb length, and upper limb length. The intra-rater reliability assessed by intra-class correlation coefficient was 0.91 and 0.92 for the forward and lateral reach test scores, respectively. Conclusions This study established reference values of forward and lateral reach scores for Saudi young adults ages 20–23 years. Height, upper limb length, and lower limb length were moderately correlated with the reach distances in forward and lateral directions. Males performed longer reach distances than females.
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Affiliation(s)
- Jaya Shanker Tedla
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
| | - Faisal Asiri
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
| | - Mastour S Alshahrani
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
| | - Devika R Sangadala
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
| | - Kumar Gular
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
| | - Kanagaraj Rengaramanujam
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
| | - Debjani Mukherjee
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
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Chan WLS, Pin TW. Practice effect and cueing of 2-minute walk test, 6-minute walk test and 10-meter walk test in frail older adults with and without dementia - Recommendations to walk tests protocols. Exp Gerontol 2019; 124:110648. [PMID: 31279000 DOI: 10.1016/j.exger.2019.110648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 06/11/2019] [Accepted: 06/27/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVES 1) To determine if there was a practice effect associated with walk tests performed by frail older adults with and without dementia, 2) to examine the role of systematic cueing in the walk tests for those with dementia, and 3) to make recommendations to testing protocols of the walk tests for frail older adults with and without dementia. SETTING Residential and day care facilities. PARTICIPANTS 44 frail older adults with normal cognition (NON-DEM) and 39 older adults with Alzheimer's disease or dementia (DEM) who were able to walk independently for at least 15 m. METHODS All the participants completed multiple trials of 2-minute walk test (2MWT), 6-minute walk test (6MWT) and 10-meter walk test (10MeWT) on three separate testing occasions. The DEM group was facilitated to complete the walk tests using a progressive cueing system. RESULTS Significant increases in the walking performance within the same testing occasion were found in the 2MWT (NON-DEM: p = .002; DEM: p ≤ .044) and 6MWT (NON-DEM: p ≤ .004; DEM: p ≤ .002) for both groups but only in the 10MeWT (p ≤ .023) for the DEM group. Significant increases in the walking performance across testing occasions were shown in the 2MWT (p ≤ .047), 6MWT (p ≤ .005) and 10MeWT (p ≤ .039) for the NON-DEM group but not the DEM group (all p > .05). Multivariate regression analyses showed that the cognitive function of the DEM group was independently and inversely associated with the level of cueing provided during the walk tests (p ≤ .007). CONCLUSION Practice effect associated with the walk tests was found within and across testing occasions for frail older adults with normal cognition, and only within the same testing occasion for those with dementia. Systematic cueing should be provided for those with dementia to complete the walk tests. Testing protocols of the walk tests have been recommended for these two population groups.
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Affiliation(s)
- Wayne L S Chan
- Physiotherapy Department, Chi Lin Nunnery Elderly Service, 5 Chi Lin Drive, Diamond Hill, Hong Kong; Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong.
| | - Tamis W Pin
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong.
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Beaudart C, Rolland Y, Cruz-Jentoft AJ, Bauer JM, Sieber C, Cooper C, Al-Daghri N, Araujo de Carvalho I, Bautmans I, Bernabei R, Bruyère O, Cesari M, Cherubini A, Dawson-Hughes B, Kanis JA, Kaufman JM, Landi F, Maggi S, McCloskey E, Petermans J, Rodriguez Mañas L, Reginster JY, Roller-Wirnsberger R, Schaap LA, Uebelhart D, Rizzoli R, Fielding RA. Assessment of Muscle Function and Physical Performance in Daily Clinical Practice : A position paper endorsed by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO). Calcif Tissue Int 2019; 105:1-14. [PMID: 30972475 DOI: 10.1007/s00223-019-00545-w] [Citation(s) in RCA: 276] [Impact Index Per Article: 55.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 03/29/2019] [Indexed: 01/06/2023]
Abstract
It is well recognized that poor muscle function and poor physical performance are strong predictors of clinically relevant adverse events in older people. Given the large number of approaches to measure muscle function and physical performance, clinicians often struggle to choose a tool that is appropriate and validated for the population of older people they deal with. In this paper, an overview of different methods available and applicable in clinical settings is proposed. This paper is based on literature reviews performed by members of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) working group on frailty and sarcopenia. Face-to-face meetings were organized afterwards where the whole group could amend and discuss the recommendations further. Several characteristics should be considered when choosing a tool: (1) purpose of the assessment (intervention, screening, diagnosis); (2) patient characteristics (population, settings, functional ability, etc.); (3) psychometric properties of the tool (test-retest reliability, inter-rater reliability, responsiveness, floor and ceiling effects, etc.); (4) applicability of the tool in clinical settings (overall cost, time required for the examination, level of training, equipment, patient acceptance, etc.); (5) prognostic reliability for relevant clinical outcomes. Based on these criteria and the available evidence, the expert group advises the use of grip strength to measure muscle strength and the use of 4-m gait speed or the Short Physical Performance Battery test to measure physical performance in daily practice. The tools proposed are relevant for the assessment of muscle weakness and physical performance. Subjects with low values should receive additional diagnostic workups to achieve a full diagnosis of the underlying condition responsible (sarcopenia, frailty or other).
