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Özden F, Uysal İ, Tümtürk İ, Özkeskin M, Özyer F. Does backward gait require more proprioception and balance in older adults after total knee arthroplasty? J Orthop 2024; 54:86-89. [PMID: 38560588 PMCID: PMC10972762 DOI: 10.1016/j.jor.2024.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 03/11/2024] [Accepted: 03/12/2024] [Indexed: 04/04/2024] Open
Abstract
Objectives Some basic and instrumental daily living activities include backward gait. There is a need to clarify which parameters should be focused more on to improve backward gait in older individuals. This research investigated the proprioception, and balance in forward-backward gait of older individuals with total knee arthroplasty (TKA). Methods A prospective cross-sectional research was conducted with 105 older adults with TKA. Individuals' forward and backward gait performance was assessed with the Timed Up & Go Test (TUG) and 3 Meter Walk Back Test (3MBWT), respectively. Proprioception was measured with a mobile application-based inclinometer. Berg Balance Scale (BBS) and Activity Specific Balance Confidence Scale (ABC) were used to assess balance and balance confidence levels, respectively. A single clinician evaluated the individuals. Results TUG was weakly and positively correlated with the Right and Left Leg Proprioception Test (RLPT and LLPT) (r1 = 0.386, r2 = 0.391, p < 0.01). Also, the 3MBWT was weakly and positively correlated with RLPT and LLPT, respectively (r1 = 0.293, r2 = 0.251, p < 0.01). In addition, TUG was strongly and negatively correlated with BBS and ABC, respectively (r1 = -0,693, r2 = -0.722, p < 0.01). Besides, 3MBWT was strongly and negatively correlated with BBS and ABC (r1 = -0.642, r2 = -0.645, p < 0.01). Conclusion The study revealed that forward and backward walking were similarly associated with balance and proprioception in older adults with TKA. Clinicians should focus more on balance ability than proprioception to improve backward walking performance in older individuals with THA.
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Affiliation(s)
- Fatih Özden
- Muğla Sıtkı Koçman University, Köyceğiz Vocational School of Health Services, Department of Health Care Services, Muğla, Turkey
| | - İsmail Uysal
- Muğla Sıtkı Koçman University, Fethiye Vocational School of Health Services, Department of Health Care Services, Muğla, Turkey
| | - İsmet Tümtürk
- Süleyman Demirel University, Institute of Health Sciences, Department of Physiotherapy and Rehabilitation, Isparta, Turkey
| | - Mehmet Özkeskin
- Ege University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, İzmir, Turkey
| | - Fatih Özyer
- Fethiye State Hospital, Department of Orthopaedics and Traumatology, Muğla, Turkey
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2
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Lim ML, van Schooten KS, Radford KA, Hadjistavropoulos T, Everett B, Zijlstra R, Delbaere K. Theoretical framework of concerns about falling in older people: the role of health literacy. Health Promot Int 2023; 38:daad122. [PMID: 37804516 DOI: 10.1093/heapro/daad122] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/09/2023] Open
Abstract
Adherence and participation can be improved in health programs for older people with concerns about falling. While health literacy empowers older people to have greater control over their health, little is known about the extent to which health literacy influences health behaviours associated with concerns about falling in older people. This study aimed to synthesise current findings on health literacy, concerns about falling and falls to propose a multicomponent theoretical model on health literacy and concerns about falling. The model was developed based on a review of the literature, existing frameworks and models on health literacy and concerns about falling. Existing evidence on the relationship between health literacy and concerns about falling in older people is limited. Evidence from other research areas, however, shows that health literacy is closely related to many of the determinants of concerns about falling. More research is needed to clarify the impact of health literacy on intervention adherence and decision-making processes of older people with concerns about falling. Our model offers a novel perspective on the role of health literacy in health behaviours associated with concerns about falling, suggesting new research directions and providing insights for clinicians to consider health literacy when managing older patients with concerns about falling.
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Affiliation(s)
- Mei Ling Lim
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, Australia
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Kimberley S van Schooten
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, Australia
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Kylie A Radford
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, Australia
- School of Medical Sciences, University of New South Wales, Sydney, Australia
| | | | - Bronwyn Everett
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Australia
| | - Rixt Zijlstra
- Care and Public Health Research Institute, Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
- Public Health Service Flevoland (GGD Flevoland), Department of Health Policy and Research, Lelystad, The Netherlands
| | - Kim Delbaere
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, Australia
- School of Population Health, University of New South Wales, Sydney, Australia
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Gadhvi C, Bean D, Rice D. A systematic review of fear of falling and related constructs after hip fracture: prevalence, measurement, associations with physical function, and interventions. BMC Geriatr 2023; 23:385. [PMID: 37353752 PMCID: PMC10288814 DOI: 10.1186/s12877-023-03855-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 02/28/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND Hip fracture is a common and debilitating injury amongst older adults. Fear of falling (FoF) and related constructs (balance confidence and falls efficacy) may impede rehabilitation after hip fracture. An updated systematic review to synthesize existing literature on FoF after hip fracture is needed. This review focussed on four research questions: In the hip fracture population: (1) What is the prevalence of FoF?; (2) What FoF assessment tools are validated? (3) What is the relationship between FoF and physical function?; (4) What interventions are effective for reducing FoF? METHODS A systematic search was undertaken in EBSCO Health, Scopus and PsychINFO in January 2021 (and updated December 2022) for articles on FoF after hip fracture. Data in relation to each research question was extracted and analysed. The quality of the studies was appraised using the 'Risk of Bias Tool for Prevalence Studies', 'COSMIN Risk of Bias checklist for Patient-reported outcome measures', modified version of the 'Appraisal Tool for Cross-sectional studies', and the 'Cochrane Risk of Bias 2' tools for each research question, respectively. RESULTS 36 studies (37 articles) with 5099 participants were included (mean age 80.2 years and average 78% female). Prevalence rates for FoF after hip fracture ranged between 22.5% and 100%, and prevalence tended to decrease as time progressed post hip fracture. The 'Falls Efficacy Scale - International' (FES-I) and 'Fear of Falling Questionnaire - Revised' (FFQ-R) were found to be reliable, internally consistent, and valid tools in hip fracture patients. FoF after hip fracture was consistently associated with measures of physical function including balance, gait speed, composite physical performance measures and self-reported function. Ten of 14 intervention studies were considered high risk of bias. Exercise-based interventions with or without a psychological component were not effective in reducing FoF after hip fracture compared to a control condition. CONCLUSION FoF is prevalent after hip fracture and is consistently associated with poorer physical function. Only two instruments (FES-I and FFQ-R) have been validated for measuring FoF in the hip fracture population. However, there remains a need for larger, higher quality randomised controlled trials targeting FoF after hip fracture in order to guide clinical practice. TRIAL REGISTRATION PROSPERO registration: CRD42020221836.
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Affiliation(s)
- Chandini Gadhvi
- Health & Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
- Allied Health - Physiotherapy, Te Whatu Ora Health New Zealand - Te Toka Tumai, Auckland, New Zealand
| | - Debbie Bean
- Health & Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand.
- Department of Anaesthesiology & Perioperative Medicine, Te Whatu Ora Health New Zealand - Waitematā, Auckland, New Zealand.
| | - David Rice
- Health & Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
- Department of Anaesthesiology & Perioperative Medicine, Te Whatu Ora Health New Zealand - Waitematā, Auckland, New Zealand
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4
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Parveen A, Parveen S, Noohu MM. Effect of concurrent and multi-component training on balance, fear of falling, and muscle strength in older adults: a review. SPORT SCIENCES FOR HEALTH 2022. [DOI: 10.1007/s11332-022-00990-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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5
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Falling Short: The Contribution of Central Insulin Receptors to Gait Dysregulation in Brain Aging. Biomedicines 2022; 10:biomedicines10081923. [PMID: 36009470 PMCID: PMC9405648 DOI: 10.3390/biomedicines10081923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/27/2022] [Accepted: 07/29/2022] [Indexed: 11/23/2022] Open
Abstract
Insulin resistance, which manifests as a reduction of insulin receptor signaling, is known to correlate with pathological changes in peripheral tissues as well as in the brain. Central insulin resistance has been associated with impaired cognitive performance, decreased neuronal health, and reduced brain metabolism; however, the mechanisms underlying central insulin resistance and its impact on brain regions outside of those associated with cognition remain unclear. Falls are a leading cause of both fatal and non-fatal injuries in the older population. Despite this, there is a paucity of work focused on age-dependent alterations in brain regions associated with ambulatory control or potential therapeutic approaches to target these processes. Here, we discuss age-dependent alterations in central modalities that may contribute to gait dysregulation, summarize current data supporting the role of insulin signaling in the brain, and highlight key findings that suggest insulin receptor sensitivity may be preserved in the aged brain. Finally, we present novel results showing that administration of insulin to the somatosensory cortex of aged animals can alter neuronal communication, cerebral blood flow, and the motivation to ambulate, emphasizing the need for further investigations of intranasal insulin as a clinical management strategy in the older population.
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Ge L, Su TT, An Y, Mejía ST. The effectiveness of exergames on fear of falling in community-dwelling older adults: a systematic review. Aging Ment Health 2022; 26:1306-1317. [PMID: 34291684 DOI: 10.1080/13607863.2021.1950615] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
ObjectivesFear of falling is common among older adults and can increase fall-risk through premature activity restriction. Exergames, an emerging tool in fall prevention, combine exercise with interactive and adaptive game elements. This review examines the extent to which exergame interventions reduce fear of falling among community-dwelling older adults. Method: Guided by the PRISMA methodology, we reviewed peer-reviewed studies that were published in English between 2006 and 2019 and employed a comparative design to test the effect of exergames on fear of falling in community-dwelling older adults. Two reviewers screened the literature and extracted data on the exergame platform, participants, study design, and results. A modified PEDro scale was used to assess study quality. Disagreements were resolved through discussion with the third reviewer. Results: Our literature search resulted in 23 eligible studies on exergame interventions where fear of falling was the primary or secondary outcome. Most interventions (35%) occurred within hospitals and were delivered via a Wii-based system (61%). Fear of falling was most commonly measured using the Falls Efficacy Scale, the Activities-specific Balance Scale and their modified versions. A total of 15 of the 23 studies reported statistically significant changes in fear of falling. Quality assessment showed 10 studies to be rated as 'good.' Conclusion: This review showed that exergame may have a positive effect in reducing fear of falling in community-dwelling older adults. The finding provides a direction for clinical practice in the research area of intervention on fear of falling in older adults.
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Affiliation(s)
- Lanying Ge
- School of Physical Education and Training, Shanghai University of Sport, Shanghai, China
| | - Tai-Te Su
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Yu An
- College of P.E and Sports, Beijing Normal University, Beijing, China
| | - Shannon T Mejía
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, USA
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7
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Development of Dynamic Measures to Assess Balance Confidence and State Anxiety While Walking at Increasing Speeds in Young and Older Adults. J Aging Phys Act 2022; 30:995-1002. [PMID: 35339111 DOI: 10.1123/japa.2021-0322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 02/06/2022] [Accepted: 02/18/2022] [Indexed: 11/18/2022]
Abstract
The purpose of this study was to determine the test-retest reliability and construct validity of tools to assess how balance confidence (BC) and state anxiety (SA) change with progressively increasing walking speeds. Sixteen young adults and 15 older adults attended two sessions. Individuals began walking on a treadmill at 0.4 m/s Participants chose to continue increasing the treadmill speed (up to 2.0 m/s) or to discontinue the protocol while rating their BC and SA after completing each speed. BC at participants' fastest speed attempted demonstrated high and moderate test-retest reliability among young (intraclass correlation coefficient [ICC] = .908) and older adults (ICC = .704). SA for young adults and older adults was good (ICC = .833) and fair (ICC = .490), respectively. Our measures also correlated with measures of dynamic stability while walking for young (r = -.67, p = .008) and older adults (r = .54, p = .046). Our dynamic measures of BC and SA are valid and reliable in young and older adults.
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8
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Gerards MHG, Sieben J, Marcellis R, de Bie RA, Meijer K, Lenssen AF. Acceptability of a perturbation-based balance training programme for falls prevention in older adults: a qualitative study. BMJ Open 2022; 12:e056623. [PMID: 35210345 PMCID: PMC8883254 DOI: 10.1136/bmjopen-2021-056623] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Perturbation-based balance training (PBT) is reported to effectively reduce falls in older adults and may even be superior compared with various exercise programmes. Due to the nature of the intervention, requiring unpredictable balance perturbations, the question arises whether acceptability is an issue in PBT. OBJECTIVE To evaluate the acceptability of PBT in older adults with a recent history of falls. DESIGN, METHOD, PARTICIPANTS AND SETTING This is a qualitative study in which semistructured interviews were conducted in 16 older adults (14 women and 2 men, mean age 73.6±6.0 years) who completed a three-session PBT protocol as part of another study in a university medical centre in the Netherlands. Typical case and purposive sampling strategies were applied. Interviews were based on the theoretical framework of acceptability (TFA) alongside context-specific factors and analysed using a template analysis approach. RESULTS The results indicate that this PBT protocol is perceived as acceptable by older adults with a recent history of falls and highlight key areas for potential future modifications. Enjoyment of the novel training and technology, being able to feel safe during training, and perceived impact of increased self-efficacy and balance confidence were identified as facilitating factors. Potential issues included initial apprehension or anxiety during training and perceived impact being predominantly psychological instead of physical. Complementary to the TFA one additional theme emerged which described challenges regarding the training setting, such as preference for group training in some participants and travel to the training location. CONCLUSIONS The results suggest that PBT is perceived acceptable by older adults with a history of falls. Increasing the social aspect of training and sharing the experiences of peers may be considered to enhance acceptability to new participants who initially feel apprehensive or anxious about their ability to participate in future implementation of PBT. TRIAL REGISTRATION NUMBER The article is linked to a randomised clinical trial registered on https://www.trialregister.nl/trial/7680, NL7680; Results.
