1
|
Klatt BN, Perera S, Dunlap PM, Rosso AL, Brach JS. Activity and Participation Are Associated With Future Falls, Hospitalizations, and Emergency Visits in Community-Dwelling Older Adults. Phys Ther 2024; 104:pzae087. [PMID: 38993047 DOI: 10.1093/ptj/pzae087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 03/21/2024] [Accepted: 06/12/2024] [Indexed: 07/13/2024]
Abstract
OBJECTIVE Activity and participation are important for older adults as they are associated with well-being and quality of life. Falls, emergency department (ED) visits, and hospitalizations are adverse health outcomes that impact older adults. Limited research has investigated whether measurement of activity and participation are related to adverse health events in community dwelling older adults. This study sought to examine the association between activity and participation with falls, ED visits, and hospitalization over 1 year in community dwelling older adults. METHODS A secondary analysis of a longitudinal clinical trial of 341 community dwelling older adults was conducted. The sample mean age was 80.9 (SD = 7.7) years and 83% were female. One-year risk of falls was associated with baseline Late Life Function and Disability Instrument (LLFDI) components of overall function and disability (frequency and limitations dimensions). Incident rate ratios (IRRs) and 95% CIs were calculated. RESULTS For each five-point higher score (clinically meaningful difference) in activity as measured by LLFDI-overall function (adjusted for age, race, sex, comorbidities and fall history), there was an 18% lower rate of falls (IRR = 0.82, 95% CI = 0.74-0.92), 12% reduction in hospitalizations (IRR = 0.88; 95% CI = 0.77-0.99), and 11% lower rate of emergency room visits (IRR = 0.89, 95% CI = 0.81-0.98). Greater participation as measured by the LLFDI limitations dimension was related to fewer falls (IRR = 0.93, 95% CI = 0.87-1.00) and hospitalizations (IRR = 0.91, 95% CI = 0.83-0.99). CONCLUSION Greater activity and participation are associated with a lower incidence of falls, ED visits, and hospitalizations representing an important consideration for targeted physical therapist interventions. IMPACT STATEMENT Physical therapists are uniquely positioned to identify and address reduced activity and participation. If activity and participation are specifically targeted and improved through physical therapy, undesirable distal health outcomes might be prevented or minimized. LAY SUMMARY Greater activity and participation were found to be related to lower rate of falls, ED visits, and hospitalizations in a sample of 341 older adults who lived in the community.
Collapse
Affiliation(s)
- Brooke N Klatt
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Subashan Perera
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Pamela M Dunlap
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Andrea L Rosso
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jennifer S Brach
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
2
|
Chaves AR, Edwards T, Awadia Z, Morin V, Walker LAS, Reed JL, Pilutti LA. Physiological fitness in people with advanced multiple sclerosis. Mult Scler Relat Disord 2024; 91:105854. [PMID: 39245024 DOI: 10.1016/j.msard.2024.105854] [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: 05/02/2024] [Revised: 08/01/2024] [Accepted: 08/28/2024] [Indexed: 09/10/2024]
Abstract
INTRODUCTION Physiological fitness, encompassing cardiorespiratory fitness (CRF) and body composition, are important markers of overall health, functional capacity, and quality of life in general and clinical populations. Characterizing fitness is important for the development of tailored interventions and strategies to optimize well-being across the spectrum of disability in multiple sclerosis (MS). While existing research has explored fitness in people with mild-to-moderate disability, there is a scarcity of data in people with advanced MS (Expanded Disability Severity Scale, EDSS≥7.0). OBJECTIVE To characterize CRF and body composition and their associations with fatigue, quality of life, and function in individuals with advanced MS. METHODS Participants (n=18, mean age=60.7 years-old, median EDSS=7.5) underwent a cardiopulmonary exercise test and dual-energy X-ray absorptiometry scanning. Main outcomes included peak volume of oxygen uptake (V̇O2peak) and whole and regional body fat, lean mass, bone mineral content, and bone density. Symptoms of fatigue (Modified Fatigue Impact Scale, MFIS), quality of life (29-item MS Impact Scale, MSIS-29), and daily function (Late-Life Function and Disability Instrument, LLFDI) were collected. RESULTS Participants exhibited notably low CRF levels (V̇O2peak=9.8 mL/min/kg) and poor body composition (lower lean mass, bone mineral content and density) compared to previous studies in the general population and in individuals with MS with lower disability. V̇O2peak was most consistently associated with function in daily life (LLFDI scores, rs≥0.637, p≤0.004). CONCLUSION These findings reinforce the potential importance of physiological fitness to preserve function in people with advanced MS.
Collapse
Affiliation(s)
- Arthur R Chaves
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada; The Royal's Institute of Mental Health Research, Ottawa, ON, Canada
| | - Thomas Edwards
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Zain Awadia
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Vanessa Morin
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Lisa A S Walker
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada; The University of Ottawa Brain and Mind Research Institute, Ottawa, ON, Canada; Carleton University, Department of Psychology, Ottawa, ON, Canada
| | - Jennifer L Reed
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada; Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, ON, Canada; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Lara A Pilutti
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada; The University of Ottawa Brain and Mind Research Institute, Ottawa, ON, Canada.
| |
Collapse
|
3
|
Adamson B, Lindsay KG, Almasri L, Koppele Duffy M, Kirkpatrick S, Hernandez ME. Evaluating the Impact of Seated Pilates on Functional Outcomes Among Those With Mild, Moderate, and Severe Multiple Sclerosis Impairment: A Pilot Feasibility Trial. Adapt Phys Activ Q 2024:1-29. [PMID: 39122240 DOI: 10.1123/apaq.2023-0159] [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: 10/31/2023] [Revised: 05/08/2024] [Accepted: 05/20/2024] [Indexed: 08/12/2024] Open
Abstract
This pilot study assessed the feasibility and functional benefits of a twice-weekly, 12-week, virtual, seated, group-based Pilates program in persons with mild to severe multiple sclerosis (MS). Participants were randomized into either a Pilates-only group or a Pilates group, which also incorporated hip and shoulder-cuff activation exercises. Process, management, and scientific-feasibility metrics were analyzed descriptively. Functional outcomes, physical activity, and MS-related outcomes (impact, fatigue, and quality of life) were measured pre- and postintervention and analyzed using mixed-effects models, analysis of variance, and cluster analysis. Twenty-two participants completed baseline testing. Sixteen completed the intervention and postintervention testing. Collapsed across groups, analyses demonstrated improvements in the Timed 25-Foot Walk (36%), Timed Up-and-Go (13%), and the Berg Balance Scale (10%, statistically significant). Neither between-groups differences nor physical activity or MS outcome changes were significant. Participants reported high satisfaction. Findings suggest that virtual, seated Pilates is feasible and may confer balance benefits to individuals with MS.
Collapse
Affiliation(s)
- Brynn Adamson
- Health Sciences, University of Colorado Colorado Springs, Colorado Springs, CO, USA
- William J. Hybl Sports Medicine and Performance Center, Colorado Springs, CO, USA
| | - Keston G Lindsay
- William J. Hybl Sports Medicine and Performance Center, Colorado Springs, CO, USA
- Human Physiology and Nutrition, University of Colorado Colorado Springs, Colorado Springs, CO, USA
| | - Layla Almasri
- Health Sciences, University of Colorado Colorado Springs, Colorado Springs, CO, USA
- William J. Hybl Sports Medicine and Performance Center, Colorado Springs, CO, USA
| | | | | | - Manuel E Hernandez
- Biomedical and Translational Sciences, Kinesiology and Community Health, University of Illinois Urbana-Champaign, Urbana, IL, USA
| |
Collapse
|
4
|
Mehdipour A, Saunders S, Reid J, D'Amore C, Richardson J, Beauchamp M, Kuspinar A. Acceptability, Reliability, and Validity of Virtually Administered Gait Speed Tests. J Am Med Dir Assoc 2024; 25:105048. [PMID: 38830594 DOI: 10.1016/j.jamda.2024.105048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 04/11/2024] [Accepted: 04/16/2024] [Indexed: 06/05/2024]
Abstract
OBJECTIVES To evaluate the acceptability, reliability (inter- and intrarater), and validity (convergent, known groups, and predictive) of virtually administered gait speed tests for community-dwelling older adults. DESIGN A prospective cohort study was performed, tracking health outcomes for a year. SETTING AND PARTICIPANTS The 3-m gait speed test at usual and fast pace was administered to community-dwelling older adults over Zoom. METHOD To examine acceptability, participants completed questionnaires regarding telehealth usability and experience. Virtual gait speed tests were administered at baseline and 24 to 72 hours later to evaluate reliability. Self-report mobility measures were used to examine convergent and known-groups validity. Participants' health outcomes were tracked for a year to evaluate predictive validity. RESULTS Sixty participants completed the baseline assessment and 52 completed the second assessment. Participants reported an overall positive experience with the test. Intraclass correlation coefficients for reliability ranged from 0.79 to 0.90. For convergent validity, correlations >0.30 were found predominantly for usual gait speed with self-report mobility measures. Both the usual- and fast-gait speed were able to discriminate between difficulty walking and gait aid use. Usual gait speed was able to predict specialist and family doctor visits and fast gait speed was able to predict rehabilitation specialist visits over 1 year. CONCLUSIONS AND IMPLICATIONS Our findings demonstrate support for the acceptability, reliability, and validity of virtually administered gait speed tests for community-dwelling older adults. Although future studies are needed to examine the validity of virtual gait speed tests in larger and more diverse samples to improve generalizability of results, clinicians and researchers can virtually administer 3-m gait speed tests with confidence that scores are trustworthy and reflect older adults' mobility.
Collapse
Affiliation(s)
- Ava Mehdipour
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Stephanie Saunders
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Julie Reid
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Cassandra D'Amore
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Julie Richardson
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Marla Beauchamp
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Ayse Kuspinar
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada.
| |
Collapse
|
5
|
De Sanctis P, Mahoney JR, Wagner J, Blumen HM, Mowrey W, Ayers E, Schneider C, Orellana N, Molholm S, Verghese J. Linking Dementia Pathology and Alteration in Brain Activation to Complex Daily Functional Decline During the Preclinical Dementia Stages: Protocol for a Prospective Observational Cohort Study. JMIR Res Protoc 2024; 13:e56726. [PMID: 38842914 PMCID: PMC11190628 DOI: 10.2196/56726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 02/07/2024] [Accepted: 02/20/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Progressive difficulty in performing everyday functional activities is a key diagnostic feature of dementia syndromes. However, not much is known about the neural signature of functional decline, particularly during the very early stages of dementia. Early intervention before overt impairment is observed offers the best hope of reducing the burdens of Alzheimer disease (AD) and other dementias. However, to justify early intervention, those at risk need to be detected earlier and more accurately. The decline in complex daily function (CdF) such as managing medications has been reported to precede impairment in basic activities of daily living (eg, eating and dressing). OBJECTIVE Our goal is to establish the neural signature of decline in CdF during the preclinical dementia period. METHODS Gait is central to many CdF and community-based activities. Hence, to elucidate the neural signature of CdF, we validated a novel electroencephalographic approach to measuring gait-related brain activation while participants perform complex gait-based functional tasks. We hypothesize that dementia-related pathology during the preclinical period activates a unique gait-related electroencephalographic (grEEG) pattern that predicts a subsequent decline in CdF. RESULTS We provide preliminary findings showing that older adults reporting CdF limitations can be characterized by a unique gait-related neural signature: weaker sensorimotor and stronger motor control activation. This subsample also had smaller brain volume and white matter hyperintensities in regions affected early by dementia and engaged in less physical exercise. We propose a prospective observational cohort study in cognitively unimpaired older adults with and without subclinical AD (plasma amyloid-β) and vascular (white matter hyperintensities) pathologies. We aim to (1) establish the unique grEEG activation as the neural signature and predictor of decline in CdF during the preclinical dementia period; (2) determine associations between dementia-related pathologies and incidence of the neural signature of CdF; and (3) establish associations between a dementia risk factor, physical inactivity, and the neural signature of CdF. CONCLUSIONS By establishing the clinical relevance and biological basis of the neural signature of CdF decline, we aim to improve prediction during the preclinical stages of ADs and other dementias. Our approach has important research and translational implications because grEEG protocols are relatively inexpensive and portable, and predicting CdF decline may have real-world benefits. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/56726.
Collapse
Affiliation(s)
- Pierfilippo De Sanctis
- Department of Neurology, Division of Cognitive and Motor Aging, Albert Einstein College of Medicine, Bronx, NY, United States
- Department of Pediatrics, Cognitive Neurophysiology Laboratory, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Jeannette R Mahoney
- Department of Neurology, Division of Cognitive and Motor Aging, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Johanna Wagner
- Swartz Center for Computational Neuroscience, Institute for Neural Computation, University of California, San Diego, La Jolla, CA, United States
| | - Helena M Blumen
- Department of Neurology, Division of Cognitive and Motor Aging, Albert Einstein College of Medicine, Bronx, NY, United States
- Department of Medicine (Geriatrics), Albert Einstein College of Medicine, Bronx, NY, United States
| | - Wenzhu Mowrey
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Emmeline Ayers
- Department of Neurology, Division of Cognitive and Motor Aging, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Claudia Schneider
- Department of Neurology, Division of Cognitive and Motor Aging, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Natasha Orellana
- Department of Neurology, Division of Cognitive and Motor Aging, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Sophie Molholm
- Department of Pediatrics, Cognitive Neurophysiology Laboratory, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Joe Verghese
- Department of Neurology, Division of Cognitive and Motor Aging, Albert Einstein College of Medicine, Bronx, NY, United States
- Department of Medicine (Geriatrics), Albert Einstein College of Medicine, Bronx, NY, United States
| |
Collapse
|
6
|
Batcir S, Berdichevsky Y, Bachner YG, Lubovsky O, Debi R, Melzer I. Characteristics of Unsuccessful Balance Reactive Responses to Lateral Loss of Balance in Older Adults. Gerontology 2024; 70:689-700. [PMID: 38657580 PMCID: PMC11239142 DOI: 10.1159/000535968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 12/19/2023] [Indexed: 04/26/2024] Open
Abstract
INTRODUCTION An effective reactive step response to an unexpected balance loss is an important factor that determines if a fall will happen. We investigated reactive step strategies and kinematics of unsuccessful balance recovery responses that ended with falls in older adults. METHODS We compared the strategies and kinematics of reactive stepping after a lateral loss of balance, i.e., perturbations, between 49 older female adults who were able to successfully recover from perturbations (perturbation-related non-fallers, PNFs) and 10 female older adults who failed to recover (perturbation-related fallers, PFs). In addition, we compared the successful versus unsuccessful recovery responses of PFs matched to perturbation magnitude. RESULTS The kinematics of the first reactive step response were significantly different between PFs and PNFs, i.e., longer initiation time, step time, swing time, and time to peak swing-leg velocity, larger first-step length, and center-of-mass displacement. Incomplete crossover stepping and leg collision were significant causes of falls among PFs. Similar findings were found when we compared the successful versus unsuccessful recovery responses of PFs. CONCLUSIONS The crossover step, which requires a complex coordinated leg movement, resulted in difficulty in controlling and decelerating the moving center of mass following a lateral perturbation, affecting the kinematics of the stepping response, leading to a fall.
Collapse
Affiliation(s)
- Shani Batcir
- Schwartz Rehabilitation and Movement Analysis Laboratory, Physical Therapy Department, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yuliya Berdichevsky
- Schwartz Rehabilitation and Movement Analysis Laboratory, Physical Therapy Department, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yaacov G. Bachner
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel
| | - Omri Lubovsky
- Orthopedic Department, Barzilai Medical Center, Ashkelon, Israel
| | - Ronen Debi
- Orthopedic Department, Barzilai Medical Center, Ashkelon, Israel
| | - Itshak Melzer
- Schwartz Rehabilitation and Movement Analysis Laboratory, Physical Therapy Department, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| |
Collapse
|
7
|
Soh SLH, Tan CW, Xu T, Yeh TT, Bte Abdul Rahman F, Soon B, Gleeson N, Lane J. The Balance Recovery Confidence (BRC) Scale. Physiother Theory Pract 2024; 40:658-669. [PMID: 36259660 DOI: 10.1080/09593985.2022.2135420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 09/20/2022] [Accepted: 09/20/2022] [Indexed: 10/24/2022]
Abstract
BACKGROUND Falls efficacy posits an understanding of the perceived ability to prevent and manage falls. There have been no validated self-reported instruments to measure the perceived ability to recover balance in response to destabilizing perturbations. PURPOSE To develop a scale of balance recovery confidence. METHODS Stage one had candidate items generated by 12 community-dwelling adults aged 65 and older using the nominal group technique. Stage two had the scale's name, instructions, response options, recall period and the items validated for appropriateness with 28 healthcare professionals and 10 older adults using an e-Delphi technique. Stage three had the scale's psychometric properties evaluated with 84 older adults who had completed self-reported and performance measures. Factor analysis was applied to confirm unidimensionality. The internal structure, reliability and validity of the scale were evaluated using the classical test theory and Rasch measurement theory. RESULTS The 19-item scale was developed and validated with experts' consensus. The scale is unidimensional with excellent internal structure (Cronbach's α = 0.975) and test-retest reliability with Intraclass Correlation Coefficient (ICC3,1) = 0.944. Construct validity of the scale was supported by its relationships with the other measures (Activities-specific Balance Confidence scale, Falls Efficacy Scale-International, Late-Life Function and Disability International-Function, handgrip strength dynamometry, 30-second chair stand test, and mini-BESTest). CONCLUSION The balance recovery confidence scale is a distinct instrument that measures perceived reactive balance recovery. The scale has good psychometric properties and can be used to complement other measurement instruments to help older adults cope with challenges to balance.
