Raising and stabilization phase of the sit-to-stand movement better discriminate healthy elderly adults from young subjects: a pilot cross-sectional study

30-Second Chair Stand and 5-Times Sit-to-Stand Tests Are Interesting Tools for Assessing Disability and Ability to Ambulate among Patients with Multiple Sclerosis

Multiple Sclerosis (MS) is a demyelinating and chronic disease with variable neurological symptoms. There are different scales that score the level of disability, but only few papers have taken into consideration the 5-times sit-to-stand (5STS) test and the 30 s chair stand test (30CST), which are valid and easily obtainable indicators of other neurological diseases. The aim of our research is to verify the validity, reproducibility, and responsiveness of these tests. Patients afflicted with MS were enrolled in the AISM outpatient facility. The inclusion criterion was an EDSS score less than 6.5. We performed the 5STS, 30CST, and timed 25-foot walk (T25-FW) tests and recorded EDSS scores in the first evaluation. Then, we recorded the performance after 5 days (conducted by a second blind operator to ensure test-retest reproducibility), and the last evaluation was made after 12 sessions of physiotherapy. We recruited 38 patients diagnosed with MS. The results show significant data regarding validity, reproducibility, and responsiveness for both scales. The data argue in favor of adding these tests to the relevant clinical assessments. These two tests are simple, reliable, and easy to administer, and the data confirm that they can be included in the evaluation of patients with MS.

A Simple Device for Measuring Sit-to-Stand Movements and Cardio-Metabolic Diseases: A Cross-Sectional Study in a Health Check-Up Population Over 20 Years Old

Introduction Several studies have reported the usefulness of measuring lower limb muscle strength through the motion of standing up using a reaction force measuring device positioned on the ground. There is inadequate information on the association between cardiovascular disease risk factors and ground reaction force (GRF) during standing up. Therefore, this study estimated the association between GRF by sit-to-stand movements and cardiovascular disease risk factors in a health check-up population. Methods This cross-sectional study included 1,182 healthy participants without chronic diseases who underwent periodic health check-ups from August 2019 to December 2020. The study included individuals aged ≥20 years who underwent a standing test from an initial seated position in a chair. A sit-to-stand force analyzer was used to measure GRF, and health status information was collected at enrollment. The relationships between blood test data and each measurement obtained from GRF measurements (forth/body mass (F/M), rate of forth development/body mass (RFD/M), and stable time) were parsed according to sex using linear regression analysis coordinated by age. GRF measurements and their relationships with cardiovascular disease risk factors were assessed using logistic regression analysis, adjusted for age and sex. Results A total of 1,182 participants was included in this study, with male participants accounting for 61.5%. The study participants had a median age of 57.0 years (IQR: 47.0-63.0). After adjusting for age, F/M was positively associated with high-density lipoprotein cholesterol in male (β=22.59, p<0.001) and female participants (β=20.35, p=0.011) and negatively associated with plasma glucose in male (β=-16.25, p=0.008) and female participants (β=-18.78, p=0.028). Stable time (time required to be stabilize after standing up movement) was positively associated with hemoglobin A1c levels in male (β=0.55, p=0.001) and female participants (β=0.56, p=0.036). Logistic regression analysis adjusted by age and sex showed that a lower F/M ratio was associated with hypertension, hyperlipidemia, and diabetes mellitus (adjusted odds ratio (aOR) =1.60, p=0.01; aOR=1.75, p=0.001; and aOR=2.23, p=0.002, respectively). Lower RFD/M was associated with hyperlipidemia and diabetes mellitus (aOR=1.46, p=0.013 and aOR=1.63, p=0.045, respectively). A shorter stable time was associated with diabetes mellitus (aOR=0.39, p<0.001). Conclusions These findings suggest that lower limb function impairment, as assessed via standing-up movements using a GRF-measuring device, may relate to cardiovascular disease. Further research is needed to confirm this association.

Overweight in elderly increases postural instability during sit-to-stand test: a Kinect-based assessment

BACKGROUND

Being overweight increases the risk of falls and subsequent injuries. However, conventional functional balance tests may not be appropriate for this population as body weight can affect test performance. Thus, it is crucial to develop reliable methods for assessing balance ability in overweight individuals.