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Affiliation(s)
- Marissa H G Gerards
- Department of Physical Therapy, Maastricht University Medical Center+, Maastricht, The Netherlands
- Department of Epidemiology, Care and Public Health Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Judith Sieben
- Department of Epidemiology, Care and Public Health Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Department of Anatomy and Embryology, Maastricht University, Maastricht, The Netherlands
| | - Rik Marcellis
- Department of Physical Therapy, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Rob A de Bie
- Department of Epidemiology, Care and Public Health Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Kenneth Meijer
- Department of Nutrition and Movement Sciences, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
| | - Antoine F Lenssen
- Department of Physical Therapy, Maastricht University Medical Center+, Maastricht, The Netherlands
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9
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Kruisbrink M, Delbaere K, Kempen GIJM, Crutzen R, Ambergen T, Cheung KL, Kendrick D, Iliffe S, Zijlstra GAR. Intervention Characteristics Associated With a Reduction in Fear of Falling Among Community-Dwelling Older People: A Systematic Review and Meta-analysis of Randomized Controlled Trials. THE GERONTOLOGIST 2021; 61:e269-e282. [PMID: 32267498 PMCID: PMC8361503 DOI: 10.1093/geront/gnaa021] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Fear of falling (FoF) is associated with decreased physical functioning and an increased fall risk. Interventions generally demonstrate moderate effects and optimized interventions are needed. Intervention characteristics, such as setting or delivery method may vary. We investigated which overarching intervention characteristics are associated with a reduction in FoF in community-dwelling older people. RESEARCH DESIGN AND METHODS A systematic review and meta-analysis of randomized controlled trials (RCTs) in community-dwelling older people without specific diseases was performed. Associations between intervention characteristics and standardized mean differences (SMD) were determined by univariate meta-regression. Sensitivity analyses were performed. RESULTS Data on 62 RCTs were extracted, 50 intervention groups were included in the meta-analysis. Most intervention characteristics and intervention types were not associated with the intervention effect. Supervision by a tai chi instructor (SMD: -1.047, 95% confidence interval [CI]: -1.598; -0.496) and delivery in a community setting (SMD: -0.528, 95% CI: -0.894; -0.161) were-compared to interventions without these characteristics-associated with a greater reduction in FoF. Holistic exercise, such as Pilates or yoga (SMD: -0.823, 95% CI: -1.255; -0.392), was also associated with a greater reduction in FoF. Delivery at home (SMD: 0.384, 95% CI: 0.002; 0.766) or with written materials (SMD: 0.452, 95% CI: 0.088; 0.815) and tailoring were less effective in reducing FoF (SMD: 0.687, 95% CI: 0.364; 1.011). DISCUSSION AND IMPLICATIONS Holistic exercise, delivery with written materials, the setting and tailoring potentially represent characteristics to take into account when designing and improving interventions for FoF in community-dwelling older people. PROSPERO international prospective register of systematic reviews, registration ID CRD42018080483.
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Affiliation(s)
- Marlot Kruisbrink
- Care and Public Health Research Institute, Department of Health Services Research, Maastricht University, Maastricht, the Netherlands.,Neuroscience Research Australia, School of Public Health and Community Medicine, UNSW, Randwick, New South Wales, Australia
| | - Kim Delbaere
- Neuroscience Research Australia, School of Public Health and Community Medicine, UNSW, Randwick, New South Wales, Australia.,Care and Public Health Research Institute, Department of Methodology and Statistics, Maastricht University, Maastricht, the Netherlands
| | - Gertrudis I J M Kempen
- Care and Public Health Research Institute, Department of Health Services Research, Maastricht University, Maastricht, the Netherlands.,Neuroscience Research Australia, School of Public Health and Community Medicine, UNSW, Randwick, New South Wales, Australia
| | - Rik Crutzen
- Maastricht University, Care and Public Health Research Institute, Department of Health Promotion, Maastricht, the Netherlands
| | - Ton Ambergen
- Care and Public Health Research Institute, Department of Methodology and Statistics, Maastricht University, Maastricht, the Netherlands
| | - Kei-Long Cheung
- Department of Clinical Sciences, College of Health and Life Sciences, Brunel University, London, United Kingdom
| | - Denise Kendrick
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Steve Iliffe
- Research Department of Primary Care & Population Health, University College London, London, United Kingdom
| | - G A Rixt Zijlstra
- Care and Public Health Research Institute, Department of Health Services Research, Maastricht University, Maastricht, the Netherlands.,Neuroscience Research Australia, School of Public Health and Community Medicine, UNSW, Randwick, New South Wales, Australia
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10
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Shaik AR, Ahmad F, Miraj M, Alqahtani M, Alzhrani M, Alanazi A, Kashoo F. Efficacy of the structured balance awareness program on perceived balance confidence and fear-related maladaptive behaviour in post-stroke survivors. NeuroRehabilitation 2021; 49:547-552. [PMID: 34542039 DOI: 10.3233/nre-210144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The risk of falling for individuals with stroke is about twice that of healthy older adults. Lack of appropriate initiative to address the fear-related maladaptive behaviour can manifest itself in the form of loss of physical functions resulting in disability and handicap. OBJECTIVE To examine the effectiveness of the structured balance awareness program (SBAP) in improving the perceived balance confidence, and thereby modifying the fear-related maladaptive behaviour in post-stroke survivors. METHODS A randomized experimental control design was used on a sample of 97 post-stroke survivors aged between 55 to 75 years. The patients received either the SBAP or health awareness program (HAP) for eight weeks and were compared on Activities-specific Balance Confidence (ABC) Scale, Berg Balance Scale (BBS) and Falls Efficacy Scale International (FESI). RESULTS A paired t-test demonstrated statistically significant improvement among all the variables in the SBAP group. An independent t-test exhibited a statistically significant improvement on ABC (t = 2.57, p = 0.012 *), BBS (t = 3.32, p = 0.001 *) and FESI (t = 3.38, p = 0.001 *) in the SBAP group. CONCLUSION The study showed that the SBAP was effective in minimizing the fear-related maladaptive behaviour in post-stroke survivors.
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Affiliation(s)
- Abdul Rahim Shaik
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Al-Majmaah, Saudi Arabia
| | - Fuzail Ahmad
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Al-Majmaah, Saudi Arabia
| | - Mohammad Miraj
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Al-Majmaah, Saudi Arabia
| | - Mazen Alqahtani
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Al-Majmaah, Saudi Arabia
| | - Msaad Alzhrani
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Al-Majmaah, Saudi Arabia
| | - Ahmad Alanazi
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Al-Majmaah, Saudi Arabia
| | - Faizan Kashoo
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Al-Majmaah, Saudi Arabia
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11
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Gill-Body KM, Hedman LD, Plummer L, Wolf L, Hanke T, Quinn L, Riley N, Kaufman R, Verma A, Quiben M, Scheets P. Movement System Diagnoses for Balance Dysfunction: Recommendations From the Academy of Neurologic Physical Therapy's Movement System Task Force. Phys Ther 2021; 101:6307337. [PMID: 34160028 DOI: 10.1093/ptj/pzab153] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/11/2021] [Accepted: 05/30/2021] [Indexed: 11/13/2022]
Abstract
UNLABELLED The movement system was identified as the focus of our expertise as physical therapists in the revised vision statement for the profession adopted by the American Physical Therapy Association in 2013. Attaining success with the profession's vision requires the development of movement system diagnoses that will be useful in clinical practice, research, and education. To date, only a few movement system diagnoses have been identified and described, and none of these specifically address balance dysfunction. Over the past 2 years, a Balance Diagnosis Task Force, a subgroup of the Movement System Task Force of the Academy of Neurologic Physical Therapy, focused on developing diagnostic labels (or diagnoses) for individuals with balance problems. This paper presents the work of the task force that followed a systematic process to review available diagnostic frameworks related to balance, identify 10 distinct movement system diagnoses that reflect balance dysfunction, and develop complete descriptions of examination findings associated with each balance diagnosis. A standardized approach to movement analysis of core tasks, the Framework for Movement Analysis developed by the Academy of Neurologic Physical Therapy Movement Analysis Task Force, was integrated into the examination and diagnostic processes. The aims of this perspective paper are to (1) summarize the process followed by the Balance Diagnosis Task Force to develop an initial set of movement system (balance) diagnoses; (2) report the recommended diagnostic labels and associated descriptions; (3) demonstrate the clinical decision-making process used to determine a balance diagnosis and develop a plan of care; and (4) identify next steps to validate and implement the diagnoses into physical therapist practice, education, and research. IMPACT The development and use of diagnostic labels to classify distinct movement system problems is needed in physical therapy. The 10 balance diagnosis proposed can aid in clinical decision making regarding intervention.
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Affiliation(s)
| | - Lois D Hedman
- Department of Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Laura Plummer
- Physical Therapy Department, MGH Institute of Health Professions, Boston, Massachusetts, USA
| | - Leslie Wolf
- Outpatient Neurologic Rehabilitation, OhioHealth, Columbus, Ohio, USA
| | - Timothy Hanke
- Physical Therapy Program, Midwestern University, Downers Grove, Illinois, USA
| | - Lori Quinn
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York, USA
| | - Nora Riley
- Physical Therapy Department, St. Ambrose University, Davenport, Iowa, USA
| | - Regina Kaufman
- Department of Physical Therapy, Springfield College, Springfield, Massachusetts, USA
| | - Akanshka Verma
- Inpatient Rehabilitation Unit & Acute Neurology Service, New York- Presbyterian Hospital, New York, New York, USA
| | - Myla Quiben
- Department of Physical Therapy, School of Health Professions, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Patricia Scheets
- Quality & Clinical Outcomes, Infinity Rehab, Wilsonville, Oregon, USA
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12
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Osho OA, Harbidge C, Hogan DB, Manns PJ, Jones CA. Evaluation of a balance and mobility program for older adults at risk of falling: a mixed methods study. J Eval Clin Pract 2021; 27:307-315. [PMID: 32452089 DOI: 10.1111/jep.13413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 04/22/2020] [Accepted: 04/24/2020] [Indexed: 11/29/2022]
Abstract
RATIONAL, AIMS, AND OBJECTIVES The FallProof Balance and Mobility Program is a multifactorial fall prevention intervention that targets intrinsic risk factors such as muscle strength, balance, gait, and posture. Using mixed methods, we evaluated the implementation of the program for older adults at high risk of falling in the community. METHODS A pre-post program evaluation and semi-structured interviews were used to evaluate FallProof Balance and Mobility Program offered to older adults who were recurrent fallers. Over a 1-year period, the 12-week program was offered five times. Feasibility, acceptability, and outcome evaluation along with semi-structured interviews were done. Over the course of the evaluation, participants were evaluated three times (baseline, 12, and 16 weeks). RESULTS Of the 19 participants, who enrolled in the program, 16 completed the program and 12 attended at least 80% of the classes. Fourteen participants had mildly impaired cognition (Montreal Cognitive Assessment <26). Large gains (effect size 0.90) were seen with self-management (Partner-in-Health Scale). Participants were very satisfied with the program. Three themes emerged from the semi-structured interviews: (a) fall-related benefits, (b) variety of activities and motivating instructors, and (c) deterrents to participation. CONCLUSION Findings provided insights into pragmatic issues of implementing a balance and mobility program for older adults at risk of falling. The FallProof program was found to be feasible and acceptable in a small cohort of older adults from the community.
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Affiliation(s)
- Oluwaseyi A Osho
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Cathy Harbidge
- Calgary Fall Prevention Clinic, Alberta Health Services, Calgary, Alberta, Canada
| | - David B Hogan
- Division of Geriatric Medicine, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Patricia J Manns
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - C Allyson Jones
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
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Backåberg S, Hellström A, Fagerström C, Halling A, Lincke A, Löwe W, Ekstedt M. Evaluation of the Skeleton Avatar Technique for Assessment of Mobility and Balance Among Older Adults. FRONTIERS IN COMPUTER SCIENCE 2020. [DOI: 10.3389/fcomp.2020.601271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Mobility and balance is essential for older adults' well-being and independence and the ability to maintain physically active. Early identification of functional impairment may enable early risk-of-fall assessments and preventive measures. There is a need to find new solutions to assess functional ability in easy, efficient, and accurate ways, which can be clinically used frequently and repetitively. Therefore, we need to understand how functional tests and expert assessments (EAs) correlate with new techniques.Objective: To explore whether the skeleton avatar technique (SAT) can predict the results of functional tests (FTs) of mobility and balance: Timed Up and Go (TUG), the 30-s chair stand test (30sCST), the 4-stage balance test (4SBT), and EA scoring of movement quality.Methods: Fifty-four older adults (+65 years) were recruited through pensioners' associations. The test procedure contained three standardized FTs: TUG, 30sCST, and 4SBT. The test performances were recorded using a three-dimensional SAT camera. EA scoring was performed based on the video recordings of the 30sCST. Functional ability scores were aggregated from balance and mobility scores. Probability theory-based statistical analyses were used on the data to aggregate sets of individual variables into scores, with correlation analysis used to assess the dependency between variables and between scores. Machine learning techniques were used to assess the appropriateness of easily observable variables/scores as predictors of the other variables included.Results: The results indicate that SAT data of the fourth 4SBT stage could be used to predict the aggregated results of all stages of 4SBT (with 7.82% mean absolute error), the results of the 30sCST (11.0%), the TUG test (8.03%), and the EA of the sit-to-stand movement (8.79%). There is a moderate (significant) correlation between the 30sCST and the 4SBT (0.31, p = 0.03), but not between the EA and the 30sCST.Conclusion: SAT can predict the results of the 4SBT, the 30sCST (moderate accuracy), and the TUG test and might add important qualitative information to the assessment of movement performance in active older adults. SAT might in the future provide the means for a simple, easy, and accessible assessment of functional ability among older adults.
