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Gallagher RM, Marquez JL, Dal S, Osmotherly PG. Predicting post-surgical outcomes in idiopathic normal pressure hydrocephalus using clinically important changes from the cerebrospinal fluid tap test. J Neurol Sci 2024; 460:122994. [PMID: 38608413 DOI: 10.1016/j.jns.2024.122994] [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: 09/17/2023] [Revised: 03/04/2024] [Accepted: 03/31/2024] [Indexed: 04/14/2024]
Abstract
OBJECTIVE Patients diagnosed with idiopathic Normal Pressure Hydrocephalus (iNPH) typically experience symptom improvements after undergoing a cerebrospinal fluid-tap test (CSF-TT), These improvements are recognized as indicative of potential improvements following surgical intervention. As gait disturbance is the most common iNPH symptom, gait improvements are of predominant interest. The purpose of this study was to examine if clinically important changes in gait and balance from CSF-TT predict meaningful changes following surgery. METHOD The study involved analysis of data collected in a prospective observational study for 34 iNPH patients who underwent a CSF-TT and subsequent surgery. Linear regression, logistic regression and classification trees were used for predictive modelling comparing changes from CSF-TT with post-surgical changes in Tinetti, Timed Up and Go (TUG) and Berg Balance Scale (BBS) outcomes. RESULTS Predictive models for minimal clinically important differences (MCIDs) from CSF-TT to surgery were significant for Tinetti (odds ratio = 1.42, p = 0.02) and BBS (odds ratio = 1.57, p < 0.01). Four items on Tinetti and two items on BBS were identified with a predictive accuracy of 79% and 76% respectively. BBS has the highest sensitivity (85%) and negative predictive value (77%). TUG had a 100% specificity and 100% positive predictive value. The predictive model using MCIDs for TUG was not significant (odds ratio = 1.13, p = 0.06). CONCLUSION Clinically important changes from CSF-TT are useful in predicting post-surgical outcomes in iNPH patients. Tinetti and BBS, both have predictive value using MCID scores as cut off values, of which BBS is a stronger outcome measure for prediction.
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Affiliation(s)
- Ryan M Gallagher
- School of Health Sciences, University of Newcastle, Callaghan, NSW 2308, Australia; Physiotherapy Department, John Hunter Hospital, Lookout Rd, New Lambton Heights, NSW 2305, Australia.
| | - Jodie L Marquez
- School of Health Sciences, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Shabnam Dal
- School of Health Sciences, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Peter G Osmotherly
- School of Health Sciences, University of Newcastle, Callaghan, NSW 2308, Australia
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2
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Monaghan PG, Murrah WM, Walker HC, Neely KA, Roper JA. Evaluating Postural Transition Movement Performance in Individuals with Essential Tremor via the Instrumented Timed Up and Go. SENSORS (BASEL, SWITZERLAND) 2024; 24:2216. [PMID: 38610427 PMCID: PMC11014324 DOI: 10.3390/s24072216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024]
Abstract
Flexibility in performing various movements like standing, walking, and turning is crucial for navigating dynamic environments in daily life. Individuals with essential tremor often experience movement difficulties that can affect these postural transitions, limiting mobility and independence. Yet, little research has examined the performance of postural transitions in people with essential tremor. Therefore, we assessed postural transition performance using two versions of the timed up and go test: the standard version and a more complex water-carry version. We examined the total duration of the standard and water-carry timed up and go in 15 people with and 15 people without essential tremor. We also compared the time taken for each phase (sit-to-stand phase, straight-line walk phase, stand-to-sit phase) and the turning velocity between groups. Our findings revealed decreased performance across all phases of standard and water-carry timed up and go assessments. Further, both ET and non-ET groups exhibited reduced performance during the water-carry timed up and go compared to the standard timed up and go. Evaluating specific phases of the timed up and go offers valuable insights into functional movement performance in essential tremor, permitting more tailored therapeutic interventions to improve functional performance during activities of daily living.
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Affiliation(s)
- Patrick G. Monaghan
- School of Kinesiology, Auburn University, Auburn, AL 36849, USA; (P.G.M.); (K.A.N.)
| | - William M. Murrah
- Department of Educational Foundations, Leadership, and Technology, Auburn University, Auburn, AL 36849, USA;
| | - Harrison C. Walker
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL 35249, USA
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL 35249, USA
- Department of Biomedical Engineering, University of Alabama at Birmingham, Birmingham, AL 35249, USA
| | - Kristina A. Neely
- School of Kinesiology, Auburn University, Auburn, AL 36849, USA; (P.G.M.); (K.A.N.)
| | - Jaimie A. Roper
- School of Kinesiology, Auburn University, Auburn, AL 36849, USA; (P.G.M.); (K.A.N.)
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Chan WLS, Chan CWL, Lam FMH, Chan HHW, Chan KCK, Chan JSK, Chan OLW, Cheung DSK. Feasibility, safety, and effects of a Nintendo Ring Fit Adventure™ balance and strengthening exercise program in community-dwelling older adults with a history of falls: A feasibility randomized controlled trial. Geriatr Gerontol Int 2024; 24 Suppl 1:334-341. [PMID: 38088479 DOI: 10.1111/ggi.14771] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/07/2023] [Accepted: 11/26/2023] [Indexed: 03/27/2024]
Abstract
AIM This pilot study examined the feasibility, safety, and effects of a Nintendo Ring Fit Adventure™-based exercise program to enhance balance and lower limb muscle strength in community-dwelling older adults with a history of falls. METHODS In total, 42 older adults who experienced at least one fall in the past year were randomly assigned to an experimental or control group. Participants in the experimental group performed 60-min sessions of the exercise program twice per week for 8 weeks. The control group received usual care. We assessed the feasibility (retention and adherence to the exercise program), safety (number of adverse events), and clinical outcomes: (1) balance (Mini-BESTest); (2) functional lower limb muscle strength (Five-Time Sit-to-Stand test); (3) mobility (Timed-Up and Go test); (4) dual-task ability (Timed-Up and Go test - Dual Task); (5) fear of falling (Icon-FES); and (6) executive function (Color Trails Test). RESULTS Thirty-one participants (74%) completed the 8-week assessment. No adverse event associated with the exercise program was reported. There was a significant interaction in the anticipatory domain score of the Mini-BESTest between the experimental and control groups over the 8 weeks (P = 0.019). CONCLUSIONS The Nintendo Ring Fit Adventure™-based exercise program was feasible, safe, and potentially effective in improving anticipatory balance in community-dwelling older fallers. Geriatr Gerontol Int 2024; 24: 334-341.
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Affiliation(s)
- Wayne Lap Sun Chan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, Hong Kong
| | - Cody Wing Lam Chan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, Hong Kong
| | - Freddy Man Hin Lam
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, Hong Kong
| | - Howard Ho Wing Chan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, Hong Kong
| | - Kelvin Chi Kin Chan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, Hong Kong
| | - Jerry Sai Kit Chan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, Hong Kong
| | - Oscar Lok Wang Chan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, Hong Kong
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Chan WLS, Chan CWL, Chan HHW, Chan KCK, Chan JSK, Chan OLW. A randomised controlled pilot study of a Nintendo Ring Fit Adventure™ balance and strengthening exercise program in community-dwelling older adults with a history of falls. Australas J Ageing 2024. [PMID: 38404233 DOI: 10.1111/ajag.13297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 01/29/2024] [Accepted: 02/05/2024] [Indexed: 02/27/2024]
Abstract
OBJECTIVES This pilot study examined the feasibility, acceptability, and effects of a Nintendo Ring Fit Adventure™-based balance and muscle strengthening exercise program in community-dwelling older adults with a history of falls. METHODS Older adults who have had at least one fall in the past year were randomly assigned to an experimental (n = 21) or control group (n = 21). The experimental group performed 16 exercise sessions in total, lasting 60 min each, twice a week for 8 weeks, whereas the control group received usual care. Feasibility was evaluated based on the scores of participants in the exercises. Acceptance was evaluated using a customised questionnaire examining participants' self-perceived enjoyment, feasibility and improvements. Clinical outcomes including balance (Mini-BESTest), lower limb muscle strength (Five-Time Sit-to-Stand test), mobility (Timed-Up and Go test), dual-task ability (Timed-Up and Go test-Dual Task), fear of falling (Icon-FES) and executive function (Color Trails Test) were evaluated at baseline and 8 weeks. RESULTS Thirty-one participants (74%) finished the 8-week assessment. The experimental group significantly improved their scores in six out of eight exercises (all p < .031). The mean scores of the self-perceived enjoyment, feasibility and improvement domains of the acceptability questionnaire were 3.46 ± .53, 3.08 ± .59, and 3.47 ± .57 respectively. A significant improvement in the anticipatory subscore of the Mini-BESTest was found in the experimental group compared to the control group (p = .02; Partial eta squared = .14). CONCLUSIONS The Nintendo Ring Fit Adventure™-based exercise program was feasible, acceptable, and potentially effective in community-dwelling older adults with a history of falls.
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Affiliation(s)
- Wayne Lap Sun Chan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Cody Wing Lam Chan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Howard Ho Wing Chan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Kelvin Chi Kin Chan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Jerry Sai Kit Chan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Oscar Lok Wang Chan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
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Walz ID, Waibel S, Kuhner A, Gollhofer A, Maurer C. Age-related changes in mobility assessments correlate with repetitive goal-directed arm-movement performance. BMC Geriatr 2023; 23:487. [PMID: 37568095 PMCID: PMC10422784 DOI: 10.1186/s12877-023-04150-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 07/04/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND There is ample evidence that mobility abilities between healthy young and elderly people differ. However, we do not know whether these differences are based on different lower leg motor capacity or instead reveal a general motor condition that could be detected by monitoring upper-limb motor behavior. We therefore captured body movements during a standard mobility task, namely the Timed Up and Go test (TUG) with subjects following different instructions while performing a rapid, repetitive goal-directed arm-movement test (arm-movement test). We hypothesized that we would be able to predict gait-related parameters from arm motor behavior, even regardless of age. METHODS Sixty healthy individuals were assigned to three groups (young: mean 26 ± 3 years, middle-aged 48 ± 9, old 68 ± 7). They performed the arm-movement and TUG test under three conditions: preferred (at preferred movement speed), dual-task (while counting backwards), and fast (at fast movement speed). We recorded the number of contacts within 20 s and the TUG duration. We also extracted TUG walking sequences to analyze spatiotemporal gait parameters and evaluated the correlation between arm-movement and TUG results. RESULTS The TUG condition at preferred speed revealed differences in gait speed and step length only between young and old, while dual-task and fast execution increased performance differences significantly among all 3 groups. Our old group's gait speed decreased the most doing the dual-task, while the young group's gait speed increased the most during the fast condition. As in our TUG results, arm-movements were significant faster in young than in middle-aged and old. We observed significant correlations between arm movements and the fast TUG condition, and that the number of contacts closely predicts TUG timefast and gait speedfast. This prediction is more accurate when including age. CONCLUSION We found that the age-related decline in mobility performance that TUG reveals strongly depends on the test instruction: the dual-task and fast condition clearly strengthened group contrasts. Interestingly, a fast TUG performance was predictable by the performance in a fast repetitive goal-directed arm-movements test, even beyond the age effect. We assume that arm movements and the fast TUG condition reflect similarly reduced motor function. TRIAL REGISTRATION German Clinical Trials Register (DRKS) number: DRKS00016999, prospectively registered on March, 26, 2019.
