Test-retest reliability and minimal detectable change scores for the timed "up & go" test, the six-minute walk test, and gait speed in people with Alzheimer disease

Configuration variability of the six-minute walk test among licensed physical therapists working with neurologic conditions: a pilot survey

BACKGROUND

The six-minute walk test (6MWT) is considered reliable and valid for assessing walking capacity in people with neurologic conditions. However, the consistency in the test length and configuration used is unclear.

PURPOSE

To determine how the 6MWT was configured by licensed physical therapists working with patients with neurologic conditions in clinical practice, identify their knowledge of the American Thoracic Society (ATS) and Academy of Neurologic Physical Therapy (ANPT) guidelines for the 6MWT and assess relationships between therapist demographic characteristics and knowledge of the 6MWT guidelines.

METHODS

One hundred forty-six therapists completed a survey related to the configuration they used for the 6MWT.

RESULTS

Configuration of the 6MWT varied widely. Space limitation was the most frequently selected reason for reported configurations. Over half had available the standardized 100-feet straight walkway but fewer than one-third used this configuration of the ATS guidelines. Fewer than half knew of the ATS guidelines and nearly three-fourths knew of the ANPT guidelines. American Physical Therapy Association membership and having a higher percentage of neurologic patients were associated with knowledge of both guidelines.

CONCLUSION

The 6MWT must be completed within the constraints of the working environment, and this requirement is clinically relevant when comparing patient results to normative values and measurements across clinics. Our results suggest a need for updated norms that are more congruent with space constraints in current practice settings.

Improvement in gait velocity variability after cerebrospinal fluid elimination and its relationship to clinical symptoms in patients with idiopathic normal pressure hydrocephalus

AIM

This study aimed to investigate the improvement in gait velocity variability after cerebrospinal fluid (CSF) elimination, and the association between gait velocity variability and gait and cognitive impairment in patients with idiopathic normal pressure hydrocephalus.

METHODS

The gait velocity of 44 patients with idiopathic normal pressure hydrocephalus was measured using the Timed Up and Go Test (TUG) for a total of 10 times over 3 days each before and after CSF elimination. The coefficient of variation (CV) in the time required for the sequence of actions in TUG (TUG-CV) was calculated using 10 TUG data, and used for measuring intraindividual gait velocity variability. Gait quality was evaluated with the Gait Status Scale Revised (GSSR), and cognitive function was evaluated with the Mini-Mental State Examination and the Frontal Assessment Battery.

RESULTS

The TUG, TUG-CV, GSSR and Frontal Assessment Battery results improved significantly after CSF elimination. The analyses using pre-CSF elimination results showed that the TUG-CV significantly and positively correlated with the TUG and GSSR results, and negatively with Mini-Mental State Examination results, but not with age and the Frontal Assessment Battery results. The stepwise multiple regression analysis indicates that the TUG, GSSR and Mini-Mental State Examination results were significant predictors of the TUG-CV. The analysis using data of change after CSF elimination showed that ΔTUG and ΔGSSR were significant predictors of ΔTUG-CV.

CONCLUSIONS

Gait velocity variability improved after CSF elimination, and gait velocity variability was associated with gait disturbances and cognitive impairment in patients with idiopathic normal pressure hydrocephalus. Geriatr Gerontol Int 2024; ••: ••-••.

Short-Term Benefits from Manual Therapy as an Adjunct Treatment for Persistent Postural-Perceptual Dizziness Symptoms: A Preliminary Prospective Case Series

