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Urquiza M, Fernández N, Arrinda I, Espin A, García-García J, Rodriguez-Larrad A, Irazusta J. Predictors of Hospital Readmission, Institutionalization, and Mortality in Geriatric Rehabilitation Following Hospitalization According to Admission Reason. J Geriatr Phys Ther 2024:00139143-990000000-00051. [PMID: 38875011 DOI: 10.1519/jpt.0000000000000414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2024]
Abstract
BACKGROUND AND PURPOSE Older adults following an inpatient geriatric rehabilitation (GR) program commonly experience adverse health outcomes such as hospital readmission, institutionalization, and mortality. Although several studies have explored factors related to these outcomes, the influence of admission reason on the predictive factors of adverse health outcomes in the rehabilitation process remains unclear. Therefore, this study aimed to identify predictive factors for adverse health outcomes in inpatients attending GR according to their admission reason. METHODS This retrospective study included patients with orthogeriatric (OG) conditions and patients with hospital-associated deconditioning (HAD) admitted to GR after an acute hospitalization between 2016 and 2020. Patients were evaluated by a comprehensive geriatric assessment at admission, including sociodemographic data, social resources, clinical data, cognitive, functional and nutritional status, and physical performance measurements. Adverse health outcomes were collected (hospital readmission, institutionalization, and mortality). Univariate analyses and multivariate backward binary logistic regressions were used to determine predictive factors. RESULTS AND DISCUSSION In this study, 290 patients were admitted for OG conditions, and 122 patients were admitted due to HAD. In patients with OG conditions, lower Mini-Mental State Examination (MMSE) predicted institutionalization and mortality. Lower Mini Nutritional Assessment-Short Form predicted institutionalization, whereas lower Barthel Index and lower Tinetti-Performance-Oriented Mobility Assessment scores were associated with higher mortality. In patients with HAD, higher age-adjusted comorbidity index predicted hospital readmission and mortality, and lower Short Physical Performance Battery scores predicted institutionalization and mortality. Finally, lower MMSE scores, worse values in Older Americans Resources and Services Scale and male gender were associated with a higher risk of institutionalization. CONCLUSIONS Predictive factors for hospital readmission, institutionalization, and mortality in patients with OG conditions and HAD during GR were different. Some of those predictors, such as nutritional status and physical performance, are modifiable. Understanding predictive factors for adverse outcomes, and how these factors differ by admission diagnosis, improves our ability to identify patients most at risk. Early identification of these patients could assist with prevention efforts and lead to a reduction of negative outcomes.
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Affiliation(s)
- Miriam Urquiza
- Department of Physiology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain
- Clinical Nursing and Community Health Research Group, BioCruces Health Research Institute, Barakaldo, Bizkaia, Spain
| | - Naiara Fernández
- Geriatric Department, Igurco Servicios Socio Sanitarios, Grupo IMQ, Bilbao, Spain
| | - Ismene Arrinda
- Geriatric Department, Igurco Servicios Socio Sanitarios, Grupo IMQ, Bilbao, Spain
| | - Ander Espin
- Department of Physiology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain
- Clinical Nursing and Community Health Research Group, BioCruces Health Research Institute, Barakaldo, Bizkaia, Spain
| | - Julia García-García
- Department of Physiology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain
- Clinical Nursing and Community Health Research Group, BioCruces Health Research Institute, Barakaldo, Bizkaia, Spain
| | - Ana Rodriguez-Larrad
- Department of Physiology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain
- Clinical Nursing and Community Health Research Group, BioCruces Health Research Institute, Barakaldo, Bizkaia, Spain
| | - Jon Irazusta
- Department of Physiology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain
- Clinical Nursing and Community Health Research Group, BioCruces Health Research Institute, Barakaldo, Bizkaia, Spain
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McCain A, McGibbon C, Carroll M, MacKenzie E, Sénéchal M, Bouchard DR. Validity of common physical function tests performed online for older adults. Arch Gerontol Geriatr 2023; 114:105104. [PMID: 37354737 PMCID: PMC10285319 DOI: 10.1016/j.archger.2023.105104] [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: 09/06/2022] [Revised: 06/13/2023] [Accepted: 06/14/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND Objectively measured physical function tests are important predictors of institutionalization, disability, and premature mortality. Although physical function was usually assessed in person prior to the COVID-19 pandemic, there is a need to investigate whether physical function tests performed online are valid. OBJECTIVE The purpose of this study was to determine the validity of common physical function tests conducted online compared to in-person testing in older adults. METHODS Physical functions included gait speed, one leg stance balance, 30-second chair stands, and the 2-minute steps were tested online and in-person using a random order for community dwellers aged 65 years and above. Using an alpha two way mixed model, average intraclass correlation coefficients (ICC) were calculated between the two settings and one sample T-test performed on the difference between the results of each test between the two settings. Finally, Bland-Altman plots were created, and proportional biases tested via linear regressions. RESULTS Besides the one-leg stance balance with eyes closed, for which the ICC was 0.47 (0.23-0.74) the average ICC's were excellent ranging from 0.87 to 0.94. No proportional biases were observed based on Bland-Altman graphs. CONCLUSION For older adults living in the community, common physical function tests can be performed online.
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Affiliation(s)
- A McCain
- Faculty of Kinesiology, University of New Brunswick, Fredericton, Canada; Cardiometabolic Exercise & Lifestyles Laboratory (CELLAB), Canada
| | - C McGibbon
- Faculty of Kinesiology, University of New Brunswick, Fredericton, Canada; Institute of Biomedical Engineering, University of New Brunswick, Fredericton, Canada
| | - M Carroll
- Faculty of Kinesiology, University of New Brunswick, Fredericton, Canada; Cardiometabolic Exercise & Lifestyles Laboratory (CELLAB), Canada
| | - E MacKenzie
- Faculty of Kinesiology, University of New Brunswick, Fredericton, Canada; Institute of Biomedical Engineering, University of New Brunswick, Fredericton, Canada
| | - M Sénéchal
- Faculty of Kinesiology, University of New Brunswick, Fredericton, Canada; Cardiometabolic Exercise & Lifestyles Laboratory (CELLAB), Canada
| | - D R Bouchard
- Faculty of Kinesiology, University of New Brunswick, Fredericton, Canada; Cardiometabolic Exercise & Lifestyles Laboratory (CELLAB), Canada.
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Perks J, Zaccardi F, Rayt H, Sayers R, Brady EM, Davies MJ, Rowlands AV, Edwardson CL, Hall A, Yates T, Henson J. Device-measured physical activity behaviours, and physical function, in people with type 2 diabetes mellitus and peripheral artery disease: A cross-sectional study. Exp Gerontol 2023; 178:112207. [PMID: 37196824 DOI: 10.1016/j.exger.2023.112207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/11/2023] [Accepted: 05/14/2023] [Indexed: 05/19/2023]
Abstract
AIM To quantify differences in device-measured physical activity (PA) behaviours, and physical function (PF), in people with type 2 diabetes mellitus (T2DM) with and without peripheral artery disease (PAD). MATERIALS AND METHODS Participants from the Chronotype of Patients with T2DM and Effect on Glycaemic Control cross-sectional study wore accelerometers on their non-dominant wrist for up to 8-days to quantify: volume and intensity distribution of PA, time spent inactive, time in light PA, moderate-to-vigorous PA in at least 1-minute bouts (MVPA1min), and the average intensity achieved during the most active continuous 2, 5, 10, 30, and 60-minute periods of the 24-h day. PF was assessed using the short physical performance battery (SPPB), the Duke Activity Status Index (DASI), sit-to-stand repetitions in 60 s (STS-60); hand-grip strength was also assessed. Differences between subjects with and without PAD were estimated using regressions adjusted for possible confounders. RESULTS 736 participants with T2DM (without diabetic foot ulcers) were included in the analysis, 689 had no PAD. People with T2DM and PAD undertake less PA (MVPA1min: -9.2 min [95 % CI: -15.3 to -3.0; p = 0.004]) (light intensity PA: -18.7 min [-36.4 to -1.0; p = 0.039]), spend more time inactive (49.2 min [12.1 to 86.2; p = 0.009]), and have reduced PF (SPPB score: -1.6 [-2.5 to -0.8; p = 0.001]) (DASI score: -14.8 [-19.8 to -9.8; p = 0.001]) (STS-60 repetitions: -7.1 [-10.5 to -3.8; p = 0.001]) compared to people without; some differences in PA were attenuated by confounders. Reduced intensity of activity for the most active continuous 2-30 min in the 24-h day, and reduced PF, persisted after accounting for confounders. There were no significant differences in hand-grip strength. CONCLUSIONS Findings from this cross-sectional study suggest that, the presence of PAD in T2DM may have been associated with lower PA levels and PF.
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Affiliation(s)
- Jemma Perks
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.
| | - Francesco Zaccardi
- Diabetes Research Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Harjeet Rayt
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Robert Sayers
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Emer M Brady
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Melanie J Davies
- Diabetes Research Centre, University Hospitals of Leicester NHS Trust, Leicester, UK; NIHR Leicester Biomedical Research Centre and Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK
| | - Alex V Rowlands
- Diabetes Research Centre, University Hospitals of Leicester NHS Trust, Leicester, UK; NIHR Leicester Biomedical Research Centre and Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK
| | - Charlotte L Edwardson
- Diabetes Research Centre, University Hospitals of Leicester NHS Trust, Leicester, UK; NIHR Leicester Biomedical Research Centre and Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK
| | - Andrew Hall
- The Hanning Sleep Laboratory, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Thomas Yates
- Diabetes Research Centre, University Hospitals of Leicester NHS Trust, Leicester, UK; NIHR Leicester Biomedical Research Centre and Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK
| | - Joseph Henson
- Diabetes Research Centre, University Hospitals of Leicester NHS Trust, Leicester, UK; NIHR Leicester Biomedical Research Centre and Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK
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Schoenfelder A, Metcalf B, Langford J, Stathi A, Western MJ, Hillsdon M. The Analytical and Clinical Validity of the pfSTEP Digital Biomarker of the Susceptibility/Risk of Declining Physical Function in Community-Dwelling Older Adults. SENSORS (BASEL, SWITZERLAND) 2023; 23:5122. [PMID: 37299849 PMCID: PMC10255880 DOI: 10.3390/s23115122] [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: 04/22/2023] [Revised: 05/19/2023] [Accepted: 05/22/2023] [Indexed: 06/12/2023]
Abstract
Measures of stepping volume and rate are common outputs from wearable devices, such as accelerometers. It has been proposed that biomedical technologies, including accelerometers and their algorithms, should undergo rigorous verification as well as analytical and clinical validation to demonstrate that they are fit for purpose. The aim of this study was to use the V3 framework to assess the analytical and clinical validity of a wrist-worn measurement system of stepping volume and rate, formed by the GENEActiv accelerometer and GENEAcount step counting algorithm. The analytical validity was assessed by measuring the level of agreement between the wrist-worn system and a thigh-worn system (activPAL), the reference measure. The clinical validity was assessed by establishing the prospective association between the changes in stepping volume and rate with changes in physical function (SPPB score). The agreement of the thigh-worn reference system and the wrist-worn system was excellent for total daily steps (CCC = 0.88, 95% CI 0.83-0.91) and moderate for walking steps and faster-paced walking steps (CCC = 0.61, 95% CI 0.53-0.68 and 0.55, 95% CI 0.46-0.64, respectively). A higher number of total steps and faster paced-walking steps was consistently associated with better physical function. After 24 months, an increase of 1000 daily faster-paced walking steps was associated with a clinically meaningful increase in physical function (0.53 SPPB score, 95% CI 0.32-0.74). We have validated a digital susceptibility/risk biomarker-pfSTEP-that identifies an associated risk of low physical function in community-dwelling older adults using a wrist-worn accelerometer and its accompanying open-source step counting algorithm.
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Affiliation(s)
| | - Brad Metcalf
- Sports and Health Sciences, University of Exeter, Exeter EX1 2LU, UK; (B.M.); (J.L.)
| | - Joss Langford
- Sports and Health Sciences, University of Exeter, Exeter EX1 2LU, UK; (B.M.); (J.L.)
- Activinsights Ltd., Huntingdon PE28 0NJ, UK
| | - Afroditi Stathi
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham B15 2TT, UK;
| | - Max J. Western
- Department of Health, University of Bath, Bath BA2 7AY, UK;
| | - Melvyn Hillsdon
- Sports and Health Sciences, University of Exeter, Exeter EX1 2LU, UK; (B.M.); (J.L.)