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Affiliation(s)
- Isabelle Daniela Walz
- Department of Neurology and Neuroscience, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Sports and Sport Science, University of Freiburg, Freiburg, Germany
| | - Sarah Waibel
- Department of Neurology and Neuroscience, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Andreas Kuhner
- Department of Computer Science, University of Freiburg, Freiburg, Germany
- Franka Emika GmbH, Freiburg, Germany
| | - Albert Gollhofer
- Department of Sports and Sport Science, University of Freiburg, Freiburg, Germany
| | - Christoph Maurer
- Department of Neurology and Neuroscience, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
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Jalili C, Talebi S, Bagheri R, Ghanavati M, Camera DM, Amirian P, Zarpoosh M, Dizaji MK, Kermani MAH, Moradi S. The Association between Dietary Inflammatory Index and Aging Biomarkers/Conditions: A Systematic Review and Dose-response Meta-analysis. J Nutr Health Aging 2023; 27:378-390. [PMID: 37248762 DOI: 10.1007/s12603-023-1919-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 04/19/2023] [Indexed: 05/31/2023]
Abstract
OBJECTIVES We performed a current study to examine the association between dietary inflammatory index (DII) score and older age-related muscle conditions, including sarcopenia, low muscle mass, low muscle strength, frailty, and/or disability. DESIGN Systematic review and dose-response meta-analysis. SETTING A systematic literature search was performed using Scopus, PubMed/MEDLINE, and ISI Web of Science without limitation until October 04, 2022. Relative risk (RR) and 95% confidence interval (CI) were pooled by applying a random-effects model, while validated methods examined assess quality and publication bias via Newcastle-Ottawa Scale, Egger's regression asymmetry, and Begg's rank correlation tests respectively. A dose-response meta-analysis was conducted to estimate the RRs per 1-unit increment in DII scores. PARTICIPANTS Adults (≥18 years). MEASURES The risk of older age-related muscle conditions (sarcopenia, low muscle mass, low muscle strength, frailty, and/or disability). RESULTS Data were available from 19 studies with 68079 participants. Results revealed that a higher DII score was significantly related to an increased risk of sarcopenia (RR=1.50; 95% CI: 1.26, 1.79; I2=53.3%; p<0.001; n=10; sample size =43097), low muscle strength (RR=1.47; 95% CI: 1.24, 1.74; I2=6.6%; p<0.001; n=4; sample size =9339), frailty (RR=1.61; 95% CI: 1.41, 1.84; I2=0.0%; p<0.001; study=5; participant=3882) and disability (RR=1.41; 95% CI: 1.16, 1.72; I2=58.4%; p=0.001; n=5; sample size =13760), but not low muscle mass (RR=1.24; 95% CI: 0.98, 1.56; I2=49.3%; p=0.069; n=4; sample size =11222). Additionally, results of the linear dose-response indicated that an increase of one point in the DII score was related to a 14% higher risk of sarcopenia, 6% higher risk of low muscle mass, 7% higher risk of low muscle strength, and a 7% higher risk of disability in adults. Non-linear dose-response relationships also revealed a positive linear association between the DII score and the risk of sarcopenia (Pnonlinearity = 0.097, Pdose-response<0.001), frailty (Pnonlinearity = 0.844, Pdose-response=0.010) and disability (Pnonlinearity = 0.596, Pdose-response=0.007). CONCLUSION Adherence to a pro-inflammatory diet was significantly associated with a higher risk of sarcopenia and other age-associated adverse effects such as low muscle strength, disability, and frailty. These results indicate a necessity to prioritize the reduction of pro-inflammatory diets to help promote overall older age-related muscle conditions.
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Affiliation(s)
- C Jalili
- Sajjad Moradi, Nutritional Sciences Department, School of Nutritional Sciences and Food Technology, Kermanshah University of Medical Sciences, Kermanshah, Iran;
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Amiss E, Cottrell M. Evaluation of a Novel Step Training Mobile App Intervention in Cardiopulmonary Rehabilitation: A Single-Arm Prospective Cohort Study. Games Health J 2022; 11:330-336. [PMID: 36067152 DOI: 10.1089/g4h.2021.0142] [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: 11/13/2022] Open
Abstract
Objective: To establish the usability, acceptability, safety, and exercise adherence of a step training mobile app. Design: A single-arm prospective cohort study. Setting: Royal Brisbane and Women's Hospital, Australia. Subjects: Twenty-six cardiopulmonary rehabilitation participants. Intervention: Twelve weeks of step training using the mobile app Clock Yourself. Participants used Clock Yourself at home and during cardiopulmonary rehabilitation sessions, prescribed for a total of 15-20 minutes three times a week. Main Measures: The primary outcomes of interest were usability and acceptability and were measured using the System Usability Scale (SUS) and Attitudes to Falls-Related Interventions Scale (AFRIS) questionnaire, respectively. Safety and adherence were measured by self-report and participant diary, respectively. Secondary outcomes measuring changes in stepping, gait, balance, and physical performance included Manual test of Choice Stepping Reaction Time (CSRT-M), Short Physical Performance Battery (SPPB), Gait speed with and without a cognitive dual task (DT) and Timed Up and Go with and without a cognitive DT (TUG and TUGcog). Results: Twenty-one participants completed the study. Clock Yourself was considered highly useable (SUS [median] = 82.5/100; interquartile range [IQR, 67.5-95], equating to an "A" rating [A-F scale]) and acceptable (AFRIS [median] = 38/42 [IQR, 31-41]). Participants practiced Clock Yourself for a median of 18.29 minutes per week and no adverse events were reported. At 12 weeks, mean change in CSRT-M, SPPB, gait speed, DT gait speed, TUG, and TUGcog were all statistically significant (P < 0.01). Conclusion: Twelve weeks of mobile app-based step training was safe and considered usable and acceptable by participants. On average, participants did not meet the prescribed practice dosage. Statistically significant changes were observed in all physical measures; however, results are confounded by participation in cardiopulmonary rehabilitation and lack of control group.
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Affiliation(s)
- Emilie Amiss
- Department of Physiotherapy, Royal Brisbane and Women's Hospital, Herston, Australia
| | - Michelle Cottrell
- Department of Physiotherapy, Royal Brisbane and Women's Hospital, Herston, Australia
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Wang J, Hong JT, Xiang Y, Zhang C. Do the dual-task "8-foot up and go" tests provide additional predictive value for early detection of cognitive decline in community-dwelling older women? Aging Clin Exp Res 2022; 34:2431-2439. [PMID: 35838984 DOI: 10.1007/s40520-022-02193-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 06/28/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND The 8-Foot Up and Go (8UG) test is a widely used mobility assessment. Some dual-task mobility assessments have been developed to help detect cognitive decline. AIMS This study developed a dual-task version of 8UG test to investigate the dual-task 8UG performance and to evaluate the ability of dual-task 8UG test in detecting cognitive decline. METHODS A total of 101 eligible community-dwelling women aged 60-74 years were grouped into the mild cognitive impairment group (MCI, n = 49) and the non-cognitive impairment group (NCI, n = 52). The 8UG tests under single-task (ST), manual dual-task (MT), and cognitive dual-task (CT) conditions were performed respectively. The dual-task cost (DTC) and the correct response rate (CRR) were calculated to quantify the dual-task interference. RESULTS Participants spent more time in performing the 8UG test under dual-task conditions. No differences were observed between NCI and MCI groups for 8UG parameters under ST and MT conditions (p > 0.05). When executing CT, significant differences were found in the number of correct answers and CRR (p < 0.05). CRR showed the strongest ability to predict MCI with a cut-off point of 0.50 (71.2% sensitivity and 61.2% specificity). DISCUSSION Both manual and cognitive dual-task were found to interfere with the 8UG performance. CRR with cutoff point of 0.50 could be a potential predictor of MCI in community-dwelling older women. CONCLUSIONS The CRR of the cognitive dual-task 8UG test could be recommended as a potential predictor for the early detection of MCI in community-dwelling older women.
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Affiliation(s)
- Jingjing Wang
- School of Exercise and Health, Shanghai University of Sport, Yangpu District, 650 Qing Yuan Huan Rd, Shanghai, 200438, China.,Shanghai Research Institute of Sports Science (Shanghai Anti-Doping Agency), Shanghai, 200030, China
| | - Jin-Tao Hong
- Shanghai Research Institute of Sports Science (Shanghai Anti-Doping Agency), Shanghai, 200030, China
| | - Yun Xiang
- School of Exercise and Health, Shanghai University of Sport, Yangpu District, 650 Qing Yuan Huan Rd, Shanghai, 200438, China.,School of Physical Education, Hubei Engineering University, Xiaogan, 432000, Hubei, China
| | - Chunhua Zhang
- School of Exercise and Health, Shanghai University of Sport, Yangpu District, 650 Qing Yuan Huan Rd, Shanghai, 200438, China.
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Cabral DF, Santos VS, Pereira OTT, Silva MJ, Pascual-Leone A, Rundek T, Loewenstein DA, Kirk-Sanchez N, Oliveira ACA, Gomes-Osman J. Feasibility and Preliminary Efficacy of a Multimodal Approach to Increase Physical Activity in Older Adults With Memory Complaints: The Education for Action Study. J Aging Phys Act 2022; 30:204-216. [PMID: 34412033 PMCID: PMC8857299 DOI: 10.1123/japa.2020-0484] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 04/13/2021] [Accepted: 04/13/2021] [Indexed: 11/18/2022]
Abstract
In this randomized controlled pilot trial, the authors explored the feasibility, technology compliance, and preliminary efficacy of the Education for Action (EDU-ACT), a multimodal intervention combining evidence-based strategies of physical activity (PA) education and coaching in PA levels over 4 weeks between EDU-ACT and control groups. The authors also assessed pre-post changes in neurocognitive function, functional mobility and dual-task performance, sleep and quality of life. Thirty-two sedentary older adults with memory complaints (age = 66 ± 5.3) completed the study (EDU-ACT = 18 and control = 14). The EDU-ACT adherence rate was 95%, and compliance of daily PA reporting was, on average, 22.7 days (94.6%). The EDU-ACT group demonstrated a significantly greater number of steps, processing speed, and dual-task performance when compared with controls (p < .05). In this study, a multimodal, evidence-based, low-cost intervention was feasible, well-accepted, with high adherence and compliance rates, and effective at promoting clinically meaningful increases in PA, for at least 1 month postintervention, in older adults with memory complaints.
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Affiliation(s)
- Danylo F. Cabral
- Department of Physical Therapy, University of Miami Miller School of Medicine, 5915 Ponce de Leon Blvd, 5th Floor, Coral Gables, FL, 33146
- Department of Physical Therapy, Alagoas State University of Health Sciences, Maceió, Alagoas, Brazil
| | - Vinicius S. Santos
- Department of Physical Therapy, Alagoas State University of Health Sciences, Maceió, Alagoas, Brazil
| | - Oceano T. T. Pereira
- Department of Physical Therapy, Alagoas State University of Health Sciences, Maceió, Alagoas, Brazil
| | - Maria J. Silva
- Department of Physical Therapy, Alagoas State University of Health Sciences, Maceió, Alagoas, Brazil
| | - Alvaro Pascual-Leone
- Department of Neurology, Harvard Medical School, Boston MA, USA
- Hinda and Arthur Marcus Institute for Aging Research and Deanna and Sidney Wolk Center for Memory Health, Hebrew SeniorLife, Rosindale, MA, USA
- Guttmann Brain Health Institute, Barcelona, Spain
| | - Tatjana Rundek
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL
| | | | - Neva Kirk-Sanchez
- Department of Physical Therapy, University of Miami Miller School of Medicine, 5915 Ponce de Leon Blvd, 5th Floor, Coral Gables, FL, 33146
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL
| | - Augusto C. A. Oliveira
- Department of Physical Therapy, Alagoas State University of Health Sciences, Maceió, Alagoas, Brazil
| | - Joyce Gomes-Osman
- Department of Physical Therapy, University of Miami Miller School of Medicine, 5915 Ponce de Leon Blvd, 5th Floor, Coral Gables, FL, 33146
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL
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Alzaabi HS, Walton LM, Arumugam A. Association between demographic characteristics, lower limb range of motion, functional performance, ability to dual task, quality of life and risk of falls in older adults of the United Arab Emirates - A cross-sectional study. Heliyon 2022; 8:e08869. [PMID: 35141442 PMCID: PMC8814690 DOI: 10.1016/j.heliyon.2022.e08869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 01/09/2022] [Accepted: 01/27/2022] [Indexed: 11/01/2022] Open
Abstract
Background Methods Results Conclusions
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11
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The 180° Turn Phase of the Timed Up and Go Test Better Predicts History of Falls in the Oldest-Old When Compared With the Full Test: A Case-Control Study. J Aging Phys Act 2022; 31:303-310. [PMID: 36216335 DOI: 10.1123/japa.2022-0091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 07/11/2022] [Accepted: 08/04/2022] [Indexed: 11/06/2022]
Abstract
The 180° turn phase of the test may better differentiate the oldest-old regarding their history of falls. This is a case-control study designed to detect the ability of the 180° turn timed up and go (TUG) phase to detect a history of falls in the oldest-old. Sixty people aged 85 years and older were assessed in their homes. The single-task and dual-task TUG tests were performed using an inertial sensor (G-Walk). Sociodemographic data, physical activity levels, mental status, depressive symptoms, concern for falls occurrence, number of medicines in use, self-perception of balance, and the functional reach test were also assessed. The logistic regressions revealed the 180° turn phase of both the single-task and dual-task TUG was almost three times better than the full TUG test to detect a history of falls, thus providing insights that can be used to better assess functional mobility in the oldest-old.