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Abou L, Alluri A, Fliflet A, Du Y, Rice LA. Effectiveness of Physical Therapy Interventions in Reducing Fear of Falling Among Individuals With Neurologic Diseases: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2020; 102:132-154. [PMID: 32745544 DOI: 10.1016/j.apmr.2020.06.025] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 06/23/2020] [Accepted: 06/30/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To summarize the effectiveness of physical therapy interventions to reduce fear of falling (FOF) among individuals living with neurologic diseases. DATA SOURCES PubMed, Physiotherapy Evidence Database, Scopus, Web of Science, PsycINFO, Cumulative Index to Nursing and Allied Health, and SportDiscuss were searched from inception until December 2019. STUDY SELECTION Clinical trials with either the primary or secondary aim to reduce FOF among adults with neurologic diseases were selected. DATA EXTRACTION Potential articles were screened for eligibility, and data were extracted by 2 independent researchers. Risk of bias was assessed by the Cochrane Risk of Bias tool for randomized controlled trials and the National Institutes of Health Quality Assessment Tool for pre-post studies. A meta-analysis was performed among trials presenting with similar clinical characteristics. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) was used to rate the overall quality of evidence. RESULTS Sixty-one trials with 3954 participants were included in the review and 53 trials with 3524 participants in the meta-analysis. The included studies presented, in general, with a low to high risk of bias. A combination of gait and balance training was significantly more effective compared with gait training alone in reducing FOF among individuals with Parkinson disease (PD) (mean difference [MD]=11.80; 95% CI, 8.22-15.38; P<.001). Home-based exercise and leisure exercise demonstrated significant improvement in reducing FOF over usual care in multiple sclerosis (MS) (MD=15.27; 95% CI, 6.15-24.38; P=.001). No statistically significant between-groups differences were reported among individuals with stroke and spinal cord injury. The overall quality of evidence presented in this review ranges from very low to moderate according to the assessment with the GRADE approach. CONCLUSIONS Gait with lower limb training combined with balance training is effective in reducing FOF in individuals with PD. Also, home-based or leisure exercise is effective among individuals with MS. However, because of several limitations of the included studies, further research is needed to examine the effectiveness of FOF intervention among individuals with neurologic diseases.
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Affiliation(s)
- Libak Abou
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - Aditya Alluri
- Department of Molecular and Cellular Biology, College of Liberal Arts & Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - Alexander Fliflet
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - Yiting Du
- Department of Interdisciplinary Health Sciences, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - Laura A Rice
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois.
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Peeters G, Bennett M, Donoghue OA, Kennelly S, Kenny RA. Understanding the aetiology of fear of falling from the perspective of a fear-avoidance model – A narrative review. Clin Psychol Rev 2020; 79:101862. [DOI: 10.1016/j.cpr.2020.101862] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 05/06/2020] [Accepted: 05/09/2020] [Indexed: 12/14/2022]
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16
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Esmaeili V, Juneau A, Dyer JO, Lamontagne A, Kairy D, Bouyer L, Duclos C. Intense and unpredictable perturbations during gait training improve dynamic balance abilities in chronic hemiparetic individuals: a randomized controlled pilot trial. J Neuroeng Rehabil 2020; 17:79. [PMID: 32552850 PMCID: PMC7298869 DOI: 10.1186/s12984-020-00707-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 06/08/2020] [Indexed: 11/26/2022] Open
Abstract
Background Previous studies have assessed the effects of perturbation training on balance after stroke. However, the perturbations were either applied while standing or were small in amplitude during gait, which is not representative of the most common fall conditions. The perturbations were also combined with other challenges such as progressive increases in treadmill speed. Objective To determine the benefit of treadmill training with intense and unpredictable perturbations compared to treadmill walking-only training for dynamic balance and gait post-stroke. Methods Twenty-one individuals post-stroke with reduced dynamic balance abilities, with or without a history of fall and ability to walk on a treadmill without external support or a walking aid for at least 1 min were allocated to either an unpredictable gait perturbation (Perturb) group or a walking-only (NonPerturb) group through covariate adaptive randomization. Nine training sessions were conducted over 3 weeks. NonPerturb participants only walked on the treadmill but were offered perturbation training after the control intervention. Pre- and post-training evaluations included balance and gait abilities, maximal knee strength, balance confidence and community integration. Six-week phone follow-ups were conducted for balance confidence and community integration. Satisfaction with perturbation training was also assessed. Results With no baseline differences between groups (p > 0.075), perturbation training yielded large improvements in most variables in the Perturb (p < 0.05, Effect Size: ES > .46) group (n = 10) and the NonPerturb (p ≤ .089, ES > .45) group (n = 7 post-crossing), except for maximal strength (p > .23) in the NonPerturb group. Walking-only training in the NonPerturb group (n = 8, pre-crossing) mostly had no effect (p > .292, ES < .26), except on balance confidence (p = .063, ES = .46). The effects of the gait training were still present on balance confidence and community integration at follow-up. Satisfaction with the training program was high. Conclusion Intense and unpredictable gait perturbations have the potential to be an efficient component of training to improve balance abilities and community integration in individuals with chronic stroke. Retrospective registration: ClinicalTrials.gov. March 18th, 2020. Identifier: NCT04314830.
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Affiliation(s)
- Vahid Esmaeili
- School of Rehabilitation, Université de Montréal, P.O. Box 6128, Station Centre-Ville, Montreal, Quebec, H3C 3J7, Canada.,Centre for Interdisciplinary Research in Rehabilitation-Institut Universitaire sur la Réadaptation en Déficience Physique de Montréal, in CIUSSS du Centre-Sud-de-l'ile-de-Montréal, Montreal, Canada
| | - Andréanne Juneau
- Centre for Interdisciplinary Research in Rehabilitation-Institut Universitaire sur la Réadaptation en Déficience Physique de Montréal, in CIUSSS du Centre-Sud-de-l'ile-de-Montréal, Montreal, Canada.,Lethbridge-Layton-MacKay Rehabilitation Centre, Montréal, Canada
| | - Joseph-Omer Dyer
- School of Rehabilitation, Université de Montréal, P.O. Box 6128, Station Centre-Ville, Montreal, Quebec, H3C 3J7, Canada
| | - Anouk Lamontagne
- Centre for Interdisciplinary Research in Rehabilitation-Institut Universitaire sur la Réadaptation en Déficience Physique de Montréal, in CIUSSS du Centre-Sud-de-l'ile-de-Montréal, Montreal, Canada.,School of Physical and Occupationnal Therapy, McGill University, Montréal, Canada
| | - Dahlia Kairy
- School of Rehabilitation, Université de Montréal, P.O. Box 6128, Station Centre-Ville, Montreal, Quebec, H3C 3J7, Canada.,Centre for Interdisciplinary Research in Rehabilitation-Institut Universitaire sur la Réadaptation en Déficience Physique de Montréal, in CIUSSS du Centre-Sud-de-l'ile-de-Montréal, Montreal, Canada
| | - Laurent Bouyer
- Department of Rehabilitation, Faculty of Medicine, Université Laval and Center for Interdisciplinary Research in Rehabilitation and Social Integration, CIUSSS-CN, Quebec City, Canada
| | - Cyril Duclos
- School of Rehabilitation, Université de Montréal, P.O. Box 6128, Station Centre-Ville, Montreal, Quebec, H3C 3J7, Canada. .,Centre for Interdisciplinary Research in Rehabilitation-Institut Universitaire sur la Réadaptation en Déficience Physique de Montréal, in CIUSSS du Centre-Sud-de-l'ile-de-Montréal, Montreal, Canada.
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Outcomes Following LSVT BIG in a Person With Idiopathic Normal Pressure Hydrocephalus: A Case Report. J Neurol Phys Ther 2020; 44:220-227. [PMID: 32516302 DOI: 10.1097/npt.0000000000000319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE There is no literature exploring physical therapy interventions for individuals with idiopathic normal pressure hydrocephalus (iNPH). There are parallels between symptoms of iNPH and Parkinson disease (PD), suggesting that similar interventions may be beneficial. An approach that promotes recalibration of movements to produce bigger motions (Lee Silverman Voice Treatment BIG [LSVT BIG]) is an evidence-based intervention for individuals with PD, which could potentially improve function in individuals with iNPH. This case report documents functional outcomes of LSVT BIG in an individual with iNPH. CASE DESCRIPTION The participant was a 62-year-old man with a 16-year history of iNPH. He demonstrated hypokinesia, impaired balance, and cognitive deficits. These resulted in frequent falls and limited community ambulation. INTERVENTION The participant completed the standardized 4-week LSVT BIG program in addition to 5 tune-up sessions 7 months later. Outcome measures included the Berg Balance Scale (BBS), Timed Up and Go (TUG), TUG cognitive and manual, Activities-Specific Balance and Confidence (ABC) scale, Five Times Sit to Stand (5TSTS) test, and a timed floor transfer. OUTCOMES Improvements, exceeding minimal detectable change values, were noted on the BBS and the ABC scale immediately following intervention. Scores declined at 4-month follow-up, but BBS scores increased again after the tune-up sessions. Quicker floor transfer times were also noted. There were no changes in TUG, TUG cognitive and manual, or 5TSTS times. DISCUSSION Therapists may wish to consider the use of the LSVT BIG program in persons with iNPH; however, a longer program and/or regular tune-up sessions may be necessary for best outcomes.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A315).
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Systematic Review of the Effects of Cognitive and Behavioral Interventions on Fall-Related Psychological Concerns in Older Adults. J Aging Phys Act 2020; 28:155-168. [DOI: 10.1123/japa.2017-0408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This systematic review aims to evaluate the efficacy of cognitive and behavioral interventions for improving fall-related psychological concerns. A systematic search yielded eight randomized controlled trials eligible for inclusion. All studies compared a cognitive and behavioral intervention with a control. The meta-analysis showed that cognitive and behavioral treatments had beneficial effects on fear of falling outcomes (lower score better) immediately after treatment (random-effects standardized mean difference [SMD]: −0.3, 95% confidence interval [CI] [−0.50, −0.10]) and at the longer term follow-up (random-effects SMD: −0.29, 95% CI [−0.49, −0.09]). Cognitive and behavioral treatments also showed a positive effect on falls efficacy outcomes (higher score better) immediately after treatment (fixed-effects SMD: 0.19, 95% CI [0.04, 0.34]) and over the longer term (fixed-effects SMD: 0.13, 95% CI [−0.00, 0.25]). However, the clinical significance of these effects on fear of falling and falls efficacy was unclear. Further work is required with best-practice comparators over a longer follow-up period.
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19
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Bourque MO, Schneider KL, Calamari JE, Reddin C, Stachowiak A, Major MJ, Duncan C, Muthukrishnan R, Rosenblatt NJ. Combining physical therapy and cognitive behavioral therapy techniques to improve balance confidence and community participation in people with unilateral transtibial amputation who use lower limb prostheses: a study protocol for a randomized sham-control clinical trial. Trials 2019; 20:812. [PMID: 31888708 PMCID: PMC6937857 DOI: 10.1186/s13063-019-3929-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 11/22/2019] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Low balance confidence is a prevalent yet overlooked issue among people who use lower limb prostheses (LLP) that can diminish community integration and quality of life. There is a critical need to develop rehabilitation programs that specifically target balance confidence in people who use LLP. Previous research has shown that multicomponent interventions including cognitive-behavioral therapy (CBT) techniques and exercise are feasible and effective for improving balance confidence in older adults. Therefore, a cognitive behavioral-physical therapy (CBPT) intervention was developed to target balance confidence and increase community integration in people who use LLP. METHODS/DESIGN This randomized control trial will recruit 60 people who use LLP with low balance confidence. Participants will be randomized to the CBPT intervention condition or control condition. DISCUSSION The trial is designed to test the effects of the CBPT intervention on balance confidence and functional mobility in lower limb prosthesis users by examining self-reported and objective measures of community integration and quality of life. The trial will also examine the relationship between changes in balance confidence and changes in community integration following participation in CBPT intervention. Additionally, through participant feedback, researchers will identify opportunities to improve intervention efficacy. TRIAL REGISTRATION ClinicalTrials.gov, NCT03411148. Registration date: January 26, 2018.