Collapse
Affiliation(s)
- Shawn Leng-Hsien Soh
- Dietetics, Nutrition and Biological Sciences, Physiotherapy, Podiatry and Radiography Division, Queen Margaret University, Queen Margaret University Way, Musselburgh, UK
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore
| | - Chee-Wee Tan
- Department of Paramedicine and Physiotherapy, Glasgow Caledonian University, Glasgow, UK
| | - Tianma Xu
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore
| | - Ting-Ting Yeh
- Master Degree Program in Healthcare Industry, Chang Gung University, Taoyuan, Taiwan
| | | | - Benjamin Soon
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore
| | - Nigel Gleeson
- Dietetics, Nutrition and Biological Sciences, Physiotherapy, Podiatry and Radiography Division, Queen Margaret University, Queen Margaret University Way, Musselburgh, UK
| | - Judith Lane
- Dietetics, Nutrition and Biological Sciences, Physiotherapy, Podiatry and Radiography Division, Queen Margaret University, Queen Margaret University Way, Musselburgh, UK
| |
Collapse
|
8
|
Coyle PC, Pohlig RT, Knox PJ, Pugliese JM, Sions JM, Hicks GE. Trajectories of Physical Function and Disability Over 12 Months in Older Adults With Chronic Low Back Pain. J Geriatr Phys Ther 2024; 47:3-12. [PMID: 36125915 PMCID: PMC10017374 DOI: 10.1519/jpt.0000000000000365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE Understanding prognosis is critical for clinical care and health policy initiatives. The purpose of this study was to determine whether distinct prognostic trajectories of physical function and disability exist in a cohort of 245 community-dwelling older adults with chronic low back pain (LBP), and to characterize the demographic, health, and pain-related profiles of each trajectory subgroup. METHODS All participants underwent standard clinic examinations at baseline, 3 months, 6 months, and 12 months. At each time point, the Late Life Function & Disability Instrument (LLFDI) was used to measure general physical function (LLFDI Function) and disability (LLFDI Disability-Limitation); the Quebec LBP Disability Questionnaire was used to measure disability due to pain. Growth mixture modeling (GMM) was performed on each outcome to identify distinct trajectory classes/subgroups; baseline demographic (eg, age and sex), health (eg, comorbidities, depressive symptoms, and physical activity level), and pain-related (eg, LBP intensity, pain-related fear, and pain catastrophizing) characteristic profiles were compared across subgroups. RESULTS GMM statistics revealed an optimal number of 3 to 4 trajectory subgroups, depending on the outcome examined. Subgroups differed across demographic, health, and pain-related characteristics; the classes with the most favorable prognoses had consistent profile patterns: fewer depressive symptoms, fewer comorbidities, higher physical activity levels, lower LBP intensities, less pain-related fear, and less pain catastrophizing. CONCLUSION Our findings indicate that several distinct trajectory subgroups exist that would have been masked by observing mean cohort change alone. Furthermore, subgroup characteristic profiles may help clinicians identify likely prognostic trajectories for their patients. Future research should focus on identifying modifiable risk factors that best predict group membership, and tailoring interventions to mitigate the risk of poor prognosis.
Collapse
Affiliation(s)
- Peter C. Coyle
- Department of Physical Therapy, University of Delaware, Newark, DE
| | - Ryan T. Pohlig
- Department of Epidemiology, University of Delaware, Newark, DE
- Biostatistics Core, University of Delaware, Newark, DE
| | - Patrick J. Knox
- Department of Physical Therapy, University of Delaware, Newark, DE
| | | | - J. Megan Sions
- Department of Physical Therapy, University of Delaware, Newark, DE
| | - Gregory E. Hicks
- Department of Physical Therapy, University of Delaware, Newark, DE
| |
Collapse
|
9
|
San Francisco CND, Zhen-Duan J, Fukuda M, Alegría M. Attitudes and perceptions toward the COVID-19 risk-mitigation strategies among racially and ethnically diverse older adults in the United States and Puerto Rico: a qualitative study. ETHNICITY & HEALTH 2024; 29:25-45. [PMID: 37543717 PMCID: PMC10867780 DOI: 10.1080/13557858.2023.2243548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 07/10/2023] [Indexed: 08/07/2023]
Abstract
OBJECTIVES There is limited qualitative research investigating how risk-mitigation strategies during the COVID-19 pandemic impacted the lives of diverse older adults, who met criteria for mild to severe generalized anxiety or depression and minor to moderate disability. This study aims to address this gap by examining how racially and ethnically diverse older adults with at least mild mental health symptoms and minor physical disability in the United States and Puerto Rico adapted to guidelines during COVID-19. It aims to inform the medical community and policymakers of potential threats to these older adults' well-being given the COVID-19 burden. DESIGN Based on descriptive qualitative inquiry and phenomenological perspectives, we conducted semi-structured interviews over the phone with a racially and ethnically diverse sample of older (age 60+), predominantly minoritized adults (N = 100) in four states and territories across the United States and Puerto Rico in 2021. Interviews were recorded, coded, and analyzed using a thematic analysis approach. RESULTS Findings centered on five themes: (1) Previous experiences with the healthcare system and cultural beliefs related to trust and distrust led to mixed attitudes toward COVID-19 risk-mitigation strategies; (2) Compliance with COVID-19 mitigation strategies ensured safety and addressed fear of illness; (3) Compliance led to isolation due to interrupted social relations; (4) Isolation and disrupted social networks negatively impacted mental health and finances, and (5) Coping strategies and embracing support reduced the effects of social isolation. CONCLUSION This study underscores the importance of increasing support and social connectedness during a pandemic and beyond to ensure the well-being of older adults in racially and ethnically diverse communities. It highlights the resiliency of older adults in identifying strategies to cope with negative impacts. We recommend safeguarding economic security through policy efforts toward financial safety nets during health crises and collaborative approaches with community-based organizations to mitigate social isolation.
Collapse
Affiliation(s)
- Carolina Nvé Díaz San Francisco
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States
- Departamento de Antropología Social y Cultural, Universidad de Educación a Distancia, UNED, Madrid, Spain
| | - Jenny Zhen-Duan
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Marie Fukuda
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Margarita Alegría
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
- Department of Medicine, Harvard Medical School, Boston, MA, United States
| |
Collapse
|
10
|
Beauchamp M, Hao Q, Kuspinar A, Alder G, Makino K, Nouredanesh M, Zhao Y, Mikton C, Thiyagarajan JA, Diaz T, Raina P. Measures of perceived mobility ability in community-dwelling older adults: a systematic review of psychometric properties. Age Ageing 2023; 52:iv100-iv111. [PMID: 37902516 PMCID: PMC10615037 DOI: 10.1093/ageing/afad124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Indexed: 10/31/2023] Open
Abstract
OBJECTIVES The objective of this systematic review was to synthesise the psychometric properties of measures of perceived mobility ability and related frameworks used to define and operationalise mobility in community-dwelling older adults. METHODS We registered the review protocol with PROSPERO (CRD42022306689) and included studies that examined the psychometric properties of perceived mobility measures in community-dwelling older adults. Five databases were searched to identify potentially relevant primary studies. We qualitatively summarised psychometric property estimates and related operational frameworks. We conducted risk of bias and overall quality assessments, and meta-analyses when at least three studies were included for a particular outcome. The synthesised results were compared against the Consensus-based Standards for the Selection of Health Measurement Instruments criteria for good measurement properties. RESULTS A total of 36 studies and 17 measures were included in the review. The Late-Life Function and Disability Index: function component (LLFDI-FC), lower extremity functional scale (LEFS), Mobility Assessment Tool (MAT)-short form (MAT-SF) or MAT-Walking, and Perceived Driving Abilities (PDA) Scale were identified with three or more eligible studies. Most measures showed sufficient test-retest reliability (moderate or high), while the PDA scale showed insufficient reliability (low). Most measures had sufficient or inconsistent convergent validity (low or moderate) or known-groups validity (low or very low), but their predictive validity and responsiveness were insufficient or inconsistent (low or very low). Few studies used a conceptual model. CONCLUSION The LLFDI-FC, LEFS, PDA and MAT-SF/Walking can be used in community-dwelling older adults by considering the summarised psychometric properties. No available comprehensive mobility measure was identified that covered all mobility domains.
Collapse
Affiliation(s)
- Marla Beauchamp
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
- McMaster Institute for Research on Aging, McMaster University, Hamilton, ON, Canada
| | - Qiukui Hao
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
- McMaster Institute for Research on Aging, McMaster University, Hamilton, ON, Canada
| | - Ayse Kuspinar
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
- McMaster Institute for Research on Aging, McMaster University, Hamilton, ON, Canada
| | - Gésine Alder
- McMaster Institute for Research on Aging, McMaster University, Hamilton, ON, Canada
| | - Keitaro Makino
- McMaster Institute for Research on Aging, McMaster University, Hamilton, ON, Canada
- Department of Preventive Gerontology, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Mina Nouredanesh
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
- McMaster Institute for Research on Aging, McMaster University, Hamilton, ON, Canada
| | - Yunli Zhao
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Christopher Mikton
- Demographic Change and Healthy Aging Unit, Social Determinants of Health, World Health Organization, Geneva, Switzerland
| | | | - Theresa Diaz
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Parminder Raina
- McMaster Institute for Research on Aging, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Labarge Centre for Mobility in Aging, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
11
|
Endress C, Schwenk M, Werner C, Becker C, Jansen CP. [Lifestyle-integrated functional exercise for fall prevention : How and why do walking characteristics change?]. Z Gerontol Geriatr 2023; 56:464-469. [PMID: 37676321 DOI: 10.1007/s00391-023-02230-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/01/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND The lifestyle-integrated functional exercise (LiFE) program has been shown to increase physical activity. It remains unclear, however, how these changes translate into long vs. short walking episodes. OBJECTIVE The aim of this work was to investigate changes in short vs. long walking episodes between baseline and 6‑month follow-up and to determine which factors are associated with these changes. MATERIAL AND METHODS This was a two-arm randomized noninferiority study with 309 older adults (mean age 78.7 ± 0.3 years; 73.5% female) at risk of falling who exercised either in a group (gLiFE; n = 153) or individually (LiFE; n = 156). Walking episodes were measured using activPAL 4micro sensors: a distinction was made between walking episodes < 10s, < 20s, and > 60 s. Changes in walking episodes between baseline and 6‑month follow-up were analyzed, including calculation of effect sizes (Cohen's d). Determinants of changes in the walking episodes were analyzed using multiple regression. RESULTS The walking episodes < 10s and < 20 s showed a significant increase in both intervention groups but not for > 60 s. The overall daily walking duration and average steps per day had an influence on changes in the walking episodes between baseline and 6 months. Parameters of objective and subjective function explained a very small but significant amount of the variance. CONCLUSION The LiFE program seems to work on a behavioral rather than on a functional level. By accumulating short walking episodes, large gains in physical activity can potentially be achieved. This can be of health-promoting benefit especially for persons living in institutional settings or for those who are cautious or even anxious to undertake longer walking episodes (e.g., outdoors).
Collapse
Affiliation(s)
- Christoph Endress
- Klinik für Geriatrische Rehabilitation, Robert-Bosch-Krankenhaus, Auerbachstraße 110, 70376, Stuttgart, Deutschland
- Geriatrisches Zentrum, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Michael Schwenk
- Human Performance Research Centre, Abteilung für Sportwissenschaft, Universität Konstanz, Konstanz, Deutschland
| | - Christian Werner
- Geriatrisches Zentrum, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Clemens Becker
- Klinik für Geriatrische Rehabilitation, Robert-Bosch-Krankenhaus, Auerbachstraße 110, 70376, Stuttgart, Deutschland
- Unit Digitale Geriatrie, Geriatrisches Zentrum, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Carl-Philipp Jansen
- Klinik für Geriatrische Rehabilitation, Robert-Bosch-Krankenhaus, Auerbachstraße 110, 70376, Stuttgart, Deutschland.
- Geriatrisches Zentrum, Universitätsklinikum Heidelberg, Heidelberg, Deutschland.
| |
Collapse
|
12
|
Sikes EM, Finlayson M, Banwell B, Marrie RA, Yeh EA, Motl R. Physical activity and functional limitations in pediatric multiple sclerosis: Are fatigue and depression confounding variables? J Pediatr Rehabil Med 2023:PRM220081. [PMID: 37807790 DOI: 10.3233/prm-220081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
Abstract
PURPOSE Pediatric-onset multiple sclerosis (MS) is associated with risk for functional limitations defined as the perceived reduction in capacity for undertaking activities of daily living. Moderate-to-vigorous physical activity (MVPA) has been associated with less frequent and less impactful functional limitations, but the symptoms of fatigue and depression have not been considered as potential confounding variables. This study examined whether fatigue and depression confound the association between MVPA and functional limitations among youth with pediatric MS. METHODS Participant data were accumulated from three ongoing observational studies. The combined sample included 65 cases of pediatric-onset MS (24 male/41 female, 16±1.7 years of age). Data on self-report MVPA, functional limitations, depression, and fatigue were analyzed. RESULTS MVPA was significantly associated with functional limitations (r = 0.45), fatigue (r = -0.28), and depression (r = -0.32). Functional limitations were associated with fatigue (r = -0.45) and depressive symptoms (r = -0.53). MVPA was significantly correlated with functional limitations (β= 0.27, p = 0.04) even after accounting for general fatigue (β= 0.08, p = 0.64) and depressive symptoms (β= -0.40, p = 0.03) among those with pediatric MS. CONCLUSION Self-reported MVPA was associated with perceived functional limitations among youth with pediatric MS independent of perceived fatigue and depressive symptoms.
Collapse
Affiliation(s)
- E Morghen Sikes
- Division of Occupational Therapy, Shenandoah University, Leesburg, VA, USA
| | - Marcia Finlayson
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
| | - Brenda Banwell
- Division of Child Neurology, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ruth Ann Marrie
- Departments of Medicine and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - E Ann Yeh
- Department of Pediatrics, Division of Neurology, Hospital for Sick Children, Toronto, ON, Canada
- Department of Pediatrics (Neurology), University of Toronto, Toronto, ON, Canada
- Division of Neurosciences and Mental Health, SickKids Research Institute, Hospital for Sick Children, Toronto, ON, Canada
| | - Rob Motl
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL, USA
| |
Collapse
|
13
|
Packer E, Debelle H, Bailey HGB, Ciravegna F, Ireson N, Evers J, Niessen M, Shi JQ, Yarnall AJ, Rochester L, Alcock L, Del Din S. Translating digital healthcare to enhance clinical management: a protocol for an observational study using a digital health technology system to monitor medication adherence and its effect on mobility in people with Parkinson's. BMJ Open 2023; 13:e073388. [PMID: 37666560 PMCID: PMC10481731 DOI: 10.1136/bmjopen-2023-073388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 08/18/2023] [Indexed: 09/06/2023] Open
Abstract
INTRODUCTION In people with Parkinson's (PwP) impaired mobility is associated with an increased falls risk. To improve mobility, dopaminergic medication is typically prescribed, but complex medication regimens result in suboptimal adherence. Exploring medication adherence and its impact on mobility in PwP will provide essential insights to optimise medication regimens and improve mobility. However, this is typically assessed in controlled environments, during one-off clinical assessments. Digital health technology (DHT) presents a means to overcome this, by continuously and remotely monitoring mobility and medication adherence. This study aims to use a novel DHT system (DHTS) (comprising of a smartphone, smartwatch and inertial measurement unit (IMU)) to assess self-reported medication adherence, and its impact on digital mobility outcomes (DMOs) in PwP. METHODS AND ANALYSIS This single-centre, UK-based study, will recruit 55 participants with Parkinson's. Participants will complete a range of clinical, and physical assessments. Participants will interact with a DHTS over 7 days, to assess self-reported medication adherence, and monitor mobility and contextual factors in the real world. Participants will complete a motor complications diary (ON-OFF-Dyskinesia) throughout the monitoring period and, at the end, a questionnaire and series of open-text questions to evaluate DHTS usability. Feasibility of the DHTS and the motor complications diary will be assessed. Validated algorithms will quantify DMOs from IMU walking activity. Time series modelling and deep learning techniques will model and predict DMO response to medication and effects of contextual factors. This study will provide essential insights into medication adherence and its effect on real-world mobility in PwP, providing insights to optimise medication regimens. ETHICS AND DISSEMINATION Ethical approval was granted by London-142 Westminster Research Ethics Committee (REC: 21/PR/0469), protocol V.2.4. Results will be published in peer-reviewed journals. All participants will provide written, informed consent. TRIAL REGISTRATION NUMBER ISRCTN13156149.
