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Dai ACK, Mackenzie L. Falls experienced by adult cancer survivors: a scoping review. Disabil Rehabil 2024:1-21. [PMID: 38946208 DOI: 10.1080/09638288.2024.2362399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 05/28/2024] [Indexed: 07/02/2024]
Abstract
PURPOSE Accidental falls among adult cancer survivors are a health concern. Falls impose economic burdens and detrimental consequences to cancer survivors. This review aimed to synthesize findings from published research to explore the relationship between falls and cancer diagnosis and treatment among cancer survivors. MATERIALS AND METHODS A scoping review was conducted using four databases (Medline, EMBASE, CINAHL, and Scopus) for the years 2001-2021. A total of 425 abstracts were identified after removing duplicates. A second search for the years 2022-2023 was completed where 80 abstracts were identified. Abstract screening, full-text review, and data extraction were conducted. Study characteristics and key findings were extracted from full texts. Descriptive numerical summaries were presented, and narrative analyses were performed. RESULTS AND CONCLUSIONS A total of 42 articles were included in the scoping review which demonstrated (1) an increased prevalence of falls among cancer survivors, (2) the presence of cancer-specific fall risk factors, (3) a lack of cancer-specific fall prediction tools, and (4) few fall prevention interventions as part of usual care among cancer survivors. Younger cancer survivors were underrepresented. Cancer survivors should be aware of their risk of falls, and health professionals should ensure that fall prevention is part of usual care.
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Affiliation(s)
- Anson Chuk Kwan Dai
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Lynette Mackenzie
- Discipline of Occupational Therapy, School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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Zak M, Wasik M, Sikorski T, Aleksandrowicz K, Miszczuk R, Courteix D, Dutheil F, Januszko-Szakiel A, Brola W. Rehabilitation in Older Adults Affected by Immobility Syndrome, Aided by Virtual Reality Technology: A Narrative Review. J Clin Med 2023; 12:5675. [PMID: 37685741 PMCID: PMC10488935 DOI: 10.3390/jcm12175675] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 08/22/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
Individual mobility deficit in older adults induces a variety of medical conditions, diminishing their functional capacity in pursuing activities of daily living. In immobility syndrome patients, such conditions are prone further deterioration through a drastically reduced scope of physical activity, owing mostly to poor self-motivation and the monotonous character of conventional rehabilitation regimens. As evidenced by published research, virtual reality technology solutions in rehabilitation management actually add significantly to patients' self-motivation, while promoting their active involvement in therapy through visual, auditory, and kinaesthetic stimuli. Effective rehabilitation training aided by virtual reality solutions helps patients acquire specific physical and cognitive skills to be subsequently emulated in the real-world environment. The extra added advantage lies in facilitating such training within patients' own home environments, combined with online monitoring of their progress, when not personally supervised by a physiotherapist, which also boosts the overall cost effectiveness of the therapeutic management itself. This narrative review appears to be the very first one principally focused on critically comparing individual immobilisation with immobility syndrome, especially through the application of the Authors' own substantial hands-on therapeutic experience in managing various rehabilitation schemes, specifically aided by diverse virtual reality technology solutions.
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Affiliation(s)
- Marek Zak
- Institute of Health Sciences, Collegium Medicum, Jan Kochanowski University, Zeromskiego 5, 25-369 Kielce, Poland;
| | - Magdalena Wasik
- Doctoral School, Collegium Medicum, Jan Kochanowski University, Zeromskiego 5, 25-369 Kielce, Poland; (M.W.); (T.S.)
| | - Tomasz Sikorski
- Doctoral School, Collegium Medicum, Jan Kochanowski University, Zeromskiego 5, 25-369 Kielce, Poland; (M.W.); (T.S.)