Persistent dizziness and balance deficits are common, often with unknown etiology. Persistent Postural-Perceptual Dizziness (3PD) is a relatively new diagnosis with symptoms that may include dizziness, unsteadiness, or non-vertiginous dizziness and be persistent the majority of time over a minimum of 90 days. The purpose of this case series was to investigate short-term outcomes of reducing dizziness symptoms using a manual therapy intervention focused on restoring mobility in the fascia using a pragmatically applied biomechanical approach, the Fascial Manipulation® method (FM®), in patients with 3PD. The preliminary prospective case series consisted of twelve (n = 12) patients with persistent complaints of dizziness who received systematic application of manual therapy to improve fascial mobility after previously receiving vestibular rehabilitation. The manual therapy consisted of strategic assessment and palpation based on the model proposed in the FM® Stecco Method. This model utilizes tangential oscillations directed toward the deep fascia at strategic points. Six males (n = 6) and females (n = 6) were included with a mean age of 68.3 ± 19.3 years. The average number of interventions was 4.5 ± 0.5. Nonparametric paired sample t-tests were performed. Significant improvements were observed toward the resolution of symptoms and improved outcomes. The metrics included the Dizziness Handicap Inventory and static and dynamic balance measures. The Dizziness Handicap Inventory scores decreased (i.e., improved) by 43.6 points (z = -3.1 and p = 0.002). The timed up and go scores decreased (i.e., improved) by 3.2 s (z = -2.8 and p = 0.005). The tandem left increased (i.e., improved) by 8.7 s (z = 2.8 and p = 0.005) and the tandem right increased (i.e., improved) by 7.5 s (z = 2.8 and p = 0.005). Four to five manual therapy treatment sessions appear to be effective for short-term improvements in dizziness complaints and balance in those with 3PD. These results should be interpreted with caution as future research using rigorous methods and a control group must be conducted.

Assessing the Effect of Data Quality on Distance Estimation in Smartphone-Based Outdoor 6MWT

As a result of technological advancements, functional capacity assessments, such as the 6-minute walk test, can be performed remotely, at home and in the community. Current studies, however, tend to overlook the crucial aspect of data quality, often limiting their focus to idealised scenarios. Challenging conditions may arise when performing a test given the risk of collecting poor-quality GNSS signal, which can undermine the reliability of the results. This work shows the impact of applying filtering rules to avoid noisy samples in common algorithms that compute the walked distance from positioning data. Then, based on signal features, we assess the reliability of the distance estimation using logistic regression from the following two perspectives: error-based analysis, which relates to the estimated distance error, and user-based analysis, which distinguishes conventional from unconventional tests based on users' previous annotations. We highlight the impact of features associated with walked path irregularity and direction changes to establish data quality. We evaluate features within a binary classification task and reach an F1-score of 0.93 and an area under the curve of 0.97 for the user-based classification. Identifying unreliable tests is helpful to clinicians, who receive the recorded test results accompanied by quality assessments, and to patients, who can be given the opportunity to repeat tests classified as not following the instructions.

Development and Validation of the Facial Line Distress Scale for Lateral Canthal Lines: FINE-LCL

Background: Currently available patient-reported outcome measures (PROM) have limited ability to assess unique issues related to lateral canthal lines (LCL). This study aimed to develop a PROM to assess the severity and psychosocial impact of LCL in afflicted patients. Methods: We conducted a cross-sectional survey at a tertiary hospital and two local clinics in Korea. Exploratory factor analysis was conducted to identify the underlying factor structure of the Facial Line Distress Scale for LCL (FINE-LCL), and the internal consistency and test-retest reliability were also examined. Results: We developed a questionnaire comprising 20 items in four domains. Coefficient alphas ranged from 0.94 to 0.97 for subdomains and 0.97 for the total questionnaire. The test-retest intraclass correlation coefficient ranged from 0.77 to 0.90. The FINE-LCL was moderately correlated with the appearance appraisal score and body image. Analysis of the accuracy of the FINE-LCL score in predicting severe LCL was characterized by an area under the curve of 0.79. Conclusions: FINE-LCL is a reliable, valid, and comprehensive PROM for the assessment of the severity of LCL and their associated distress.