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Lavoie V, Bouchard M, Turcotte S, Tousignant M. Telerehabilitation for Individuals with Parkinson's Disease and a History of Falls: A Pilot Study. Physiother Can 2021; 73:343-350. [PMID: 34880539 DOI: 10.3138/ptc-2019-0108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose: Falls among persons with Parkinson's disease (PD) decrease health-related quality of life (HRQOL) and are a risk factor for hospitalization. Although physiotherapy can decrease falls and improve functional capacity, people living in remote areas have limited access to such services. This pilot study aimed to document the feasibility of a physiotherapy telerehabilitation intervention for patients with PD and to estimate the change over time in functional capacity, HRQOL, and the rate of falls. Methods: Eleven persons with PD participated in an 8-week physiotherapy telerehabilitation intervention. We assessed feasibility by computing retention rate and assiduity, number of undesirable health events, and technical problems. We assessed functional capacity, HRQOL, and falls at baseline, after the intervention, and at the 3-month follow-up. Results: Retention rate and assiduity were 91% and 100%. We resolved all technical problems (21.9% of sessions). No undesirable health events occurred. Point estimates suggest an improvement in functional capacity (Mini-BESTest) and HRQOL. Forty percent of participants fell during the intervention phase. Conclusion: Physiotherapy telerehabilitation is feasible and safe for persons with PD. Improvements in functional capacity and HRQOL must be confirmed with an appropriate design.
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Affiliation(s)
- Violaine Lavoie
- Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, Quebec, Canada.,Centre de recherche CISSS-CA, Lévis, Quebec, Canada
| | - Manon Bouchard
- Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, Quebec, Canada.,Clinique Neuro-Lévis, Lévis, Quebec, Canada
| | - Stéphane Turcotte
- Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, Quebec, Canada
| | - Michel Tousignant
- School of Rehabilitation, Université de Sherbrooke, Sherbrooke, Quebec, Canada.,Research Centre on Aging, Centre intégré universitaire de santé et de services sociaux - Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
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13
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Meekes WM, Korevaar JC, Leemrijse CJ, van de Goor IA. Practical and validated tool to assess falls risk in the primary care setting: a systematic review. BMJ Open 2021; 11:e045431. [PMID: 34588228 PMCID: PMC8483054 DOI: 10.1136/bmjopen-2020-045431] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE Although several falls risk assessment tools are available, it is unclear which have been validated and which would be most suitable for primary care practices. This systematic review aims to identify the most suitable falls risk assessment tool for the primary care setting (ie, requires limited time, no expensive equipment and no additional space) and that has good predictive performance in the assessment of falls risk among older people living independently. DESIGN A systematic review based on prospective studies. METHODS An extensive search was conducted in the following databases: PubMed, Embase, CINAHL, Cochrane and PsycINFO. Tools were excluded if they required expensive and/or advanced software that is not usually available in primary care units and if they had not been validated in at least three different studies. Of 2492 articles published between January 2000 and July 2020, 27 were included. RESULTS Six falls risk assessment tools were identified: Timed Up and Go (TUG) test, Gait Speed test, Berg Balance Scale, Performance Oriented Mobility Assessment, Functional Reach test and falls history. Most articles reported area under the curve (AUC) values ranging from 0.5 to 0.7 for these tools. Sensitivity and specificity varied substantially across studies (eg, TUG, sensitivity:10%-83.3%, specificity:28.4%-96.6%). CONCLUSIONS Given that none of the falls risk assessment tools had sufficient predictive performance (AUC <0.7), other ways of assessing high falls risk among independently living older people in primary care should be investigated. For now, the most suitable way to assess falls risk in the primary care setting appears to involve asking patients about their falls history. Compared with the other five tools, the falls history requires the least amount of time, no expensive equipment, no training and no spatial adjustments. The clinical judgement of healthcare professionals continues to be most important, as it enables the identification of high falls risk even for patients with no falls history. TRIAL REGISTRAION NUMBER The Netherlands Trial Register, NL7917; Pre-results.
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Affiliation(s)
- Wytske Ma Meekes
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | | | | | - Ien Am van de Goor
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
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14
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Gafner SC, Allet L, Hilfiker R, Bastiaenen CHG. Reliability and Diagnostic Accuracy of Commonly Used Performance Tests Relative to Fall History in Older Persons: A Systematic Review. Clin Interv Aging 2021; 16:1591-1616. [PMID: 34483656 PMCID: PMC8409789 DOI: 10.2147/cia.s322506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 07/24/2021] [Indexed: 12/30/2022] Open
Abstract
Background/Objectives Early detection of fall risk is crucial for targeted fall prevention and rehabilitation. This systematic review facilitates decision-making concerning the optimal choice for a suitable fall risk assessment test for older persons in four different settings. This systematic review provides an overview of reliability and diagnostic accuracy (sensitivity [SE], specificity, likelihood ratios, and post-test probabilities) of commonly used performance measures to assess older persons' fall risk. Methods Two reviewers independently screened titles, abstracts, and full texts of all articles identified through a systematic search on the PubMed, Embase, CINAHL, and Web of Science databases. The methodological quality was critically appraised using the Quality Assessment of Diagnostic Accuracy Studies-2 tool and the COSMIN risk of bias tool. Due to a setting-dependent fall risk, four relevant settings were selected for the analyses: 1) community dwelling, 2) nursing home, 3) hospital, and 4) the combined setting of hospitalized and community-dwelling persons. Results Recommendations for diagnostic accuracy can be made for the specific settings: setting 1) mini-balance evaluation system test, timed up and go test with fast speed (TUG FAST), cognitive TUG FAST, functional reach test, and fast gait speed; 2) TUG at usual speed; 3) none of the included tests; and 4) some hip muscle strength and hand grip strength tests might be recommended. Conclusion The review's results are applicable for use in clinical practice, both on a population and on an individual level for patients and caregivers. Most measures' reliability is sufficient. However, the included tests' discriminative ability is not optimal for clinical use in relevant settings. The low sample sizes of most of the included studies and a limited amount of studies in all but the community-dwelling setting hinder us from making strong recommendations.
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Affiliation(s)
- Simone Chantal Gafner
- Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Geneva, Switzerland.,Department of Epidemiology, Research Line Functioning, Participation and Rehabilitation, CAPHRI, Maastricht University, Maastricht, the Netherlands
| | - Lara Allet
- Department of Community Medicine, University Hospitals and University of Geneva, Geneva, Switzerland.,School of Health Sciences, HES-SO Valais-Wallis, University of Applied Sciences and Arts Western Switzerland, Valais, Switzerland
| | - Roger Hilfiker
- School of Health Sciences, HES-SO Valais-Wallis, University of Applied Sciences and Arts Western Switzerland, Valais, Switzerland
| | - Caroline Henrice Germaine Bastiaenen
- Department of Epidemiology, Research Line Functioning, Participation and Rehabilitation, CAPHRI, Maastricht University, Maastricht, the Netherlands
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15
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Detecting subtle mobility changes among older adults: the Quantitative Timed Up and Go test. Aging Clin Exp Res 2021; 33:2157-2164. [PMID: 33098079 DOI: 10.1007/s40520-020-01733-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 10/01/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND The Quantitative Timed Up and Go (QTUG) test uses wearable sensors, containing a triaxial accelerometer and an add-on triaxial gyroscope, to quantify performance during the TUG test with potential to capture more minor changes in mobility. AIMS To examine the responsiveness, minimum detectable change (MDC) and observed effect size of QTUG in a cohort of socially active adults aged 50 years and over participating in a structured community exercise program. METHODS 54 participants (91% females, mean age 63.6 ± 6.5 years) completed repeated QTUG testing under single- and dual-task conditions. Responsiveness of the QTUG was assessed by correlation of change in standard TUG with QTUG change (Pearson's correlation coefficient). MDC and effect sizes (standardized mean difference and Cohen's d) were also calculated for QTUG. RESULTS There was a strong positive correlation between change in the standard TUG and change in QTUG (single task r = 0.91, p < 0.001). MDC in QTUG was calculated as 0.77 (Sd, 1.39; ICC 0.96) seconds (single task) and 2.33 (Sd 2.18; ICC 0.85) seconds (dual task). Several QTUG parameters showed improvements in mean values with small effect sizes (sit -to-stand transition time d = 0.418; walk time d = 0.398; cadence d = 0.306, swing time d = 0.314; step time d = 0.479; gait velocity d = 0.365; time to reach turn d = 0.322) under single-task conditions and with a moderate effect size (d = 0.549) in time taken to turn under the dual-task condition. CONCLUSION Initial evidence of QTUG's responsiveness to change in mobility in active middle to older age adults has been demonstrated with small to moderate effect sizes observed in specific QTUG parameters.
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16
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Mate K, Fulmer T, Pelton L, Berman A, Bonner A, Huang W, Zhang J. Evidence for the 4Ms: Interactions and Outcomes across the Care Continuum. J Aging Health 2021; 33:469-481. [PMID: 33555233 PMCID: PMC8236661 DOI: 10.1177/0898264321991658] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objectives: An expert panel reviewed and summarized the literature related to the evidence for the 4Ms-what matters, medication, mentation, and mobility-in supporting care for older adults. Methods: In 2017, geriatric experts and health system executives collaborated with the Institute for Healthcare Improvement (IHI) to develop the 4Ms framework. Through a strategic search of the IHI database and recent literature, evidence was compiled in support of the framework's positive clinical outcomes. Results: Asking what matters from the outset of care planning improved both psychological and physiological health statuses. Using screening protocols such as the Beers' criteria inhibited overprescribing. Mentation strategies aided in prevention and treatment. Fall risk and physical function assessment with early goals and safe environments allowed for safe mobility. Discussion: Through a framework that reduces cognitive load of providers and improves the reliability of evidence-based care for older adults, all clinicians and healthcare workers can engage in age-friendly care.
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Affiliation(s)
- Kedar Mate
- Institute for Healthcare Improvement, Cambridge, MA, USA
| | - Terry Fulmer
- The John A. Hartford Foundation, New York, NY, USA
| | - Leslie Pelton
- Institute for Healthcare Improvement, Cambridge, MA, USA
| | - Amy Berman
- The John A. Hartford Foundation, New York, NY, USA
| | - Alice Bonner
- Institute for Healthcare Improvement, Cambridge, MA, USA
| | - Wendy Huang
- Columbia University Mailman School of Public Health, New York, NY, USA
| | - Jinghan Zhang
- Columbia University Mailman School of Public Health, New York, NY, USA
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17
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Gait Flexibility among Older Persons Significantly More Impaired in Fallers Than Non-Fallers-A Longitudinal Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18137074. [PMID: 34281011 PMCID: PMC8297078 DOI: 10.3390/ijerph18137074] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/28/2021] [Accepted: 06/29/2021] [Indexed: 01/12/2023]
Abstract
Gait disorders are a relevant factor for falls and possible to measure with wearable devices. If a wearable sensor can detect differences in gait parameters between fallers and non-fallers has not yet been studied. The aim of this study was to measure and compare gait parameters, vestibular function, and balance performance between fallers and non-fallers among a group of older persons. Participants were senior members (n = 101) of a Swedish non-profit gymnastic association. Gait parameters were obtained using an inertial measurement unit (IMU) that the participants wore on the leg while walking an obstacle course and on an even surface. Vestibular function was assessed by the Head-shake test, the Head impulse test, and the Dix-Hallpike maneuver. Balance was assessed by the Timed Up and Go, the Timed Up and Go manual, and the Timed Up and Go cognitive tests. Falls during the 12-month follow-up period were monitored using fall diaries. Forty-two persons (41%) had fallen during the 12-month follow-up. Fallers had more limited ability to vary their gait (gait flexibility) than non-fallers (p < 0.001). No other differences between fallers and non-fallers were found. The use of gait flexibility, captured by an IMU, seems better for identifying future fallers among healthy older persons than Timed Up and Go or Timed Up and Go combined with a cognitive or manual task.