| | - Krzysztof Aleksandrowicz
- Department of Physiotherapy, Faculty of Health Sciences, Wroclaw Medical University, T. Chałubińskiego 3, 50-368 Wroclaw, Poland;
- Institute of Heart Diseases, University Hospital, Borowska 213, 50-556 Wroclaw, Poland
| | - Renata Miszczuk
- Institute of Pedagogy, Jan Kochanowski University, Zeromskiego 5, 25-369 Kielce, Poland;
| | - Daniel Courteix
- Laboratory of the Metabolic Adaptations to Exercise under Physiological and Pathological Conditions (AME2P), Université Clermont Auvergne, 63000 Clermont-Ferrand, France;
| | - Frederic Dutheil
- Occupational and Environmental Medicine, CHU, 63000 Clermont-Ferrand, France;
- Physiological and Psychosocial Stress, Université Clermont Auvergne, CNRS, LaPSCo, 63000 Clermont-Ferrand, France
| | - Aneta Januszko-Szakiel
- Institute of Information Studies, Faculty of Managment and Social Communication, Jagiellonian University, ul. Lojasiewicza 4, 30-348 Krakow, Poland;
| | - Waldemar Brola
- Institute of Health Sciences, Collegium Medicum, Jan Kochanowski University, Zeromskiego 5, 25-369 Kielce, Poland;
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Zak M, Sikorski T, Krupnik S, Wasik M, Grzanka K, Courteix D, Dutheil F, Brola W. Physiotherapy Programmes Aided by VR Solutions Applied to the Seniors Affected by Functional Capacity Impairment: Randomised Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:6018. [PMID: 35627554 PMCID: PMC9141836 DOI: 10.3390/ijerph19106018] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/11/2022] [Accepted: 05/12/2022] [Indexed: 02/04/2023]
Abstract
Modern technologies are presently harnessed in response to a complex challenge of providing physiotherapeutic management in older adults. Fully immersive virtual reality (VR) solutions are acknowledged to viably enhance the overall effectiveness of traditional physiotherapeutic methods. A total of 60 community-dwelling older adults (over 75 years of age) were recruited for the study protocol. They were subsequently randomly split into four equally sized study groups (VR, CVR, OCULUS, and the classic programme group (OTAGO), and the physiotherapy sessions were pursued in the subjects’ homes for 3 weeks, 3 times a week, for 30 min in each group. At the first measurement point, respective study groups differed significantly in functional performance, as expressed in gait (POMA G) and individual static balance. The post hoc analysis indicated significantly higher scores in POMA G for the classic programme group vs. the results of the VR and CVR groups. On the other hand, the OCULUS group held significantly higher scores in individual balance and TUG, as compared to the other groups (p < 0.001). Making use of a virtual reality (VR) environment in the physiotherapeutic management of community-dwelling older adults appreciably enhanced individual functional performance, especially in terms of static balance. Physiotherapy management aided by VR technology solutions offers a viable alternative to traditional physiotherapeutic regimens (e.g., OTAGO programme) in enhancing individual functional performance. The innovatively self-designed VIRTUAL REALITY COMPREHENSIVE REHABILITATION ROOMS (VRCRR) solution may help out in pursuing a complex physiotherapy programme on an individual basis within one’s own home environment.
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Affiliation(s)
- Marek Zak
- Jan Kochanowski University, Institute of Health Sciences, Collegium Medicum, Zeromskiego 5, 25-369 Kielce, Poland;
| | - Tomasz Sikorski
- Jan Kochanowski University, Doctoral School, Zeromskiego 5, 25-369 Kielce, Poland; (T.S.); (M.W.); (K.G.)
| | - Szymon Krupnik
- Symmetry, Medical Rehabilitation Centre, 41-208 Sosnowiec, Poland;
| | - Magdalena Wasik
- Jan Kochanowski University, Doctoral School, Zeromskiego 5, 25-369 Kielce, Poland; (T.S.); (M.W.); (K.G.)
