1
|
Abdollahi M, Kuber PM, Rashedi E. Dual Tasking Affects the Outcomes of Instrumented Timed up and Go, Sit-to-Stand, Balance, and 10-Meter Walk Tests in Stroke Survivors. SENSORS (BASEL, SWITZERLAND) 2024; 24:2996. [PMID: 38793850 PMCID: PMC11125653 DOI: 10.3390/s24102996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/29/2024] [Accepted: 05/07/2024] [Indexed: 05/26/2024]
Abstract
Stroke can impair mobility, with deficits more pronounced while simultaneously performing multiple activities. In this study, common clinical tests were instrumented with wearable motion sensors to study motor-cognitive interference effects in stroke survivors (SS). A total of 21 SS and 20 healthy controls performed the Timed Up and Go (TUG), Sit-to-Stand (STS), balance, and 10-Meter Walk (10MWT) tests under single and dual-task (counting backward) conditions. Calculated measures included total time and gait measures for TUG, STS, and 10MWT. Balance tests for both open and closed eyes conditions were assessed using sway, measured using the linear acceleration of the thorax, pelvis, and thighs. SS exhibited poorer performance with slower TUG (16.15 s vs. 13.34 s, single-task p < 0.001), greater sway in the eyes open balance test (0.1 m/s2 vs. 0.08 m/s2, p = 0.035), and slower 10MWT (12.94 s vs. 10.98 s p = 0.01) compared to the controls. Dual tasking increased the TUG time (~14%, p < 0.001), balance thorax sway (~64%, p < 0.001), and 10MWT time (~17%, p < 0.001) in the SS group. Interaction effects were minimal, suggesting similar dual-task costs. The findings demonstrate exaggerated mobility deficits in SS during dual-task clinical testing. Dual-task assessments may be more effective in revealing impairments. Integrating cognitive challenges into evaluation can optimize the identification of fall risks and personalize interventions targeting identified cognitive-motor limitations post stroke.
Collapse
Affiliation(s)
| | | | - Ehsan Rashedi
- Industrial and Systems Engineering Department, Rochester Institute of Technology, Rochester, NY 14623, USA; (M.A.); (P.M.K.)
| |
Collapse
|
2
|
Abdollahi M, Rashedi E, Kuber PM, Jahangiri S, Kazempour B, Dombovy M, Azadeh-Fard N. Post-Stroke Functional Changes: In-Depth Analysis of Clinical Tests and Motor-Cognitive Dual-Tasking Using Wearable Sensors. Bioengineering (Basel) 2024; 11:349. [PMID: 38671771 PMCID: PMC11048064 DOI: 10.3390/bioengineering11040349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 03/26/2024] [Accepted: 03/28/2024] [Indexed: 04/28/2024] Open
Abstract
Clinical tests like Timed Up and Go (TUG) facilitate the assessment of post-stroke mobility, but they lack detailed measures. In this study, 21 stroke survivors and 20 control participants underwent TUG, sit-to-stand (STS), and the 10 Meter Walk Test (10MWT). Tests incorporated single tasks (STs) and motor-cognitive dual-task (DTs) involving reverse counting from 200 in decrements of 10. Eight wearable motion sensors were placed on feet, shanks, thighs, sacrum, and sternum to record kinematic data. These data were analyzed to investigate the effects of stroke and DT conditions on the extracted features across segmented portions of the tests. The findings showed that stroke survivors (SS) took 23% longer for total TUG (p < 0.001), with 31% longer turn time (p = 0.035). TUG time increased by 20% (p < 0.001) from STs to DTs. In DTs, turning time increased by 31% (p = 0.005). Specifically, SS showed 20% lower trunk angular velocity in sit-to-stand (p = 0.003), 21% longer 10-Meter Walk time (p = 0.010), and 18% slower gait speed (p = 0.012). As expected, turning was especially challenging and worsened with divided attention. The outcomes of our study demonstrate the benefits of instrumented clinical tests and DTs in effectively identifying motor deficits post-stroke across sitting, standing, walking, and turning activities, thereby indicating that quantitative motion analysis can optimize rehabilitation procedures.
Collapse
Affiliation(s)
- Masoud Abdollahi
- Department of Industrial and Systems Engineering, Rochester Institute of Technology, Rochester, NY 14623, USA; (M.A.); (P.M.K.); (S.J.); (B.K.); (N.A.-F.)
| | - Ehsan Rashedi
- Department of Industrial and Systems Engineering, Rochester Institute of Technology, Rochester, NY 14623, USA; (M.A.); (P.M.K.); (S.J.); (B.K.); (N.A.-F.)
| | - Pranav Madhav Kuber
- Department of Industrial and Systems Engineering, Rochester Institute of Technology, Rochester, NY 14623, USA; (M.A.); (P.M.K.); (S.J.); (B.K.); (N.A.-F.)
| | - Sonia Jahangiri
- Department of Industrial and Systems Engineering, Rochester Institute of Technology, Rochester, NY 14623, USA; (M.A.); (P.M.K.); (S.J.); (B.K.); (N.A.-F.)
| | - Behnam Kazempour
- Department of Industrial and Systems Engineering, Rochester Institute of Technology, Rochester, NY 14623, USA; (M.A.); (P.M.K.); (S.J.); (B.K.); (N.A.-F.)
| | - Mary Dombovy
- Department of Rehabilitation and Neurology, Unity Hospital, Rochester, NY 14626, USA;
| | - Nasibeh Azadeh-Fard
- Department of Industrial and Systems Engineering, Rochester Institute of Technology, Rochester, NY 14623, USA; (M.A.); (P.M.K.); (S.J.); (B.K.); (N.A.-F.)
| |
Collapse
|
3
|
Monaghan PG, Murrah WM, Walker HC, Neely KA, Roper JA. Evaluating Postural Transition Movement Performance in Individuals with Essential Tremor via the Instrumented Timed Up and Go. SENSORS (BASEL, SWITZERLAND) 2024; 24:2216. [PMID: 38610427 PMCID: PMC11014324 DOI: 10.3390/s24072216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024]
Abstract
Flexibility in performing various movements like standing, walking, and turning is crucial for navigating dynamic environments in daily life. Individuals with essential tremor often experience movement difficulties that can affect these postural transitions, limiting mobility and independence. Yet, little research has examined the performance of postural transitions in people with essential tremor. Therefore, we assessed postural transition performance using two versions of the timed up and go test: the standard version and a more complex water-carry version. We examined the total duration of the standard and water-carry timed up and go in 15 people with and 15 people without essential tremor. We also compared the time taken for each phase (sit-to-stand phase, straight-line walk phase, stand-to-sit phase) and the turning velocity between groups. Our findings revealed decreased performance across all phases of standard and water-carry timed up and go assessments. Further, both ET and non-ET groups exhibited reduced performance during the water-carry timed up and go compared to the standard timed up and go. Evaluating specific phases of the timed up and go offers valuable insights into functional movement performance in essential tremor, permitting more tailored therapeutic interventions to improve functional performance during activities of daily living.
Collapse
Affiliation(s)
- Patrick G. Monaghan
- School of Kinesiology, Auburn University, Auburn, AL 36849, USA; (P.G.M.); (K.A.N.)
| | - William M. Murrah
- Department of Educational Foundations, Leadership, and Technology, Auburn University, Auburn, AL 36849, USA;
| | - Harrison C. Walker
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL 35249, USA
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL 35249, USA
- Department of Biomedical Engineering, University of Alabama at Birmingham, Birmingham, AL 35249, USA
| | - Kristina A. Neely
- School of Kinesiology, Auburn University, Auburn, AL 36849, USA; (P.G.M.); (K.A.N.)
| | - Jaimie A. Roper
- School of Kinesiology, Auburn University, Auburn, AL 36849, USA; (P.G.M.); (K.A.N.)
| |
Collapse
|
4
|
Palmer JA, Payne AM, Mirdamadi JL, Ting LH, Borich MR. Delayed cortical engagement associated with balance dysfunction after stroke. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.11.28.23299035. [PMID: 38076827 PMCID: PMC10705625 DOI: 10.1101/2023.11.28.23299035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
Cortical resources are typically engaged for balance and mobility in older adults, but these resources are impaired post-stroke. Although slowed balance and mobility after stroke have been well-characterized, the effects of unilateral cortical lesions due to stroke on neuromechanical control of balance is poorly understood. Our central hypothesis is that stroke impairs the ability to rapidly and effectively engage the cerebral cortex during balance and mobility behaviors, resulting in asymmetrical contributions of each limb to balance control. Using electroencephalography (EEG), we assessed cortical N1 responses evoked over fronto-midline regions (Cz) during balance recovery in response to backward support-surface perturbations loading both legs, as well as posterior-lateral directions that preferentially load the paretic or nonparetic leg. Cortical N1 responses were smaller and delayed in the stroke group. While older adults exhibited weak or absent relationships between cortical responses and clinical function, stroke survivors exhibited strong associations between slower N1 latencies and slower walking, lower clinical mobility, and lower balance function. We further assessed kinetics of balance recovery during perturbations using center of pressure rate of rise. During backward support-surface perturbations that loaded the legs bilaterally, balance recovery kinetics were not different between stroke and control groups and were not associated with cortical response latency. However, lateralized perturbations revealed slower kinetic reactions during paretic loading compared to controls, and to non-paretic loading within stroke participants. Individuals post stroke had similar nonparetic-loaded kinetic reactions to controls implicating that they effectively compensate for impaired paretic leg kinetics when relying on the non-paretic leg. In contrast, paretic-loaded balance recovery revealed time-synchronized associations between slower cortical responses and slower kinetic reactions only in the stroke group, potentially reflecting the limits of cortical engagement for balance recovery revealed within the behavioral context of paretic motor capacity. Overall, our results implicate individuals after stroke may be uniquely limited in their balance ability by the slowed speed of their cortical engagement, particularly under challenging balance conditions that rely on the paretic leg. We expect this neuromechanical insight will enable progress toward an individualized framework for the assessment and treatment of balance impairments based on the interaction between neuropathology and behavioral context.