C-Mill Virtual Reality/Augmented Reality Treadmill Training for Reducing Risk of Fall in the Elderly: A Randomized Controlled Trial

Objective: Falling is considered one of the major problems that may affect the elderly, leading to multiple health issues. Walking adaptability to environmental demands is essential for safe walking in the elderly. The aim of this study was to evaluate the efficacy of virtual reality (VR)/augmented reality (AR) treadmill training on balance performance and the risk of falls in the elderly. Materials and Methods: Sixty Saudi elderly individuals of both genders, aged between 60 and 70 years, participated in the study. The participants were categorized into two groups: the experimental and the control groups. Both groups received 1 hour of training: 30 minutes of conventional exercises and 30 minutes of gait training on the C-Mill VR/AR treadmill. The experimental group used the C-Mill treadmill with VR and AR games therapy. The control group had gait training on the C-Mill treadmill without VR and AR. The training for both groups was conducted for 6 successive weeks/three times a week. The changes in the scores of the following variables were recorded at baseline, after 6 weeks of training, and 4 weeks after the completion of training. These variables involved the time needed for completing the Timed Up and Go (TUG) test, overall stability indices of the Fall Risk (FR) test and Limit of Stability (LOS) test evaluated using the Biodex Balance System (BBS), and the time required for completing the LOS test. Results: Both groups demonstrated significant improvement in all measured variables immediately post-training, and this improvement persisted for 4 weeks after completing the training. The experimental group exhibited greater improvement in the recorded values of all measured variables compared with the control group following the training. Conclusions: This study concluded that C-Mill VR/AR treadmill training is effective in improving balance control and reducing the fall risk in the elderly.

Test-retest reliability and concurrent validity assessment of a novel high-frequency sensor device for anterior tibial translation measurement in loaded and unloaded condition: an exploratory cross-sectional study

BACKGROUND

Magnetic resonance imaging (MRI) and manual tests remain the standard for diagnosing anterior cruciate ligament (ACL) rupture. Furthermore, the passive knee displacement, also described as anterior tibial translation (ATT), is used in order to make decisions about surgery or to assess rehabilitation outcomes. Unfortunately, these manual tests are limited to passive situations, and their application to assess knee stability in loaded, weight-bearing positions are missing. Therefore, a new device with high-performance sensors and a new sensor setting was developed. The aim of this exploratory cross-sectional study was to assess the test-retest reliability of this new device in a first step and the concurrent validity in a second step.

METHODS

A total of 20 healthy volunteers were measured. Measurement consistency of the new device was assessed on the basis of reliability during Lachman test setting and in loaded position by artificial knee perturbation in a test-retest procedure. In a second step, the concurrent validity was evaluated with the Lachmeter® as a reference instrument. Intraclass correlation coefficient (ICC), standard error of measurement (SEM), the minimal detectable change (MDC) and Bland-Altman analysis were evaluated to assess the quality criteria.

RESULTS

The measurements with the new device during the Lachman test provided a mean ATT of 5.46±2.22mm. The SEM ranged from 0.60 to 0.69mm resulting in an MDC between 1.67 and 1.93mm for the new device. In the loaded test situation, the mean ATT was 2.11±1.20mm, with test-retest reliability also showing good correlation (r>0.83). The comparison of the two measurement methods with an ICC of (r>0.89) showed good correlation, which also underlines the reasonable agreement of the Bland-Altman analysis.

CONCLUSIONS

The evaluation of the test-retest reliability of the new device during the knee stability testing in passive situation as well as in a functional, loaded situation presented good reliability. In addition, the new device demonstrated good agreement with the reference device and therefore good validity. Furthermore, the quality criteria demonstrated the ability of the new device to detect the cut-off value (3-5mm) described in the literature for the diagnosis of ACL-deficient knees, which underlines the clinical relevance of this new device as a reliable and valid tool.

Validity and reliability of a ruler drop test to measure dual-task reaction time, choice reaction time and discrimination reaction time

BACKGROUND

The aim of this study was to determine the absolute and relative reliability of the Ruler Drop Test (RDT) for assessing dual-task, choice, and discrimination reaction time. In addition, the construct validity of the RDT is examined in comparison to the Deary-Liewald reaction time (DLRT).