Collapse
Affiliation(s)
- Emma Packer
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Héloïse Debelle
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Harry G B Bailey
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Fabio Ciravegna
- Dipartimento di Informatica, Università di Torino, Torino, Italy
| | - Neil Ireson
- Department of Computer Science and INSIGNEO Institute for in silico Medicine, The University of Sheffield, Sheffield, UK
| | | | | | - Jian Qing Shi
- Department of Statistics and Data Science, Southern University of Science and Technology, Shenzhen, Guangdong, China
- National Center for Applied Mathematics, Shenzhen, Guangdong, China
| | - Alison J Yarnall
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Lynn Rochester
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Lisa Alcock
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Based at The Newcastle upon Tyne Hospitals NHS Foundation Trust, NIHR Newcastle Biomedical Research Centre, Newcastle University, Newcastle upon Tyne, UK
| | - Silvia Del Din
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Based at The Newcastle upon Tyne Hospitals NHS Foundation Trust, NIHR Newcastle Biomedical Research Centre, Newcastle University, Newcastle upon Tyne, UK
| |
Collapse
|
14
|
Dunlap PM, Crane BM, Perera S, Moored KD, Carlson MC, Brach JS, Klatt BN, Rosso AL. Effects of a Physical Therapist Intervention on GPS Indicators of Community Mobility in Older Adults: A Secondary Analysis of a Randomized Controlled Trial. Phys Ther 2023; 103:pzad071. [PMID: 37364044 PMCID: PMC10471202 DOI: 10.1093/ptj/pzad071] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 12/22/2022] [Accepted: 05/04/2023] [Indexed: 06/28/2023]
Abstract
OBJECTIVE The authors compared the effects of a standard strength and endurance intervention with a standard plus timing and coordination training intervention on community mobility measured using global positioning systems (GPS) among community-dwelling older adults in this secondary analysis of a randomized controlled trial. METHODS Participants were randomized to a standard or a standard plus timing and coordination training program. Community mobility was measured using the Life Space Assessment (LSA) and GPS indicators of community mobility at baseline, as well as at 12 (immediately after the intervention), 24, and 36 weeks. Linear mixed models were used for analysis. RESULTS There were 166 participants with GPS data at baseline, including 81 in the standard plus group and 85 in the standard group. The groups did not differ in participant characteristics or GPS measures at baseline. There were no significant within-group changes in GPS indicators of community mobility or LSA score over time, nor between-group differences of the same. CONCLUSION There were no significant changes in community mobility with either intervention or between-intervention differences. These findings suggest that interventions targeting physical function alone may not be sufficient to improve community mobility or participation in older adults. Future research should focus on the development of multifaceted interventions targeted to improve real-world participation. IMPACT The studied interventions did not significantly change community mobility measured using GPS-derived community mobility measures or self-report measures in older adults, suggesting that more comprehensive interventions may be needed to target improvements in community mobility.
Collapse
Affiliation(s)
- Pamela M Dunlap
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Breanna M Crane
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Subashan Perera
- Division of Geriatric Medicine and Department of Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kyle D Moored
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Michelle C Carlson
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Jennifer S Brach
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Brooke N Klatt
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Andrea L Rosso
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
15
|
Vesnaver E, Dietrich N, Kirkwood R, Ma J, Guennel R, Beauchamp M, Keller H, Macedo L, Astephan Wilson J, Vrkljan B. Exploring Distress and Occupational Participation Among Older Canadians During the COVID-19 Pandemic. Can J Occup Ther 2023; 90:173-184. [PMID: 37186792 DOI: 10.1177/00084174231165832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Background. The coronavirus disease 2019 (COVID-19) pandemic disrupted daily life with corresponding implications on levels of distress. Purpose. To describe factors associated with high distress among community-dwelling older adults during the first lockdown and explore how occupational participation was managed. Methods. A mixed methods design whereby multivariate regression analysis of a survey (N = 263) identified factors associated with high distress, as per the Impact of Events of Scale-Revised (IES-R). Follow-up interviews with a sub-sample of those surveyed who reflected a range of IES-R scores were conducted (N = 32). Findings. Those with lower resilience and anxiety/depression had 6.84 and 4.09 greater odds respectively of high distress. From the interviews, the main theme, "Lost and Found," and subthemes (Interruption and Disruption; Surving, not Thriving; Moving Forward, Finding Meaning) highlighted the process and corresponding stages, including adaptive strategies, by which participants navigated changes in their occupational participation. Implications. While the results suggest that many older adults, including those with high distress, were able to manage daily life under lockdown, some experienced ongoing challenges in doing so. Future studies should focus on those who experienced or who are at-higher risk for such challenges to identify supports that mitigate adverse consequences if another event of this magnitude occurs again.
Collapse
|
16
|
Sukoff Rizzo SJ, Finkel T, Greenspan SL, Resnick NM, Brach JS. Speaking the Same Language: Team Science Approaches in Aging Research for Integrating Basic and Translational Science With Clinical Practice. Innov Aging 2023; 7:igad035. [PMID: 37213324 PMCID: PMC10198772 DOI: 10.1093/geroni/igad035] [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: 02/06/2023] [Indexed: 05/23/2023] Open
Abstract
Research on aging is at an important inflection point, where the insights accumulated over the last 2 decades in the basic biology of aging are poised to be translated into new interventions to promote health span and improve longevity. Progress in the basic science of aging is increasingly influencing medical practice, and the application and translation of geroscience require seamless integration of basic, translational, and clinical researchers. This includes the identification of new biomarkers, novel molecular targets as potential therapeutic agents, and translational in vivo studies to assess the potential efficacy of new interventions. To facilitate the required dialog between basic, translational, and clinical investigators, a multidisciplinary approach is essential and requires the collaborative expertise of investigators spanning molecular and cellular biology, neuroscience, physiology, animal models, physiologic and metabolic processes, pharmacology, genetics, and high-throughput drug screening approaches. In an effort to better enable the cross-talk of investigators across the broad spectrum of aging-related research disciplines, a goal of our University of Pittsburgh Claude D. Pepper Older Americans Independence Center has been to reduce the barriers to collaborative interactions by promoting a common language through team science. The culmination of these efforts will ultimately accelerate the ability to conduct first-in-human clinical trials of novel agents to extend health span and life span.
Collapse
Affiliation(s)
- Stacey J Sukoff Rizzo
- Aging Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Pittsburgh Claude D. Pepper Older Americans Independence Center, Division of Geriatrics and Gerontology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Toren Finkel
- Aging Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Pittsburgh Claude D. Pepper Older Americans Independence Center, Division of Geriatrics and Gerontology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Susan L Greenspan
- Pittsburgh Claude D. Pepper Older Americans Independence Center, Division of Geriatrics and Gerontology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Neil M Resnick
- Pittsburgh Claude D. Pepper Older Americans Independence Center, Division of Geriatrics and Gerontology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jennifer S Brach
- Pittsburgh Claude D. Pepper Older Americans Independence Center, Division of Geriatrics and Gerontology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
17
|
Simon CB, Hicks GE, Pieper CF, Kraus VB, Keefe FJ, Colón-Emeric C. A Novel Movement-Evoked Pain Provocation Test for Older Adults With Persistent Low Back Pain: Safety, Feasibility, and Associations With Self-reported Physical Function and Usual Gait Speed. Clin J Pain 2023; 39:166-174. [PMID: 36943160 PMCID: PMC10034602 DOI: 10.1097/ajp.0000000000001101] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 01/24/2023] [Indexed: 03/23/2023]
Abstract
OBJECTIVES Low back pain (LBP) is highly prevalent and disabling for older adults. Movement-evoked pain is an emerging measure that may help to predict disability; but is not currently a part of geriatric LBP clinical care. This study tested the safety and feasibility of a new Movement-Evoked Provocation Test for Low Back Pain in Older Adults (MEPLO). We also compared associations between movement-evoked pain via 2 different scoring methods and disability-associated outcomes. MATERIALS AND METHODS Thirty-nine older adults with persistent LBP provided baseline recalled and resting pain ratings, self-reported physical function, and usual gait speed. Participants then completed MEPLO, involving 4 tasks essential for functional independence: chair rises, trunk rotation, reaching, and walking. Movement-evoked pain was then quantified using the traditional change score (delta) method of pain premovement to postmovement; and also, a new aggregate method that combines pain ratings after the 4 tasks. RESULTS No safety or feasibility issues were identified. Compared with the delta score, the aggregate score was more strongly associated with self-reported physical function (beta: -0.495 vs. -0.090) and usual gait speed (beta: -0.450 vs. -0.053). Similarly, the aggregate score was more strongly associated with self-reported physical function than recalled and resting pain (beta: -0.470, -0.283, and 0.136, respectively). DISCUSSION This study shows the safety and feasibility of testing movement-evoked pain in older adults with persistent LBP, and its potential superiority to traditional pain measures. Future studies must validate these findings and test the extent to which MEPLO is implementable to change with geriatric LBP standard of care.
Collapse
Affiliation(s)
- Corey B. Simon
- Department of Orthopaedic Surgery, Duke University, Durham, NC
| | - Gregory E. Hicks
- Department of Physical Therapy, University of Delaware, Newark, DE
| | - Carl F. Pieper
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC
| | - Virginia Byers Kraus
- Department of Medicine, Duke University School of Medicine, Durham, NC
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC
| | - Francis J. Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC
| | - Cathleen Colón-Emeric
- Department of Medicine, Duke University School of Medicine, Durham, NC
- Durham VA Geriatric Research Education and Clinical Center, Durham, NC
| |
Collapse
|
18
|
Sigurdsson HP, Hunter H, Alcock L, Wilson R, Pienaar I, Want E, Baker MR, Taylor JP, Rochester L, Yarnall AJ. Safety and tolerability of adjunct non-invasive vagus nerve stimulation in people with parkinson's: a study protocol. BMC Neurol 2023; 23:58. [PMID: 36737716 PMCID: PMC9896761 DOI: 10.1186/s12883-023-03081-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 01/19/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Parkinson's disease (PD) is the fastest growing neurological condition worldwide. Recent theories suggest that symptoms of PD may arise due to spread of Lewy-body pathology where the process begins in the gut and propagate transynaptically via the vagus nerve to the central nervous system. In PD, gait impairments are common motor manifestations that are progressive and can appear early in the disease course. As therapies to mitigate gait impairments are limited, novel interventions targeting these and their consequences, i.e., reducing the risk of falls, are urgently needed. Non-invasive vagus nerve stimulation (nVNS) is a neuromodulation technique targeting the vagus nerve. We recently showed in a small pilot trial that a single dose of nVNS improved (decreased) discrete gait variability characteristics in those receiving active stimulation relative to those receiving sham stimulation. Further multi-dose, multi-session studies are needed to assess the safety and tolerability of the stimulation and if improvement in gait is sustained over time. DESIGN This will be an investigator-initiated, single-site, proof-of-concept, double-blind sham-controlled randomised pilot trial in 40 people with PD. Participants will be randomly assigned on a 1:1 ratio to receive either active or sham transcutaneous cervical VNS. All participants will undergo comprehensive cognitive, autonomic and gait assessments during three sessions over 24 weeks, in addition to remote monitoring of ambulatory activity and falls, and exploratory analyses of cholinergic peripheral plasma markers. The primary outcome measure is the safety and tolerability of multi-dose nVNS in PD. Secondary outcomes include improvements in gait, cognition and autonomic function that will be summarised using descriptive statistics. DISCUSSION This study will report on the proportion of eligible and enrolled patients, rates of eligibility and reasons for ineligibility. Adverse events will be recorded informing on the safety and device tolerability in PD. This study will additionally provide us with information for sample size calculations for future studies and evidence whether improvement in gait control is enhanced when nVNS is delivered repeatedly and sustained over time. TRIAL REGISTRATION This trial is prospectively registered at www.isrctn.com/ISRCTN19394828 . Registered August 23, 2021.
Collapse
Affiliation(s)
- Hilmar P. Sigurdsson
- grid.1006.70000 0001 0462 7212Clinical Ageing Research Unit, Campus for Aging and Vitality, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, NE4 5PL Tyne and Wear UK
| | - Heather Hunter
- grid.1006.70000 0001 0462 7212Clinical Ageing Research Unit, Campus for Aging and Vitality, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, NE4 5PL Tyne and Wear UK ,grid.420004.20000 0004 0444 2244The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Lisa Alcock
- grid.1006.70000 0001 0462 7212Clinical Ageing Research Unit, Campus for Aging and Vitality, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, NE4 5PL Tyne and Wear UK
| | - Ross Wilson
- grid.1006.70000 0001 0462 7212Clinical Ageing Research Unit, Campus for Aging and Vitality, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, NE4 5PL Tyne and Wear UK
| | - Ilse Pienaar
- grid.6572.60000 0004 1936 7486Institute of Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, B12 2TT UK
| | - Elizabeth Want
- grid.7445.20000 0001 2113 8111Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Mark R. Baker
- grid.1006.70000 0001 0462 7212Clinical Ageing Research Unit, Campus for Aging and Vitality, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, NE4 5PL Tyne and Wear UK
| | - John-Paul Taylor
- grid.1006.70000 0001 0462 7212Clinical Ageing Research Unit, Campus for Aging and Vitality, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, NE4 5PL Tyne and Wear UK
| | - Lynn Rochester
- grid.1006.70000 0001 0462 7212Clinical Ageing Research Unit, Campus for Aging and Vitality, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, NE4 5PL Tyne and Wear UK
| | - Alison J. Yarnall
- grid.1006.70000 0001 0462 7212Clinical Ageing Research Unit, Campus for Aging and Vitality, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, NE4 5PL Tyne and Wear UK ,grid.420004.20000 0004 0444 2244The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| |
Collapse
|
19
|
De Sanctis P, Wagner J, Molholm S, Foxe JJ, Blumen HM, Horsthuis DJ. Neural signature of mobility-related everyday function in older adults at-risk of cognitive impairment. Neurobiol Aging 2023; 122:1-11. [PMID: 36463848 PMCID: PMC10281759 DOI: 10.1016/j.neurobiolaging.2022.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 10/27/2022] [Accepted: 11/03/2022] [Indexed: 11/10/2022]
Abstract
Assessment of everyday activities is central to the diagnosis of dementia. Yet, little is known about brain processes associated with everyday functional limitations, particularly during early stages of cognitive decline. Twenty-six older adults (mean = 74.9 y) were stratified by risk using the Montreal Cognitive Assessment battery (MoCA, range: 0- 30) to classify individuals as higher (22-26) and lower risk (27+) of cognitive impairment. We investigated everyday function using a gait task designed to destabilize posture and applied Mobile Brain/Body Imaging. We predicted that participants would increase step width to gain stability, yet the underlying neural signatures would be different for lower versus higher risk individuals. Step width and fronto-parietal activation increased during visually perturbed input. Frontomedial theta increased in higher risk individuals during perturbed and unperturbed inputs. Left sensorimotor beta decreased in lower risk individuals during visually perturbed input. Modulations in theta and beta power were associated with MoCA scores. Our findings suggest that older adults at-risk of cognitive impairment can be characterized by a unique neural signature of everyday function.