Collapse
Affiliation(s)
- Jacqueline A Palmer
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University, 1441 Clifton Road NE, Atlanta, GA 30322 USA
| | - Aiden M Payne
- Department of Psychology, College of Arts and Sciences, Florida State University, Tallahassee, FL, USA
| | - Jasmine L Mirdamadi
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University, 1441 Clifton Road NE, Atlanta, GA 30322 USA
| | - Lena H Ting
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University, 1441 Clifton Road NE, Atlanta, GA 30322 USA
- Department of Biomedical Engineering, Emory and Georgia Tech, 1760 Haygood Road, Atlanta, GA, 30322, USA
| | - Michael R Borich
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University, 1441 Clifton Road NE, Atlanta, GA 30322 USA
| |
Collapse
|
5
|
Mori L, Collino F, Marzi A, Pellegrino L, Ponzano M, Chiaro DD, Maestrini S, Caneva S, Pardini M, Fiaschi P, Zona G, Trompetto C. Useful outcome measures in INPH patients evaluation. Front Neurol 2023; 14:1201932. [PMID: 37609661 PMCID: PMC10441237 DOI: 10.3389/fneur.2023.1201932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 07/11/2023] [Indexed: 08/24/2023] Open
Abstract
Introduction Idiopathic normal pressure hydrocephalus (INPH) is a neurological disorder that is potentially reversible and clinically characterized by a specific triad of symptoms, including gait disturbance, cognitive disorders, and urinary incontinence. In INPH assessment, the most commonly used test is the Timed Up and Go test (TUG), but a more comprehensive assessment would be necessary. The first aim of the present study is to verify the sensitivity of a protocol with both clinical and instrumental outcome measures for gait and balance in recognizing INPH patients. The second aim is to verify the most important spatio-temporal parameters in INPH assessment and their possible correlations with clinical outcome measures. Methods Between January 2019 and June 2022, we evaluated 70 INPH subjects. We assessed balance performances with the Berg Balance Scale (BBS), Short Physical Performance Battery (SPPB), and TUG, both single (ST) and dual task (DT). We also performed an instrumental gait assessment with the GAITRite electronic walkway system, asking the patients to walk on the carpet for one minute at normal speed, fast speed, and while performing a dual task. We compared the results with those of 20 age-matched healthy subjects (HS). Results INPH patients obtained statistically significant lower scores at the BBS, SPPB, and TUG DT but not at the TUG ST, likely because the DT involves cognitive factors altered in these subjects. Concerning instrumental gait evaluation, we found significant differences between HS and INPH patients in almost all spatio-temporal parameters except cadence, which is considered a relevant factor in INPH guidelines. We also found significant correlations between balance outcome measures and gait parameters. Discussion Our results confirm the usefulness of BBS and suggest improving the assessment with SPPB. Although the TUG ST is the most commonly used test in the literature to evaluate INPH performances, it does not identify INPH; the TUG DT, instead, might be more useful. The GAITRite system is recognized as a quick and reliable tool to assess walking abilities and spatio-temporal parameters in INPH patients, and the most useful parameters are stride length, stride width, speed, and the percentage of double support. Both clinical and instrumental evaluation may be useful in recognizing subjects at risk for falls.
Collapse
Affiliation(s)
- Laura Mori
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Federica Collino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Annalisa Marzi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Lucia Pellegrino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Marta Ponzano
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Davide Del Chiaro
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Sara Maestrini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Stefano Caneva
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Matteo Pardini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Pietro Fiaschi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Gianluigi Zona
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Carlo Trompetto
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| |
Collapse
|
6
|
Weng SC, Lin CF, Hsu CY, Lin SY. Effect of frailty, physical performance, and chronic kidney disease on mortality in older patients with diabetes : a retrospective longitudinal cohort study. Diabetol Metab Syndr 2023; 15:7. [PMID: 36650566 PMCID: PMC9843852 DOI: 10.1186/s13098-022-00972-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 12/24/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Declined renal function is associated with physical function impairment and frailty in a graded fashion. This study aimed to examine the relationship between renal function, frailty and physical performance with mortality in older patients with diabetes, while also determining their combined effects on patient outcome. METHODS A retrospective longitudinal study was conducted in elderly patients with diabetes. Kidney disease staging was based on clinical practice guidelines of the International Society of Nephrology, and chronic kiney disease (CKD) was defined as urinary albumin to creatinine ratio (UACR) > 30 mg/g, persistent reduction in estimated glomerular filtration rate (eGFR) below 60 mL/min per 1.73 m2 or both. The modified Rockwood frailty index (RFI) was composed of cumulative health deficits, and physical function was determined by handgrip strength (HGS). Additionally, a timed up and go (TUG) test was assessed at baseline. Kaplan-Meier survival and Cox proportional hazard analyses were used to analyze the association between CKD, frailty, physical function and mortality. RESULTS For the 921 enrolled patients, their mean age was 82.0 ± 6.7 years. After a median 2.92 (interquartile range [IQR] 1.06-4.43) year follow-up, the survival rate was 67.6% and 85.5% in patients with and without CKD, respectively. The mortality hazard ratio (crude HR) with CKD was 5.92 for those with an RFI higher than 0.313 (95% CI 3.44-10.18), 2.50 for a TUG time longer than 21 s (95% CI 1.22-5.13), and 2.67 for an HGS lower than 10.57 kg in females or 20.4 kg in males (95% CI 1.12-6.37). After multivariate adjustment, the mortality hazard ratio for an RFI ≥ 0.313 was 5.34 (95% CI 2.23-12.80) in CKD patients, but not in patients without CKD. In subgroup analysis, patients experiencing CKD and frailty, or physical function impairment, had the lowest survival proportion followed by only frailty/declined physical function, only CKD, without CKD, and non-frailty/non-physical impairment. CONCLUSION CKD, frailty and physical function impairment were all associated with an increased mortality risk in older patients with diabetes, while the combined effects of these 3 factors were seen on patient outcome.
Collapse
Affiliation(s)
- Shuo-Chun Weng
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Research Center for Geriatrics and Gerontology, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Center for Geriatrics and Gerontology, Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Institute of Clinical Medicine, School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Cheng-Fu Lin
- Research Center for Geriatrics and Gerontology, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Center for Geriatrics and Gerontology, Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Institute of Clinical Medicine, School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Occupational Medicine, Department of Emergency, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chiann-Yi Hsu
- Biostatistics Task Force of Taichung Veterans General Hospital, Taichung, Taiwan
| | - Shih-Yi Lin
- Research Center for Geriatrics and Gerontology, College of Medicine, National Chung Hsing University, Taichung, Taiwan.
- Institute of Clinical Medicine, School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
- Center for Geriatrics and Gerontology, Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
| |
Collapse
|
7
|
Saraiva M, Vilas-Boas JP, Fernandes OJ, Castro MA. Effects of Motor Task Difficulty on Postural Control Complexity during Dual Tasks in Young Adults: A Nonlinear Approach. SENSORS (BASEL, SWITZERLAND) 2023; 23:628. [PMID: 36679423 PMCID: PMC9866022 DOI: 10.3390/s23020628] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/11/2022] [Accepted: 12/21/2022] [Indexed: 06/17/2023]
Abstract
Few studies have evaluated the effect of a secondary motor task on the standing posture based on nonlinear analysis. However, it is helpful to extract information related to the complexity, stability, and adaptability to the environment of the human postural system. This study aimed to analyze the effect of two motor tasks with different difficulty levels in motor performance complexity on the static standing posture in healthy young adults. Thirty-five healthy participants (23.08 ± 3.92 years) performed a postural single task (ST: keep a quiet standing posture) and two motor dual tasks (DT). i.e., mot-DT(A)—perform the ST while performing simultaneously an easy motor task (taking a smartphone out of a bag, bringing it to the ear, and putting it back in the bag)—and mot-DT(T)—perform the ST while performing a concurrent difficult motor task (typing on the smartphone keyboard). The approximate entropy (ApEn), Lyapunov exponent (LyE), correlation dimension (CoDim), and fractal dimension (detrending fluctuation analysis, DFA) for the mediolateral (ML) and anterior-posterior (AP) center-of-pressure (CoP) displacement were measured with a force plate while performing the tasks. A significant difference was found between the two motor dual tasks in ApEn, DFA, and CoDim-AP (p < 0.05). For the ML CoP direction, all nonlinear variables in the study were significantly different (p < 0.05) between ST and mot-DT(T), showing impairment in postural control during mot-DT(T) compared to ST. Differences were found across ST and mot-DT(A) in ApEn-AP and DFA (p < 0.05). The mot-DT(T) was associated with less effectiveness in postural control, a lower number of degrees of freedom, less complexity and adaptability of the dynamic system than the postural single task and the mot-DT(A).