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18
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Haigis D, Pomiersky R, Altmeier D, Frahsa A, Sudeck G, Thiel A, Eschweiler G, Nieß AM. Feasibility of a Geriatric Assessment to Detect and Quantify Sarcopenia and Physical Functioning in German Nursing Home Residents-A Pilot Study. Geriatrics (Basel) 2021; 6:geriatrics6030069. [PMID: 34287326 PMCID: PMC8293077 DOI: 10.3390/geriatrics6030069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 06/27/2021] [Accepted: 07/01/2021] [Indexed: 01/21/2023] Open
Abstract
Background: Entering into a nursing home leads to increased immobility and further reductions in physical and cognitive functioning. As a result, there is a risk of sarcopenia, which is characterized by loss of muscle strength, muscle mass and physical functioning. To our knowledge, the feasibility of sarcopenia screening has not yet been performed in the German nursing home setting. Methods: For sarcopenia screening, the specifications of EWGSOP2 were applied. The quantification of sarcopenia was performed according to the corresponding cut-off values. The collection of anthropometric data and the morbidity status were recorded. SARC-F, mini-mental state examination, Barthel Index, Short Physical Performance Battery and Timed Up and Go tests were implemented. Results: In one participant, severe sarcopenia could be identified. The quantification was not possible for four participants. A suspicion of sarcopenia was not confirmed in five participants. Only one person was able to perform all assessments. Conclusions: Sarcopenia screening according to EWGSOP2 presented satisfactory feasibility by nursing home residents. However, further tests to assess the physical functioning of the participants often could not be performed. Moreover, inconsistencies in individual assessments became apparent, leading to inconclusive analyses. The recording of sarcopenia prevalence in German nursing homes should be the goal of further research.
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Affiliation(s)
- Daniel Haigis
- Department of Sports Medicine, University Hospital of Tuebingen, 72076 Tübingen, Germany;
- Interfaculty Research Institute for Sport and Physical Activity, University of Tuebingen, 72074 Tübingen, Germany; (R.P.); (D.A.); (A.F.); (G.S.); (A.T.)
- Correspondence:
| | - Rebekka Pomiersky
- Interfaculty Research Institute for Sport and Physical Activity, University of Tuebingen, 72074 Tübingen, Germany; (R.P.); (D.A.); (A.F.); (G.S.); (A.T.)
- Institute of Sport Science, Eberhard Karls University of Tuebingen, 72074 Tübingen, Germany
| | - Dorotheé Altmeier
- Interfaculty Research Institute for Sport and Physical Activity, University of Tuebingen, 72074 Tübingen, Germany; (R.P.); (D.A.); (A.F.); (G.S.); (A.T.)
- Institute of Sport Science, Eberhard Karls University of Tuebingen, 72074 Tübingen, Germany
| | - Annika Frahsa
- Interfaculty Research Institute for Sport and Physical Activity, University of Tuebingen, 72074 Tübingen, Germany; (R.P.); (D.A.); (A.F.); (G.S.); (A.T.)
- Institute of Sport Science, Eberhard Karls University of Tuebingen, 72074 Tübingen, Germany
- Institute of Social and Preventive Medicine, University of Bern, 3012 Bern, Switzerland
| | - Gorden Sudeck
- Interfaculty Research Institute for Sport and Physical Activity, University of Tuebingen, 72074 Tübingen, Germany; (R.P.); (D.A.); (A.F.); (G.S.); (A.T.)
- Institute of Sport Science, Eberhard Karls University of Tuebingen, 72074 Tübingen, Germany
| | - Ansgar Thiel
- Interfaculty Research Institute for Sport and Physical Activity, University of Tuebingen, 72074 Tübingen, Germany; (R.P.); (D.A.); (A.F.); (G.S.); (A.T.)
- Institute of Sport Science, Eberhard Karls University of Tuebingen, 72074 Tübingen, Germany
| | - Gerhard Eschweiler
- Centre for Geriatric Medicine, University Hospital of Tuebingen, 72076 Tübingen, Germany;
| | - Andreas Michael Nieß
- Department of Sports Medicine, University Hospital of Tuebingen, 72076 Tübingen, Germany;
- Interfaculty Research Institute for Sport and Physical Activity, University of Tuebingen, 72074 Tübingen, Germany; (R.P.); (D.A.); (A.F.); (G.S.); (A.T.)
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19
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Blackwood J, Rybicki K. Assessment of Gait Speed and Timed Up and Go Measures as Predictors of Falls in Older Breast Cancer Survivors. Integr Cancer Ther 2021; 20:15347354211006462. [PMID: 33784836 PMCID: PMC8020039 DOI: 10.1177/15347354211006462] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Older breast cancer survivors are at an increased risk of loss of postural balance and accidental falls, however, the ability of clinical mobility measures to predict falls has not been determined. The purpose of this study was to examine the prognostic ability, sensitivity, and specificity to predict accidental falls in measures of gait speed and functional mobility in older breast cancer survivors. METHODS Thirty-four breast cancer survivors 65 years and older performed 3 measures of gait speed (GS) (usual, fast, dual-task) and Timed Up and Go (TUG) (TUG, TUG-Cognitive, TUG-Manual). Follow-up calls were made 3 months after testing to track falls. RESULTS The area under the curve (AUC) was below 0.5 for all GS measures, indicating poor predictive ability and all GS measures had low sensitivity and specificity to predict falls. All TUG measures had AUC values above 0.5. The cutoff score with the best sensitivity/specificity to predict falls was: TUG-Cognitive = 11.32 seconds, Sens = 0.64, Spec = 0.80; TUG-Manual = 9.84 seconds, Sens = 0.71, Spec = 0.65. CONCLUSION When assessing fall risk in older breast cancer survivors, performance on the TUG and TUG-Cognitive are able to predict falls.
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20
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Mayer KP, Steele AK, Soper MK, Branton JD, Lusby ML, Kalema AG, Dupont-Versteegden EE, Montgomery AA. Physical Therapy Management of an Individual With Post-COVID Syndrome: A Case Report. Phys Ther 2021; 101:6177704. [PMID: 33735380 PMCID: PMC7989151 DOI: 10.1093/ptj/pzab098] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 03/07/2021] [Accepted: 03/10/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The purpose of this case report is to provide the clinical presentation and physical therapist management for a patient with post-COVID syndrome. Secondarily, the report highlights the importance of assessing cognitive and emotional health in patients with post-COVID syndrome. METHODS (CASE DESCRIPTION) A 37-year-old woman tested positive for SARS-CoV-2 and developed mild COVID-19 disease but did not require supplemental oxygen or hospitalization. The patient experienced persistent symptoms, including dyspnea, headaches, and cognitive fog. On day 62, they participated in an outpatient physical therapist evaluation that revealed deficits in exercise capacity, obtaining 50% of their age-predicted 6-minute walk distance. They had minor reductions in muscle strength and cognitive function. Self-reported quality of life was 50, and they scored above established cut-off scores for provisional diagnosis of posttraumatic stress disorder (PTSD). RESULTS The patient participated in biweekly physical therapist sessions for 8 weeks, which included aerobic training, strengthening exercises, diaphragmatic breathing techniques, and mindfulness training. Metabolic equivalent for task levels increased with variability over the course of the program. The patient's muscle strength, physical function, and exercise capacity improved. 6-Minute walk distance increased by 199 m, equating to 80% of their age-predicted distance. Quality of life and PTSD scores did not improve. At evaluation after physical therapy, the patient was still experiencing migraines, dyspnea, fatigue, and cognitive dysfunction. CONCLUSION This case report described the clinical presentation and physical therapist management of a person with post-COVID syndrome, a novel health condition for which little evidence exists to guide rehabilitation examination and interventions. Physical therapists should consider cognitive function and emotional health in their plan of care for patients with post-COVID syndromes. IMPACT This case alerts physical therapists to post-COVID syndrome-which can include debilitating symptoms of decreased aerobic tolerance, anxiety, PTSD, and cognitive dysfunction-and to the role that therapists can play in assessing these symptoms and managing these patients.
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Affiliation(s)
- Kirby P Mayer
- Address all correspondence to Kirby P. Mayer, DPT, Ph.D. 900 S. Limestone, CTW 204D, Lexington, KY 40536,
| | - Angela K Steele
- Pulmonary Rehabilitation, Medicine Specialties Clinic, Therapeutic Services, University of Kentucky Healthcare
| | - Melissa K Soper
- Division of Pulmonary, Critical Care and Sleep Medicine, College of Medicine, University of Kentucky
| | - Jill D Branton
- Pulmonary Rehabilitation, Medicine Specialties Clinic, Therapeutic Services, University of Kentucky Healthcare
| | - Megan L Lusby
- Pulmonary Rehabilitation, Medicine Specialties Clinic, Therapeutic Services, University of Kentucky Healthcare
| | - Anna G Kalema
- Division of Pulmonary, Critical Care and Sleep Medicine, College of Medicine, University of Kentucky
| | | | - Ashley A Montgomery
- Division of Pulmonary, Critical Care and Sleep Medicine, College of Medicine, University of Kentucky
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Malmström EM, Ekvall Hansson E, Hafström A, Magnusson M, Fransson PA. Co-morbidities to Vestibular Impairments-Some Concomitant Disorders in Young and Older Adults. Front Neurol 2021; 11:609928. [PMID: 33584509 PMCID: PMC7873354 DOI: 10.3389/fneur.2020.609928] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 12/21/2020] [Indexed: 01/14/2023] Open
Abstract
Background: Dizziness and pain are common complaints that often appear concomitantly, with or without a causal relationship. However, these symptoms might maintain and exacerbate each other and other co-morbidities. Therefore, adequate rehabilitation may have to include an expanded focus on other deficits and preconditions, especially in older adults and in patients. Objective: To understand how frequently vestibular dysfunction coincided with medical conditions and aging, we studied two categories: Study 1: patients referred to a vestibular unit and Study 2: senior members in a fitness association. Method: Study 1: 49 patients [34 females/15 males; mean age 52 years (SEM 2.0)] seeking health care for balance disorders and vestibular deficits were asked in questionnaires about their perception of dizziness and pain, and emotional and functional strains. Study 2: 101 senior members in a fitness association [91 females/10 males; mean age 75 years (SEM 0.6)], were assessed for vestibular and balance deficits and for any co-morbidities. The participants were monitored for falls for 12 months after the initial assessments. Result: Study 1: Co-morbidity often existed between dizziness and pain (65%). The patients reported high emotional and functional strain related to their dizziness and pain. Patients older than 60 years reported longer durations of pain (p ≤ 0.028) but less emotional strain (p = 0.036), compared to younger patients. Study 2: 84% of the participants had a vestibular impairment, often without noticing any symptoms. Furthermore, 40% reported cardiovascular illnesses, 12% musculoskeletal disorders, and 63% reported other medical conditions. Forty-two percent experienced falls within 1 year after the initial assessments (thereof 42% in the group with vestibular deficits and 38% in the group without vestibular deficits). Conclusion: To enhance and preserve postural control, both in patients with vestibular deficits and in older adults, we suggest an expanded clinical perspective. Hence, we recommend detailed examinations of the vestibular system but simultaneously probing for possible co-morbidities. Since aging often entails deterioration of multimodal processes related to maintained mobility and postural stability, our results add focus on the importance of addressing balance disorders together with additional medical conditions.