METHODS

Tests were administered by the same evaluator, one week apart. Intraclass Correlation Coefficient (ICC3.1) was used to measure relative reliability, and the standard error of measurement (SEM) and minimal detectable change (MDC95) were used to measure absolute reliability. Spearman correlation test was used to measure construct validity.

RESULTS

The results showed that the relative reliability was good for the choice ruler drop (ICC = 0.81), moderate for the dual-task ruler drop test (ICC = 0.70) and discrimination ruler drop test (ICC = 0.72), and good for simple ruler drop test. However, the simple ruler drop test had poor reliability (ICC = 0.57). The RDT shows construct validity compared to the DLRT.

CONCLUSION

We conclude that the RDT is a suitable instrument for measuring dual-task, choice and discrimination reaction time. Future studies should explore the reliability of these measures in other populations.

Psychometric validation of the Functional Assessment of Cancer Therapy-Endometrial among endometrial cancer patients

OBJECTIVE

To evaluate a psychometric validation of the endometrial cancer subscales (EnCS) in the Functional Assessment of Cancer Therapy-Endometrial (FACT-EN) among patients with endometrial cancer.

METHODS

This cross-sectional study was conducted at a tertiary university-based hospital in South Korea between April and October 2022. Participants completed a survey questionnaire that included the FACT-EN. Exploratory and confirmatory factor analyses (EFA, CFA) and the reliability were measured using the intraclass correlation coefficient (ICC) under a two-way mixed model. Pearson's correlations were used to evaluate the validity. We also tested known-group validity.

RESULTS

In total, 240 patients with endometrial cancer participated in the survey. In EFA, we found EnCS included four domains. In CFA, four-factor solution model was good: CFI = 0.659; SRMR = 0.066, and RMSEA = 0.073. The mean (SD) of total score of FACT-EN was 122.84 (23.58). The floor and ceiling effects were 0.4% and 0.4%, respectively. Cronbach's α coefficients for the five scales of the EnCS ranged from 0.78 to 0.91. The ICC of EnCS was 0.76. The convergent and discriminant validity of EnCS was acceptable. In the group analysis, older age and lower ECOG performance scores were associated with higher EnCS scores. The stomach and vaginal domains in EnCS were higher in patients who had completed treatment for more than 1 year compared to those who were still undergoing treatment.

CONCLUSIONS

FACT-EN has demonstrated its validity as an assessment tool with significant implications for capturing various symptoms in patients with endometrial cancer.

Test-Retest Reliability of Isokinetic Strength in Lower Limbs under Single and Dual Task Conditions in Women with Fibromyalgia

Background: Previous research has established good test-retest reliability for isokinetic dynamometry in fibromyalgia. However, the reliability of this test under dual-task conditions has not been investigated in fibromyalgia. Methods: A total of 10 women with fibromyalgia participated in this study. Participants completed the concentric/concentric test. The dual-task condition involved subtracting two by two while performing the test. Results: Reliability analysis under the single condition showed "poor" to "excellent" values for maximum peak torque in knee extension and "moderate" to "excellent" values for average. "Poor" to "excellent" reliability values were found in knee flexion for the maximum and average. Dual-task condition in knee extension ranged from "moderate" to "excellent" for maximum and average values, and in knee flexion, it ranged from "poor" to "excellent" for maximum value and from "moderate" to "excellent" for average value. Conclusions: Isokinetic dynamometry demonstrated sufficient reliability for measuring strength in knee extension maximum and average during single-task and dual-task conditions, along with knee flexion dual-task average in fibromyalgia. For knee flexion single-task maximum and average and knee flexion dual-task maximum, we did not obtain sufficiently reliable measurements. Only the concentric/concentric test has been studied, and future studies with a larger sample size are needed in order to generalize the results.

Development and Validation of Facial Line Distress Scale for Forehead Lines: FINE-FL

BACKGROUND

Forehead lines (FL) are one of the main signs of aging. Traditional tools to measure FL have limited ability to evaluate the multidimensional impact of these lines on appearance, confidence, and psychological and social relationships.