Collapse
Affiliation(s)
- Marina Saraiva
- RoboCorp Laboratory, i2A, Polytechnic Institute of Coimbra, 3046-854 Coimbra, Portugal
- Faculty of Sports, University of Porto, 4200-450 Porto, Portugal
| | - João Paulo Vilas-Boas
- Faculty of Sports, University of Porto, 4200-450 Porto, Portugal
- LABIOMEP-UP, Faculty of Sports and CIFI2D, University of Porto, 4200-450 Porto, Portugal
| | - Orlando J. Fernandes
- Sport and Health Department, School of Health and Human Development, University of Évora, 7000-671 Évora, Portugal
- Comprehensive Health Research Center (CHRC), University of Évora, 7000-671 Évora, Portugal
| | - Maria António Castro
- RoboCorp Laboratory, i2A, Polytechnic Institute of Coimbra, 3046-854 Coimbra, Portugal
- Department of Mechanical Engineering, University of Coimbra, CEMMPRE, 3030-788 Coimbra, Portugal
- Sector of Physiotherapy, School of Health Sciences, Polytechnic Institute of Leiria, 2411-901 Leiria, Portugal
| |
Collapse
|
8
|
Albarrati AM, Gale NS, Munnery MM, Reid N, Cockcroft JR, Shale DJ. The Timed Up and Go test predicts frailty in patients with COPD. NPJ Prim Care Respir Med 2022; 32:24. [PMID: 35794130 PMCID: PMC9259691 DOI: 10.1038/s41533-022-00287-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 05/24/2022] [Indexed: 11/16/2022] Open
Abstract
The Timed Up and Go (TUG) is a global measure of mobility and has the ability to detect frail individuals. Frail patients with chronic obstructive pulmonary disease (COPD) are usually undiagnosed. We hypothesised that the TUG would identify frail patients with COPD. Frailty was assessed in 520 patients diagnosed with COPD and 150 controls using a Comprehensive Geriatric Assessment questionnaire and frailty index (FI) was derived. The TUG was used to assess physical mobility. All participants were assessed for lung function and body composition. A ROC curve was used to identify how well TUG discriminates between frail and non-frail patients with COPD. The patients with COPD and controls were similar in age, sex and BMI but the patients with COPD were more frail, mean ± SD FI 0.16 ± 0.08 than controls 0.05 ± 0.03, P < 0.001. Frail patients with COPD had a greater TUG time (11.55 ± 4.03 s) compared to non-frail patients (9.2 ± 1.6 sec), after controlling for age and lung function (F = 15.94, P < 0.001), and both were greater than the controls (8.3 ± 1.2 sec), P < 0.001. The TUG discriminated between frail and non-frail patients with COPD with an area under the curve of 72 (95% CI: 67–76), and a diagnostic odds ratio of 2.67 (95% CI:1.5–4.6), P < 0.001. The TUG showed the ability to discriminate between frail and non-frail patients with COPD, independent of age and severity of the airflow obstruction. The TUG is a simple, easy and quick measure that could be easily applied in restricted settings to screen for frailty in COPD.
Collapse
Affiliation(s)
- Ali M Albarrati
- School of Healthcare Sciences, Cardiff University, University Hospital of Wales, Cardiff, CF14 4XN, UK. .,College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia.
| | - Nichola S Gale
- School of Healthcare Sciences, Cardiff University, University Hospital of Wales, Cardiff, CF14 4XN, UK
| | - Margaret M Munnery
- School of Health Sciences, Cardiff Metropolitan University, Llandaff Campus, Western Avenue, Cardiff, CF5 2YB, UK
| | - Natasha Reid
- Centre for Health Services Research, Faculty of Medicine, Princess Alexandra Hospital, The University of Queensland, St Lucia, Australia
| | - John R Cockcroft
- School of Health Sciences, Cardiff Metropolitan University, Llandaff Campus, Western Avenue, Cardiff, CF5 2YB, UK
| | - Dennis J Shale
- School of Healthcare Sciences, Cardiff University, University Hospital of Wales, Cardiff, CF14 4XN, UK
| |
Collapse
|
9
|
Shehu E, Roggendorf S, Golla A, Koenig A, Stangl GI, Diestelhorst A, Medenwald D, Vordermark D, Steckelberg A, Schmidt H. Development and Evaluation of a Multimodal Supportive Intervention for Promoting Physical Function in Older Patients with Cancer. Cancers (Basel) 2022; 14:cancers14112599. [PMID: 35681580 PMCID: PMC9179325 DOI: 10.3390/cancers14112599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/12/2022] [Accepted: 05/20/2022] [Indexed: 12/10/2022] Open
Abstract
Physical function (PF) in older patients with cancer may decline during and after oncologic therapy. This study aimed to develop and pilot test an individually tailored unsupervised physical activity (PA) program and dietary recommendations to promote PF in older patients with cancer. Following development and pretest, the intervention was pilot tested to explore feasibility, acceptance, adherence and potential benefit. Patients ≥60 years, with heterogeneous cancer diagnoses, starting outpatient radiotherapy were randomized in two study arms: paper-based vs. video-based instructions. Based on assessments of PF, PA, nutrition, cognition, mental health, social support, HRQOL and personal goals, participants received individual recommendations for PA and nutrition. After 12 weeks of intervention (T1), reassessments were performed. The postal 4-week follow-up questionnaire included PA, nutrition and HRQOL. Participants (n = 24, 14 female, mean age 70 ± 7 years) showed comparable characteristics in both study arms. The majority rated the program as helpful. Facilitators and barriers to PA adherence were collected. Both modes of instructions were appreciated equally. PF (EORTC QLQ-C30) declined slightly (not clinically relevant >10 pts.) at group level T0: 76 ± 16, T1: 68 ± 21, T2: 69 ± 24. The intervention was feasible, well accepted, showing potential benefit for the maintenance of PF during outpatient radiotherapy, and should be further tested in a larger sample.
Collapse
Affiliation(s)
- Eni Shehu
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, 06112 Halle, Germany; (E.S.); (S.R.); (A.S.)
| | - Sigrid Roggendorf
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, 06112 Halle, Germany; (E.S.); (S.R.); (A.S.)
| | - André Golla
- Institute of Rehabilitation Medicine, Medical Faculty, Martin Luther University Halle-Wittenberg, 06112 Halle, Germany;
| | - Antonia Koenig
- Institute of Agricultural and Nutrition Science, Martin Luther University Halle-Wittenberg, 06120 Halle, Germany; (A.K.); (G.I.S.)
| | - Gabriele I. Stangl
- Institute of Agricultural and Nutrition Science, Martin Luther University Halle-Wittenberg, 06120 Halle, Germany; (A.K.); (G.I.S.)
| | - Andrea Diestelhorst
- Clinic and Polyclinic of Radiotherapy, University Hospital Halle, 06120 Halle, Germany; (A.D.); (D.M.); (D.V.)
| | - Daniel Medenwald
- Clinic and Polyclinic of Radiotherapy, University Hospital Halle, 06120 Halle, Germany; (A.D.); (D.M.); (D.V.)
| | - Dirk Vordermark
- Clinic and Polyclinic of Radiotherapy, University Hospital Halle, 06120 Halle, Germany; (A.D.); (D.M.); (D.V.)
| | - Anke Steckelberg
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, 06112 Halle, Germany; (E.S.); (S.R.); (A.S.)
| | - Heike Schmidt
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, 06112 Halle, Germany; (E.S.); (S.R.); (A.S.)
- Clinic and Polyclinic of Radiotherapy, University Hospital Halle, 06120 Halle, Germany; (A.D.); (D.M.); (D.V.)
- Correspondence:
| |
Collapse
|
10
|
Campos-Magdaleno M, Pereiro A, Navarro-Pardo E, Juncos-Rabadán O, Facal D. Dual-task performance in old adults: cognitive, functional, psychosocial and socio-demographic variables. Aging Clin Exp Res 2022; 34:827-835. [PMID: 34648173 PMCID: PMC9076699 DOI: 10.1007/s40520-021-02002-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 10/06/2021] [Indexed: 11/25/2022]
Abstract
Background Dual tasking, or the ability to executing two tasks simultaneously, has been used in recent research to predict cognitive impairments, physical frailty, and has been linked with cognitive frailty in old adults. Aim This study aimed to determine age-related variables can predict dual-task (DT) performance in the older population. Methods A total of 258 healthy community-dwelling participants + 60 years were assessed in relation to their functional capacity, health, well-being, social support and years of education. Performance of a cognitive (Fluency) task and a cognitive–motor (Tracking) task was recorded under single and DT conditions. Multiple linear regression analysis was carried out for each dependent variable, in separate models including cognitive, functional and psychosocial variables. Results Performance in Fluency in DT conditions was predicted by cognitive variables, whereas performance in Tracking DT conditions was predicted by positive interaction, health status, age and motor variables. Discussion The findings suggest that a wide range of cognitive, psychological, social, physical and functional variables influence cognitive and motor performance in aging. Conclusion DT methodology is sensitive to different age-related changes and could be related to frailty conditions in aging.
Collapse
Affiliation(s)
- María Campos-Magdaleno
- Department of Developmental Psychology, University of Santiago de Compostela, Santiago, Spain
| | - Arturo Pereiro
- Department of Developmental Psychology, University of Santiago de Compostela, Santiago, Spain
| | | | - Onésimo Juncos-Rabadán
- Department of Developmental Psychology, University of Santiago de Compostela, Santiago, Spain
| | - David Facal
- Department of Developmental Psychology, University of Santiago de Compostela, Santiago, Spain.