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Affiliation(s)
- Eva-Maj Malmström
- Department of Clinical Sciences, Section of Otorhinolaryngology, Lund University, Lund, Sweden.,Department of Neurosurgery and Pain Rehabilitation, Skåne University Hospital, Lund, Sweden
| | | | - Anna Hafström
- Department of Clinical Sciences, Section of Otorhinolaryngology, Lund University, Lund, Sweden
| | - Måns Magnusson
- Department of Clinical Sciences, Section of Otorhinolaryngology, Lund University, Lund, Sweden
| | - Per-Anders Fransson
- Department of Clinical Sciences, Section of Otorhinolaryngology, Lund University, Lund, Sweden
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Murillo-Garcia A, Leon-Llamas JL, Villafaina S, Rohlfs-Dominguez P, Gusi N. MoCA vs. MMSE of Fibromyalgia Patients: The Possible Role of Dual-Task Tests in Detecting Cognitive Impairment. J Clin Med 2021; 10:E125. [PMID: 33401439 PMCID: PMC7796019 DOI: 10.3390/jcm10010125] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 12/23/2020] [Accepted: 12/29/2020] [Indexed: 11/17/2022] Open
Abstract
Fibromyalgia is a syndrome that is characterized by widespread pain; fatigue; stiffness; reduced physical fitness; sleep disturbances; psychological symptoms, such as anxiety and depression; and deficits in cognitive functions, such as attention, executive function, and verbal memory deficits. It is important to analyze the potentially different performance on the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) test in patients with fibromyalgia as well as examine the relationship of that performance with physical and cognitive performance. A total of 36 women with fibromyalgia participated in the study. Participants completed the MoCA test, the MMSE, and the TUG physical fitness test under dual-task conditions. The results obtained on cognitive tests were 28.19 (1.74) on the MMSE and 25.17 (2.79) on the MoCA. The participants' performance on cognitive tests was significantly related to the results of the TUG dual-task test. In this way, cognitive performance on a dual-task test can be used to support the diagnosis of cognitive impairment in patients with fibromyalgia. The MoCA test may be a more sensitive cognitive screening tool than the MMSE for patients with fibromyalgia.
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Affiliation(s)
- Alvaro Murillo-Garcia
- Physical Activity and Quality of Life Research Group (AFYCAV), Faculty of Sport Science, University of Extremadura, 10003 Cáceres, Spain; (A.M.-G.); (S.V.); (P.R.-D.); (N.G.)
| | - Juan Luis Leon-Llamas
- Physical Activity and Quality of Life Research Group (AFYCAV), Faculty of Sport Science, University of Extremadura, 10003 Cáceres, Spain; (A.M.-G.); (S.V.); (P.R.-D.); (N.G.)
| | - Santos Villafaina
- Physical Activity and Quality of Life Research Group (AFYCAV), Faculty of Sport Science, University of Extremadura, 10003 Cáceres, Spain; (A.M.-G.); (S.V.); (P.R.-D.); (N.G.)
| | - Paloma Rohlfs-Dominguez
- Physical Activity and Quality of Life Research Group (AFYCAV), Faculty of Sport Science, University of Extremadura, 10003 Cáceres, Spain; (A.M.-G.); (S.V.); (P.R.-D.); (N.G.)
- Department of Psychology and Anthropology, University of Extremadura, 10003 Caceres, Spain
| | - Narcis Gusi
- Physical Activity and Quality of Life Research Group (AFYCAV), Faculty of Sport Science, University of Extremadura, 10003 Cáceres, Spain; (A.M.-G.); (S.V.); (P.R.-D.); (N.G.)
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Asai T, Oshima K, Fukumoto Y, Yonezawa Y, Matsuo A, Misu S. Does dual-tasking provide additional value in timed "up and go" test for predicting the occurrence of falls? A longitudinal observation study by age group (young-older or old-older adults). Aging Clin Exp Res 2021; 33:77-84. [PMID: 32086716 DOI: 10.1007/s40520-020-01510-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 02/11/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Previous studies using relatively large samples and longitudinal observational designs reported dual-tasking had additional value in timed "up and go" test (TUG) for falls assessment among well-functioning older adults. AIM To elucidate the additional value of dual-tasking in TUG for predicting the occurrence of falls among community-dwelling older adults by age group using a predictive model. METHODS This longitudinal observation study included 987 community-dwelling older adults at baseline. A TUG without performing another task (single-TUG) and a TUG while counting aloud backward from 100 were conducted at baseline. We computed the dual-task cost (DTC) value, which is used to quantify trends in subjects' execution of motor tests under dual-task conditions. Data on fall history were obtained using a self-administered questionnaire at the 1-year follow-up. The final analysis included 649 individuals divided into a young-older adult group (aged 60-74 years) and an old-older adult group (aged ≥ 75 years). Associations between the occurrence of falls and TUG-related values were analyzed by age group using multivariate logistic regression models. RESULTS For old-older adults, there were significant associations between the occurrence of falls and single-TUG time (odds ratio [OR] 1.143, 95% confidence interval [CI] 1.018-1.285) and DTC value (OR 0.981, 95% CI 0.963-0.999). No significant associations were observed for young-older adults. CONCLUSIONS Slower single-TUG time and lower DTC value are associated with the occurrence of falls among old-older adults but not among young-older adults. Dual tasking may provide an additional value in TUG for predicting falls among old-older adults.
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Affiliation(s)
- Tsuyoshi Asai
- Department of Physical Therapy, Faculty of Rehabilitation, Kobe Gakuin University, 518 Arise, Ikawadani-cho, Nishi-ku, Kobe, Hyogo, 651-2180, Japan.
| | - Kensuke Oshima
- Faculty of Rehabilitation, Kobe Gakuin University Graduate School, 518 Arise, Ikawadani-cho, Nishi-ku, Kobe, Hyogo, 651-2180, Japan
| | - Yoshihiro Fukumoto
- Department of Physical Medicine and Rehabilitation, Kansai Medical University, 2-5-1, Shin-machi, Hirakata, Osaka, Japan
| | - Yuri Yonezawa
- Inami Town Office, 1-1 Kunioka, Inami-town, Kako-gun, Hyogo, 675-1115, Japan
| | - Asuka Matsuo
- Inami-cho Social Welfare Council, 4369-3 Kako, Inami-town, Kako-gun, Hyogo, 675-1105, Japan
| | - Shogo Misu
- Department of Physical Therapy, Faculty of Nursing and Rehabilitation, Konan Women's University, 6-2-23 Morikita-cho, Higashinada-ku, Kobe, Hyogo, 658-0001, Japan
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Ziegl A, Hayn D, Kastner P, Löffler K, Weidinger L, Brix B, Goswami N, Schreier G. Quantitative falls risk assessment in elderly people: results from a clinical study with distance based timed up-and-go test recordings. Physiol Meas 2020; 41:115006. [PMID: 33086193 DOI: 10.1088/1361-6579/abc352] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE A third of people over 65 years experiences at least one fall a year. The Timed Up-and-Go (TUG) test is commonly used to assess gait and balance and to evaluate an individual's risk of falling. APPROACH We conducted a clinical study with 46 older participants for evaluating the fall risk assessment capabilities of an ultra-sound based TUG test device. The fall protocols over a period of one year were used to classify participants as fallers and non-fallers. For frailty evaluation, state-of-the-art questionnaires were used. Fall recordings were compared to six TUG test measurements that were recorded in fallers and non-fallers. MAIN RESULTS TUG test data were available for 39 participants (36 f, age 84.2 ± 8.2, BMI 26.0 ± 5.1). Twenty-three participants did fall at least once within the fall screening period. We fitted two different regression and probability models into a region of interest of the distance over time curve as derived from the TUG device. We found that the coefficient of determination for Gaussian bell-shaped curves (p < 0.05, AUC = 0.71) and linear regression lines (p < 0.02, AUC = 0.74) significantly separated fallers from non-fallers. Subtasks of the TUG test like the sit-up time showed near significance (p < 0.07, AUC = 0.67). SIGNIFICANCE We found that specific features calculated from the TUG distance over time curve were significantly different between fallers and non-fallers in our study population. Automatic recording and analysis of TUG measurements could, therefore, reduce time of measurements and improve precision as compared to other methods currently being used in the assessments of fall risk.
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Affiliation(s)
- Andreas Ziegl
- AIT Austrian Institute of Technology GmbH, Graz, Austria. Institute of Neural Engineering, Graz University of Technology, Graz, Austria
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Wettasinghe AH, Dissanayake DWN, Allet L, Katulanda P, Lord SR. Falls in older people with diabetes: Identification of simple screening measures and explanatory risk factors. Prim Care Diabetes 2020; 14:723-728. [PMID: 32473990 DOI: 10.1016/j.pcd.2020.05.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 03/11/2020] [Accepted: 05/17/2020] [Indexed: 11/21/2022]
Abstract
AIMS To identify risk factors for falls in older people with diabetes mellitus (DM) and to develop a low-cost fall risk screening tool. METHODS Older adults with DM (n = 103; age = 61.6 + 6.0 years) were recruited from diabetic clinics. Demographic, DM specific factors, lower limb strength and sensation, cognition, fear of falling, hand reaction time, balance, mobility and gait parameters were assessed using validated methods. Falls were prospectively recorded over six months. RESULTS Past falls and female gender were identified as significant predictors of falls: history of falls and female gender increased fall rates by 4.62 (95% CI = 2.31-9.27) and 2.40 (95% CI = 1.04-5.54) respectively. Fall rates were significantly associated with Diabetic Neuropathy scores, HbA1c level, contrast sensitivity, quadriceps strength, postural sway, tandem balance, stride length and Timed Up and Go Test times. A multi-variable fall risk tool derived using five measures, revealed that absolute risk for multiple falls increased from 0% in participants with zero or one factor to 83% in participants with all five risk factors. CONCLUSIONS Simple screening items for fall risk in people with DM were identified, with parsimonious explanatory risk factors. These findings help guide tailored interventions for preventing falls in DM.
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Affiliation(s)
- Asha H Wettasinghe
- Department of Allied Health Sciences, Faculty of Medicine, University of Colombo, Sri Lanka.
| | | | - Lara Allet
- Department of Community Medicine, University Hospitals and University of Geneva, Geneva, Switzerland; Department of Physiotherapy, School for Health Sciences, HES-SO, University of Applied Sciences & Arts of Western Switzerland, Geneva, Switzerland
| | - Prasad Katulanda
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Sri Lanka
| | - Stephen R Lord
- Neuroscience Research Australia, UNSW, Randwick, Sydney, Australia
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Wiśniowska-Szurlej A, Ćwirlej-Sozańska A, Wołoszyn N, Sozański B, Wilmowska-Pietruszyńska A, Washburn R. Cultural adaptation and validation of the Polish version of the physical activity scale for older people living in a community: a cross-sectional study. Eur Rev Aging Phys Act 2020; 17:19. [PMID: 33292174 PMCID: PMC7679979 DOI: 10.1186/s11556-020-00252-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 11/16/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Polish clinicians and researchers face challenges in selecting physical activity tools appropriate and validated for older people. The aim of this study is to provide cultural adaptation and validation of the Polish version of the Physical Activity Scale for Elderly (PASE-P). METHODS This cross-sectional study was carried out among 115 older adults living in south-eastern Poland. The original version of the scale has been translated into the Polish language following standardized translation procedures. Validation was evaluated by Pearson's rank correlation coefficients between PASE-P, the normal Timed Up and Go test and that with a cognitive task (TUG and TUG cog, respectively), grip strength, basic and instrumental activities of daily living (ADL and IADL, respectively), Five Times Sit to Stand (5x STS), 10-m Walk Test (10MWT), the Berg Balance Scale (BBS) and the International Physical Activity Questionnaire (IPAQ). RESULTS The mean PASE-P was 91.54 (SD 71.15). Sufficient reliability of the test-retest of the PASE-P questionnaire components was found between the trials. The ICC test was strong and ranged from 0.988 to 0.778 for both major domains and the total scale score. A significant correlation was found between the total PASE-P score and the shorter TUG, TUG cog (r = - 0.514, p < 0.001; r = - 0.481, p < 0.001) and 10MWT (r = 0.472, p < 0.001). The total PASE-P score was also positively correlated with ADL and IADL (r = 0.337, p < 0.001; r = 0.415 p < 0.001), BBS (r = 0.537, p < 0.001) and 5xSTS (r = 0.558, p < 0.001). CONCLUSIONS The results obtained in the study confirm that the Polish version of the PASE scale is a valid and reliable tool for assessing the level of physical activity in older adults living in a community.
