Association ankle function and balance in community-dwelling older adults

Effectiveness of a web-based foot-ankle exercise program for treating ulcer risk factors in diabetic neuropathy in a randomized controlled trial

The need for strategies to prevent complications from diabetic neuropathy (DPN) is well recognized. However, foot-ankle exercise programs show weak to moderate evidence, and barriers to their implementation persist, including broad and facilitated access to exercise programs, which guarantee for equity. In this paper, we report for the first time the effectiveness of a web-based foot-ankle exercise program aiming to improve DPN-related outcomes, gait biomechanics and functional outcomes. Sixty-two participants with DPN were randomly allocated into the control group (CG; n = 31), which received the usual care, or the intervention group (IG; n = 31), which received the usual care plus a 12-week foot-ankle exercise program using a web-based software (the SOPeD software). The primary outcomes, DPN symptoms and severity, were assessed using the Brazilian version of the Michigan Neuropathy Screening Instrument and the Decision Support System for Classification of Diabetic Polyneuropathy, respectively. Secondary outcomes included tactile sensitivity (monofilaments) and vibration perception (tuning fork), functional outcomes, such as foot pain and function (Foot Health Status Questionnaire), foot muscle strength and plantar pressure during gait (emed plate), and foot-ankle kinematics and kinetics during gait. Outcomes were assessed at baseline, 12 and 24 weeks by an assessor blinded to group allocation. DPN symptoms and severity remained unchanged after the web-based foot-ankle program. However, IG showed improvements compared to CG, with greater functional reach at 12 weeks, better foot function, reduced foot pain and greater plantarflexion degree during push-off at 24 weeks. Regarding plantar loading during gait, the forefoot pressure reduced in the IG at 12 weeks compared to baseline, but at 24 weeks, forefoot load increased in the IG compared to CG. The 12-week web-based foot-ankle exercise program was feasible, acceptable, demonstrating safety with minimal adverse events, such as delayed onset muscle soreness and foot muscle cramping. While DPN-related outcomes were unaffected by the 12-week SOPeD program, modest improvements in foot pain and function, functional reach, and changes in plantar pressure and plantarflexion degree during gait were noted, mostly at 24 weeks.Trial registration: ClinicalTrials.gov, NCT04011267. Registered on 8 July 2019.

Muscle characteristics of lower limb in association with physical activity in candidates of total knee arthroplasty with knee osteoarthritis

BACKGROUND & AIMS

This study aimed to clarify the association between physical activity (PA) and physical functions, including both muscle quantity and quality of ankle plantar flexor muscles in patients with knee osteoarthritis (OA).

METHODS

A retrospective cohort study was conducted with ninety-two patients with knee OA. PA, leg muscle cross-sectional area (CSA), knee strength, passive knee angle, and knee pain of the affected side were assessed. PA was assessed by the 2011 Knee Society scoring system. CSA of the quadriceps and ankle plantar flexor muscles on the affected side was measured using a computed tomography image. Based on muscle attenuation assessed with Hounsfield units (HU), the muscle quality of targeted muscle was divided into 4 groups as follows: fat tissue (-190 to -30 HU), very low-density muscle (-29 to -1 HU), low-density muscle (0 to 34 HU), and normal-density muscle (NDM, 35 to 100 HU). The CSA was obtained for each of the 4 groups. Univariate and multivariate linear regression analyses were performed to determine the factors associated with PA.

RESULTS

The regression analysis revealed that higher PA was independently associated with the NDM CSA of ankle plantar flexor (β = 0.51), higher knee extension strength (β = 0.28), and milder knee pain (β = -0.29) after adjustment with age, sex, height, weight, and body mass index.

CONCLUSION

The present study suggested that NDM CSA of ankle plantar flexor in addition to knee function is one of the factors determining the PA in patients with knee OA.