- Facultade de Psicoloxía, Rúa Xosé María Suárez Núñez, s/n. Campus Vida, 15782, Santiago de Compostela, Galicia, Spain.
| |
Collapse
|
11
|
Cabral DF, Santos VS, Pereira OTT, Silva MJ, Pascual-Leone A, Rundek T, Loewenstein DA, Kirk-Sanchez N, Oliveira ACA, Gomes-Osman J. Feasibility and Preliminary Efficacy of a Multimodal Approach to Increase Physical Activity in Older Adults With Memory Complaints: The Education for Action Study. J Aging Phys Act 2022; 30:204-216. [PMID: 34412033 PMCID: PMC8857299 DOI: 10.1123/japa.2020-0484] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 04/13/2021] [Accepted: 04/13/2021] [Indexed: 11/18/2022]
Abstract
In this randomized controlled pilot trial, the authors explored the feasibility, technology compliance, and preliminary efficacy of the Education for Action (EDU-ACT), a multimodal intervention combining evidence-based strategies of physical activity (PA) education and coaching in PA levels over 4 weeks between EDU-ACT and control groups. The authors also assessed pre-post changes in neurocognitive function, functional mobility and dual-task performance, sleep and quality of life. Thirty-two sedentary older adults with memory complaints (age = 66 ± 5.3) completed the study (EDU-ACT = 18 and control = 14). The EDU-ACT adherence rate was 95%, and compliance of daily PA reporting was, on average, 22.7 days (94.6%). The EDU-ACT group demonstrated a significantly greater number of steps, processing speed, and dual-task performance when compared with controls (p < .05). In this study, a multimodal, evidence-based, low-cost intervention was feasible, well-accepted, with high adherence and compliance rates, and effective at promoting clinically meaningful increases in PA, for at least 1 month postintervention, in older adults with memory complaints.
Collapse
Affiliation(s)
- Danylo F. Cabral
- Department of Physical Therapy, University of Miami Miller School of Medicine, 5915 Ponce de Leon Blvd, 5th Floor, Coral Gables, FL, 33146
- Department of Physical Therapy, Alagoas State University of Health Sciences, Maceió, Alagoas, Brazil
| | - Vinicius S. Santos
- Department of Physical Therapy, Alagoas State University of Health Sciences, Maceió, Alagoas, Brazil
| | - Oceano T. T. Pereira
- Department of Physical Therapy, Alagoas State University of Health Sciences, Maceió, Alagoas, Brazil
| | - Maria J. Silva
- Department of Physical Therapy, Alagoas State University of Health Sciences, Maceió, Alagoas, Brazil
| | - Alvaro Pascual-Leone
- Department of Neurology, Harvard Medical School, Boston MA, USA
- Hinda and Arthur Marcus Institute for Aging Research and Deanna and Sidney Wolk Center for Memory Health, Hebrew SeniorLife, Rosindale, MA, USA
- Guttmann Brain Health Institute, Barcelona, Spain
| | - Tatjana Rundek
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL
| | | | - Neva Kirk-Sanchez
- Department of Physical Therapy, University of Miami Miller School of Medicine, 5915 Ponce de Leon Blvd, 5th Floor, Coral Gables, FL, 33146
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL
| | - Augusto C. A. Oliveira
- Department of Physical Therapy, Alagoas State University of Health Sciences, Maceió, Alagoas, Brazil
| | - Joyce Gomes-Osman
- Department of Physical Therapy, University of Miami Miller School of Medicine, 5915 Ponce de Leon Blvd, 5th Floor, Coral Gables, FL, 33146
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL
| |
Collapse
|
12
|
TUG-10: A Modification of the Timed Up and Go Test for Aerobic Assessment in Older Adults. Cardiopulm Phys Ther J 2022. [DOI: 10.1097/cpt.0000000000000202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
13
|
Nualyong T, Siriphorn A. Accuracy of the figure of 8 walk test with and without dual-task to predict falls in older adults. J Bodyw Mov Ther 2022; 30:69-75. [DOI: 10.1016/j.jbmt.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 11/01/2021] [Accepted: 02/04/2022] [Indexed: 11/24/2022]
|
14
|
Savcun Demirci C, Sütçü G, Ayvat F, Onursal Kılınç Ö, Doğan M, Ayvat E, Bekircan-Kurt CE, Erdem-Özdamar S, Yıldırım SA, Kılınç M, Tan E. Identifying A Cut-Off Point for Timed Up and Go Test in Neuromuscular Diseases. TURKISH JOURNAL OF NEUROLOGY 2022. [DOI: 10.4274/tnd.2021.84553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
|
15
|
Vellani S, Cumal A, Degan C. Frailty assessment and interventions for community-dwelling older adults: a rapid review. Nurs Older People 2021; 33:28-34. [PMID: 34286521 DOI: 10.7748/nop.2021.e1327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2021] [Indexed: 11/09/2022]
Abstract
Frailty is a syndrome involving increased vulnerability that usually develops from age-related decline in physiological reserves and function in multiple organ systems, resulting in an impaired ability to respond to acute changes in health conditions. It is imperative that healthcare providers who work with older adults in primary care and community settings understand how to assess frailty and can identify appropriate interventions. This article reports the results of a rapid review that examined how frailty is assessed in community-dwelling older adults and what interventions are used to address frailty in this population.
Collapse
Affiliation(s)
- Shirin Vellani
- KITE Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Alexia Cumal
- KITE Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | | |
Collapse
|
16
|
Palmer JA, Payne AM, Ting LH, Borich MR. Cortical Engagement Metrics During Reactive Balance Are Associated With Distinct Aspects of Balance Behavior in Older Adults. Front Aging Neurosci 2021; 13:684743. [PMID: 34335230 PMCID: PMC8317134 DOI: 10.3389/fnagi.2021.684743] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 06/17/2021] [Indexed: 11/20/2022] Open
Abstract
Heightened reliance on the cerebral cortex for postural stability with aging is well-known, yet the cortical mechanisms for balance control, particularly in relation to balance function, remain unclear. Here we aimed to investigate motor cortical activity in relation to the level of balance challenge presented during reactive balance recovery and identify circuit-specific interactions between motor cortex and prefrontal or somatosensory regions in relation to metrics of balance function that predict fall risk. Using electroencephalography, we assessed motor cortical beta power, and beta coherence during balance reactions to perturbations in older adults. We found that individuals with greater motor cortical beta power evoked following standing balance perturbations demonstrated lower general clinical balance function. Individual older adults demonstrated a wide range of cortical responses during balance reactions at the same perturbation magnitude, showing no group-level change in prefrontal- or somatosensory-motor coherence in response to perturbations. However, older adults with the highest prefrontal-motor coherence during the post-perturbation, but not pre-perturbation, period showed greater cognitive dual-task interference (DTI) and elicited stepping reactions at lower perturbation magnitudes. Our results support motor cortical beta activity as a potential biomarker for individual level of balance challenge and implicate prefrontal-motor cortical networks in distinct aspects of balance control involving response inhibition of reactive stepping in older adults. Cortical network activity during balance may provide a neural target for precision-medicine efforts aimed at fall prevention with aging.
Collapse
Affiliation(s)
- Jacqueline A. Palmer
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University, Atlanta, GA, United States
| | - Aiden M. Payne
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University, Atlanta, GA, United States
| | - Lena H. Ting
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University, Atlanta, GA, United States
- Department of Biomedical Engineering, Emory and Georgia Tech, Atlanta, GA, United States
| | - Michael R. Borich
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University, Atlanta, GA, United States
| |
Collapse
|
17
|
Esmaeili Bijarsari S. A Current View on Dual-Task Paradigms and Their Limitations to Capture Cognitive Load. Front Psychol 2021; 12:648586. [PMID: 34093335 PMCID: PMC8173029 DOI: 10.3389/fpsyg.2021.648586] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 04/28/2021] [Indexed: 12/11/2022] Open
Abstract
Dual-task paradigms encompass a broad range of approaches to measure cognitive load in instructional settings. As a common characteristic, an additional task is implemented alongside a learning task to capture the individual's unengaged cognitive capacities during the learning process. Measures to determine these capacities are, for instance, reaction times and interval errors on the additional task, while the performance on the learning task is to be maintained. Opposite to retrospectively applied subjective ratings, the continuous assessment within a dual-task paradigm allows to simultaneously monitor changes in the performance related to previously defined tasks. Following the Cognitive Load Theory, these changes in performance correspond to cognitive changes related to the establishment of permanently existing knowledge structures. Yet the current state of research indicates a clear lack of standardization of dual-task paradigms over study settings and task procedures. Typically, dual-task designs are adapted uniquely for each study, albeit with some similarities across different settings and task procedures. These similarities range from the type of modality to the frequency used for the additional task. This results in a lack of validity and comparability between studies due to arbitrarily chosen patterns of frequency without a sound scientific base, potentially confounding variables, or undecided adaptation potentials for future studies. In this paper, the lack of validity and comparability between dual-task settings will be presented, the current taxonomies compared and the future steps for a better standardization and implementation discussed.