AIM

The purpose of this study was to utilize a portable gaming device (Kinect Xbox 360) to measure the center of mass (CoM) of elderly individuals and compare the results between normal weight and overweight elderly women.

METHODS

The study included 64 female elderly individuals who were divided into two groups: 32 normal weight and 32 overweight subjects, matched for age (matched pairs design). The study collected the body's CoM during the five-time sit-to-stand test (FTSST) using Kinect camera. Additionally, the participants underwent the time up and go test (TUGT) and one-leg standing balance (OLSB) tests. The Kinect Xbox 360 demonstrated high test-retest reliability for measuring body's center of mass sway, with ICC3,1 value of 0.982 in the vertical direction, 0.983 in the mediolateral (ML) direction, and 0.997 in the anteroposterior (AP) direction. Additionally, the technical error of measurement (TEM) was very low at 0.006, 0.002, and 0.004, respectively. The % coefficient of variation ranged from 1.31% to 5.68%, indicating good measurement consistency.

RESULTS

Overweight individuals took longer to complete FTSST and TUGT compared to normal weight individuals, but no significant difference was observed in OLSB tests. Moreover, overweight elderly individuals had greater sway length in the ML and AP directions compared to normal weight elderly individuals.

DISCUSSION AND CONCLUSION

Overweight elderly individuals had poorer balance than their normal weight counterparts when using Kinect camera. The researchers suggest that Kinect device can be a cost-effective alternative to measure balance performance among overweight elderly in the community-based setting.

Biomechanical and neuromuscular control characteristics of sit-to-stand transfer in young and older adults: A systematic review with implications for balance regulation mechanisms

BACKGROUND

Falls are major health concerns in older adults. Sit-to-stand transfer is an important functional movement that can predict falling risk in older adults. Aging-associated declines in neuromechanical control of movement may negatively impact sit-to-stand performance. This systematic review aims to summarize differences in neuromechanical characteristics of younger vs. older adults that likely affect balance regulation during sit-to-stand.

METHODS

Five databases (Academic search complete, MEDLINE, APA PsycInfo, Pubmed, and SPORTDiscus) were systematically searched from January 1985 through March 2023. Three reviewers assessed the quality of methodology, study design, results, and risk of bias using the Appraisal tool for Cross-Sectional Studies. Studies reported neuromuscular and biomechanical characteristics during sit-to-stand in young versus older adults were included.

FINDINGS

Seventeen studies (343 older and 225 younger adults) were included. Compared to younger adults, older adults showed slower sit-to-stand time, higher trunk flexion, postural sway, agonist-antagonist muscle co-activation of the ankle and knee muscles, and lower ankle dorsiflexion torque. Lower magnitude and rate of vertical ground reaction force development and lower vertical momentum during rising were observed with aging during fast-speed sit-to-stand. There was heterogeneity among studies on sit-to-stand speed, foot position, use of arms, and seat height adjustability.

INTERPRETATIONS

Higher trunk angular displacement and velocity accompanied by higher anterior momentum, likely to compensate for knee extensor muscle weaknesses, may lead to higher postural sway upon standing and therefore require higher knee and ankle muscle co-activation to maintain balance stability. Thus, additional attention to trunk control strategies is needed during clinical evaluations.

The five times sit-to-stand test: safety, validity and reliability with critical care survivors's at ICU discharge

BACKGROUND

The Five Times Sit-to-Stand Test (FTSST) has been found reliable, safe and valid for measuring healthy adults' lower limb muscle strength and for determining balance control, fall risk, and exercise capacity among older examinees. We believe that the FTSST has the potential to be a straightforward, low cost and valuable tool for identifying muscle disability and functional status following critical illness. The aim of our study was to establish the applicability, safety, and psychometric qualities of FTSST in patients at Intensive Care Unit (ICU) discharge.