Collapse
Affiliation(s)
- Pierfilippo De Sanctis
- The Cognitive Neurophysiology Laboratory, Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA; Department of Neurology, Division of Cognitive & Motor Aging, Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Johanna Wagner
- Computational Neuroscience, Institute for Neural Computation, University of California, San Diego, La Jolla, CA, USA
| | - Sophie Molholm
- The Cognitive Neurophysiology Laboratory, Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA; The Dominick P. Purpura Department of Neuroscience, Rose F. Kennedy Intellectual and Developmental Disabilities Research Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - John J Foxe
- The Cognitive Neurophysiology Laboratory, Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA; The Cognitive Neurophysiology Laboratory, The Del Monte Institute for Neuroscience, Department of Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Helena M Blumen
- Department of Neurology, Division of Cognitive & Motor Aging, Albert Einstein College of Medicine, Bronx, NY, USA; Department of Medicine (Geriatrics), Albert Einstein College of Medicine, Bronx, NY, USA
| | - Douwe J Horsthuis
- The Cognitive Neurophysiology Laboratory, Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA
| |
Collapse
|
20
|
Verghese J, De Sanctis P, Ayers E. Everyday function profiles in prodromal stages of MCI: Prospective cohort study. Alzheimers Dement 2023; 19:498-506. [PMID: 35472732 PMCID: PMC9596617 DOI: 10.1002/alz.12681] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 03/16/2022] [Accepted: 03/29/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION The nature and course of limitations in everyday function in the early clinical stages of cognitive decline is not well known. METHODS We compared complex everyday functional profiles at baseline in 59 community-dwelling older individuals with normal cognitive performance who went on to develop incident mild cognitive impairment (MCI) ("pre-MCI") with 284 older individuals who remained cognitively normal over follow-up. RESULTS The mean number of limitations on complex everyday function at baseline was 3.1 ± 3.0 in the 59 pre-MCI cases and 2.0 ± 2.4 in the 284 normal controls (P = .003). Pre-MCI cases had limitations in traveling, entertaining, remembering appointments, and hobbies compared to normal controls. A progressive increase in mild limitations on complex everyday function preceded the incidence of MCI (mean change: pre-MCI 1.9 ± 3.6 vs normal controls 0.5 ± 2.7, P < .001). DISCUSSION Prodromal stages of MCI are associated with progressive mild limitations in complex activities of daily living.
Collapse
Affiliation(s)
- Joe Verghese
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Pierfilippo De Sanctis
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Emmeline Ayers
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| |
Collapse
|
21
|
Daily Outdoor Cycling by Older Adults Preserves Reactive Balance Behavior: A Case-Control Study. J Aging Phys Act 2023; 31:7-17. [PMID: 35562104 DOI: 10.1123/japa.2021-0378] [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: 10/20/2021] [Revised: 03/19/2022] [Accepted: 03/19/2022] [Indexed: 02/03/2023]
Abstract
We examined whether older adults who cycle outdoors regularly have better reactive balance control than noncycling older adults. Sixteen cyclist older adults and 24 age-, sex-, and health-matched controls who did not cycle (noncyclists) were exposed to unannounced perturbations of increased magnitudes in standing. We evaluated the strategies and kinematics employed at each perturbation magnitude. We found that cyclists exhibited a significantly higher stepping threshold, lower probability of stepping at each perturbation magnitude, and lower number of trials in which the participant needed to make a step to retain their balance. Cyclists also tended to recover balance using unloaded leg strategies in the first recovery step rather than a loaded leg strategy; they showed faster swing phase duration in the first recovery step, better controlling the displacement of center of mass than noncyclists. Older adults who cycle regularly outdoors preserve their reactive balance functions, which may reduce fall risks.
Collapse
|
22
|
Factors Influencing Mobility During the COVID-19 Pandemic in Community-Dwelling Older Adults. Arch Phys Med Rehabil 2023; 104:34-42. [PMID: 36055379 PMCID: PMC9424116 DOI: 10.1016/j.apmr.2022.08.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 07/22/2022] [Accepted: 08/17/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To describe and identify factors influencing mobility among older adults during the first 5 months of the COVID-19 pandemic. DESIGN A cross-sectional telesurvey. SETTING Community dwelling older adults, situated within the first 5 months of the COVID-19 pandemic, in Hamilton, Canada. PARTICIPANTS A random sample of 2343 older adults were approached to be in the study, of which 247 completed the survey (N=247). Eligible participants were aged ≥65 years. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Mobility was measured using global rating of change items and the Late Life Function Instrument (LLFI). Multivariate linear regression models were used to examine the association between mobility and related factors based on Webber's model. RESULTS 247 older adults (29% male, mean age 78±7.3 years) completed surveys between May and August 2020. Respectively, 26%, 10%, and 9%, rated their ability to engage in physical activity, housework, and move around their home as worse compared with the start of the pandemic. The mean LLFI score was 60.9±13.4. In the model, walking volume (β=0.03 95% confidence interval 0.013, 0.047), fall history (β=-0.04, 95% confidence interval -0.08, -0.04), male sex (β=0.06, 95% confidence interval 0.02, 0.09), unpleasant neighborhood (β=-0.06, 95% confidence interval -0.11, -0.02), musculoskeletal pain (β=-0.07, 95% confidence interval -0.11, -0.03), and self-reported health (β=0.08, 95% confidence interval 0.03, 0.13) had the strongest associations with LLFI scores and explained 64% of the variance in the LLFI score. CONCLUSIONS Physical and environmental factors may help explain poorer mobility during lockdowns. Future research should examine these associations longitudinally to see if factors remain consistent over time and could be targeted for rehabilitation.
Collapse
|
23
|
Criss MG, Chui KK, Gallichio J, Centra J, Canbek J. Reliability, responsiveness, and validity of slow walking speed in community dwelling older adults. Gait Posture 2023; 99:54-59. [PMID: 36327539 DOI: 10.1016/j.gaitpost.2022.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 09/20/2022] [Accepted: 10/23/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Independent ambulation requires adaptability. Self-selected and maximum walking speeds are often both assessed to demonstrate the ability to adapt speed to different tasks and environments. However, purposefully walking at a slow speed (slowWS) could also be an appropriate adaptation in certain situations but has rarely been investigated. RESEARCH QUESTION The purpose of this study was to assess the reliability, responsiveness, and concurrent validity of slowWS in community-dwelling older adults. METHODS This was an observational, cross-sectional study of 110 community-dwelling older adults. Test-retest and inter-rater reliabilities of slowWS were assessed with intra-class correlation coefficients. Standard error of measurement (SEM) and minimal detectable change (MDC95) were calculated to determine responsiveness. Concurrent validity was assessed with Spearman rank-order correlations between slowWS and a battery of tests previously shown to be related to walking speed. RESULTS Walking speed measurement for slowWS was shown to have excellent test-retest and interrater reliability (ICCs values of 0.971-0.997). Standard error of measurement value was small (0.015 m/sec) and MDC95 was 0.04 m/sec. SlowWS was not found to significantly correlate to any other study variable. SIGNIFICANCE Walking speed, whether self-selected, maximum, or slow, can be measured reliably with a stopwatch and specific verbal commands. While slowWS could be beneficial for certain tasks or environments, walking slowly was not associated with age, sex, comorbidity, or measures of cognition, depression, strength, balance, disability, or life-space in this sample.
Collapse
Affiliation(s)
- Michelle G Criss
- Doctor of Physical Therapy Program, Chatham University, Woodland Rd, Pittsburgh 15232, PA, USA.
| | - Kevin K Chui
- Department of Physical Therapy, Radford University, 101 Elm Avenue, 8th Floor, Roanoke 24013, VA, USA.
| | - Joann Gallichio
- Doctor of Physical Therapy Program, Nova Southeastern University, 3400 Gulf to Bay Blvd., Clearwater 33759, FL, USA.
| | - Jacob Centra
- ReMed Maryland, 5999 Harpers Ferry Road, Columbia 20144, MD, USA.
| | - Jennifer Canbek
- Doctor of Physical Therapy Program, Nova Southeastern University, 3200 South University Drive, Fort Lauderdale 33328, FL, USA.
| |
Collapse
|
24
|
Nguyen K, Macedo LG, Vrkljan B, Kirkwood R, Ma J, Vesnaver E, Keller H, Astephen-Wilson J, Beauchamp MK. Participation Among Community-Dwelling Older Adults During the COVID-19 Pandemic: A Cross-Sectional Analysis. Phys Ther 2022; 103:pzac132. [PMID: 36200394 PMCID: PMC9619742 DOI: 10.1093/ptj/pzac132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 03/27/2022] [Accepted: 08/20/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Participation in life situations is a critical aspect of health recognized by the World Health Organization. Guidelines to prevent spreading of COVID-19 place older adults at risk of worsening participation. The purpose of this study was to identify the factors associated with participation during the COVID-19 pandemic among community-dwelling older adults living in Hamilton, Ontario, Canada. METHODS Participants were recruited from identified census dissemination areas in Hamilton. Participants completed surveys either by phone or online during the months of May to August 2020. Measures were organized into factors related to body functions and structures, activities, participation, as well as personal and environmental contextual factors using the International Classification of Functioning, Disability, and Health (ICF) framework. Multivariable regression analysis was conducted to identify factors associated with participation as measured by the Late-Life Disability Instrument's (LLDI) frequency and limitations scales. RESULTS A total of 272 older adults completed the survey (78 [7.3] years; 70% female). Use of a walking aid, driving status, perceived mental health status, nutrition risk, and physical function explained 48.2% of the variance observed in the LLDI-frequency scale scores. Use of a walking aid, driving status, perceived mental health status, receiving health assistance, and physical function explained 38.5% of the variance observed in the LLDI-limitation scale scores. CONCLUSION Results highlighted factors across multiple ICF domains that are associated with participation restriction among a sample of community-dwelling older adults during the pandemic. Participation during the pandemic was greatest in those that were able to walk without needing to use a walking aid, being a licensed and current driver, perceiving good to excellent mental health, and having greater physical function. IMPACT Our findings contribute to the literature on older adult participation during lockdowns, restrictions, pandemics, and/or other similar circumstances.
Collapse
Affiliation(s)
- Khang Nguyen
- School of Rehabilitation Science, McMaster University, Hamilton ON, Canada
| | - Luciana G Macedo
- School of Rehabilitation Science, McMaster University, Hamilton ON, Canada
| | - Brenda Vrkljan
- School of Rehabilitation Science, McMaster University, Hamilton ON, Canada
| | - Renata Kirkwood
- School of Rehabilitation Science, McMaster University, Hamilton ON, Canada
| | - Jinhui Ma
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton ON, Canada
| | - Elisabeth Vesnaver
- School of Epidemiology and Public Health, University of Ottawa, Ottawa ON, Canada
| | - Heather Keller
- Schlegel-UW Research Institute for Aging and Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo ON, Canada
| | | | - Marla K Beauchamp
- School of Rehabilitation Science, McMaster University, Hamilton ON, Canada
| |
Collapse
|
25
|
Mastrogiovanni C, Rosenbaum S, Delbaere K, Tiedemann A, Teasdale S, McGavin A, Briggs N, McKeon G. A mental health-informed, online health promotion programme targeting physical activity and healthy eating for adults aged 60+ years: study protocol for the MovingTogether randomised controlled trial. Trials 2022; 23:1052. [PMID: 36575463 PMCID: PMC9793388 DOI: 10.1186/s13063-022-06978-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 12/02/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic and associated social distancing regulations have led to an increased risk of social isolation and physical inactivity, particularly among older adults. The benefits of physical activity for reducing fall risk and improving mood and mental functioning have been well documented. The aim of this trial is to investigate the effect of the MovingTogether programme on psychological distress (primary outcome) and physical activity, social capital, cognition, concern about falling, loneliness, physical functioning, quality of life and physical activity enjoyment (secondary outcomes). METHODS A randomised controlled trial with a waitlist control will be conducted, recruiting 80 adults aged 60+ years with access to Facebook and a computer or tablet and not currently meeting the aerobic physical activity guidelines. Randomisation will be completed using REDCap. The intervention group (n = 40) will join a private Facebook group where allied health facilitators will provide targeted healthy lifestyle education throughout the 10-week programme with weekly telehealth group calls. Intervention participants will also be provided access to tailored strength and aerobic exercise guidance and an evidence-based eHealth balance exercise programme. Psychological distress and secondary outcomes will be assessed at baseline, 11 weeks (post-intervention) and 16 weeks (1-month follow-up). Linear mixed models will be applied for each outcome measure as per an intention-to-treat approach to determine the between-group differences. Secondary analyses are planned in people with greater adherence and those with higher psychological distress. DISCUSSION COVID-19 has highlighted the need for scalable, effective and novel methods to improve and protect the health of older adults. The integration of an evidence-based fall prevention programme with a mental health-informed online health promotion programme may help to improve mental and physical health outcomes among older adults. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12621001322820p. Registered on 29 September 2021.
Collapse
Affiliation(s)
- Chiara Mastrogiovanni
- Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, NSW 2052 Australia
| | - Simon Rosenbaum
- Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, NSW 2052 Australia
- School of Health Sciences, University of New South Wales, Sydney, NSW 2052 Australia
| | - Kim Delbaere
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, NSW 2031 Australia
- School of Population Health, University of New South Wales, Sydney, NSW 2052 Australia
| | - Anne Tiedemann
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Camperdown, NSW 2050 Australia
| | - Scott Teasdale
- Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, NSW 2052 Australia
- Mindgardens Neuroscience Network, Sydney, NSW 2052 Australia
| | - Annaliese McGavin
- School of Psychology, University of New South Wales, Sydney, NSW 2052 Australia
| | - Nancy Briggs
- Stats Central, Mark Wainwright Analytical Centre, University of New South Wales, Sydney, NSW 2052 Australia
| | - Grace McKeon
- Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, NSW 2052 Australia
- School of Population Health, University of New South Wales, Sydney, NSW 2052 Australia
| |
Collapse
|
26
|
Ge L, Pereira MJ, Yap CW, Heng BH. Chronic low back pain and its impact on physical function, mental health, and health-related quality of life: a cross-sectional study in Singapore. Sci Rep 2022; 12:20040. [PMID: 36414674 PMCID: PMC9681885 DOI: 10.1038/s41598-022-24703-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 11/18/2022] [Indexed: 11/23/2022] Open
Abstract
Chronic low back pain, defined as low back pain lasting more than 3 months, is a globally prevalent health problem with significantly high medical and economic burden on individuals and the society. This study aimed to estimate the prevalence of chronic low back pain and examine its association with health outcomes including physical function, mental health, and quality of life among adult population in Singapore. Cross-sectional secondary data analysis was performed using baseline data of the 1941 adults (mean age: 52.6 years, range: 21-97 years) from a representative population health survey conducted in the Central region of Singapore. Those with self-reported chronic low back pain in past six months were identified. The Late-Life Function and Disability Instrument, Patient Health Questionnaire-9, and EQ-5D-5L were used to measure physical function and limitation, mental health, and health-related quality of life, respectively. Generalized Linear Regressions were used to examine the association of chronic low back pain with physical function, limitation, depressive symptoms, and health-related quality of life. There were 8.1% (n = 180) participants reporting having chronic low back pain in past six months, among whom 80.5% sought treatments at either primary care, specialist outpatient, or Traditional Chinese Medicine clinics. Individuals with chronic low back pain reported poorer physical function, more limitations in performing major life tasks and social activities, more depressive symptoms, and lower health-related quality of life (all p < 0.01), even after adjusting for socio-demographics, lifestyle factors, and number of morbidities. The prevalence of chronic low back pain was 8.1% among the study population. Chronic low back pain was associated with poorer physical function, more limitations and depressive symptoms, and lower health-related quality of life. The findings highlight the significant impact of chronic low back pain on physical function and limitation, mental health, and health-related quality of life in a general population. Increased awareness on prevention, early and proper management of low back pain, and rehabilitation policies are required to better tackle the burden of low back pain at the population level.
