Functional reach: a new clinical measure of balance

Motor learning-based clinical pilates training for the Parkinson's disease rehabilitation @Parkinsonpilates: A parallel group, randomised controlled trial with 3-month follow-up

OBJECTIVES

To examine the effect of integrated motor learning clinical pilates protocol we developed for patients with Parkinson's Disease (pwPD) on providing enduring motor skills in walking, balance, reaction time, cadence, and functional mobility at 3-months follow-up.

DESIGN

A parallel-group, randomized controlled trial (RCT).

SETTING

XXX Medical Center, XXX, and XXX Physiotherapy and Rehabilitation Center, Nicosia.

PARTICIPANTS

32 pwPD with Hoehn&Yahr stages 2-3 were randomly assigned to the Parkinsonpilates Group (PP) and the Conventional Physiotherapy (CP) Group.

INTERVENTIONS

Both groups received 60 min of training, twice a week, and a home physiotherapy program 4 times a week, for 12 weeks. The intervention group received PP, while the CP group received general physiotherapy training for PD.

MAIN OUTCOME MEASURES

The primary outcomes were untimed Gait and Balance Scale, Cadence, and Nelson Foot Reaction Test scores. The secondary outcomes were The Unified Parkinson's Disease Rating Scale-III subscales, Timed Up and Go Test, Functional Reach Test, and Berg Balance Scale. Outcomes were convened 4 times: pre-test, 6. weeks, post-treatment, and after 3-month follow-up.

RESULTS

At post-test, gait and balance, reaction time, functional mobility, static and dynamic balance showed a significant improvement in PP compared to CP, and the motor examination was similar(p > .05). In addition to these results at follow-up, functional mobility was similar(p > .05) and cadence(p < .05) showed a significant improvement in PP. In addition, according to pairwise comparisons, the PP showed a significant improvement in cadence and reaction time in all 4 measures compared to CP.

CONCLUSIONS

More studies are needed to clarify the effects of the program we developed for PD. It should not be ignored that our protocol can be improved again according to the suggestions of future studies.

The validity and reliability of the 10-meter walk test with obstacles in community-dwelling older adults

The aim of this study was to determine the validity and reliability of the 10-meter walk test modified by adding 5 and 17 cm obstacles (10MWT-O) in community-dwelling older adults and to examine its ability to differentiate between older and younger adults. The study included 65 older adults and 55 younger adults. 10MWT-O (obstacle height: 0, 5, 17 cm) was performed on two different days (day 1 and day 2). All participants were assessed by the same assessor on days 1 and 2. Berg Balance Scale (BBS), Time Up and Go (TUG) test, Mini Mental State Test, and Functional Reach Test (FRT) assessments were performed on day 1. 10MWT-O speed for all obstacle heights showed moderate to good correlations with FRT distance ( r  = 0.474-0.539, P  < 0.001), TUG Test time ( r  = -0.722 to -0.671, P  < 0.001), and BBS score ( r  = 0.619-0.660, P  < 0.001). Test-retest reliability (intraclass correlation coefficient = 0.924-0.960) was found to be within the excellent range for 10MWT-O speed across all obstacle heights. For obstacle heights of 0, 5, and 17 cm, the minimum detectable change for 10MWT-O speed was 0.16, 0.19, and 0.20 m/s, and the optimal cutoff values for differentiating older from young adults were 1.12, 0.98, and 0.85 m/s, respectively. The 10MWT-O is a reliable and valid clinical measure for assessing walking ability and adaptability in older adults. ClinicalTrials.gov identifier: NCT06307769.

Age-stratified validation of the performance index (P-Index) as a metric for dual-task cost in functional mobility across the adult lifespan

OBJECTIVES

To evaluate the predictive validity of the Performance Index (P-Index), a metric that integrates functional mobility and accuracy of cognitive responses to quantify dual-task (DT) performance, for cognitive outcomes measured by the Mini-Mental State Examination (MMSE) across the adult lifespan during the instrumented Timed Up and Go (iTUG) test.

STUDY DESIGN

This cross-sectional study included 247 participants from diverse age groups who completed single-task (ST) and dual-task (DT) iTUG tests in a semi-randomized order. The P-Index (range: 0-1) was calculated using iTUG completion times (measured with inertial sensors) and cognitive task accuracy (backward recitation of days of the week), with weighted components for time (W1) and accuracy (W2).

MAIN OUTCOME MEASURES

The relationship between the P-Index and MMSE scores.

RESULTS

The optimal weighting for predictive accuracy was W1 = 0.6 and W2 = 0.4, yielding a P-Index threshold of 0.90 with a sensitivity of 0.69 and specificity of 0.64 for detecting MMSE scores ≥ 26. Participants who reported depressive symptoms (OR: 1.19, p = 0.02) were less likely to achieve MMSE ≥ 26. Conversely, each additional medication (OR: 1.04, p = 0005) and each unit increase in the P-Index significantly improved the odds of higher MMSE scores (OR: 3.89, p = 0.002).

SIGNIFICANCE

The P-Index reliably measures dual-task interference and serves as a strong predictor of cognitive performance across the adult lifespan. It shows potential as a practical tool for cognitive-motor assessments and early detection of cognitive decline.

Enhancing cognitive and physical performance in older adults through wearable sensor-based interactive cognitive-motor training: a randomized clinical trial

Cognitive decline in older adults, often manifested as reduced processing speed and memory, represents a significant challenge to daily functioning and overall quality of life (QoL). Physical inactivity compounds these issues, whereas increased physical activity can lead to healthier cognitive aging. This study examines the impact of wearable sensor-based interactive cognitive-motor training (ICMT) on cognitive and physical performance in older adults. In a single-blind, randomized, parallel-group trial, 36 community-dwelling older adults aged 65 and older were divided into an ICMT and a cognitive training (CT) group. For six weeks, the ICMT group participated in cognitive training using the developed equipment, while the CT group participated in cognitive training using a seated tablet. The ICMT group demonstrated a significant improvement in cognitive function, increasing 1.94 ± 2.98 score (8.60% increase, p < 0.05), and enhanced balance and strength (p < 0.05). Hemodynamic responses of the prefrontal cortex showed a decreasing trend between groups. The ICMT group also demonstrated improved endurance in the 6-minute walk test, covering 18.00 ± 31.0 m more (4.65% farther) than the CT group (p < 0.05). These findings suggest that wearable sensor-based ICMT may offer a practical and effective method to improve cognitive and physical function in older adults, enhancing daily living activities and QoL. Moreover, the wearable sensor-based ICMT offers ease of use, portability, and the ability to conduct training in various settings without requiring specialized facilities, making it a promising method for older adults.

Feasibility and Effects of a Gait Assistance and Gait Resistance Training Program Using a Walking-Assist Wearable Robot for Community-Dwelling Older Adults: Single-Group, Pre-, and Posttest Study

Background

Two-thirds of people aged 65 years and older may require help with daily activities such as eating, bathing, and getting in and out of bed or a chair. Walking-assist wearable robots have shown significant improvements in physical function in controlled settings for patients.

Objective

In this study, we aimed to assess the feasibility and the effect of a gait assistance and gait resistance training program using a walking-assist wearable robot for community-dwelling older adults.

Methods

A total of 23 community-dwelling older adults aged 65 years and older (30 participants recruited, 7 dropped out) enrolled in a 12-session, 6-week gait assistance and gait resistance training program using a walking-assist wearable robot. A single-group, pre- and posttest design was employed to evaluate the feasibility based on program adherence and effectiveness. The primary and secondary outcomes for evaluating effectiveness were walking speed and functional performance, respectively.

Results

Regarding the feasibility, the average number of sessions attended was 11.7 out of 12, indicating a mean adherence rate of 97.8%. Linear mixed model analysis revealed significant improvements in walking speed and functional performance at the end of the program compared with baseline. Specifically, the walking speed measured using the 10-Meter Walk Test, which includes self-selected velocity and fastest safe velocity, improved by a mean of 0.15  (SD 0.13) m/s (P<.001) and 0.15 (SD 0.17) m/s (P<.001), respectively. Functional performance also improved, with faster performance in Timed Up-and-Go (mean -0.63, SD 0.92 s; P=.003) and Four Square Step Test (mean -1.71, SD 1.64 s; P≤.001). Leg muscle strength increased across all measured domains, including plantarflexion (mean +7.29, SD 4.92; P=.004), hip adduction (mean +3.03, SD 2.73; P≤.001), hip extension (mean +2.63, SD 2.50; P≤.001), knee extension (mean +2.33, SD 3.12; P≤.001), knee flexion (mean +2.19, SD 2.17; P≤.001), dorsiflexion (mean +2.10, SD 3.06; P≤.001), hip abduction (mean +1.59, SD 1.92; P=.002), and hip flexion (mean +0.90, SD 1.56; P≤.001).

Conclusions

This study stands out for applying gait assistance and resistance training across various terrains, unlike previous studies that only tested gait assistance in controlled environments. The results demonstrated significant improvements in walking speed and functional performance in older adults, suggesting the effectiveness of preventive health care services using a walking-assist wearable robot as an intervention that can contribute to improving independent functioning and frailty among community-dwelling older adults.

Discriminative ability of functional performance tests on risk of falling among older adults with knee osteoarthritis: A cross-sectional study

Identifying fall risk among older adults with knee osteoarthritis (OA) is essential for targeted prevention. Although functional tests assessing mobility, strength, and balance are widely used, no consensus exists on the most effective test to identify fall risk in this population. This study aimed to compare functional performance tests and fall risk between older adults with and without knee OA, compare the tests in older adults with and without fall risk in both groups, and determine cutoff scores for these tests to identify fall risk among older adults with knee OA. This cross-sectional study included 106 participants aged ≥ 60 years (53 in each group). The participants completed the Thai falls risk assessment test and performed 5 functional performance tests, including the timed-up and go test (TUGT), functional reach test, alternate-step test (AST), 5 times sit-to-stand test (FTSST), and 10-meter walk test (10MWT). The independent t-test and Mann-Whitney U test were used to compare outcomes, and receiver operating characteristic curves were used to identify the optimal cutoff scores. Older adults with knee OA had a higher fall risk and performed significantly worse on the TUGT, AST, FTSST, and 10MWT than those without knee OA. The TUGT and AST scores effectively distinguished the fall risk between older adults with and without knee OA. cutoff scores of 10.5 and 24.5 seconds for the TUGT and AST, respectively, had acceptable area under curve values, effectively discriminating fall risk among older adults with knee OA. Older adults with knee OA exhibit a higher risk of falls and reduced functional abilities. The TUGT and AST may serve as useful fall-risk screening tools among this population.