Implicit motor imagery: examining motor vs. visual strategies in laterality judgments among older adults

Cognitive states like motor imagery (MI; simulating actions without overtly executing them) share a close correspondence with action execution, and hence, activate the motor system in a similar way. However, as people age, reduction in specific cognitive abilities like motor action simulation and action planning/prediction are commonly experienced. The present study examined the effect of visual-spatial processing for both typical and challenging upper-limb movements using the Hand Laterality Judgment Task (HLJT), in which participants were asked to judge whether the depicted hand is a left or right hand. Several main findings emerged: (1) Compared to younger adults, older adults exhibited slower responses and greater error rates in both Experiment 1 and 2. This suggests that visual-spatial transformations undergo alterations with age; (2) Older adults displayed higher error rates with realistic hands at both back and palm viewpoints of the hands compared to younger adults. However, this pattern did not hold for response times; (3) Participants responded faster to medial hand orientations (i.e., closer to the midline of the body) compared to lateral hand orientations (i.e., farther from the midline of the body) for palm-views in both Experiment 1 and Experiment 2. Given that we observed better performance on medial orientations compared to lateral orientations, this suggests that participants follow the same motor rules and biomechanical constraints of the represented movement. Novel information is provided about differences in individuals' use of strategies (visual vs. motor imagery) to solve the HLJT for both mannequin and real hands.

Prevalence and Associated Factors with Frailty Using the Kihon Checklist among Community-Dwelling Older Adults in Taiwan

Background and Objectives: Frailty in older adults is associated with adverse health outcomes. This study aimed to analyze the frailty status of community-dwelling older adults in Taiwan using the Kihon Checklist (KCL) and explore associations with demographic, physiological, and functional factors. Materials and Methods: In this cross-sectional study, 278 community-dwelling older adults were classified as robust, prefrail, or frail based on their KCL scores. Participants underwent physical fitness assessments including muscle strength and endurance tests, walking speed tests, and flexibility tests. One-way ANOVA and logistic regression analyses were used to examine differences and associations between frailty status and physical fitness indicators. Results: 36% of participants were robust, 47.1% prefrail, and 16.9% frail. The robust group significantly outperformed the prefrail and frail groups in the 30 s sit-to-stand test, 2.44 m sit-to-walk test, and walking speed (p < 0.001). The 2.44 m sit-to-walk test was a significant predictor of prefrailty (OR = 1.18, 95% CI = 1.02-1.36) after adjusting for other physical fitness indicators. Conclusions: Lower limb functional capacity, particularly in the 2.44 m sit-to-walk test, was significantly associated with pre-frailty among community-dwelling older adults in Taiwan. Early screening, the classification of frailty by the Kihon Checklist, and targeted interventions focusing on lower limb strength, endurance, and mobility are crucial for preventing and delaying frailty progression in older populations.

Age-Related Dysfunction in Balance: A Comprehensive Review of Causes, Consequences, and Interventions

This review delves into the multifaceted aspects of age-related balance changes, highlighting their prevalence, underlying causes, and the impact they have on the elderly population. Central to this discussion is the exploration of various physiological changes that occur with aging, such as alterations in the vestibular, visual, proprioceptive systems, and musculoskeletal degeneration. We examine the role of neurological disorders, cognitive decline, and medication side effects in exacerbating balance issues. The review underscores the significance of early detection and effective intervention strategies in mitigating the risks associated with balance problems, such as falls and reduced mobility. It discusses the effectiveness of diverse intervention strategies, including exercise programs, rehabilitation techniques, and technological advancements like virtual reality, wearable devices, and telemedicine. Additionally, the review stresses the importance of a holistic approach in managing balance disorders, encompassing medication review, addressing comorbidities, and environmental modifications. The paper also presents future research directions, emphasizing the need for a deeper understanding of the complex mechanisms underlying balance changes with aging and the potential of emerging technologies and interdisciplinary approaches in enhancing assessment and intervention methods. This comprehensive review aims to provide valuable insights for healthcare providers, researchers, and policymakers in developing targeted strategies to improve the quality of life and ensure the well-being of the aging population.

Measures of attributes of locomotor capacity in older people: a systematic literature review following the COSMIN methodology

BACKGROUND

Locomotor capacity (LC) is an important domain of intrinsic capacity and key determinant of functional ability and well-being in older age. The United Nations Decade of Healthy Ageing (2021-2030) calls for strengthening data and research on healthy ageing, including the measurement of older persons' LC. To advance the measurement and monitoring of LC, there is pressing need to identify valid and reliable measures.

OBJECTIVE

To identify all the available tools that were validated for measurement of LC or of its specific attributes in older people and to assess the methodological quality of the studies and measurement properties of the tools.