Collapse
Affiliation(s)
- Shirin Esmaeili Bijarsari
- Department of Educational Psychology, Institute of Psychology, Goethe University Frankfurt, Frankfurt, Germany
| |
Collapse
|
18
|
Weng SC, Lin CS, Tarng DC, Lin SY. Physical frailty and long-term mortality in older people with chronic heart failure with preserved and reduced ejection fraction: a retrospective longitudinal study. BMC Geriatr 2021; 21:92. [PMID: 33522908 PMCID: PMC7849094 DOI: 10.1186/s12877-020-01971-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 12/16/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Frailty, a syndrome characterized by a decline in function reserve, is common in older patients with heart failure (HF) and is associated with prognosis. This study aimed to evaluate the impact of frailty on outcomes in older patients with preserved and reduced cardiac function. METHODS In total, 811 adults aged ≥65 years were consecutively enrolled from 2009 to 2018. HF was diagnosed according to the ICD9 code and a 2D echocardiogram was categorized by reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF). The index date was registered at the time of HF. All patients received a comprehensive geriatric assessment, and clinical outcomes were examined with adjustment of the other prognostic variables. RESULTS Mean age was 80.5 ± 7.1 years. The prevalence of HF, HFpEF, HFrEF, Fried, and Rockwood frailty indicators was 28.5, 10.4, 9.7, 52.5, and 74.9%, respectively. At baseline, scores in the Timed Up and Go test was closely associated with the severity of HF, either with HFpEF or HFrEF. After a mean follow-up of 3.2 ± 2.0 years, we found that HF patients with low handgrip strength (HGS) had the poorest survival, followed by non-HF patients with decreased HGS, and HF with fair HGS in comparison with non-HF with fair HGS (p = 0.008) if participants were arbitrarily divided into two HGS groups. In all patients, a high Rockwood frailty index was independently associated with increased mortality (adjusted hazard ratio [aHR] = 1.05; 95% confidence interval [CI]: 1.0004 to 1.10). In addition, the adjusted mortality HR was 3.42 with decreased HGS (95% CI: 1.03 to 11.40), 7.65 with use of mineralocorticoid receptor antagonist (95% CI: 2.22 to 26.32), and 1.26 with associated multi-comorbidities assessed by Charlson comorbidity index (95% CI: 1.05 to 1.51). CONCLUSIONS Our study results indicate that frailty and decreased physical functions were associated with HF. Besides, frailty and HGS predicted prognosis in the patients, and there was a combined effect of HF and low HGS on survival.
Collapse
Affiliation(s)
- Shuo-Chun Weng
- Institute of Clinical Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, Taichung, Taiwan.,Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chu-Sheng Lin
- Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Family Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Der-Cherng Tarng
- Institute of Clinical Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department and Institute of Physiology, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Center for intelligent Drug Systems and Smart Bio-devices (IDS2B), Hsinchu, Taiwan.,Department of Biological Science and Technology, College of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Shih-Yi Lin
- Institute of Clinical Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan. .,Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, Taichung, Taiwan. .,Center for Geriatrics and Gerontology, Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, No.1650 Boulevard Sect. 4, Taichung, Taiwan.
| |
Collapse
|
19
|
Lorenzo-López L, Campos-Magdaleno M, López-López R, Facal D, Pereiro AX, Maseda A, Blanco-Fandiño J, Millán-Calenti JC. Dual and triple tasks performance in institutionalized prefrail and frail older adults. Int J Geriatr Psychiatry 2020; 35:1358-1366. [PMID: 32662207 DOI: 10.1002/gps.5375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 06/17/2020] [Accepted: 07/06/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The aim of this pilot study was to investigate differences on dual- and triple-task performance in institutionalized prefrail and frail older adults. Performance on these tasks is relevant since many activities of daily living involve simultaneous motor and cognitive tasks. METHODS We used a phenotypic description of frailty based on the presence or absence of five criteria related to physical fitness and metabolism (unintentional weight loss, self-reported exhaustion, muscle weakness, low gait speed, and low physical activity). Thirty-three institutionalized older adults (≥ 65 years, 78.8% females) were divided according to their frailty status. Participants completed cognitive tasks (a phonemic verbal fluency task and a visuospatial tracking task) while cycling on a stationary cycle (upper- and lower-extremity function was assessed). Cycling (number of arm and foot cycles) and cognitive (number of correct answers) performances were measured during single-, dual-, and triple-task conditions. Performances and costs of dual -and triple- tasking on cycling and cognitive performances were compared between prefrail and frail groups. RESULTS Prefrail and frail older adults did not differ in their performance in dual-tasks; however, frail older adults showed a poorer performance in the triple-task. CONCLUSIONS Although future studies need to confirm our observations in larger samples, this pilot study suggests that developing new tools based on triple tasking could be useful for the comprehensive assessment of frailty.
Collapse
Affiliation(s)
- Laura Lorenzo-López
- Gerontology and Geriatrics Research Group, Instituto de Investigación biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidade da Coruña, A Coruña, Spain
| | - María Campos-Magdaleno
- Department of Developmental Psychology, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Rocío López-López
- Gerontology and Geriatrics Research Group, Instituto de Investigación biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidade da Coruña, A Coruña, Spain
| | - David Facal
- Department of Developmental Psychology, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Arturo X Pereiro
- Department of Developmental Psychology, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Ana Maseda
- Gerontology and Geriatrics Research Group, Instituto de Investigación biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidade da Coruña, A Coruña, Spain
| | - Julia Blanco-Fandiño
- Gerontology and Geriatrics Research Group, Instituto de Investigación biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidade da Coruña, A Coruña, Spain
| | - José Carlos Millán-Calenti
- Gerontology and Geriatrics Research Group, Instituto de Investigación biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidade da Coruña, A Coruña, Spain
| |
Collapse
|
20
|
Valenzuela PL, Maffiuletti NA, Saner H, Schütz N, Rudin B, Nef T, Urwyler P. Isometric Strength Measures are Superior to the Timed Up and Go Test for Fall Prediction in Older Adults: Results from a Prospective Cohort Study. Clin Interv Aging 2020; 15:2001-2008. [PMID: 33149561 PMCID: PMC7602904 DOI: 10.2147/cia.s276828] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 09/23/2020] [Indexed: 11/23/2022] Open
Abstract
Background Isometric strength measures and timed up and go (TUG) tests are both recognized as valuable tools for fall prediction in older adults. However, results from direct comparison of these two tests are lacking. We aimed to assess the potential of isometric strength measures and the different modalities of the TUG test to detect individuals at risk of falling. Methods This is a prospective cohort study including 24 community-dwelling older adults (≥65 years, 19 females, 88±7 years). Participants performed three variations of the TUG test (standard, counting and holding a full cup) and three isometric strength tests (handgrip, knee extension and hip flexion) at several time points (at baseline and every ~6 weeks) during a one-year follow-up. The association between these tests and the incidence of falls during the follow-up was assessed. Results Twelve participants out of 24 participants experienced falls during the follow-up. Fallers showed a significantly lower handgrip strength (-5.7 kg, 95% confidence interval: -10.4 to -1.1, p=0.019) and knee extension strength (-4.9 kg, -9.6 to -0.2, p=0.042) at follow-up, while no significant differences were found for any TUG variation. Conclusions Handgrip and knee extension strength measures - particularly when assessed regularly over time - have the potential to serve as a simple and easy tool for detecting individuals at risk of falling as compared to functional mobility measures (ie, TUG test).
Collapse
Affiliation(s)
| | | | - Hugo Saner
- Institute for Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Gerontechnology & Rehabilitation Group, University of Bern, Bern, Switzerland
| | - Narayan Schütz
- Gerontechnology & Rehabilitation Group, University of Bern, Bern, Switzerland
| | - Beatrice Rudin
- Höhere Fachschule Pflege, Berufsbildungszentrum Olten, Olten, Switzerland
| | - Tobias Nef
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Prabitha Urwyler
- Gerontechnology & Rehabilitation Group, University of Bern, Bern, Switzerland.,ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland.,Department of Neurology, University Neurorehabilitation Unit, University Hospital Inselspital, Bern, Switzerland
| |
Collapse
|
21
|
Cheung DSK, Kwan RYC, Wong ASW, Ho LYW, Chin KC, Liu JYW, Tse MMY, Lai CKY. Factors Associated With Improving or Worsening the State of Frailty: A Secondary Data Analysis of a 5-Year Longitudinal Study. J Nurs Scholarsh 2020; 52:515-526. [PMID: 32741137 DOI: 10.1111/jnu.12588] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE This study aims to examine the frailty transition patterns of older adults recruited from both community and residential care settings within a 5-year period, and to identify the physical and psychosocial factors associated with the transitions. DESIGN This study is a secondary data analysis of a longitudinal study for tracking the change of health status of older adults 60 years of age or older. Participants who had undergone at least two assessments during 2013-2017 were selected for analysis. Guided by the Gobben's Frailty Model, biopsychosocial predictors were comprehensively identified from the literature, and their relationship to frailty state transition was explored. METHODS We compared the baseline characteristics of participants at the frail, pre-frail, and robust states (categorized using the Fried Frailty Index). A generalized estimating equation was used to identify factors associated with an improvement or a deterioration in frailty. The probability of transitions between frailty states was calculated. FINDINGS Among the 306 participants, 19% (n = 59) improved and 30% (n = 92) declined in frailty within the project period. Sleep difficulties (odds ratio [OR] = 1.76; 95% confidence interval [CI]: 1.07-2.90; p = .027), better cognitive status (OR = 0.80-0.84; 95% CI: 0.66-0.98 and 0.73-2.73; p = .031 and .018), good nutritional status (OR = 0.74; 95% CI: 0.59-0.91; p = .005), slow mobility (OR = 1.03-1.13; 95% CI: 1.00-1.05 and 1.03-1.25; p = .047 and .014), hearing impairment (OR = 2.83; 95% CI: 1.00-8.01; p = .05), better quality of health-physical domain (OR = 0.95; 95% CI: 0.92-0.99; p = .006), and better functional ability (OR = 0.85-0.97; 95% CI: 0.79-0.92 and 0.96-0.99; p < .001 and p = .003) were significant associated factors in the worsening group. More physical activity (OR = 1.01; 95% CI: 1.00-1.01 and 1.01-1.02; p = .026 and p < .001), hearing impairment (OR = 0.26; 95% CI: 0.08-0.86; p = .028), and slow mobility (OR = 0.93; 95% CI: 0.87-1.00; p = .037) were significant associated factors in the improvement group. CONCLUSIONS Frailty is a crucial global public health issue. This study provides evidence for nurses to holistically consider the associated factors and to design effective interventions to combat frailty in our ageing society. CLINICAL RELEVANCE Frailty is a transient state that can be reversed. Professional nurses working in both community and residential care settings should be able to identify older adults at risk and improve their health conditions appropriately.