Derivation of clinical prediction rules for assessing fall risk among community-dwelling older adults: A prospective cohort study

This prospective cohort study aimed to derive clinical prediction rules (CPRs) to assess fall risk within 1 year of a baseline measurement and identify fall-risk subgroups in community-dwelling older adults. Data from 129 community-dwelling older adults aged ≥60 years were analyzed. CPRs were derived for participants who completed the 1-year follow-up (main analysis) and those without a fall history in the past year (subanalysis). When the total CPR score was 3 points (age ≥77 years; fall history, yes; one-leg standing test [OLST] ≤3.8 s), the positive likelihood ratio was 13.35, and the fall rate increased from 31.0 % to 85.7 % in the main analysis. When the total CPR score was 2 points (body mass index ≥23.3 kg/m2; OLST ≤3.9 s), the positive likelihood ratio was 17.65; the fall rate increased from 23.8 % to 84.6 % in the subanalysis. These CPRs can be used to identify fall-risk subgroups among community-dwelling older adults.

Effectiveness of exercise prescription variables to reduce fall risk among older adults: a meta-analysis

OBJECTIVE

This meta-analysis explored the relationship between various exercise prescription variables and their effects on fall risk reduction in older adults, enabling the selection of targeted and evidence-based intervention prescription variables tailored to individual risk-assessment results.

METHOD

Databases including PubMed, Embase, Web of Science, and the Cochrane Library were systematically searched for randomized controlled trials that investigated the impact of exercise intervention on fall prevention. Study quality was assessed using the Cochrane risk-of-bias tool. Meta-analyses, subgroup analyses, sensitivity analyses, and assessments of publication bias were performed using Stata 16.0.

RESULTS

A total of 43 articles comprising 51 studies and involving 2,743 participants were included. The results indicated significant improvements in fall risk assessment indices due to Mind-body Exercise (MBE), Multi-component Physical Activity (MCPA), and Muscle-strengthening Activity(MSA). Subgroup analyses revealed differential optimal type, cycle (week), frequency (day/week), and session time (minutes) across assessment tools, such as the unipedal stance test with eyes open (MCPA, < 8, 3, 45 ≤ Time < 60), functional reach (MCPA, < 8, < 3, ≥ 60), the "get-up and go" test (MSA, ≥ 24, < 3, 30 ≤ Time < 45), Berg balance scale (MBE, 8 ≤ Time < 12, 3, 30 ≤ Time < 45), Five stands sit-to-stand (MCPA, ≥ 24, > 3, 30 ≤ Time < 45), the 30-s chair-stand test (MSA, 12 ≤ Time, < 3, 45 ≤ Time < 60), short physical performance battery (MCPA, 12 ≤ Time < 24, < 3, ≥ 60), and Falls Efficacy Scale-International (MBE, 8 ≤ Time < 12, < 3, 45 ≤ Time < 60).

CONCLUSION

The findings suggest that prescription variables combining MCPA and MBE, ≥ 8-week programs, and ≥ 30-min sessions, effectively reduce fall risk through concurrent enhancement of balance, strength, and self-efficacy; their integration into community-based protocols with individualized resistance-balance combinations optimizes functional outcomes in older adults.

The Role of Periarticular Knee Muscle Torques in Ensuring the Body Balance of Older Adults with Balance Disturbances

Background: The role of the periarticular muscles of the knee joint in ensuring body balance is still ambiguous. Therefore, we conducted clinical and biomechanical assessments on 52 older adults (36 women and 16 men, age of 67.58 ± 7.30 years, body weight of 75.10 ± 13.42 kg, and height of 163.92 ± 8.80 cm) to determine the role of the knee muscles in balance maintenance. Methods: The clinical examination included the Dizziness Handicap Inventory (DHI), the Geriatric Depression Scale (GDS), the Performance-Oriented Mobility Assessment (POMA), the Functional Reach Test (FRT), the Falls Efficacy Scale-International (FES-I), and bioimpedance parameters (skeletal muscle mass-SMM-and its derived parameter-Diff SMM). The biomechanical assessment involved parameters that characterize muscle torques of knee joint extensors and flexors in isokinetic and isometric conditions, as well as changes in the centre of pressure (COP) position while standing with eyes open and closed. Results: Based on treatment history and DHI results (>10 points), 26 participants were identified as having balance disorders, while the remaining participants formed the control group. Statistical analysis was performed to determine differences between the groups. The groups significantly differed in terms of the results obtained from the DHI (p < 0.001) and GDS (p = 0.04) questionnaires as well as FES-I (p < 0.001) and POMA (p = 0.002) tests. While SMM (p = 0.012) was similar in the groups, Diff SMM (p = 0.04) significantly differed. The multiple regression analysis confirmed the knee joint extensor parameters' significant role in predicting the COP path (p = 0.03 and p = 0.04 for two assumed models). Conclusions: The obtained results proved that the muscle torques of knee extensors can be used in the diagnostic process of older patients with balance disorders, indicating possible rehabilitation directions.

Effects of acceptance and commitment therapy plus exercise for older adults with chronic low back pain: A preliminary cluster randomized controlled trial with qualitative interviews

Chronic low back pain (CLBP) is increasingly prevalent in older adults and often leads to functional disability and depressive symptoms. This 2-arm, double-blinded, pilot cluster RCT, with semi-structured interviews, aimed to evaluate the acceptability, feasibility, and preliminary clinical efficacy of ACT plus exercise training (ACT+Ex) on improving pain-related outcomes, psychological outcomes, and physical fitness in older adults with CLBP at post-treatment and 6-month follow-up. Forty community-dwelling older adults (62-85 years) with CLBP, predominantly female, were randomized to ACT+Ex (n=20) or Education plus exercise program (Edu+Ex) (n=20) for 8 weekly group-based sessions, with assessments at baseline, post-treatment, and 6-month follow-up (primary endpoint). Self-reported outcomes included pain intensity, functional disability (Roland Morris Disability Questionnaires, RMDQ), health-related quality of life (EuroQol-5 Dimensions, EQ-5D-5L), psychological inflexibility (Acceptance and Action Questionnaire-Version 2, AAQ-II), and psychological well-being (Depression Anxiety Stress Scale). Physical fitness was assessed using the functional reach test (FRT), Timed Up and Go test (TUG), 6-minute walk test (6MWT), hand grip strength (HGS), and 30-second sit-to-stand (STS-30) test. This trial achieved high recruitment (23.5 participants per week) and completion rates (92.5%). Exploratory analyses revealed that ACT+Ex significantly improved pain intensity, disability, psychological inflexibility, HRQoL, and physical fitness at post-treatment and 6-month follow-up. Qualitative data identified 3 superordinate themes: previous healthcare experience affecting pain beliefs; acceptance strategies guiding behavioral changes; and facilitators and barriers to treatment compliance. These findings support the need for a definitive RCT and form a valuable basis for future exploration regarding the behavioral mechanisms of ACT in clinical applications. PERSPECTIVE: A multimodal therapy incorporating ACT and exercise promotes positive behavioral changes and its treatment effects are maintained at the 6-month follow-up especially for physical performance.

Temporospatial gait analysis of squat walking using a passive lower extremity exoskeleton

This study examined the impact of a chair-type wearable exoskeleton (CEX) on ambulation in a squatting posture. Twenty participants underwent forward, backward, and sideways walking trials with and without the CEX. Results indicated a significant (more than 70 %) reduction in anterior and posterior walking speed on CEX, while lateral walking speed remained unaffected (less than 25 %). Despite the diminished pace in forward and backward walking, CEX demonstrated potential as a dynamic assistive device in occupations involving frequent squatting. More importantly, lateral walking with CEX did not exhibit a significant decrease in speed compared to walking without the device, positioning it as a pragmatic solution for individuals operating in lowered workplaces without compromising overall productivity. These findings highlight the potential of the CEX as an effective intervention to enhance mobility while squatting in confined areas, such as during tile installation. The study provides recommendations for safe and effective utilization of CEX in the workplace.

The Effect of Virtual Reality Therapy on Functional Recovery in Subacute Stroke Patients: A Randomized Controlled Trial

Virtual reality (VR) therapy can potentially enhance upper extremity recovery and motivation in stroke rehabilitation. The BTS Nirvana system, equipped with infrared sensors and real-time audiovisual feedback, enables objective performance recording and supports task-oriented, intensive exercises. This study evaluates the combined effect of VR therapy using BTS Nirvana and conventional rehabilitation on upper extremity functions in subacute stroke patients. This randomized, controlled, single-masked study included 22 subacute hemiplegic patients divided into a virtual reality group (n = 11) and a control group (n = 11). Both groups received conventional therapy for three weeks, with the VR group undergoing additional sessions using the BTS Nirvana system. Upper extremity functions were assessed using the Fugl-Meyer upper extremity scale, Brunnstrom stage, Functional Reach Test, Chedoke Arm and Hand Activity tests, and range of motion measurements. Both groups showed significant improvements (p < 0.05) in most outcomes, except for shoulder adduction (p = 0.222) and shoulder external rotation (p = 0.113). Intergroup analysis favored the VR group for upper extremity Brunnstrom stage (p = 0.030), shoulder external rotation (p = 0.029), and Chedoke arm test scores (p = 0.039). Time-group interaction analysis also highlighted superior improvements in the VR group for these measures (p < 0.05). The BTS Nirvana system is a safe and effective complement to conventional therapy, offering intensive and repetitive training for upper extremity rehabilitation in subacute stroke patients. Further research with larger sample sizes and extended treatment durations is needed to confirm these findings and refine treatment protocols.