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Oh MH, Shin HE, Kim KS, Won CW, Kim M. Combinations of Sarcopenia Diagnostic Criteria by Asian Working Group of Sarcopenia (AWGS) 2019 Guideline and Incident Adverse Health Outcomes in Community-Dwelling Older Adults. J Am Med Dir Assoc 2023:S1525-8610(23)00395-X. [PMID: 37209713 DOI: 10.1016/j.jamda.2023.04.005] [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: 02/09/2023] [Revised: 04/05/2023] [Accepted: 04/05/2023] [Indexed: 05/22/2023]
Abstract
OBJECTIVES This study aimed to investigate the association between combinations of sarcopenia criteria by the Asian Working Group of Sarcopenia (AWGS) 2019 guideline and incident adverse health outcomes. DESIGN Longitudinal analyses of a cohort study. SETTING AND PARTICIPANTS We conducted prospective 2-year follow-up analyses (N = 1959) among community-dwelling older adults enrolled in the nationwide Korean Frailty and Aging Cohort Study (KFACS). METHODS From the KFACS, 1959 older adults (52.8% women; mean age = 75.9 ± 3.9 years) who underwent assessments for appendicular skeletal mass using dual-energy X-ray absorptiometry, handgrip strength, usual gait speed, 5-times sit-to-stand test, and Short Physical Performance Battery (SPPB) at baseline were included. Participants with each adverse health outcome [mobility disability, falls, and instrumental activities of daily living (IADL) disabilities] at baseline were excluded for each corresponding analysis. Multivariable logistic regression was performed to examine whether sarcopenia defined by different diagnostic criteria was associated with incident adverse health outcomes after 2 years. RESULTS A total of 444 participants (22.7%) were diagnosed with sarcopenia as defined by AWGS 2019. In the multivariable analysis, sarcopenia defined as both low muscle mass and low physical performance increased the risk of mobility disability (OR 2.14, 95% CI 1.35-3.38) and falls (1.74, 95% CI 1.21-2.49). Only the criterion defined as both low muscle mass and physical performance using the SPPB increased the risk of falls with fracture (2.53, 95% CI 1.01-6.35) and IADL disabilities (2.77, 95% CI 1.21-6.33). However, sarcopenia defined as both low muscle mass and low hand grip strength showed no associations with the incidence of any of the adverse health outcomes. CONCLUSIONS AND IMPLICATIONS Our study suggests that the predictive value of adverse health outcomes for community-dwelling older adults is better when diagnosed with sarcopenia based on low muscle mass and physical performance. Furthermore, using the SPPB as a diagnostic tool for low physical performance may improve the predictive validity for falls with fracture and IADL disability. Our findings may be helpful for the early detection of individuals with sarcopenia who have a higher risk of adverse health outcomes.
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Affiliation(s)
- Min Hyung Oh
- College of Medicine, Kyung Hee University, Seoul, Korea
| | - Hyung Eun Shin
- Department of Biomedical Science and Technology, Kyung Hee University, Seoul, Korea
| | - Kyoung Soo Kim
- Department of Clinical Pharmacology and Therapeutics, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Chang Won Won
- Elderly Frailty Research Center, Department of Family Medicine, College of Medicine, Kyung Hee University, Seoul, Korea.
| | - Miji Kim
- Department of Biomedical Science and Technology, College of Medicine, East-West Medical Research Institute, Kyung Hee University, Seoul, Korea.
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Buckinx F, Aubertin-Leheudre M, Daoust R, Hegg S, Martel D, Martel-Thibault M, Sirois MJ. Impacts of Remote Physical Exercises on Functional Status and Mobility among Community-Dwelling Pre-Disabled Seniors during the Covid-19 Lockdown. J Nutr Health Aging 2023; 27:354-361. [PMID: 37248759 PMCID: PMC10155135 DOI: 10.1007/s12603-023-1914-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 03/31/2023] [Indexed: 05/31/2023]
Abstract
OBJECTIVES To assess whether remote physical exercise interventions helped maintain function in daily life, level of physical activities, basic mobility and frailty status in pre-disabled seniors during the first Covid-19 lockdown. DESIGN This is an interventional study conducted from May 2020 to May 2021. SETTING Community-dwelling older adults in 2 Canadian cities. PARTICIPANTS 84 pre-disabled seniors. INTERVENTION 12-week physical exercise programs (1 hour/ 3 times/ week) in kinesiologist-guided groups using Zoom or phone-supervised individual booklet-based home-program (n=44) vs. Control (usual life habits; n=40). MEASUREMENTS Functional status in daily activities (OARS scale); Daily level of aerobic (TAPA-1) and strengthening/flexibility (TAPA-2) physical activities; Basic mobility abilities (SPPB: balance, lower limbs strength, walking speed; Timed Up-and-Go) and Frailty (SOF index) were assessed at baseline and at 3, 6, 9 and 12-month follow-ups. RESULTS The participants' mean age was 78.5 ± 7.2 and 76.5 % were women. There was a group * time effect for the OARS scale (p=0.02), the TAPA-1 (p=0.06) and the TAPA-2 (p=0.007) scores. For these outcomes, scores significantly improved during the first 3 months of follow-up and then stabilised in the intervention group whereas they remained constant in the control group over time. There was an overall time effect for the SPPB (p=0.004), the 4-m walking speed (p=0.02) and for the SOF index (p=0.004), with no between-group differences. Finally, no effect was observed for the TUG. CONCLUSION Remote home-based physical exercise interventions and monitoring during the first Covid-19 lockdown seemed to have helped maintain seniors' level of physical activities without impacting on basic mobility abilities. Further studies are needed to identify parameters of remote exercise programs that can improve daily function and mobility in this population.
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Affiliation(s)
- F Buckinx
- Marie-Josée Sirois, PhD, 1435 de Longueuil, Québec, Qc, G1S 2G2, Canada, e-mail:
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Braun T, Thiel C, Peter RS, Bahns C, Büchele G, Rapp K, Becker C, Grüneberg C. Association of clinical outcome assessments of mobility capacity and incident disability in community-dwelling older adults - a systematic review and meta-analysis. Ageing Res Rev 2022; 81:101704. [PMID: 35931411 DOI: 10.1016/j.arr.2022.101704] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/19/2022] [Accepted: 08/01/2022] [Indexed: 01/31/2023]
Abstract
The objective of the present review is to synthesize all available research on the association between mobility capacity and incident disability in non-disabled older adults. MEDLINE, EMBASE and CINAHL databases were searched without any limits or restrictions until February 2021. Published reports of longitudinal cohort studies that estimated a direct association between baseline mobility capacity, assessed with a standardized outcome assessment, and subsequent development of disability, including initially non-disabled older adults were included. The risk of bias was assessed using the Quality in Prognosis Studies (QUIPS) tool. Random-effect models were used to explore the objective. The certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. The main outcome measures were the pooled relative risks (RR) per one conventional unit per mobility assessment for incident disability. A total of 40 reports (85,515 participants at baseline) were included. For usual and fast gait speed, the RR per -0.1 m/s was 1.23 (95% CI: 1.18-1.28; 26,638 participants) and 1.28 (95% CI: 1.19-1.38; 8161 participants), respectively. Each point decrease in Short Physical Performance Battery score increased the risk of incident disability by 30% (RR = 1.30, 95% CI: 1.23-1.38; 9183 participants). The RR of incident disability by each second increase in Timed Up and Go test and Chair Rise Test performance was 1.15 (95% CI: 1.09-1.21; 30,426 participants) and 1.07 (95% CI: 1.04-1.10; 9450 participants), respectively. The review concludes that among community-dwelling non-disabled older adults, poor mobility capacity is a potent modifiable risk factor for incident disability. Mobility impairment should be mandated as a quality indicator of health for older people.
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Affiliation(s)
- Tobias Braun
- Department of Applied Health Sciences, Hochschule für Gesundheit (University of Applied Sciences), Bochum, Germany; Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany; HSD Hochschule Döpfer (University of Applied Sciences), Department of Health, Cologne, Germany.
| | - Christian Thiel
- Department of Applied Health Sciences, Hochschule für Gesundheit (University of Applied Sciences), Bochum, Germany; Faculty of Sports Science, Ruhr-University Bochum, Bochum, Germany
| | - Raphael Simon Peter
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Carolin Bahns
- Department of Therapy Science I, Brandenburg Technical University Cottbus - Senftenberg, Senftenberg, Germany
| | - Gisela Büchele
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Kilian Rapp
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Clemens Becker
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany; Digital Geriatric Medicine, Medical Clinic, Heidelberg University, Germany
| | - Christian Grüneberg
- Department of Applied Health Sciences, Hochschule für Gesundheit (University of Applied Sciences), Bochum, Germany
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Rundell SD, Patel KV, Phelan EA, Jones BL, Marcum ZA. Trajectories of physical capacity among community-dwelling older adults in the United States. Arch Gerontol Geriatr 2022; 100:104643. [PMID: 35131531 PMCID: PMC10824500 DOI: 10.1016/j.archger.2022.104643] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 01/25/2022] [Accepted: 01/27/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Although the prognostic value of physical capacity is well-established, less is known about longitudinal patterns of physical capacity among community-dwelling older adults. We sought to describe long-term trajectories of physical capacity in a nationally representative sample of Medicare beneficiaries. DESIGN Cohort study SETTING AND PARTICIPANTS: Annually collected data on 6,783 community-dwelling participants in the National Health and Aging Trends Study from 2011 to 2016 were analyzed. METHODS Performance-based physical capacity was measured using the Short Physical Performance Battery [(SPPB) range: 0-12, higher is better]. Self-reported physical capacity was measured using six pairs of activities with composite scores from 0 to 12 (higher is better). We then used group-based trajectory modeling to identify longitudinal patterns of each physical capacity measure over 6 years. Associations of baseline characteristics with trajectories were examined using multinomial logistic regression. RESULTS The cohort was 57% female, 68% white, and 58% were ≥75 years. Six distinct trajectories of SPPB scores were identified. Two "high" groups (n = 2192, 43%) maintained high average SPPB scores. Two "moderate decline" groups (n = 1459, 29%) had a mid-range SPPB score at baseline and demonstrated gradual decline. A "low decline" group (n = 811, 16%) started with a low SPPB score and experienced a greater decline. A "very low" group (n = 590, 12%) had very low SPPB scores in all years. Six trajectories for self-reported physical capacity were also identified. Older age, worse health, lower income and education, and being Black or Hispanic were associated with lower and declining physical capacity.
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Affiliation(s)
- Sean D Rundell
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA; Department of Health Systems and Population Health, University of Washington, Seattle, WA.
| | - Kushang V Patel
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA; Department of Medicine, Division of Gerontology and Geriatric Medicine, University of Washington, Seattle, WA
| | - Elizabeth A Phelan
- Department of Health Systems and Population Health, University of Washington, Seattle, WA; Department of Medicine, Division of Gerontology and Geriatric Medicine, University of Washington, Seattle, WA
| | - Bobby L Jones
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
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Bujan Rivera J, Kühl R, Zech U, Hendricks A, Luft T, Dreger P, Friedmann-Bette B, Betz TM, Wiskemann J. Impact of Resistance Exercise and Nutritional Endorsement on physical performance in patients with GvHD (IRENE-G study) - design and rational of a randomized controlled trial. BMC Cancer 2022; 22:440. [PMID: 35459108 PMCID: PMC9024288 DOI: 10.1186/s12885-022-09497-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 04/06/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Graft-versus-host disease (GvHD) remains a major complication and limitation to successful allogeneic hematopoietic stem cell transplantation. Treatment of GvHD is challenging due to its heterogeneous nature of presentation, with steroids remaining the established first-line treatment. Long-term doses of systemic corticosteroids have many well-known side-effects including muscle atrophy. Despite the fact that reports in non-cancer clinical populations treated with glucocorticoids demonstrated that resistance training can reverse atrophy and weakness, no RCT has evaluated the potential of resistance training on preventing the disease- and treatment-induced loss of skeletal muscle mass and function in GvHD patients yet. In this context, ensuring adequate nutrition is important as protein deprivation may accelerate the wasting process. As GvHD patients are commonly found to be malnourished, nutritional medical care should be considered when investigating the effect of exercise in GvHD patients. Therefore, the aim of the present "Impact of Resistance Exercise and Nutritional Endorsement on physical performance in patients with GvHD" - Study (IRENE-G) is to evaluate the effects of resistance exercise in combination with nutritional endorsement on physical, nutritional and patient-reported outcomes in GvHD patients. METHODS IRENE-G is a 24-week prospective interventional RCT. One hundred twelve participants will be randomly allocated (1:1) to one of two arms: resistance exercise and nutritional optimization (experimental) vs. nutritional optimization only (control). Participants in the experimental group will engage in a supervised, progressive moderate-to-high intensity resistance training that is consistent with exercise guidelines for cancer patients, while additionally receiving nutritional support/therapy. Subjects of the control group solely receive nutritional support/therapy based on individual needs. Participants will be assessed at baseline, at 8, 16, 24 weeks for physical performance and various physiological, nutritional and patient-reported outcomes. Follow-up will be 6 months after intervention completion. DISCUSSION To our knowledge, this will be the first RCT to assess and compare the effects of a resistance intervention supplemented by nutritional support/therapy against nutritional support only on various health-related outcomes in GvHD patients. The study will contribute to our understanding of the value of exercise and nutritional endorsement in counteracting the negative consequences of GvHD and its treatment. TRIAL REGISTRATION ClinicalTrials.gov : NCT05111834 . Registered 8 November 2021 - Retrospectively registered.