Collapse
Affiliation(s)
- Daphne Sze Ki Cheung
- Assistant Professor, Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Rick Yiu Cho Kwan
- Assistant Professor, Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Anthony Siu Wo Wong
- Research Assistant, Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Lily Yuen Wah Ho
- Clinical Instructor, Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Kenny Cw Chin
- Statistical Consultant, Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Justina Yat Wah Liu
- Associate Professor, Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Mimi Mun Yee Tse
- Associate Professor, Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Claudia Kam Yuk Lai
- Honorary Professor, Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| |
Collapse
|
22
|
Ansai JH, Farche ACS, Rossi PG, de Andrade LP, Nakagawa TH, Takahashi ACDM. Performance of Different Timed Up and Go Subtasks in Frailty Syndrome. J Geriatr Phys Ther 2020; 42:287-293. [PMID: 29210935 DOI: 10.1519/jpt.0000000000000162] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE Gait speed, mobility, and postural transitions should be taken into account in older adults with frailty syndrome and can be assessed by the Timed Up and Go (TUG) Test. However, it is unclear which TUG subtasks have greater influence in identifying frail people and whether prefrail individuals present with any reduced subtask performance. The objective of this study was to investigate the differences in performance of TUG subtasks between frail, prefrail, and nonfrail older adults. METHODS A cross-sectional study was performed with community-dwelling older adults, including 43 nonfrail, 30 prefrail, and 7 frail individuals. The TUG subtasks (sit-to-stand, walking forward, turning, walking back, and turn-to-sit) were assessed using a Qualisys motion system. Data were captured by Qualisys Track Manager software and processed by Visual 3D software. The Matlab program was used to detect, separate, and analyze the TUG subtasks. Statistical significance was set at α= .05 and SigmaPlot software (11.0) was used. RESULTS AND DISCUSSION The total time to complete the TUG was significantly longer among frail participants than among those who were prefrail and nonfrail. Statistically significant differences in temporal parameters in the turning, walking forward, and walking back subtasks between nonfrail/prefrail and frail older people were found. In addition, the transition TUG subtasks (average and peak velocities of the trunk) distinguished the frail group from the other groups, demonstrating altered quality of movement. CONCLUSIONS The findings support the value of analyzing the TUG subtasks to improve understanding of mobility deficits in frailty syndrome.
Collapse
Affiliation(s)
- Juliana Hotta Ansai
- Department of Physiotherapy, Federal University of Mato Grosso do Sul, Brazil
| | | | - Paulo Giusti Rossi
- Department of Physiotherapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | | | | | | |
Collapse
|
23
|
Gordon SJ, Baker N, Kidd M, Maeder A, Grimmer KA. Pre-frailty factors in community-dwelling 40-75 year olds: opportunities for successful ageing. BMC Geriatr 2020; 20:96. [PMID: 32143634 PMCID: PMC7060633 DOI: 10.1186/s12877-020-1490-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 02/24/2020] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND There is little known about pre-frailty attributes or when changes which contribute to frailty might be detectable and amenable to change. This study explores pre-frailty and frailty in independent community-dwelling adults aged 40-75 years. METHODS Participants were recruited through local council networks, a national bank and one university in Adelaide, Australia. Fried frailty phenotype scores were calculated from measures of unintentional weight loss, exhaustion, low physical activity levels, poor hand grip strength and slow walking speed. Participants were identified as not frail (no phenotypes), pre-frail (one or two phenotypes) or frail (three or more phenotypes). Factor analysis was applied to binary forms of 25 published frailty measures Differences were tested in mean factor scores between the three Fried frailty phenotypes and ROC curves estimated predictive capacity of factors. RESULTS Of 656 participants (67% female; mean age 59.9 years, SD 10.6) 59.2% were classified as not frail, 39.0% pre-frail and 1.8% frail. There were no gender or age differences. Seven frailty factors were identified, incorporating all 25 frailty measures. Factors 1 and 7 significantly predicted progression from not-frail to pre-frail (Factor 1 AUC 0.64 (95%CI 0.60-0.68, combined dynamic trunk stability and lower limb functional strength, balance, foot sensation, hearing, lean muscle mass and low BMI; Factor 7 AUC 0.55 (95%CI 0.52-0.59) comprising continence and nutrition. Factors 3 and 4 significantly predicted progression from pre-frail to frail (Factor 3 AUC 0.65 (95% CI 0.59-0.70)), combining living alone, sleep quality, depression and anxiety, and lung function; Factor 4 AUC 0.60 (95%CI 0.54-0.66) comprising perceived exertion on exercise, and falls history. CONCLUSIONS This research identified pre-frailty and frailty states in people aged in their 40s and 50s. Pre-frailty in body systems performance can be detected by a range of mutable measures, and interventions to prevent progression to frailty could be commenced from the fourth decade of life.
Collapse
Affiliation(s)
- S. J. Gordon
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia 5005 Australia
- Digital Health Research Centre, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia 5005 Australia
| | - N. Baker
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia 5005 Australia
- Digital Health Research Centre, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia 5005 Australia
| | - M. Kidd
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, South Australia 5005 Australia
- Department of Family & Community Medicine, University of Toronto, Toronto, Canada
| | - A. Maeder
- Digital Health Research Centre, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia 5005 Australia
| | - K. A. Grimmer
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia 5005 Australia
- Physiotherapy Department, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, 7500 South Africa
| |
Collapse
|
24
|
Pinto VA, Campolina AB, Mazoni AF, Mattos DJS, Vaz DV. Attention Focus Does Not Influence Performance of Sit-to-Stand in Young and Older Adults. J Mot Behav 2020; 53:11-19. [PMID: 32046609 DOI: 10.1080/00222895.2020.1723477] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
An external focus of attention can improve performance, but there is little research on effects for the elderly in every day, well-learned mobility tasks. 57 older and 59 young adults performed the sit-to-stand and stand-to-sit while holding a cup, at three difficulty levels (cup empty or full, at normal or fast speed). Half were instructed to focus internally (on their movements) and half externally (on the cup). The effects of focus, age, and difficulty level were tested for movement time, mean inclination of the cup, inclination variability, and smoothness with 2 × 2 × 3 ANOVAs. Significant effects of difficulty were consistent across variables (p < 0.05). An effect of focus was present only for the inclination variability of the stand-to-sit (p < 0.03), favoring an internal focus (less variability). The age × focus interaction was significant for mean cup inclination, but post hoc tests failed to reveal any significant differences. The results of this study, together with the literature, suggest that an external focus may not benefit the performance of young or older adults in general mobility activities of daily living. The prevalent assumption that an external focus is always beneficial for performance needs further empirical testing.
Collapse
Affiliation(s)
- Valéria A Pinto
- Rehabilitation Sciences Graduate Program, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Alice B Campolina
- Rehabilitation Sciences Graduate Program, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Alysson F Mazoni
- Physical Education Graduate Program, Universidade Estadual de Campinas, Campinas, Brazil
| | - Daniela J S Mattos
- Washington University School of Medicine in Saint Louis, Saint Louis, Missouri, United States
| | - Daniela V Vaz
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| |
Collapse
|
25
|
Carnavale BF, Fiogbé E, Farche ACS, Catai AM, Porta A, Takahashi ACDM. Complexity of knee extensor torque in patients with frailty syndrome: a cross-sectional study. Braz J Phys Ther 2020; 24:30-38. [PMID: 30587398 PMCID: PMC6994311 DOI: 10.1016/j.bjpt.2018.12.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 09/27/2018] [Accepted: 12/10/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Frailty syndrome is characterized by a marked reduction in physiological reserves and a clinical state of vulnerability to stress. Torque complexity analysis could reveal changes in the musculoskeletal systems that are the result of having the syndrome. OBJECTIVE The aim of this study was to evaluate the complexity of submaximal isometric knee extensor torque in frail, pre-frail, and non-frail older adults. A secondary aim was to analyze the torque complexity behavior in different force levels in each group. METHODS A cross-sectional study was conducted. Forty-two older adults were divided into three groups: non-frail (n=15), pre-frail (n=15), and frail (n=12). The data collected included body composition, five times sit-to-stand test, walking speed, and isometric knee extensor torque at 15, 30, and 40% of maximal voluntary contraction. The knee extensor torque variability was evaluated by coefficient of variation, and the torque complexity was evaluated by approximate entropy and sample entropy. RESULTS The frail group presented a reduction in body mass and peak torque value compared to the non-frail group. Also, the frail group showed worse physical performance (on the five times sit-to-stand test and walking speed) compared to the pre-frail and non-frail groups. In addition, the frail older adults showed reduced torque complexity compared to the non-frail group. Finally, the association between torque complexity and force levels remained similar in all groups. CONCLUSION Torque complexity is reduced in the presence of frailty syndrome.