Effectiveness of tele-guidance for physiotherapy in older patients with type 2 diabetes: A randomized controlled trial

AIMS/INTRODUCTION

Whether regular intervention via modern communication tools is effective in older patients with type 2 diabetes is unclear. We aimed to determine the effects of tele-guidance for physiotherapy on muscle strength in such patients.

MATERIALS AND METHODS

This randomized controlled trial was conducted at seven hospitals across Japan. The study participants were 74 older patients with type 2 diabetes randomly assigned to either the tele-guidance for physiotherapy group, which received weekly telephone interventions, or the non-intervention group. Both groups performed a combined aerobic and resistance exercise program. The intervention period was 6 months, during which the tele-guidance for physiotherapy and non-intervention groups received remote physiotherapy instruction once weekly and at the 3-month mark, respectively.

RESULTS

Knee extension force was significantly increased in the tele-guidance for physiotherapy group (from 1.25 ± 0.52 to 1.34 ± 0.54 Nm/kg) but significantly decreased in the non-intervention group (from 1.28 ± 0.46 to 1.22 ± 0.43 Nm/kg). Hemoglobin A1c levels improved significantly in the tele-guidance for physiotherapy and non-intervention groups (from 9.5 ± 2.6 to 7.4 ± 1.6% and from 10.2 ± 2.5 to 7.6 ± 2.0%, respectively). Adherence to the physiotherapy program was significantly higher in the tele-guidance for physiotherapy group than in the non-intervention group (71.8% vs 48.6%).

CONCLUSIONS

Weekly tele-guidance for physiotherapy proved effective in improving knee extension force and increasing physiotherapy adherence in older patients with type 2 diabetes. Tele-guidance may be a valuable intervention to improve muscle strength in such patients, offering a cost-effective, accessible solution for healthcare management.

Low frequency physiotherapy on joint health, hemarthrosis, walking, balance and reaction time in hemophilic arthropathy: a controlled trial

BACKGROUND

Physiotherapy is recommended for people with hemophilic arthropathy (PwHA) to improve musculoskeletal health and is typically administered in 2 or 3 sessions per week. We aimed to investigate the effects of once a week comprehensive physiotherapy and home exercise on musculoskeletal system of PwHA.

METHODS

In this study 19 young PwHA with knee and/or ankle were non-randomly divided into two groups: The Home Exercise Group (HEG) and the Comprehensive Physiotherapy Group (CPG). Joint health was evaluated with the Hemophilia Joint Health Score (HJHS), muscle strength (MS) with manual muscle tester, range of motion (ROM) with universal goniometer, pain with Numerical Pain Scale (NPS). The following functional tests were used: 6 min Walking Test (6MWT) for walking capacity, Functional Reach Test (FRT) for dynamic balance and Fitlight® system for visuomotor reaction time (VMRT). The frequency of hemarthrosis (FoH) in the last 6 weeks was obtained from the self-recorded data. The CPG received comprehensive physiotherapy once a week, including manual therapy, neuromuscular electrical stimulation and supervised exercises, and they performed home exercises for the other two days of the week. The HEG only performed home exercises 3 days a week. All the treatments lasted 6 weeks and evaluations were repeated.

RESULTS

Compared with the HEG, the CPG significantly ameliorated for NPS, FoH, HJHS, VMRT (time and mean), 6MWT, all MS and several ROMs. CPG significantly improved in all outcomes except for 1 ROM. The HEG significantly improved in FoH, HJHS, VMRT (time), 6MWT and MS, but not in the ROMs.

CONCLUSION

Comprehensive physiotherapy once a week and continuing home exercise significantly improve joint health, functionality and balance, and reduce pain and hemarthrosis in PwHA.

TRIAL REGISTRATION

The study was registered at Clinicaltrials.gov (Study ID NCT06331091, retrospectively registered).

Evaluating Postural Sway in the Elderly Using Inertial Measurement Units: A Study on Center of Mass Measurements via Accelerometers and Gyroscopes

Background

Assessment of center of mass (COM) changes during static stance control has practical implications in clinical settings, notably among older adults. Recently portable and wearable devices, including accelerometers and gyroscopes, have emerged as a promising alternative to traditional clinical and laboratory assessments. The objectives of the study were to evaluate COM postural sway parameters derived from accelerometer and gyroscope data during static balance tasks with varying bases of support in healthy elderly individuals, and to examine the correlation and agreement between accelerometer-based and gyroscope-based parameters in postural sway assessment.

Methods

One hundred and fourteen healthy elderly individuals who had not experienced falls within the preceding 6 months and were confirmed to have no risk of falling as determined by the timed up and go test, were included in this study. They were evaluated for postural sway while standing, using the sensor securely with a belt attached to the L5 vertebra. The four-stage balance test, including standing in a double stance (SO), semi-tandem stance (STO), tandem stance (TO), and single-leg stance (SL), was employed to assess each participant's ability to maintain balance under increasingly challenging standing positions on a stable surface.

Results

The study demonstrated that COM posture sway increased with a demanding position and a decreasing base of support. Spearman's rho correlation coefficients from the anteroposterior and mediolateral planes exhibited strong correlation (0.75 - 0.9). Moderate reliability was observed for both the accelerometer and gyroscope parameters in both planes (intraclass correlation coefficient: 0.5 and 0.75).

Conclusions

Accelerometry and gyroscopes provide objective quantification of balance that have the potential to be utilized in conjunction with clinical tests to effectively evaluate the risk of falling.

Fall Prevention after Hip and Knee Arthroplasty

Despite the success of total knee arthroplasty and total hip arthroplasty, patients face an increased risk of postoperative falls, often due to surgery-induced changes in muscle strength. Falls can lead to serious consequences, including fractures and reduced quality of life. The majority of falls related to total joint arthroplasty occurs outside the hospital. Effective fall prevention strategies, such as patient education, exercise interventions, environmental modifications, and medication management, are crucial for reducing fall risks and improving patient outcomes. Continued research and innovation in fall prevention are essential for improving patient safety and well-being following joint arthroplasty.

Ultra-lightweight robotic hip exoskeleton with anti-phase torque symmetry for enhanced walking efficiency

This paper presents a novel robotic exoskeleton that is exceptionally lightweight and compact, while providing effective gait assistance. To maximize the system's assistance-to-weight/size ratio, the design focuses on two key aspects of human gait mechanics: (1) the contribution of the hip joints to power generation, and (2) the symmetrical nature of hip flexion and extension torques during walking. Based on these principles, we developed a compact hip exoskeleton with a single actuator. This actuator simultaneously drives the hip joint in the sagittal plane, facilitating both flexion and extension during gait. An adaptive delayed output feedback controller was implemented, ensuring consistent performance across diverse walking conditions using a single rotational sensor and actuator. To evaluate the exoskeleton's effectiveness, a 4-week outdoor walking exercise program was conducted with nine elderly participants. Their gait, balance, and muscle strength were measured before and after the program to assess improvements. Results showed significant improvements in walking speed (14.8% in the 10-m walk and 10.6% in the 6-min walk), as well as enhanced performance in the timed up-and-go test (24.5%) and the short physical performance battery test (18.7%). Ankle dorsiflexion and plantar flexion muscle strength increased by 75.45% and 45.8%, respectively. Additionally, metabolic measurements from three young adults indicated a 13.6 ± 3.2% reduction in the net metabolic cost of walking with the exoskeleton compared to walking without it. These results demonstrate that the single actuator-based hip exoskeleton offers effective gait assistance while maintaining a lightweight and compact design, highlighting its potential for widespread use in various applications.

The effect of proprioceptive neuromuscular facilitation techniques compared to general aerobic exercise on balance, fear of falling, and quality of life in older adults living in nursing homes: a randomized controlled trial

BACKGROUND

With aging, changes occur in various body systems, such as cardiovascular, respiratory, neuromusculoskeletal, and vestibular, leading to a decreased quality of life (QOL) and an increased fear of falling (FOF). Exercise and physical activity reduce the progression of aging complications. Therefore, we examined the effect of proprioceptive neuromuscular facilitation techniques compared to aerobic exercise on balance, fear of falling, and quality of life in older adults living in nursing homes.

METHODS

Fifty-two older adults aged over 60 (31 males, 21 females) living in nursing homes were included. After initial evaluation, individuals were randomly assigned to two treatment groups (PNF techniques and aerobic exercise). Both treatment groups received 12 treatment sessions over 4 weeks. Balance, fear of falling, and quality of life were assessed at baseline and after a 4-week intervention. Analysis of covariance (ANCOVA) and paired samples t-test were utilized to between and within-group changes of variables.

RESULTS

The results showed no significant differences in balance, fear of falling, and quality of life between groups after the intervention (P > 0.05). In the within-group comparison, only the PNF techniques group showed significant improvement in the Berg Balance Scale (BBS) after the intervention (P < 0.05).

CONCLUSION

The findings suggest that PNF techniques compared with aerobic exercise could not contribute to improved balance, fear of falling, and quality of life. Therefore, more clinical trial studies with a control group are needed to determine the exact effects of these techniques.

TRIAL REGISTRATION NUMBER (TRN) AND DATE OF REGISTRATION

The trial was registered at the ( https://www.irct.ir ), (IRCT20210505051181N4) on 9/2/2023.

