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Onuma R, Yamasaki HR, Hoshi F, Tozawa R, Soutome Y, Sakai T, Jinno T. Analysis of the characteristics of anticipatory postural adjustments in older adults using smartphones: Association between cognitive and balance functions. Gait Posture 2024; 112:115-119. [PMID: 38759590 DOI: 10.1016/j.gaitpost.2024.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/10/2024] [Accepted: 05/13/2024] [Indexed: 05/19/2024]
Abstract
OBJECTIVES Using smartphones, we aimed to clarify the characteristics of anticipatory postural adjustments (APA) in older adults and examine the relationship between cognitive and balance functions. METHODS The study participants were 10 young and 13 older adults. An accelerometer built into a smartphone was attached to the lower back (L5) of the participant, and acceleration in the mediolateral direction was measured using a one-leg stance (OLS). As APA features, we analyzed the time to the peak value in the stance direction (peak latency [PL]) and the amount of displacement to the peak value in the stance direction (peak magnitude [PM]). Additionally, the measured PL was divided by PM for each group to obtain the APA ratio (APAr). We investigated the relationship between the APAr and Mini-BESTest subitems. RESULTS Older adults showed delayed PL and decreased PM levels (p < 0.01). While in the Mini-BESTest sub-items, deductions were most common in the order of dual-task and single-leg standing, and most participants with low APAr scores were degraded in APA of sub-items. The correlation was observed between APAr and both TUG and dual-task cost (DTC) (r= -0.56, r= -0.67). According to the receiver operating characteristic curve, the APAr value was 1.71 in the older age group. CONCLUSIONS Older adults showed delayed PL and decreased PM, and APAr was associated with cognitive and locomotor functions. By evaluating the APAr at the initiation of movement, it may be possible to distinguish the APA of the older adluts from the possible to the impossible of OLS movement.
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Affiliation(s)
- Ryo Onuma
- Faculty of Health Science, Mejiro University, 320 Ukiya, Saitama, Saitama 339-850, Japan; Department of Rehabilitation Medicine, Tokyo Medical and Dental University Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan.
| | - Hiroshi R Yamasaki
- Graduate School of Health and Social Services, Saitama Prefectural University, 820 Sannomiya, Koshigaya, Saitama 343-8540, Japan
| | - Fumihiko Hoshi
- Graduate School of Health and Social Services, Saitama Prefectural University, 820 Sannomiya, Koshigaya, Saitama 343-8540, Japan
| | - Ryosuke Tozawa
- Faculty of Health Science, Ryotokuji University, 5-8-1 Akemi, Urayasu, Chiba 279-8567, Japan
| | - Yuki Soutome
- Department of Physical Medicine and Rehabilitation, Geriatric Health Services Facility, Caretown Yuyu, Medical Corporation Meikeikai, 994-1 Nishishinshuku, Hasuda, Saitama 349-0142, Japan
| | - Tomoko Sakai
- Department of Rehabilitation Medicine, Tokyo Medical and Dental University Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Tetsuya Jinno
- Department of Rehabilitation Medicine, Tokyo Medical and Dental University Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; Department of Orthopaedic Surgery, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minamikoshigaya, Koshigaya, Saitama 343-8555, Japan
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Onuma R, Hoshi F, Tozawa R, Soutome Y, Sakai T, Jinno T. Reliability and validity of quantitative evaluation of anticipatory postural adjustments using smartphones. J Phys Ther Sci 2023; 35:553-558. [PMID: 37405178 PMCID: PMC10315206 DOI: 10.1589/jpts.35.553] [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: 03/16/2023] [Accepted: 04/16/2023] [Indexed: 07/06/2023] Open
Abstract
[Purpose] This study aimed to investigate the reliability and validity of the quantitative evaluation of anticipatory postural adjustments using smartphones. [Participants and Methods] The study included 10 young control participants who underwent a one-legged stance with an accelerometer and a smartphone that were simultaneously attached to their lower back (L5). Acceleration was measured as the mediolateral component of the lumbar movement toward the stance side. The peak value of the time (peak latency) and the amount of displacement (peak magnitude) in the stance side direction of the lumbar acceleration were analyzed as anticipatory postural adjustment features. Intra-rater reliability was calculated for both accelerometer and smartphone measurements, while inter-rater reliability was calculated for smartphone measurements by two examiners. Validity was determined for both accelerometer and smartphone measurements. [Results] In this study, the intra-rater reliability of the peak latency and peak magnitude in accelerometer and smartphone measurements was confirmed, as was the inter-rater reliability in smartphone measurements. The intra-rater reliability was confirmed through re-testing, while the validity of the accelerometer and smartphone measurements was also confirmed. [Conclusion] The findings of this study suggest that the use of smartphones to measure anticipatory postural adjustments is highly reliable and valid, making it a useful clinical balance index. The method is simple and can be used for continuous patient monitoring.