Collapse
Affiliation(s)
- Bianca Ferdin Carnavale
- Department of Physical Therapy, Universidade Federal de São Carlos (UFSCar), São Carlos, SP, Brazil
| | - Elie Fiogbé
- Department of Physical Therapy, Universidade Federal de São Carlos (UFSCar), São Carlos, SP, Brazil
| | - Ana Claudia Silva Farche
- Department of Physical Therapy, Universidade Federal de São Carlos (UFSCar), São Carlos, SP, Brazil
| | - Aparecida Maria Catai
- Department of Physical Therapy, Universidade Federal de São Carlos (UFSCar), São Carlos, SP, Brazil
| | - Alberto Porta
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy; Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy
| | | |
Collapse
|
26
|
The repeatability of the instrumented timed Up & Go test: The performance of older adults and parkinson’s disease patients under different conditions. Biocybern Biomed Eng 2020. [DOI: 10.1016/j.bbe.2019.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
27
|
Pohl PS, Gras LZ, Bosch PR, Ganley KJ, Mayer J. Dual Task Timed Up-and-Go for Older Adults With and Without Balance Deficits. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2019. [DOI: 10.1080/02703181.2019.1642975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Patricia S. Pohl
- Department of Physical Therapy & Athletic Training, Northern Arizona University, Phoenix, USA
| | - Laura Z. Gras
- Department of Physical Therapy, Ithaca College, New York, USA
| | - Pamela R. Bosch
- Department of Physical Therapy & Athletic Training, Northern Arizona University, Phoenix, USA
| | - Kathleen J. Ganley
- Department of Physical Therapy & Athletic Training, Northern Arizona University, Phoenix, USA
| | - Jill Mayer
- Department of Physical Therapy, Ithaca College, New York, USA
| |
Collapse
|
28
|
Giusti Rossi P, Pires de Andrade L, Hotta Ansai J, Silva Farche AC, Carnaz L, Dalpubel D, Ferriolli E, Assis Carvalho Vale F, de Medeiros Takahashi AC. Dual-Task Performance: Influence of Frailty, Level of Physical Activity, and Cognition. J Geriatr Phys Ther 2019. [DOI: 10.1519/jpt.0000000000000182] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
29
|
Owen PJ, Daly RM, Livingston PM, Mundell NL, Dalla Via J, Millar JL, Fraser SF. Efficacy of a multi-component exercise programme and nutritional supplementation on musculoskeletal health in men treated with androgen deprivation therapy for prostate cancer (IMPACT): study protocol of a randomised controlled trial. Trials 2017; 18:451. [PMID: 28974267 PMCID: PMC5627417 DOI: 10.1186/s13063-017-2185-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Accepted: 09/08/2017] [Indexed: 12/26/2022] Open
Abstract
Background Prostate cancer is the most commonly diagnosed cancer in men in developed countries. Androgen deprivation therapy (ADT) is a systemic treatment shown to increase survival in selected patients with prostate cancer. The use of ADT continues to increase for all stages and grades of prostate cancer despite known treatment-induced adverse effects. The primary aim of this study is to examine the efficacy of a targeted, multi-component resistance and impact-loading exercise programme together with a daily protein-, calcium- and vitamin D-enriched supplement on bone health in men treated with ADT for prostate cancer. Secondary aims are to determine the effects of this intervention on measures of total body and regional body composition, cardiometabolic risk, inflammatory markers, health-related quality of life and cognitive function. Methods This study is a two-arm randomised controlled trial. Men currently treated with ADT for prostate cancer will be randomised to either a 52-week, community-based, exercise training and nutritional supplementation intervention (n = 51) or usual care control (n = 51). Participants will be assessed at baseline, 26 weeks and 52 weeks for all measures. The primary outcome measures are proximal femur and lumbar spine areal bone mineral density (BMD). Secondary outcomes comprise: changes in tibial and radial bone structure and strength, total body and regional body composition, muscle strength and function, as well as cardiometabolic health, catabolic/inflammatory and anabolic/anti-inflammatory cytokines, health-related quality of life and cognitive function. Discussion This study investigates whether a multi-component intervention incorporating a targeted bone and muscle-loading programme in combination with a protein-, calcium- and vitamin D-enriched supplement can ameliorate multiple adverse effects of ADT when compared to usual care. The results will contribute to the development of exercise training and nutrition guidelines for optimising overall health in men treated with ADT for prostate cancer. Trial registration Australia New Zealand Clinical Trial Registry (ANZCTR), ID: ACTRN12614000317695. Registered on 25 march 2014. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2185-z) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Patrick J Owen
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, Australia.
| | - Robin M Daly
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, Australia
| | | | - Niamh L Mundell
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, Australia
| | - Jack Dalla Via
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, Australia
| | - Jeremy L Millar
- Alfred Health Radiation Oncology, The Alfred, Melbourne, Australia
| | - Steve F Fraser
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, Australia
| |
Collapse
|
30
|
Evaluation of Static and Dynamic Balance Tests in Single and Dual Task Conditions in Participants With Nonspecific Chronic Low Back Pain. J Chiropr Med 2017; 16:189-194. [PMID: 29097947 DOI: 10.1016/j.jcm.2017.06.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 06/01/2017] [Accepted: 06/16/2017] [Indexed: 01/07/2023] Open
Abstract
Objective The purpose of this study was to investigate static and dynamic balance tests in single, dual cognitive, and dual manual task conditions in participants with and without nonspecific chronic low back pain. Methods In this case control study, 40 patients (age range 18-50 years) with nonspecific chronic low back pain for at least 3 months and 40 healthy participants matched for age, weight, height, and sex participated in this study. Balance performance was evaluated using static (One Leg Stance) and dynamic (Modified Star Excursion Balance Test, 10-m walk test, and Timed Up and Go) balance tests. All tests were performed in three conditions: single task (balance only), dual cognitive task (balance and counting numbers backward), and dual manual task (balance and carrying a cup of water). Results The results indicated that different balance tests were impaired in dual task conditions compared with single task in each group. Cognitive and balance performances were not significantly different between nonspecific chronic low back pain and healthy participants in all clinical balance tests. Conclusion It seems that the static and dynamic balance performance under dual task conditions (excluding the Modified Star Excursion Balance Test) was impaired in each group. Dual tasking did not differ between nonspecific chronic low back pain participants with low level of pain and disability compared with healthy participants.
Collapse
|
31
|
Lemke NC, Wiloth S, Werner C, Hauer K. Validity, test-retest reliability, sensitivity to change and feasibility of motor-cognitive dual task assessments in patients with dementia. Arch Gerontol Geriatr 2017; 70:169-179. [DOI: 10.1016/j.archger.2017.01.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 01/23/2017] [Accepted: 01/24/2017] [Indexed: 10/20/2022]
|
32
|
Ponti M, Bet P, Oliveira CL, Castro PC. Better than counting seconds: Identifying fallers among healthy elderly using fusion of accelerometer features and dual-task Timed Up and Go. PLoS One 2017; 12:e0175559. [PMID: 28448509 PMCID: PMC5407756 DOI: 10.1371/journal.pone.0175559] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 03/28/2017] [Indexed: 11/14/2022] Open
Abstract
Devices and sensors for identification of fallers can be used to implement actions to prevent falls and to allow the elderly to live an independent life while reducing the long-term care costs. In this study we aimed to investigate the accuracy of Timed Up and Go test, for fallers’ identification, using fusion of features extracted from accelerometer data. Single and dual tasks TUG (manual and cognitive) were performed by a final sample (94% power) of 36 community dwelling healthy older persons (18 fallers paired with 18 non-fallers) while they wear a single triaxial accelerometer at waist with sampling rate of 200Hz. The segmentation of the TUG different trials and its comparative analysis allows to better discriminate fallers from non-fallers, while conventional functional tests fail to do so. In addition, we show that the fusion of features improve the discrimination power, achieving AUC of 0.84 (Sensitivity = Specificity = 0.83, 95% CI 0.62-0.91), and demonstrating the clinical relevance of the study. We concluded that features extracted from segmented TUG trials acquired with dual tasks has potential to improve performance when identifying fallers via accelerometer sensors, which can improve TUG accuracy for clinical and epidemiological applications.
Collapse
Affiliation(s)
- Moacir Ponti
- ICMC, Universidade de São Paulo, São Carlos, SP, Brazil
- * E-mail:
| | - Patricia Bet
- DGero, Universidade Federal de São Carlos, São Carlos, SP, Brazil
| | | | - Paula C. Castro
- DGero, Universidade Federal de São Carlos, São Carlos, SP, Brazil
| |
Collapse
|
33
|
Chan PP, Si Tou JI, Tse MM, Ng SS. Reliability and Validity of the Timed Up and Go Test With a Motor Task in People With Chronic Stroke. Arch Phys Med Rehabil 2017; 98:2213-2220. [PMID: 28392324 DOI: 10.1016/j.apmr.2017.03.008] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 03/03/2017] [Accepted: 03/10/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To examine (1) the intra-rater, interrater, and test-retest reliabilities of the timed Up and Go test with a motor task (TUGmotor) in terms of the number of steps taken in the test and completion time in a population with chronic stroke; (2) the relation between stroke-specific impairments and the number of steps taken in the test and the completion time; (3) the minimum detectable change in TUGmotor times; and (4) the cutoff time that best discriminates the performance of people with stroke from that of older adults without stroke. DESIGN Cross-sectional study. SETTING University-based rehabilitation center. PARTICIPANTS A sample (N=65) of chronic stroke survivors (n=33) and healthy older adults (n=32). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES TUGmotor times and number of steps taken; Fugl-Meyer Assessment for the Lower Extremities score; handheld dynamometer measurements of hip abductor, knee flexor and extensor, and ankle dorsiflexor and plantar flexor muscle strength; 5-times sit-to-stand test time, Berg Balance Scale score; conventional timed Up and Go test time, and Activities-specific Balance Confidence scale and Community Integration Measure questionnaire scores. RESULTS The TUGmotor completion times and number of steps demonstrated excellent intra-rater, interrater, and test-retest reliabilities. The TUGmotor times correlated significantly with the Fugl-Meyer Assessment for the Lower Extremities and Berg Balance Scale scores, with hip abductor, knee flexor, ankle dorsiflexor and plantar flexor strength on the paretic side, with 5-times sit-to-stand test times, and with times on the conventional timed Up and Go test. The minimum detectable change in TUGmotor time was 3.53 seconds in stroke survivors. A TUGmotor cutoff time of 13.49 seconds was found to best discriminate the performance of stroke survivors from that of older adults without stroke. CONCLUSIONS The TUGmotor is a reliable, valid, and easy-to-administer clinical tool for assessing advanced functional mobility after a stroke.