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Affiliation(s)
- Charlotte Beaudart
- Department of Public Health, Epidemiology and Health Economics, University of Liège, Avenue Hippocrate 13, CHU B23, 4000, Liège, Belgium
- WHO Collaborating Centre for Public Health Aspects of Musculo-Skeletal Health and Aging, Liège, Belgium
| | - Yves Rolland
- Gérontopôle of Toulouse, University of Toulouse III, CHU Purpan, Toulouse, France
| | | | - Jürgen M Bauer
- Center for Geriatric Medicine, University of Heidelberg, Agaplesion Bethanien Hospital, Heidelberg, Germany
| | - Cornel Sieber
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, England, UK
- NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK
| | - Nasser Al-Daghri
- Prince Mutaib Chair for Biomarkers of Osteoporosis, Biochemistry Department, College of Science, King Saud University, Riyadh, 11451, Saudi Arabia
| | | | - Ivan Bautmans
- Gerontology and Frailty in Ageing Research Department, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Roberto Bernabei
- Department of Geriatrics, Neurosciences and Orthopedics, Catholic University of the Sacred Heart Rome, Milan, Italy
| | - Olivier Bruyère
- Department of Public Health, Epidemiology and Health Economics, University of Liège, Avenue Hippocrate 13, CHU B23, 4000, Liège, Belgium.
- WHO Collaborating Centre for Public Health Aspects of Musculo-Skeletal Health and Aging, Liège, Belgium.
| | - Matteo Cesari
- Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical and Community Sciences, University of Milan, Milan, Italy
| | - Antonio Cherubini
- Geriatria, Accettazione Geriatrica e Centro di Ricerca per l'invecchiamento, IRCCS-INRCA, Ancona, Italy
| | - Bess Dawson-Hughes
- Bone Metabolism Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
| | - John A Kanis
- Mary McKillop Health Institute, Australian Catholic University, Melbourne, Australia
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
| | - Jean-Marc Kaufman
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - Francesco Landi
- Department of Geriatrics, Neurosciences and Orthopedics, Catholic University of the Sacred Heart Rome, Milan, Italy
| | | | - Eugene McCloskey
- Mary McKillop Health Institute, Australian Catholic University, Melbourne, Australia
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
- CNR Neuroscience Institute, Aging Branch, Padua, Italy
- MRC and Arthritis Research UK Centre for Integrated Research in Musculoskeletal Ageing (CIMA), Sheffield, UK
| | - Jean Petermans
- Geriatric Department, CHU Sart-Tilman, Bât B35, 4000, Liège, Belgium
| | | | - Jean-Yves Reginster
- Department of Public Health, Epidemiology and Health Economics, University of Liège, Avenue Hippocrate 13, CHU B23, 4000, Liège, Belgium
- WHO Collaborating Centre for Public Health Aspects of Musculo-Skeletal Health and Aging, Liège, Belgium
| | | | - Laura A Schaap
- Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Daniel Uebelhart
- Centre Hospitalier du Valais Romand, Centre Valaisan de Pneumologie, Crans-Montana, Switzerland
| | - René Rizzoli
- Service of Bone Diseases, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Roger A Fielding
- Nutrition, Exercise Physiology and Sarcopenia Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, USA
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The Automatic Assessment of Strength and Mobility in Older Adults: A Test-Retest Reliability Study. ACTA ACUST UNITED AC 2019; 55:medicina55060270. [PMID: 31212695 PMCID: PMC6631724 DOI: 10.3390/medicina55060270] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 06/02/2019] [Accepted: 06/04/2019] [Indexed: 11/16/2022]
Abstract
Background: Simple field tests such as the Timed Up and Go test (TUG) and 30 s Chair Stand test are commonly used to evaluate physical function in the elderly, providing crude outcome measures. Using an automatic chronometer, it is possible to obtain additional kinematic parameters that may lead to obtaining extra information and drawing further conclusions. However, there is a lack of studies that evaluate the test-retest reliability of these parameters, which may help to judge and interpret changes caused by an intervention or differences between populations. Thus, the aim of this study was to evaluate the test-retest reliability of the Timed Up and Go test (TUG) and 30 s Chair Stand test in healthy older adults. Methods: A total of 99 healthy older adults participated in this cross-sectional study. The TUG and the 30 s Chair Stand test were performed five times and twice, respectively, using an automatic chronometer. The sit-to-stand-to-sit cycle from the 30 s Chair Stand test was divided into two phases. Results: Overall, reliability for the 30 s Chair Stand test was good for almost each variable (intraclass correlation coefficient (ICC) >0.70). Furthermore, the use of an automatic chronometer improved the reliability for the TUG (ICC >0.86 for a manual chronometer and ICC >0.88 for an automatic chronometer). Conclusions: The TUG and the 30 s Chair Stand test are reliable in older adults. The use of an automatic chronometer in the TUG is strongly recommended as it increased the reliability of the test. This device enables researchers to obtain relevant and reliable data from the 30 s Chair Stand test, such as the duration of the sit-to-stand-to-sit cycles and phases.