Collapse
Affiliation(s)
- Lixia Ge
- Health Services & Outcomes Research, National Healthcare Group, 3 Fusionopolis Link, #03-08 Nexus@One-North (South Lobby), Singapore, 13854, Singapore.
| | - Michelle Jessica Pereira
- Health Services & Outcomes Research, National Healthcare Group, 3 Fusionopolis Link, #03-08 Nexus@One-North (South Lobby), Singapore, 13854, Singapore
| | - Chun Wei Yap
- Health Services & Outcomes Research, National Healthcare Group, 3 Fusionopolis Link, #03-08 Nexus@One-North (South Lobby), Singapore, 13854, Singapore
| | - Bee Hoon Heng
- Health Services & Outcomes Research, National Healthcare Group, 3 Fusionopolis Link, #03-08 Nexus@One-North (South Lobby), Singapore, 13854, Singapore
| |
Collapse
|
27
|
Hassani D, Koelper N, Borodyanskaya Y, Arya NG, Rao H, Andy U. Cognitive function following surgery for pelvic organ prolapse. Neurourol Urodyn 2022; 41:1853-1861. [PMID: 36047412 PMCID: PMC9633552 DOI: 10.1002/nau.25035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/29/2022] [Accepted: 08/16/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Older women are at higher risk for cognitive dysfunction following surgery. We hypothesized that for women undergoing pelvic organ prolapse (POP) surgery, memory function would not be significantly different at delayed postoperative assessment compared to baseline. OBJECTIVE We sought to compare performance on tests of various neurocognitive domains before and after surgery for POP. METHODS A prospective cohort study was conducted with women, aged 60 years and older who were undergoing surgery for POP. A battery of highly sensitive neurocognitive tests was administered preoperatively (baseline), on postoperative day 1 (postoperative visit 1, POV1), and at the first postoperative clinic visit 4-6 weeks after surgery (postoperative visit 2, POV2). The test battery included the scene-encoding memory task, the n-back task, the Iowa gambling task, the balloon analogue risk task, and the psychomotor vigilance task. These tests assessed the neurocognitive subdomains of episodic memory, working memory, decision-making, risk-taking, and sustained attention. Two score comparisons were made: between baseline and POV1, and between baseline and POV2. RESULTS In 29 women, performance on the scene-encoding memory task was worse at POV1 than at baseline (2.22 ± 0.4 vs. 2.45 ± 0.6, p < 0.05) but was better than baseline at POV2 (2.7 ± 0.7 vs. 2.45 ± 0.6, p < 0.05). Similarly, performance on the psychomotor vigilance test was worse at POV1 than at baseline (p < 0.01) but there was no difference at POV2. There was no difference in performance on the Iowa gambling test, n-back test, and balloon analogue risk tasks between baseline and any postoperative visit. CONCLUSION Cognitive test scores did not worsen significantly between baseline and delayed postoperative assessments in older women undergoing surgery for POP.
Collapse
Affiliation(s)
- Daisy Hassani
- University of Pennsylvania Department of Obstetrics and Gynecology, Division of Urogynecology and Pelvic Reconstructive Surgery
| | - Nathanael Koelper
- Department of Obstetrics and Gynecology, Center for Research on Reproduction and Women's Health (N.K.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Yelizaveta Borodyanskaya
- University of Pennsylvania Department of Obstetrics and Gynecology, Division of Urogynecology and Pelvic Reconstructive Surgery
| | | | - Hengyi Rao
- University of Pennsylvania Perelman School of Medicine, Department of Neurology
| | - Uduak Andy
- University of Pennsylvania Department of Obstetrics and Gynecology, Division of Urogynecology and Pelvic Reconstructive Surgery
| |
Collapse
|
28
|
Zhang L, Cruz-Gonzalez M, Lin Z, Ouyang X, Zhao F, Alegría M. Association of everyday discrimination with health outcomes among Asian and non-Asian US older adults before and during the COVID-19 pandemic. Front Public Health 2022; 10:953155. [PMID: 36339195 PMCID: PMC9627216 DOI: 10.3389/fpubh.2022.953155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 09/30/2022] [Indexed: 01/24/2023] Open
Abstract
Increases in anti-Asian COVID-19 related discriminatory behaviors have been observed, many of which targeted older adults. Studies demonstrate that racial discrimination is associated with worse health outcomes, including anxiety, depression, and sleep difficulties. No previous studies have examined the impact of day-to-day experiences of discrimination before and during COVID-19 on both Asian and non-Asian older adults within the same sample. We examined whether everyday discrimination was associated with increased anxiety and depression symptoms, decreased levels of functioning, and increased sleep difficulties among Asian and non-Asian US older adults before and during the pandemic. Data came from the Positive Minds-Strong Bodies randomized clinical trial, an evidence-based mental health and disability prevention intervention for racially and ethnically diverse older adults with elevated depression or anxiety symptoms and minor to moderate disability. We conducted secondary data analyses in a cohort of 165 older adults (56 Asian and 109 non-Asian) assessed before COVID-19 (May 2015-May 2018) and during COVID-19 (March 2021-July 2022). Regression models examined whether everyday discrimination impacted health outcomes differently before and during COVID-19, and whether this effect was stronger among Asian compared to non-Asian older adults. Non-Asian older adults reported the same levels of everyday discrimination before and during COVID-19. Consistent with literature suggesting that social distancing has inadvertently kept US Asian populations from experiencing discrimination, Asian older adults reported marginally lower levels of everyday discrimination during the pandemic compared with pre-pandemic. We found that everyday discrimination was not associated with health outcomes before COVID-19. In contrast, during the pandemic, everyday discrimination was associated with worse anxiety and depression symptoms and worse levels of functioning, although only the impact on depression was significantly stronger compared with before the pandemic. This negative impact of everyday discrimination on health outcomes during the pandemic appeared to affect both Asian and non-Asian older adults similarly. Social support and social cohesion buffered against the negative effect of everyday discrimination on depression and level of functioning during the pandemic. Results suggest that public health interventions aimed at reducing everyday discrimination and emphasizing social support and cohesion can potentially improve health outcomes for all US older adult populations. Clinical trial registration www.ClinicalTrials.gov; identifier: NCT02317432.
Collapse
Affiliation(s)
- Lulu Zhang
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Mario Cruz-Gonzalez
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States
- Department of Medicine, Harvard Medical School, Boston, MA, United States
| | - Ziqiang Lin
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Xinyi Ouyang
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Fengnuan Zhao
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Margarita Alegría
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States
- Department of Medicine, Harvard Medical School, Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| |
Collapse
|
29
|
Connecting real-world digital mobility assessment to clinical outcomes for regulatory and clinical endorsement-the Mobilise-D study protocol. PLoS One 2022; 17:e0269615. [PMID: 36201476 PMCID: PMC9536536 DOI: 10.1371/journal.pone.0269615] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 06/17/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The development of optimal strategies to treat impaired mobility related to ageing and chronic disease requires better ways to detect and measure it. Digital health technology, including body worn sensors, has the potential to directly and accurately capture real-world mobility. Mobilise-D consists of 34 partners from 13 countries who are working together to jointly develop and implement a digital mobility assessment solution to demonstrate that real-world digital mobility outcomes have the potential to provide a better, safer, and quicker way to assess, monitor, and predict the efficacy of new interventions on impaired mobility. The overarching objective of the study is to establish the clinical validity of digital outcomes in patient populations impacted by mobility challenges, and to support engagement with regulatory and health technology agencies towards acceptance of digital mobility assessment in regulatory and health technology assessment decisions. METHODS/DESIGN The Mobilise-D clinical validation study is a longitudinal observational cohort study that will recruit 2400 participants from four clinical cohorts. The populations of the Innovative Medicine Initiative-Joint Undertaking represent neurodegenerative conditions (Parkinson's Disease), respiratory disease (Chronic Obstructive Pulmonary Disease), neuro-inflammatory disorder (Multiple Sclerosis), fall-related injuries, osteoporosis, sarcopenia, and frailty (Proximal Femoral Fracture). In total, 17 clinical sites in ten countries will recruit participants who will be evaluated every six months over a period of two years. A wide range of core and cohort specific outcome measures will be collected, spanning patient-reported, observer-reported, and clinician-reported outcomes as well as performance-based outcomes (physical measures and cognitive/mental measures). Daily-living mobility and physical capacity will be assessed directly using a wearable device. These four clinical cohorts were chosen to obtain generalizable clinical findings, including diverse clinical, cultural, geographical, and age representation. The disease cohorts include a broad and heterogeneous range of subject characteristics with varying chronic care needs, and represent different trajectories of mobility disability. DISCUSSION The results of Mobilise-D will provide longitudinal data on the use of digital mobility outcomes to identify, stratify, and monitor disability. This will support the development of widespread, cost-effective access to optimal clinical mobility management through personalised healthcare. Further, Mobilise-D will provide evidence-based, direct measures which can be endorsed by regulatory agencies and health technology assessment bodies to quantify the impact of disease-modifying interventions on mobility. TRIAL REGISTRATION ISRCTN12051706.
Collapse
|
30
|
Mikolaizak AS, Taraldsen K, Boulton E, Gordt K, Maier AB, Mellone S, Hawley-Hague H, Aminian K, Chiari L, Paraschiv-Ionescu A, Pijnappels M, Todd C, Vereijken B, Helbostad JL, Becker C. Impact of adherence to a lifestyle-integrated programme on physical function and behavioural complexity in young older adults at risk of functional decline: a multicentre RCT secondary analysis. BMJ Open 2022; 12:e054229. [PMID: 36198449 PMCID: PMC9535207 DOI: 10.1136/bmjopen-2021-054229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
CONTEXT Long-term adherence to physical activity (PA) interventions is challenging. The Lifestyle-integrated Functional Exercise programmes were adapted Lifestyle-integrated Functional Exercise (aLiFE) to include more challenging activities and a behavioural change framework, and then enhanced Lifestyle-integrated Functional Exercise (eLiFE) to be delivered using smartphones and smartwatches. OBJECTIVES To (1) compare adherence measures, (2) identify determinants of adherence and (3) assess the impact on outcome measures of a lifestyle-integrated programme. DESIGN, SETTING AND PARTICIPANTS A multicentre, feasibility randomised controlled trial including participants aged 61-70 years conducted in three European cities. INTERVENTIONS Six-month trainer-supported aLiFE or eLiFE compared with a control group, which received written PA advice. OUTCOME MEASURES Self-reporting adherence per month using a single question and after 6-month intervention using the Exercise Adherence Rating Scale (EARS, score range 6-24). Treatment outcomes included function and disability scores (measured using the Late-Life Function and Disability Index) and sensor-derived physical behaviour complexity measure. Determinants of adherence (EARS score) were identified using linear multivariate analysis. Linear regression estimated the association of adherence on treatment outcome. RESULTS We included 120 participants randomised to the intervention groups (aLiFE/eLiFE) (66.3±2.3 years, 53% women). The 106 participants reassessed after 6 months had a mean EARS score of 16.0±5.1. Better adherence was associated with lower number of medications taken, lower depression and lower risk of functional decline. We estimated adherence to significantly increase basic lower extremity function by 1.3 points (p<0.0001), advanced lower extremity function by 1.0 point (p<0.0001) and behavioural complexity by 0.008 per 1.0 point higher EARS score (F(3,91)=3.55, p=0.017) regardless of group allocation. CONCLUSION PA adherence was associated with better lower extremity function and physical behavioural complexity. Barriers to adherence should be addressed preintervention to enhance intervention efficacy. Further research is needed to unravel the impact of behaviour change techniques embedded into technology-delivered activity interventions on adherence. TRIAL REGISTRATION NUMBER NCT03065088.
Collapse
Affiliation(s)
- A Stefanie Mikolaizak
- Department of Clinical Gerontology, Robert-Bosch-Krankenhaus GmbH, Stuttgart, Germany
| | - Kristin Taraldsen
- Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Elisabeth Boulton
- School of Health Sciences, The University of Manchester, Manchester, UK
- Health & Care Policy, Age UK, London, UK
- Manchester Academic Health Science Centre, Manchester, UK
| | - Katharina Gordt
- Department of Clinical Gerontology, Robert-Bosch-Krankenhaus GmbH, Stuttgart, Germany
| | - Andrea Britta Maier
- Department of Human Movement Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Sabato Mellone
- Department of Electrical, Electronic and Information Engineering, University of Bologna, Bologna, Italy
| | - Helen Hawley-Hague
- School of Health Sciences, The University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
| | - Kamiar Aminian
- Ecole Polytechnique Federale de Lausanne, Lausanne, Switzerland
| | - Lorenzo Chiari
- Department of Electrical, Electronic and Information Engineering, University of Bologna, Bologna, Italy
| | | | - Mirjam Pijnappels
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Chris Todd
- School of Health Sciences, The University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Beatrix Vereijken
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Jorunn L Helbostad
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Clemens Becker
- Department of Clinical Gerontology, Robert-Bosch-Krankenhaus GmbH, Stuttgart, Germany
| |
Collapse
|
31
|
Ayers E, Wang C, Verghese J. Validation of a "subjective motoric cognitive risk syndrome" screening tool for motoric cognitive risk syndrome-A prospective cohort study. Eur J Neurol 2022; 29:2925-2933. [PMID: 35748730 PMCID: PMC9875832 DOI: 10.1111/ene.15476] [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: 04/07/2022] [Revised: 06/02/2022] [Accepted: 06/19/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND PURPOSE Motoric cognitive risk syndrome (MCR) is a gait-based pre-dementia syndrome associated with risk of dementia. Ascertaining subjective cognitive and motoric complaints may facilitate early and remote identification of individuals with MCR as they are reported to precede and predict objective cognitive and motoric impairments in aging. METHODS The validity of five subjective motoric complaint (SMC) questions and 10 subjective cognitive complaint (SCC) questions was examined for discriminating MCR in 538 non-demented community-dwelling adults. Backward logistic regression was used to identify questions to develop a weighted score to define subjective MCR (MCR-S). Receiver operating characteristic analysis was applied to determine the discriminative ability of MCR-S for the objective MCR (MCR-O) definition based on SCCs and objectively measured gait. Cox proportional hazard models adjusted for potential confounders were used to examine the predictive validity of MCR-S for incident dementia. RESULTS Five subjective complaint questions (three SCC and two SMC) were associated with MCR-O. They were combined to define an MCR-S score (range 0-7) which yielded an area under the curve of 0.89 for discriminating MCR-O from receiver operating characteristic analysis. An optimal cut-score of 2 on the MCR-S score was determined to have good sensitivity (84%) and specificity (82%) for MCR-O. Over a median follow-up of 2.5 years, 29 participants developed dementia. Both MCR-S (adjusted hazard ratio 2.39) and MCR-O at baseline (adjusted hazard ratio 3.16) predicted risk of incident dementia. CONCLUSIONS Subjective MCR had high concordance with MCR-O and can provide a remote screening assessment for MCR-O, which can identify those at high risk for dementia.
Collapse
Affiliation(s)
- Emmeline Ayers
- Department of Neurology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Cuiling Wang
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Joe Verghese
- Department of Neurology, Albert Einstein College of Medicine, Bronx, New York, USA,Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| |
Collapse
|
32
|
Bidirectional Associations Between Physical Activity and Pain Among Older Adults: An Ecological Momentary Assessment Study. J Aging Phys Act 2022; 31:240-248. [PMID: 35995422 DOI: 10.1123/japa.2022-0014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 06/08/2022] [Accepted: 07/07/2022] [Indexed: 11/18/2022]
Abstract
This paper examines the within-day, bidirectional associations between physical activity and self-reported pain among older adults. Older adults (N = 104; range: 60-98 years) participated in a 10-day Ecological Momentary Assessment (EMA) study. Participants received six EMA prompts/day with a single item assessing pain. Participants wore an activPAL monitor measuring step counts. At the within-person level, on occasions when participants took more steps than usual in the 30 min before the EMA prompt, they were more likely to experience pain at the prompt (β^02=0.0003, p < .03). At the between-person level, greater step counts in the 30 min before the EMA prompt, on average, were associated with less pain on occasions when pain was experienced (β^01=-0.0005, p < .04). Pain was not related to subsequent stepping. Bidirectional associations between physical activity and pain were not documented, but physical activity did appear to be related to subsequent pain.
Collapse
|
33
|
Richardson DL, Tallis J, Duncan MJ, Clarke ND, Myers TD. The ongoing effects of the COVID-19 pandemic on perceived physical activity, physical function and mood of older adults in the U.K: A follow-up study (March 2020-June 2021). Exp Gerontol 2022; 165:111838. [PMID: 35618184 PMCID: PMC9126621 DOI: 10.1016/j.exger.2022.111838] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/29/2022] [Accepted: 05/17/2022] [Indexed: 01/31/2023]
Abstract
Coronavirus (COVID-19) and its variants, continue to spread globally more than two years after the discovery of the wild-type virus in Wuhan, China. Following the onset of COVID-19, fluctuating restrictions have likely impacted the daily lives of older adults living in the United Kingdom (UK). Subsequently, the longer term effects of COVID-19 on physical activity levels, perceived physical function and mood of older adults are unclear. Therefore, the present study aimed to follow a group of older adult's living in the UK for one year, to monitor physical activity levels, perceived physical function and mood. A longitudinal, mixed-methods, observational study was conducted using self-administered, online surveys at 3-month intervals between March 2020 and June 2021. A total of 100 participants (46 males [age: 76 ± 5 years] and 54 females [age:74 ± 4 years]) completed all surveys. Bayesian analysis allowed calculation of direct probabilities whilst incorporating our prior knowledge. Throughout this period, older adults maintained or increased their pre-lockdown physical activity levels despite a decrease in intensity of effort of physical activity tasks, whilst sitting time increased at two of the follow-up time-points. Furthermore, perceived physical function decreased (ps = 91.78%;>1.21 AU) and mood undulated in a pattern that reflected the tightening and easing of restrictions. Despite total physical activity being maintained, perceived physical function decreased by a small but clinically meaningful margin.