Balance Assessment in Juvenile Idiopathic Arthritis: A Literature Review

Juvenile idiopathic arthritis is an inflammatory disease, and children with lower limb involvement have impaired balance compared with healthy peers. The objective of this review was to identify balance instruments used in clinical practice for balance testing in children with juvenile idiopathic arthritis. Three independent reviewers searched the PubMed/Medline, Web of Science, Cochrane, Scopus, and Science Direct databases to identify relevant studies published before 3 March 2025. Five studies were included in the review. Two studies investigated the use of specific tests for balance assessment in children with juvenile idiopathic arthritis (the Bruininks-Oseretsky Test of Motor Proficiency, Second Edition Short Form for motor skills, including balance, the Functional Reach Test for static balance, and the Flamingo Balance Test for postural balance). Three studies used balance testing systems (the S3-Check balance board, the FreeMed posturography system, and the Biodex Balance System). Patients who performed physical exercise programs (including clinical Pilates, strengthening exercises, proprioceptive balance exercises, or home exercises) had significant balance improvements. There are various ways to assess the balance in children suffering from juvenile idiopathic arthritis. None of the review studies used both the specific tests and testing systems. Future research targeting the evaluation of static and dynamic balance through combined tests and equipment is needed. Physical exercise should be an integral part of managing patients suffering from juvenile idiopathic arthritis, as postural control is linked to the overall functioning of this category of patients, who should be involved in recreational activities.

Effects of Tactile Sensory Stimulation Training of the Trunk and Sole on Standing Balance Ability in Older Adults: A Randomized Controlled Trial

Background: Aging is associated with a decline in both motor and sensory functions that destabilizes posture, increasing the risk of falls. Dynamic standing balance is strongly linked to fall risk in older adults. Sensory information from the soles and trunk is essential for balance control. Few studies have demonstrated the efficacy of targeted sensory training on balance improvement. Objectives: To assess vibratory sensation function in the trunk and sole using a vibration device and evaluate the effects of trunk and sole tactile sensation training on dynamic standing balance performance in older adults. Methods: In this randomized controlled trial, eighteen older adults were randomly assigned to three groups: control (n = 8, mean age 66.6 ± 3.4), trunk training (n = 5, mean age 71.0 ± 1.9), and sole training (n = 5, mean age 66.4 ± 3.6). The training lasted for 10 weeks, utilizing vibratory stimulation at 128 Hz through tuning forks for 15 min during each session, conducted three times a week. The primary outcomes were vibratory sensitivity, assessed with a belt-fitted device on the trunk and a plate equipped with vibrators on the soles, and dynamic balance, evaluated through force plate testing that measured limits of stability (LoS) in multiple directions. Results: Correct response rates for trunk vibratory stimulation significantly improved in the trunk training group (p < 0.05). The rate of two-stimuli discrimination improved in both training groups. Significant advancements in balance metrics were observed in the trunk and sole training groups when compared to the control group, especially regarding anterior-posterior tilts (p < 0.05). A positive correlation was identified between two-point vibratory discrimination and LoS test performance. Conclusions: Sensory training of the trunk and sole enhances balance performance in older adults, suggesting potential benefits for fall prevention. Future studies should assess long-term effects and explore optimal training duration with larger sample sizes.

Dancing Towards Stability: The Therapeutic Potential of Argentine Tango for Balance and Mobility in Parkinson's Disease

Background: Parkinson's Disease (PD) is a progressive neurodegenerative disorder characterized by motor impairments, including balance deficits, gait disturbances, and postural instability. Given the limitations of pharmacological treatments, alternative rehabilitative strategies such as Argentine Tango (AT) have been explored for their potential benefits in improving mobility and quality of life in individuals with PD. This systematic review evaluates the effectiveness of AT in enhancing balance, gait, and functional mobility in PD patients. Methods: A systematic literature search was conducted across PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, PEDro, and Web of Science. Studies were included if they were randomized controlled trials (RCTs) assessing the impact of AT on motor outcomes in PD. Data extraction and risk of bias assessment were performed independently by two reviewers using the Risk of Bias 2 (RoB 2) tool. Results: Five randomized controlled trials (RCTs) were included, with sample sizes ranging from 10 to 62 participants and intervention durations varying from 10 weeks to 24 months. AT significantly improved balance (Mini-BESTest, BBS, FRT), gait performance (6MWT, TUG), and mobility compared to usual care or conventional exercise. Some studies also reported psychological benefits, including reduced depressive symptoms and increased balance confidence. However, freezing of gait outcomes were inconclusive, and methodological limitations, such as small sample sizes and inconsistent intervention durations, were noted. Outcomes for freezing of gait (FoG) remained inconclusive due to the variability in assessment methods and inconsistent reporting across studies. Conclusions: AT appears to be an effective rehabilitation strategy for improving balance, gait, and functional mobility in PD. While preliminary evidence suggests additional psychological benefits, larger, high-quality trials are needed to confirm its long-term efficacy and establish standardized intervention protocols. AT may be integrated into multimodal rehabilitation programs to enhance motor and psychosocial outcomes in PD management. However, the small sample sizes of included studies and the heterogeneity in intervention durations limit the generalizability of findings. AT may serve as a structured rehabilitative approach for improving mobility and psychosocial outcomes in PD and could be integrated into community-based or clinical rehabilitation programs.

Examining the effects of non-immersive virtual reality game-based training on knee hyperextension control and balance in chronic stroke patients: a single-blind randomized controlled study

BACKGROUND

Post-stroke hemiparesis can lead to decreased mobility, gait disturbances, impaired balance, postural instability, limitations in activities of daily living (ADL), and long-term disability.

AIMS

The aim of this study was to examine the effect of non-immersive virtual reality game-based training (nIVRGT) in addition to conventional rehabilitation in stroke patients on dynamic balance, knee hyperextension control, and ADL.

METHODS

Twenty-five chronic stroke patients aged between 51 and 70 were included in the study. Stroke patients were randomized to a control group (n = 12) and a study group (n = 13). Individuals in control group participated conventional physiotherapy and rehabilitation program for 60 min, 3 days a week for 6 weeks. individuals in the study group received 40 min of conventional physiotherapy and rehabilitation program plus 20 min nIVRGT. Functional Reach Test, Timed Up and Go Test, Computerized Gait Evaluation System and Barthel Index were used in the evaluation.

RESULT

The study group improved significantly in dynamic balance, knee control, and ADL (p < 0.05). In the control group, significant improvements were observed in dynamic balance and knee control (p < 0.05), except ADL (p > 0.05). The study group improved in dynamic balance compared with the control group (p < 0.05). Knee control and ADL improved similarly in both groups (p > 0.05).

CONCLUSION

Our results showed that conventional and additional nIVRGT rehabilitation improved dynamic balance and knee hyperextension control in chronic stroke. However, it was observed that the non-immersive virtual reality (nIVR) approach was more effective in improving dynamic balance in stroke patients than conventional rehabilitation alone.

CLINICAL TRIAL CODE

NCT05907473.

Do patients with cervical dystonia present a greater risk and more fear of falling?

BACKGROUND

 Cervical dystonia (CD) is a movement disorder characterized by involuntary contractions that affect the muscles of the cervical region, causing movements in a twisting pattern. Its chronic-progressive nature can lead to pain, impaired mobility, and greater propensity to falls.

OBJECTIVE

 To verify gait and balance characteristics and their correlation with the risk and fear of falling in 46 CD patients.

METHODS

 The present was a descriptive and cross-sectional study. For the assessments, we sued the Berg Balance Scale (BBE), the Tinetti Scale (also known as the Performance-Oriented Mobility Assessment, POMA), the Dynamic Gait Index (DGI), the Fall Efficacy Scale-International (FES-I), and the Functional Reach Test (FRT). The patients were recruited during their routine consultations, before the administration of botulinum toxin. For data analysis, we used the BioEstat 5.0 software (free) to verify the distribution of samples (Shapiro-Wilk test) and the correlations among variables (Spearman test) considering p ≤ 0.05%.

RESULTS

 The results showed that the patients presented gait changes related to static and dynamic components of balance. Therefore, we observed a greater propensity to falls, with a correlation involving lack of balance, a greater risk of falling and, consequently, more fear of falling.

CONCLUSION

 We verified that changes in the balance of CD patients have a negative impact on gait, increase the risk and the fear of falling, and can lead the individual to restrict their activity levels.

Teleneurorehabilitation and Motor and Nonmotor Symptoms and Quality of Life in Parkinson Disease: The TELEPARK Randomized Clinical Trial

Importance

To our knowledge, no randomized clinical trials have compared the efficacy and safety of teleneurorehabilitation (TNR) with in-person rehabilitation in Parkinson disease (PD) during the COVID-19 pandemic lockdown.

Objective

To assess the efficacy and safety of TNR among patients with PD during the COVID-19 lockdown.

Design, Setting, and Participants

The TELEPARK single-center, assessor-blinded, randomized clinical trial was conducted over 11 months from September 2020 to July 2021, with follow-up after 12 weeks. Final data could be analyzed on July 1, 2024. Patients aged 18 years or older diagnosed with idiopathic PD with Hoehn and Yahr stage 1 to 2.5, Mini-Mental State Examination score of 24 or higher, and who possessed a smartphone allowing videocalling were eligible for inclusion and randomized to in-person or TNR therapy.

Intervention

The in-person group received physiotherapy, aerobic, and breathing exercises for 30 minutes in person once a week for 4 weeks and then once every 2 weeks for 8 weeks. The TNR group received in-person sessions on day 1, followed by supervised sessions via videocalling once a week for the first 4 weeks, then once every 2 weeks for 8 weeks.

Main Outcome and Measures

The primary outcome was mean change in the Movement Disorder Society-Unified Parkinson's Disease Rating Scale III (MDS-UPDRS III) postintervention score from baseline. Mean changes in postintervention MDS-UPDRS II and III, Non-Motor Symptom Scale (NMSS), Parkinson's Disease Questionnaire-8 Summary Index (PDQ8-SI), 6-minute walk test (6MWT), and functional reach test (FRT) scores from baseline between groups was assessed using unpaired t tests.