METHODS

In our study applicability was determined by assessing the percentage of patients who could perform the test at ICU discharge. Safety was assessed by examining data regarding any exacerbated haemodynamic and respiratory responses or adverse events associated with the test. For assessing FTSST reliability, intraclass correlation coefficients (ICCs), standard error of measurement (SEM) and Bland-Altman plot were used. For assessing concurrent validity handgrip strength, ICU length of stay, duration of invasive ventilation, Simplified Acute Physiology Score 3 (SAPS3) and age variables were used. For investigating predictive validity, correlations between the FTSST and measures of hospital length of stay and functional independence were evaluated.

RESULTS

Only 30% of ICU survivors (n = 261 out of 817) were eligible to perform the FTSST and 7% of patients who performed the test (n = 10 out of 142) presented adverse events. Both inter (ICC 0.92 CI95% 0.89-0.94) and intra-rater (ICC 0.95 CI95% 0.93-0.96) reliability were excellent and higher scores were associated with lower muscle strength, longer hospital stay and greater functional impairment at hospital discharge in adult survivors of critical diseases.

CONCLUSION

Our results suggest that the FTSST may be applicable only to high-functioning critical care survivors. In this specifical population, FTSST is a safe, easy to perform, valid and reliable measure that can be applied to fall risk and functional recovery management.

Circumstances of Falls During Sit-to-Stand Transfers in Older People: A Cohort Study of Video-Captured Falls in Long-Term Care

OBJECTIVE

To characterize the circumstances of falls during sit-to-stand transfers in long-term care (LTC), including the frequency, direction, stepping and grasping responses, and injury risk, based on video analysis of real-life falls.

DESIGN

Cohort study.

SETTING

LTC.

PARTICIPANTS

We analyzed video footage of 306 real-life falls by 183 LTC residents that occurred during sit-to-stand transfers, collected from 2007 to 2020. The mean age was 83.7 years (SD=9.0 years), and 93 were female (50.8%).

INTERVENTION

Not applicable.

MAIN OUTCOME MEASURES

We used Generalized Estimating Equations to test for differences in the odds that a resident would fall at least once during the rising vs stabilization phases of sit-to-stand and to test the association between the phase of the transfer when the fall occurred (rising vs stabilization) and the following outcomes: (1) the initial fall direction; (2) the occurrence, number, and direction of stepping responses; (3) grasping of environmental supports; and (4) documented injury.

RESULTS

Falls occurred twice as often in the rising phase than in the stabilization phase of the transfer (64.0% and 36.0%, respectively). Falls during rising were more often directed backward, while falls during stabilization were more likely to be sideways (odds ratio [OR]=1.95; 95% confidence interval [CI]=1.07-3.55). Falls during rising were more often accompanied by grasping responses, while falls during stabilization were more likely to elicit stepping responses (grasping: OR=0.30; 95% CI=0.14-0.64; stepping: OR=8.29; 95% CI=4.54-15.11). Injuries were more likely for falls during the stabilization phase than the rising phase of the transfer (OR=1.73; 95% CI=1.04-2.87).

CONCLUSION

Most falls during sit-to-stand transfers occurred from imbalance during the rising phase of the transfer. However, falls during the subsequent stabilization phase were more likely to cause injury.

Persistent cancer-related fatigue after breast cancer treatment predicts postural sway and post-exertional changes in sit-to-stand strategy

Background

Chemotherapy-induced peripheral neuropathy (CIPN) is considered a primary mechanism of imbalance among women diagnosed with breast cancer. Recent evidence, however, suggests that cancer-related fatigue (CRF) may also influence balance.

Purpose

Examine the contributions of CRF and CIPN to static and dynamic balance before and after a period of fatiguing exercise.

Methods

This is a secondary analysis of data examining functional differences between women with breast cancer with and without persistent CRF. Postural sway was measured during static standing and the rising phase of an instrumented sit-to-stand (ISTS) before and after exercise. Regression analyses were performed to determine how CRF and severity of CIPN predicted sway and how much variance was attributable to each.