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Affiliation(s)
- McKenzie O. Bourque
- Department of Psychology, Rosalind Franklin University of Medicine and Science, 3333 Green Bay Road, North Chicago, IL 60064 USA
| | - Kristin L. Schneider
- Department of Psychology, Rosalind Franklin University of Medicine and Science, 3333 Green Bay Road, North Chicago, IL 60064 USA
| | - John E. Calamari
- Department of Psychology, Rosalind Franklin University of Medicine and Science, 3333 Green Bay Road, North Chicago, IL 60064 USA
| | - Christopher Reddin
- Captain James A Lovell Federal Health Care Center, 2450 Buckley Rd, North Chicago, IL 60064 USA
| | - Aaron Stachowiak
- Captain James A Lovell Federal Health Care Center, 2450 Buckley Rd, North Chicago, IL 60064 USA
| | - Matthew J. Major
- Department of Physical Medicine and Rehabilitation, Northwestern University, Prosthetics and Orthotics Center, 680 North Lake Shore Drive, Chicago, IL 60611 USA
- Jesse Brown VA Medical Center, 820 S Damen Ave, Chicago, IL 60612 USA
| | - Chad Duncan
- Department of Physical Medicine and Rehabilitation, Northwestern University, Prosthetics and Orthotics Center, 680 North Lake Shore Drive, Chicago, IL 60611 USA
| | | | - Noah J. Rosenblatt
- Dr. William M. Scholl College of Podiatric Medicines’ Center for Lower Extremity Ambulatory Research (CLEAR), Rosalind Franklin University of Medicine and Science, 3333 Green Bay Road, North Chicago, IL 60064 USA
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20
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Chen SK, Voaklander D, Perry D, Jones CA. Falls and fear of falling in older adults with total joint arthroplasty: a scoping review. BMC Musculoskelet Disord 2019; 20:599. [PMID: 31830974 PMCID: PMC6909481 DOI: 10.1186/s12891-019-2954-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 11/18/2019] [Indexed: 01/27/2023] Open
Abstract
Background Patients waiting or recovering from total joint arthroplasty (TJA) are at risk for falls which can lead to restriction of activity and negatively impact recovery. The objective of this scoping review is to critically appraise and synthesize the evidence in the reported number of falls, fear of falling, and risk factors associated with falls in older patients waiting for or recovering from TJA. Methods Seven electronic databases were searched with no date limits and using language restriction (English). The inclusion criteria were 1) cohorts that included older adults 60+ years of age, 2) reported prevalence of falls, fear of falling, and/or risk factors for falls in patients who were waiting or recovering from TJA and 3) cross-sectional studies, cohort studies, and case control study designs. The quality assessment of selected articles was assessed using the SIGN Guidelines Checklist. Results Of the 866 citations identified, 12 studies met the inclusion criteria and were reviewed. Prevalence of falls in pre-operative TJA patients and post-operative TJA patients ranged from 23 to 63%, and 13 to 42%, respectively. Of those five studies that examined fear of falling, pre-operative TJA patients reported greater fear of falling than post-operative patients. Modifiable risk factors for falls included fear of falling, joint range of motion, and depression. Conclusions An increased risk of falls in patients with TJA was reported both for patients waiting for and recovering from surgery. A number of modifiable risk factors were identified including fear of falling that could be targeted in fall prevention programs for TJA.
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Affiliation(s)
- Serena Kuangyi Chen
- School of Public Health, University of Alberta Edmonton, Alberta, T6G 1C9, Canada
| | - Don Voaklander
- School of Public Health, University of Alberta Edmonton, Alberta, T6G 1C9, Canada
| | - Danielle Perry
- School of Public Health, University of Alberta Edmonton, Alberta, T6G 1C9, Canada
| | - C Allyson Jones
- Department of Physical Therapy, University of Alberta Edmonton, Alberta, T6G 2G4, Canada.
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21
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Evers SMAA, Dorresteijn TAC, Wijnen BFM, van Haastregt JCM, Kempen GIJM, Zijlstra GAR. Economic evaluation of a home-based programme to reduce concerns about falls in frail, independently-living older people. Expert Rev Pharmacoecon Outcomes Res 2019; 20:641-651. [PMID: 31502897 DOI: 10.1080/14737167.2019.1666714] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Concerns about falls, or fear of falling, are frequently reported by older people and can have serious consequences. Aim of this study was to evaluate the cost-effectiveness of a home-based, cognitive behavioral programme for independently-living, frail older people in comparison with usual care from a societal perspective. Methods: This economic evaluation was embedded in a randomized-controlled trial with a follow-up of 12-months. In the trial 389 people aged 70 years or older were allocated to usual care (n = 195) or the intervention group (n = 194). The intervention group received a home-based, cognitive behavioral programme. Main outcome measures were concerns about falls and Quality Adjusted Life Years (QALYs). Results: Average total costs per participant in the usual care group were 8,094 Euros and 7,890 Euros for participants in the intervention group. The intervention group showed a significant decrease in concerns about falls and a non-significant increase in QALYS in comparison with the usual care group. The probability that the intervention was cost-effective was 75% at a willingness to pay of 20,000 Euros per QALY. Discussion: The programme is likely to be cost-effective, and therefore a useful addition to current geriatric care, particularly for those persons who are not able or willing to attend group programmes. Trial registration: NCT01358032.
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Affiliation(s)
- Silvia M A A Evers
- Department of Health Services Research CAPHRI School for Public Health and Primary Care, Maastricht University , Maastricht, The Netherlands.,Department of Public Mental Health Centre for economic evaluations, Trimbos Institute, Netherlands Institute of Mental Health and Addiction , Utrecht, The Netherlands
| | - Tanja A C Dorresteijn
- Department of Health Services Research CAPHRI School for Public Health and Primary Care, Maastricht University , Maastricht, The Netherlands
| | - Ben F M Wijnen
- Department of Health Services Research CAPHRI School for Public Health and Primary Care, Maastricht University , Maastricht, The Netherlands.,Department of Public Mental Health Centre for economic evaluations, Trimbos Institute, Netherlands Institute of Mental Health and Addiction , Utrecht, The Netherlands.,Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre , Maastricht, The Netherlands
| | - Jolanda C M van Haastregt
- Department of Health Services Research CAPHRI School for Public Health and Primary Care, Maastricht University , Maastricht, The Netherlands
| | - Gertrudis I J M Kempen
- Department of Health Services Research CAPHRI School for Public Health and Primary Care, Maastricht University , Maastricht, The Netherlands
| | - G A Rixt Zijlstra
- Department of Health Services Research CAPHRI School for Public Health and Primary Care, Maastricht University , Maastricht, The Netherlands
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Kongsuk J, Brown DA, Hurt CP. Dynamic stability during increased walking speeds is related to balance confidence of older adults: a pilot study. Gait Posture 2019; 73:86-92. [PMID: 31302337 PMCID: PMC6711748 DOI: 10.1016/j.gaitpost.2019.06.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 06/21/2019] [Accepted: 06/22/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Some older individuals walk slower, which may be due to decreases in mechanical stability at faster speeds or due to psychological factors like balance confidence. RESEARCH QUESTION What is the relationship between progressively increasing walking speeds on dynamic stability in older and younger adults and how does this relationship interact with balance confidence in older adults? METHODS 10 young adults and 14 older adults were recruited for this pilot study. Individuals completed the Activities Specific Balance Confidence Scale. Individuals walked on a treadmill in a robotic device that interfaced with individuals at the pelvis allowing all degrees of freedom of movement and provided safety for a loss of balance. Participants walked at speeds from 0.4 - 2.0m/s in 0.2m/s increments or until the participant chose not to attempt a faster speed. Margin of stability was assessed. RESULTS The ABC of older adults was lower than younger adults (89±13 vs 99±1 scores, p=0.006) and some older adults chose to stop walking before 2.0m/s (n=6). The margin of stability variability of the older adults was significantly greater than young adults in the sagittal (p=0.013) and frontal plane (p=0.007). Older adults became unstable (margin of stability<0) at a slower speed (p<0.001). For older adults, balance confidence was correlated to the fastest speed attempted on the treadmill (rho=0.85, p<0.001). However, the balance confidence and walking speed individuals became unstable were not significantly correlated. Finally, a significant relationship was found between the zero crossing and the fastest speed attempted (rho=0.60, p=0.022). SIGNIFICANCE Some older adults with lower balance confidence were less willing to experience instability at faster walking speeds on the treadmill, even though the external threat to balance was low. Lower balance confidence and a sense of loss of stability may be factors in decreased willingness to experience activities for some older adults.
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Affiliation(s)
- Jutaluk Kongsuk
- Rehabilitation Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - David A. Brown
- Rehabilitation Sciences, University of Alabama at Birmingham, Birmingham, AL, USA,Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Christopher P Hurt
- Rehabilitation Sciences, University of Alabama at Birmingham, Birmingham, AL, USA,Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA,Corresponding author: Department of Physical Therapy, University of Alabama at Birmingham, 1720 2nd Avenue South Birmingham, Alabama 35294 Tel: 205.934.3566 FAX: 205.975.7787, (C.P. Hurt)
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Paraschiv-Ionescu A, Büla CJ, Major K, Lenoble-Hoskovec C, Krief H, El-Moufawad C, Aminian K. Concern about Falling and Complexity of Free-Living Physical Activity Patterns in Well-Functioning Older Adults. Gerontology 2018; 64:603-611. [PMID: 29972821 DOI: 10.1159/000490310] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 05/23/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Fall-related psychological concerns are common among older adults, potentially contributing to functional decline as well as to restriction of activities and social participation. To effectively prevent such negative consequences, it is important to understand how even very low concern about falling could affect physical activity behavior in everyday life. We hypothesized that concern about falling is associated with a reduction in diversity, dynamics, and performance of daily activities, and that these features can be comprehensively quantified in terms of complexity of physical activity patterns. METHODS A sample of 40 community-dwelling older adults were assessed for concern about falling using the Falls Efficacy Scale-International (FES-I). Free-living physical activity was assessed using a set of metrics derived from data recorded with a chest-worn tri-axial accelerometer. The devised metrics characterized physical activity behavior in terms of endurance (total locomotion time, longest locomotion period, usual walking cadence), performance (cadence of longest locomotion period, locomotion periods with at least 30 steps and 100 steps/min), and complexity of physical activity patterns. Complexity was quantified according to variations in type, intensity, and duration of activities, and was considered as an adaptive response to environmental exigencies over the course of the day. RESULTS Based on FES-I score, participants were classified into two groups: not concerned at all/fully confident (n = 25) and concerned/less confident (n = 15). Demographic and health-related variables did not differ significantly between groups. Comparison of physical activity behavior indicated no significant differences for endurance-related metrics. In contrast, performance and complexity metrics were significantly lower in the less confident group compared to the fully confident group. Among all metrics, complexity of physical activity patterns appeared as the most discriminative feature between fully confident and less confident participants (p = 0.001, non-parametric Cliff's delta effect size = 0.63). CONCLUSIONS These results extend our understanding of the interplay between low concern about falling and physical activity behavior of community-dwelling older persons in their everyday life context. This information could serve to better design and evaluate personalized intervention programs in future prospective studies.
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Affiliation(s)
| | - Christophe J Büla
- Service of Geriatric Medicine, University of Lausanne Medical Center (CHUV), Lausanne, Switzerland
| | - Kristof Major
- Service of Geriatric Medicine, University of Lausanne Medical Center (CHUV), Lausanne, Switzerland
| | | | - Hélène Krief
- Service of Geriatric Medicine, University of Lausanne Medical Center (CHUV), Lausanne, Switzerland
| | - Christopher El-Moufawad
- Institute of Bioengineering, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Kamiar Aminian
- Institute of Bioengineering, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
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Liu TW, Ng GYF, Chung RCK, Ng SSM. Cognitive behavioural therapy for fear of falling and balance among older people: a systematic review and meta-analysis. Age Ageing 2018; 47:520-527. [PMID: 29471428 DOI: 10.1093/ageing/afy010] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 12/22/2017] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND fear of falling is prevalent among older people and associated with various health outcomes. A growing number of studies have examined the effects of interventions designed to reduce the fear of falling and improve balance among older people, yet our current understanding is restricted to physiological interventions. Psychological interventions such as cognitive behavioural therapy (CBT) have not been reviewed and meta-analysed. OBJECTIVE to perform a systematic review and meta-analysis evaluating the effects of CBT on reducing fear of falling and enhancing balance in community-dwelling older people. METHOD randomised controlled trials (RCTs) addressing fear of falling and balance were identified through searches of six electronic databases, concurrent registered clinical trials, forward citation and reference lists of three previous systematic reviews. RESULTS a total of six trials involving 1,626 participants were identified. Four studies used group-based interventions and two adopted individual intervention. Intervention period ranged from 4 to 20 weeks, and the number and duration of face-to-face contact varied. Core components of the CBT intervention included cognitive restructuring, personal goal setting and promotion of physical activities. The risk of bias was low across the included studies. Our analysis suggests that CBT interventions have significant immediate and retention effects up to 12 months on reducing fear of falling, and 6 months post-intervention effect on enhancing balance. CONCLUSIONS CBT appears to be effective in reducing fear of falling and improving balance among older people. Future researches to investigate the use of CBT on reducing fear of falling and improving balance are warranted.
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Affiliation(s)
- Tai-Wa Liu
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong (SAR), China
- School of Nursing and Health Studies, The Open University of Hong Kong, Ho Man Tin, Hong Kong (SAR), China
| | - Gabriel Y F Ng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong (SAR), China
| | - Raymond C K Chung
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong (SAR), China
| | - Shamay S M Ng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong (SAR), China
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Skelton DA, Mavroeidi A. Which strength and balance activities are safe and efficacious for individuals with specific challenges (osteoporosis, vertebral fractures, frailty, dementia)?: A Narrative review. J Frailty Sarcopenia Falls 2018; 3:85-104. [PMID: 32300697 PMCID: PMC7155323 DOI: 10.22540/jfsf-03-085] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2018] [Indexed: 12/29/2022] Open
Abstract
Physical activity guidelines advocate the inclusion of strength and balance activities, twice a week, for adults and older adults, but with caveat that in some individuals there will be certain movements and activities that could lead to adverse events. This scoping review summarizes the evidence about how safe and efficacious these activities are in older adults with specific challenges that might make them more prone to injury (e.g. having recently fractured or at risk of fracture (osteoporosis) or those who are frail or who have cognitive impairment). The review identified that for prevention of falls in people with a falls history and/or frailer older adults, structured exercise programmes that incorporate progressive resistance training (PRT) with increasing balance challenges over time are safe and effective if performed regularly, with supervision and support, over at least 6 months. Some minor adverse effects mainly transient musculoskeletal pain) have been reported. For those with a higher risk of falls and fractures (very poor balance, vertebral fractures), supervised structured exercise programmes are most appropriate. People with diagnosed osteoporosis should be as active as possible and only avoid activities with a high risk of falls if they are naïve to those activities. For those in transition to frailty who have poor strength and balance, exercises that are known to help maintain strength and balance (such as Tai Chi) are effective in preventing a decline in falls risk. For the very frail older adult, supervised structured exercise that has PRT, balance training and some endurance work, supervised and progressed by a trained person are advocated.