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Affiliation(s)
- Janina Bujan Rivera
- Division of Medical Oncology, National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany
| | - Rea Kühl
- Division of Medical Oncology, National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany
| | - Ulrike Zech
- Department of Internal Medicine I, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Anne Hendricks
- Department of Internal Medicine I, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Thomas Luft
- Department of Internal Medicine V, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Peter Dreger
- Department of Internal Medicine V, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Birgit Friedmann-Bette
- Department of Internal Medicine VII, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Theresa-Maria Betz
- Department of Internal Medicine III, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Joachim Wiskemann
- Division of Medical Oncology, National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany.
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Arena SK, Wilson CM, Boright L, Peterson E. Impact of the HOP-UP-PT program on older adults at risk to fall: a randomized controlled trial. BMC Geriatr 2021; 21:520. [PMID: 34598692 PMCID: PMC8485496 DOI: 10.1186/s12877-021-02450-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 09/02/2021] [Indexed: 01/06/2023] Open
Abstract
Background Reduced falls and fall risks have been observed among older adults referred to the HOP-UP-PT (Home-based Older Persons Upstreaming Prevention-Physical Therapy) program. The purpose of this study was to describe outcomes of HOP-UP-PT program participants and then to compare these outcomes to non-participants. Methods Six Michigan senior centers referred adults ≥65 years who were at-risk for functional decline or falls. 144 participants (n = 72 per group) were randomized to either the experimental group (EG) or the control group (CG). Physical therapists (PTs) delivered physical, environmental, and health interventions to the EG over nine encounters (six in-person, three telerehabilitation) spanning seven months. The CG participants were told to continue their usual physical activity routines during the same time frame. Baseline and re-assessments were conducted at 0-, 3-, and 7-months in both groups. Descriptions and comparisons from each assessment encounter were analyzed. Results Participants ages were: EG = 76.6 (7.0) years and CG = 77.2 (8.2). Baseline measures were not significantly different apart from the Short Physical Performance Battery (SPPB) which favored the EG (P = 0.02). While no significant differences were identified in the survey outcomes or home environment assessments, significant differences in favor of the EG were identified in common fall risk indicators including the Timed Up and Go (P = 0.04), Four Test Balance Scale (P = 0.01), and the modified SPPB (P = 0.02) at the 3-month assessment visit. However, these differences were not sustained at the 7-month assessment as, notably, both groups demonstrated positive improvements in the Four Test Balance Score and SPPB. For individuals at a moderate/high fall risk at baseline, 47.8% of CG reported falling at seven months; whereas, only 6.3% of EG participants meeting the same criteria reported a fall after HOP-UP-PT participation. Conclusions A prevention-focused multimodal program provided by PTs in older adults’ homes proved beneficial and those with the highest fall risk demonstrated a significant decrease in falls. A collaboration between PTs and community senior centers resulted in upstreaming care delivery that may reduce both the financial and personal burdens associated with falls in an older adult population. Trial registration This study was retrospective registered at Clinical Trials.gov, TRN: NCT04814459 on 24/03/2021. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02450-0.
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Affiliation(s)
- Sara K Arena
- Physical Therapy Program, Oakland University, School of Health Sciences, Human Health Bldg, 433 Meadowbrook Road, Rochester, MI, 48309-4401, USA.
| | - Christopher M Wilson
- Physical Therapy Program, Oakland University, School of Health Sciences, Human Health Bldg, 433 Meadowbrook Road, Rochester, MI, 48309-4401, USA
| | - Lori Boright
- Physical Therapy Program, Oakland University, School of Health Sciences, Human Health Bldg, 433 Meadowbrook Road, Rochester, MI, 48309-4401, USA
| | - Edward Peterson
- Henry Ford Health System, Department of Public Health Sciences, Detroit, MI, USA
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Status Quo or Drop-Off: Do Older Adults Maintain Benefits From Choose to Move-A Scaled-Up Physical Activity Program-12 Months After Withdrawing the Intervention? J Phys Act Health 2021; 18:1236-1244. [PMID: 34407507 DOI: 10.1123/jpah.2020-0850] [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: 12/15/2020] [Revised: 04/27/2021] [Accepted: 06/07/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Choose to Move is one of few scaled-up health-promoting interventions for older adults. The authors evaluated whether Choose to Move participants maintained their intervention-related gains in physical activity (PA), mobility, and social connectedness 12 months after the intervention ended. METHODS The authors assessed PA, mobility, loneliness, social isolation, and muscle strength via questionnaire and objective measures in 235 older adults at 0 months (baseline), 6 months (end of intervention), and 18 months (12-months postintervention). The authors fitted linear mixed models to examine the change in each outcome from 6 to 18 months (primary objective) and 0 to 18 months (secondary objective) and reported by age group (60-74 and ≥75 y). RESULTS In younger participants, PA decreased between 6 and 18 months, but remained significantly higher than at baseline. Intervention-related benefits in loneliness, social isolation, mobility, and muscle strength were maintained between 6 and 18 months in the younger participants. Older participants maintained their intervention benefits in loneliness, mobility, and muscle strength. When compared with baseline values, PA levels in older participants were unchanged, whereas social isolation increased. CONCLUSIONS Older adults maintained some, but not all, health benefits of Choose to Move 12 months after the intervention ended. Long-term commitments are needed to deliver effective health-promoting interventions for older adults if benefits are to be maintained.
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12
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Río X, Guerra-Balic M, González-Pérez A, Larrinaga-Undabarrena A, Coca A. [Reference values for SPPB in people over 60 years of age in the Basque Country]. Aten Primaria 2021; 53:102075. [PMID: 34004592 PMCID: PMC8141526 DOI: 10.1016/j.aprim.2021.102075] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/30/2020] [Accepted: 02/27/2021] [Indexed: 01/07/2023] Open
Abstract
Objetivo Proporcionar valores de referencia del Short Physical Performance Battery (SPPB) en adultos y adultos mayores en el País Vasco, identificando puntos de corte para medir la fragilidad y comparar los valores con otras poblaciones de España. Emplazamiento Bilbao capital, País Vasco (España). Participantes 1.923 personas mayores de 60 años incluidos en el Programa de Salud para Personas Mayores del Ayuntamiento de Bilbao participaron en el estudio. El programa de actividad física (AF) se impartió dos veces por semana durante un mínimo de 12 semanas, con sesiones de 50 minutos. Mediciones principales Se evaluó a los participantes con la prueba SPPB que evalúa: equilibrio (PE), velocidad de la marcha en 4 m (PM) y la fuerza a través de la prueba de levantarse y sentarse de la silla (PS). Según el resultado obtenido de todas las pruebas, se identificó la funcionalidad de las personas en: limitación grave (cero a cuatro puntos), moderada (cuatro a seis puntos), leve (siete a nueve puntos) y mínima (10 a 12 puntos). Resultados Edad media 77,9 (5,6) años, siendo el 87,9% mujeres y el 12,1% hombres. La batería SPPB mostro diferencias significativas en la edad (p = 0,000) y género (p = 0,005) Además, se realizó una comparación con una población similar: 70 a 75 años = 0,6 (d de Cohen), 76 a 79 años = 0,98 (d de Cohen) y >80 años = 0,98 (d de Cohen). Conclusiones El presente estudio señala los valores normativos para SPPB. La funcionalidad de las personas disminuye a medida que avanza la edad. A pesar de los hallazgos actuales que los profesionales de la salud disponen para una detección más eficaz de la fragilidad, muchos de ellos aún no se han traducido a la práctica clínica.
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Affiliation(s)
- Xabier Río
- Facultad de Psicología y Educación, Ciencias de la Actividad Física y del Deporte, Universidad de Deusto, Bizkaia, España; Departamento de Actividad Física y Salud, Mugikon, Bizkaia, España.
| | - Myriam Guerra-Balic
- Facultad de Psicología, Educación y Ciencias del Deporte de Blanquerna, Universitad Ramon Llul, Barcelona, España
| | - Alexander González-Pérez
- Facultad de Psicología y Educación, Ciencias de la Actividad Física y del Deporte, Universidad de Deusto, Bizkaia, España
| | - Arkaitz Larrinaga-Undabarrena
- Facultad de Psicología y Educación, Ciencias de la Actividad Física y del Deporte, Universidad de Deusto, Bizkaia, España; Departamento de Actividad Física y Salud, Mugikon, Bizkaia, España
| | - Aitor Coca
- Facultad de Psicología y Educación, Ciencias de la Actividad Física y del Deporte, Universidad de Deusto, Bizkaia, España
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Vaarst J, Boyle E, Vestergaard S, Hvid LG, Strotmeyer ES, Glynn NW, Caserotti P. Does physical performance and muscle strength predict future personal and nursing care services in community-dwelling older adults aged 75+? Scand J Public Health 2021; 49:441-448. [PMID: 33467973 DOI: 10.1177/1403494820979094] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
AIM The objective of this study was to investigate if grip strength or the short physical performance battery could predict the rate of receiving two different types of home care services: (a) personal care and (b) home nursing care for community-dwelling older adults aged 75+ years. METHODS A secondary data analysis of a prospective cohort study including 323 community-dwelling older adults. Measures of grip strength and the short physical performance battery were incorporated in a nationally regulated preventive home visit programme. Referral to personal and home nursing care were obtained from an administrative database with an average follow-up of 4.1 years. The rate of receiving the individual home care services and the study measures were determined using multivariable Cox proportional hazards models controlling for a priori selected covariates (age, sex, living status, obesity, smoking and prior use of home care). RESULTS The mean age was 81.7 years with 58.8% being women. The rate of receiving personal care differed between the short physical performance battery groups but not between the grip strength groups after adjusting for all covariates with hazard ratios (95% confidence intervals) of 1.90 (1.29-2.81) and 1.41 (0.95-2.08), respectively. The rate of receiving home nursing care differed between both the short physical performance battery and grip strength groups after adjusting for all covariates with hazard ratios of 2.03 (1.41-2.94) and 1.48 (1.01-2.16), respectively. CONCLUSIONS The short physical performance battery was associated with the rate of receiving both personal care and home nursing care. The short physical performance battery can be used to predict home care needs of community-dwelling older adults aged 75+ years.
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Affiliation(s)
- Jonathan Vaarst
- Department of Sports Science and Clinical Biomechanics and the Center for Active and Healthy Ageing, University of Southern Denmark, Odense, Denmark
| | - Eleanor Boyle
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Sonja Vestergaard
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Lars G Hvid
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Elsa S Strotmeyer
- Department of Epidemiology Pittsburgh, University of Pittsburgh, Pittsburgh, USA
| | - Nancy W Glynn
- Department of Epidemiology Pittsburgh, University of Pittsburgh, Pittsburgh, USA
| | - Paolo Caserotti
- Department of Sports Science and Clinical Biomechanics and the Center for Active and Healthy Ageing, University of Southern Denmark, Odense, Denmark
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de Bruin ED, Baur H, Brülhart Y, Luijckx E, Hinrichs T, Rogan S. Combining Stochastic Resonance Vibration With Exergaming for Motor-Cognitive Training in Long-Term Care; A Sham-Control Randomized Controlled Pilot Trial. Front Med (Lausanne) 2020; 7:507155. [PMID: 33330519 PMCID: PMC7734185 DOI: 10.3389/fmed.2020.507155] [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: 10/24/2019] [Accepted: 11/09/2020] [Indexed: 01/06/2023] Open
Abstract
Purpose: Physical and mental functions allow classifying older adults as “Go-Go” (independent functioning); “Slow-Go” (in need of care with a slight handicap); and “No-Go” (in need of care with severe functional limitation). The latter group exhibits reduced exercise tolerance. More recently technology-based motor-cognitive types of training services emerged as a possible training service. This study examined the use of technology including stochastic resonance whole-body vibration and Exergame-dance training for motor-cognitive training in care home dwelling adults. Methods: Seventeen older adults (10 women, 7 men, age range: 79–98) were randomly assigned to the intervention (IG, n = 9) or the sham group (SG, n = 8). IG performed five sets of 1-min whole-body vibration with 1-min rest in between, three times a week for the first 4 weeks of the training period with varying frequency. From weeks five to eight the Exergame-dance training was conducted after the vibration sessions. SG performed a stochastic resonance whole-body vibration training with the same terms applied, however, with a fixed frequency of 1 Hz, Noise 1. From weeks five to eight a passive trampoline-programme of 5 min was applied following the vibration sessions. Primary outcome was the Short Physical Performance Battery (SPPB). Secondary outcomes were the Trail Making Test A and B (TMT A & B) and the Falls Efficacy Scale–International (FES-I). Outcomes were measured at baseline, after 4 and 8 weeks of intervention and at follow-up (4 weeks after the intervention). The non-parametric Puri and Sen rank-order test was applied, followed by an ANOVA for repeated measures to analyse main and interaction effects. Mann–Whitney U-Test was used to determine differences between the groups. Results: The post-hoc analysis showed significant effects on the SPPB total score with large effect sizes from baseline to 8 weeks (+72%, p = 0.005, η2 = 0.423). The TMT part B displayed significant improvements with large effect sizes from baseline to 8 weeks (+17.5%, p = 0.002, η2 = 0.779) and to follow-up (+21%, p = 0.001, η2 = 0.827). Conclusion: The technology based 8-week training programme consisting of a combination of stochastic resonance whole-body vibration and Exergame-dance training showed beneficial effects on both physical and cognitive performance in older care home dwelling adults.