Collapse
Affiliation(s)
- Darren L Richardson
- Centre for Applied Biological & Exercise Sciences, School of Life Sciences, Coventry University, Coventry, UK.
| | - Jason Tallis
- Centre for Applied Biological & Exercise Sciences, School of Life Sciences, Coventry University, Coventry, UK
| | - Michael J Duncan
- Centre for Applied Biological & Exercise Sciences, School of Life Sciences, Coventry University, Coventry, UK
| | - Neil D Clarke
- Centre for Applied Biological & Exercise Sciences, School of Life Sciences, Coventry University, Coventry, UK
| | - Tony D Myers
- Sport, Physical Activity and Health Research Centre, Newman University, Birmingham, UK
| |
Collapse
|
34
|
Maximos M, Stratford P, Tang A, Dal Bello-Haas V. Description and Functional Benefits of Meeting Frequency, Intensity, and Time of Resistance and Cardiovascular Exercises: A Study of Older Adults in a Community-Based, Slow-Stream Rehabilitation, Hospital-to-Home Transition Program. Gerontol Geriatr Med 2022; 8:23337214221096303. [PMID: 35615344 PMCID: PMC9125058 DOI: 10.1177/23337214221096303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 04/01/2022] [Accepted: 04/06/2022] [Indexed: 11/18/2022] Open
Abstract
This prospective cohort study described cardiovascular and resistance exercises completed by older adults in a community-based, slow-stream rehabilitation, hospital-to-home transition program; compared exercises completed to the American College of Sports Medicine (ACSM) exercise guidelines; and, assessed differences in Late Life Function and Disability Index (LLFDI)-Function Component (FC) between older adults who met and did not meet the ACSM guidelines. Descriptive statistics and Factorial ANCOVA were conducted. For cardiovascular exercise 59.3% of participants met frequency, 73.4% met intensity, and 35.9% met time. For resistance exercise, 67.2% of participants met frequency, 42.2% met intensity, and 76.6% number of repetitions. Participants who met both frequency and time for cardiovascular exercise had higher LLFDI-FC scores, as did those who met intensity and/or number of repetitions for resistance exercise. The findings provide support that older adults engaged in a slow-stream rehabilitation program can meet the ACSM exercise guidelines for community-dwelling older adults, and that meeting the guidelines improves function.
Collapse
Affiliation(s)
- Melody Maximos
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON, USA
| | - Paul Stratford
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON, USA
| | - Ada Tang
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON, USA
| | - Vanina Dal Bello-Haas
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON, USA
| |
Collapse
|
35
|
Brach JS, Perera S, Shuman V, Gil AB, Kriska A, Nadkarni NK, Rockette-Wagner B, Cham R, VanSwearingen JM. Effect of Timing and Coordination Training on Mobility and Physical Activity Among Community-Dwelling Older Adults: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2212921. [PMID: 35604689 PMCID: PMC9127558 DOI: 10.1001/jamanetworkopen.2022.12921] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 03/31/2022] [Indexed: 11/21/2022] Open
Abstract
Importance Standard exercise interventions targeting underlying physiologic system impairments have limited success in improving walking. Augmenting standard interventions with timing and coordination training, which incorporates the principles of motor learning and integrates multiple systems, may be more successful. Objective To determine whether a standard strength and endurance program incorporating timing and coordination training (standard-plus) improves gait speed more than strength and endurance training alone. Design, Setting, and Participants The Program to Improve Mobility in Aging (PRIMA) study was an assessor-blinded, randomized, 2-group intervention trial that included a 12-week intervention and 24-week follow-up period. The trial was conducted at a university research clinic from 2016 to 2020. Participants included 249 community-dwelling older adults (aged ≥65 years) with gait speed between 0.60 and 1.20 m/s. Statistical analysis was performed from December 2020 to March 2021. Interventions Participants were randomized to standard strength and endurance (n = 125) or standard-plus, including timing and coordination training (n = 124), 50 to 60 minutes, twice a week for 12 weeks. Main Outcomes and Measures Primary outcome of gait speed and secondary outcomes representing components of the intervention (leg strength and power, 6-minute walk test, chair sit-and-reach test, and figure of 8 walk test) and activity and participation (Late Life Function and Disability Instrument and daily physical activity measured by accelerometry) were measured at 12, 24, and 36 weeks. Results Among 249 randomized participants, 163 (65.5%) were female, 22 (8.8%) were Black, 219 (88.0%) were White; mean (SD) age was 77.4 (6.6) years; mean (SD) gait speed was 1.07 (0.16) m/s; and 244 (98.0%) completed the intervention. The 2 groups did not have significantly different improvements in gait speed or secondary outcomes representing the components of the intervention at any time point. For gait speed, individuals in the standard-plus group had a mean (SD) improvement of 0.079 (0.135) m/s over 12 weeks, 0.065 m/s (0.141) over 24 weeks, and 0.059 (0.150) m/s over 36 weeks; individuals in the standard group improved gait speed by 0.081 (0.124) m/s over 12 weeks, 0.051 (0.129) m/s over 24 weeks, and 0.065 (0.148) m/s over 36 weeks. Conclusions and Relevance This randomized clinical trial found no difference in gait speed change between the standard and standard-plus intervention groups, and both groups showed sustained improvements in mobility 24 weeks after the intervention. Trial Registration ClinicalTrials.gov Identifier: NCT02663778.
Collapse
Affiliation(s)
- Jennifer S. Brach
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Subashan Perera
- Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Valerie Shuman
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Alexandra B. Gil
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Andrea Kriska
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Neelesh K. Nadkarni
- Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Rakie Cham
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | |
Collapse
|
36
|
Winters-Stone KM, Torgrimson-Ojerio B, Dieckmann N, Stoyles S, Mitri Z, Luoh SW. A randomized-controlled trial comparing supervised aerobic training to resistance training followed by unsupervised exercise on physical functioning in older breast cancer survivors. J Geriatr Oncol 2022; 13:152-160. [PMID: 34426142 PMCID: PMC9003120 DOI: 10.1016/j.jgo.2021.08.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 08/03/2021] [Accepted: 08/04/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION This study compared the relative efficacy of aerobic training to resistance training on physical functioning in older breast cancer survivors and determined whether benefits could be maintained by transitioning to unsupervised home-based training. MATERIALS AND METHODS Early-stage, post-treatment, older (≥65 years) breast cancer survivors (n = 114; mean age 72 years) were randomized to 12 months of supervised aerobic (n = 37), resistance (n = 39) or stretching (active control; n = 38) training followed by 6 months of unsupervised home-based training. Outcomes included aerobic capacity by 6-min walk distance (6MWD; m), maximal upper and lower body strength (1-repetition maximum; kg); physical function by short physical performance battery (SPPB), SF-36 and Late Life Function and Disability Instruments. RESULTS Over 12-months of supervised exercise, all groups improved in muscle strength and SPPB scores, but resistance trained women also improved 6MWD. Improvements in upper and lower body strength in the resistance group were significantly greater than those in the stretching control (+2.5 kg vs. +1.8 kg; p = 0.05) and aerobic groups (+8.3 kg vs +2.7 kg; p = 0.047), respectively, with trends for greater improvements in 6MWD (+57.9 m vs. +22.5 m; p = 0.057) and self-report physical function (+4.8 vs. -4.4; 0.066) in resistance trained women versus controls. Compared to values at 12 months, there were no changes during unsupervised training in any measure within or between groups, except for self-reported advanced lower extremity function which improved in the resistance group and fell in the aerobic group (+1.3 vs. -3.1; p = 0.043). DISCUSSION Supervised exercise can improve strength and physical functioning among older breast cancer survivors. Resistance training may lead to better improvements compared to aerobic or flexibility training, whether in a supervised or unsupervised setting. Clinicaltrials.govNCT00662103.
Collapse
Affiliation(s)
- Kerri M. Winters-Stone
- School of Nursing, Oregon Health & Science University, Portland, OR,Knight Cancer Institute, Oregon Health & Science University, Portland, OR,Corresponding author at: Oregon Health & Science University Mailcode: KCRB-CPC 3455 SW US Veteran’s Hospital Rd Portland, OR 97239,
| | | | - Nathan Dieckmann
- School of Nursing, Oregon Health & Science University, Portland, OR
| | - Sydnee Stoyles
- School of Nursing, Oregon Health & Science University, Portland, OR
| | - Zahi Mitri
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR
| | - Shiuh-Wen Luoh
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR,Portland Veterans Affairs Health Care System, Portland, OR
| |
Collapse
|
37
|
Mansson L, Pettersson B, Rosendahl E, Skelton DA, Lundin-Olsson L, Sandlund M. Feasibility of performance-based and self-reported outcomes in self-managed falls prevention exercise interventions for independent older adults living in the community. BMC Geriatr 2022; 22:147. [PMID: 35193495 PMCID: PMC8862529 DOI: 10.1186/s12877-022-02851-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 02/17/2022] [Indexed: 11/11/2022] Open
Abstract
Background Little is known about associations between performance-based measurements and self-reported scales, nor about ceiling effects or sensitivity to change to evaluate effects in the target population for self-managed exercise interventions. This study aimed to explore the feasibility of using performance-based outcomes for gait speed, functional leg strength and balance, and self-reported outcomes of falls-efficacy and functional ability in two self-managed falls prevention exercise interventions for community dwelling older adults. Methods Independent living, community-dwelling older adults (n = 67) exercised with one of two self-managed falls prevention exercise programmes, a digital programme (DP) or a paper booklet (PB) in a 4-month participant preference trial. Pre- and post-assessments, by blinded assessors, included Short Physical Performance Battery (SPPB) and 30s Chair stand test (30s CST). Participants completed self-reported questionnaires: Activities-specific and Balance Confidence scale (ABC), Iconographical Falls Efficacy Scale (Icon-FES), Late-Life Function and Disability Instrument Function Component (LLFDI-FC). In addition, improvement in balance and leg strength was also self-rated at post-assessment. Participants’ mean age was 76 ± 4 years and 72% were women. Results Ceiling effects were evident for the balance sub-component of the SPPB, and also indicated for ABC and Icon-FES in this high functioning population. In SPPB, gait speed, 30s CST, and LLFDI-FC, 21–56% of participants did not change their scores beyond the Minimal Clinically Important Difference (MCID). At pre-assessment all performance-based tests correlated significantly with the self-reported scales, however, no such significant correlations were seen with change-scores. Improvement of performance-based functional leg strength with substantial effect sizes and significant correlations with self-reported exercise time was shown. There were no differences in outcomes between the exercise programmes except that DP users reported improved change of leg strength to a higher degree than PB users. Conclusion The LLFDI-FC and sit-to-stand tests were feasible and sensitive to change in this specific population. The balance sub-component of SPPB and self-reported measures ABC and Icon-FES indicated ceiling effects and might not be suitable as outcome measures for use in a high functioning older population. Development and evaluation of new outcome measures are needed for self-managed fall-preventive interventions with high functioning community-dwelling older adults. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-02851-9.
Collapse
Affiliation(s)
- Linda Mansson
- Department of Community Medicine and Rehabilitation, Section of Physiotherapy, Umeå University, Umeå, Sweden
| | - Beatrice Pettersson
- Department of Community Medicine and Rehabilitation, Section of Physiotherapy, Umeå University, Umeå, Sweden
| | - Erik Rosendahl
- Department of Community Medicine and Rehabilitation, Section of Physiotherapy, Umeå University, Umeå, Sweden
| | - Dawn A Skelton
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Lillemor Lundin-Olsson
- Department of Community Medicine and Rehabilitation, Section of Physiotherapy, Umeå University, Umeå, Sweden
| | - Marlene Sandlund
- Department of Community Medicine and Rehabilitation, Section of Physiotherapy, Umeå University, Umeå, Sweden.
| |
Collapse
|
38
|
Krupp S, Schöne F, Balck F, Hofmann W, Willkomm M, Kasper J. Selbstbeurteilung von Alltagsaktivitäten mittels Duruöz-Hand-Index – Validierung der deutschen Übersetzung. Z Gerontol Geriatr 2022; 55:99-104. [DOI: 10.1007/s00391-022-02041-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 02/14/2022] [Indexed: 11/30/2022]
|
39
|
Werner C, Wolf-Belala N, Nerz C, Abel B, Braun T, Grüneberg C, Thiel C, Büchele G, Muche R, Hendlmeier I, Schäufele M, Dams J, König HH, Bauer JM, Denkinger M, Rapp K. A multifactorial interdisciplinary intervention to prevent functional and mobility decline for more participation in (pre-)frail community-dwelling older adults (PromeTheus): study protocol for a multicenter randomized controlled trial. BMC Geriatr 2022; 22:124. [PMID: 35164686 PMCID: PMC8842871 DOI: 10.1186/s12877-022-02783-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 01/24/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Age-related decline in physical capacity can lead to frailty, associated with an increased vulnerability to adverse health outcomes and greater healthcare utilization. In an aging population, effective strategies to prevent physical decline and frailty, and preserve independence are needed. Prevention programs for vulnerable community-dwelling older adults are, however, often not yet established and implemented in routine practice. Research on the feasibility, implementation, and (cost-)effectiveness of multifactorial, interdisciplinary intervention programs that take advantage of available services of healthcare providers is also limited. The main aim of this study is to evaluate the effectiveness of such an intervention program (PromeTheus) to prevent functional and mobility decline for more participation in community-dwelling (pre-)frail older adults. METHODS The study is designed as a three-center, randomized controlled trial with a 12-month intervention period. Four hundred community-dwelling (pre-)frail (Clinical Frailty Scale score 4-6) older adults (≥70 years) will be randomized in a 1:1 ratio to the intervention group (IG) or the control group (CG). The IG will receive the PromeTheus program consisting of obligatory home-based physical exercises (Weight-bearing Exercise for Better Balance) accompanied by physiotherapists and facultative counseling services (person-environment-fit, coping with everyday life, nutrition, group-based activities) delivered via existing healthcare structures (e.g., social workers, nutritionists). The CG will receive usual care and a one-time counseling session on recommendations for physical activity and nutrition. Primary outcomes assessed at months 6 and 12 are the function component of the Late-Life Function and Disability Instrument and the University of Alabama at Birmingham Life-Space Assessment. Secondary outcomes are disability, physical capacity and activity, frailty, nutritional status, falls, fear of falling, health status, and psychosocial components. Process and economic evaluations are also conducted. Primary statistical analyses will be based on the intention-to-treat principle. DISCUSSION Compared to usual care, the PromeTheus program is expected to result in higher function and mobility, greater independence and lower need for care, and more participation. As the PromeTheus program draws on existing German healthcare structures, its large-scale translation and delivery will be feasible, if evidence of (cost-)effectiveness and successful implementation can be demonstrated. TRIAL REGISTRATION German Clinical Trials Register, . Registered on March 11, 2021.