OBJECTIVES

We developed and validated the Facial Line Distress Scale-Forehead Lines (FINE-FL) to evaluate the severity and psychosocial distress associated with FL.

METHODS

We conducted a cross-sectional survey for FINE-FL psychometric validation at a tertiary hospital and 2 local clinics in Korea. First, a preliminary item pool for the FINE-FL was developed through a qualitative interview based on literature reviews and expert consultations. Second, cognitive interviews and a pilot test were conducted to evaluate comprehension, ease of response, acceptability of terminology, phrasing, and response options. FINE-FL consisted of 26 items. In this study, exploratory factor analysis was conducted to identify the underlying factor structure of the FINE-FL, and internal consistency and test-retest reliability were also examined.

RESULTS

We found 21 items in 4 domains. The model fit was good. Coefficient αs ranged from 0.89 to 0.95 for subdomains and 0.96 for the total. The FINE-FL was moderately correlated with the appearance appraisal score. On the test-retest, the range of the intraclass correlation coefficient was 0.65 to 0.79.

CONCLUSIONS

FINE-FL is a reliable, valid, and comprehensive patient-reported outcome measure for assessing FL severity and distress. This will be helpful in determining a patient's eligibility for inclusion in a study and measuring primary or secondary effectiveness endpoints for forehead line treatment.

Development and validation of the Japanese version of the Bedtime Procrastination Scale (BPS-J)

BACKGROUND

The average sleep duration of Japanese people is shorter than that of people from other countries, and bedtime procrastination is suspected to be one of the factors contributing to this issue. This study aimed to develop and validate the Japanese version of the Bedtime Procrastination Scale (BPS-J).

METHODS

The BPS-J was developed through procedures including the translation and back-translation of the scale, cognitive interviews with 100 participants who reported having experiences of being diagnosed with insufficient sleep syndrome (ISS) or receiving treatment for ISS using open-ended online questionnaires, and expert checking. To investigate the scale's validity and reliability, an online survey was conducted with daytime workers aged 20 - 65 years without a history of sleep disorders other than ISS. Half the participants were retested using the same survey after 14 days. Participants' responses to the Brief Self-Control Scale (BSCS), General Procrastination Scale (GPS), and Munich ChronoType Questionnaire (MCTQ), and data on sleep-related variables such as sleep duration on workdays and the days per week of fatigue or sleep loss, sex, and age, were collected.

RESULTS

We analyzed data from 574 participants to assess scale validity. We then analyzed data from 280 participants to determine test-retest reliability. Confirmatory factor analyses revealed that the two-factor model without Item 2 was most suitable for the BPS-J, unlike other language versions. Regardless of the full-item model or the model with Item 2 eliminated, sufficient reliability and significant correlations with the BSCS, GPS, MCTQ, and sleep-related variables such as sleep duration per night on work days, days per week of feeling fatigued, and days per week of sleep loss were observed. Logistic and linear regressions showed that the relationships between the BPS-J, sleep-related variables, and MCTQ were maintained after adjusting for sex and age.

CONCLUSION

The BPS-J had sufficient validity and reliability. Further, eliminating Item 2 from the original version of the BPS strengthened the ability to survey Japanese daytime workers.

Minimal Detectable Change for the ImPACT Subtests at Baseline

OBJECTIVE

To establish the minimal detectable change (MDC) of the subtests that comprise the composite scores from remotely administered Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) baselines.

METHOD

Remote ImPACT baseline data from 172 (male = 45, female = 127) National Collegiate Athletic Association Division I student-athletes from the 2020 and 2021 athletic preseasons were used to calculate the MDC at the 95%, 90%, and 80% confidence intervals (CIs) for all subtest scores used to generate the four core composite scores and the impulse control composite.