Collapse
Affiliation(s)
- Peggy P Chan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong (SAR)
| | - Joyce I Si Tou
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong (SAR)
| | - Mimi M Tse
- School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong (SAR)
| | - Shamay S Ng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong (SAR).
| |
Collapse
|
34
|
Paranjape S, Chitalia D. Assessment of Simple Gait Related Dual and Triple Tests in Predicting the Risk of Fall in Adults Above Age of 50 years. Cureus 2016; 8:e651. [PMID: 27462477 PMCID: PMC4959821 DOI: 10.7759/cureus.651] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Timed UP and Go Test (TUG) is conventionally used as predictor of falls in adults. Routine daily activities include multiple tasks performed concurrently. When two or more tasks (Dual/Triple test) needed to be carried out concurrently, task performance declined at least in one of them. Our study aimed to find temporal and demographic variations in the performance after adding a cognitive, motor or both tasks, while performing TUG, compared to performance during conventional TUG. Sixty randomly selected healthy adults, with age ranging from 53 to 90 years, consented to participate in the study. Each participant underwent six tests (Conventional TUG, Motor TUG, Cognitive TUG, Motor and Cognitive TUG, Visuospatial TUG, Motor and Visuospatial TUG), with time measured in seconds. 6 (10%) had a previous history of fall. Triple test identified the highest number of participants at risk of fall (16.67%). One way ANOVA test showed significant temporal variation with the addition of task (p value< 0.0002). There was moderate positive correlation of age with the time taken to perform each test with addition of task. Conventional TUG in itself was found to be most sensitive and specific test to identify fallers. Though dual and triple task tests were also comparable, addition of task to TUG is not a sensitive indicator to identify fallers as compared to TUG.
Collapse
Affiliation(s)
- Swati Paranjape
- Physiotherapy Department, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College
| | | |
Collapse
|
35
|
Factors Contributing to Single- and Dual-Task Timed "Up & Go" Test Performance in Middle-Aged and Older Adults Who Are Active and Dwell in the Community. Phys Ther 2016; 96:284-92. [PMID: 26183585 DOI: 10.2522/ptj.20140292] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 07/05/2015] [Indexed: 02/09/2023]
Abstract
BACKGROUND Dual-task Timed "Up & Go" (TUG) tests are likely to have applications different from those of a single-task TUG test and may have different contributing factors. OBJECTIVE The purpose of this study was to compare factors contributing to performance on single- and dual-task TUG tests. DESIGN This investigation was a cross-sectional study. METHODS Sixty-four adults who were more than 50 years of age and dwelled in the community were recruited. Interviews and physical examinations were performed to identify potential contributors to TUG test performance. The time to complete the single-task TUG test (TUGsingle) or the dual-task TUG test, which consisted of completing the TUG test while performing a serial subtraction task (TUGcognitive) or while carrying water (TUGmanual), was measured. RESULTS Age, hip extensor strength, walking speed, general mental function, and Stroop scores for word and color were significantly associated with performance on all TUG tests. Hierarchical multiple regression models, without the input of walking speed, revealed different independent factors contributing to TUGsingle performance (Mini-Mental Status Examination score, β=-0.32), TUGmanual performance (age, β=0.35), and TUGcognitive performance (Stroop word score, β=-0.40; Mini-Mental Status Examination score, β=-0.31). LIMITATIONS At least 40% of the variance in the performance on the 3 TUG tests was not explained by common clinical measures, even when the factor of walking speed was considered. However, this study successfully identified some important factors contributing to performance on different TUG tests, and other studies have reported similar findings for single-task TUG test and dual-task gait performance. CONCLUSIONS Although the TUGsingle and the TUGcognitive shared general mental function as a common factor, the TUGmanual was uniquely influenced by age and the TUGcognitive was uniquely influenced by focused attention. These results suggest that both common and unique factors contribute to performance on single- and dual-task TUG tests and suggest important applications of the combined use of the 3 TUG tests.
Collapse
|
36
|
Yang L, He C, Pang MYC. Reliability and Validity of Dual-Task Mobility Assessments in People with Chronic Stroke. PLoS One 2016; 11:e0147833. [PMID: 26808662 PMCID: PMC4726712 DOI: 10.1371/journal.pone.0147833] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 01/08/2016] [Indexed: 02/05/2023] Open
Abstract
Background The ability to perform a cognitive task while walking simultaneously (dual-tasking) is important in real life. However, the psychometric properties of dual-task walking tests have not been well established in stroke. Objective To assess the test-retest reliability, concurrent and known-groups validity of various dual-task walking tests in people with chronic stroke. Design Observational measurement study with a test-retest design. Methods Eighty-eight individuals with chronic stroke participated. The testing protocol involved four walking tasks (walking forward at self-selected and maximal speed, walking backward at self-selected speed, and crossing over obstacles) performed simultaneously with each of the three attention-demanding tasks (verbal fluency, serial 3 subtractions or carrying a cup of water). For each dual-task condition, the time taken to complete the walking task, the correct response rate (CRR) of the cognitive task, and the dual-task effect (DTE) for the walking time and CRR were calculated. Forty-six of the participants were tested twice within 3–4 days to establish test-retest reliability. Results The walking time in various dual-task assessments demonstrated good to excellent reliability [Intraclass correlation coefficient (ICC2,1) = 0.70–0.93; relative minimal detectable change at 95% confidence level (MDC95%) = 29%-45%]. The reliability of the CRR (ICC2,1 = 0.58–0.81) and the DTE in walking time (ICC2,1 = 0.11–0.80) was more varied. The reliability of the DTE in CRR (ICC2,1 = -0.31–0.40) was poor to fair. The walking time and CRR obtained in various dual-task walking tests were moderately to strongly correlated with those of the dual-task Timed-up-and-Go test, thus demonstrating good concurrent validity. None of the tests could discriminate fallers (those who had sustained at least one fall in the past year) from non-fallers. Limitation The results are generalizable to community-dwelling individuals with chronic stroke only. Conclusions The walking time derived from the various dual-task assessments generally demonstrated good to excellent reliability, making them potentially useful in clinical practice and future research endeavors. However, the usefulness of these measurements in predicting falls needs to be further explored. Relatively low reliability was shown in the cognitive outcomes and DTE, which may not be preferred measurements for assessing dual-task performance.
Collapse
Affiliation(s)
- Lei Yang
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
- Institute of Disaster Management and Reconstruction, Sichuan University –The Hong Kong Polytechnic University, Chengdu, Sichuan, China
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hong Kong, China
| | - Chengqi He
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Marco Yiu Chung Pang
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hong Kong, China
- * E-mail:
| |
Collapse
|
37
|
Brustio PR, Magistro D, Rabaglietti E, Liubicich ME. Age-related differences in dual task performance: A cross-sectional study on women. Geriatr Gerontol Int 2015; 17:315-321. [PMID: 26712164 DOI: 10.1111/ggi.12700] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2015] [Indexed: 11/29/2022]
Abstract
AIM Simultaneous performances of motor and attention-demanding tasks are common in activities of everyday life. The present cross-sectional study examined the changes and age-related differences on mobility performance with an additional cognitive or motor task, and evaluated the relative dual-task cost (DTC) on the motor performance in young, middle-aged and older women. METHODS A total of 30 young (mean age 25.12 ± 3.00 years), 30 middle-aged (mean age 47.82 ± 5.06 years) and 30 older women (mean age 72.74 ± 5.95 years) were recruited. Participants carried out: (i) single task: Timed Up & Go Test; (ii) cognitive dual-task: Timed Up & Go Test while counting backwards by three; (iii) manual dual-task: Timed Up & Go Test while carrying a glass of water. A repeated measures anova with between-factor as age groups and within-factor as tasks was carried out to assess the effect of aging on the performance of mobility tasks. DTC was calculated as ([performance in single-task - performance in dual-task] / performance in single task) × 100%. One-way ancova were carried out to compare the DTC among the three age groups. RESULTS A significant interaction between age groups and task (F4,172 = 6.716, P < 0.001, partial η2 = 0.135) was observed. Specifically, older women showed a worse mobility performance under dual-task condition compared with young and middle-aged groups. Furthermore, DTC differences in cognitive task were observed in older women compared with younger and middle-aged women (F2,86 = 7.649, P < 0.001, partial η2 = 0.151), but not in manual task. CONCLUSION Dual-task conditions might affect mobility performance differently across the lifespan, and could be particularly challenging in older women. Geriatr Gerontol Int 2017; 17: 315-321.
Collapse
Affiliation(s)
- Paolo R Brustio
- Department of Psychology, University of Torino, Torino, Italy
| | - Daniele Magistro
- Department of Psychology, University of Torino, Torino, Italy.,School of Electronic, Electrical and Systems Engineering, Loughborough University, Leicestershire, UK
| | - Emanuela Rabaglietti
- Department of Psychology, University of Torino, Torino, Italy.,SUISM, University of Torino, Torino, Italy
| | | |
Collapse
|
38
|
Hwang WJ, Cho MK, Chung Y. Relationship between anticipatory postural adjustment of the trunk, dual tasks and physical performance with chronic stroke survivors: a pilot test. ACTA ACUST UNITED AC 2015. [DOI: 10.14474/ptrs.2015.4.1.44] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|