Results

A total of 63 participants (28 in-person and 35 TNR) were analyzed. Mean (SD) ages in the in-person and TNR groups were 60.50 (7.08) years and 62.80 (12.46) years, respectively. Twelve of 28 patients in the in-person group (42.9%) and 16 of 35 patients in the TNR group (45.7%) were female. Mean (SD) MDS-UPDRS III scores were significantly lower following TNR (pre-TNR: 35.17 [17.72] vs post-TNR: 28.6 [19.7]; P = .001). Mean (SD) change in postintervention MDS-UPDRS III scores was not significantly different between the 2 groups (TNR: -6.74 [11.07] vs in-person: -7.54 [10.52]; P = .39). Median changes in NMSS and PDQ8-SI scores were similar between the groups.

Conclusions and Relevance

TNR is safe and effective in improving motor and nonmotor symptoms and quality of life among Indian patients with PD.

Assessment of the psychometric properties of the Frailty and Injuries: Cooperative Studies of Intervention Techniques - 4 in people with stroke

BACKGROUND

The Frailty and Injuries: Cooperative Studies of Intervention Techniques - 4 (FICSIT-4) is a measure that assesses standing balance ability. However, the psychometric properties of the FICSIT-4 have not been examined in people with stroke.

OBJECTIVES

To investigate the psychometric properties of the FICSIT-4, including its internal consistency, test - retest reliability, concurrent validity, and known-group validity, and identify the cutoff score on the FICSIT-4 that discriminates people with stroke from healthy older people.

METHODS

Sixty-two participants with stroke and 49 age-matched healthy controls were recruited. The FICSIT-4 was administered twice, on days 1 and 2, with a 1-week interval, to the participants with stroke to examine test - retest reliability. Various health-related measures were also administered to the stroke participants on day 1. The FICISIT-4 was only administered once, on day 1, to the healthy participants.

RESULTS

The FICIST-4 was found to exhibit fair internal consistency, good test - retest reliability and significant correlations with various health-related outcome measures. It also demonstrated known-group validity, and a score of 25 was found to distinguish people with stroke from healthy older people.

CONCLUSION

The FICISIT-4 is a reliable and valid measure for assessing the standing balance ability of people with stroke.

Effects of Lee Silverman Voice Treatment-BIG on Motor, Cognition, Mental Health, Occupational Performance, and Occupational Balance in Patients With Schizophrenia: A Single-Subject Experimental Study

Introduction: In this study, we aim to apply BIG to patients with schizophrenia to confirm changes in mental symptoms, task performance, and occupational balance through motor and cognitive enhancement. Method: This study used a single-subject A-B-A design. It consisted of a total of 22 sessions, with 4 sessions in the baseline period, 16 sessions in the intervention period (Lee Silverman Voice Treatment-BIG), and 2 sessions in the follow-up period. The subjects were three male patients diagnosed with chronic schizophrenia, all severe cases. During the 22 sessions, the timed up and go test (TUG) and functional reach test (FRT) and the Montreal Cognitive Assessment (MoCA) were used to determine changes in motor function and cognition, and the subjective cognitive and mental score (SS), Canadian Occupational Performance Measure (COPM), and Occupational Balance Questionnaire-Korean (OBQ-K) were used to determine changes in psychiatric symptoms, work performance, and work balance satisfaction before and after the intervention. Statistically significant changes were determined using the two standard deviation (2SD) band method. Results: The TUG, FRT, and MoCA showed significant results in the intervention period compared to the baseline period. The SS, COPM, and OBQ-K also showed positive changes in scores from pre- to postintervention. Conclusion: In this study, BIG was found to promote improvement in motor and cognitive function in chronic schizophrenia patients, with positive effects on psychiatric symptoms, task performance, and occupational balance satisfaction.

Flexibility, Resistance, Aerobic, Movement Execution (FRAME) training program to improve gait capacity in adults with Hereditary Spastic Paraplegia: protocol for a single-cohort feasibility trial

Background

Hereditary Spastic Paraplegia (HSP) is a heterogeneous group of inherited neurological disorders characterized by progressive weakness and spasticity in the lower limbs, significantly affecting gait capacity (endurance and speed). Although specific interventions have been already investigated, there is currently a lack of comprehensive, structured neurorehabilitation programs to improve gait capacity in adults with HSP. Thus, this protocol aims to explore the feasibility and effectiveness of a composite training targeting flexibility, muscle strength, motor control, balance, and aerobic capacity.

Methods

20 adults diagnosed with HSP will participate in 10 to 16 therapist-guided sessions (intervention), lasting 60 to 120 minutes each, occurring once or twice weekly based on individual preferences. Depending on the number and frequency of sessions, the intervention period may vary in between five to 10 weeks. Upon completion, participants will receive a transfer package (manual, video tutorials) to stimulate long-term exercise at home. Assessments will take place before intervention (T0), at the end of the intervention (T1), and 12 weeks post-T1 (T2). Primary outcomes will focus on feasibility (recruitment, retention, adherence, absence of adverse events, and patient's satisfaction). Secondary outcomes will evaluate improvements in gait capacity and specific contributing factors such as reduced spasticity, increased muscle strength, and improved balance.

Relevance

The significance of this protocol is to provide valuable insights for clinicians regarding the feasibility and potential efficacy of a comprehensive, clinical-oriented program to improve gait capacity in adults with HSP, and inform future translational research studies in the field.

Clinical trial registration

ClinicalTrials.gov, identifier NCT06742697.

Effects of Unpredictable Perturbation Training on a Split-Belt Treadmill on Physical Performance in Older Adults: A Randomized Controlled Trial

Background/Objectives: This clinical trial aimed to determine whether perturbation-based gait training (PBGT) on a split-belt treadmill enhances balance and muscle strength in older adults, comparing its effectiveness with walking-only training on a treadmill. Methods: This single-center, prospective, single-blind (assessor), randomized controlled trial included 24 older adults from the Rehabilitation Center of Jeonbuk National University Hospital. Participants were equally divided into the PBGT and control groups. Both groups underwent 12 training sessions, three times a week for 4 weeks, for a total of 43 min per session. The outcomes, including the Five Times Sit-to-Stand Test (FTSST), Falls Efficacy Scale International, timed up-and-go (TUG) test, functional reach test, and lower-extremity manual muscle test scores, were measured at three time points: pre-training, post-training, and four weeks after training. Results: While there were no significant differences between the two groups, the PBGT group demonstrated significant improvements in its FTSST and TUG values. Conclusions: Unpredictable perturbation training on a split-belt treadmill can be safely performed by older adults and may serve as an alternative exercise method to enhance physical performance and balance ability for fall prevention.

Non-Immersive Virtual Reality Exercise Can Increase Exercise in Older Adults Living in the Community and in Long-Term Care: A Randomized Controlled Trial

Purpose

To assess the impact of an 8-week non-immersive virtual reality exercise program for older adults on 1) balance, physical function, community integration and quality of life; 2) falls, emergency room visits, hospital and long-term care admissions; 3) quantity of exercise performed; and 4) acceptance of non-immersive virtual reality.

Patients and Methods

This prospective, assessor-blinded, randomized controlled trial was carried out on two separate samples of older adults: those living in their own homes ("home-based") and those living in long-term care ("facility-based"). Participants were randomized to non-immersive virtual reality or usual activity. Non-immersive virtual reality consisted of 20-30 minutes of customized, gamified exercises for balance, stepping, strengthening, and aerobic conditioning, performed 3-5x/week for 8 weeks. Outcomes were measured before the intervention, immediately after, and 1 month later. Physical testing and questionnaires addressed objective 1). Counts for objectives 2) and 3) were reported by the participants and retrieved from the non-immersive virtual reality platform. Logbooks and a short interview addressed objective 4).

Results

Recruitment was substantially impacted by the COVID-19 pandemic. The facility-based sample had 31 participants; the home-based sample had 16. There were no statistically-significant benefits to non-immersive virtual reality in either sample for objective 1), although the facility-based non-immersive virtual reality group showed a clinically-significant improvement in functional walking. Effect sizes were small (≤ 0.16). No falls occurred during non-immersive virtual reality exercise. The facility-based non-immersive virtual reality group did an average of 14.1 sessions (average 20.1 minutes/session) and the home-based non-immersive virtual reality group did an average of 17.2 sessions (22.6 minutes/session). Participants enjoyed the non-immersive virtual reality, found it challenging and motivating and felt that it improved balance and walking. Most were interested to continue beyond the study.

Conclusion

Non-immersive virtual reality for home-based and facility-based older adults is safe, enjoyable and feasible and may increase users' weekly levels of physical activity leading to clinical benefits for functional walking in facility-based users.

Trial Registration

ClinicalTrials.gov (NCT04083885; registered 2019-09-06).

Exploring the Impact of Adaptive Behaviors on Balance: A Comparative Analysis of Static and Dynamic Balance in Athletes With and Without Intellectual Disabilities

BACKGROUND

Individuals with intellectual disability (ID) shows less development on their motor skills. Understanding the interaction between intellectual and physical performance will provide valuable information for the design of personalized interventions and support programs able to enhance active participation of these individuals.

METHOD

A descriptive-analytical study with 93 participants (59 with ID) was designed to evaluate both static and dynamic balance in athletes. In addition, the relationship between balance and adaptive behaviors was analyzed to determine whether static and dynamic balance is affected to a greater or lesser extent depending on the level of adaptive skills or intellectual capacity.

RESULTS

Significant differences were found in balance's variables between individuals with and without ID. IQ measurements (processing speed) and adaptive behaviors showed a correlation with some balance variables. In athletes with less ID levels, the correlation between balance and adaptive behaviors is more notable.

CONCLUSIONS

There are clear differences in both static and dynamic balance between individuals with and without intellectual disabilities. In addition, the level of adaptive skills and processing speed is related to balance, with those having lower levels of adaptive skills experiencing greater difficulties in maintaining better balance.