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Affiliation(s)
- Eling D de Bruin
- Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland.,Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Heiner Baur
- Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Yvonne Brülhart
- Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Eefje Luijckx
- Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Timo Hinrichs
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Slavko Rogan
- Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
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Abstract
OBJECTIVE The objective of this study was to identify and describe long-term trajectories of bothersome pain and activity-limiting pain in a population-based sample of older adults. MATERIALS AND METHODS We conducted a retrospective cohort study of 6783 community-dwelling participants using 6 years of longitudinal data from the National Health and Aging Trends Study (NHATS). NHATS is a cohort of older adults that is representative of Medicare Beneficiaries aged 65 years and older. NHATS data collection began in 2011, and demographic and health data are collected annually through in-person interviews. Participants were asked if they had bothersome pain and activity-limiting pain in the past month. We used group-based trajectory modeling to identify longitudinal patterns of bothersome pain and activity-limiting pain over 6 years. We used weighted, multinomial logistic regression to examine associations with each trajectory. RESULTS The cohort was 57% female, 68% white, and 58% were 75 years and older. Four trajectories were identified for the probability of bothersome pain: persistently high (n=1901, 35%), increasing (n=898, 17%), decreasing (n=917, 17%), and low (n=1735, 32%). Similar trajectories were identified for activity-limiting pain: persistently high (n=721, 13%), increasing (n=812, 15%), decreasing (n=677, 12%), and low (n=3241, 60%). The persistently high bothersome and activity-limiting pain groups had worse health characteristics, were more likely to have fallen in the past year, and had slower gait speed and worse physical capacity compared with the low groups. DISCUSSION Approximately one half of older adults had a high or increasing probability of long-term bothersome pain, and over one quarter had a high or increasing probability of long-term activity-limiting pain.
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Shin D, Kang EK. Dual-task interference is related to attentional level in healthy farmers: An observational study. Medicine (Baltimore) 2020; 99:e20720. [PMID: 32629646 PMCID: PMC7337427 DOI: 10.1097/md.0000000000020720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Dual-task interference (DTI) is a decreased performance when conducting 2 tasks simultaneously, such as cognitive and motor tasks. This study aimed to identify the DTI-related factors with individually computerized interference and analyze the relative implications of decreasing DTI in healthy farmers.It followed 3 computerized experiments:The reaction time of correct releases (CRT) of BT1 in all tasks was measured, and the CRT ratios of DT were divided by the CRT values from CT and MT to obtain the DTI value. CRT during CT and MT was decreased compared to that during DT. The interference by CT (CRT of DT/CRT of MT × 100, CTI) was increased compared to the interference by MT (CRT of DT/CRT of CT×100, MTI). Additionally, comprehensive baseline characteristics, body composition, psycho-cognitive, and physical factors were assessed.Of a total of 54 participants, 16 are males (67.2 ± 8.9 years) and 38 females (62.5 ± 6.6 years). CTI showed significant correlations with age (r = 0.436, P < .001), farming period (r = 0.290, P = .033), score of the Mini-Mental State Examination in the Korean version of CERAD Assessment Packet (r = -0.329, P = .015), CRT of the Go/No-Go test (r = 0.67, P < .001), score of the short physical performance battery (r = -0.304, P = .026), and time of the timed up and go test (r = 0.364, P = .007). Regression analysis showed that the CRT of the Go/No-Go test (β = 0.558, P < .001) was the most explanatory factors for CTI.Based on the individualized DTI values quantified, interference during cognitive task was mostly related to CRT of Go/No-Go test, reflecting the attentional level. These results could suggest strategies for the active attentional training to reduce DTI and passive simplification and modification of lifestyles.
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Affiliation(s)
- Dabi Shin
- Department of Rehabilitation Medicine, Kangwon National University Hospital
- Department of Rehabilitation Medicine, School of Medicine, Kangwon National University, Chuncheon, Republic of Korea
| | - Eun Kyoung Kang
- Department of Rehabilitation Medicine, Kangwon National University Hospital
- Department of Rehabilitation Medicine, School of Medicine, Kangwon National University, Chuncheon, Republic of Korea
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Arkkukangas M, Strömqvist Bååthe K, Ekholm A, Tonkonogi M. Health promotion and prevention: The impact of specifically adapted judo-inspired training program on risk factors for falls among adults. Prev Med Rep 2020; 19:101126. [PMID: 32489772 PMCID: PMC7256641 DOI: 10.1016/j.pmedr.2020.101126] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 05/11/2020] [Accepted: 05/13/2020] [Indexed: 12/24/2022] Open
Abstract
Judo-inspired exercises may be effective for learning techniques for falling safely among adults. Physical and psychological functions increase after 10 sessions of judo-inspired exercises. Judo-inspired exercises may serve as an additional measure to address risk factors for falls.
Globally, falls and fall-related injuries constitute a severe threat to public health at all ages. New approaches are warranted since existing knowledge and actions have failed to reduce the incidence of falls and fall-related injuries, both at work and during leisure time. The purpose of this quasi-experimental study was to investigate the impact of a 10-week supervised judo-inspired exercise program, Judo4Balance, provided in a workplace setting among men and women targeting: physical functions, activity level, fall-related self-efficacy, and techniques for safe landing when falling. A total of 79 adults from seven different workplaces in Sweden, mean age 45 years (18–68), participated in the program. The study was conducted from May 2018 to June 2019. The 10-week exercise program performed in a workplace setting improved physical and psychological functions, as well as techniques for falling safely, factors of great importance to prevent falls and fall-related injuries among men and women. Therefore, it is suggested that the judo-inspired exercise program may be an effective tool in the quest to promote health and prevention of risk factors for falls and fall-related injuries among those of working age.
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Affiliation(s)
- Marina Arkkukangas
- Research and Development in Sörmland, Sweden
- Centre for Clinical Research Sörmland, Uppsala University, Uppsala, Sweden
- Department of Physiotherapy, School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
- Department of Neuroscience, Physiotherapy, Uppsala University, Uppsala, Sweden
- Corresponding author at: Research and Development in Sörmland, Sweden.
| | - Karin Strömqvist Bååthe
- School of Education, Health and Social Studies, Department of Medicine, Sport and Fitness Science, Högskolan Dalarna, Falun, Sweden
| | - Anna Ekholm
- Research and Development in Sörmland, Sweden
| | - Michail Tonkonogi
- School of Education, Health and Social Studies, Department of Medicine, Sport and Fitness Science, Högskolan Dalarna, Falun, Sweden
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18
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Senior physical activity contests in nursing homes: a feasibility study. Aging Clin Exp Res 2020; 32:869-876. [PMID: 32189244 DOI: 10.1007/s40520-020-01529-9] [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: 01/10/2020] [Accepted: 03/04/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Competition has been shown to improve motivation and physical performance in young people. This method has been rarely studied in older people. AIMS To evaluate the feasibility of senior physical activity (PA) contests between two nursing homes and to assess changes in the motivational level and physical performance of the residents over time. METHODS Residents from two Belgian nursing homes were invited to participate in PA contests. A pretest and three contest sessions were organized over a period of 3 months. The activities proposed were body balance, gait speed, sit-to-stand performance, arm curl and address tests. Feasibility was measured by contest session adherence (expected score > 80%), difficulty scores (expected score < 40%) and appreciation scores (expected score > 80%). Motivational questionnaires were administered: the BREQ-2 (assessing amotivation, introjected regulation, identified regulation, intrinsic motivation and external motivation) and the A-PMCEQ (assessing ego- and task-involving climates). Friedman's analysis of variance was performed to evaluate the changes in physical performance and motivational levels. RESULTS Of the 24 participants, seven did not complete all sessions because of medical or personal reasons not related to the study. During the three sessions, the adherence was 86%, the mean difficulty score was 30.8% and the satisfaction score was 87%. After three sessions, residents experienced a significant decrease ranged from 3 to 0 point for amotivation (p = 0.03), 1 to 0 point for external motivation (p = 0.03) and 2.5 to 2 points for ego-involving climate (p = 0.02) and a significant improvement ranged from 0.7 to 0.9 m/s for gait speed (p < 0.001), 18.5 to 15.6 s for sit-to-stand performance (p < 0.001) and 11.5 to 15 curls for arm curl scores (p < 0.001). CONCLUSIONS In nursing home settings, senior PA contests are feasible and may improve the motivational climate and physical performance.
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19
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Withall J, Greaves CJ, Thompson JL, de Koning JL, Bollen JC, Moorlock SJ, Fox KR, Western MJ, Snowsill T, Medina-Lara A, Cross R, Ladlow P, Taylor G, Zisi V, Clynes J, Gray S, Agyapong-Badu S, Guralnik JM, Rejeski WJ, Stathi A. The Tribulations of Trials: Lessons Learnt Recruiting 777 Older Adults Into REtirement in ACTion (REACT), a Trial of a Community, Group-Based Active Aging Intervention Targeting Mobility Disability. J Gerontol A Biol Sci Med Sci 2020; 75:2387-2395. [PMID: 32147709 PMCID: PMC7662171 DOI: 10.1093/gerona/glaa051] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Challenges of recruitment to randomized controlled trials (RCTs) and successful strategies to overcome them should be clearly reported to improve recruitment into future trials. REtirement in ACTion (REACT) is a United Kingdom-based multicenter RCT recruiting older adults at high risk of mobility disability to a 12-month group-based exercise and behavior maintenance program or to a minimal Healthy Aging control intervention. METHODS The recruitment target was 768 adults, aged 65 years and older scoring 4-9 on the Short Physical Performance Battery (SPPB). Recruitment methods include the following: (a) invitations mailed by general practitioners (GPs); (b) invitations distributed via third-sector organizations; and (c) public relations (PR) campaign. Yields, efficiency, and costs were calculated. RESULTS The study recruited 777 (33.9% men) community-dwelling, older adults (mean age 77.55 years (SD 6.79), mean SPPB score 7.37 (SD 1.56)), 95.11% white (n = 739) and broadly representative of UK quintiles of deprivation. Over a 20-month recruitment period, 25,559 invitations were issued. Eighty-eight percent of the participants were recruited via GP invitations, 5.4% via the PR campaign, 3% via word-of-mouth, and 2.5% via third-sector organizations. Mean recruitment cost per participant was £78.47, with an extra £26.54 per recruit paid to GPs to cover research costs. CONCLUSIONS REACT successfully recruited to target. Response rates were lower than initially predicted and recruitment timescales required adjustment. Written invitations from GPs were the most efficient method for recruiting older adults at risk of mobility disability. Targeted efforts could achieve more ethnically diverse cohorts. All trials should be required to provide recruitment data to enable evidence-based planning of future trials.