| | - Katarzyna Grzanka
- Jan Kochanowski University, Doctoral School, Zeromskiego 5, 25-369 Kielce, Poland; (T.S.); (M.W.); (K.G.)
| | - Daniel Courteix
- Université Clermont Auvergne, Laboratory of the Metabolic Adaptations to Exercise under Physiological and Pathological Conditions (AME2P), 63000 Clermont-Ferrand, France;
| | - Frederic Dutheil
- CHU Clermont-Ferrand, Occupational and Environmental Medicine, 63000 Clermont-Ferrand, France;
- Université Clermont Auvergne, CNRS, LaPSCo, Physiological and Psychosocial Stress, 63000 Clermont-Ferrand, France
| | - Waldemar Brola
- Jan Kochanowski University, Institute of Health Sciences, Collegium Medicum, Zeromskiego 5, 25-369 Kielce, Poland;
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Zak M, Sikorski T, Wasik M, Courteix D, Dutheil F, Brola W. Frailty Syndrome-Fall Risk and Rehabilitation Management Aided by Virtual Reality (VR) Technology Solutions: A Narrative Review of the Current Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:2985. [PMID: 35270677 PMCID: PMC8910391 DOI: 10.3390/ijerph19052985] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 02/27/2022] [Accepted: 02/28/2022] [Indexed: 02/06/2023]
Abstract
Frailty, a physiological syndrome (FS) affecting primarily the older adults, manifests itself through significantly depleted bodily reserves, and appreciably higher (up to over threefold) individual exposure to fall risk. Concomitant medical conditions such as balance impairment, reduced visual acuity, limited mobility, and significantly diminished daily functional performance further exacerbate the patients' condition. Their resultant susceptibility to frequent hospitalisations makes their prognosis even worse. This narrative review aimed to provide an overview of published studies focused on rehabilitation management approaches aided by virtual reality (VR) technology in frail older adults. The authors had it also augmented with their own, evidence-based body of experience in rehabilitation. Making use of technologically advanced exercise machinery, specially adapted for rehabilitating frail older adults, combined with a structured exercise regimen, further aided by the application of select virtual reality (VR) technology solutions, clearly proved effective. Consequently, the patients were helped to move back from the frail to the pre-frail stage, as well as had their motor and cognitive functions appreciably enhanced. The application of modern technology in rehabilitating older adults over 65, affected by FS, when specifically aided by the select VR technology solutions, was also proven to complement successfully the conventional rehabilitation management. The overall versatility of the VR technology solutions, e.g., adaptation for home use allowing remote supervision, also makes this novel approach to rehabilitation far more appealing to the patients. They find it both very attractive and far more mentally engaging. Its considerable potential lies mostly in being appreciably more effective in bringing in desirable therapeutic outcomes.
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Affiliation(s)
- Marek Zak
- Institute of Health Sciences, Collegium Medicum, The Jan Kochanowski University of Kielce, Zeromskiego 5, 25-369 Kielce, Poland;
| | - Tomasz Sikorski
- Doctoral School, Collegium Medicum, The Jan Kochanowski University of Kielce, Zeromskiego 5, 25-369 Kielce, Poland; (T.S.); (M.W.)
| | - Magdalena Wasik
- Doctoral School, Collegium Medicum, The Jan Kochanowski University of Kielce, Zeromskiego 5, 25-369 Kielce, Poland; (T.S.); (M.W.)