Effects of structured positive feedback intervention on standing reach ability among older adults admitted to a convalescent rehabilitation ward: a small-sample pilot randomized controlled trial

PURPOSE

Interventions to improve the standing reach ability of older adults are essential for full functional independence, and structured positive feedback (PF) may be an effective intervention strategy. The purposes of this pilot randomized controlled trial (RCT) are to investigate the preliminary efficacy of structured PF for improving the standing reach ability of older patients admitted to a convalescent rehabilitation ward and evaluate the feasibility of a future full-scale RCT.

METHODS

Thirty-two eligible older adults (83.3 ± 5.9 years, 23 women) out of 587 potential participants were randomly assigned 1:1 to structured PF (experimental) and conventional rehabilitation (control) groups. Only the experimental group received PF intervention for standing reach ability once every 3 days. Both groups engaged in conventional rehabilitation programs for 2-3 h every day. The primary outcome was change in Functional Reach Test (FRT) performance after 5 weeks of the indicated intervention compared to baseline. Secondary outcomes were change in Short Falls Efficacy Scale International (Short FES-I), a self-reported measure of fear of falling, and Functional Independence Measure (FIM) scores after the 5-week intervention.

RESULTS

The estimated difference in mean FRT change (∆) between experimental and control groups was - 4.1 cm (P = 0.07) according to a linear mixed model, supporting the potential efficacy of PF for improving standing reach ability. Further, Hedge's g value was 0.71, consistent with a moderate effect size. However, the estimated mean change in Short FES-I between groups also indicated greater fear of falling in the experimental group (∆ = - 4.5, P = 0.009, g = 1.0). In contrast, the intervention effect on FIM was negligible (∆ = 2.0, P = 0.66, g = - 0.1).

CONCLUSIONS

These results support the preliminary effectiveness of structured PF for improving the standing reach ability of older adults. A larger-sample RCT is warranted for validation and optimization of the structured PF protocol.

TRIAL REGISTRATION

The University Hospital Medical Information Network (UMIN) Registered 31 May 2022 (UMIN000047647).

Battery for fall risk assessment in older adult people-BARQ: analysis of reliability and objectivity

Introduction

This study aims to address significant gaps in fall risk assessment among older adult individuals, using a methodological approach to develop and validate effective instruments.

Objective

To establish the objectivity and reliability of the Battery for Fall Risk Assessment in older adult people - BARQ.

Methodology

This descriptive, cross-sectional, exploratory study started with a preliminary version of BARQ, based on the Comprehensive Falls Risk Screening Instrument-CFRSI. The following variables were included: Fall History and Adverse Events (FH), Medication Use (MU), Home Safety (HS), Balance (Ba), Mobility (Mo), and Visual Acuity (VA). BARQ was administered to 136 older adult participants (X̅ = 70.3 ± 7.20 years) by two assessment teams (∝ and β), at three different times, to examine instrument reliability and objectivity. Statistical analyses included Pearson's correlation, Cronbach's alpha coefficient, Student's t-test, and Hedges' g.

Results

Intra-rater and inter-rater correlations were significant for mobility (r = 0.90 and r = 0.88, respectively; p < 0.01) and visual acuity (r = 0.86 and r = 0.87, respectively; p < 0.01). Cronbach's alpha coefficients indicated nearly perfect reliability for mobility (0.97) and visual acuity (0.96). No statistically significant differences were found in intra-rater assessments (p ranging from 0.11 to 0.55) and inter-rater assessments (p ranging from 0.37 to 0.55). Hedges' g test showed medium effect sizes for the overall fall risk index between S1 and S2 (g = 0.39) and small to medium for other variables.

Reliability, validity, responsiveness and minimal important changes of common clinical standing balance tests in individuals with knee osteoarthritis

INTRODUCTION

Standing balance is essential for physical functioning. Therefore, improving balance control is a key priority in the management of knee osteoarthritis (OA), underscoring the importance of accurately assessing standing balance.

PURPOSE

To assess reliability, construct validity and responsiveness of common clinical balance tests, including Step Test, Single-Leg Stance Test, and Functional Reach Test, in patients with knee OA.

METHODS

In the initial session, 100 participants underwent balance tests and completed Persian-version of Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Timed Up and Go Test (TUG) as comparators for evaluating the construct validity of balance tests. For test-retest reliability, a subset of 70 participants repeated balance tests 1 week after initial assessment. To examine responsiveness, a subset of 90 participants underwent tests and completed WOMAC and TUG at baseline and after completing intervention. At post-intervention assessment, participants also completed global rating of change scale.

RESULTS

Three balance tests showed excellent test-retest reliability (intra-class correlation coefficient >0.75). All balance tests were considered valid and responsive because they confirmed 100% of priori hypotheses. Minimal detectable change (MDC) values were 2.71 steps for Step Test, 7.15 seconds for Single-Leg Stance Test, and 4.90 centimeters for Functional Reach Test. Minimal important change (MIC) values were 4.5 steps for Step Test, 13.10 seconds for Single-Leg Stance Test, and 5.5 centimeters for Functional Reach Test.

CONCLUSION

Three tests are reliable, valid and responsive for measuring balance in patients with knee OA. The MIC values aid clinicians and researchers in assessing the clinical relevance of changes in balance for these patients.

Motor Assessment Timed Test (MATT): A New Timed Test to Assess Functional Mobility in Parkinson's Disease Patients

Background/Objectives: Parkinson's disease (PD) is a neurodegenerative disorder that significantly impairs motor function, leading to mobility challenges and an increased risk of falls. Current assessment tools often inadequately measure the complexities of motor impairments associated with PD, highlighting the need for a reliable tool. This study introduces the Motor Assessment Timed Test (MATT), designed to assess functional mobility in PD patients. Methods: A cross-sectional study was conducted involving 57 participants (38 men and 19 women) aged 44 to 84, diagnosed with idiopathic PD. Participants were recruited from three PD associations and underwent a series of assessments, including MATT, to evaluate gait, balance, and dual-task performance under conditions that reflect real-life challenges faced by individuals with PD. Results: MATT demonstrated excellent reliability with intra-rater reliability (ICC = 0.99), inter-rater reliability (ICC = 0.96-0.99), and test-retest reliability (ICC = 0.93-0.99). The coefficient of variation for total time and each segment ranged from 4.73% to 13.71%, indicating consistent performance across trials. The concurrent validity showed very high correlations with established tools such as the Timed Up and Go (TUG) test (ρ = 0.86, p < 0.001) and the Berg Balance Scale (BBS) (ρ = -0.83, p < 0.001), among others. Only 7.3% of participants reported difficulties in understanding the MATT, predominantly those in advanced stages of the disease. In addition, 23.6% of participants experienced significant challenges in performing the test, particularly individuals with lower Mini-Mental State Examination (MMSE) scores (≤ 26) and more advanced disease progression. Conclusions: MATT is a promising tool for assessing motor complications in PD, offering a comprehensive evaluation of functional mobility. Its implementation in clinical practice could enhance the management of PD, facilitating tailored interventions and improving patient outcomes.

Effects of an exercise program with augmented reality on functional fitness and physical activity of community-dwelling older adults

Background

This study aims to investigate the effects of a multimodal program using augmented reality on the functional fitness and physical activity of older adults living in the community.

Method

Seventy-eight older adults living in the community participated in this study. Participants were divided into three groups: a control group that maintained their usual activities, and two experimental groups, one with multimodal training (EG1) and the other with multimodal training combined with augmented reality (EG2). Participants were assessed at baseline and post-intervention, after 12 weeks. Functional fitness was assessed using the Rikli and Jones Senior Fitness Test, handgrip strength, the functional reach test, and the Fullerton Advanced Balance Scale. Physical activity was measured using accelerometry.

Results

In EG1, lower limb flexibility, agility, cardiorespiratory fitness, and balance improved significantly between baseline and the 12-week outcome (p ≤ 0.001 for all). In EG2, improvements were observed in upper and lower limb strength, lower limb flexibility, agility, cardiorespiratory fitness, handgrip strength, and balance (p < 0.05 for all). Sedentary behavior increased in EG1 after the intervention. The clinical effect sizes of the interventions were large for balance (ES = 1.19) in EG1 and for upper limb strength (ES = 1.24) in EG2, and medium for cardiorespiratory fitness (ES = 0.74), agility (ES = 0.50), and lower limb flexibility (ES = 0.65) in EG1, and lower limb strength (ES = 0.61) and cardiorespiratory fitness (ES = 0.79) in EG2.

Conclusion

Both intervention programs led to improvements in several functional domains. However, the multimodal training combined with augmented reality program showed improvements across more domains, resulting in greater changes. Physical activity did not show significant improvements.

The psychometric properties of the Four Square Step Test in older adults with mild cognitive impairment

PURPOSE

The study aimed to determine the test-retest, interrater, and minimum detectable change, concurrent and known-groups validity in older adults with mild cognitive impairment. Minimal detectable change values are the degree of change needed to exceed a measurement's error within a confidence limit.

METHODS

A total of 46 older adults with mild cognitive impairment and 34 healthy controls were included. The Four Square Step Test was used together with the Timed Up and Go Test, Berg Balance Scale, Functional Reach Test, and One-Leg Stand Test.

RESULTS

The Four Square Step Test revealed high interrater and test-retest reliability (ICC = 0.963-0.986 and 0.937-0.956, respectively). The cut-off times of 15.11 s best distinguished older adults as fallers from non-fallers with mild cognitive impairment.

CONCLUSIONS

The Four Square Step Test is a valid, reliable, applicable, and safe dynamic balance evaluation to identify subtle changes to dynamic balance in mild cognitive impairment patients.

Balance Changes in Adult Cancer Survivors Participating in a 16-Week Therapeutic Yoga Program

INTRODUCTION

Balance problems arising from cancer and its treatments can significantly impact daily functionality and quality of life. Improving balance as part of a cancer treatment plan could result in better patient outcomes. Thus, the aim of this study was to determine whether an integrative therapeutic yoga intervention can improve balance in a heterogenous population of cancer survivors (CS).