Collapse
Affiliation(s)
- Christian Werner
- Center for Geriatric Medicine, Agaplesion Bethanien Hospital Heidelberg, Heidelberg University, Heidelberg, Germany.
| | | | - Corinna Nerz
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Bastian Abel
- Center for Geriatric Medicine, Agaplesion Bethanien Hospital Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Tobias Braun
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule für Gesundheit Bochum (University of Applied Sciences), Bochum, Germany
| | - Christian Grüneberg
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule für Gesundheit Bochum (University of Applied Sciences), Bochum, Germany
| | - Christian Thiel
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule für Gesundheit Bochum (University of Applied Sciences), Bochum, Germany
| | - Gisela Büchele
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Reiner Muche
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Ingrid Hendlmeier
- Department of Social Work, University of Applied Sciences, Mannheim, Germany
| | - Martina Schäufele
- Department of Social Work, University of Applied Sciences, Mannheim, Germany
| | - Judith Dams
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jürgen M Bauer
- Center for Geriatric Medicine, Agaplesion Bethanien Hospital Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Michael Denkinger
- Institute for Geriatric Research, Ulm University, Ulm, Germany
- Agaplesion Bethesda Clinic, Ulm, Germany
| | - Kilian Rapp
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| |
Collapse
|
40
|
Wallbank G, Sherrington C, Hassett L, Kwasnicka D, Chau JY, Phongsavan P, Grunseit A, Martin F, Canning CG, Baird M, Shepherd R, Tiedemann A. Acceptability and feasibility of an online physical activity program for women over 50: a pilot trial. Transl Behav Med 2022; 12:225-236. [PMID: 35020938 DOI: 10.1093/tbm/ibab161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Regular physical activity benefits health across the lifespan. Women in middle-age often juggle carer and work responsibilities, are often inactive, and may benefit from tailored support to increase physical activity. Establish the acceptability, feasibility, and impact on physical activity of a scalable program for women 50+ years. This pilot trial randomized participants to immediate program access, or to a wait-list control. [Active Women over 50 Online] program included: (1) study-specific website, (2) 8 emails or 24 SMS motivation-based messages, (3) one telephone health-coaching session. Outcomes, at 3 months, were acceptability (recommend study participation, intervention uptake), feasibility (recruitment, reach, completion), intervention impact (physical activity), intervention impressions. At baseline, 62 participants of mean (SD) age 59 (±7) years took 7459 (±2424) steps/day and most (92%) reported ≥2 medical conditions. At 3 months, acceptability and impact data were available for 52 (84%) and 57 (92%) participants, respectively. Study participation was recommended by 83% of participants. Participants mostly agreed to receive health coaching (81%) and messages (87%: email = 56%, SMS = 44%), opened 82% of emails and accessed the website 4.8 times on average. Respondents reported the intervention supported their physical activity. Intervention participants were more likely to increase steps from baseline by 2000+/day (OR: 6.31, 95% CI: 1.22 to 32.70, p = .028) than controls, and trended toward more light-intensity (p = .075) and moderate-vigorous intensity physical activity (p = .11). The [Active Women over 50 Online] program demonstrated acceptability and feasibility among the target population, and effectiveness in some domains in the short term. Results warrant further testing in a full-scale RCT.
Collapse
Affiliation(s)
- Geraldine Wallbank
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, NSW, Australia.,School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Catherine Sherrington
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, NSW, Australia.,School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Leanne Hassett
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, NSW, Australia.,School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Discipline of Physiotherapy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Dominika Kwasnicka
- Faculty of Psychology, SWPS University of Social Sciences and Humanities, Wrocław, Poland.,Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Josephine Y Chau
- Department of Health Systems and Populations, Macquarie University, Sydney, NSW, Australia.,Prevention Research Collaboration, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Philayrath Phongsavan
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Prevention Research Collaboration, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Anne Grunseit
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Prevention Research Collaboration, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Fiona Martin
- Department of Media and Communications, Faculty of Arts and Social Sciences, The University of Sydney, Sydney, Australia
| | - Colleen G Canning
- Discipline of Physiotherapy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Marian Baird
- Sydney Business School, The University of Sydney, Sydney, NSW, Australia
| | - Roberta Shepherd
- Discipline of Physiotherapy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Anne Tiedemann
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, NSW, Australia.,School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
41
|
Ge L, Yap CW, Kaur P, Ong R, Heng BH. Psychometric evaluation of the 8-item Altarum Consumer Engagement (ACE) Measure™ in community-dwelling adults in Singapore. BMC Health Serv Res 2021; 21:1347. [PMID: 34915884 PMCID: PMC8680055 DOI: 10.1186/s12913-021-07369-1] [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: 02/08/2021] [Accepted: 12/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A valid and reliable measure is essential to assess patient engagement and its impact on health outcomes. This study aimed to examine the psychometric properties of the 8-item Altarum Consumer Engagement Measure™ (ACE Measure) among English-speaking community-dwelling adults in Singapore. METHODS This cross-sectional study involved 400 randomly selected community-dwelling adults (mean age: 49.7 years, 50.0% were female, 72.3% were Chinese) who completed the English version of the 8-item ACE Measure independently. The item-level statistics were described. The internal consistency of the measure was measured by Cronbach alpha and item-rest correlations. Validity of the tool was assessed by 1) factorial validity using confirmatory factor analysis (CFA), 2) hypothesis-testing validity by correlating ACE subscales (Commitment and Navigation) with health-related outcomes, and 3) criterion validity against the Patient Activation Measure and Health Confidence Measure. RESULTS There was no floor or ceiling effect for Commitment and Navigation subscales, and the Cronbach alpha for each subscale was 0.76 and 0.54, respectively. The two-factor structure was confirmed by CFA. In general, Commitment and Navigation subscales were positively correlated with frequency of activity participation (rho = 0.30 - 0.33) and EQ-5D visual analog scale (rho = 0.15 - 0.30). Individuals who perceived better health than peers had higher subscale scores (p < 0.01). Each subscale score had moderate and positive correlations with activation score (rho = 0.48 - 0.55) and health confidence score (rho = 0.35 - 0.47). CONCLUSIONS The two-subscale ACE Measure demonstrated good construct validity in English-speaking Singapore community-dwelling adults. Evidence in internal consistency was mixed, indicating further investigation.
Collapse
Affiliation(s)
- Lixia Ge
- Health Services and Outcomes Research, National Healthcare Group, 3 Fusionopolis Link #03-08, Nexus@one-north, Singapore, 138543, Singapore.
| | - Chun Wei Yap
- Health Services and Outcomes Research, National Healthcare Group, 3 Fusionopolis Link #03-08, Nexus@one-north, Singapore, 138543, Singapore
| | - Palvinder Kaur
- Health Services and Outcomes Research, National Healthcare Group, 3 Fusionopolis Link #03-08, Nexus@one-north, Singapore, 138543, Singapore
| | - Reuben Ong
- Health Services and Outcomes Research, National Healthcare Group, 3 Fusionopolis Link #03-08, Nexus@one-north, Singapore, 138543, Singapore
| | - Bee Hoon Heng
- Health Services and Outcomes Research, National Healthcare Group, 3 Fusionopolis Link #03-08, Nexus@one-north, Singapore, 138543, Singapore
| |
Collapse
|
42
|
Beauchamp MK, Vrkljan B, Kirkwood R, Vesnaver E, Macedo LG, Keller H, Astephen-Wilson J, Sohel N, Noble T, Dietrich N, Gardner P, Newbold KB, Scott D. Impact of COVID-19 on mobility and participation of older adults living in Hamilton, Ontario, Canada: a multimethod cohort design protocol. BMJ Open 2021; 11:e053758. [PMID: 34916322 PMCID: PMC8678540 DOI: 10.1136/bmjopen-2021-053758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION The novel COVID-19 required many countries to impose public health measures that likely impacted the participation and mobility of community-dwelling older adults. This protocol details a multimethod cohort design undertaken to describe short-term and medium-term changes to the mobility and participation of older Canadians living in the community rather than retirement facilities during the COVID-19 pandemic. METHODS AND ANALYSIS A longitudinal telephone (or online)-administered survey is being conducted with a random sample of older adults living within 20 km of McMaster University, Hamilton, Ontario, Canada, identified from census dissemination areas. Baseline data collection of community-dwelling older adults aged 65 years and over began in May 2020 with follow-ups at 3, 6, 9 and 12 months. The Late-Life Function and Disability Instrument and global rating of change anchors are the primary outcomes of interest. A subsample of respondents will participate in open-ended, semistructured interviews conducted over the telephone or through video-conference, to explore participants' lived experiences with respect to their mobility and participation during the pandemic. Descriptive statistics and quantitative approaches will be used to determine changes in mobility and social and personal participation, and associated personal and environmental factors. For the interviews, qualitative data will be analysed using descriptive phenomenology. ETHICS AND DISSEMINATION Approval was obtained from the Hamilton Integrated Research Ethics Board of McMaster University (2020-10814-GRA). This study may inform the design of programmes that can support community-dwelling older adults during and after the COVID-19 pandemic. Findings will be disseminated through peer-reviewed publications and conferences focused on ageing.
Collapse
Affiliation(s)
- Marla K Beauchamp
- School of Rehabilitation Science, McMaster University, Hamilton, California, Canada
| | - Brenda Vrkljan
- School of Rehabilitation Science, McMaster University, Hamilton, California, Canada
| | - Renata Kirkwood
- School of Rehabilitation Science, McMaster University, Hamilton, California, Canada
| | - Elisabeth Vesnaver
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Luciana G Macedo
- School of Rehabilitation Science, McMaster University, Hamilton, California, Canada
| | - Heather Keller
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
| | | | - Nazmul Sohel
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, California, Canada
| | - Tara Noble
- School of Rehabilitation Science, McMaster University, Hamilton, California, Canada
| | - Nicholas Dietrich
- School of Rehabilitation Science, McMaster University, Hamilton, California, Canada
| | - Paula Gardner
- Department of Communication Studies and Multimedia, McMaster University, Hamilton, California, Canada
| | - K Bruce Newbold
- School of Earth, Environment & Society, McMaster University, Hamilton, California, Canada
| | - Darren Scott
- School of Earth, Environment & Society, McMaster University, Hamilton, California, Canada
| |
Collapse
|
43
|
Mazzà C, Alcock L, Aminian K, Becker C, Bertuletti S, Bonci T, Brown P, Brozgol M, Buckley E, Carsin AE, Caruso M, Caulfield B, Cereatti A, Chiari L, Chynkiamis N, Ciravegna F, Del Din S, Eskofier B, Evers J, Garcia Aymerich J, Gazit E, Hansen C, Hausdorff JM, Helbostad JL, Hiden H, Hume E, Paraschiv-Ionescu A, Ireson N, Keogh A, Kirk C, Kluge F, Koch S, Küderle A, Lanfranchi V, Maetzler W, Micó-Amigo ME, Mueller A, Neatrour I, Niessen M, Palmerini L, Pluimgraaff L, Reggi L, Salis F, Schwickert L, Scott K, Sharrack B, Sillen H, Singleton D, Soltani A, Taraldsen K, Ullrich M, Van Gelder L, Vereijken B, Vogiatzis I, Warmerdam E, Yarnall A, Rochester L. Technical validation of real-world monitoring of gait: a multicentric observational study. BMJ Open 2021; 11:e050785. [PMID: 34857567 PMCID: PMC8640671 DOI: 10.1136/bmjopen-2021-050785] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Existing mobility endpoints based on functional performance, physical assessments and patient self-reporting are often affected by lack of sensitivity, limiting their utility in clinical practice. Wearable devices including inertial measurement units (IMUs) can overcome these limitations by quantifying digital mobility outcomes (DMOs) both during supervised structured assessments and in real-world conditions. The validity of IMU-based methods in the real-world, however, is still limited in patient populations. Rigorous validation procedures should cover the device metrological verification, the validation of the algorithms for the DMOs computation specifically for the population of interest and in daily life situations, and the users' perspective on the device. METHODS AND ANALYSIS This protocol was designed to establish the technical validity and patient acceptability of the approach used to quantify digital mobility in the real world by Mobilise-D, a consortium funded by the European Union (EU) as part of the Innovative Medicine Initiative, aiming at fostering regulatory approval and clinical adoption of DMOs.After defining the procedures for the metrological verification of an IMU-based device, the experimental procedures for the validation of algorithms used to calculate the DMOs are presented. These include laboratory and real-world assessment in 120 participants from five groups: healthy older adults; chronic obstructive pulmonary disease, Parkinson's disease, multiple sclerosis, proximal femoral fracture and congestive heart failure. DMOs extracted from the monitoring device will be compared with those from different reference systems, chosen according to the contexts of observation. Questionnaires and interviews will evaluate the users' perspective on the deployed technology and relevance of the mobility assessment. ETHICS AND DISSEMINATION The study has been granted ethics approval by the centre's committees (London-Bloomsbury Research Ethics committee; Helsinki Committee, Tel Aviv Sourasky Medical Centre; Medical Faculties of The University of Tübingen and of the University of Kiel). Data and algorithms will be made publicly available. TRIAL REGISTRATION NUMBER ISRCTN (12246987).
Collapse
Affiliation(s)
- Claudia Mazzà
- INSIGNEO Institute for in silico Medicine, The University of Sheffield, Sheffield, UK
- Department of Mechanical Engineering, The University of Sheffield, Sheffield, UK
| | - Lisa Alcock
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Kamiar Aminian
- Laboratory of Movement Analysis and Measurement, Ecole Polytechnique Federale de Lausanne, Lausanne, Switzerland
| | - Clemens Becker
- Robert Bosch Gesellschaft für Medizinische Forschung, Stuttgart, Germany
| | - Stefano Bertuletti
- Department of Biomedical Sciences, University of Sassari, Sassari, Sardegna, Italy
| | - Tecla Bonci
- INSIGNEO Institute for in silico Medicine, The University of Sheffield, Sheffield, UK
- Department of Mechanical Engineering, The University of Sheffield, Sheffield, UK
| | - Philip Brown
- The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Marina Brozgol
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ellen Buckley
- INSIGNEO Institute for in silico Medicine, The University of Sheffield, Sheffield, UK
- Department of Mechanical Engineering, The University of Sheffield, Sheffield, UK
| | - Anne-Elie Carsin
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Marco Caruso
- Dipartimento di Elettronica e Telecomunicazioni, Politecnico di Torino, Torino, Italy
- PolitoBIOMed Lab - Biomedical Engineering Lab, Politecnico di Torino, Torino, Italy
| | - Brian Caulfield
- Insight Centre for Data Analytics, O'Brien Science Centre, University College Dublin, Dublin, Ireland
- UCD School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Andrea Cereatti
- Dipartimento di Elettronica e Telecomunicazioni, Politecnico di Torino, Torino, Italy
| | - Lorenzo Chiari
- Department of Electrical, Electronic and Information Engineering «Guglielmo Marconi», University of Bologna, Bologna, Italy
- Health Sciences and Technologies-Interdepartmental Center for Industrial Research (CIRI-SDV), University of Bologna, Bologna, Italy
| | - Nikolaos Chynkiamis
- Department of Sport, Exercise and Rehabilitation, Northumbria University Newcastle, Newcastle upon Tyne, UK
| | - Fabio Ciravegna
- INSIGNEO Institute for in silico Medicine, The University of Sheffield, Sheffield, UK
- Department of Computer Science, The University of Sheffield, Sheffield, UK
| | - Silvia Del Din
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Björn Eskofier
- Machine Learning and Data Analytics Lab, Department of Artificial Intelligence in Biomedical Engineering, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Jordi Evers
- McRoberts BV, Den Haag, Zuid-Holland, Netherlands
| | - Judith Garcia Aymerich
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Eran Gazit
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Clint Hansen
- Department of Neurology, University Medical Center Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Jeffrey M Hausdorff
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Department of Physical Therapy, Sackler Faculty of Medicine & Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Jorunn L Helbostad
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Hugo Hiden
- School of Computing, Newcastle University, Newcastle upon Tyne, UK
| | - Emily Hume
- Department of Sport, Exercise and Rehabilitation, Northumbria University Newcastle, Newcastle upon Tyne, UK
| | - Anisoara Paraschiv-Ionescu
- Laboratory of Movement Analysis and Measurement, Ecole Polytechnique Federale de Lausanne, Lausanne, Switzerland
| | - Neil Ireson
- INSIGNEO Institute for in silico Medicine, The University of Sheffield, Sheffield, UK
- Department of Computer Science, The University of Sheffield, Sheffield, UK
| | - Alison Keogh
- Insight Centre for Data Analytics, O'Brien Science Centre, University College Dublin, Dublin, Ireland
- UCD School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Cameron Kirk
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Felix Kluge
- Machine Learning and Data Analytics Lab, Department of Artificial Intelligence in Biomedical Engineering, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Sarah Koch
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Arne Küderle
- Machine Learning and Data Analytics Lab, Department of Artificial Intelligence in Biomedical Engineering, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Vitaveska Lanfranchi
- INSIGNEO Institute for in silico Medicine, The University of Sheffield, Sheffield, UK
- Department of Computer Science, The University of Sheffield, Sheffield, UK
| | - Walter Maetzler
- Department of Neurology, University Medical Center Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - M Encarna Micó-Amigo
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Arne Mueller
- Novartis Institutes of Biomedical Research, Novartis Pharma AG, Basel, Switzerland
| | - Isabel Neatrour
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | | | - Luca Palmerini
- Department of Electrical, Electronic and Information Engineering «Guglielmo Marconi», University of Bologna, Bologna, Italy
- Health Sciences and Technologies-Interdepartmental Center for Industrial Research (CIRI-SDV), University of Bologna, Bologna, Italy
| | | | - Luca Reggi
- Health Sciences and Technologies-Interdepartmental Center for Industrial Research (CIRI-SDV), University of Bologna, Bologna, Italy
| | - Francesca Salis
- Department of Biomedical Sciences, University of Sassari, Sassari, Sardegna, Italy
| | - Lars Schwickert
- Robert Bosch Gesellschaft für Medizinische Forschung, Stuttgart, Germany
| | - Kirsty Scott
- INSIGNEO Institute for in silico Medicine, The University of Sheffield, Sheffield, UK
- Department of Mechanical Engineering, The University of Sheffield, Sheffield, UK
| | - Basil Sharrack
- Department of Neuroscience and Sheffield NIHR Translational Neuroscience BRC, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Henrik Sillen
- Digital Health R&D, AstraZeneca Sweden, Sodertalje, Sweden
| | - David Singleton
- Insight Centre for Data Analytics, O'Brien Science Centre, University College Dublin, Dublin, Ireland
- UCD School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Abolfazi Soltani
- Laboratory of Movement Analysis and Measurement, Ecole Polytechnique Federale de Lausanne, Lausanne, Switzerland
| | - Kristin Taraldsen
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Martin Ullrich
- Machine Learning and Data Analytics Lab, Department of Artificial Intelligence in Biomedical Engineering, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Linda Van Gelder
- INSIGNEO Institute for in silico Medicine, The University of Sheffield, Sheffield, UK
- Department of Mechanical Engineering, The University of Sheffield, Sheffield, UK
| | - Beatrix Vereijken
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ioannis Vogiatzis
- Department of Sport, Exercise and Rehabilitation, Northumbria University Newcastle, Newcastle upon Tyne, UK
| | - Elke Warmerdam
- Department of Neurology, University Medical Center Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Alison Yarnall
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Lynn Rochester
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| |
Collapse
|
44
|
Brick R, Turner R, Bender C, Douglas M, Eilers R, Ferguson R, Leland N, Lyons KD, Toto P, Skidmore E. Impact of non-pharmacological interventions on activity limitations and participation restrictions in older breast cancer survivors: A scoping review. J Geriatr Oncol 2021; 13:132-142. [PMID: 34598902 DOI: 10.1016/j.jgo.2021.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 08/20/2021] [Accepted: 09/15/2021] [Indexed: 11/18/2022]
Abstract
Cancer-related disability is a complex problem for older breast cancer survivors. One aspect of cancer-related disability is a survivor's inability to complete meaningful daily activities and engage in life roles, referred to as activity limitations and participation restrictions respectively. There is a limited understanding of how interventions influence activity limitations and participation restrictions in this population. A scoping review was undertaken to identify and characterize nonpharmacological interventions developed to address activity limitations and participation restrictions. A systematic search of electronic databases (Ovid Medline, Embase, EBSCO CINAHL, and Ovid PsycINFO) was conducted in April 2020 and updated October 2020. Eleven studies met inclusion criteria. Most frequently observed delivery features were in-person and one-on-one format. Six interventions incorporated telehealth delivery components. Interventions were often complex and varied in content. Exercise and behavioral strategies were among the most frequently used active ingredients. Activity limitations and participation restrictions were often secondary outcomes, and measures of these outcomes were varied in content and assessment method. Study samples were not representative of the current population of older adult breast cancer survivors. Future intervention research should clarify intervention delivery, content, and dose, prioritize comprehensive measurement of activity limitations and participation restrictions, as well as recruit and involve representative study samples to enhance generalizability of findings.