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Affiliation(s)
- Dawn A. Skelton
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Alexandra Mavroeidi
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
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Liu TW, Ng GYF, Ng SSM. Effectiveness of a combination of cognitive behavioral therapy and task-oriented balance training in reducing the fear of falling in patients with chronic stroke: study protocol for a randomized controlled trial. Trials 2018; 19:168. [PMID: 29514677 PMCID: PMC5842580 DOI: 10.1186/s13063-018-2549-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 02/15/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The consequences of falls are devastating for patients with stroke. Balance problems and fear of falling are two major challenges, and recent systematic reviews have revealed that habitual physical exercise training alone cannot reduce the occurrence of falls in stroke survivors. However, recent trials with community-dwelling healthy older adults yielded the promising result that interventions with a cognitive behavioral therapy (CBT) component can simultaneously promote balance and reduce the fear of falling. Therefore, the aim of the proposed clinical trial is to evaluate the effectiveness of a combination of CBT and task-oriented balance training (TOBT) in promoting subjective balance confidence, and thereby reducing fear-avoidance behavior, improving balance ability, reducing fall risk, and promoting independent living, community reintegration, and health-related quality of life of patients with stroke. METHODS The study will constitute a placebo-controlled single-blind parallel-group randomized controlled trial in which patients are assessed immediately, at 3 months, and at 12 months. The selected participants will be randomly allocated into one of two parallel groups (the experimental group and the control group) with a 1:1 ratio. Both groups will receive 45 min of TOBT twice per week for 8 weeks. In addition, the experimental group will receive a 45-min CBT-based group intervention, and the control group will receive 45 min of general health education (GHE) twice per week for 8 weeks. The primary outcome measure is subjective balance confidence. The secondary outcome measures are fear-avoidance behavior, balance ability, fall risk, level of activities of daily living, community reintegration, and health-related quality of life. DISCUSSION The proposed clinical trial will compare the effectiveness of CBT combined with TOBT and GHE combined with TOBT in promoting subjective balance confidence among chronic stroke patients. We hope our results will provide evidence of a safe, cost-effective, and readily transferrable therapeutic approach to clinical practice that reduces fear-avoidance behavior, improves balance ability, reduces fall risk, promotes independence and community reintegration, and enhances health-related quality of life. TRIAL REGISTRATION ClinicalTrials.gov, NCT02937532 . Registered on 17 October 2016.
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Affiliation(s)
- Tai-Wa Liu
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, Special Administrative Region of China
- Division of Nursing and Health Studies, The Open University of Hong Kong, Ho Man Tin, Hong Kong, Special Administrative Region of China
| | - Gabriel Y. F. Ng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, Special Administrative Region of China
| | - Shamay S. M. Ng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, Special Administrative Region of China
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Jones GR, Stathokostas L, Young BW, Wister AV, Chau S, Clark P, Duggan M, Mitchell D, Nordland P. Development of a physical literacy model for older adults - a consensus process by the collaborative working group on physical literacy for older Canadians. BMC Geriatr 2018; 18:13. [PMID: 29338694 PMCID: PMC5769546 DOI: 10.1186/s12877-017-0687-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 12/12/2017] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Arguably the uptake and usability of the physical activity (PA) guidelines for older adults has not been effective with only 12% of this population meeting the minimum guidelines to maintain health. Health promoters must consider innovative ways to increase PA adoption and long-term sustainability. Physical literacy (PL) is emerging as a promising strategy to increase lifelong PA participation in younger age-groups, yet there is relatively little evidence of PL being used to support older adults in achieving the PA guidelines. METHODS An iterative and mixed-methods consensus development process was utilized over a series of six informed processes and meetings to develop a model of physical literacy for adults aged 65 years and older. RESULTS A multi-disciplinary collaborative working group (n = 9) from diverse practice settings across Canada, and representative and reflective of the full range of key elements of PL, was assembled. Three consensus meetings and two Delphi surveys, using an international cohort of 65 expert researchers, practitioners, non-government organizations and older adults, was conducted. 45% responded on the first round and consensus was achieved; however, we elected to run a second survey to support our results. With 79% response rate, there was consensus to support the new PL model for older adults. CONCLUSION Older adults are a unique group who have yet to be exposed to PL as a means to promote long-term PA participation. This new PL model uses an ecological approach to integrate PL into the lifestyles of most older adults. Understanding the interactions between components and elements that facilitate PL will ultimately provide a new and effective tool to target PA promotion and adherence for all older Canadians.
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Affiliation(s)
- Gareth R. Jones
- School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia Okanagan Campus, Kelowna, BC V1V 1V7 Canada
| | - Liza Stathokostas
- School of Kinesiology, Faculty of Health Sciences, University of Western Ontario, London, ON N6A 3K7 Canada
| | - Bradley W. Young
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5 Canada
| | - Andrew V. Wister
- Gerontology Department, Simon Fraser University, Vancouver, BC V6B 5K3 Canada
| | - Shirley Chau
- School of Social Work, Faculty of Health & Social Development, University of British ColumbiaOkanagan Campus, Kelowna, BC V1V 1V7 Canada
| | | | - Mary Duggan
- Canadian Society for Exercise Physiology, Ottawa, ON K1R 6Y6 Canada
| | - Drew Mitchell
- Physical Literacy, Sport for Life, Port Moody, BC V3H 4W6 Canada
| | - Peter Nordland
- Canadian Senior Games Association, Edmonton, AB T6H 4J8 Canada
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A Cross-sectional Analysis of the Characteristics of Individuals With Parkinson Disease Who Avoid Activities and Participation Due to Fear of Falling. J Neurol Phys Ther 2017; 41:31-42. [PMID: 27977519 DOI: 10.1097/npt.0000000000000162] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND PURPOSE Avoidance behavior can have deleterious consequences on health and quality of life for persons with Parkinson disease (PD); for this reason, it is important to identify potentially mitigable characteristics. We compared the characteristics of individuals with PD who exhibit fear of falling (FOF) avoidance behavior with those who do not. METHODS Fifty-nine participants with PD were classified as avoiders (n = 27) or nonavoiders (n = 32) by using the Fear of Falling Avoidance Behavior Questionnaire and compared across 5 domains: demographic characteristics; PD-specific symptoms (subtype, Movement Disorder Society-Unified Parkinson's Disease Rating Scale [MDS-UPDRS], Hoehn and Yahr Scale, Parkinson's Disease Questionnaire-39 [PDQ-39]); balance and falls (fall history, Berg Balance Scale [BBS], Activities-Specific Balance Confidence [ABC] Scale, Impact of Events Scale, Consequences of Falling Questionnaire [CoFQ]); physical performance (30 Second Sit-to-Stand Test, Timed Up and Go Test, physical activity monitoring); and psychological factors (Zung Anxiety Scale, Beck Depression Inventory [BDI]). RESULTS There were no differences between avoiders and nonavoiders for demographic characteristics and fall history (Ps > 0.272). Avoiders had worse MDS-UPDRS (Ps < 0.014) and PDQ-39 scores (Ps < 0.028). Avoiders had poorer balance performance (BBS, P = 0.003), lower balance confidence (ABC, P < 0.001), and more fall catastrophization (CoFQ, P < 0.001). Avoiders reported more depression (P = 0.015) and anxiety (P = 0.028). DISCUSSION AND CONCLUSIONS PD FOF avoiders had more involved symptoms and scored lower on balance and physical performance measures. In addition, they reported greater psychological stress. Several potentially mitigable characteristics of those with FOF avoidance behavior were identified.Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A153).
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Underwood F, Burrows L, Gegg R, Latour JM, Kent B. The meaning of confidence for older people living with frailty: a qualitative systematic review. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2017; 15:1316-1349. [PMID: 28498173 DOI: 10.11124/jbisrir-2016-002951] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
BACKGROUND In many countries, the oldest old (those aged 85 years and older) are now the fastest growing proportion of the total population. This oldest population will increasingly be living with the clinical condition of frailty. Frailty syndromes negatively impact on the person as they do the healthcare systems supporting them. Within healthcare literature "loss of confidence" is occasionally connected to older people living with frailty, but ambiguously described. Understanding the concept of confidence within the context of frailty could inform interventions to meet this growing challenge. OBJECTIVES The objective of this systematic review was to explore the meaning of confidence from the perspective of older people living with frailty through synthesis of qualitative evidence to inform healthcare practice, research and policy. INCLUSION CRITERIA TYPES OF PARTICIPANTS Studies that included frail adults, aged over 60 years, experiencing acute hospital and or post-acute care in the last 12 months. PHENOMENA OF INTEREST The concept of "confidence" and its impact on the physical health and mental well-being of older people living with frailty. CONTEXT Studies that reported on the older person's descriptions, understanding and meaning of confidence in relation to their frailty or recent healthcare experiences. TYPES OF STUDIES Studies of qualitative design and method. SEARCH STRATEGY A three step search strategy was used. The search strategy explored published studies and gray literature. Publications in English from the last 20 years were considered for inclusion. METHODOLOGICAL QUALITY All included articles were assessed by two independent reviewers using the Joanna Briggs Institute Qualitative Assessment Review Instrument (JBI-QARI). DATA EXTRACTION Data were extracted from included studies using the data extraction tools developed by the Joanna Briggs Institute. DATA SYNTHESIS Qualitative research findings were collated using a meta-aggregative approach and JBI-QARI software. RESULTS Synthesized findings of this review were drawn from just four research studies that met the inclusion criteria. Only six findings contributed to the creation of three categories. These informed a single synthesized finding: Vulnerability, described as a fragile state of well-being that is exposed to the conflicting tensions between physical, emotional and social factors. These tensions have the capability to enhance or erode this state. CONCLUSIONS Assertions that an understanding of the concept confidence has been reached cannot be made. The review data offer limited insight into the concept of confidence being described by the cohort of older people living with frailty.
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Affiliation(s)
- Frazer Underwood
- 1Royal Cornwall Hospitals NHS Trust, Truro, UK 2School of Nursing and Midwifery, Faculty of Health and Human Science, Plymouth University, Plymouth, UK 3The University of Plymouth Centre for Innovations in Health and Social Care: a Joanna Briggs Institute Centre of Excellence, UK
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Solloway MR, Taylor SL, Shekelle PG, Miake-Lye IM, Beroes JM, Shanman RM, Hempel S. An evidence map of the effect of Tai Chi on health outcomes. Syst Rev 2016; 5:126. [PMID: 27460789 PMCID: PMC4962385 DOI: 10.1186/s13643-016-0300-y] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Accepted: 07/14/2016] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND This evidence map describes the volume and focus of Tai Chi research reporting health outcomes. Originally developed as a martial art, Tai Chi is typically taught as a series of slow, low-impact movements that integrate the breath, mind, and physical activity to achieve greater awareness and a sense of well-being. METHODS The evidence map is based on a systematic review of systematic reviews. We searched 11 electronic databases from inception to February 2014, screened reviews of reviews, and consulted with topic experts. We used a bubble plot to graphically display clinical topics, literature size, number of reviews, and a broad estimate of effectiveness. RESULTS The map is based on 107 systematic reviews. Two thirds of the reviews were published in the last five years. The topics with the largest number of published randomized controlled trials (RCTs) were general health benefits (51 RCTs), psychological well-being (37 RCTs), interventions for older adults (31 RCTs), balance (27 RCTs), hypertension (18 RCTs), fall prevention (15 RCTs), and cognitive performance (11 RCTs). The map identified a number of areas with evidence of a potentially positive treatment effect on patient outcomes, including Tai Chi for hypertension, fall prevention outside of institutions, cognitive performance, osteoarthritis, depression, chronic obstructive pulmonary disease, pain, balance confidence, and muscle strength. However, identified reviews cautioned that firm conclusions cannot be drawn due to methodological limitations in the original studies and/or an insufficient number of existing research studies. CONCLUSIONS Tai Chi has been applied in diverse clinical areas, and for a number of these, systematic reviews have indicated promising results. The evidence map provides a visual overview of Tai Chi research volume and content. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42014009907.
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Affiliation(s)
| | | | - Paul G Shekelle
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.,VA Evidence-based Synthesis Program (ESP) Center, Los Angeles, CA, USA.,University of California, Los Angeles, CA, USA.,Evidence-based Practice Center (EPC), RAND Corporation, Santa Monica, CA, USA
| | - Isomi M Miake-Lye
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.,VA Evidence-based Synthesis Program (ESP) Center, Los Angeles, CA, USA
| | - Jessica M Beroes
- VA Evidence-based Synthesis Program (ESP) Center, Los Angeles, CA, USA
| | - Roberta M Shanman
- Evidence-based Practice Center (EPC), RAND Corporation, Santa Monica, CA, USA
| | - Susanne Hempel
- Evidence-based Practice Center (EPC), RAND Corporation, Santa Monica, CA, USA.
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Del-Pino-Casado R, Obrero-Gaitán E, Lomas-Vega R. The Effect of Tai Chi on Reducing the Risk of Falling: A Systematic Review and Meta-Analysis. THE AMERICAN JOURNAL OF CHINESE MEDICINE 2016; 44:895-906. [PMID: 27430918 DOI: 10.1142/s0192415x1650049x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Tai Chi has frequently been used as a preventive measure against falling in at-risk populations. However, studies have yielded contradictory results, and literature reviews have considered only a small number of trials and have not addressed some key aspects, such as sources of heterogeneity and publication bias. This study includes 13 controlled trials published before June 2015 that analyzed the effectiveness of Tai Chi in fall prevention in populations of frail and at-risk adults. The effect measure used in this meta-analysis was absolute risk reduction (ARR) with a 95% confidence interval (CI). According to our findings, practice of Tai Chi significantly prevents the risk of falling (ARR, [Formula: see text]; 95% CI: [Formula: see text], [Formula: see text]). The heterogeneity of results across the trials was low, with a reduced risk of publication bias, and no significant effect differences were observed between studies comparing Tai Chi with other interventions or non-treatment. We therefore conclude that Tai Chi is more effective than other measures, or no intervention, for fall prevention in at-risk populations. Further research is warranted to analyze the consequences of falls and to study the episodes rather than the cases of falls.