| | - Daniel Courteix
- Laboratory of the Metabolic Adaptations to Exercise under Physiological and Pathological Conditions (AME2P), Université Clermont Auvergne, 63000 Clermont-Ferrand, France;
| | - Frederic Dutheil
- Occupational and Environmental Medicine, CHU, 63000 Clermont-Ferrand, France;
- CNRS, LaPSCo, Physiological and Psychosocial Stress, Université Clermont Auvergne, 63000 Clermont-Ferrand, France
| | - Waldemar Brola
- Institute of Health Sciences, Collegium Medicum, The Jan Kochanowski University of Kielce, Zeromskiego 5, 25-369 Kielce, Poland;
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Zak M, Sikorski T, Wasik M, Krupnik S, Andrychowski J, Brola W. Pisa syndrome: Pathophysiology, physical rehabilitation and falls risk. NeuroRehabilitation 2021; 49:363-373. [PMID: 34542040 DOI: 10.3233/nre-210167] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND Pisa syndrome (PS) is a postural disorder characterised by lateral flexion of the spine (> 10°), predisposing the affected individuals to falls, and contributing to increased mortality in neurodegenerative diseases. OBJECTIVE An overview of currently applied therapeutic management options, primarily focused on specifically structured rehabilitation exercises, in conjunction with falls-risk assessment in the individuals affected by PS. METHODS A narrative literature review, augmented with the authors' own experience in physical rehabilitation management. RESULTS As individuals affected by PS are evidenced to be intrinsically exposed to higher falls-risk through acquired postural deformities, they often fall victims of traumatic accidents, occasionally also facing relocation into 24-hour nursing facilities due to the injuries sustained/resultant disability, consequently having overall quality of their life appreciably reduced. CONCLUSIONS sA comprehensive approach is postulated in designing optimal therapeutic management, comprised of the exercises controlling postural stability, whilst reducing lower back pain, and the ones also promoting specific skills essential for coping unassisted after an accidental fall effectively. Rehabilitation of individuals affected by PS should be a fully integrated service, eliminating all identified risk factors for falls. As clinical PS symptoms tend to recur after completion of a full course of therapeutic management, all PS patients should continue the pursuit of therapeutic exercises on an individual basis, to effectively retard their recurrence. In view of overall scarcity of clinical studies completed on the large population samples of PS patients, further in-depth research is still required to ensure higher credence to overall efficacy of the presently proposed therapeutic solutions.
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Affiliation(s)
- Marek Zak
- Institute of Health Sciences, Collegium Medicum, Jan Kochanowski University of Kielce, Kielce, Poland
| | - Tomasz Sikorski
- Doctoral School, Collegium Medicum, Jan Kochanowski University of Kielce, Kielce, Poland
| | - Magdalena Wasik
- Doctoral School, Collegium Medicum, Jan Kochanowski University of Kielce, Kielce, Poland
| | - Szymon Krupnik
- Symmetry, Medical Rehabilitation Centre, Sosnowiec, Poland
| | - Jaroslaw Andrychowski
- Institute of Health Sciences, Collegium Medicum, Jan Kochanowski University of Kielce, Kielce, Poland
| | - Waldemar Brola
- Institute of Health Sciences, Collegium Medicum, Jan Kochanowski University of Kielce, Kielce, Poland
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Variability in physical function for patients living with breast cancer during a 12-week exercise program. Support Care Cancer 2021; 30:69-76. [PMID: 34226960 DOI: 10.1007/s00520-021-06394-4] [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: 02/18/2021] [Accepted: 06/23/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To describe the variability during weekly performance on physical function tests during a 12-week individualized exercise program for patients with breast cancer and to test if the expected improvements in physical function surpass the minimally clinically important difference (MCID), after accounting for week-to-week variance. METHODS Twenty-five participants, 19 years and older living with breast cancer within 2 years of their initial diagnosis, were recruited. Some participants were undergoing active treatment, while others completed their treatment. The intervention was an individualized exercise session twice a week, for 1 h each session, for a total of 12 weeks. Main outcomes tested included the 6-min walk test and chair stand test. RESULTS A significant average improvement was observed in the 6MWT (p < .01) and the chair stand test (p < .001) following the intervention. Individual confidence intervals were wide across all testing measures with only 28% and 8% of participants meeting or surpassing the MCID for the 6MWT and chair stand test, respectively. CONCLUSION Despite a significant improvement in physical function during the program, the majority of patients did not reach the MCID, which could be due to large variability resulting from treatment-related side effects or measurement error.