DESIGN

Systematic review.

SETTING

Anywhere (Community-dwelling; long-term care facility; etc.).

SUBJECTS

Older people.

METHODS

We used highly sensitive search strategies to search the following databases: Medline, Embase, Scopus, CINAHL and PsycINFO. The study was conducted following the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) methodology for systematic review of outcome measurement instruments.

RESULTS

A total of 125 studies were included, which assessed tools for balance (n = 84), muscle power (n = 12), muscle strength (n = 32, including four studies about tools for balance and muscle power) and endurance (n = 1). No studies on tools for muscle function, joint function, or locomotor capacity overall, were retrieved. We identified 69 clinician-report or objective assessment tools for balance, 30 for muscle strength, 12 for muscle power and 1 endurance assessment tool. The GRADE assessment of quality of evidence showed that only a few tools have high quality evidence for both sufficient validity and reliability: The Balance Evaluation Systems Test (BESTest), the Mini-Balance Evaluation Systems Test (Mini-BESTest), the Berg Balance Scale (BBS) and the Timed Up and Go (TUG) test.

CONCLUSIONS

A few tools with high quality evidence for sufficient validity and reliability are currently available for balance assessment in older people that may be recommended for use in clinical and research settings. Further validation studies are required for muscle strength, muscle power and endurance assessment tools.

Using a Standing Heel-Rise Test as a Predictor of Ankle Muscle Strength in the Elderly

The senior population is at increased risk of falling due to a reduction in ankle muscle strength. Evaluating the strength of the ankle muscles in older adults is of paramount importance. The purpose of this study was to formulate an equation to estimate ankle muscle strength by utilizing the basic physical characteristics of the subject and the variables related to their ability to perform the standing heel-rise test (SHRT). One hundred and thirty-two healthy elderly participants (mean age 67.30 ± 7.60) completed the SHRT and provided demographic information. Ankle plantar flexor (PF) muscle strength was evaluated using a push-pull dynamometer. Multiple regression analysis was utilized to develop a prediction equation for ankle PF muscle strength. The study revealed that the ankle PF strength equation was derived from variables including the power index of the SHRT, gender, age, calf circumference, and single-leg standing balance test. The equation exhibited a strong correlation (r = 0.816) and had a predictive power of 65.3%. The equation is represented as follows: ankle PF strength = 24.31 - 0.20(A) + 8.14(G) + 0.49(CC) + 0.07(SSEO) + 0.20(BW/t-SHRT). The equation had an estimation error of 5.51 kg. The strength of ankle PFs in elderly individuals can be estimated by considering demographic variables, including gender, age, calf circumference, single-leg standing balance test, and the power index of the SHRT. These factors were identified as significant determinants of ankle PF strength in this population.

Factors that cause women with osteoporosis to fall

Objective

To analyze and compare intrinsic and extrinsic factors that cause falls among women receiving treatment for osteoporosis.

Subjects and methods

A cross-sectional study of women ≥50 years receiving treatment for osteoporosis. Participants filled out questionnaires (demographic characteristics), and researchers took anthropometric measurements of bone mineral density, handgrip strength (HGS), ankle range of motion (ROM), and gait speed (GS). We also evaluated the Timed Up and Go Test (TUGT), Five Times Sit-to-Stand Test (SST), and Falls Efficacy Scale-International (FES-I) and investigated the extrinsic factors for falls.

Results

We included 144 participants (71.6 [8.3 years]), who reported 133 falls. We classified participants into a non-faller group (NFG; 0 falls, n=71, 49.5%), a faller group (FG; 1 fall, n=42, 28.9%), and a recurrent-faller group (RFG; more than 1 fall, n=31, 21.5%). Most patients had an increased risk of falling according to the TUGT, SST, reduced ankle ROM, and GS (P<.005 for all). FES-I was associated with sporadic and recurrent falls. For the multivariate analysis, the number of falls was influenced by the presence of ramps (RR 0.48, 95% CI, 0.26-0.87, P=.015), uneven surfaces (RR 1.6, 95% CI. 1.05-2.43, P=.028), and antislippery adhesive on stairs (RR 2.75, 95% CI, 1.77-4.28, P<.001).