RESULTS

The MDCs for the verbal memory subtests at the 95% CI were 10.31 for word memory percent correct, 4.68 for symbol match total correct hidden, and 18.25 for three letters percentage correct. Visual memory subtest MDCs were 19.03 for design memory total percent correct and 4.90 for XO total correct memory. Visual motor speed subtest MDCs were 18.89 for XO total correct interference and 5.40 for three letters average counted correctly. Reaction time (RT) MDCs were 0.12 for XO average correct, 0.95 for symbol match average correct RT, and 0.28 for color match average correct. Impulse control MDCs were 5.97 for XO total incorrect and 1.15 for color match total commissions. One-way repeated measures MANOVA, repeated measures ANOVAs, and Wilcoxon signed-ranks test all suggested no significant difference between any subtests across two remote ImPACT baselines.

CONCLUSIONS

The ImPACT subtest scores did not significantly change between athletic seasons. Our study suggests the subtests be evaluated in conjunction with the composite scores to provide additional metrics for clinical interpretation.

Characterization of Walking in Mild Parkinson's Disease: Reliability, Validity and Discriminant Ability of the Six-Minute Walk Test Instrumented with a Single Inertial Sensor

Although the 6-Minute Walk Test (6MWT) is among the recommended clinical tools to assess gait impairments in individuals with Parkinson's disease (PD), its standard clinical outcome consists only of the distance walked in 6 min. Integrating a single Inertial Measurement Unit (IMU) could provide additional quantitative and objective information about gait quality complementing standard clinical outcome. This study aims to evaluate the test-retest reliability, validity and discriminant ability of gait parameters obtained by a single IMU during the 6MWT in subjects with mild PD. Twenty-two people with mild PD and ten healthy persons performed the 6MWT wearing an IMU placed on the lower trunk. Features belonging to rhythm and pace, variability, regularity, jerkiness, intensity, dynamic instability and symmetry domains were computed. Test-retest reliability was evaluated through the Intraclass Correlation Coefficient (ICC), while concurrent validity was determined by Spearman's coefficient. Mann-Whitney U test and the Area Under the receiver operating characteristic Curve (AUC) were then applied to assess the discriminant ability of reliable and valid parameters. Results showed an overall high reliability (ICC ≥ 0.75) and multiple significant correlations with clinical scales in all domains. Several features exhibited significant alterations compared to healthy controls. Our findings suggested that the 6MWT instrumented with a single IMU can provide reliable and valid information about gait features in individuals with PD. This offers objective details about gait quality and the possibility of being integrated into clinical evaluations to better define walking rehabilitation strategies in a quick and easy way.

Determinants and reference values of the 6-min walk distance in the general population-results of the population-based STAAB cohort study

AIMS

The 6-min walk test is an inexpensive, safe, and easy tool to assess functional capacity in patients with cardiopulmonary diseases including heart failure (HF). There is a lack of reference values, which are a prerequisite for the interpretation of test results in patients. Furthermore, determinants independent of the respective disease need to be considered when interpreting the 6-min walk distance (6MWD).

METHODS

The prospective Characteristics and Course of Heart Failure Stages A-B and Determinants of Progression (STAAB) cohort study investigates a representative sample of residents of the City of Würzburg, Germany, aged 30 to 79 years, without a history of HF. Participants underwent detailed clinical and echocardiographic phenotyping as well as a standardized assessment of the 6MWD using a 15-m hallway.

RESULTS

In a sample of 2762 participants (51% women, mean age 58 ± 11 years), we identified age and height, but not sex, as determinants of the 6MWD. While a worse metabolic profile showed a negative association with the 6MWD, a better systolic and diastolic function showed a positive association with 6MWD. From a subgroup of 681 individuals without any cardiovascular risk factors (60% women, mean age 52 ± 10 years), we computed age- and height-specific reference percentiles.

CONCLUSION

In a representative sample of the general population free from HF, we identified determinants of the 6MWD implying objective physical fitness associated with metabolic health as well as with cardiac structure and function. Furthermore, we derived reference percentiles applicable when using a 15-m hallway.