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Sattar S, Haase K, Kuster S, Puts M, Spoelstra S, Bradley C, Wildes TM, Alibhai S. Falls in older adults with cancer: an updated systematic review of prevalence, injurious falls, and impact on cancer treatment. Support Care Cancer 2020; 29:21-33. [PMID: 32671565 DOI: 10.1007/s00520-020-05619-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 07/07/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE This update of our 2016 systematic review answers the following questions: (1) How often do older adults with cancer fall? (2) What are the predictors for falls? (3) What are the rates and predictors of injurious falls? (4) What are the circumstances and outcomes of falls? (5) How do falls in older patients affect subsequent cancer treatment? and a new research question, (6) Which fall reduction interventions are efficacious in this population? METHODS MEDLINE, PubMed, CINAHL, and Embase were searched (September 2015-January 25, 2019). Eligible studies included clinical trials and cohort, case-control, and cross-sectional studies published in English in which the sample (or subgroup) included adults aged ≥ 60, with cancer, in whom falls were examined as an outcome. RESULTS A total of 2521 titles were reviewed, 67 full-text articles were screened for eligibility, and 30 new studies were identified. The majority involved the outpatient setting (n = 19) utilizing cross-sectional method (n = 18). Sample size ranged from 21 to 17,958. Fall rates ranged from 1.52 to 3.41% per 1000 patient days (inpatient setting) and from 39%/24 months to 64%/12 months (outpatient setting). One out of the 6 research questions contributed to a new finding: one study reported that 1 in 20 older patients experienced impact on cancer treatment due to falls. No consistent predictors for falls/fall injuries and no studies on fall reduction interventions in the geriatric oncology setting were identified. CONCLUSION This updated review highlights a new gap in knowledge pertaining to interventions to prevent falls. Additionally, new knowledge also emerged in terms of impact of falls on cancer treatment; however, further research may increase generalizability. Falls and fall-related injuries are common in older adults with cancer and may affect subsequent cancer treatment. Further studies on predictors of falls, subsequent impacts, and fall reduction in the oncology setting are warranted.
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Affiliation(s)
- S Sattar
- College of Nursing, University of Saskatchewan, 4400 4th Avenue, Room 108, Regina, Saskatchewan, S4T 0H8, Canada.
| | - K Haase
- College of Nursing, University of Saskatchewan, Saskatoon, Canada
| | - S Kuster
- Faculty of Kinesiology & Health Studies, University of Regina, Regina, Canada
| | - M Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - S Spoelstra
- Kirkhof College of Nursing, Grand Valley State University, Grand Rapids, MI, USA
| | - C Bradley
- Library, University of Regina, Regina, Canada
| | - T M Wildes
- Division of Medical Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - S Alibhai
- Department of Medicine, Institute of Health Policy, Management, and Evaluations, University of Toronto, Toronto, Canada.,University Health Network, Toronto, Canada
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Bertoli J, de Souza Bezerra E, Dias Reis A, Amice da Costa Barros Ê, Gobbo LA, Forte Freitas Júnior I. Long-Term Side Effects of Breast Cancer on Force Production Parameters. J Strength Cond Res 2020; 36:1450-1458. [DOI: 10.1519/jsc.0000000000003631] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Puszczalowska-Lizis E, Flak K, Biskup M, Zak M. Physical Activity of Women After Radical Unilateral Mastectomy and Its Impact on Overall Quality of Life. Cancer Control 2020; 27:1073274819900407. [PMID: 32003236 PMCID: PMC7003178 DOI: 10.1177/1073274819900407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Radical unilateral mastectomy is an acknowledged source of traumatic experience for women, adversely affecting their behavioral and emotional paradigm. The present study aimed to assess the quality of life in physically active and inactive postmastectomy women. Population sample involved 100 women, aged 50 to 60 years, having undergone radical unilateral mastectomy, allocated into 2 groups, upon assumption of undertaking physical activity. The abbreviated version of WHOQOL-BREF questionnaire was a research tool of choice. The data were analyzed with the aid of χ2 test, Kruskal-Wallis test, and Mann-Whitney U test. Statistically significant dependence was established between physical activity actually pursued and self-assessment of overall quality of life (P = .014) and overall the self-rated perception of health (P < .001). In the group of physically inactive women, physical health was a variable dependent upon individual level of education (P = .031). The highest scores in this domain were noted in the women boasting secondary education, whereas the lowest in the ones with vocational education. Social domain was the highest rated aspect of quality of life in both the physically active and inactive postmastectomy women, while the physical health domain was rated the lowest. Both in the case of physically active and inactive postmastectomy women, the quality of life in the respective domains, as listed in the WHOQOL-BREF questionnaire, was found independent of the living environment.