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Affiliation(s)
| | - Agnieszka Ćwirlej-Sozańska
- Institute of Health Sciences, Medical College of Rzeszow University, Warzywna 1a, Rzeszow, 35-310, Poland
| | - Natalia Wołoszyn
- Institute of Health Sciences, Medical College of Rzeszow University, Warzywna 1a, Rzeszow, 35-310, Poland
| | - Bernard Sozański
- Institute of Medicine, Medical College of Rzeszow University, Warzywna 1a, Rzeszow, 35-310, Poland
| | | | - Richard Washburn
- Department of Internal Medicine, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
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Valenzuela PL, Maffiuletti NA, Saner H, Schütz N, Rudin B, Nef T, Urwyler P. Isometric Strength Measures are Superior to the Timed Up and Go Test for Fall Prediction in Older Adults: Results from a Prospective Cohort Study. Clin Interv Aging 2020; 15:2001-2008. [PMID: 33149561 PMCID: PMC7602904 DOI: 10.2147/cia.s276828] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 09/23/2020] [Indexed: 11/23/2022] Open
Abstract
Background Isometric strength measures and timed up and go (TUG) tests are both recognized as valuable tools for fall prediction in older adults. However, results from direct comparison of these two tests are lacking. We aimed to assess the potential of isometric strength measures and the different modalities of the TUG test to detect individuals at risk of falling. Methods This is a prospective cohort study including 24 community-dwelling older adults (≥65 years, 19 females, 88±7 years). Participants performed three variations of the TUG test (standard, counting and holding a full cup) and three isometric strength tests (handgrip, knee extension and hip flexion) at several time points (at baseline and every ~6 weeks) during a one-year follow-up. The association between these tests and the incidence of falls during the follow-up was assessed. Results Twelve participants out of 24 participants experienced falls during the follow-up. Fallers showed a significantly lower handgrip strength (-5.7 kg, 95% confidence interval: -10.4 to -1.1, p=0.019) and knee extension strength (-4.9 kg, -9.6 to -0.2, p=0.042) at follow-up, while no significant differences were found for any TUG variation. Conclusions Handgrip and knee extension strength measures - particularly when assessed regularly over time - have the potential to serve as a simple and easy tool for detecting individuals at risk of falling as compared to functional mobility measures (ie, TUG test).
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Affiliation(s)
| | | | - Hugo Saner
- Institute for Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Gerontechnology & Rehabilitation Group, University of Bern, Bern, Switzerland
| | - Narayan Schütz
- Gerontechnology & Rehabilitation Group, University of Bern, Bern, Switzerland
| | - Beatrice Rudin
- Höhere Fachschule Pflege, Berufsbildungszentrum Olten, Olten, Switzerland
| | - Tobias Nef
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Prabitha Urwyler
- Gerontechnology & Rehabilitation Group, University of Bern, Bern, Switzerland.,ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland.,Department of Neurology, University Neurorehabilitation Unit, University Hospital Inselspital, Bern, Switzerland
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How to Improve the Functional Capacity of Frail and Pre-Frail Elderly People? Health, Nutritional Status and Exercise Intervention. The EXERNET-Elder 3.0 Project. SUSTAINABILITY 2020. [DOI: 10.3390/su12156246] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Aging is associated with the impairment of health and functional capacity, and physical exercise seems to be an effective tool in frailty prevention and treatment. The purpose of this study was to present the methodology used in the EXERNET-Elder 3.0 project that aims to evaluate the immediate and residual effects and of a multicomponent exercise training program called Elder-fit on frailty, fitness, body composition and quality of life, and also to analyse a possible dietary intake interaction according to health and metabolic status. A total of 110 frail and pre-frail elders participated in this study and were divided into a control group (CG = 52) and an intervention group (IG = 58). The IG performed a supervised multicomponent exercise training program of 6 months and 3 days per week, which included strength, endurance, balance, coordination and flexibility exercises, while the CG continued with their usual daily activities. Both groups received four speeches about healthy habits along the project. Four evaluations were performed: at baseline, after 3 months of training, at the end of the training program (6 months) and 4 months after the program had ended to examine the effects of detraining. Evaluating the efficacy, safety and feasibility of this program will help to develop efficacious physical interventions against frailty. Further, protocols should be described accurately to allow exercise programs to be successfully replicated.
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Marzuca-Nassr GN, SanMartín-Calísto Y, Guerra-Vega P, Artigas-Arias M, Alegría A, Curi R. Skeletal Muscle Aging Atrophy: Assessment and Exercise-Based Treatment. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1260:123-158. [PMID: 32304033 DOI: 10.1007/978-3-030-42667-5_6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
In the ordinary course of aging, individuals change their body composition, mainly reducing their skeletal muscle mass and increasing their fat mass. In association, muscle strength and functionality also decrease. The geriatric assessment allows knowing the baseline situation of the patients, determines the impact of diseases, and defines specific treatments. There are various tools to evaluate the health condition of older people. These tools include the assessment scales of necessary Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL), physical and functional assessment scales, and instruments that assess the cognitive state of the person. There are several strategies that have been proposed to combat skeletal muscle atrophy due to aging, such as physical exercise, nutritional supplements, or drugs. Some researchers have highlighted the efficacy of the combination of the mentioned strategies. In this chapter, we will focus only on physical exercise as a strategy to reduce skeletal muscle loss during aging.
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Affiliation(s)
- Gabriel Nasri Marzuca-Nassr
- Departamento de Medicina Interna, Facultad de Medicina, Universidad de La Frontera, Temuco, Chile. .,Magíster en Terapia Física con menciones, Facultad de Medicina, Universidad de La Frontera, Temuco, Chile.
| | - Yuri SanMartín-Calísto
- Magíster en Terapia Física con menciones, Facultad de Medicina, Universidad de La Frontera, Temuco, Chile
| | - Pablo Guerra-Vega
- Magíster en Terapia Física con menciones, Facultad de Medicina, Universidad de La Frontera, Temuco, Chile.,Escuela de Kinesiología, Facultad de Ciencias de la Salud, Universidad San Sebastián, Puerto Montt, Chile
| | - Macarena Artigas-Arias
- Magíster en Terapia Física con menciones, Facultad de Medicina, Universidad de La Frontera, Temuco, Chile
| | - Andrea Alegría
- Magíster en Terapia Física con menciones, Facultad de Medicina, Universidad de La Frontera, Temuco, Chile
| | - Rui Curi
- Interdisciplinary Post-Graduate Program in Health Sciences, Cruzeiro do Sul University, Sao Paulo, Brazil
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Fioritto AP, Cruz DTD, Leite ICG. Prevalência do risco de queda e fatores associados em idosos residentes na comunidade. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2020. [DOI: 10.1590/1981-22562020023.200076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetivo: Estimar a prevalência do risco de queda e fatores associados. Método: Estudo transversal com 339 idosos comunitários residentes em Juiz de Fora, MG. O risco de queda foi avaliado pelo Teste Timed Up and Go categorizado em baixo (<10 segundos), moderado (11-20 segundos) e alto (>20 segundos). Os sintomas de ansiedade e depressão, medo de cair, capacidade funcional para atividades instrumentais de vida diária e força de preensão palmar foram avaliados pelo Patient Health Questionnaire, Falls Efficacy Scale – Internacional – Brasil, Escala de Lawton e Brody e dinamômetro manual JAMAR, respectivamente. Foi construído um modelo teórico de determinação com três blocos hierarquizados. As variáveis com valor de p≤0,05 permaneceram no modelo final. Resultados: A prevalência de baixo, moderado e alto risco de queda foi de 36%, 43,7% e 20,3%, respectivamente. As variáveis associadas ao moderado risco de queda foram sexo feminino, idade entre 71-80 anos e >80 anos. Permaneceram associadas ao alto risco idade >80 anos, autopercepção de saúde geral negativa, necessidade de ajuda para andar através de dispositivo auxiliar, auxílio humano e medo de cair. Conclusão: O estudo evidenciou alta prevalência de moderado e alto risco de queda. Com exceção da idade avançada, os fatores associados ao moderado e alto risco foram distintos. Esses resultados podem ser considerados na abordagem do idoso sob risco a fim de possibilitar a escolha da intervenção mais adequada e nos convoca a pensar em estratégias e políticas públicas que garantam a prevenção de quedas e um envelhecimento saudável.
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Fioritto AP, Cruz DTD, Leite ICG. Correlation of functional mobility with handgrip strength, functional capacity for instrumental activities of daily living, fear of falling and number of falls in community-dwelling elderly. FISIOTERAPIA EM MOVIMENTO 2020. [DOI: 10.1590/1980-5918.033.ao35] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract Introduction: Functional mobility is essential for quality life and its worsening is the first sign of functional decline in the elderly. Objective: To assess the correlation of functional mobility with handgrip strength (HGS), functional capacity for IADL (FC-IADL) and fear of falling and number of falls in community-dwelling elderly. Method: A cross-sectional study was conducted with 303 community-dwelling elderly of both sexes, in Juiz de Fora (MG, Brazil). Functional mobility (TUG), HGS (dynamometer, JAMAR), FC-IADL (Lawton and Brody Scale), fear of falling (FES-I-Brazil) and number of falls were assessed. The data were analyzed using Pearson’s correlation test, and significance was established at ≤ 5%. Results: The elderly studied consisted of 61.7% females, were 73.5 ± 7.8 years old and had little schooling (4.3 ± 3.5 years). Functional mobility showed a moderate correlation with HGS (r = -0.383 and r = -0.322; women and men respectively) and FC-IADL (r = -0.568 and r = -0.583) in both sexes and fear of falling (r = 0.511) in females, a weak correlation with fear of falling in males (r = 0.243) and number of falls in both sexes (r = 0.101 and r = 0.195). Conclusion: Functional mobility showed a moderate correlation with HGS and FC-IADL in both sexes and fear of falling in females. It showed a weak correlation with fear of falling in males and number of falls in both sexes. The overestimated self-efficacy to prevent falls in men and the protective role of fear of falling in individuals with functional mobility limitations may explain these findings.