Adapted Home-Based Exercises in Dementia: An Exploratory Pre-post Pilot and Feasibility Study

The goals of this exploratory pre-post pilot and feasibility study (NCT04916964) were to assess the feasibility and effectiveness of an adapted Test-and-Exercise home-based exercise program on basic functional mobility and executive functions in persons with prodromal or mild Alzheimer's disease. Participants followed an 8 week exercise program at home, once per week with a physiotherapist and twice per week with their usual caregiver or independently. Functional mobility and executive functions were assessed before and after the intervention. Feasibility criteria were recruitment opportunity, participation agreement rate, cost adequacy, and drop-out rate. Twelve participants aged 80.83 ± 4.65 years took part in the study. All the basic functional mobility measures showed small effect sizes. Concerning executive functions, 5 measures showed small to moderate effect sizes. The 4 feasibility criteria were met. A larger scale study would, however, need adaptations and prior research on the ability of this population to use touch-screen technology.

Higher baseline resting metabolic rate is associated with 1-year frailty decline among older adults residing in an urban area

BACKGROUND

Dysregulated energy metabolism is one hypothesized mechanism underlying frailty. Resting energy expenditure, as reflected by resting metabolic rate (RMR), makes up the largest component of total energy expenditure. Prior work relating RMR to frailty has largely been done in cross section with mixed results. We investigated whether and how RMR related to 1-year frailty change while adjusting for body composition.

METHODS

N = 116 urban, predominantly African-American older adults were recruited between 2011 and 2019. One-year frailty phenotype (0-5) was regressed on baseline RMR, frailty phenotype, demographics and body composition (DEXA) in an ordinal logistic regression model. Multimorbidity (Charlson comorbidity scale, polypharmacy) and cognitive function (Montreal Cognitive Assessment) were separately added to the model to assess for change to the RMR-frailty relationship. The model was then stratified by baseline frailty status (non-frail, pre-frail) to explore differential RMR effects across frailty.

RESULTS

Higher baseline RMR was associated with worse 1-year frailty (odds ratio = 1.006 for each kcal/day, p = 0.001) independent of baseline frailty, demographics, and body composition. Lower fat-free mass (odds ratio = 0.88 per kg mass, p = 0.008) was independently associated with worse 1-year frailty scores. Neither multimorbidity nor cognitive function altered these relationships. The associations between worse 1-year frailty and higher baseline RMR (odds ratio = 1.009, p < 0.001) and lower baseline fat-free mass (odds ratio = 0.81, p = 0.006) were strongest among those who were pre-frail at baseline.

DISCUSSION

We are among the first to relate RMR to 1-year change in frailty scores. Those with higher baseline RMR and lower fat-free mass had worse 1-year frailty scores, but these relationships were strongest among adults who were pre-frail at baseline. These relationships were not explained by chronic disease or impaired cognition. These results provide new evidence suggesting higher resting energy expenditure is associated with accelerate frailty decline.

Cross-Cultural Adaptation and Psychometric Validation of the Hindi Version of the Neck Disability Index in Patients With Chronic Neck Pain

STUDY DESIGN

Translation and psychometric testing.

OBJECTIVES

To cross-culturally adapt the Neck Disability Index (NDI) into the Hindi language, the local language of India, and to investigate the psychometric properties of the Neck Disability Index-Hindi (NDI-H) version in patients with neck pain.

SUMMARY OF BACKGROUND DATA

The NDI is the most used self-reported outcome measure for neck pain. The previous NDI-H version did not obtain advance permission from Mapi trust to translate this scale. As a result, this scale's availability is limited.

MATERIALS AND METHODS

Following established guidelines, the NDI was translated and culturally adapted into Hindi. A total of 120 chronic neck pain patients (20 for cognitive interviews and 100 for psychometric testing) participated in this study. The content validity, construct validity, internal consistency, test-retest reliability, and responsiveness of the NDI-H were all evaluated. The intraclass correlation coefficient was computed to determine test-retest reliability. Internal consistency was assessed using Cronbach α. The NDI's factor structure was investigated using principal component factor analysis. The Neck Pain and Disability Scale, Numeric Pain Rating Scale, and Anxiety and Depression scales were used to test criterion validity. The receiver operating characteristic curve analysis was used to determine the cut-off point and the area under the curve.