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Rajtar-Zembaty A, Rajtar-Zembaty J, Sałakowski A, Starowicz-Filip A, Skalska A. Executive functions and working memory in motor control: Does the type of MCI matter? APPLIED NEUROPSYCHOLOGY-ADULT 2019; 27:580-588. [PMID: 31043086 DOI: 10.1080/23279095.2019.1585349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The purpose of this study was to evaluate the association between functional mobility performance and executive functions in older adults with the amnestic (aMCI) and nonamnestic (naMCI) type of mild cognitive impairment (MCI), as well as in a control group. A cross-sectional study was conducted among 800 older adults (147 with MCI) who participated in a longitudinal study consisting in an interdisciplinary geriatric assessment and rehabilitation program in Kraków. Motor performance was measured with the Timed Up and Go test (TUG), while standard neuropsychological tests were used to assess different cognitive domains. Analysis of the entire sample showed that almost all cognitive domains and the presence of MCI are associated with functional mobility. Executive functions, letter fluency, and working memory were associated with TUG in the MCI group. The MCI type was not a significant moderator of the relationship between cognitive and motor performance. In group analyses, various cognitive predictors for TUG in the aMCI group, naMCI, and control group were demonstrated. Our results suggest that executive functions and working memory in aMCI and letter fluency in naMCI are independently associated with functional mobility performance. Executive functions are important for gait control in MCI.
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Affiliation(s)
- Anna Rajtar-Zembaty
- Department of Psychiatry, Jagiellonian University Medical College, Kraków, Poland
| | - Jakub Rajtar-Zembaty
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Kraków, Poland
| | - Andrzej Sałakowski
- Nowa Rehabilitacja, Medical-Rehabilitation Center Kraków-Południe, Kraków, Poland
| | - Anna Starowicz-Filip
- Department of Psychiatry, Jagiellonian University Medical College, Kraków, Poland
| | - Anna Skalska
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Kraków, Poland
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Fujita K, Kaburagi H, Nimura A, Miyamoto T, Wakabayashi Y, Seki Y, Aoyama H, Shimura H, Kato R, Okawa A. Lower grip strength and dynamic body balance in women with distal radial fractures. Osteoporos Int 2019; 30:949-956. [PMID: 30607458 PMCID: PMC6502779 DOI: 10.1007/s00198-018-04816-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 12/14/2018] [Indexed: 12/30/2022]
Abstract
In this case-control study, we concluded that women with distal radial fractures who were surgically treated showed lower grip strength and dynamic body balancing than those of controls. These results suggest that measurements of grip strength and dynamic body balance may be useful screening tools to assess future fracture risk. INTRODUCTION Patients with distal radial fractures (DRFs) are at risk of future fragility fractures. However, their physical characteristics and tendencies for falls remain unclear. We aimed to compare the physical characteristics of women with and without distal radial fractures. METHODS We included 128 women with a DRF as their first fragility fracture (fracture group) who underwent surgical treatment. Concurrently, 128 age- and sex-matched participants without a history of fragility fractures were selected as controls (control group). The participants underwent assessments of grip strength and the body balancing ability test. Measurements were taken twice in the fracture group, at 2 weeks and 6 months postoperatively, and once in the control group. The body balancing ability test included the Functional Reach Test, Timed Up and Go test (TUG), 2-Step test (2ST), and Timed Uni-pedal Stance test. The participants also completed questionnaires about their health. RESULTS There were no significant differences (p > 0.05) in patient characteristics between the groups. The fracture group showed lower grip strength across all age groups. In the DRF group, prolonged TUG time was observed at 2 weeks postoperatively in all age groups and at 6 months in participants aged 55-74 years; the 2ST score was significantly lower in participants aged between 65 and 74 years. CONCLUSIONS Women with DRF demonstrated lower grip strength and dynamic body balancing ability. Lower grip strength and dynamic body balancing ability were identified as significant risk factors in women with DRF, suggesting that these may be useful screening tools to assess fracture risk.