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Affiliation(s)
| | - Kinga Flak
- Non-Public Physiotherapy Practice, Jaroslaw, Poland
| | - Malgorzata Biskup
- Department of Rehabilitation, Holycross Cancer Centre, Kielce, Poland.,Faculty of Medicine and Health Sciences, Institute of Physiotherapy, The Jan Kochanowski University, Kielce, Poland
| | - Marek Zak
- Faculty of Medicine and Health Sciences, Institute of Physiotherapy, The Jan Kochanowski University, Kielce, Poland
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Huang MH, Hile E, Croarkin E, Wampler-Kuhn M, Blackwood J, Colon G, Pfalzer LA. Academy of Oncologic Physical Therapy EDGE Task Force: A Systematic Review of Measures of Balance in Adult Cancer Survivors. REHABILITATION ONCOLOGY 2019. [DOI: 10.1097/01.reo.0000000000000177] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Madansingh SI, Murphree DH, Kaufman KR, Fortune E. Assessment of gait kinetics in post-menopausal women using tri-axial ankle accelerometers during barefoot walking. Gait Posture 2019; 69:85-90. [PMID: 30682643 PMCID: PMC6579643 DOI: 10.1016/j.gaitpost.2019.01.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 12/04/2018] [Accepted: 01/14/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Physical activity (PA) interventions, designed to increase exposure to ground reaction force (GRF) loading, are a common target for reducing fracture risk in post-menopausal women with low bone mineral density (BMD). Unfortunately, accurate tracking of PA in free-living environments and the ability to translate this activity into evaluations of bone health is currently limited. RESEARCH QUESTION This study evaluates the effectiveness of ankle-worn accelerometers to estimate the vertical GRFs responsible for bone and joint loading in post-menopausal women at a range of self-selected walking speeds during barefoot walking. METHODS Seventy women, at least one year post-menopause, wore Actigraph GT3X + on both ankles and completed walking trials at self-selected speeds (a minimum of five each at fast, normal and slow walking) along a 30 m instrumented walkway with force plates and photocells to measure loading and estimate gait velocity. Repeated measures correlation analysis and step-wise mixed-effects modelling were performed to evaluate significant predictors of peak vertical GRFs normalized to body weight (pVGRFbw), including peak vertical ankle accelerations (pVacc), walking velocity (Velw) and age. RESULTS A strong repeated measures correlation of r = 0.75 (95%CI [0.71-0.76] via 1000 bootstrap passes) between pVacc and pVGRFbw was observed. Five-fold cross-validation of mixed-model predictions yielded an average mean-absolute-error (MAE[95%CI]) and root-mean-square-error (RMSE) rate of 5.98%[5.61-6.42] and 0.076 [0.069-0.082] with a more complex model (including Velw,) and 6.80%[6.37-7.54] and 0.087BW[0.081-0.095] with a simpler model (including only pVacc), when comparing accelerometer-based estimations of pVGRFbw to force plate measures of pVGRFbw. Age was not found to be significant. SIGNIFICANCE This study is the first to show a strong relationship among ankle accelerometry data and high fidelity lower-limb loading approximations in post-menopausal women. The results provide the first steps necessary for estimation of real-world limb and joint loading supporting the goals of accurate PA tracking and improved individualization of clinical interventions.