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Pohl PS, Gras LZ, Bosch PR, Ganley KJ, Mayer J. Dual Task Timed Up-and-Go for Older Adults With and Without Balance Deficits. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2019. [DOI: 10.1080/02703181.2019.1642975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Patricia S. Pohl
- Department of Physical Therapy & Athletic Training, Northern Arizona University, Phoenix, USA
| | - Laura Z. Gras
- Department of Physical Therapy, Ithaca College, New York, USA
| | - Pamela R. Bosch
- Department of Physical Therapy & Athletic Training, Northern Arizona University, Phoenix, USA
| | - Kathleen J. Ganley
- Department of Physical Therapy & Athletic Training, Northern Arizona University, Phoenix, USA
| | - Jill Mayer
- Department of Physical Therapy, Ithaca College, New York, USA
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Ozaldemir I, Iyigun G, Malkoc M. Comparison of processing speed, balance, mobility and fear of falling between hypertensive and normotensive individuals. Braz J Phys Ther 2019; 24:503-511. [PMID: 31570266 DOI: 10.1016/j.bjpt.2019.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 03/13/2019] [Accepted: 09/04/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Hypertension (HT) contributes substantially to poor physical function, cognitive dysfunction, cardiovascular problems and to all-cause mortality. Performance in activities requiring attention, speed and coordination might also be affected in individuals with HT. OBJECTIVE This study compared the processing speed, static and dynamic balance, functional mobility and fear of falling between individuals with hypertension (HT group) and normotensive individuals (NT group). METHODS One-hundred and twenty-eight individuals were included: NT group (n = 64) and HT group (n = 64). The Choice Stepping Reaction Time Test was used for the evaluation of processing speed, Single Leg Stance test for static balance evaluation, "Y" Balance Test for dynamic balance evaluation, Timed Up and Go test with single and dual tasking for the evaluation of functional mobility and Falls Efficacy Scale for assessing fear of falling. RESULTS The processing speed of the HT group was slower than that of the NT group; the total response time (RsT) in Stepping Reaction Test (SRT) (mean difference [MD] = -0.2, 95% CI = -0.3, 0), and Stroop Test (ST) [ST-A (MD = -0.4, 95% CI = -0.5, -0.2), ST-B (MD = -0.5, 95% CI = -0.7, -0.2) and ST-C (MD = -0.6, 95% CI = -0.8, -0.3). Additionally, the static [single leg stance, eyes open, right side (MD = 12.7, 95% CI = 6.3, 19.0) and left side (MD = 13.6, 95% CI = 7.2, 19.9)] and dynamic balance [Y balance test, composite score, right lower extremity (MD = 8.5, 95% CI = 4.4, 12.5) and left lower extremity (MD = 5.2, 95% CI = 1.5, 8.8) scores of the HT group were lower than those of the NT group. The HT group required a longer time to complete the functional mobility test measured with Timed Up And Go Test during both single task (MD = -0.8, 95% CI = -1.1, -0.4), cognitive dual task (MD = -1.5, 95% CI = -2.4, -0.5) and manual dual task (MD = -0.9, 95% CI = -1.3, -0.4) in comparison to the NT group. Also, the HT group had higher levels of fear of falling (MD = -7.6, 95% CI = -10.9, -4.2). CONCLUSION Hypertensive individuals present slower processing speed, reduced static and dynamic balance, decreased functional mobility and higher fear of falling in comparison to normotensive individuals.
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Affiliation(s)
- Isılay Ozaldemir
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Eastern Mediterranean University, Famagusta, Mersin, 10, Turkey
| | - Gozde Iyigun
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Eastern Mediterranean University, Famagusta, Mersin, 10, Turkey.
| | - Mehtap Malkoc
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Eastern Mediterranean University, Famagusta, Mersin, 10, Turkey
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Dual task performance and history of falls in community-dwelling older adults. Exp Gerontol 2019; 120:35-39. [PMID: 30825548 DOI: 10.1016/j.exger.2019.02.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 01/24/2019] [Accepted: 02/25/2019] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Falls are a common problem for older adults, and the identification of people at high risk of falling is a major challenge to health systems. OBJECTIVE To evaluate the association between the history of falls and single-task Timed Up and Go Test (single TUG) or dual-task TUG variables. METHODS Three hundred seventy seven community-dwelling older persons, with ages ranging from 65 and 92 years, participated in this cross-sectional study. Each participant performed two tests: single TUG and dual TUG. The cognitive task for dual TUG consisted of counting backward by one from 100 while performing the test. The number of cognitive errors, cognitive stops and motor stops were recorded. A new variable comprising time, errors and stops in the dual TUG was computed. RESULTS The number of falls was significantly associated with mean single and dual TUG performance, mean cognitive errors, mean cognitive stops and mean motor stops. The score in the single TUG time was not able to significantly classify participants as fallers or non-fallers in any of the sexes. On the other hand, the variable "dual TUG time spent adding cognitive stops and cognitive errors" achieved the best ability to classify women as fallers or non-fallers, while "dual task cost" and "dual TUG time spent adding cognitive stops" were the best variables to classify men. CONCLUSIONS Dual TUG including cognitive stops and cognitive errors may be more capable than the single TUG to detect differences and accurately classify fallers and non-fallers in the elderly.
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Bower K, Thilarajah S, Pua YH, Williams G, Tan D, Mentiplay B, Denehy L, Clark R. Dynamic balance and instrumented gait variables are independent predictors of falls following stroke. J Neuroeng Rehabil 2019; 16:3. [PMID: 30612584 PMCID: PMC6322221 DOI: 10.1186/s12984-018-0478-4] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 12/19/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Falls are common following stroke and are frequently related to deficits in balance and mobility. This study aimed to investigate the predictive strength of gait and balance variables for evaluating post-stroke falls risk over 12 months following rehabilitation discharge. METHODS A prospective cohort study was undertaken in inpatient rehabilitation centres based in Australia and Singapore. A consecutive sample of 81 individuals (mean age 63 years; median 24 days post stroke) were assessed within one week prior to discharge. In addition to comfortable gait speed over six metres (6mWT), a depth-sensing camera (Kinect) was used to obtain fast-paced gait speed, stride length, cadence, step width, step length asymmetry, gait speed variability, and mediolateral and vertical pelvic displacement. Balance variables were the step test, timed up and go (TUG), dual-task TUG, and Wii Balance Board-derived centre of pressure velocity during static standing. Falls data were collected using monthly calendars. RESULTS Over 12 months, 28% of individuals fell at least once. The faller group had increased TUG time and reduced stride length, gait speed variability, mediolateral and vertical pelvic displacement, and step test scores (P < 0.001-0.048). Significant predictors, when adjusted for country, prior falls and assistance (i.e., physical assistance and/or gait aid use) were stride length, step length asymmetry, mediolateral pelvic displacement, step test and TUG scores (P < 0.040; IQR-odds ratio(OR) = 1.37-7.85). With comfortable gait speed as an additional covariate, to determine the additive benefit over standard clinical assessment, only mediolateral pelvic displacement, TUG and step test scores remained significant (P = 0.001-0.018; IQR-OR = 5.28-10.29). CONCLUSIONS Reduced displacement of the pelvis in the mediolateral direction during walking was the strongest predictor of post-stroke falls compared with other gait variables. Dynamic balance measures, such as the TUG and step test, may better predict falls than gait speed or static balance measures.
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Affiliation(s)
- Kelly Bower
- Department of Physiotherapy, The University of Melbourne, Parkville, VIC, 3010, Australia.
| | - Shamala Thilarajah
- School of Health and Sport Sciences, University of the Sunshine Coast, Queensland, Sippy Downs, 4556, Australia.,Department of Physiotherapy, Singapore General Hospital, Bukit Merah, Singapore, 169608, Singapore
| | - Yong-Hao Pua
- Department of Physiotherapy, Singapore General Hospital, Bukit Merah, Singapore, 169608, Singapore
| | - Gavin Williams
- Department of Physiotherapy, The University of Melbourne, Parkville, VIC, 3010, Australia.,Department of Physiotherapy, Epworth HealthCare, Richmond, VIC, 3121, Australia
| | - Dawn Tan
- Department of Physiotherapy, Singapore General Hospital, Bukit Merah, Singapore, 169608, Singapore
| | - Benjamin Mentiplay
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, VIC, 3086, Australia.,Victorian Infant Brain Studies, Murdoch Children's Research Institute, Parkville, VIC, 3052, Australia
| | - Linda Denehy
- Department of Physiotherapy, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Ross Clark
- School of Health and Sport Sciences, University of the Sunshine Coast, Queensland, Sippy Downs, 4556, Australia
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Sjöholm H, Hägg S, Nyberg L, Rolander B, Kammerlind AS. The Cone Evasion Walk test: Reliability and validity in acute stroke. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2018; 24:e1744. [PMID: 30209845 DOI: 10.1002/pri.1744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 06/26/2018] [Accepted: 07/27/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To estimate the reliability and validity of the Cone Evasion Walk test (CEW), a new test assessing the ability to evade obstacles, in people with acute stroke. METHODS To estimate the reliability of the CEW, video recordings of 20 people with acute stroke performing the test were assessed by 10 physiotherapists on two occasions, resulting in a total of 400 ratings. Patients performed the CEW (n = 221), functional ambulation classification (FAC; n = 204), Timed Up and Go (TUG; n = 173), TUG cognitive (TUG-cog; n = 139), Serial 7s attention task from the Montreal Cognitive Assessment (MoCA-S7; n = 127), and the Star Cancellation Test (SCT; n = 151). These tests and side of lesion (n = 143) were used to examine construct validity. The predictive validity was evaluated in relation to falls during the following 6 months (n = 203). RESULTS The intraclass correlation coefficients for intrarater and interrater reliability were 0.88-0.98. For validity, there were significant correlations between the CEW and FAC (rs = -0.67), TUG (rs = 0.45), MoCA-S7 (rs = -0.36), and SCT total score (rs = -0.36). There was a significant correlation between the number of cones touched on the left side and the proportion of cancelled stars on the left (rs = -0.23) and right (rs = 0.23) side in the SCT. Among right hemisphere stroke participants (n = 79), significantly more persons hit cones on the left side (n = 25) than the right side (n = 8), whereas among those with a left hemisphere stroke (n = 64) significantly more persons hit cones on the right side (n = 11) than the left (n = 3). Cox regression showed that participants who touched four to eight cones had an increased risk of falls over time (hazard ratio 2.11, 95% CI [1.07, 4.17]) compared with those who touched none. CONCLUSION The new CEW test was reliable and valid in assessing the ability to evade obstacles while walking and to predict falls in patients with acute stroke.
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Affiliation(s)
- Hanna Sjöholm
- Rehabilitation Centre, Region Jönköping County, Jönköping and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Staffan Hägg
- Futurum, Region Jönköping County, Jönköping and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Lars Nyberg
- Department of Health Sciences, Luleå University of Technology, Luleå, Sweden
| | - Bo Rolander
- Futurum, Region Jönköping County, Jönköping, Sweden
| | - Ann-Sofi Kammerlind
- Futurum, Region Jönköping County, Jönköping and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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Abstract
Enhanced recovery after surgery (ERAS) pathways target specific areas within perioperative patient care in a multidisciplinary and evidence-based manner. Because of the subsequent positive outcomes associated with its use, ERAS has expanded to most surgical subspecialties, including hepatopancreatobiliary surgery. Although certain concepts are universal to all ERAS protocols, there are unique areas of emphasis pertaining to the hepatopancreatobiliary specialties, which will be highlighted throughout this article. In addition, some of the less frequently discussed aspects of enhanced recovery, including patient-reported outcomes, recovery assessment, cost, and auditing, will be addressed.
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Affiliation(s)
- Heather A Lillemoe
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Thomas A Aloia
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Martini DN, Zeeboer E, Hildebrand A, Fling BW, Hugos CL, Cameron MH. ADSTEP: Preliminary Investigation of a Multicomponent Walking Aid Program in People With Multiple Sclerosis. Arch Phys Med Rehabil 2018; 99:2050-2058. [PMID: 29958906 DOI: 10.1016/j.apmr.2018.05.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 05/05/2018] [Accepted: 05/14/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the effect of the Assistive Device Selection, Training and Education Program (ADSTEP) on falls and walking and sitting activity in people with multiple sclerosis (PwMS). DESIGN Randomized controlled trial. SETTING Veterans affairs medical center. PARTICIPANTS PwMS (N=40) using a walking aid at baseline who had fallen in the previous year. INTERVENTIONS Participants were randomly assigned to ADSTEP or control. ADSTEP had 6 weekly, 40-minute, 1-on-1 sessions with a physical therapist, starting with walking aid selection and fitting, followed by task-oriented progressive gait training. Control was usual medical care with the option of ADSTEP after the study. MAIN OUTCOME MEASURES The following were assessed at baseline, intervention completion, and 3 months later: falls, timed Up and Go, timed 25-foot walk, 2-minute walk, Four Square Step Test, International Physical Activity Questionnaire, Quebec User Evaluation of Satisfaction with Assistive Technologies, Multiple Sclerosis Walking Scale-12, Activities-Specific Balance Confidence Scale, and Multiple Sclerosis Impact Scale-29. Effect on these outcomes was estimated by a 2-by-2 repeated measures general linear model. RESULTS Fewer ADSTEP than control participants fell (χ2=3.96, P<.05. number needed to treat =3.3). Time spent sitting changed significantly differently with ADSTEP than with control from baseline to intervention completion (F=11.16, P=.002. ADSTEP: reduced 87.00±194.89min/d; control: increased 103.50±142.21min/d; d=0.88) and to 3-month follow-up (F=9.25, P=.004. ADSTEP: reduced 75.79±171.57min/d; control: increased 84.50±149.23min/d; d=0.79). ADSTEP yielded a moderate effect on time spent walking compared to control at 3-month follow-up (P>.05. ADSTEP 117.53±148.40min/d; control 46.43±58.55min/d; d=0.63). CONCLUSIONS ADSTEP prevents falls, reduces sitting, and may increase walking in PwMS.