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Affiliation(s)
- K Fujita
- Department of Orthopaedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
| | - H Kaburagi
- Department of Orthopaedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - A Nimura
- Department of Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - T Miyamoto
- Department of Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Y Wakabayashi
- Department of Orthopedic Surgery, Yokohama City Minato Red Cross Hospital, Kanagawa, Japan
| | - Y Seki
- Department of Orthopedic Surgery, Suwa Central Hospital, Nagano, Japan
| | - H Aoyama
- Department of Orthopedic Surgery, JA Toride Medical Center, Ibaraki, Japan
| | - H Shimura
- Department of Orthopedic Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan
| | - R Kato
- JA Kyosai Research Institute, Tokyo, Japan
| | - A Okawa
- Department of Orthopaedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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Trautwein S, Barisch-Fritz B, Scharpf A, Bossers W, Meinzer M, Steib S, Stein T, Bös K, Stahn A, Niessner C, Altmann S, Wittelsberger R, Woll A. Recommendations for assessing motor performance in individuals with dementia: suggestions of an expert panel - a qualitative approach. Eur Rev Aging Phys Act 2019; 16:5. [PMID: 31015865 PMCID: PMC6463628 DOI: 10.1186/s11556-019-0212-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 03/31/2019] [Indexed: 12/02/2022] Open
Abstract
Background Recommendations for assessing motor performance in individuals with dementia (IWD) are rare, and most existing assessment tools previously applied in IWD were initially developed for healthy older adults. However, IWD and their healthy counterparts differ in motor and cognitive capabilities, which needs to be considered when designing studies for this population. This article aims to give recommendations for motor assessments for IWD and to promote standardisation based on a structured discussion of identified assessment tools used in previous trials. Methods Appropriateness and standardisation of previously applied motor assessments for IWD were intensively discussed using a qualitative approach during an expert panel. Furthermore, the use of external cues and walking aids, as well as psychometric properties were considered. Starting with a comprehensive overview of current research practice, the discussion was gradually specified and resulted in the elaboration of specific recommendations. Results The superior discussion emphasised the need for tailoring motor assessments to specific characteristics of IWD and attaching importance to standardised assessment procedures. Specific recommendations include the use of sequential approaches, which incorporate a gradual increase of complexity from simple to more difficult tasks, a selection of motor assessments showing sufficient relative reliability and appropriateness for IWD, as well as allowing external cues and walking aids when restricted to repeated instructions and commonly used devices, respectively. Conclusions These are the first recommendations for assessing motor performance in IWD based on a comprehensive qualitative approach. Due to limited evidence, it was not possible to address all existing questions. It is therefore important to evaluate these recommendations in studies with IWD. Besides tailoring and evaluating available assessments, future research should focus on developing specific tools for IWD. Moreover, further progress in standardisation is necessary to enhance comparability between different trials. This article provides initial approaches for overcoming existing limitations in trials with IWD by giving recommendations and identifying future research questions, and therefore contributes to enhancing evidence regarding efficacy and effectiveness of physical activity interventions.