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Affiliation(s)
- Stefan I. Madansingh
- Assistive and Restorative Technology Laboratory, Rehabilitation Medicine Research Center, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, 55905, USA
| | - Dennis H. Murphree
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, 55905, USA,Division of Biomedical Informatics and Statistics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, 55905, USA
| | - Kenton R. Kaufman
- Motion Analysis Laboratory, Division of Orthopedic Research, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, 55905, USA
| | - Emma Fortune
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, 55905, USA,Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, 55905, USA,Corresponding author at: Department of Health Sciences Research, Kern Center of the Science of Health Care Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA. (E. Fortune)
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Hsieh KL, Wood TA, An R, Trinh L, Sosnoff JJ. Gait and Balance Impairments in Breast Cancer Survivors: A Systematic Review and Meta-analysis of Observational Studies. Arch Rehabil Res Clin Transl 2019; 1:100001. [PMID: 33570512 PMCID: PMC7853379 DOI: 10.1016/j.arrct.2018.12.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Objective To systematically review and quantitatively synthesize gait and balance impairments in breast cancer survivors compared with age-matched controls or normative values for adults who never had breast cancer. Data Sources PubMed, Cumulative Index of Nursing and Allied Health, and Web of Science was searched using terms associated with breast cancer, mobility, and adult until November 2018. Study Selection Studies were included if they were randomized control trials, cross-sectional, prospective, pre-post, or case-control by design, included adult breast cancer survivors, reported gait and/or balance metrics as primary or secondary outcomes, were peer-reviewed publications, and were written in English. The search yielded 2117 results with 29 studies meeting the inclusion criteria. Data Extraction Two reviewers assessed study quality by the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies to determine the strength of evidence for each study that met the inclusion criteria. Basic descriptors of each study, study protocol, and balance and gait measures were extracted. Meta-analysis was performed for the single leg stance, functional reach, center of pressure velocity, gait speed, and timed up and go. Data Synthesis For quality assessment, 3 studies were rated good, 16 fair, and 10 poor. The meta-analysis indicated that there were no significant differences in single leg stance between breast cancer survivors and those who never had breast cancer (P=.33). Pooled values of the functional reach task (22.16cm; 95% CI, 8.98-35.33) and center of pressure velocity (1.2cm/s; 95% CI, 0.87-1.55) suggest balance impairment in breast cancer survivors when compared with normative values. Breast cancer survivors also performed worse than those who never had breast cancer in challenging balance conditions that reduced sensory information or altered base of support. Pooled gait speed at a usual speed (0.91m/s; 95% CI, 0.2-1.6), fast speed across a short distance (1.2m/s; 95% CI, 0.31-2.1), and fast gait speed across a long distance (1.65m/s; 95% CI, 1.64-1.66) suggest gait impairments when compared with normative values. Conclusions Breast cancer survivors may demonstrate gait and balance impairments compared with normative values. Clinicians should consider assessing changes in balance and gait in breast cancer survivors to improve functional independence and prevent fall-related injuries.
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Affiliation(s)
- Katherine L Hsieh
- Department of Kinesiology and Community Health, University of Illinois at Urbana Champaign, Urbana, IL
| | - Tyler A Wood
- Department of Kinesiology and Community Health, University of Illinois at Urbana Champaign, Urbana, IL
| | - Ruopeng An
- Department of Kinesiology and Community Health, University of Illinois at Urbana Champaign, Urbana, IL
| | - Linda Trinh
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Jacob J Sosnoff
- Department of Kinesiology and Community Health, University of Illinois at Urbana Champaign, Urbana, IL
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