Collapse
Affiliation(s)
- Rachelle Brick
- University of Pittsburgh, Department of Occupational Therapy, Bridgeside Point I, 100 Technology Drive, Pittsburgh, PA 15219, United States of America.
| | - Rose Turner
- University of Pittsburgh, Health Sciences Library System, Falk Library, 200 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA 15261, United States of America.
| | - Catherine Bender
- University of Pittsburgh, School of Nursing, 415 Victoria Building, 3500 Victoria Street, Pittsburgh, PA 15261, United States of America.
| | - Madilyn Douglas
- University of Pittsburgh, Department of Occupational Therapy, Bridgeside Point I, 100 Technology Drive, Pittsburgh, PA 15219, United States of America.
| | - Rachel Eilers
- University of Pittsburgh, Department of Occupational Therapy, Bridgeside Point I, 100 Technology Drive, Pittsburgh, PA 15219, United States of America.
| | - Robert Ferguson
- Center for Counseling and Cancer Support, 5220 Centre Avenue, Shadyside Medical Bldg, Suite 604, Pittsburgh, PA 15232, United States of America.
| | - Natalie Leland
- University of Pittsburgh, Department of Occupational Therapy, Bridgeside Point I, 100 Technology Drive, Pittsburgh, PA 15219, United States of America.
| | - Kathleen D Lyons
- 7750 Psychiatry Dept, Dartmouth-Hitchcock Medical Center, 1 Medical Center Dr, Lebanon, NH 03756, United States of America.
| | - Pamela Toto
- University of Pittsburgh, Department of Occupational Therapy, Bridgeside Point I, 100 Technology Drive, Pittsburgh, PA 15219, United States of America.
| | - Elizabeth Skidmore
- University of Pittsburgh, Department of Occupational Therapy, Bridgeside Point I, 100 Technology Drive, Pittsburgh, PA 15219, United States of America.
| |
Collapse
|
45
|
Dunlap PM, Rosso AL, Zhu X, Klatt BN, Brach JS. The Association of Mobility Determinants and Life Space Among Older Adults. J Gerontol A Biol Sci Med Sci 2021; 77:2320-2328. [PMID: 34529773 DOI: 10.1093/gerona/glab268] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND It is important to understand the factors associated with life space mobility so that mobility disability can be prevented/treated. The purpose of this study was to identify the association between mobility determinants and life space among older adults. METHODS This study was a cross-sectional analysis of 249 community-dwelling older adults (mean age=77.4 years, 65.5% female, 88% white) who were recruited for a randomized, controlled, clinical intervention trial. Associations between cognitive, physical, psychosocial, financial, and environmental mobility determinants and the Life Space Assessment (LSA) at baseline were determined using Spearman's correlation coefficients and one-way analysis of variance. Multivariate analysis was performed using multivariable linear regression models. RESULTS The mean LSA score for the sample was 75.3 (SD=17.8). Personal factors (age, gender, education, comorbidities), cognitive (Trail Making Test A and B), physical (gait speed, lower extremity power, Six Minute Walk Test, Figure of 8 Walk Test, tandem stance, energy cost of walking, and Late Life Function and Disability Function Scale), psychosocial (Modified Gait Efficacy Scale), and financial (neighborhood socio-economic status) domains of mobility were significantly associated with LSA score. In the final regression model, age (β=-0.43), lower extremity power (β=0.03), gait efficacy (β=0.19), and energy cost of walking (β=-57.41) were associated with life space (R 2=0.238). CONCLUSIONS Younger age, greater lower extremity power, more confidence in walking, and lower energy cost of walking were associated with greater life space. Clinicians treating individuals with mobility disability should consider personal, physical, and psychosocial factors assessing barriers to life space mobility.
Collapse
Affiliation(s)
- Pamela M Dunlap
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Andrea L Rosso
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Xiaonan Zhu
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Brooke N Klatt
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jennifer S Brach
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| |
Collapse
|
46
|
Soh SLH, Lane J, Gleeson N, Xu T, Bte Abdul Rahman F, Yeh TT, Soon B, Tan CW. Validation of a new patient-reported outcome measure of balance recovery confidence (BRC) for community-dwelling older adults: a study protocol. PHYSICAL THERAPY REVIEWS 2021. [DOI: 10.1080/10833196.2021.1938867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Shawn Leng-Hsien Soh
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore, Singapore
- Dietetics, Nutrition & Biological Sciences, Physiotherapy, Podiatry & Radiography Division, Queen Margaret University, Musselburgh, UK
| | - Judith Lane
- Dietetics, Nutrition & Biological Sciences, Physiotherapy, Podiatry & Radiography Division, Queen Margaret University, Musselburgh, UK
| | - Nigel Gleeson
- Dietetics, Nutrition & Biological Sciences, Physiotherapy, Podiatry & Radiography Division, Queen Margaret University, Musselburgh, UK
| | - Tianma Xu
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore, Singapore
| | | | - Ting-Ting Yeh
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore, Singapore
| | - Benjamin Soon
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore, Singapore
| | - Chee-Wee Tan
- Department of Physiotherapy and Paramedicine, Glasgow Caledonian University, Glasgow, UK
| |
Collapse
|
47
|
Brynjolfsdottir M, Palmadottir G, Arnadottir SA. Activities and participation of 65-91-year-old adults: population-based study among residents of a sparsely populated and remote area in Iceland. Int J Circumpolar Health 2021; 80:1903778. [PMID: 33983104 PMCID: PMC8128186 DOI: 10.1080/22423982.2021.1903778] [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] [Indexed: 11/22/2022] Open
Abstract
Southern Westfjords of Iceland is a sparsely populated, remote area with rather high proportion of older residents. This study´s aim was to investigate activities and participation in this population, using a descriptive cross-sectional population-based design. The participants were 129 community-dwelling residents, 65–91 years old. The Late Life Function and Disability Instrument was used to measure participants’ activities and participation. It provides interval scale scores where a higher score means less difficulties in activities, more frequent participation, and fewer participation restrictions. Participants had most difficulties in Advanced Lower Extremity functioning and least in Upper Extremity functioning and scored lower on participation frequency than participation restriction. Overall, men reported fewer difficulties in activities than women and the 65–74 years group fewer difficulties than the 75–91 years group. Frequency of participation was higher for women than men and higher for the younger group than the older one who also experienced their participation to be more limited, but men and women did not differ. The participants described barriers limiting their participation in self-care and social life. The results provide valuable information on activities and participation of older residents living rurally and have practical implications for community services in remote arctic areas.
Collapse
Affiliation(s)
- Margret Brynjolfsdottir
- School of Health Sciences, University of Akureyri, Akureyri, Iceland.,Department of Physical Therapy, Heilbrigdisstofnun Vestfjarda, Patreksfjordur, Iceland
| | | | - Solveig A Arnadottir
- Department of Physical Therapy, Faculty of Medicine School of Health Sciences, University of Iceland, Reykjavik, Iceland
| |
Collapse
|
48
|
Tenoxicam loaded hyalcubosomes for osteoarthritis. Int J Pharm 2021; 601:120483. [PMID: 33737098 DOI: 10.1016/j.ijpharm.2021.120483] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 02/24/2021] [Accepted: 03/08/2021] [Indexed: 12/25/2022]
Abstract
The main aim is to develop transcutaneous tenoxicam (TNX) loaded vesicles to control osteoarthritis (OA) without common side effects. Different vesicles were prepared by the emulsification technique, where poloxamer and glyceryl monooleate used for cubosomes. Then, hyalcubosomes were prepared by adding sodium hyaluronate to cubosomes components. Different characterization techniques were used. The selected formulations were tested using an ex-vivo permeation study to evaluate the ability to penetrate and retained in skin layers. Also, in-vitro cell studies using human skin fibroblasts were evaluated the safety of the formulation. The anti-inflammatory efficiency was tested using an in-vivo carrageenan-induced rat paw edema model. Finally, the efficiency to control OA symptoms was tested on three patients with a medical history of knee OA. Results confirmed the successful development of spherical cubosomes with particle size <250 nm, -14.5 mV, high entrapment efficiency percentage (>90%). Moreover, the addition of sodium hyaluronate to selected cubosomes improved viscosity and spreadability. Permeation study confirmed drug penetration and deposition. Cell studies proved the safety of the selected formulation. The animal model showed high anti-inflammatory activity. Finally, the preliminary clinical study demonstrates the potential efficacy and safety of the formulation in controlling OA symptoms over 8 weeks of therapy.
Collapse
|
49
|
Yip W, Ge L, Heng BH, Tan WS. Association between patient-reported functional measures and incident falls. Sci Rep 2021; 11:5201. [PMID: 33664301 PMCID: PMC7933133 DOI: 10.1038/s41598-021-84557-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 02/16/2021] [Indexed: 11/09/2022] Open
Abstract
Lower extremity muscle strength, and functional limitations are important modifiable predictors of falls, but are often examined using performance based measures. We examined the association between self-reported physical function limitations, determined using Late-Life Function and Disability Instrument(LLFDI) and incident falls in community-dwelling elderly individuals. 283 older adults participants were included in this analysis. Physical function limitations were defined as a person's difficulty in completing items of the lower extremity function domain and composite scores of the LLFDI. Information on falls was obtained through a standardised questionnaire. At one-year follow-up, 15.2% (43) of the participants experienced their first fall. In the multivariable analysis, individuals who reported difficulties in items of lower extremity function domain were more likely to experience a fall (incidence rate ratio[IRR]: ranging between 2.43 and 7.01; all P ≤ 0.046). In addition, decreasing advanced lower extremity function scores (IRR: 1.70, 95% confidence interval[CI]): 1.04, 2.78) and overall function component score (IRR: 2.05, 95% CI: 1.22, 3.44) were associated with higher risk of incident falls. Physical function limitations, determined using LLFDI, were associated with incident falls. Our findings provide further evidence that the LLFDI function component has the potential to be used as a self-assessment tool for fall risk.
Collapse
Affiliation(s)
- Wanfen Yip
- Health Services and Outcomes Research, National Healthcare Group, 3 Fusionopolis Link #03-08, Nexus@one-north, Singapore, 138543, Singapore
| | - Lixia Ge
- Health Services and Outcomes Research, National Healthcare Group, 3 Fusionopolis Link #03-08, Nexus@one-north, Singapore, 138543, Singapore
| | - Bee Hoon Heng
- Health Services and Outcomes Research, National Healthcare Group, 3 Fusionopolis Link #03-08, Nexus@one-north, Singapore, 138543, Singapore
| | - Woan Shin Tan
- Health Services and Outcomes Research, National Healthcare Group, 3 Fusionopolis Link #03-08, Nexus@one-north, Singapore, 138543, Singapore.
- Geriatric Education and Research Institute, Singapore, Singapore.
| |
Collapse
|
50
|
Cruz-Gonzalez M, Shrout PE, Alvarez K, Hostetter I, Alegría M. Measurement Invariance of Screening Measures of Anxiety, Depression, and Level of Functioning in a US Sample of Minority Older Adults Assessed in Four Languages. Front Psychiatry 2021; 12:579173. [PMID: 33658950 PMCID: PMC7917233 DOI: 10.3389/fpsyt.2021.579173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 01/25/2021] [Indexed: 01/21/2023] Open
Abstract
Population aging in the US and its increase in racial/ethnic diversity has resulted in a growing body of literature aimed at measuring health disparities among minority older adults. Disparities in health outcomes are often evaluated using self-reported measures and, to attend to linguistic diversity, these measures are increasingly being used in languages for which they were not originally developed and validated. However, observed differences in self-reported measures cannot be used to infer disparities in theoretical attributes, such as late-life depression, unless there is evidence that individuals from different groups responded similarly to the measures-a property known as measurement invariance. Using data from the Positive Minds-Strong Bodies randomized controlled trial, which delivered evidence-based mental health and disability prevention services to a racially/ethnically diverse sample of minority older adults, we applied invariance tests to two common measures of anxiety and depression (the GAD-7 and the HSCL-25) and two measures of level of functioning (the Late-Life FDI and the WHODAS 2.0) comparing four different languages: English, Spanish, Mandarin, and Cantonese. We found that these measures were conceptualized similarly across languages. However, at the item-level symptom burden, we identified a non-negligible number of symptoms with some degree of differential item functioning. Spanish speakers reported more worry symptoms and less somatic symptoms for reasons unrelated to their psychological distress. Mandarin speakers reported more feelings of restlessness, and both Mandarin and Cantonese speakers reported no interest in things more often for reasons unrelated to their psychological distress. Mandarin and Cantonese speakers were also found to consistently report more difficulties performing physical activities for reasons unrelated to their level of functioning. In general, invariance tests have been insufficiently applied within psychological research, but they are particularly relevant as a prerequisite to accurately measure health disparities. Our results highlight the importance of conducting invariance testing, as we singled out several items that may require careful examination before considering their use to compare symptoms of psychological distress and level of functioning among ethnically and linguistically diverse older adult populations.
Collapse
Affiliation(s)
- Mario Cruz-Gonzalez
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States.,Department of Medicine, Harvard Medical School, Boston, MA, United States
| | - Patrick E Shrout
- Department of Psychology, New York University, New York, NY, United States
| | - Kiara Alvarez
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States.,Department of Medicine, Harvard Medical School, Boston, MA, United States
| | - Isaure Hostetter
- Department of Health Policy, Harvard School of Public Health, Boston, MA, United States
| | - Margarita Alegría
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States.,Department of Medicine, Harvard Medical School, Boston, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| |
Collapse
|