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Affiliation(s)
- Janet Withall
- Department for Health, University of Bath, UK,Address correspondence to: Janet Withall, PhD, Department for Health, University of Bath, Claverton Down, Bath BA2 7AY, UK. E-mail:
| | - Colin J Greaves
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, UK
| | - Janice L Thompson
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, UK
| | | | | | - Sarah J Moorlock
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, UK
| | - Kenneth R Fox
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, UK
| | | | - Tristan Snowsill
- Institute of Health Research, College of Medicine and Health, South Cloisters, University of Exeter, St Luke’s Campus, UK
| | | | | | - Peter Ladlow
- Academic Department of Military Rehabilitation (ADMR), Defence Medical Rehabilitation Centre (DMRC) Stanford Hall, Loughborough, UK
| | - Gordon Taylor
- University of Exeter Medical School, St Luke’s Campus, UK
| | - Vasiliki Zisi
- Department of Physical Education and Sport Sciences, University of Thessaly, Trikala, Greece
| | | | - Selena Gray
- Faculty of Health and Applied Sciences (HAS), University of the West of England (UWE Bristol), Frenchay Campus, Bristol, UK
| | - Sandra Agyapong-Badu
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, UK
| | - Jack M Guralnik
- Department of Epidemiology and Public Health, University of Maryland, School of Medicine, Baltimore
| | - W Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina
| | - Afroditi Stathi
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, UK
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Wang DX, Yao J, Zirek Y, Reijnierse EM, Maier AB. Muscle mass, strength, and physical performance predicting activities of daily living: a meta-analysis. J Cachexia Sarcopenia Muscle 2020; 11:3-25. [PMID: 31788969 PMCID: PMC7015244 DOI: 10.1002/jcsm.12502] [Citation(s) in RCA: 285] [Impact Index Per Article: 71.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 08/06/2019] [Accepted: 09/09/2019] [Indexed: 12/16/2022] Open
Abstract
Background Activities of daily living (ADLs) and instrumental activities of daily living (IADLs) are essential for independent living and are predictors of morbidity and mortality in older populations. Older adults who are dependent in ADLs and IADLs are also more likely to have poor muscle measures defined as low muscle mass, muscle strength, and physical performance, which further limit their ability to perform activities. The aim of this systematic review and meta-analysis was to determine if muscle measures are predictive of ADL and IADL in older populations. Methods A systematic search was conducted using four databases (MEDLINE, EMBASE, Cochrane, and CINAHL) from date of inception to 7 June 2018. Longitudinal cohorts were included that reported baseline muscle measures defined by muscle mass, muscle strength, and physical performance in conjunction with prospective ADL or IADL in participants aged 65 years and older at follow-up. Meta-analyses were conducted using a random effect model. Results Of the 7760 articles screened, 83 articles were included for the systematic review and involved a total of 108 428 (54.8% female) participants with a follow-up duration ranging from 11 days to 25 years. Low muscle mass was positively associated with ADL dependency in 5/9 articles and 5/5 for IADL dependency. Low muscle strength was associated with ADL dependency in 22/34 articles and IADL dependency in 8/9 articles. Low physical performance was associated with ADL dependency in 37/49 articles and with IADL dependency in 9/11 articles. Forty-five articles were pooled into the meta-analyses, 36 reported ADL, 11 reported IADL, and 2 reported ADL and IADL as a composite outcome. Low muscle mass was associated with worsening ADL (pooled odds ratio (95% confidence interval) 3.19 (1.29-7.92)) and worsening IADL (1.28 (1.02-1.61)). Low handgrip strength was associated with both worsening ADL and IADL (1.51 (1.34-1.70); 1.59 (1.04-2.31) respectively). Low scores on the short physical performance battery and gait speed were associated with worsening ADL (3.49 (2.47-4.92); 2.33 (1.58-3.44) respectively) and IADL (3.09 (1.06-8.98); 1.93 (1.69-2.21) respectively). Low one leg balance (2.74 (1.31-5.72)), timed up and go (3.41 (1.86-6.28)), and chair stand test time (1.90 (1.63-2.21)) were associated with worsening ADL. Conclusions Muscle measures at baseline are predictors of future ADL and IADL dependence in the older adult population.
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Affiliation(s)
- Daniel X.M. Wang
- Department of Medicine and Aged Care, @AgeMelbourneThe University of Melbourne, The Royal Melbourne HospitalParkvilleVICAustralia
| | - Jessica Yao
- Department of Medicine and Aged Care, @AgeMelbourneThe University of Melbourne, The Royal Melbourne HospitalParkvilleVICAustralia
| | - Yasar Zirek
- Department of Medicine and Aged Care, @AgeMelbourneThe University of Melbourne, The Royal Melbourne HospitalParkvilleVICAustralia
| | - Esmee M. Reijnierse
- Department of Medicine and Aged Care, @AgeMelbourneThe University of Melbourne, The Royal Melbourne HospitalParkvilleVICAustralia
| | - Andrea B. Maier
- Department of Medicine and Aged Care, @AgeMelbourneThe University of Melbourne, The Royal Melbourne HospitalParkvilleVICAustralia
- Department of Human Movement Sciences, @AgeAmsterdamVrije Universiteit Amsterdam, Amsterdam Movement SciencesAmsterdamThe Netherlands
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Arkkukangas M, Söderlund A, Eriksson S, Johansson AC. Fall Preventive Exercise With or Without Behavior Change Support for Community-Dwelling Older Adults: A Randomized Controlled Trial With Short-Term Follow-up. J Geriatr Phys Ther 2020; 42:9-17. [PMID: 28244890 DOI: 10.1519/jpt.0000000000000129] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND PURPOSE In Western countries, falls and fall-related injuries are a well-known threat to health in the aging population. Studies indicate that regular exercise improves strength and balance and can therefore decrease the incidence of falls and fall-related injuries. The challenge, however, is to provide exercise programs that are safe, effective, and attractive to the older population. The aim of this study was to investigate the short-term effect of a home-based exercise program with or without motivational interviewing (MI) compared with standard care on physical performance, fall self-efficacy, balance, activity level, handgrip strength, adherence to the exercise, and fall frequency. METHOD A total of 175 older adults participated in this randomized controlled study. They were randomly allocated for the Otago Exercise Program (OEP) (n = 61), OEP combined with MI (n = 58), or a control group (n = 56). The participants' mean age was 83 years. The recruitment period was from October 2012 to May 2015. Measurements of physical performance, fall self-efficacy, balance, activity level, handgrip strength, adherence to the exercise, and fall frequency were done before and 12 weeks after randomization. RESULTS AND DISCUSSION A total of 161 participants were followed up, and there were no significant differences between groups after a period of 12 weeks of regular exercise. Within the OEP + MI group, physical performance, fall self-efficacy, physical activity level, and handgrip strength improved significantly; likewise, improved physical performance and fall self-efficacy were found in the control group. A corresponding difference did not occur in the OEP group. Adherence to the exercise was generally high in both exercise groups. CONCLUSION In the short-term perspective, there were no benefits of an exercise program with or without MI regarding physical performance, fall self-efficacy, activity level, handgrip strength, adherence to the exercise, and fall frequency in comparison to a control group. However, some small effects occurred within the OEP + MI group, indicating that there may be some possible value in behavioral change support combined with exercise in older adults that requires further evaluation in both short- and long-term studies.
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Affiliation(s)
- Marina Arkkukangas
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
| | - Anne Söderlund
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
| | - Staffan Eriksson
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden.,Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden.,Department of Neuroscience, Physiotherapy, Uppsala University, Uppsala, Sweden
| | - Ann-Christin Johansson
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden.,Centre for Clinical Research, Uppsala University, Västerås, Sweden
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22
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Charles A, Buckinx F, Cataldo D, Rygaert X, Gruslin B, Reginster JY, Bruyère O. Relationship between peak expiratory flow and incidence of frailty, deaths and falls among nursing home residents: Results of the SENIOR cohort. Arch Gerontol Geriatr 2019; 85:103913. [PMID: 31357107 DOI: 10.1016/j.archger.2019.103913] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 07/01/2019] [Accepted: 07/11/2019] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To correlate peak expiratory flow (PEF) with the incidence of frailty, deaths and falls among nursing home residents. METHODS This is a 1-year longitudinal analysis performed on the clinical data of the SENIOR cohort. PEF, measured by peak flow meter, was considered as "low" when the observed value was ≤80% of the theoretical value. Physical capacity was evaluated using Short Physical Performance Battery, balance and gait using Tinetti test and muscle strength using a dynamometer. The incidence of frailty was defined as the transition from a "robust" or "prefrail" status to a "frail" status following Fried's criteria. Deaths and falls were also collected. RESULTS Among 646 subjects included at baseline (83.2 ± 9 years and 72.1% women), 297 (45.7%) displayed a low PEF. In this subgroup, physical capacity (p-values from 0.01 to <0.001), muscle strength (p < 0.001), balance and gait score (p < 0.001) were significantly lower compared to subjects displaying normal PEF. Subjects who became frail after one year displayed a lower % of the theoretical PEF value compared to those that did not (88.52 ± 45.06 vs 102.78 ± 50.29, respectively, p = 0.03). After adjustment for potential confounding variables (calf circumference, Tinetti test, SPPB test and handgrip strength), PEF was no longer associated with the occurrence of frailty. There was no association between PEF and mortality and falls. CONCLUSION In a nursing home setting, PEF is not an independent factor associated with the incidence of frailty, deaths and falls.
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Affiliation(s)
- Alexia Charles
- Department of Public Health, Epidemiology and Health Economics, University of Liège, WHO Collaborating Center for Public Health Aspects of Musculoskeletal Health and Ageing, Avenue Hippocrate 13, Liège, Belgium.
| | - Fanny Buckinx
- Department of Public Health, Epidemiology and Health Economics, University of Liège, WHO Collaborating Center for Public Health Aspects of Musculoskeletal Health and Ageing, Avenue Hippocrate 13, Liège, Belgium.
| | - Didier Cataldo
- Department of Respiratory Diseases and Laboratory of Tumor Biology and Development, University of Liège and CHU Liege, Avenue de l'Hôpital 11, Liège, Belgium.
| | - Xavier Rygaert
- Department of Public Health, Epidemiology and Health Economics, University of Liège, WHO Collaborating Center for Public Health Aspects of Musculoskeletal Health and Ageing, Avenue Hippocrate 13, Liège, Belgium.
| | - Bastien Gruslin
- Department of Public Health, Epidemiology and Health Economics, University of Liège, WHO Collaborating Center for Public Health Aspects of Musculoskeletal Health and Ageing, Avenue Hippocrate 13, Liège, Belgium.
| | - Jean-Yves Reginster
- Department of Public Health, Epidemiology and Health Economics, University of Liège, WHO Collaborating Center for Public Health Aspects of Musculoskeletal Health and Ageing, Avenue Hippocrate 13, Liège, Belgium; Chair for Biomarkers of Osteoporosis, Biochemistry Department, College of Science, King Saud University, Riyadh, Saudi Arabia.
| | - Olivier Bruyère
- Department of Public Health, Epidemiology and Health Economics, University of Liège, WHO Collaborating Center for Public Health Aspects of Musculoskeletal Health and Ageing, Avenue Hippocrate 13, Liège, Belgium; Department of Rehabilitation and Sport Sciences, University of Liège, Allée des Sports 4, Liège, Belgium.
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23
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Arkkukangas M, Johnson ST, Hellström K, Anens E, Tonkonogi M, Larsson U. Fall Prevention Exercises With or Without Behavior Change Support for Community-Dwelling Older Adults: A Two-Year Follow-Up of a Randomized Controlled Trial. J Aging Phys Act 2019; 28:34-41. [PMID: 31188707 DOI: 10.1123/japa.2019-0116] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study investigates the effectiveness of two fall prevention exercise interventions targeting physical performance, activity level, fall-related self-efficacy, health-related quality of life, and falls: the Otago Exercise Programme (OEP) with and the OEP without behavior change support. In this randomized controlled trial (RCT), 175 participants were randomised into two intervention groups and one control group. A total of 124 community-dwelling older adults over the age of 75 who needed walking aids or home support participated in the two-year follow-up. The OEP with and the OEP without support for behavior change displayed no long-term benefits on physical performance, fall-related self-efficacy, health-related quality of life, and falls compared to a control group. Although no significant differences were detected between the groups, the results implied the control group's physical activity level decreased compared to the intervention groups at two-year follow up.