METHODS

This is a secondary analysis of data from a 16-week feasibility study where therapeutic yoga was supplemented with psychosocial support to maximize health-related quality of life in adult CS of any stage and site. In this study, we investigated balance, as it has been shown to be an important outcome in CS due to its role in physical function and quality of life. The intervention included therapeutic yoga three times per week for 16 weeks and daily psychosocial support provided via text message. Participants' balance was assessed while standing on a pressure mat with feet together, eyes opened and closed, for 30 seconds in each condition. Data on the "sway path distance" (displacement of the center of gravity) in the two conditions were obtained. Changes in balance after the intervention (from baseline to follow-up) were analyzed using paired-sample t-tests. Changes in balance were also assessed using responder analysis. We described the proportion of participants that improved their balance or not based on 10% difference from baseline scores.

RESULTS

Of the 29 participants included, 22 (76%) completed post-assessments. Changes in both balance assessment conditions were not statistically significant (eyes opened: 80.06 ± 374.99, p = .702; eyes closed: -1.82 ± 24.01, p = .068). Responder analysis showed that 8 participants improved their balance with eyes opened, while 8 worsened, and 6 did not change. Analysis of balance with eyes closed showed that 5 improved, 8 worsened, and 9 did not change.

CONCLUSION

This secondary analysis of data from a heterogenous cohort of adult CS did not support our hypothesis at the group level. However, at the individual level, responder analysis indicated improved balance in some survivors. Future research is needed to determine factors related to the cancer experience which might mediate balance outcomes to inform better integrative interventions.

Validity and reliability of Glittre activities of daily living test in lower-limb prosthetic users

BACKGROUND

Functional capacity assessments have an important role in determining the level of mobility in lower-limb prosthetic users.

OBJECTIVES

Our aim was to investigate the reliability and validity of the Glittre activities of daily living (ADL) test in lower-limb prosthetic users.

STUDY DESIGN

A cross-sectional study.

METHODS

The study included 66 people over the age of 18 years who had used a lower-limb prosthesis for at least 6 months and could walk at least 30 m independently. For construct validity, the correlation of the Glittre ADL test with the 2-min walk test, timed up and go test, and functional reach test was examined, and Bland-Altman agreement analysis was performed. Intra-rater reliability was examined with 2 tests performed by the same physiotherapist on different days, and inter-rater reliability was examined with a test performed by a second physiotherapist on a different day.

RESULTS

The reliability of the Glittre ADL test was found to be excellent for intra-rater (intraclass correlation coefficient = 0.940, 95% confidence interval = 0.903-0.963, standard error of measurement = 26.03, minimal detectable change = 72.31) and good for inter-rater (intraclass correlation coefficient = 0.890, 95% confidence interval = 0.806-0.936, standard error of measurement = 36.80, minimal detectable change = 102.06, p < 0.001). There was a strong negative correlation between Glittre ADL test and 2-min walk test (r = -0.785), a strong positive correlation with timed up and go (r = 0.805), and a weak negative correlation with functional reach test (r = -0.266, p < 0.05). Bland-Altman plots showed 95% agreement for both validity and reliability measurements.

CONCLUSIONS

The Glittre ADL test is a valid and reliable test that can be used in the assessment of functional capacity in lower extremity prosthesis users.

Fall assessment in healthy older adults: Approach using rambling-trembling decomposition method

BACKGROUND

This study explored useful indices of potential fall risk in healthy older adults based on comprehensive clinical and simple quantitative posturographic measurements.

METHODS

A total of 64 community-dwelling older adults aged ≥65 years were classified into fallers and non-fallers based on previous fall history. After excluding two participants due to missing data, 16 and 46 participants were included in the faller and non-faller groups, respectively. We conducted major clinical measurements, including timed up and go test, 10-m walk test, functional reach test, one-leg stand test, isometric muscle strength tests, open-close stepping test, and sit-to-stand test. For quantitative posturographic measurements, participants performed standing tasks with their eyes open and closed. In the standing tasks, the time series of the center of pressure in the anteroposterior and mediolateral directions were measured and decomposed into rambling and trembling components to evaluate postural control in detail, separately. The mean velocity and root mean square of the center of pressure, rambling, and trembling were calculated and compared between fallers and non-fallers.

FINDINGS

A significant fall-related difference was found only in the mean velocity of the rambling in the anteroposterior direction; fallers displayed greater values than non-fallers, especially while standing with their eyes closed.

INTERPRETATION

The clinical measures failed to distinguish differences in fall risk, whereas the rambling component in the anteroposterior direction could detect substantial differences. The mean velocity of the rambling component could be useful as a sensitive screening biomarker for potential fall risks in healthy older adults.

Examining the association between balance self-efficacy and virtual balance performance in individuals with stroke: a cross-sectional study

BACKGROUND

Balance self-efficacy is a strong predictor of fall risk after stroke and is related to performance on balance and walking tests. The use of telerehabilitation for delivering stroke rehabilitation has increased in recent years and there is a need to adapt common clinical assessments to be administered in virtual formats, but the association between balance self-efficacy and virtually administered clinical tests of balance performance has yet to be established. This study examined the association between the Activities-specific Balance Confidence (ABC) Scale and virtually administered Timed Up and Go (TUG), Tandem Stand, and Functional Reach tests (FRT) in individuals with stroke.

METHODS

This was a secondary analysis of baseline data from two telerehabilitation trials with individuals with stroke. All assessments were administered by trained physical therapists through videoconferencing software. Multivariate regression analyses were used to examine the associations between the ABC scale and TUG test, Tandem Stand test, and FRT, adjusted for age and number of comorbidities.

RESULTS

Data from 51 participants (n = 11 female, median age = 64 [IQR: 18] years, 9.3 ± 4.6 months poststroke) were analyzed. The ABC scores were associated with TUG (R2 = 0.56, F(3,47) = 20.26, p < 0.01), but not Tandem Stand (R2 = 0.18, F(5,45) = 1.93, p = 0.11) or FRT (R2 = 0.14, F(3,47) = 2.55, p = 0.07) tests.

CONCLUSION

We observed associations between the ABC scores and virtual TUG, but not with Tandem Stand or FRT, which may be attributed to the context-specificity of balance self-efficacy. As virtual administration of outcomes assessments becomes part of common practice in stroke rehabilitation, our study supports the use of virtually administered TUG in stroke.

Differentiation in theta and gamma activation in weight-shifting learning between people with parkinson's disease of different anxiety severities

Anxiety and postural control deficits may be related in people with Parkinson's disease (PwPD). However, the association between anxiety levels and weight-shifting control remains ambiguous. This study investigated whether 1) weight-shifting control differed between PwPD with and without anxiety, and 2) the learning effect of weight-shifting differed between the two populations. Additionally, we evaluated cortical activities to investigate neural mechanisms underlying weight-shifting control. Twenty-eight PwPD (14 anxiety, 14 nonanxiety) participated in a 5-day weight-shifting study by coupling the bearing weight of their more-affected leg to a sinusoidal target at 0.25 Hz. We tested the weight-shifting control on day 1 (pretest), day 3 (posttest), and day 5 (retention test) with a learning session on day 3. The error and jerk of weight-shifting trajectory and the theta and gamma powers of electroencephalography in prefrontal, frontal, sensorimotor and parietal-occipital areas were measured. At the pretest, the anxiety group showed larger error and smaller jerk of weight-shifting with greater prefrontal theta, frontal gamma, and sensorimotor gamma powers than the nonanxiety group. Anxiety intensity was correlated positively with weight-shifting error and theta power but negatively with weight-shifting jerk. Reduced weight-shifting error with increased theta power after weight-shifting learning was observed in the nonanxiety group. However, the anxiety group showed decreased gamma power after weight-shifting learning without behavior change. Our findings suggest differential weight-shifting control and associated cortical activation between PwPD with and without anxiety. In addition, anxiety would deteriorate weight-shifting control and hinder weight-shifting learning benefits in PwPD, leading to less weight-shifting accuracy and correction.

Increased stride time variability is associated with a higher risk of falls in patients with ataxia after stroke

INTRODUCTION

Patients presenting with ataxia are at high risk of falling, however, there are limited studies evaluating fall factors restricted to patients presenting with ataxia due to stroke.

PURPOSE

This study aimed to examine the characteristics of patients with ataxia after stroke based on their motor function to identify variables associated with fall occurrence.

METHODS

We divided 33 participants who presented with ataxia after stroke into fall and non-fall groups. Data on motor function, cognitive function, and daily functionality were extracted from their admission records. Walking ability was measured as comfortable walking speed and Stride Time Variability (STV). Independent sample t-tests, Mann - Whitney U tests, and multiple logistic regression analysis were performed.

RESULTS

There were significant differences between fallers and non-fallers in the STV (p < .001), Mini-Balance Evaluations Systems Test score (p < .014) and Scale for Assessment and Rating of Ataxia score assessment (p < .028). In the multiple logistic regression analysis, only STV was associated with an increased risk of falls (p < .02). The area under the receiver operating characteristic curve was 0.839; the cutoff value of gait cycle variability for falls was 6.345% (sensitivity, 80.0%; specificity, 74.0%).

CONCLUSION

Increased stride time variability is a useful indicator that sensitively captures fall risk in patients with ataxia after stroke.