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Affiliation(s)
| | | | - Rafael Lomas-Vega
- ‡ Faculty of Health Science, Department of Health Science, University of Jaen, Jaen, Spain
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Goldberg A, Talley SA, Adamo DE. Construct validity of the Modified Gait Efficacy Scale in older females. Physiother Theory Pract 2016; 32:307-14. [DOI: 10.3109/09593985.2016.1138349] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Allon Goldberg
- School of Health Professions and Studies, Physical Therapy Department, University of Michigan-Flint, Flint, MI, USA
| | - Susan Ann Talley
- School of Health Professions and Studies, Physical Therapy Department, University of Michigan-Flint, Flint, MI, USA
| | - Diane E. Adamo
- Department of Health Care Sciences, Physical Therapy Program, Wayne State University, Detroit, MI, USA
- Institute of Gerontology, Wayne State University, Detroit, MI, USA
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Eichinger K, Odrzywolski K, Sowden J, Herrmann DN. Patient Reported Falls and Balance Confidence in Individuals with Charcot-Marie-Tooth Disease. J Neuromuscul Dis 2016; 3:289-292. [DOI: 10.3233/jnd-160159] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Kumar A, Delbaere K, Zijlstra GAR, Carpenter H, Iliffe S, Masud T, Skelton D, Morris R, Kendrick D. Exercise for reducing fear of falling in older people living in the community: Cochrane systematic review and meta-analysis. Age Ageing 2016; 45:345-52. [PMID: 27121683 DOI: 10.1093/ageing/afw036] [Citation(s) in RCA: 143] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 01/20/2016] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE to determine the effect of exercise interventions on fear of falling in community-living people aged ≥65. DESIGN systematic review and meta-analysis. Bibliographic databases, trial registers and other sources were searched for randomised or quasi-randomised trials. Data were independently extracted by pairs of reviewers using a standard form. RESULTS thirty trials (2,878 participants) reported 36 interventions (Tai Chi and yoga (n = 9); balance training (n = 19); strength and resistance training (n = 8)). The risk of bias was low in few trials. Most studies were from high-income countries (Australia = 8, USA = 7). Intervention periods (<12 weeks = 22; 13-26 weeks = 7; >26 weeks = 7) and exercise frequency (1-3 times/week = 32; ≥4 times/week = 4) varied between studies. Fear of falling was measured by single-item questions (7) and scales measuring falls efficacy (14), balance confidence (9) and concern or worry about falling (2). Meta-analyses showed a small to moderate effect of exercise interventions on reducing fear of falling immediately post-intervention (standardised mean difference (SMD) 0.37, 95% CI 0.18, 0.56; 24 studies; low-quality evidence). There was a small, but not statistically significant effect in the longer term (<6 months (SMD 0.17, 95% CI -0.05, 0.38 (four studies) and ≥6 months post-intervention SMD 0.20, 95% CI -0.01, 0.41 (three studies)). CONCLUSIONS exercise interventions probably reduce fear of falling to a small to moderate degree immediately post-intervention in community-living older people. The high risk of bias in most included trials suggests findings should be interpreted with caution. High-quality trials are needed to strengthen the evidence base in this area.
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Affiliation(s)
- Arun Kumar
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Kim Delbaere
- NeuRA, University of New South Wales, New South Wales, Australia
| | - G A R Zijlstra
- Department of Health Services Research, Maastricht University and CAPHRI School for Public Health and Primary Care, Maastricht, The Netherlands
| | - Hannah Carpenter
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Steve Iliffe
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Tahir Masud
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Dawn Skelton
- Institute of Allied Health Research, Glasgow Caledonian University, Glasgow, UK
| | - Richard Morris
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Denise Kendrick
- Division of Primary Care, University of Nottingham, Nottingham, UK
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Kostić R, Uzunović S, Purenović-Ivanović T, Miletić Đ, Katsora G, Pantelić S, Milanović Z. The effects of dance training program on the postural stability of middle aged women. Cent Eur J Public Health 2016; 23 Suppl:S67-73. [PMID: 26849547 DOI: 10.21101/cejph.a4206] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 05/29/2015] [Indexed: 11/15/2022]
Abstract
AIM The aim of the study was to determine the effects of Greek folk dancing on postural stability in middle age women. METHODS Sixty-three women aged from 47-53 participated in this study. All participants were randomly divided into the experimental group - 33 participants (mean ± SD; body height=160.13 ± 12.07 cm, body mass=63.81 ± 10.56 kg), and the control group - 30 participants (mean ± SD; body height=160.63 ± 6.22 cm, body mass=64.79 ± 8.19 kg). The following tests were used to evaluate the motor balance and posture stability of participants; the double-leg stance along the length of a balance beam (eyes open), the double-leg stance along the width of a balance beam (eyes open), the single-leg stance (eyes open) and the double-leg stance on one's toes (eyes closed). The Functional Reach Test for balance and the Star Excursion Balance Test were used to evaluate dynamic balance. RESULTS The multivariate analysis of covariance of static and dynamic balance between participants of the experimental and control group at the final measuring, with neutralized differences at the initial measuring (Wilks' λ=0.45), revealed a significant difference (p<0.05). The intergroup difference at the final measuring was also found to be significant (p<0.05) for the following variables; the double-leg stance on one's toes, the Functional Reach Test, balance of the right anterolateral, balance of the right posterolateral and balance of the left posteromedial. CONCLUSION An organized dance activity programme does lead to the improvement of static and dynamic balance in middle aged women.
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Affiliation(s)
- Radmila Kostić
- Faculty of Sport and Physical Education, University of Niš, Niš, Serbia
| | | | | | | | | | - Saša Pantelić
- Faculty of Sport and Physical Education, University of Niš, Niš, Serbia
| | - Zoran Milanović
- Faculty of Sport and Physical Education, University of Niš, Niš, Serbia
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Dorresteijn TAC, Zijlstra GAR, Ambergen AW, Delbaere K, Vlaeyen JWS, Kempen GIJM. Effectiveness of a home-based cognitive behavioral program to manage concerns about falls in community-dwelling, frail older people: results of a randomized controlled trial. BMC Geriatr 2016; 16:2. [PMID: 26739339 PMCID: PMC4704266 DOI: 10.1186/s12877-015-0177-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 12/17/2015] [Indexed: 11/05/2022] Open
Abstract
Background Concerns about falls are common among older people. These concerns, also referred to as fear of falling, can have serious physical and psychosocial consequences, such as functional decline, increased risk of falls, activity restriction, and lower social participation. Although cognitive behavioral group programs to reduce concerns about falls are available, no home-based approaches for older people with health problems, who may not be able to attend such group programs are available yet. The aim of this study was to assess the effectiveness of a home-based cognitive behavioral program on concerns about falls, in frail, older people living in the community. Methods In a randomized controlled trial in the Netherlands, 389 people aged 70 years and older, in fair or poor perceived health, who reported at least some concerns about falls and related activity avoidance were allocated to a control (n = 195) or intervention group (n = 194). The intervention was a home-based, cognitive behavioral program consisting of seven sessions including three home visits and four telephone contacts. The program aims to instill adaptive and realistic views about fall risks via cognitive restructuring and to increase activity and safe behavior using goal setting and action planning and was facilitated by community nurses. Control group participants received usual care. Outcomes at 5 and 12 months follow-up were concerns about falls, activity avoidance due to concerns about falls, disability and falls. Results At 12 months, the intervention group showed significant lower levels of concerns about falls compared to the control group. Furthermore, significant reductions in activity avoidance, disability and indoor falls were identified in the intervention group compared with the control group. Effect sizes were small to medium. No significant difference in total number of falls was noted between the groups. Conclusions The home-based, cognitive behavioral program significantly reduces concerns about falls, related activity avoidance, disability and indoor falls in community-living, frail older people. The program may prolong independent living and provides an alternative for those people who are not able or willing to attend group programs. Trial registration ClinicalTrials.gov, NCT01358032. Registered 17 May 2011
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Affiliation(s)
- Tanja A C Dorresteijn
- Department of Health Services Research - Focusing on Chronic Care and Ageing, CAPHRI School for Public Health and Primary Care, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - G A Rixt Zijlstra
- Department of Health Services Research - Focusing on Chronic Care and Ageing, CAPHRI School for Public Health and Primary Care, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Antonius W Ambergen
- Department of Methodology and Statistics, CAPHRI School for Public Health and Primary Care, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Kim Delbaere
- Neuroscience Research Australia, University of New South Wales, P.O. Box 1165, Randwick, NSW, 2031, Australia.
| | - Johan W S Vlaeyen
- Research Group Health Psychology, University of Leuven, Tiensestraat 102, 3000, Leuven, Belgium. .,Department of Clinical Psychological Science, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Gertrudis I J M Kempen
- Department of Health Services Research - Focusing on Chronic Care and Ageing, CAPHRI School for Public Health and Primary Care, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
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Schoene D, Valenzuela T, Toson B, Delbaere K, Severino C, Garcia J, Davies TA, Russell F, Smith ST, Lord SR. Interactive Cognitive-Motor Step Training Improves Cognitive Risk Factors of Falling in Older Adults - A Randomized Controlled Trial. PLoS One 2015; 10:e0145161. [PMID: 26673919 PMCID: PMC4682965 DOI: 10.1371/journal.pone.0145161] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 11/29/2015] [Indexed: 12/11/2022] Open
Abstract
Purpose Interactive cognitive-motor training (ICMT) requires individuals to perform both gross motor movements and complex information processing. This study investigated the effectiveness of ICMT on cognitive functions associated with falls in older adults. Methods A single-blinded randomized controlled trial was conducted in community-dwelling older adults (N = 90, mean age 81.5±7) without major cognitive impairment. Participants in the intervention group (IG) played four stepping games that required them to divide attention, inhibit irrelevant stimuli, switch between tasks, rotate objects and make rapid decisions. The recommended minimum dose was three 20-minute sessions per week over a period of 16 weeks unsupervised at home. Participants in the control group (CG) received an evidence-based brochure on fall prevention. Measures of processing speed, attention/executive function (EF), visuo-spatial ability, concerns about falling and depression were assessed before and after the intervention. Results Eighty-one participants (90%) attended re-assessment. There were no improvements with respect to the Stroop Stepping Test (primary outcome) in the intervention group. Compared to the CG, the IG improved significantly in measures of processing speed, visuo-spatial ability and concern about falling. Significant interactions were observed for measures of EF and divided attention, indicating group differences varied for different levels of the covariate with larger improvements in IG participants with poorer baseline performance. The interaction for depression showed no change for the IG but an increase in the CG for those with low depressive symptoms at baseline. Additionally, low and high-adherer groups differed in their baseline performance and responded differently to the intervention. Compared to high adherers, low adherers improved more in processing speed and visual scanning while high-adherers improved more in tasks related to EF. Conclusions This study shows that unsupervised stepping ICMT led to improvements in specific cognitive functions associated with falls in older people. Low adherers improved in less complex functions while high-adherers improved in EF. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12613000671763
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Affiliation(s)
- Daniel Schoene
- Neuroscience Research Australia, University of New South Wales, Sydney, Australia
- Institute for Biomedicine of Aging, Friedrich-Alexander University Erlangen-Nürnberg, Nuremberg, Germany
| | - Trinidad Valenzuela
- Neuroscience Research Australia, University of New South Wales, Sydney, Australia
- Exercise Science Laboratory, School of Kinesiology, Faculty of Medicine Universidad Finis Terrae, Santiago, Chile
| | - Barbara Toson
- Neuroscience Research Australia, University of New South Wales, Sydney, Australia
| | - Kim Delbaere
- Neuroscience Research Australia, University of New South Wales, Sydney, Australia
| | - Connie Severino
- Neuroscience Research Australia, University of New South Wales, Sydney, Australia
| | - Jaime Garcia
- mHealth Laboratory, iNEXT, University of Technology Sydney, Sydney, Australia
| | - Thomas A. Davies
- Neuroscience Research Australia, University of New South Wales, Sydney, Australia
| | - Frances Russell
- RSL LifeCare Chair of Ageing, Australian Catholic University, Sydney, Australia
| | - Stuart T. Smith
- Neuroscience Research Australia, University of New South Wales, Sydney, Australia
- Faculty of Arts and Business, University of the Sunshine Coast, Sippy Downs, Australia
| | - Stephen R. Lord
- Neuroscience Research Australia, University of New South Wales, Sydney, Australia
- * E-mail:
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Nguyen AM, Arora KS, Swenor BK, Friedman DS, Ramulu PY. Physical activity restriction in age-related eye disease: a cross-sectional study exploring fear of falling as a potential mediator. BMC Geriatr 2015; 15:64. [PMID: 26062727 PMCID: PMC4464712 DOI: 10.1186/s12877-015-0062-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 05/26/2015] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Fear of falling (FoF) is predictive of decreased physical activity. This study sought to determine if FoF mediates the relationship between decreased vision and physical activity restriction in individuals with glaucoma and age-related macular degeneration (AMD). METHODS Accelerometers were used to measure physical activity over 1 week in 59 control, 83 glaucoma, and 58 AMD subjects. Subjects completed the University of Illinois at Chicago Fear of Falling Questionnaire, and the extent of FoF was estimated using Rasch analysis. In negative binomial models adjusting for demographic, health, and social factors, FoF was investigated as a potential mediator between the severity of visual field (VF) loss (in glaucoma patients) or the severity of contrast sensitivity (CS) loss (in AMD patients) and decreased engagement in physical activity, defined as minutes spent in moderate-to-vigorous physical activity (MVPA) per day. RESULTS In multivariate negative binomial regression models, 5-decibels worse VF mean deviation was associated with 26 % less engagement in MVPA [rate ratio (RR) = 0.74, p < 0.01] amongst glaucoma subjects. When FoF was added to the model, the RR increased from 0.74 to 0.78, and VF loss severity remained associated with less MVPA at a statistically significant level (p < 0.01). Likewise, 0.1 log units worse CS was associated with 11 % less daily MVPA (RR = 0.89, p < 0.01) amongst AMD subjects. When FoF was added to the model, the RR increased from 0.89 to 1.02, and CS loss was no longer associated with MVPA at a statistically significant level (p = 0.53). CONCLUSIONS FoF may mediate the relationship between vision loss and physical activity restriction amongst patients with AMD. Future work should determine optimal strategies for reducing FoF in individuals with vision loss in order to prevent the deleterious effects of physical activity restriction.