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Affiliation(s)
- Marina Arkkukangas
- 1 Department of Neuroscience, Physiotherapy Uppsala University, Uppsala, Sweden
- 2 Centre for Clinical Research Sörmland County Council and Uppsala University, Sweden
| | | | - Karin Hellström
- 1 Department of Neuroscience, Physiotherapy Uppsala University, Uppsala, Sweden
| | - Elisabeth Anens
- 1 Department of Neuroscience, Physiotherapy Uppsala University, Uppsala, Sweden
| | - Michail Tonkonogi
- 3 School of Education, Health and Social Studies, department of Medicine, Sport and Fitness Science, Högskolan Dalarna, Falun, Sweden
| | - Ulf Larsson
- 2 Centre for Clinical Research Sörmland County Council and Uppsala University, Sweden
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24
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Morgan GS, Haase AM, Campbell RM, Ben-Shlomo Y. A pilot randomised controlled trial of physical activity facilitation for older adults: feasibility study findings. Pilot Feasibility Stud 2019; 5:40. [PMID: 30891309 PMCID: PMC6407174 DOI: 10.1186/s40814-019-0414-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 02/06/2019] [Indexed: 11/10/2022] Open
Abstract
Background More people are living longer lives leading to a growth in the population of older adults, many of whom have comorbidities and low levels of physical function. Physical activity in later life can prevent or delay age-related disability. Identifying a cost-effective means of increasing physical activity in older adults therefore remains an important public health priority. Physical Activity Facilitation (PAF) is an intervention shown to increase physical activity in adults with depression. The PAF model was modified for a population of older adults at risk of disability. This study aimed to assess the feasibility of undertaking a definitive RCT of the PAF intervention in the target population. Methods A pilot randomised controlled trial (RCT) was delivered through primary care. Patients at risk of disability and who were not meeting recommended levels of physical activity were recruited through postal invitation and direct approach in the practice waiting room. Those meeting eligibility criteria were enrolled and randomised at a 2:1 ratio to the PAF intervention and control. Behaviour change techniques were used by facilitators with participants over the telephone and face-to-face for 6 months. Outcome measures including physical function, physical activity, depression, social support, and quality of life were collected at baseline and at 6 months. Results A high proportion of patients responded to the initial invitation (68%), yet many were ineligible due to high levels of self-reported physical activity and baseline physical function. Fifty-one participants were recruited to the trial, with an average age of 74 years (range 65–89), and there were high rates of adherence and retention to the study (94% follow-up at 6 months). The majority of outcome data collected from participants was complete; however, the validated scale used to measure self-reported physical activity was associated with high levels of missing data. Conclusions The findings of this pilot RCT suggest that it is feasible to deliver a definitive RCT of the PAF intervention in this population. Further work is required to improve the efficiency of recruitment and to minimise missing data from self-reported physical activity measures. Trial registration Current controlled trials ISRCTN80470273. Registered 25 October 2013. Electronic supplementary material The online version of this article (10.1186/s40814-019-0414-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gemma S Morgan
- 1Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Anne M Haase
- 2School of Policy Studies, University of Bristol, Bristol, UK
| | - Rona M Campbell
- 1Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Yoav Ben-Shlomo
- 1Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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25
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Chen YC, Lin KC, Wu CY, Chen CJ, Hsieh YW. Determinants of quality of life in the older residents of long-term care facilities using the World Health Organization International Classification of Functioning, Disability and Health framework in Taiwan. Disabil Rehabil 2019; 42:2325-2333. [PMID: 30741036 DOI: 10.1080/09638288.2018.1559888] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objectives: The purpose of this study was to identify determinants within the International Classification of Functioning, Disability and Health as a conceptual framework regarding the quality of life of older long-term care facility residents.Methods: A questionnaire-based cross-sectional design was conducted. All participants (n = 210) completed a questionnaire that included the Sheltered Care Environmental Scale, the Beck Depression Inventory, the Short Physical Performance Battery, the Mini-Mental State Examination, the World Health Organization Disability Assessment Schedule, and the World Health Organization Quality of Life Scale. The outcome was assessed using mixed-design multiple regression with a covariance model and hierarchical regression.Results: Personal factors, environmental factors, body function and structures, and activity and participation explained 35.9%, 18.5%, 25.2%, and 52.1% of the variability in quality of life, respectively. The hierarchical model included 10 variables and explained 84.3% of the total variability in quality of life.Conclusions: Activity and participation showed high explanatory power for the quality of life of older long-term care facility residents. The influence of activity and participation in the older population is an important issue, although these factors remain relatively unexplored. This exploratory study used the International Classification of Functioning, Disability and Health as a conceptual framework to provide a more sophisticated understanding of quality of life.Implications for rehabilitationAlthough the viewpoint of quality of life involves many more factors than an understanding of an individual disease or disability condition, activity and participation were found to be the most important factors.Simple clinical measures, such as activity limitations and participation restrictions, can be used as clinical markers of quality of life, thus enabling rehabilitation professionals to determine the quality of life of older people in institutions.The conceptual framework of determinants of quality of life that this study reports may be helpful for rehabilitation professionals to explore with patients to implement interventions.
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Affiliation(s)
- Yi-Chang Chen
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Keh-Chung Lin
- Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Ching-Yi Wu
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Chen-Jung Chen
- Department of Nursing, Mackay Medical College, New Taipei, Taiwan
| | - Yu-Wei Hsieh
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, Chang Gung University, Taoyuan, Taiwan
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27
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McKay H, Nettlefold L, Bauman A, Hoy C, Gray SM, Lau E, Sims-Gould J. Implementation of a co-designed physical activity program for older adults: positive impact when delivered at scale. BMC Public Health 2018; 18:1289. [PMID: 30470209 PMCID: PMC6251145 DOI: 10.1186/s12889-018-6210-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 11/08/2018] [Indexed: 12/01/2022] Open
Abstract
Background Despite known health benefits of physical activity (PA), older adults remain among the least physically active age group globally with 30–60% not meeting guidelines. In Canada, 87% do not meet recommended guidelines. To influence population health, interventions that are effective in small trials must be disseminated at scale. Despite evidence for efficacy, few PA interventions are scaled up to reach the wider community. In 2015, British Columbia (BC) Ministry of Health released a PA strategy where older adults were identified as a priority. In partnership with the Ministry, the Active Aging Research Team co-created a health promotion program called Choose to Move (CTM). CTM will be implemented in three phases at increasingly greater scale across BC. The objective of this study is to evaluate the effectiveness of CTM during Phase I (pilot) and Phase II (initial scale up) on PA, mobility, and social connectedness among older adults in BC, Canada. Methods We used a type 2 hybrid effectiveness-implementation study design, and herein focus on effectiveness. The implementation evaluation will be published as a companion paper elsewhere. Two community delivery partner organizations delivered 56 CTM programs in 26 large and small urban locations across BC. Outcome measurement occurred at 0 (baseline), 3 (mid-intervention) and 6 (post-intervention) months. We collected survey data from all participants (n = 458; province-wide) and also conducted a subset evaluation (n = 209). Results PA increased significantly during the active intervention phase (baseline-3 months) in younger (60–74 yrs.; + 1.6 days/week; p < 0.001) and older (≥75 yrs.; + 1.0 days/week; p < 0.001) participants. The increase was sustained at 6 months in younger participants only, who remained significantly more active than at baseline (+ 1.4 days/week; p < 0.001). Social exclusion indicators declined significantly in the younger group. Mobility and strength improved significantly at 3 months in the younger group, and in both groups at 6 months. Conclusions CTM adopted central tenets of implementation science that consider the complicated systems where interventions are delivered to improve public health. In this iteration of CTM we demonstrate that a partner-based health promotion intervention can be effectively implemented across settings to enhance PA, mobility and social connectedness in older adults. Electronic supplementary material The online version of this article (10.1186/s12889-018-6210-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Heather McKay
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Centre, 7th Floor Robert H.N. Ho Research Centre, 795-2635 Laurel St, Vancouver, BC, V5Z 1M9, Canada. .,Department of Family Practice, University of British Columbia, 3rd Floor David Strangway Building, 5950 University Boulevard, Vancouver, BC, V6T 1Z3, Canada.
| | - Lindsay Nettlefold
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Centre, 7th Floor Robert H.N. Ho Research Centre, 795-2635 Laurel St, Vancouver, BC, V5Z 1M9, Canada
| | - Adrian Bauman
- Sydney School of Public Health, University of Sydney, Charles Perkins Centre, Building D17, Camperdown, NSW, 2006, Australia
| | - Christa Hoy
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Centre, 7th Floor Robert H.N. Ho Research Centre, 795-2635 Laurel St, Vancouver, BC, V5Z 1M9, Canada
| | - Samantha M Gray
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Centre, 7th Floor Robert H.N. Ho Research Centre, 795-2635 Laurel St, Vancouver, BC, V5Z 1M9, Canada
| | - Erica Lau
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Centre, 7th Floor Robert H.N. Ho Research Centre, 795-2635 Laurel St, Vancouver, BC, V5Z 1M9, Canada.,Department of Family Practice, University of British Columbia, 3rd Floor David Strangway Building, 5950 University Boulevard, Vancouver, BC, V6T 1Z3, Canada
| | - Joanie Sims-Gould
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Centre, 7th Floor Robert H.N. Ho Research Centre, 795-2635 Laurel St, Vancouver, BC, V5Z 1M9, Canada.,Department of Family Practice, University of British Columbia, 3rd Floor David Strangway Building, 5950 University Boulevard, Vancouver, BC, V6T 1Z3, Canada
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Difference scores between single-task and dual-task gait measures are better than clinical measures for detection of fall-risk in community-dwelling older adults. Gait Posture 2018; 66:155-159. [PMID: 30195218 DOI: 10.1016/j.gaitpost.2018.08.020] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 06/07/2018] [Accepted: 08/13/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND As the proportion of older adults in the population increases, so does the associated prevalence of falls, making falls the leading cause of fatal and nonfatal injuries among adults aged ≥65 years. In response, researchers and clinicians seek to develop a clinical tool that accurately predicts fall risk. These Investigations have included measures of clinical mobility and balance tests, strength, physiologically based tests, postural sway, and mean and variability of gait measures. To date, no study has concurrently explored all these measures to determine which measures, alone or in combination, emerge as the most predictive of fall risk. While there is evidence that dual-task gait conditions are sensitive indicators of fall risk, difference scores between dual-task and single-task gait conditions (DS) have not been explored. RESEARCH QUESTION This study included outcome measures representing diverse domains (clinical mobility and balance, strength, physiological, postural sway, and mean and variability of difference scores between dual- and single-task gait conditions) to determine the combination of measures that were the most sensitive for retrospectively classifying fallers from non-fallers. METHODS Forty-two (mean: 75.8 yrs ± 3.3) community-dwelling older adults completed a comprehensive battery of 76 measures and classified into two groups based on self-report of having one or more falls in the previous year. RESULTS Results suggest that 11 measures captured the salient characteristics of the total cohort (fallers (N = 27) and non-fallers (N = 15) and that five gait measures were sufficient for correctly classifying fallers and non-fallers with 92.3% sensitivity and 66.7% specificity with a total model classification of 82.9%. SIGNIFICANCE The five variables comprise mean DS of stride timing, stride width, and stride length and DS in variability for stride width and stride velocity demonstrating that difference in performance between dual-task and single-task gait trials was essential for discriminating fallers and superior to other measures.
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Kang EK, Shin D, Yun JY, Park W, Park HW. Investigating the interference pattern of dual tasks using serial decomposition. Restor Neurol Neurosci 2018; 36:639-646. [PMID: 30056440 DOI: 10.3233/rnn-180825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Specific investigation of dual task-interference (DTI) may help researchers to develop the optimal training exercise for enhancing the performance of daily activities. OBJECTIVES To reveal the DTI by comparing the performances between personalized single tasks (cognitive or motor task) and dual task with serial decomposition in normal healthy adults. METHODS After a preliminary period, healthy participants randomly (n = 46) performed three computerized experiments of cognitive (CT), motor (MT) and dual tasks (DT). In CT, participants were required to release button 1 (BT1) as rapidly as possible when the font color of a word and its meaning were congruent (Go), and in MT, they had to release BT1 and then tap button 2 (BT2) 10 times as rapidly as possible if the symbol "○" was presented (Go). The DT consisted of a combination of CT and MT elements. The reaction time (RT) of correct releases (RTCR) of BT1 in all tasks was measured, as well as the button shifting time between releasing BT1 and pressing BT2, and the finger tapping rate in MT and DT. To obtain the DTI values, we calculated the RTCR ratio in CT and MT and divided the outcome by the RTCR of DT. RESULTS The ratio of RTCR in CT (% CT/DT, 78.6±13.0%) and MT (% MT/DT, 74.2±10.1%) were significantly lower than the ratio of RTCR in DT (% DT/DT, 100%). The button shifting time of MT was at 92.0±23.7% of baseline, and the finger tapping rate of MT was 106.1±19.1%, which was significantly higher than baseline. CONCLUSIONS The % DT/DT is significantly higher than both % CT/DT and % MT/DT, which suggests that the cognitive load depends on the type of cognitive task that is being performed. Additionally, the significant increase of % DT/DT compared to % CT/DT indicated that there is a cognitive load prior to a motor task. The increased button shifting time and decreased tapping rate in DT may indicate that a residual cognitive load and a concurrent motor load were present.
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Affiliation(s)
- Eun Kyoung Kang
- Department of Rehabilitation Medicine, Kangwon National University Hospital, Chuncheon, Republic of Korea.,Department of Rehabilitation Medicine, School of Medicine, Kangwon National University, Chuncheon, Republic of Korea
| | - Dabi Shin
- Department of Rehabilitation Medicine, Kangwon National University Hospital, Chuncheon, Republic of Korea.,Department of Rehabilitation Medicine, School of Medicine, Kangwon National University, Chuncheon, Republic of Korea
| | - Jeong-Yeon Yun
- Gangwon Do Rehabilitation Hospital, Chuncheon, Republic of Korea.,Department of Forensic Science, College of Health Science, Yonsei University, Wonju, Republic of Korea
| | - Wanjoo Park
- New York University Abu Dhabi, Engineering Division, Abu Dhabi, United Arab Emirates
| | - Hee-Won Park
- Department of Rehabilitation Medicine, Kangwon National University Hospital, Chuncheon, Republic of Korea.,Department of Rehabilitation Medicine, School of Medicine, Kangwon National University, Chuncheon, Republic of Korea.,Gangwon Do Rehabilitation Hospital, Chuncheon, Republic of Korea
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30
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Venditti EM, Zgibor JC, Vander Bilt J, Kieffer LA, Boudreau RM, Burke LE, Glynn NW, Jakicic JM, Smith KJ, Semler LN, Rager JR, Albert SM, Newman AB. Mobility and Vitality Lifestyle Program (MOVE UP): A Community Health Worker Intervention for Older Adults With Obesity to Improve Weight, Health, and Physical Function. Innov Aging 2018; 2:igy012. [PMID: 30480135 PMCID: PMC6176958 DOI: 10.1093/geroni/igy012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Obesity rates in adults ≥65 years have increased more than other age groups in the last decade, elevating risk for chronic disease and poor physical function, particularly in underserved racial and ethnic minorities. Effective, sustainable lifestyle interventions are needed to help community-based older adults prevent or delay mobility disability. Design, baseline recruitment, and implementation features of the Mobility and Vitality Lifestyle Program (MOVE UP) study are reported. RESEARCH DESIGN AND METHODS MOVE UP aimed to recruit 26 intervention sites in underserved areas around Allegheny County, Pennsylvania and train a similar number of community health workers to deliver a manualized intervention to groups of approximately 12 participants in each location. We adapted a 13-month healthy aging/weight management intervention aligned with several evidence-based lifestyle modification programs. A nonrandomized, pre-post design was used to measure intervention impact on physical function performance, the primary study endpoint. Secondary outcomes included weight, self-reported physical activity and dietary changes, exercise self-efficacy, health status, health-related quality of life, and accelerometry in a subsample. RESULTS Of 58 community-based organizations approached, nearly half engaged with MOVE UP. Facilities included neighborhood community centers (25%), YMCAs (25%), senior service centers (20%), libraries (18%), senior living residences (6%), and churches (6%). Of 24 site-based cohorts with baseline data completed through November 2017, 21 community health workers were recruited and trained to implement the standardized intervention, and 287 participants were enrolled (mean age 68 years, 89% female, 33% African American, other, or more than one race). DISCUSSION AND IMPLICATIONS The MOVE UP translational recruitment, training, and intervention approach is feasible and could be generalizable to diverse aging individuals with obesity and a variety of baseline medical conditions. Additional data regarding strategies for program sustainability considering program cost, organizational capacity, and other adaptations will inform public health dissemination efforts.