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Affiliation(s)
- Ryo Onuma
- Faculty of Health Science, Mejiro University: 320 Ukiya,
Saitama-shi, Saitama 339-850, Japan
- Department of Rehabilitation Medicine, Tokyo Medical and
Dental University Graduate School, Japan
| | - Fumihiko Hoshi
- Graduate School of Health and Social Services, Saitama
Prefectural University, Japan
| | | | - Yuki Soutome
- Department of Physical Medicine and Rehabilitation,
Geriatric Health Services Facility, Caretown Yuyu, Medical Corporation Meikeikai,
Japan
| | - Tomoko Sakai
- Department of Rehabilitation Medicine, Tokyo Medical and
Dental University Graduate School, Japan
| | - Tetsuya Jinno
- Department of Rehabilitation Medicine, Tokyo Medical and
Dental University Graduate School, Japan
- Department of Orthopaedic Surgery, Dokkyo Medical
University Saitama Medical Center, Japan
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Wang I, Li PC, Lee SC, Lee YC, Wang CH, Hsieh CL. Development of a Berg Balance Scale Short-Form Using a Machine Learning Approach in Patients With Stroke. J Neurol Phys Ther 2023; 47:44-51. [PMID: 36047823 DOI: 10.1097/npt.0000000000000417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND PURPOSE The Berg Balance Scale (BBS) is frequently used in routine clinical care and research settings and has good psychometric properties. This study was conducted to develop a short form of the BBS using a machine learning approach (BBS-ML). METHODS Data of 408 individuals poststroke were extracted from a published database. The initial (ie, 4-, 5-, 6-, 7-, and 8-item) versions were constructed by selecting top-ranked items based on the feature selection algorithm in the artificial neural network model. The final version of the BBS-ML was chosen by selecting the short form that used a smaller number of items to achieve a higher predictive power R2 , a lower 95% limit of agreement (LoA), and an adequate possible scoring point (PSP). An independent sample of 226 persons with stroke was used for external validation. RESULTS The R2 values for the initial 4-, 5-, 6-, 7-, and 8-item short forms were 0.93, 0.95, 0.97, 0.97, and 0.97, respectively. The 95% LoAs were 14.2, 12.2, 9.7, 9.6, and 8.9, respectively. The PSPs were 25, 35, 34, 35, and 36, respectively. The 6-item version was selected as the final BBS-ML. Preliminary external validation supported its performance in an independent sample of persons with stroke ( R2 = 0.99, LoA = 10.6, PSP = 37). DISCUSSION AND CONCLUSIONS The BBS-ML seems to be a promising short-form alternative to improve administrative efficiency. Future research is needed to examine the psychometric properties and clinical usage of the 6-item BBS-ML in various settings and samples.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A402 ).
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Affiliation(s)
- Inga Wang
- Department of Rehabilitation Sciences & Technology (I.W.), University of Wisconsin-Milwaukee, Milwaukee, Wisconsin; School of Occupational Therapy (P.-C.L., S.-C.L., C.-L.H.), College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Occupational Therapy (S.-C.L.), College of Medicine, National Cheng Kung University, Tainan City, Taiwan; Department of Occupational Therapy (Y.-C.L., C.-L.H.), College of Medical and Health Science, Asia University, Taichung, Taiwan; Institute of Long-Term Care (S.-C.L.), MacKay Medical College, New Taipei City, Taiwan; Department of Physical Therapy (C.-H.W.) and Physical Therapy Room (C.-H.W.), Chung Shan Medical University Hospital, Taichung, Taiwan; and Department of Physical Medicine and Rehabilitation (C.-L.H.), National Taiwan University Hospital, Taipei, Taiwan
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Bruyneel AV, Dubé F. Best Quantitative Tools for Assessing Static and Dynamic Standing Balance after Stroke: A Systematic Review. Physiother Can 2021; 73:329-340. [PMID: 34880537 DOI: 10.3138/ptc-2020-0005] [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: 11/20/2022]
Abstract
Purpose: Our objective was to examine the psychometric qualities (reliability and validity) and clinical utility of quantitative tools in measuring the static and dynamic standing balance of individuals after stroke. Method: We searched four databases (PubMed/MEDLINE, PEDro, Embase, and CINAHL) for studies published from January 2018 through September 2019 and included those that assessed the psychometric properties of standing balance tests with an adult stroke population. We evaluated the quality of the studies using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist and assessed each test on a utility assessment scale. Results: A total of 22 studies met the inclusion criteria, and 18 quantitative tools for assessing static or dynamic standing balance of individuals with stroke were analyzed. Findings support good or excellent reliability for all tests, whereas correlations for validity ranged from weak to strong. Study quality was variable. Dynamic balance tests had better clinical utility scores than static ones. Five tests had complete psychometric analyses: quiet standing on a force platform, five-step test, sideways step, step length, and turn tests.