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Affiliation(s)
- Sandra Trautwein
- 1Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, 76131 Karlsruhe, Germany
| | - Bettina Barisch-Fritz
- 1Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, 76131 Karlsruhe, Germany
| | - Andrea Scharpf
- 1Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, 76131 Karlsruhe, Germany
| | - Willem Bossers
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marcus Meinzer
- 3Centre for Clinical Research, University of Queensland, Brisbane, Australia.,4Department of Neurology, Greifswald University Medicine, Greifswald, Germany
| | - Simon Steib
- 5Department of Sport Science and Sport, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Thorsten Stein
- 1Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, 76131 Karlsruhe, Germany
| | - Klaus Bös
- 1Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, 76131 Karlsruhe, Germany
| | - Alexander Stahn
- 6Unit of Experimental Psychiatry, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA.,Institute of Physiology, Charité - Universitätsmedizin Berlin, a corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Claudia Niessner
- 1Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, 76131 Karlsruhe, Germany
| | - Stefan Altmann
- 1Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, 76131 Karlsruhe, Germany
| | - Rita Wittelsberger
- 1Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, 76131 Karlsruhe, Germany
| | - Alexander Woll
- 1Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, 76131 Karlsruhe, Germany
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De Cock AM, Fransen E, Perkisas S, Verhoeven V, Beauchet O, Vandewoude M, Remmen R. Comprehensive Quantitative Spatiotemporal Gait Analysis Identifies Gait Characteristics for Early Dementia Subtyping in Community Dwelling Older Adults. Front Neurol 2019; 10:313. [PMID: 31024419 PMCID: PMC6459932 DOI: 10.3389/fneur.2019.00313] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 03/12/2019] [Indexed: 12/21/2022] Open
Abstract
Background: Recent studies associated gait patterns with cognitive impairment stages. The current study examined the relation between dementia type and spatiotemporal gait characteristics under different walking conditions in pre and mild neurocognitive disorder stage. Methods: Community-dwelling older adults (age 50+) with memory complaints consulting a memory clinic underwent, at baseline and during follow-up (every 4 months), a standard dementia assessment and a comprehensive spatiotemporal gait analysis [walking on an electronic walkway at usual pace (UP) with and without a counting-backwards (CW) or animal-reciting dual-task (AW), at fast (FP) and at slow (SP) pace]. At baseline the participants were categorized according to the Clinical Dementia Rating (CDR) scale. At the end of the study, the dementia diagnosis was used to stratify the categories in three outcome groups: developed “No-dementia,” “AD+FTD” (grouping Alzheimer's or Fronto-temporal dementia) or “VascD+LBD” dementia (grouping Vascular dementia or Lewy body dementia). The gait characteristics were compared per category in paired groups. Sub-analyzing in the ≥70-years-old participants evaluated the age effect. Results: Five hundred and thirty-six participants, age 50-to-95-years old were followed for 31-to-41 months. In the CDR 0, no differences were seen between eventual dementia and no-dementia individuals. In the CDR 0.5, CW dual task cost (DTC) step width was larger in the imminent “AD+FTD” and AW (normalized) gait speed was slower in the future “VascD+LBD” group compared to the no-dementia participants. Slower UP (normalized) gait speed differed the future “VascD+LBD” from the “AD+FTD” individuals. In the CDR 1: Wider steps in UP, SP and CW differed the “VascD+LBD” from the “AD+FTD” group. In the ≥70-years old CDR 0 category, higher AW cycle time variability in the imminent “AD+FTD” dementia group, wider UP step width and higher AW cycle time variability in the “VascD+LBD” group differed them from the no-dementia group up to 3 years before dementia diagnosis. The distinctive gait characteristics between the no-dementia and the imminent dementia groups in CDR 0.5 and CDR 1 remained the same as in the overall group. However, no gait differences were found between “VascD+LBD” and “AD+FTD” groups in the pre-dementia stages. Conclusion: Distinctive spatiotemporal gait characteristics were associated with specific dementia types up to 3 years before diagnosis. The association is influenced by the cognitive stage and age.