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Affiliation(s)
- Elizabeth M Venditti
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pennsylvania
| | - Janice C Zgibor
- Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa
| | | | - Lori A Kieffer
- Department of Epidemiology, Center of Aging and Population Health, University of Pittsburgh Prevention Research Center, Pennsylvania
| | - Robert M Boudreau
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania
| | - Lora E Burke
- Department of Health & Community Systems, School of Nursing, University of Pittsburgh, Pennsylvania
| | - Nancy W Glynn
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania
| | - John M Jakicic
- Department of Health and Physical Activity, Healthy Lifestyle Institute, University of Pittsburgh, Pennsylvania
| | - Kenneth J Smith
- Department of Medicine, University of Pittsburgh School of Medicine, Pennsylvania
| | - Linda N Semler
- Department of Health and Physical Activity, School of Education, University of Pittsburgh, Pennsylvania
| | - Judith R Rager
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania
| | - Steven M Albert
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pennsylvania
| | - Anne B Newman
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania
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Silva AG, Queirós A, Rocha NP. Functioning and primary healthcare utilization in older adults: a 1-year follow-up study. Physiother Theory Pract 2018; 35:1-10. [PMID: 29461129 DOI: 10.1080/09593985.2018.1442536] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 06/02/2017] [Accepted: 07/24/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND/PURPOSE Older adults are high users of healthcare services, mainly due to health conditions and their impact on daily activities, challenging the ability of health systems to provide timely and high-quality care. Conceivably, using disability-related variables to predict future healthcare utilization could contribute to reduce both older adults' disability and healthcare costs. This study aimed to explore the association between aspects of disability and older adults' primary healthcare utilization and hospitalization over a period of 1 year. METHODS Older adults (n = 129) were assessed for self-reported disability, lower limb performance, pain intensity and number of painful body sites, depressive symptoms, and self-reported physical activity. Data on primary healthcare utilization and hospitalization were collected for the period of 1 year through registries and phone interviews. RESULTS Regression analysis, adjusted for potential confounders, showed that self-reported disability and pain intensity were significantly associated with total primary healthcare utilization and together with a confounding variable (number of chronic conditions) explained 16% of its variance (p < 0.05). Increased physical activity was significantly associated with a decreased likelihood of being admitted to hospital (95% CI for exponentiation (B) = 0.27-0.81). DISCUSSION Data suggest that decreasing self-reported disability and increasing physical activity may decrease primary healthcare utilization and hospitalization, respectively.
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Affiliation(s)
- Anabela G Silva
- a School of Health Sciences , University of Aveiro , Aveiro , Portugal
- b Center for Health Technology and Services Research (CINTESIS) , Porto , Portugal
| | - Alexandra Queirós
- a School of Health Sciences , University of Aveiro , Aveiro , Portugal
- c Institute of Electronics and Telematics Engineering of Aveiro (IEETA) , University of Aveiro , Aveiro , Portugal
| | - Nelson P Rocha
- c Institute of Electronics and Telematics Engineering of Aveiro (IEETA) , University of Aveiro , Aveiro , Portugal
- d Department of Health Sciences , University of Aveiro , Aveiro , Portugal
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Frailty: the missing piece of the pre- hematopoietic cell transplantation assessment? Bone Marrow Transplant 2017; 53:3-10. [PMID: 29084201 DOI: 10.1038/bmt.2017.192] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 07/03/2017] [Accepted: 07/22/2017] [Indexed: 12/20/2022]
Abstract
Hematopoietic stem cell transplantation (HSCT) represents a curative option for those afflicted with numerous hematologic malignancies and bone marrow failure syndromes. Advances and refinement of the HSCT process have resulted in increasing number of transplants performed on older patients in the recent years. Pre-transplant assessments (PTA) function to risk stratify patients prior to undergoing HSCT in an effort to predict those at higher risk of treatment-related toxicity, to inform risk/benefit assessments and to aid clinical decision making. Traditionally used risk stratification parameters such as chronologic age, comorbidity and performance status may not fully capture physical function, physiologic fitness, highlighting a need for improvement in PTA. Incorporation of frailty measurements in pre-HSCT assessments, particularly in elderly transplant candidates, may result in improving predictive ability of existing tools such as the Hematopoietic Cell Transplantation Comorbidity Index and Karnofsky performance status. Here, we review existing pre-HSCT assessment tools, measures of frailty that may aid in risk stratification for patients undergoing HSCT and directions for future research using frailty in the pre-HSCT setting.
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Promoting Activity in Geriatric Rehabilitation: A Randomized Controlled Trial of Accelerometry. PLoS One 2016; 11:e0160906. [PMID: 27564857 PMCID: PMC5001632 DOI: 10.1371/journal.pone.0160906] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 07/26/2016] [Indexed: 11/25/2022] Open
Abstract
Background Low activity levels in inpatient rehabilitation are associated with adverse outcomes. The study aimed to test whether activity levels can be increased by the provision of monitored activity data to patients and clinicians in the context of explicit goal setting. Methods A randomized controlled trial in three sites in Australia included 255 inpatients aged 60 and older who had a rehabilitation goal to become ambulant. The primary outcome was patients’ walking time measured by accelerometers during the rehabilitation admission. Walking times from accelerometry were made available daily to treating therapists and intervention participants to motivate patients to improve incidental activity levels and reach set goals. For the control group, ‘usual care’ was followed, including the setting of mobility goals; however, for this group, neither staff nor patients received data on walking times to aid the setting of daily walking time targets. Results The median daily walking time in the intervention group increased from 10.3 minutes at baseline to 32.1 minutes at day 28, compared with an increase from 9.5 to 26.5 minutes per day in the control group. Subjects in the intervention group had significantly higher non-therapy walking time by about 7 minutes [mean (95% CI): 24.6 (21.7, 27.4)] compared to those in the control group [mean(95% CI): 17.3 (14.4, 20.3)] (p = 0.001). Conclusions Daily feedback to patients and therapists using an accelerometer increased walking times during rehabilitation admissions. The results of this study suggest objective monitoring of activity levels could provide clinicians with information on clinically important, mobility-related activities to assist goal setting. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12611000034932 http://www.ANZCTR.org.au/
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Rajendran V, Jeevanantham D. Assessment of physical function in geriatric oncology based on International Classification of Functioning, Disability and Health (ICF) framework. CURRENT GERIATRICS REPORTS 2016. [DOI: 10.1007/s13670-016-0162-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Fulton RL, McMurdo MET, Hill A, Abboud RJ, Arnold GP, Struthers AD, Khan F, Vermeer C, Knapen MHJ, Drummen NEA, Witham MD. Effect of Vitamin K on Vascular Health and Physical Function in Older People with Vascular Disease--A Randomised Controlled Trial. J Nutr Health Aging 2016; 20:325-33. [PMID: 26892582 DOI: 10.1007/s12603-015-0619-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND AIMS Vitamin K insufficiency is common and linked to an increased risk of cardiovascular disease and osteoporotic fractures. The aim of this study was to examine whether daily supplementation with oral vitamin K could improve vascular health and physical function in older people with established vascular disease. METHODS AND RESULTS A double blind, randomised, placebo-controlled trial. Participants aged ≤ 70 years with a history of vascular disease were randomised to receive 6 months of daily oral 100mcg vitamin K2 (MK7 subtype) or matching placebo with outcomes measured at 0, 3 and 6 months. The primary outcome was between-group difference in endothelial function assessed using flow-mediated dilatation of the brachial artery at 6 months. Secondary outcomes included carotid-radial pulse wave velocity, augmentation index, blood pressure, carotid intima-media thickness, C-reactive protein, B-type natriuretic peptide, cholesterol and desphospho-uncarboxylated matrix Gla protein levels. Handgrip strength and the Short Physical Performance Battery assessed physical function, while postural sway was measured using a 3-dimensional force platform. RESULTS 80 participants were randomised, mean age 77 (SD 5) years; 44/80 were male. Vitamin K levels rose in the intervention arm compared to placebo (+48 pg/ml vs -6 pg/ml, p=0.03) at 6 months. Desphospho-uncarboxylated Matrix Gla protein levels fell in the intervention group compared to placebo at 6 months (-130 [SD 117] pmol/L vs +13 [SD 180] pmol/L, p<0.001). No change was seen in endothelial function (between group difference -0.3% [95%CI -1.3 to 0.8], p=0.62). A modest, non-significant improvement in pulse wave velocity was seen in the vitamin K group (-0.8m/s [95%CI -1.8 to 0.3], p=0.15) while all other vascular and physical function outcomes unchanged. CONCLUSIONS Six months of vitamin K2 supplementation did not improve markers of vascular health or physical function in older patients with vascular disease.
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Affiliation(s)
- R L Fulton
- RL Fulton, Ageing and Health, Mailbox 1, Medical Research Institute, Division of Diabetes and Cardiovascular Medicine, Ninewells Hospital and Medical School, Dundee DD1 9SY. Telephone 441382 383086, Fax 441382 383670, Email
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Self-Reported Disability: Association With Lower Extremity Performance and Other Determinants in Older Adults Attending Primary Care. Phys Ther 2015; 95:1628-37. [PMID: 26023215 DOI: 10.2522/ptj.20140323] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 05/19/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Measurement of function usually involves the use of both performance-based and self-report instruments. However, the relationship between both types of measures is not yet completely understood, in particular for older adults attending primary care. OBJECTIVE The main objective of the study was to investigate the association between the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) and the Short Physical Performance Battery (SPPB) for older adults at primary care. A secondary objective was to determine the influence of sociodemographic and health-related variables on this relationship. DESIGN This was a cross-sectional study. METHODS A total of 504 participants aged 60 years and older from 18 different primary care centers underwent a one-session assessment including: sociodemographic variables, comorbidities, performance, self-reported disability, pain, depressive symptoms, and physical activity. Performance was assessed using the SPPB, and self-reported disability was assessed using the WHODAS 2.0. RESULTS The correlation between WHODAS 2.0 and SPPB scores was strong (r=.65). Regression analysis showed that the SPPB total score explained 41.7% of the variance in WHODAS 2.0 scores (adjusted R(2)=41.6%). A second model including the SPPB subtests (balance, gait, and sit-to-stand), depressive symptoms, number of pain sites, pain intensity, and level of physical activity explained 61.7% of the variance in WHODAS 2.0 scores (adjusted R(2)=60.4%). No model improvement was found when considering the 6 WHODAS 2.0 individual domains. LIMITATIONS The cross-sectional nature of the study does not allow inferences on causal relationships. CONCLUSIONS This study's findings confirm that self-report and performance-based measures relate to different aspects of functioning. Further study is needed to determine if primary care interventions targeting lower extremity performance and depressive symptoms improve self-reported disability.