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Affiliation(s)
- Anne-Violette Bruyneel
- Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts, Delémont, Western Switzerland, Switzerland
| | - François Dubé
- School of Rehabilitation, Université de Montréal, Montreal, Quebec, Canada.,Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Ȋle-de-Montréal, Montreal, Quebec, Canada
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Chauvin S, Kirkwood R, Brooks D, Goldstein RS, Beauchamp MK. Which Balance Subcomponents Distinguish Between Fallers and Non-Fallers in People with COPD? Int J Chron Obstruct Pulmon Dis 2020; 15:1557-1564. [PMID: 32669841 PMCID: PMC7335868 DOI: 10.2147/copd.s253561] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 06/12/2020] [Indexed: 11/30/2022] Open
Abstract
Rationale Chronic obstructive pulmonary disease (COPD) is an increasingly prevalent lung disease linked to dysfunctional balance and an increased risk of falls. The Balance Evaluation Systems Test (BESTest) evaluates the six underlying subcomponents of functional balance. The aim of this study was to determine the specific balance subcomponents and cut-off scores that discriminate between fallers and non-fallers with COPD to guide fall risk assessment and prevention. Methods A secondary analysis of cross-sectional data from two prior studies in COPD was performed. Independent samples t-tests were used to explore the differences in the BESTest sub-system scores between fallers and non-fallers. Receiver operating characteristic curves were used to determine the optimal subcomponent cut-off scores that identified fallers, and the area under the curve (AUC) was used to assess test accuracy. Results Data from 72 subjects with COPD (mean age, 70.3 ± 7.4y; mean forced expiratory volume in 1 second, 38.9 ± 15.8% predicted) were analyzed. Two BESTest subcomponents, stability limits/verticality (fallers: 75.4%, non-fallers: 83.8%; p=0.002) and postural responses (fallers: 67.5%, non-fallers: 79.7%; p=0.008) distinguished between fallers and non-fallers. Stability limits/verticality had an AUC of 0.70 and optimal cut-off score of 73.8% for identifying fallers; postural responses had an AUC of 0.67 and optimal cut-off score of 69.4%. Conclusion The stability limits/verticality and postural responses subcomponents of the BESTest distinguished between fallers and non-fallers with COPD. The stability limits/verticality subcomponent can also be used to identify whether an individual with COPD is at risk of falling using a cut-off score of 73.8%. These findings suggest that specific subcomponents of balance could be targeted to optimize fall risk assessment and prevention in COPD.