Results

Greater CRF predicted increased pre-, p=.04, and post-exertional, p=.02, static sway in the anterior-posterior plane. CRF accounted for 10.5% and 9.5% of the variance in pre- and post-exertional sway (respectively) compared to the 0.9% and 1.4% accounted for by CIPN severity which was not a significant predictor. After exercise, greater CRF predicted smaller, more conservative, anterior weight shifting during the ISTS, p=.01, and accounted for 6.6% of the variance in sway compared to 3% attributed to CIPN which was not a significant predictor.

Limitations

This analysis is limited by its small and demographically homogenous sample.

Conclusions

These results suggest that CRF may influence balance independent of CIPN symptoms. While CIPN remains a risk factor for imbalance in this population, CRF warrants consideration in clinical practice and research as a mechanism of postural instability.

Spinopelvic movement strategies during sit-to-stand and stand-to-sit in adult spinal deformity

BACKGROUND

Research interest on the impact of adult spinal deformity (ASD) on spinopelvic and whole body motion has increased over the past years. Studies focusing on overground walking, showed that patients with ASD indeed present with functional impairments. Functional tasks challenging the spinopelvic complex, such as sit-to-stand-to-sit, might identify clinically relevant biomechanical parameters and could further increase our insights on how ASD impacts functioning and disability.

RESEARCH QUESTION

Do patients with ASD use different spinopelvic strategies during sit-to-stand (STSt) and stand-to-sit (StTS) compared to healthy controls?

METHODS

In this prospective study, marker-based motion analysis and a subject-specific polynomial fit were used to assess spinopelvic kinematics (thoracic kyphosis (TK), lumbar lordosis (LL), sagittal vertical axis (SVA), trunk, pelvis) during STSt/StTS in 42 patients with ASD and 18 control subjects. All parameters were compared between controls and patients with ASD, divided in three groups based on their sagittal alignment (ASD 1: decompensated sagittal malalignment; ASD 2: compensated sagittal malalignment; ASD 3: scoliosis and normal sagittal alignment). Continuous kinematic and kinetic data were analyzed through statistical parametric mapping.

RESULTS

Patients with ASD showed decreased LL and increased trunk flexion and SVA during STSt/StTS compared to controls. These differences were mainly observed in sagittal deformity patients (ASD 1 and 2). In contrast, coronal patients (ASD 3) did not differ from controls. Dynamic LL and SVA significantly correlated with radiographic LL and SVA, however these relations decreased during the middle third of the motion cycle.

SIGNIFICANCE

Patients with ASD use aberrant spinopelvic strategies during STSt/StTS compared to healthy controls. Only partial correlation to static radiographic parameters suggests other mechanisms need to be identified in addition to spinal malalignment. These might include impaired neuromuscular control or muscle weakness. Further research on movement patterns during functional tasks might ultimately result in treatment strategies that aim to augment activity participation by targeting improvements in movement function.

Postural Balance in Individuals With Knee Osteoarthritis During Stand-to-Sit Task

Objective: Stand-to-sit task is an important daily function, but there is a lack of research evidence on whether knee osteoarthritis (knee OA) affects the postural balance during the task. This study aimed to compare individuals with knee OA and asymptomatic controls in postural balance and identify kinematic and lower extremity muscle activity characteristics in individuals with knee OA during the stand-to-sit task. Methods: In total, 30 individuals with knee OA and 30 age-matched asymptomatic controls performed the 30-s Chair Stand Test (30sCST) at self-selected speeds. Motion analysis data and surface electromyography (sEMG) were collected while participants performed the 30sCST. To quantify postural balance, the displacement of the center of mass (CoM) and the peak instantaneous velocity of the CoM were calculated. The kinematic data included forward lean angles of the trunk and pelvic, range of motion (RoM) of the hip, knee, and ankle joints in the sagittal plane. The averaged activation levels of gluteus maximus, vastus lateralis, vastus medialis, rectus femoris, biceps femoris (BF), tibialis anterior (TA), and medial head of gastrocnemius muscles were indicated by the normalized root mean square amplitudes. Results: Compared with the asymptomatic control group, the knee OA group prolonged the duration of the stand-to-sit task, demonstrated significantly larger CoM displacement and peak instantaneous CoM velocity in the anterior-posterior direction, reduced ankle dorsiflexion RoM, greater anterior pelvic tilt RoM, and lower quadriceps femoris and muscles activation level coupled with higher BF muscle activation level during the stand-to-sit task. Conclusion: This study indicates that individuals with knee OA adopt greater pelvic forward lean RoM and higher BF muscle activation level during the stand-to-sit task. However, these individuals exist greater CoM excursion in the anterior-posterior direction and take more time to complete the task. This daily functional activity should be added to the rehabilitation goals for individuals with knee OA. The knee OA group performs reduced ankle dorsiflexion RoM, quadriceps femoris, and TA activation deficit. In the future, the rehabilitation programs targeting these impairments could be beneficial for restoring the functional transfer in individuals with knee OA.