Conclusion

Patients receiving treatment for osteoporosis are influenced by intrinsic and extrinsic factors that cause falls. Lower-limb strength and power-discriminated participants at a higher risk of falls, but extrinsic factors varied. Only uneven floors and antislippery adhesives on stairs were associated with increased frequency of falls.

The Efficacy of Virtual Reality Training in the Rehabilitation of Orthopedic Ankle Injuries: A Systematic Review and Meta-analysis

Introduction

Orthopedic ankle injuries are considered among the most common musculoskeletal injuries. A wide variety of modalities and techniques have been used for the management of these injuries, and virtual reality (VR) is one modality that has been examined in ankle injuries rehabilitation.

Purpose

This study aims to systemically review previous studies evaluating the effect of virtual reality in rehabilitating orthopedic ankle injuries.

Methods

We searched six online databases: PubMed, Web of Science (WOS), Scopus, the Physiotherapy Evidence Database (PEDro), Virtual Health Library (VHL), and Cochrane Central Register of Controlled Trials (CENTRAL).

Results

Ten randomized clinical trials met the inclusion criteria. Our results showed that VR had a significant effect on overall balance compared to conventional physiotherapy (SMD = 0.359, 0.009-0.710 P = 0.04), [I 2= 17%, P = 0.30]. Compared with conventional physiotherapy, VR programs significantly improved gait parameters such as speed and cadence, muscle power, and perceived ankle instability; however, no significant difference was detected in the foot and ankle ability measure (FAAM). Additionally, significant improvements in static balance and perceived ankle instability were reported after the use of VR balance and strengthening programs. Finally, only two articles were deemed to have good quality, and the other studies' quality ranged from poor to fair.

Conclusion

VR rehabilitation programs can be used to rehabilitate ankle injuries, as they are regarded as safe interventions and have promising effects. However, there is a need for studies with high quality since most included studies' quality varied from poor to fair.

Longitudinal and Cross-Sectional Association Between Gait Speed, Ankle Proprioception, and LE Numbness—Results From the Baltimore Longitudinal Study of Aging

Mobility declines in older adults can be determined through monitoring longitudinal changes in gait speed. We examined longitudinal changes [in] ankle proprioception among those with and without baseline lower extremity numbness to develop a better understanding of mobility declines in healthy older adults. Participants included 568 adults (52.8% women) aged 60–98 years from the Baltimore Longitudinal Study of Aging. Larger ankle proprioception decreases during plantar flexion were found in the participants with lower extremity numbness compared with those without numbness (p = .034). Among participants with lower extremity numbness, slower baseline speeds from both usual and fast pace gait were associated with performance decline in ankle proprioception measured during ankle dorsiflexion (p = .039 and p = .004, respectively). Assisting older adults, especially those with lower extremity numbness, to maintain and improve ankle proprioception may help prevent mobility declines that have previously been considered age related.

Ankle Proprioception Deficit Is the Strongest Factor Predicting Balance Impairment in Patients With Chronic Stroke

OBJECTIVE

To determine the main factor that predicts balance impairment in patients with chronic stroke.

DESIGN

Cross-sectional study.

SETTING

Inpatient rehabilitation hospital and research laboratory.

PARTICIPANTS

A total of 57 patients (42 men, 15 women; mean age 55.7±12.2 years) with chronic symptoms after stroke.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Primary outcomes were ankle functions, including strength, range of motion, and proprioception, and balance, including Berg Balance Scale score and Timed Up and Go test values. Secondary outcomes included gait kinematics, Fugl-Meyer Scale score, and Fall Efficacy Scale score.

RESULTS

According to the cutoff score <46 on the Berg Balance Scale and the Timed Up and Go test ≥13.5 seconds, 21 patients were classified as having a balance impairment (36.8%). Multivariable logistic regressions showed that ankle proprioception (odds ratio = 3.49; 95% confidence interval, 1.17-10.42) was a significant predictor when coupled with step length (odds ratio = 0.00; 95% confidence interval, 0.00-0.22). A cutoff score of 2.59 for the ankle proprioception value predicts balance impairment in patients with stroke (area under the curve 0.784).

CONCLUSION

Ankle proprioception can be used to predict balance impairment in patients with stroke.