Effectiveness of a web-based foot-ankle exercise program for treating ulcer risk factors in diabetic neuropathy in a randomized controlled trial

The need for strategies to prevent complications from diabetic neuropathy (DPN) is well recognized. However, foot-ankle exercise programs show weak to moderate evidence, and barriers to their implementation persist, including broad and facilitated access to exercise programs, which guarantee for equity. In this paper, we report for the first time the effectiveness of a web-based foot-ankle exercise program aiming to improve DPN-related outcomes, gait biomechanics and functional outcomes. Sixty-two participants with DPN were randomly allocated into the control group (CG; n = 31), which received the usual care, or the intervention group (IG; n = 31), which received the usual care plus a 12-week foot-ankle exercise program using a web-based software (the SOPeD software). The primary outcomes, DPN symptoms and severity, were assessed using the Brazilian version of the Michigan Neuropathy Screening Instrument and the Decision Support System for Classification of Diabetic Polyneuropathy, respectively. Secondary outcomes included tactile sensitivity (monofilaments) and vibration perception (tuning fork), functional outcomes, such as foot pain and function (Foot Health Status Questionnaire), foot muscle strength and plantar pressure during gait (emed plate), and foot-ankle kinematics and kinetics during gait. Outcomes were assessed at baseline, 12 and 24 weeks by an assessor blinded to group allocation. DPN symptoms and severity remained unchanged after the web-based foot-ankle program. However, IG showed improvements compared to CG, with greater functional reach at 12 weeks, better foot function, reduced foot pain and greater plantarflexion degree during push-off at 24 weeks. Regarding plantar loading during gait, the forefoot pressure reduced in the IG at 12 weeks compared to baseline, but at 24 weeks, forefoot load increased in the IG compared to CG. The 12-week web-based foot-ankle exercise program was feasible, acceptable, demonstrating safety with minimal adverse events, such as delayed onset muscle soreness and foot muscle cramping. While DPN-related outcomes were unaffected by the 12-week SOPeD program, modest improvements in foot pain and function, functional reach, and changes in plantar pressure and plantarflexion degree during gait were noted, mostly at 24 weeks.Trial registration: ClinicalTrials.gov, NCT04011267. Registered on 8 July 2019.

Age-Related Influence on Static and Dynamic Balance Abilities: An Inertial Measurement Unit-Based Evaluation

Balance control, a complex sensorimotor skill, declines with age. Assessing balance is crucial for identifying fall risk and implementing interventions in the older population. This study aimed to measure age-dependent changes in static and dynamic balance using inertial measurement units in a clinical setting. This study included 82 healthy participants aged 20-85 years. For the dynamic balance test, participants stood on a horizontally swaying balance board. For the static balance test, they stood on one leg. Inertial measurement units attached to their bodies recorded kinematic data, with average absolute angular velocities assessing balance capabilities. In the dynamic test, the younger participants had smaller average absolute angular velocities in most body parts than those of the middle-aged and older groups, with no significant differences between the middle-aged and older groups. Conversely, in the single-leg stance tests, the young and middle-aged groups outperformed the older group, with no significant differences between the young and middle-aged groups. Thus, dynamic and static balance decline at different stages with age. These results highlight the complementary role of inertial measurement unit-based evaluation in understanding the effect of age on postural control mechanisms, offering valuable insights for tailoring rehabilitation protocols in clinical settings.

The effect of advanced age and stool modification on reaching distance in sitting

[Purpose] Reaching is an important functional ability. We investigated the effect of advanced age and stool modification on sitting reach distance. [Participants and Methods] Twenty-four participants (twelve older adults 70 ± 4 years and twelve young adults 29 ± 4 years) reached forward and laterally while sitting on an adjustable stool with 0°, 10° forward, 10° backward, 10° right or 10° left inclination of the seat, with and without footrest and front, back or side leg support. [Results] The outcome of this exploratory study revealed that young adults reached farther than older adults across all the directions of reach and seat conditions. While the inclined seat was utilized, both young and older adults reached farthest in the forward direction. Additional leg supports allowed to reach further; however, older adults were not able to reach in the forward direction as far as young adults. When reaching in the lateral direction, leg support had minimal effect on the reach distance. [Conclusion] Age affects the sitting functional reach ability. Future research should focus on investigating the efficiency of interventions to enhance performance of functional tasks in sitting older adults.

Posture, balance and gait in axial spondyloarthritis: a case-control study

Axial spondyloarthritis (axSpA) is a chronic inflammatory disease that primarily involves the axial skeleton but may also present with peripheral joint involvement and extra-articular involvement. The present study aims to quantitatively analyze posture, balance, and gait parameters in patients with axSpA and and assess associated factors. This cross-sectional case-control study included 51 axSpA patients (30 males, 21 females; mean age 40.94 ± 10.48 years) and 51 age- and sex-matched healthy controls. In patients with axSpA, the Ankylosing Spondylitis Disease Activity Score CRP, the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Bath Ankylosing Spondylitis Functional Index (BASFI), the Bath Ankylosing Spondylitis Metrology Index (BASMI), the Maastrich Ankylosing Spondylitis Enthesitis Score (MASES), and the Ankylosing Spondylitis Quality of Life (ASQoL) scale were used. For postural analysis, DIERS formetric (Diers GmbH, Schlangenbad, Germany) videoraster- stereography device was utilized. HUR SmartBalance BTG4 (HUR-labs Oy, Kokkola, Finland) balance platform was used for postural balance and limit of stability (LOS) measurement. Participants were evaluated using Berg Balance Scale (BBS), Functional Reach Test (FRT) and Timed Up and Go Test (TUG). The Zebris FDM type 3 (Zebris Medical GmbH, Germany) walking platform was used to measure the spatiotemporal parameters of the participants. Comparison of postural parameters showed that sagittal imbalance and cervical depth distance were increased in the axSpA group than in the healthy participants (p < 0.004). Comparison of functional balance parameters showed that BBS and FRT scores were significantly lower (p < 0.001) in the axSpA group than in the control group, while TUG scores were significantly higher (p < 0.001). The LOS values, which evaluate dynamic balance were significantly lower, indicating impairment, in the axSpA group. In the measurement of postural sway, which indicates static balance, all 23 subparameters were found to be similar. When analyzing the spatiotemporal gait parameters, in the axSpA group compared with those in the control group; Foot angles (p= 0.028) and stride width (p = 0.004) were increased, whereas step lengths (p = 0.004) and stride lengths (P = 0.004) were decreased. In the axSpA group the gait speed was decreased (p = 0.004). When axSpA was analyzed separately as radiographic and nonradiographic axSpA, similar findings were observed in posture, balance, and gait parameters. No significant difference was observed. We found that the clinical assessments most closely associated with posture, balance, and gait analyses were BBS, FRT, TUG, and BASFI.

Caffeine optimizes Zumba training benefits on functional performances in middle-aged women: a randomized trial study

The current study aimed to explore the effect of daily caffeine supplementation (100 mg/day) and 12-week of Zumba training on functional performances in middle-aged women. Eighty-five middle-aged women were randomized into 4 groups including control, Zumba training (ZT), caffeine supplementation (Ca) or caffeine-Zumba training (Ca + ZT) groups. Functional performances were assessed using 10 m Walk, Timed Up and Go, Functional Reach, and 30-Second Chair Stand tests. As results, ZT, Ca and Ca + ZT intervention programs showed a significant (p < 0.05) functional performances improvement. However, Ca + ZT group showed significant (p < 0.001) better scores in terms of mobility (95%CI [0.71, 1.43]), gait speed (95%CI [0.52, 1.71]) and lower body endurance strength (95%CI [-6.93, -1.92]), except for dynamic balance (95%CI [-9.41, -3.44]). In conclusion, 12-week of Zumba training improves functional performances in middle-aged women, and daily caffeine intake is an effective alternative for improving such performances. Supplementing caffeine (100 mg/day) to Zumba training was effective in boosting Zumba benefits on these functional performances.

Relationship of Pain, Depression, Fatigue, and Sleep Problems with Functional Capacity, Balance, and Fear of Falling in Women with Fibromyalgia: Cross-Sectional Study

(1) Background: Fibromyalgia (FM) is a syndrome marked by chronic widespread pain, fatigue, sleep issues, and other symptoms. Interventions like physical exercise can potentially enhance physical function in individuals with FM. This study aimed to assess physical function, perceived physical fitness, balance confidence, and fear of falling in women with FM based on their levels of pain, depression, fatigue, and sleep problems. (2) Methods: Participants underwent a series of tests and questionnaires to evaluate physical and perceptual aspects. These included the Time Up and Go, Four Step Square Test, 6-Minute Walking Test, Maximum Handgrip Strength, Back Scratch, International Fitness Scale, Activities-Specific Balance Confidence Scale, and Fall Efficacy Scale-International. Participants were categorised by the severity of their pain, depression, fatigue, and sleep problems (mild, moderate, severe). A Kruskal-Wallis test assessed intergroup differences, while Spearman's rho evaluated correlations between the study variables and symptom levels. (3) Results: Perceived physical condition varied significantly with symptom severity. Symptoms and sleep problems were notably linked to fear of falling, though no significant differences emerged in the physical tests. (4) Conclusions: In women with fibromyalgia, symptom severity was primarily related to perceptual and subjective aspects of physical condition and fall safety.

Immediate effect of hip exercises-inducing motor unit recruitment on static and dynamic postural balance in patients with piriformis muscle syndrome

INTRODUCTION

A single session of exercises-inducing motor unit recruitment has been reported to immediately improve static and dynamic postural balance in different populations. It remains unclear whether such an effect occurs in patients with piriformis muscle syndrome (PMS). Thus, this study aimed to explore the immediate effect of hip exercises-inducing motor unit recruitment on postural balance in these patients.

METHODS

In this pre-post-repeated measure study design, twelve patients with PMS were enrolled. These patients participated in a single session of hip exercises-inducing motor unit recruitment, consisting of two exercises, bilateral bridging to target hip extensors and side lying clams to target hip abductors and external rotators. Static (stabilometric platform) and dynamic (timed up and go test (TUGT) and Functional reach test (FRT)) postural balance, and pain were evaluated before and immediately after the intervention protocol.

RESULTS

Patients with PMS had significant (p < 0.001) lower centre of pressure velocity and symmetry index values during the unipedal posture (eyes closed) in post-compared to pre-session. However, no significant effects of hip exercises-inducing motor unit recruitment were found on static bipedal and dynamic postural balance or pain in these patients.

CONCLUSION

A single session of hip exercises-inducing motor unit recruitment immediately improved static postural balance (unipedal posture with eyes closed) in patients with PMS. Given that this protocol is simple and easy to implement, it is recommended that patients with PMS consider incorporating these exercises into their daily physical activity.