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Affiliation(s)
- Stephanie Chauvin
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Renata Kirkwood
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Dina Brooks
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada.,Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada
| | - Roger S Goldstein
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Marla K Beauchamp
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada.,Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada.,Firestone Institute for Respiratory Health, St. Joseph's Healthcare, Hamilton, Ontario, Canada
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Laratta JL, Glassman SD, Atanda AA, Dimar JR, Gum JL, Crawford CH, Bratcher K, Carreon LY. The Berg balance scale for assessing dynamic stability and balance in the adult spinal deformity (ASD) population. JOURNAL OF SPINE SURGERY 2019; 5:451-456. [PMID: 32042995 DOI: 10.21037/jss.2019.09.15] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Adult spinal deformity (ASD) is a prevalent condition in individuals over the age of 65; leading to impaired standing balance and abnormal gait patterns. This functional impairment may be due to the fixed sagittal or coronal malalignment; associated spinal stenosis or deconditioning. The Berg balance scale (BBS) was developed to measure balance by assessing the performance of functional tasks. The purpose of this study is to determine if BBS is a useful metric for evaluating functional status in ASD patients. Methods ASD patients who required fusion from the thoracic spine to the pelvis from 2014 to 2016 were enrolled and asked to complete the BBS prior to and six months after surgery. BBS were obtained by a certified physical therapist. Standard demographic; radiographic and surgical data were collected. The Oswestry disability index (ODI), EuroQOL-5D and numeric rating scales (0 to 10) for back and leg pain were assessed at baseline and post-intervention. Results Of 21 patients enrolled; 19 completed pre- and post-surgery BBS. The mean age was 59.8±13.3 years with 14 females. There was a statistically significant improvement in all outcome scores and radiographic parameters after surgery; but no difference in BBS. Only one patient had a BBS score low enough to be considered a medium fall risk. There was no difference in the pre-op BBS scores in the four patients that had revision surgery compared to those that did not. Conclusions In this small pilot study; BBS did not appear to be associated with measures of clinical and radiographic improvement in ASD patients. The test was also potentially problematic in that it has a ceiling effect and required significant time with a trained physical therapist for administration. Continued effort to identify a viable measure of balance dysfunction in ASD patients is warranted.
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Affiliation(s)
- Joseph L Laratta
- Norton Leatherman Spine Center, Louisville, KY, USA.,Department of Orthopaedic Surgery, University of Louisville School of Medicine, Louisville, KY, USA
| | - Steven D Glassman
- Norton Leatherman Spine Center, Louisville, KY, USA.,Department of Orthopaedic Surgery, University of Louisville School of Medicine, Louisville, KY, USA
| | | | - John R Dimar
- Norton Leatherman Spine Center, Louisville, KY, USA.,Department of Orthopaedic Surgery, University of Louisville School of Medicine, Louisville, KY, USA
| | - Jeffrey L Gum
- Norton Leatherman Spine Center, Louisville, KY, USA.,Department of Orthopaedic Surgery, University of Louisville School of Medicine, Louisville, KY, USA
| | - Charles H Crawford
- Norton Leatherman Spine Center, Louisville, KY, USA.,Department of Orthopaedic Surgery, University of Louisville School of Medicine, Louisville, KY, USA
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Miyata K, Hasegawa S, Iwamoto H, Otani T, Kaizu Y, Shinohara T, Usuda S. Structural validity of Balance Evaluation Systems Test assessed using factor and Rasch analyses in patients with stroke. J Phys Ther Sci 2018; 30:1446-1454. [PMID: 30568332 PMCID: PMC6279694 DOI: 10.1589/jpts.30.1446] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 09/12/2018] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The Balance Evaluation Systems Test (BESTest) is a comprehensive assessment
tool, although it is not confined for use in stroke patients. This study aimed to
determine the structural validity of the BESTest in self-ambulatory patients with stroke
using both factor and Rasch analyses. [Participants and Methods] This retrospective study
included 140 self-ambulatory patients with stroke. The structural validity of the BESTest
was analyzed according to principal component, exploratory factor, Rasch, confirmatory
factor, and correlation analyses. [Results] The analytical results supported a four-factor
model comprising 25 items. The four factors included dynamic postural control with gait,
static postural control, stepping reaction, and stability limits in sitting. Evidence of
high structural validity and reliable internal consistency suggested that the 25-item
BESTest is valid and reliable. Each factor was significantly correlated with lower
extremity motor function and walking ability. [Conclusion] Eleven items in the BESTest
were poorly correlated, and the remaining 25 items were grouped into four factors that
demonstrated good structural validity for patients with stroke. Further studies should
validate the applicability of the 25-item BESTest four-factor model in a larger sample of
patients with stroke in a clinical setting.
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Affiliation(s)
- Kazuhiro Miyata
- Department of Physical Therapy, Ibaraki Prefectural University of Health Science: 4669-2, Ami-Machi, Inashiki-gun, Ibaraki, 300-0394 Japan.,Gunma University Graduate School of Health Sciences, Japan
| | - Satoshi Hasegawa
- Gunma University Graduate School of Health Sciences, Japan.,Public Nanokaichi Hospital, Japan
| | | | | | | | | | - Shigeru Usuda
- Gunma University Graduate School of Health Sciences, Japan
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