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Affiliation(s)
- Douglas N Martini
- Department of Neurology, Oregon Health & Science University, Portland, OR
| | - Eline Zeeboer
- Department of Neurology, Oregon Health & Science University, Portland, OR
| | | | - Brett W Fling
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO
| | - Cinda L Hugos
- Department of Neurology, Oregon Health & Science University, Portland, OR; Veterans Affairs Portland Health Care System, Portland, OR
| | - Michelle H Cameron
- Department of Neurology, Oregon Health & Science University, Portland, OR; Veterans Affairs Portland Health Care System, Portland, OR.
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Reid N, Healy GN, Gianoudis J, Formica M, Gardiner PA, Eakin EE, Nowson CA, Daly RM. Association of sitting time and breaks in sitting with muscle mass, strength, function, and inflammation in community-dwelling older adults. Osteoporos Int 2018; 29:1341-1350. [PMID: 29479645 DOI: 10.1007/s00198-018-4428-6] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Accepted: 02/06/2018] [Indexed: 12/11/2022]
Abstract
UNLABELLED The mechanisms through which excessive sitting time impacts health are important to understand. This study found that each hour of sitting per day was not associated with physical function, although associations with poor body composition were observed. Reducing sitting time for improved weight management in older adults needs further exploration. INTRODUCTION To examine the association of sitting time and breaks in sitting time with muscle mass, strength, function, and inflammation in older Australians. METHODS Data from the thigh-worn activPAL3™ monitor (7-day continuous wear) was used to derive time spent sitting (hours) and total number of sit-stand transitions per day. Body composition (dual energy X-ray absorptiometry), lower-body muscle strength, function (timed up-and-go [TUG], 4-m gait speed, four square step test, 30-second sit-to-stand), and serum inflammatory markers (interleukin-[IL-6], IL-8, IL-10, tumor necrosis factor-alpha [TNF-α], and adiponectin) were measured. Multiple regression analyses, adjusted for age, sex, ethnicity, education, employment status, marital status, number of prescription medications, smoking status, vitamin D, and stepping time, were used to assess the associations. RESULTS Data from 123 community-dwelling older adults (aged 65-84 years, 63% female) were used. Total daily sitting time was associated with lower percentage lean mass (β [95%CI], - 1.70% [- 2.30, - 1.10]) and higher total body fat mass (2.92 kg [1.94, 3.30]). More frequent breaks in sitting time were associated with a 45% reduced risk of having pre-sarcopenia (OR = 0.55; 95% CI 0.34, 0.91; model 1), defined as appendicular lean mass divided by BMI. No significant associations were observed for sitting time or breaks in sitting with measures of muscle strength, function, or inflammation. CONCLUSION In older community-dwelling adults, greater sitting time was associated with a lower percentage lean mass, while more frequent breaks in sitting time were associated with lower odds of having pre-sarcopenia. This suggests that reducing sedentary time and introducing frequent breaks in sedentary time may be beneficial for improving body composition in healthy older adults.
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Affiliation(s)
- N Reid
- School of Public Health, The University of Queensland, Herston Rd, Herston, Brisbane, Queensland, 4006, Australia.
| | - G N Healy
- School of Public Health, The University of Queensland, Herston Rd, Herston, Brisbane, Queensland, 4006, Australia
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
- School of Physiotherapy, Curtin University, Perth, Australia
| | - J Gianoudis
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - M Formica
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - P A Gardiner
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
- Mater Research Institute, The University of Queensland, South Brisbane, Australia
| | - E E Eakin
- School of Public Health, The University of Queensland, Herston Rd, Herston, Brisbane, Queensland, 4006, Australia
| | - C A Nowson
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - R M Daly
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
- Department of Medicine, Western Health, The University of Melbourne, Melbourne, Australia
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Asai T, Oshima K, Fukumoto Y, Yonezawa Y, Matsuo A, Misu S. Association of fall history with the Timed Up and Go test score and the dual task cost: A cross-sectional study among independent community-dwelling older adults. Geriatr Gerontol Int 2018; 18:1189-1193. [DOI: 10.1111/ggi.13439] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 03/08/2018] [Accepted: 04/04/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Tsuyoshi Asai
- Department of Physical Therapy; Faculty of Rehabilitation; Kobe Hyogo Japan
| | - Kensuke Oshima
- Faculty of Rehabilitation; Kobe Gakuin University Graduate School; Kobe Hyogo Japan
| | - Yoshihiro Fukumoto
- Department of Physical Therapy; Faculty of Rehabilitation; Kobe Hyogo Japan
| | | | | | - Shogo Misu
- Department of Physical Therapy, Faculty of Nursing and Rehabilitation; Konan Women's University; Kobe Hyogo Japan
- Department of Community Health Sciences; Kobe University Graduate School of Health Sciences; Kobe Hyogo Japan
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Isaacson S, O'Brien A, Lazaro JD, Ray A, Fluet G. The JFK BIG study: the impact of LSVT BIG ® on dual task walking and mobility in persons with Parkinson's disease. J Phys Ther Sci 2018; 30:636-641. [PMID: 29706722 PMCID: PMC5909018 DOI: 10.1589/jpts.30.636] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 01/29/2018] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The aim of this study was to test the hypothesis that Lee Silverman Voice Treatment-BIG decreases the negative impact of hypokinesia on dual task performance in persons with Parkinson's disease. [Subjects and Methods] The records of 114 patients with Parkinson's admitted to outpatient rehabilitation at a suburban hospital were reviewed. Demographics and data for 8 outcome measures were extracted for subjects that completed 14 of 16 sessions of BIG. 93 of these subjects had records of pre and post-test Timed Up and Go, Timed Up and Go Motor, and Timed Up and Go Cognitive scores. Average age was 68.4 years (SD=10.6) and average disease duration was 4.9 years (SD=5.3). [Results] Subjects demonstrated statistically significant improvements for Timed Up and Go (3.3 SD=4.5), Timed Up and Go Motor (4.4 SD=5.8) and Timed Up and Go Cognitive (4.7 SD=5.4). Concurrent motor and cognitive performance remained stable. Dual task cost decreased at a statistically significant level for Timed Up and Go Cognitive (7% SD=31%) but not Motor (4% SD=32%). [Conclusion] These findings suggest that cueing strategies associated with LSVT BIG become internalized and decrease the negative impact of hypokinesia on mobility and cognitive performance while performing two tasks simultaneously in persons with Parkinson's.
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Affiliation(s)
- Sara Isaacson
- Department of Rehabilitation & Movement Sciences, Rutgers The State University of New Jersey: 65 Bergen Street, Newark, NJ, 07101, USA
| | - Ashley O'Brien
- Department of Physical Therapy, JFK Johnson Rehabilitation Institute, USA
| | - Jennifer D Lazaro
- Department of Physical Therapy, JFK Johnson Rehabilitation Institute, USA
| | - Arlen Ray
- Department of Physical Therapy, JFK Johnson Rehabilitation Institute, USA
| | - Gerard Fluet
- Department of Rehabilitation & Movement Sciences, Rutgers The State University of New Jersey: 65 Bergen Street, Newark, NJ, 07101, USA.,Department of Physical Therapy, JFK Johnson Rehabilitation Institute, USA
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Spreng L, Favrat B, Borruat FX, Vaucher P. Cross-sectional study assessing the addition of contrast sensitivity to visual acuity when testing for fitness to drive. BMJ Open 2018; 8:e018546. [PMID: 29374663 PMCID: PMC5829587 DOI: 10.1136/bmjopen-2017-018546] [Citation(s) in RCA: 9] [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: 11/03/2022] Open
Abstract
OBJECTIVES The aim of this study is to quantify the importance of loss of contrast sensitivity (CS) and its relationship to loss of visual acuity (VA), driving restrictions and daytime, on-road driving evaluations in drivers aged 70+. DESIGN A predictive cross-sectional study. SETTING Volunteer participants to a drivers' refresher course for adults aged 70+ delivered by the Swiss Automobile Club in western Switzerland from 2011 to 2013. PARTICIPANTS 162 drivers, male and female, aged 70 years or older. CLINICAL PREDICTORS We used a vision screener to estimate VA and the The Mars Letter Contrast Sensitivity Test to test CS. OUTCOMES We asked drivers to report whether they found five driving restrictions useful for their condition; restrict driving to known roads, avoid driving on highways, avoid driving in the dark, avoid driving in dense traffic and avoid driving in fog. All participants also underwent a standardised on-road evaluation carried out by a driving instructor. RESULTS Moderate to severe loss of CS for at least one eye was frequent (21.0% (95% CI 15.0% to 28.1%)) and often isolated from a loss of VA (11/162 cases had a VA ≥0.8 decimal and a CS of ≤1.5 log(CS); 6.8% (95% CI 3.4% to 11.8%)). Drivers were more likely (R2=0.116, P=0.004) to report a belief that self-imposed driving restrictions would be useful if they had reduced CS in at least one eye. Daytime evaluation of driving performance seems limited in its ability to correctly identify difficulties related to CS loss (VA: R2=0.004, P=0.454; CS: R2=0.006, P=0.332). CONCLUSION CS loss is common for older drivers. Screening CS and referring for cataract surgery even in the absence of VA loss could help maintain mobility. Reduced CS and moderate reduction of VA were both poor predictors of daytime on-road driving performances in this research study.
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Affiliation(s)
- Lucie Spreng
- Doctoral School of Medicine, Faculty of Medicine and Biology, University of Lausanne, Lausanne, Switzerland
| | - Bernard Favrat
- Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland
- Unit of Psychology and Traffic Medicine, University Centre of Legal Medicine Lausanne-Geneva, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - François-Xavier Borruat
- Ophthalmology Department, Jules-Gonin Eye Hospital, University of Lausanne, Lausanne, Switzerland
| | - Paul Vaucher
- Unit of Psychology and Traffic Medicine, University Centre of Legal Medicine Lausanne-Geneva, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
- aR&D, School of Health Sciences Fribourg, University of Applied Sciences and Arts Western Switzerland (HES-SO), Fribourg, Switzerland
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Kim BJ, Aloia TA. What Is "Enhanced Recovery," and How Can I Do It? J Gastrointest Surg 2018; 22:164-171. [PMID: 29067620 PMCID: PMC5784849 DOI: 10.1007/s11605-017-3605-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 09/28/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND Enhanced recovery (ER) and fast-track protocols were initially implemented in the perioperative management of the surgical patient over 20 years ago. These standardized protocols are now broadly implemented across most surgical specialties for its many benefits. ER is well known for its positive effects on decreasing length of stay and complications. However, patient-centric outcomes for adequate pain control, functional recovery, costs, and overall patient experience are less considered. HOW I DO IT A successful ER foundation stands on the pillars of several perioperative care principles: early feeding, early ambulation, goal-directed fluid therapy, and opiate-sparing analgesia. Moreover, it requires a multi-disciplinary team buy-in (including patient and family) that must also be thoughtfully executed. The following is a review of key elements within successful evidence-based ER protocols and relevant concepts to consider when starting a successful enhanced recovery program.
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Affiliation(s)
- Bradford J. Kim
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Thomas A. Aloia
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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