The Korean version of relative and absolute reliability of gait and balance assessment tools for patients with dementia in day care center and nursing home

Concurrent Validity of Dual-Task Walking Speed With CERAD-NP Assessment Battery in Community-Dwelling Older Adults

Objective

To explore the concurrent validity of the dual-task walking speed assessments in older adults using the Consortium to Establish a Registry for Alzheimer's Disease Neuro-Psychological (CERAD-NP) Assessment Battery.

Design

Cross-sectional design.

Setting

Welfare care centers, Senior complex centers, and Dementia prevention care centers.

Participants

A total of 163 community-dwelling older adults (N=163) were recruited using consecutive sampling. Participants were composed of 65 older adults with cognitive decline and 98 without cognitive decline.

Interventions

Not applicable.

Main Outcome Measures

This study assessed the concurrent validity between dual-task walking speed assessments and the Total II score of CERAD-NP using Spearman's rank order correlations. The effect of the dual-task walking speed assessments on the Total II score was further investigated through multiple linear regression analysis.

Results

There was a moderate and statically significant association between the Total II score and all 8 dual-task walking speed assessments (P<.05). The Total II score was strongly associated with the dual tasks of walking on a straight path while counting backward and crossing over an obstacle (r=0.698, r=0.697, respectively; P<.05). According to multiple linear regression, only the dual task of walking while counting backward was significantly associated with the Total II score (P<.05).

Conclusion

The dual-task walking speed assessments, which involved walking and performing a secondary task such as counting backward or crossing an obstacle on a straight path, were highly indicative of cognitive decline. The combination of results from both tasks may provide a more comprehensive evaluation of cognitive decline compared with relying solely on a single-task assessment.

The effectiveness of mental imagery on motor, cognitive and emotional status of older people with early-stage dementia: A study protocol

Dementia involves the loss of cognitive abilities and represents a decline from the prior level of function which impairs functional abilities in day-to-day life. No previous experimental research has been done to assess mental imagery (MI) effectiveness in the motor, cognitive and emotional status of individuals with early-stage dementia. One hundred and forty older individuals with early-stage dementia from the Day Care Centre of the Alzheimer Association in Athens will take part in this study. The sample will be randomly divided into three groups: MI and physical exercise (intervention group), only physical exercise (1^st control group), and neither MI nor physical exercise (2^nd control group). Assessment will be obtained one week prior to the program, in the middle of the program (6^th week of the intervention program) and after the end of the program (13^th week of the intervention program). Participants of the intervention group will perform a 30-minute MI programme after the end of every physiotherapy session. Reliable and valid instruments will be used to assess the primary outcomes, i.e., balance and functional status as well as the secondary outcomes i.e., cognitive ability, emotional state and quality of life. The two-way Mixed ANOVA with factors 'intervention' (between groups) and 'time' (within group) will be used as a statistical analysis. Approvals of clinical trial protocol: a) UNIWA Research Committee study protocol approval: 93292 - 26/10/2021. b) ClinicalTrials.gov: ID NCT05232526.

Reproducibility of Assessment Tests Addressing Body Structure and Function and Activity in Older Adults With Dementia: A Systematic Review

OBJECTIVE

The purpose of this study was to analyze the relative and absolute reliability of assessment tests addressing body structure and function and activity in older adults with dementia.

METHODS

Medline, Embase, Web of Science, The Cochrane Library, and Scielo were searched from inception until March 2021. Two independent reviewers performed the selection process based on titles, abstracts, and full text. Reliability studies of assessment tests in older adults with dementia were included. Methodological quality of the studies was evaluated using the COnsensus-based Standards for the selection of health Measurement INstruments Risk of Bias checklist. Relative reliability was analyzed using the intraclass correlation coefficient (ICC) interpreted based on Munro classification. Absolute reliability was analyzed using the minimal detectable change (MDC) and standard error of measurement.

RESULTS

Fifteen studies involving a total of 560 older adults with dementia were included. Nineteen assessment tests were identified: 13 addressing body structure and function (muscle strength, postural balance, cardiorespiratory fitness) and 6 addressing activity (walking and mobility). Studies determined test-retest and interrater reliability. Fifteen studies evaluated relative reliability using the ICC, with values ranging from no or small correlation to very high correlations. Ten studies evaluated absolute reliability using the MDC or standard error of measurement or both.

CONCLUSION

Relative reliability of the assessment tests for body structure and function and activity was high to very high based on ICCs, demonstrating good reproducibility. Regarding absolute reliability, the analysis of the MDC values revealed the need for substantial change to determine that a real change had occurred. Future investigations should consider the type of dementia and standardization of verbal encouragement during the assessment.