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Affiliation(s)
- Angeline M Nguyen
- Wilmer Eye Institute, Johns Hopkins University, 600 North Wolfe Street, Maumenee B-110, Baltimore, MD, 21287, USA.
| | - Karun S Arora
- Wilmer Eye Institute, Johns Hopkins University, 600 North Wolfe Street, Maumenee B-110, Baltimore, MD, 21287, USA.
| | - Bonnielin K Swenor
- Wilmer Eye Institute, Johns Hopkins University, 600 North Wolfe Street, Maumenee B-110, Baltimore, MD, 21287, USA.
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
- The Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, 600 North Wolfe Street, Maumenee B-110, Baltimore, MD, 21287, USA.
| | - David S Friedman
- Wilmer Eye Institute, Johns Hopkins University, 600 North Wolfe Street, Maumenee B-110, Baltimore, MD, 21287, USA.
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
- The Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, 600 North Wolfe Street, Maumenee B-110, Baltimore, MD, 21287, USA.
| | - Pradeep Y Ramulu
- Wilmer Eye Institute, Johns Hopkins University, 600 North Wolfe Street, Maumenee B-110, Baltimore, MD, 21287, USA.
- The Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, 600 North Wolfe Street, Maumenee B-110, Baltimore, MD, 21287, USA.
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Ilmane N, Croteau S, Duclos C. Quantifying dynamic and postural balance difficulty during gait perturbations using stabilizing/destabilizing forces. J Biomech 2015; 48:441-8. [DOI: 10.1016/j.jbiomech.2014.12.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 11/03/2014] [Accepted: 12/09/2014] [Indexed: 11/29/2022]
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Denkinger MD, Lukas A, Nikolaus T, Hauer K. Factors associated with fear of falling and associated activity restriction in community-dwelling older adults: a systematic review. Am J Geriatr Psychiatry 2015; 23:72-86. [PMID: 24745560 DOI: 10.1016/j.jagp.2014.03.002] [Citation(s) in RCA: 197] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Revised: 02/05/2014] [Accepted: 03/06/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Fear of falling (FOF) is an important threat to autonomy. Current interventions to reduce FOF have yielded conflicting results. A possible reason for this discrepancy could be its multicausality. Some risk factors may not have been identified and addressed in recent studies. The last systematic review included studies until 2006. METHODS To identify additional risk factors for FOF and to test those mentioned previously, we conducted a systematic literature review. Studies examining FOF in community-dwelling older adults between 2006 and October 2013 were screened. RESULTS Outcomes are summarized with respect to different constructs such as FOF, fall-related self-efficacy/balance confidence, and FOF-related activity restriction. Odds ratios and p values are reported. There is no clear pattern with regard to the different FOF-related constructs studied. The only parameters robustly associated across all constructs were female gender, performance-based and questionnaire-based physical function, the use of a walking aid, and, less robust, a history of falls and poor self-rated health. Conflicting results were identified for depression and anxiety, multiple drugs, and psychotropic drugs. Other potentially modifiable risk factors were only mentioned in one or two studies and warrant further investigation. Parameters with mainly negative results are also presented. CONCLUSION Only few risk factors identified were robustly associated across all FOF-related constructs and should be included in future studies on FOF. Some newer factors have to be tested again in different cohorts. The comprehensive overview might assist in the conceptualization of future studies.
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Affiliation(s)
- Michael D Denkinger
- Agaplesion Bethesda Clinic, Geriatric Chair of Ulm University, Ulm, Germany.
| | - Albert Lukas
- Agaplesion Bethesda Clinic, Geriatric Chair of Ulm University, Ulm, Germany
| | - Thorsten Nikolaus
- Agaplesion Bethesda Clinic, Geriatric Chair of Ulm University, Ulm, Germany
| | - Klaus Hauer
- Agaplesion Bethanien Clinic, Geriatric Centre of Heidelberg University, Heidelberg, Germany
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Kendrick D, Kumar A, Carpenter H, Zijlstra GAR, Skelton DA, Cook JR, Stevens Z, Belcher CM, Haworth D, Gawler SJ, Gage H, Masud T, Bowling A, Pearl M, Morris RW, Iliffe S, Delbaere K. Exercise for reducing fear of falling in older people living in the community. Cochrane Database Syst Rev 2014; 2014:CD009848. [PMID: 25432016 PMCID: PMC7388865 DOI: 10.1002/14651858.cd009848.pub2] [Citation(s) in RCA: 139] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Fear of falling is common in older people and associated with serious physical and psychosocial consequences. Exercise (planned, structured, repetitive and purposive physical activity aimed at improving physical fitness) may reduce fear of falling by improving strength, gait, balance and mood, and reducing the occurrence of falls. OBJECTIVES To assess the effects (benefits, harms and costs) of exercise interventions for reducing fear of falling in older people living in the community. SEARCH METHODS We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (July 2013), the Central Register of Controlled Trials (CENTRAL 2013, Issue 7), MEDLINE (1946 to July Week 3 2013), EMBASE (1980 to 2013 Week 30), CINAHL (1982 to July 2013), PsycINFO (1967 to August 2013), AMED (1985 to August 2013), the World Health Organization International Clinical Trials Registry Platform (accessed 7 August 2013) and Current Controlled Trials (accessed 7 August 2013). We applied no language restrictions. We handsearched reference lists and consulted experts. SELECTION CRITERIA We included randomised and quasi-randomised trials that recruited community-dwelling people (where the majority were aged 65 and over) and were not restricted to specific medical conditions (e.g. stroke, hip fracture). We included trials that evaluated exercise interventions compared with no intervention or a non-exercise intervention (e.g. social visits), and that measured fear of falling. Exercise interventions were varied; for example, they could be 'prescriptions' or recommendations, group-based or individual, supervised or unsupervised. DATA COLLECTION AND ANALYSIS Pairs of review authors independently assessed studies for inclusion, assessed the risk of bias in the studies and extracted data. We combined effect sizes across studies using the fixed-effect model, with the random-effect model used where significant statistical heterogeneity was present. We estimated risk ratios (RR) for dichotomous outcomes and incidence rate ratios (IRR) for rate outcomes. We estimated mean differences (MD) where studies used the same continuous measures and standardised mean differences (SMD) where different measures or different formats of the same measure were used. Where possible, we performed various, usually prespecified, sensitivity and subgroup analyses. MAIN RESULTS We included 30 studies, which evaluated 3D exercise (Tai Chi and yoga), balance training or strength and resistance training. Two of these were cluster-randomised trials, two were cross-over trials and one was quasi-randomised. The studies included a total of 2878 participants with a mean age ranging from 68 to 85 years. Most studies included more women than men, with four studies recruiting women only. Twelve studies recruited participants at increased risk of falls; three of these recruited participants who also had fear of falling.Poor reporting of the allocation methods in the trials made it difficult to assess the risk of selection bias in most studies. All of the studies were at high risk of performance and detection biases as there was no blinding of participants and outcome assessors and the outcomes were self reported. Twelve studies were at high risk of attrition bias. Using GRADE criteria, we judged the quality of evidence to be 'low' for fear of falling immediately post intervention and 'very low' for fear of falling at short or long-term follow-up and all other outcomes.Exercise interventions were associated with a small to moderate reduction in fear of falling immediately post intervention (SMD 0.37 favouring exercise, 95% confidence interval (CI) 0.18 to 0.56; 24 studies; 1692 participants, low quality evidence). Pooled effect sizes did not differ significantly between the different scales used to measure fear of falling. Although none of the sensitivity analyses changed the direction of effect, the greatest reduction in the size of the effect was on removal of an extreme outlier study with 73 participants (SMD 0.24 favouring exercise, 95% CI 0.12 to 0.36). None of our subgroup analyses provided robust evidence of differences in effect in terms of either the study primary aim (reduction of fear of falling or other aim), the study population (recruitment on the basis of increased falls risk or not), the characteristics of the study exercise intervention or the study control intervention (no treatment or alternative intervention). However, there was some weak evidence of a smaller effect, which included no reduction, of exercise when compared with an alternative control.There was very low quality evidence that exercise interventions may be associated with a small reduction in fear of falling up to six months post intervention (SMD 0.17, 95% CI -0.05 to 0.38; four studies, 356 participants) and more than six months post intervention (SMD 0.20, 95% CI -0.01 to 0.41; three studies, 386 participants).Very low quality evidence suggests exercise interventions in these studies that also reported on fear of falling reduced the risk of falling measured either as participants incurring at least one fall during follow-up or the number of falls during follow-up. Very low quality evidence from four studies indicated that exercise interventions did not appear to reduce symptoms of depression or increase physical activity. The only study reporting the effects of exercise interventions on anxiety found no difference between groups. No studies reported the effects of exercise interventions on activity avoidance or costs. It is important to remember that our included studies do not represent the totality of the evidence of the effect of exercise interventions on falls, depression, anxiety or physical activity as our review only includes studies that reported fear of falling. AUTHORS' CONCLUSIONS Exercise interventions in community-dwelling older people probably reduce fear of falling to a limited extent immediately after the intervention, without increasing the risk or frequency of falls. There is insufficient evidence to determine whether exercise interventions reduce fear of falling beyond the end of the intervention or their effect on other outcomes. Although further evidence from well-designed randomised trials is required, priority should be given to establishing a core set of outcomes that includes fear of falling for all trials examining the effects of exercise interventions in older people living in the community.
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Affiliation(s)
- Denise Kendrick
- The University of NottinghamDivision of Primary Care, School of MedicineFloor 13, Tower BuildingUniversity ParkNottinghamUKNG7 2RD
| | - Arun Kumar
- University of NottinghamSchool of Medicine, Division of Primary CareQueen's Medical Centre (B‐Floor)Derby RoadNottinghamUKNG2 6SN
| | - Hannah Carpenter
- University of NottinghamSchool of Medicine, Division of Primary CareQueen's Medical Centre (B‐Floor)Derby RoadNottinghamUKNG2 6SN
| | - G A Rixt Zijlstra
- Maastricht UniversityDepartment of Health Services Research and CAPHRI School for Public Health and Primary CareP O Box 616MaastrichtNetherlands6200 MD
| | - Dawn A Skelton
- Glasgow Caledonian UniversitySchool of Health & Life Sciences, Institute of Applied Health ResearchCowcaddens RdGlasgowUKG4 0BA
| | - Juliette R Cook
- University of NottinghamSchool of Medicine, Division of Primary CareQueen's Medical Centre (B‐Floor)Derby RoadNottinghamUKNG2 6SN
| | - Zoe Stevens
- University College LondonResearch Department of Primary Care and Population HealthFaculty of Biomedical SciencesRoyal Free Campus, Rowland Hill StreetLondonUKNW3 2PF
| | - Carolyn M Belcher
- University of NottinghamSchool of Medicine, Division of Primary CareQueen's Medical Centre (B‐Floor)Derby RoadNottinghamUKNG2 6SN
| | - Deborah Haworth
- University College LondonResearch Department of Primary Care and Population HealthFaculty of Biomedical SciencesRoyal Free Campus, Rowland Hill StreetLondonUKNW3 2PF
| | - Sheena J Gawler
- University College LondonResearch Department of Primary Care and Population HealthFaculty of Biomedical SciencesRoyal Free Campus, Rowland Hill StreetLondonUKNW3 2PF
| | - Heather Gage
- University of SurreySchool of EconomicsGuildfordSurreyUKGU2 7XH
| | - Tahir Masud
- Nottingham University Hospitals NHS TrustQueens Medical Centre CampusNottinghamUKNG7 2UH
| | - Ann Bowling
- University of SouthamptonFaculty of Health SciencesBuilding 45Highfield CampusSouthamptonUKSO17 1BJ
| | | | - Richard W Morris
- University of BristolSchool of Social and Community MedicineCanynge Hall39 Whatley RoadBristolUKBS8 2PS
- Royal Free Campus, UCL Medical SchoolResearch Department of Primary Care and Population HealthLondonUK
| | - Steve Iliffe
- University College LondonResearch Department of Primary Care and Population HealthFaculty of Biomedical SciencesRoyal Free Campus, Rowland Hill StreetLondonUKNW3 2PF
| | - Kim Delbaere
- University of New South WalesNeuroscience Research AustraliaBarker StreetRandwick, SydneyNew South WalesAustralia2223
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Schoene D, Valenzuela T, Lord SR, de Bruin ED. The effect of interactive cognitive-motor training in reducing fall risk in older people: a systematic review. BMC Geriatr 2014; 14:107. [PMID: 25240384 PMCID: PMC4181419 DOI: 10.1186/1471-2318-14-107] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 09/11/2014] [Indexed: 11/16/2022] Open
Abstract
Background It is well-known physical exercise programs can reduce falls in older people. Recently, several studies have evaluated interactive cognitive-motor training that combines cognitive and gross motor physical exercise components. The aim of this systematic review was to determine the effects of these interactive cognitive-motor interventions on fall risk in older people. Methods Studies were identified with searches of the PubMed, EMBASE, and Cochrane CENTRAL databases from their inception up to 31 December 2013. Criteria for inclusion were a) at least one treatment arm that contained an interactive cognitive-motor intervention component; b) a minimum age of 60 or a mean age of 65 years; c) reported falls or at least one physical, psychological or cognitive fall risk factor as an outcome measure; d) published in Dutch, English or German. Single case studies and robot-assisted training interventions were excluded. Due to the diversity of populations included, outcome measures and heterogeneity in study designs, no meta-analyses were conducted. Results Thirty-seven studies fulfilled the inclusion criteria. Reporting and methodological quality were often poor and sample sizes were mostly small. One pilot study found balance board training reduced falls and most studies reported training improved physical (e.g. balance and strength) and cognitive (e.g. attention, executive function) measures. Inconsistent results were found for psychological measures related to falls-efficacy. Very few between-group differences were evident when interactive cognitive-motor interventions were compared to traditional training programs. Conclusions The review findings provide preliminary evidence that interactive cognitive-motor interventions can improve physical and cognitive fall risk factors in older people, but that the effect of such interventions on falls has not been definitively demonstrated. Interactive cognitive-motor interventions appear to be of equivalent efficacy in ameliorating fall risk as traditional training programs. However, as most studies have methodological limitations, larger, high-quality trials are needed. Electronic supplementary material The online version of this article (doi:10.1186/1471-2318-14-107) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | | | - Eling D de Bruin
- Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Wolfgang-Pauli-Str, 27, HIT J 31,2, CH-8093 Zurich, Switzerland.