Effect of local somatosensory stimulus on postural sway during sit-to-stand movement in the elderly

Background

Sit-to-stand (STS) is a complex movement that requires successful postural control. Aging is a normal part of human life that leads to weakness of sensory capabilities, resulting in diminished postural control. Therefore, STS movement is a challenging task for the elderly. Local tendon vibration (LTV) can be utilized to assist STS of the elderly by improving postural control. Many studies have revealed that the LTV has various physiological positive effect. However, previous studies did not consider subjects’ individual difference for properties of applied LTV. Also, there are almost no studies to assist and to improve elder’s STS movement. Thus, the purpose of this study was to examine the influence of lower limb LTV on postural sway during STS in the elderly, and to examine whether a specific vibration frequency can increase postural control in the elderly.

Results

The common characteristic differences between the elderly and younger population during STS movement were analyzed. In addition, the effect of vibration on the center of mass (COM) and the center of pressure (COP) variable responses in young adults and the elderly were investigated. As a result, the elderly exhibit larger COP sway area and higher COP mediolateral (ML) displacement than the young adults. In addition, the elderly generally have lower COM velocities in all directions compared to the young adults. It was found that COP and COM related to postural stability are affected when LTV of the 180 Hz, 190 Hz and 250 Hz is applied to the elderly. Particularly, the 190 Hz vibration induced significant reduction in COP sway area and COP ML displacement.

Conclusions

These results mean that the LTV contributes to stability of elders’ STS movement by reducing postural sway. Furthermore, a reduction of postural sway depends on frequency of the LTV. These findings suggest that individual response to characteristics of vibration must be considered, and imply that the LTV can be used as rehabilitation therapy to improve postural control in the elderly, and utilized in motion assistive devices to deliver apt vibration frequencies.

Trial registration

CRIS, KCT0005434, Registered 25 September 2020, Retrospectively registered, https://cris.nih.go.kr/cris/index/index.do

Quantitative Comparison of Human and Software Reliability in the Categorization of Sit-to-Stand Motion Pattern

The Sit-to-Stand (STS) test is used in clinical practice as an indicator of lower-limb functionality decline, especially for older adults. Due to its high variability, there is no standard approach for categorising the STS movement and recognising its motion pattern. This paper presents a comparative analysis between visual assessments and an automated-software for the categorisation of STS, relying on registrations from a force plate. 5 participants (30 ± 6 years) took part in 2 different sessions of visual inspections on 200 STS movements under self-paced and controlled speed conditions. Assessors were asked to identify three specific STS events from the Ground Reaction Force, simultaneously with the software analysis: the start of the trunk movement (Initiation), the beginning of the stable upright stance (Standing) and the sitting movement (Sitting). The absolute agreement between the repeated raters' assessments as well as between the raters' and software's assessment in the first trial, were considered as indexes of human and software performance, respectively. No statistical differences between methods were found for the identification of the Initiation and the Sitting events at self-paced speed and for only the Sitting event at controlled speed. The estimated significant values of maximum discrepancy between visual and automated assessments were 0.200 [0.039; 0.361] s in unconstrained conditions and 0.340 [0.014; 0.666] s for standardised movements. The software assessments displayed an overall good agreement against visual evaluations of the Ground Reaction Force, relying, at the same time, on objective measures.