IMPACT

This review identified the good reproducibility of assessment tests of body structure and function (muscle strength, postural balance, cardiorespiratory fitness) and activity (walking and mobility) domains in older adults with dementia. Clinically important values may differ when older adults with dementia of diverse etiologies are analyzed together and older adults specifically with Alzheimer disease. Identifying the type of dementia, analyzing types of dementia separately, and standardizing verbal commands during the execution of tests is of considerable clinical importance for this population of older adults.

Minimum Detectable Change of Visual Acuity Measurements Using ETDRS Charts (Early Treatment Diabetic Retinopathy Study)

In our work, we determined the value of visual acuity (VA) with ETDRS charts (Early Treatment Diabetic Retinopathy Study). The purpose of the study was to determine the measurement reliabilities, calculating the correlation coefficient interclass (ICC), the value of the error associated with the measure (SEM), and the minimal detectable change (MDC). Forty healthy subjects took part. The mean age was 23.5 ± 3.1 (19 to 26) years. Visual acuities were measured with ETDRS charts (96% ETDRS chart nº 2140) and (10% SLOAN Contrast Eye Test chart nº 2153). The measurements were made (at 4 m) under four conditions: Firstly, photopic conditions with high contrast (HC) and low contrast (LC) and after 15 min of visual rest, mesopic conditions with high and low contrast. Under photopic conditions and high contrast, the ICC = 0.866 and decreased to 0.580 when the luminosity and contrast decreased. The % MDC in the four conditions was always less than 10%. It was minor under photopic conditions and HC (5.83) and maximum in mesopic conditions and LC (9.70). Our results conclude a high reliability of the ETDRS test, which is higher in photopic and high contrast conditions and lower when the luminosity and contrast decreases.

Recommended motor assessments based on psychometric properties in individuals with dementia: a systematic review

BACKGROUND

Motor assessments are important to determine effectiveness of physical activity in individuals with dementia (IWD). However, inappropriate and non-standardised assessments without sound psychometric properties have been used. This systematic review aims to examine psychometric properties of motor assessments in IWD combined with frequency of use and effect sizes and to provide recommendations based on observed findings.We performed a two-stage systematic literature search using Pubmed, Web of Science, Cochrane Library, ALOIS, and Scopus (inception - July/September 2018, English and German). The first search purposed to identify motor assessments used in randomised controlled trials assessing effectiveness of physical activity in IWD and to display their frequency of use and effect sizes. The second search focused on psychometric properties considering influence of severity and aetiology of dementia and cueing on test-retest reliability. Two reviewers independently extracted and analysed findings of eligible studies in a narrative synthesis.

RESULTS

Literature searches identified 46 randomised controlled trials and 21 psychometric property studies. While insufficient information was available for validity, we observed sufficient inter-rater and relative test-retest reliability but unacceptable absolute test-retest reliability for most assessments. Combining these findings with frequency of use and effect sizes, we recommend Functional Reach Test, Groningen Meander Walking Test (time), Berg Balance Scale, Performance Oriented Mobility Assessment, Timed Up & Go Test, instrumented gait analysis (spatiotemporal parameters), Sit-to-Stand assessments (repetitions> 1), and 6-min walk test. It is important to consider that severity and aetiology of dementia and cueing influenced test-retest reliability of some assessments.

CONCLUSION

This review establishes an important foundation for future investigations. Sufficient relative reliability supports the conclusiveness of recommended assessments at group level, while unacceptable absolute reliability advices caution in assessing intra-individual changes. Moreover, influences on test-retest reliability suggest tailoring assessments and instructions to IWD and applying cueing only where it is inevitable. Considering heterogeneity of included studies and insufficient examination in various areas, these recommendations are not comprehensive. Further research, especially on validity and influences on test-retest reliability, as well as standardisation and development of tailored assessments for IWD is crucial.This systematic review was registered in PROSPERO (CRD42018105399).

Relationship between knee extension strength and gait styles in patients with dementia

This study aimed to investigate the relationship between knee extension strength and gait performance with walking aids and the threshold level of strength to predict gait performance with walking aids in patients with dementia using ordinal logistic modeling.This cross-sectional, observational correlation study was conducted in 56 hospital inpatients with dementia. Knee extensor strength was measured using a hand-held dynamometer. Gait performance was assessed by determining the walking aid that enables the subject to walk 10 m independently as well as without a walking aid.Ordinal logistic modeling showed that the strength of the knee extensor muscles was a significant gait predictor with walking aids (P = .028). Knee extension strength of 0.17, 0.43, and 0.57 N m/kg could reach 80% independence probability for gait with walker, with cane, and without walking aid, respectively.Knee extension strength was significantly related to gait performance with walking aid in people with dementia. Moreover, there are threshold levels of strength that could predict gait with particular walking aid in people with dementia. With regard to resistance training and prescription of walking aids, the probability of independence evaluated from ordinal logistic modeling contributes to efficient rehabilitation intervention.