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Martin JT, Wolf A, Moore JL, Rolenz E, DiNinno A, Reneker JC. The effectiveness of physical therapist-administered group-based exercise on fall prevention: a systematic review of randomized controlled trials. J Geriatr Phys Ther 2014; 36:182-93. [PMID: 23449007 DOI: 10.1519/jpt.0b013e3182816045] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Falls are a verified cause of morbidity and mortality in adults older than 65 years. Exercise under the direction of a physical therapist has been shown to reduce the risk of falls in older adults; however, it is not clear whether physical therapist-directed group-based exercise could produce similar results. PURPOSE The purpose of this systematic review was to summarize the evidence on the effectiveness of physical therapist-administered group-based exercise when compared with various controls for falls prevention and improvement of quality of life. METHODS A computerized search of PubMed and CINAHL was performed. An exhaustive hand search was also performed of the references of all full-text articles. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed for this review. Studies were included if they met the following criteria: (1) comparison of group-based exercise led by a physical therapist to a control group; (2) ambulatory elderly men or women, aged 65 years or older; (3) subjects in the community or institutional setting; (4) the use of 1 or more outcome measures related to functional balance and/or quality of life; (5) randomized controlled or clinical trials; and (6) published in English, between December 1, 2001, and June 7, 2012. The PEDro scale was used to assess the quality of each study included in this review. RESULTS The computerized search strategy and hand search revealed 213 potential articles, 10 of which met the inclusion criteria. After assessment with the PEDro scale, 8 of these were considered high-quality studies (score > 6/10). Seven studies compared group-based exercise to a nonexercise control group, while 3 studies compared group-based exercise with a physical therapist-prescribed home exercise program. Outcomes measured include fall rate, balance, physical performance, health-related quality of life, and fear of falling. DISCUSSION When group-based exercise was compared with no intervention, group-based exercise was found to be more effective in decreasing fall frequency, increase balance, and improve quality of life. When compared with a physical therapist-prescribed home exercise program, the group-based exercise results were not statistically different but showed improvements in some quality of life and physical functioning measures. There is also some evidence to suggest that group-based exercise promotes greater patient satisfaction and exercise adherence. CONCLUSION There is preliminary evidence to suggest that the group-based exercise is effective for falls prevention, quality-of-life enhancement, and balance improvements in the older adults comparable with traditional home exercise programs.
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Shen X, Mak MKY. Balance and Gait Training With Augmented Feedback Improves Balance Confidence in People With Parkinson’s Disease. Neurorehabil Neural Repair 2014; 28:524-35. [PMID: 24407915 DOI: 10.1177/1545968313517752] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Background. Fear of falling has been identified as an important and independent fall-risk predictor in patients with Parkinson’s disease (PD). However, there are inconsistent findings on the effects of balance and gait training on balance confidence. Objective. To explore whether balance and gait training with augmented feedback can enhance balance confidence in PD patients immediately after treatment and at 3- and 12-month follow-ups. Methods. A total of 51 PD patients were randomly assigned to a balance and gait training (BAL) group or to an active control (CON) group. The BAL group received balance and gait training with augmented feedback, whereas CON participants received lower-limb strength training for 12 weeks. Outcome measures included Activities-Specific Balance Confidence (ABC) Scale, limits-of-stability test, single-leg-stance test, and spatiotemporal gait characteristics. All tests were administered before intervention (Pre), immediately after training (Post), and at 3 months (Post3m) and 12 months (Post12m) after treatment completion. Results. The ABC score improved marginally at Post and significantly at Post3m and Post12m only in the BAL group ( P < .017). Both participant groups increased their end point excursion at Post, but only the BAL group maintained the improvement at Post3m. The BAL group maintained significantly longer time-to-loss-of-balance during the single-leg stance test than the CON group at Post3m and Post12m ( P < .05). For gait characteristics, both participant groups increased gait velocity, but only the BAL group increased stride length at Post, Post3m, and Post12m ( P < .017). Conclusions. Positive findings from this study provide evidence that BAL with augmented feedback could enhance balance confidence and balance and gait performance in patients with PD.
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Affiliation(s)
- Xia Shen
- Hong Kong Polytechnic University, Hong Kong, China
- Guangdong Provincial Work Injury Rehabilitation Hospital, Guangzhou, China
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Lunenfeld B, Stratton P. The clinical consequences of an ageing world and preventive strategies. Best Pract Res Clin Obstet Gynaecol 2013; 27:643-59. [PMID: 23541823 PMCID: PMC3776003 DOI: 10.1016/j.bpobgyn.2013.02.005] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2012] [Accepted: 02/10/2013] [Indexed: 12/21/2022]
Abstract
Over the past century, the world has seen unprecedented declines in mortality rates, leading to an accelerated increase in the world population. This century will realise falling fertility rates alongside ageing populations. The 20th century was the century of population growth; the 21st century will be remembered as the century of ageing. Increase in life expectancy is one of the highest achievements of humankind; however, ageing and age-related disease is a mounting challenge for individuals, families, and for social, economic, and healthcare systems. Since healthy life expectancy has lagged behind the increase in life expectancy, the rise in morbidity will increase the burden on healthcare systems. Implementation of preventive health strategies to decrease, delay or prevent frailty, lung, breast and colon cancer, cardiovascular disease, metabolic syndrome, osteoporosis and osteopaenia, may increase health expectancy, and permit women to age gracefully and maintain independent living, without disability, for as long as possible.
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Affiliation(s)
- Bruno Lunenfeld
- Faculty of Life Sciences, Bar-Ilan University, Ramat Gan 52900, Israel.
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Abstract
Studies examining fear of falling among older adult men remain limited. The objectives of this study were to compare balance confidence in 2 age cohorts of older clergy and identify predictive determinants of balance confidence in a liturgical research initiative. Participants included 131 community-dwelling Roman Catholic priests age 60–97 yr living in religious communities in 10 mid-Atlantic states. Subjects completed the Activities-specific Balance Confidence Scale (ABC), Berg Balance Scale (BBS), timed up-and-go (TUG) test, and 15-item Geriatric Depression Scale (GDS). Younger priests (60–74 yr) demonstrated a significantly higher ABC score than the older cohort (75 and above yr) of priests (89.1 ± 12.6 vs.78.4 ± 13.9,p= .001). Confidence was significantly correlated with BBS (rho = .69,p< .01), TUG (r= –.58,p< .01), and GDS (r= –.39,p< .01) scores. A stepwise-regression model demonstrated that balance ability, mood, assistive-device use, and physical activity predicted 52% of the variance in balance confidence.
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Viljanen A, Kulmala J, Rantakokko M, Koskenvuo M, Kaprio J, Rantanen T. Accumulation of sensory difficulties predicts fear of falling in older women. J Aging Health 2013; 25:776-91. [PMID: 23832841 DOI: 10.1177/0898264313494412] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To explore whether the accumulation of sensory difficulties predicts fear of falling (FOF), and whether the traits correlate with each other regardless of familial factors. METHODS Self-reported hearing, vision and balance difficulties, and FOF were assessed using structured questionnaires at the baseline and after a 3-year follow-up in 63- to 76-year-old women (n = 434). RESULTS Among the women without FOF at baseline (n = 245), 41% reported FOF at follow-up. Increasing numbers of sensory difficulties at baseline predicted higher incidence of FOF. The relationship between accumulated sensory difficulties and FOF was not mediated by familial factors. DISCUSSION The accumulation of multiple sensory difficulties may hinder older people from receiving compensatory information about body position and environment, thus jeopardizing a person's confidence in maintaining a balanced position. Regular screening of sensory functions followed by appropriate actions may prevent the development of FOF, and thus contribute to prevention of falls and promotion of healthy aging.
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Affiliation(s)
- Anne Viljanen
- Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
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Dorresteijn TAC, Rixt Zijlstra GA, Van Haastregt JCM, Vlaeyen JWS, Kempen GIJM. Feasibility of a nurse-led in-home cognitive behavioral program to manage concerns about falls in frail older people: a process evaluation. Res Nurs Health 2013; 36:257-70. [PMID: 23533013 DOI: 10.1002/nur.21534] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2013] [Indexed: 11/07/2022]
Abstract
Concerns about falls and related avoidance of activities are common problems among older people living in the community. In this study we examined the feasibility and acceptability of AMB-Home (the Dutch in-home version of A Matter of Balance), a nurse-led in-home cognitive behavioral program developed for frail community-living older people with concerns about falls and related activity avoidance. The multicomponent program consisted of seven individual sessions, including three home visits and four telephone contacts. Data were collected from eight nurses and 194 participants. Generally, the program was considered acceptable and feasible by both the nurses and the participants. When AMB-Home turns out to be effective, the implementation of a fine-tuned version of this in-home program in regular health care, would be a natural next step.
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Affiliation(s)
- Tanja A C Dorresteijn
- CAPHRI School for Public Health and Primary Care and Department of Health Services Research, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
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Zijlstra GAR, van Haastregt JCM, Kempen GIJM. ["A matter of balance--Netherlands": an effective intervention to reduce concerns about falls and related avoidance of activity in older people]. Tijdschr Gerontol Geriatr 2012; 43:164-74. [PMID: 23082409 DOI: 10.1007/s12439-012-0026-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Concerns about falls and related avoidance behavior are common among older people and may lead to decreased quality of life, decreased physical and psychosocial functioning, and premature admission to a nursing home. In a randomized controlled trial among 540 community-dwelling older people we studied the feasibility and effects of a cognitive behavioral program on concerns about falls, related avoidance of activity, and falls. Data of the process evaluation obtained from participants in the intervention group (n = 280) and the trainers (n = 6) showed that the program was considered as feasible by the trainers, and positively judged by participants and trainers. Furthermore, participants experienced benefits from attending the program (61% still reported benefits one year after the program). Prior to the start of the program 26% of the participants of the intervention dropped out, yet, among the participants who started the program completion was high (84%). The effect evaluation showed positive outcomes for concerns about falls, related avoidance of activity, and daily activity at 2 months (after the program) when comparing the intervention group with the control group (n = 260). Long-term effects were also shown for, amongst others, concerns about falls and recurrent falls. Following these positive results the cognitive behavioral group program is currently made available to geriatric care settings nationwide in the Netherlands.
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Affiliation(s)
- G A R Zijlstra
- Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht.
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Balance, Falls-Related Self-Efficacy, and Psychological Factors amongst Older Women with Chronic Low Back Pain: A Preliminary Case-Control Study. Rehabil Res Pract 2012; 2012:430374. [PMID: 22937276 PMCID: PMC3425864 DOI: 10.1155/2012/430374] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Revised: 04/20/2012] [Accepted: 06/27/2012] [Indexed: 12/14/2022] Open
Abstract
Objective. To investigate balance functions in older women and evaluate the association of the fear-avoidance beliefs model (FABM) factors with balance and mobility performance. Participants. Fifteen older women with CLBP was compared with age-matched pain-free controls (n = 15). Main Outcome Measures. Pain intensity, falls-related self-efficacy and intrinsic constructs in the FABM were evaluated. Postural steadiness (centre of pressure (COP)) and mobility functions were assessed. Linear relationships of FABM variables with COP and mobility score were estimated. Results. CLBP showed lower mobility score compared to controls. CLBP presented lower falls-related self-efficacy and it was associated with reduced mobility scores. FABM variables and falls-related self-efficacy were correlated with postural steadiness. Physical activity was reduced in CLBP, but no between-group difference was evident for knee extensor strength. No systematic linkages were observed between FABM variables with mobility score or postural steadiness. Conclusions. Back pain status affects balance and mobility functions in older women. Falls-related self-efficacy is lower in CLBP and is associated with reduced mobility. Disuse syndrome in CLBP elderly is partly supported by the results of this preliminary study.
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