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Turkeshi E, Vaes B, Andreeva E, Matheï C, Adriaensen W, Van Pottelbergh G, Degryse JM. Short-term prognostic value of forced expiratory volume in 1 second divided by height cubed in a prospective cohort of people 80 years and older. BMC Geriatr 2015; 15:15. [PMID: 25888051 PMCID: PMC4345023 DOI: 10.1186/s12877-015-0013-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 02/11/2015] [Indexed: 11/17/2022] Open
Abstract
Background Spirometry-based parameters of pulmonary function such as forced expiratory volume in 1 second (FEV1) have prognostic value beyond respiratory morbidity and mortality. FEV1 divided by height cubed (FEV1/Ht3) has been found to be better at predicting all-cause mortality than the usual standardization as percentage of predicted "normal values" (FEV1%) and its use is independent of reference equations. Yet, limited data are available on the very old adults (80 years and older) and in association to other adverse health outcomes relevant for this age group. This study aims to investigate the short-term prognostic value of FEV1/Ht3 for all-cause mortality, hospitalization, physical and mental decline in a cohort of very old adults. Methods In a population-based prospective cohort study of 501 very old adults in Belgium, comprehensive geriatric assessment and spirometry were performed at baseline and after 1.7 ± 0.21 years. Kaplan-Meier curves for 3-year all-cause mortality and hospitalization rates and multivariable analysis adjusted for age, sex, smoking status, co-morbidities, anemia, high C reactive protein and creatinine levels examined the association of FEV1/Ht3 with all-cause mortality, unplanned hospitalization and decline in mental and physical functioning. Physical functioning was assessed by activities of daily living, a battery of physical performance tests and grip strength. Mental functioning was assessed with mini mental state examination and 15 items geriatric depression scale. Results Individuals in the lowest quartile of FEV1/Ht3 had a statistically significant increased adjusted risk for all-cause mortality (hazard ratio [HR] 1.69, 95% confidence interval [CI] 1.10-2.60) and unplanned hospitalization (HR 1.65, 95% CI 1.21-2.25), as well as decline in physical (odds ratio [OR] 1.89, 95% CI 1.05-3.39) and mental functioning (OR 2.39, 95% CI 1.30-4.40) compared to the rest of the study population. Conclusions In a cohort of very old adults, low FEV1 expressed as FEV1/Ht3 was found to be a short-term predictor of all-cause mortality, hospitalization and decline in physical and mental functioning independently of age, smoking status, chronic lung disease and other co-morbidities. Further research is needed on FEV1/Ht3 as a potential risk marker for frailty and adverse health outcomes in this age group.
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Affiliation(s)
- Eralda Turkeshi
- Institute of Health and Society, Université Catholique de Louvain (UCL), Clos Chapelle-aux-Champs 30, bte B1.30.15, 1200, Brussels, Belgium.
| | - Bert Vaes
- Institute of Health and Society, Université Catholique de Louvain (UCL), Clos Chapelle-aux-Champs 30, bte B1.30.15, 1200, Brussels, Belgium. .,Department of Public Health and Primary Care, Katholieke Universiteit Leuven (KUL), Kapucijnenvoer 33, blok J, PB 7001 3000, Leuven, Belgium.
| | - Elena Andreeva
- Institute of Health and Society, Université Catholique de Louvain (UCL), Clos Chapelle-aux-Champs 30, bte B1.30.15, 1200, Brussels, Belgium.
| | - Catharina Matheï
- Institute of Health and Society, Université Catholique de Louvain (UCL), Clos Chapelle-aux-Champs 30, bte B1.30.15, 1200, Brussels, Belgium. .,Department of Public Health and Primary Care, Katholieke Universiteit Leuven (KUL), Kapucijnenvoer 33, blok J, PB 7001 3000, Leuven, Belgium.
| | - Wim Adriaensen
- Institute of Health and Society, Université Catholique de Louvain (UCL), Clos Chapelle-aux-Champs 30, bte B1.30.15, 1200, Brussels, Belgium. .,Department of Public Health and Primary Care, Katholieke Universiteit Leuven (KUL), Kapucijnenvoer 33, blok J, PB 7001 3000, Leuven, Belgium.
| | - Gijs Van Pottelbergh
- Institute of Health and Society, Université Catholique de Louvain (UCL), Clos Chapelle-aux-Champs 30, bte B1.30.15, 1200, Brussels, Belgium. .,Department of Public Health and Primary Care, Katholieke Universiteit Leuven (KUL), Kapucijnenvoer 33, blok J, PB 7001 3000, Leuven, Belgium.
| | - Jean-Marie Degryse
- Institute of Health and Society, Université Catholique de Louvain (UCL), Clos Chapelle-aux-Champs 30, bte B1.30.15, 1200, Brussels, Belgium. .,Department of Public Health and Primary Care, Katholieke Universiteit Leuven (KUL), Kapucijnenvoer 33, blok J, PB 7001 3000, Leuven, Belgium.
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Arkkukangas M, Johnson ST, Hellström K, Söderlund A, Eriksson S, Johansson AC. A feasibility study of a randomised controlled trial comparing fall prevention using exercise with or without the support of motivational interviewing. Prev Med Rep 2015; 2:134-40. [PMID: 26844061 PMCID: PMC4721421 DOI: 10.1016/j.pmedr.2015.01.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE The aim of this investigation was to study the feasibility of a randomised controlled trial (RCT) based on a multicentre fall prevention intervention including exercise with or without motivational interviewing compared to standard care in community-living people 75 years and older. METHOD The feasibility of a three-armed, randomised controlled trial was evaluated according to the following: process, resources, management by questionnaire, and treatment outcomes. The outcome measures were fall frequency, physical performance and falls self-efficacy evaluated after three months. Twelve physiotherapists conducted the measurements and treatments and responded to the questionnaire. The first 45 participants recruited to the ongoing RCT were included: 16 individuals in the Otago Exercise Program group (OEP), 16 individuals in the OEP combined with motivational interviewing group (MI), and 13 individuals in the control group. The study was conducted from November 2012 to December 2013. RESULTS The feasibility of the study process, resources and management reached the set goals in most aspects; however, the set goal regarding the MI guide and planned exercise for the participating older people was not completely reached. No significant differences were found between the groups regarding the outcome measures. CONCLUSION This study confirmed the acceptable feasibility for the study protocol in the ongoing RCT.
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Affiliation(s)
- Marina Arkkukangas
- School of Health, Care and Social Welfare, Mälardalen University, Box 883, SE-721 23 Västerås, Sweden
| | - Susanna Tuvemo Johnson
- Department of Neuroscience, Physiotherapy, Uppsala University, Box 593, BMC, Uppsala, Sweden
| | - Karin Hellström
- Department of Neuroscience, Physiotherapy, Uppsala University, Box 593, BMC, Uppsala, Sweden
| | - Anne Söderlund
- School of Health, Care and Social Welfare, Mälardalen University, Box 883, SE-721 23 Västerås, Sweden
| | - Staffan Eriksson
- Centre for Clinical Research Sörmland, Uppsala University, Kungsgatan 41, 631 88 Eskilstuna, Sweden
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, SE-901 87 Umeå, Sweden
| | - Ann-Christin Johansson
- School of Health, Care and Social Welfare, Mälardalen University, Box 883, SE-721 23 Västerås, Sweden
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Silva AG, Queirós A, Alvarelhão J, Rocha NP. Validity and reliability of the Portuguese version of the Rapid Assessment of Physical Activity questionnaire. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2014. [DOI: 10.12968/ijtr.2014.21.10.469] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Anabela G Silva
- Assistant professor at the School of Health Sciences, University of Aveiro, Campus Universitário de Santiago, Portugal, and Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
| | - Alexandra Queirós
- Full professor at the School of Health Sciences, University of Aveiro, Campus Universitário de Santiago, Portugal
| | - Joaquim Alvarelhão
- Assistant professor at the School of Health Sciences, University of Aveiro, Campus Universitário de Santiago, Portugal
| | - Nelson P Rocha
- Full professor at the Department of Health Sciences, University of Aveiro, Campus Universitário de Santiago, Portugal
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Pain intensity is associated with both performance-based disability and self-reported disability in a sample of older adults attending primary health care centers. Disabil Health J 2014; 7:457-65. [DOI: 10.1016/j.dhjo.2014.05.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 04/14/2014] [Accepted: 05/01/2014] [Indexed: 11/22/2022]
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Legrand D, Vaes B, Matheï C, Adriaensen W, Van Pottelbergh G, Degryse JM. Muscle strength and physical performance as predictors of mortality, hospitalization, and disability in the oldest old. J Am Geriatr Soc 2014; 62:1030-8. [PMID: 24802886 DOI: 10.1111/jgs.12840] [Citation(s) in RCA: 146] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To evaluate the predictive value of muscle strength and physical performance in the oldest old for all-cause mortality; hospitalization; and the onset of disability, defined as a decline in activities of daily living (ADLs), independent of muscle mass, inflammatory markers, and comorbidities. DESIGN A prospective, observational, population-based follow-up study. SETTING Three well-circumscribed areas of Belgium. PARTICIPANTS Five hundred sixty participants aged 80 and older were followed for 33.5 months (interquartile range 31.1-35.6 months). MEASUREMENTS Grip strength, Short Physical Performance Battery (SPPB) score, and muscle mass were measured at baseline; ADLs at baseline and after 20 months; and all-cause mortality and time to first hospitalization from inclusion onward. Kaplan-Meier curves and Cox proportional hazards models were calculated for all-cause mortality and hospitalization. Logistic regression analysis was used to determine predictors of decline in ADLs. RESULTS Kaplan-Meier curves showed significantly higher all-cause mortality and hospitalization in subjects in the lowest tertile of grip strength and SPPB score. The adjusted Cox proportional hazards model showed that participants with high grip strength or a high SPPB score had a lower risk of mortality and hospitalization, independent of muscle mass, inflammatory markers, and comorbidity. A relationship was found between SPPB score and decline in ADLs, independent of muscle mass, inflammation, and comorbidity. CONCLUSION In people aged 80 and older, physical performance is a strong predictor of mortality, hospitalization, and disability, and muscle strength is a strong predictor of mortality and hospitalization. All of these relationships were independent of muscle mass, inflammatory markers, and comorbidity.
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Affiliation(s)
- Delphine Legrand
- Institut de Recherche Santé et Societé, Université Catholique de Louvain, Brussels, Belgium
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Weigel MM, Armijos RX, Beltran O. Musculoskeletal Injury, Functional Disability, and Health-Related Quality of Life in Aging Mexican Immigrant Farmworkers. J Immigr Minor Health 2013; 16:904-13. [DOI: 10.1007/s10903-013-9788-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Stookey AD, Katzel LI, Steinbrenner G, Shaughnessy M, Ivey FM. The short physical performance battery as a predictor of functional capacity after stroke. J Stroke Cerebrovasc Dis 2012; 23:130-5. [PMID: 23253531 DOI: 10.1016/j.jstrokecerebrovasdis.2012.11.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Revised: 11/02/2012] [Accepted: 11/04/2012] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND The short physical performance battery is a widely used instrument for quantifying lower extremity function in older adults. However, its utility for predicting endurance-based measures of functional performance that are more difficult to conduct in clinical settings is unknown. An understanding of this could be particularly relevant in mobility impaired stroke survivors, for whom establishing the predictive strength of simpler to perform measures would aid in tracking broader categories of functional disability. This cross-sectional study was conducted to determine whether the short physical performance battery is related to functional measures with a strong endurance component. METHODS Functional measures (short physical performance battery, peak aerobic capacity, and 6-minute walk) were obtained and compared for the first time in stroke survivors with hemiparetic gait. Pearson correlation coefficients were used to assess strength of the relationships (α P < .05). RESULTS Forty-three stroke participants performed a standardized short physical performance battery. Forty-one of the subjects completed a 6-minute walk, and 40 completed a peak treadmill test. Mean short physical performance battery (6.3 ± 2.5 [mean ± SD]), 6-minute walk (242 ± 115 meters), and peak aerobic capacity (17.4 ± 5.4 mL/kg/min) indicated subjects had moderate to severely impaired lower extremity functional performance. The short physical performance battery was related to both 6-minute walk (r = 0.76; P < .0001) and peak fitness (r = 0.52; P < .001). CONCLUSIONS Our results show that the short physical performance battery may be reflective of endurance-based, longer-distance performance measures that would be difficult to perform in standard clinical stroke settings. Additional studies are needed to explore the value of using the short physical performance battery to assess rehabilitation-related functional progression after stroke.
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Affiliation(s)
- Alyssa D Stookey
- Department of Veterans Affairs and Veterans Affairs Medical Center, Geriatric Research, Education and Clinical Center (GRECC), Baltimore, Maryland.
| | - Leslie I Katzel
- Department of Veterans Affairs and Veterans Affairs Medical Center, Geriatric Research, Education and Clinical Center (GRECC), Baltimore, Maryland; Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Gregory Steinbrenner
- Department of Veterans Affairs and Veterans Affairs Medical Center, Geriatric Research, Education and Clinical Center (GRECC), Baltimore, Maryland; Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Marianne Shaughnessy
- Department of Veterans Affairs and Veterans Affairs Medical Center, Geriatric Research, Education and Clinical Center (GRECC), Baltimore, Maryland; Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Frederick M Ivey
- Department of Veterans Affairs and Veterans Affairs Medical Center, Geriatric Research, Education and Clinical Center (GRECC), Baltimore, Maryland; Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland
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Vermeulen J, Neyens JCL. Predicting disability and institutionalization in elderly people: how strong is the evidence for the predictive value of the short physical performance battery? PHYSICAL THERAPY REVIEWS 2012. [DOI: 10.1179/1743288x12y.0000000003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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