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Affiliation(s)
- Anne-Marie De Cock
- Department of Geriatrics, University of Antwerp, Antwerp, Belgium.,Department of Primary and Interdisciplinary Care (ELIZA), University of Antwerp, Antwerp, Belgium.,Department of Geriatric Medicine, General Hospital ZNA, Antwerp, Belgium
| | - Erik Fransen
- StatUa Centre for Statistics, University of Antwerp, Antwerp, Belgium
| | - Stany Perkisas
- Department of Geriatric Medicine, General Hospital ZNA, Antwerp, Belgium
| | - Veronique Verhoeven
- Department of Geriatrics, University of Antwerp, Antwerp, Belgium.,Department of Primary and Interdisciplinary Care (ELIZA), University of Antwerp, Antwerp, Belgium
| | - Olivier Beauchet
- Division of Geriatric Medicine, Department of Medicine, Centre of Excellence on Aging and Chronic Disease (CEViMaC), McGill University, Montreal, QC, Canada
| | - Maurits Vandewoude
- Department of Geriatrics, University of Antwerp, Antwerp, Belgium.,Department of Primary and Interdisciplinary Care (ELIZA), University of Antwerp, Antwerp, Belgium.,Department of Geriatric Medicine, General Hospital ZNA, Antwerp, Belgium
| | - Roy Remmen
- Department of Geriatrics, University of Antwerp, Antwerp, Belgium.,Department of Primary and Interdisciplinary Care (ELIZA), University of Antwerp, Antwerp, Belgium
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Usefulness, assessment and normative data of the Functional Reach Test in older adults: A systematic review and meta-analysis. Arch Gerontol Geriatr 2019; 81:149-170. [DOI: 10.1016/j.archger.2018.11.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 11/28/2018] [Accepted: 11/30/2018] [Indexed: 11/29/2022]
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50
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Braun T, Thiel C, Schulz RJ, Grüneberg C. Reliability of mobility measures in older medical patients with cognitive impairment. BMC Geriatr 2019; 19:20. [PMID: 30674278 PMCID: PMC6343264 DOI: 10.1186/s12877-019-1036-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 01/14/2019] [Indexed: 01/06/2023] Open
Abstract
Background Mobility is a key indicator of physical functioning in older people, but there is limited evidence of the reliability of mobility measures in older people with cognitive impairment. This study aimed to examine the test-retest reliability and measurement error of common measurement instruments of mobility and physical functioning in older patients with dementia, delirium or other cognitive impairment. Methods A cross-sectional study was performed in a geriatric hospital. Older acute medical patients with cognitive impairment, indicated by a Mini-Mental State Examination (MMSE) score of ≤24 points, were assessed twice within 1 day by a trained physiotherapist. The following instruments were applied: de Morton Mobility Index, Hierarchical Assessment of Balance and Mobility, Performance-Oriented Mobility Assessment, Short Physical Performance Battery, 4-m gait speed, 5-times chair rise test, 2-min walk test, timed up and go test, Barthel Index mobility subscale and Functional Ambulation Categories. As appropriate, the intraclass correlation coefficient (ICC), Cohen’s kappa, standard error of measurement, limits of agreement and minimal detectable change (MDC) values were estimated. Results Sixty-five older acute medical patients with cognitive impairment participated in the study (mean age: 82 ± 7 years; mean MMSE: 20 ± 4, range: 10 to 24 points). Some participants were physically or cognitively unable to perform the gait speed (46%), 2-min walk (46%), timed up and go (51%) and chair rise (75%) tests. ICC and kappa values were above 0.9 in all instruments except for the gait speed (ICC = 0.86) and chair rise (ICC = 0.72) measures. Measurement error is reported for each instrument. The absolute limits of agreement ranged from 11% (de Morton Mobility Index and Hierarchical Assessment of Balance and Mobility) to 35% (chair rise test). Conclusions The test-retest reliability is sufficient (> 0.7) for group-comparisons in all examined instruments. Most mobility measurements have limited use for individual monitoring of mobility over time in older hospital patients with cognitive impairment because of the large measurement error (> 20% of scale width), even though relative reliability estimations seem sufficient (> 0.9) for this purpose. Trial registration German Clinical Trials Register (DRKS00005591). Registered 2 February 2015. Electronic supplementary material The online version of this article (10.1186/s12877-019-1036-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tobias Braun
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801, Bochum, Germany.
| | - Christian Thiel
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801, Bochum, Germany.,Faculty of Sports Science, Training and Exercise Science, Ruhr-University Bochum, Bochum, Germany
| | - Ralf-Joachim Schulz
- Department of Geriatric Medicine, St. Marien-Hospital, Kunibertskloster 11-13, 50668, Cologne, Germany
| | - Christian Grüneberg
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801, Bochum, Germany
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