RESULTS

The NDI-H demonstrated good test-retest reliability (intraclass correlation coefficient = 0.92) and excellent internal consistency (Cronbach α = 0.90). The one-factor structure was revealed by the factor analysis. The NDI has a strong relationship with the Neck Pain and Disability Scale and Numeric Pain Rating Scale, as well as the Anxiety and Depression scales. The cut-point for detecting a change was 9.3.

CONCLUSIONS

The NDI was successfully translated into Hindi in this study. The NDI-H is a reliable and valid and responsive instrument that can be used to treat patients with chronic neck pain in clinical and research settings.

Validity and reliability of self-reported and neural measures of listening effort

Listening effort can be defined as a measure of cognitive resources used by listeners to perform a listening task. Various methods have been proposed to measure this effort, yet their reliability remains unestablished, a crucial step before their application in research or clinical settings. This study encompassed 32 participants undertaking speech-in-noise tasks across two sessions, approximately a week apart. They listened to sentences and word lists at varying signal-to-noise ratios (SNRs) (-9, -6, -3 and 0 dB), then retaining them for roughly 3 s. We evaluated the test-retest reliability of self-reported effort ratings, theta (4-7 Hz) and alpha (8-13 Hz) oscillatory power, suggested previously as neural markers of listening effort. Additionally, we examined the reliability of correct word percentages. Both relative and absolute reliability were assessed using intraclass correlation coefficients (ICC) and Bland-Altman analysis. We also computed the standard error of measurement (SEM) and smallest detectable change (SDC). Our findings indicated heightened frontal midline theta power for word lists compared to sentences during the retention phase under high SNRs (0 dB, -3 dB), likely indicating a greater memory load for word lists. We observed SNR's impact on alpha power in the right central region during the listening phase and frontal theta power during the retention phase in sentences. Overall, the reliability analysis demonstrated satisfactory between-session variability for correct words and effort ratings. However, neural measures (frontal midline theta power and right central alpha power) displayed substantial variability, even though group-level outcomes appeared consistent across sessions.

EFFECTS OF REHABILITATION PROGRAM FOCUSED ON IMPROVING REAL-LIFE DAILY ACTIVITIES OF PATIENTS WITH MILD COGNITIVE IMPAIRMENTS OR DEMENTIA AND THEIR CAREGIVERS

Objective

To evaluate the effectiveness of a dyadic outpatient rehabilitation program focused on improving the real-life daily activities of patients with mild cognitive impairments or dementia and their caregivers.

Design

Retrospective study.

Subjects

Eight patients with mild cognitive impairments or dementia and their caregivers.

Methods

The rehabilitation program comprised eight 1-hour sessions by occupational therapists with patients and his/her caregivers. Patients were assessed for motor function, cognitive function, and quality of life, and their caregivers were assessed for depression and caregiver burden. Participants were assessed at pre-program and post-program, and 3-month follow-up.

Results

The scores of caregiver-assessed Quality of life in Alzheimer's disease scale in patients significantly improved at post-program (median [interquartile range], 30.0 [7.0]) compared with pre-program (27.0 [2.8], effect size = 0.77, p = 0.029). In caregivers, the Zarit Caregiver Burden Interview scores decreased significantly at post-program (16.5 [13.0]) compared with pre-program (22.0 [17.5], effect size = 0.72, p = 0.042). There were no significant differences in other assessments.

Conclusions

The rehabilitation program focused on real daily activities and demonstrated to improve patients' quality of life and caregivers' depression and caring burden through patient-caregiver interaction. Future enhanced follow-up systems are warranted.

Investigation of the relationship between trunk control and balance, gait, functional mobility, and fear of falling in people with Alzheimer's disease

INTRODUCTION

Optimal trunk control relies on adequate musculoskeletal, motor, and somatosensory systems that are often affected in people with Alzheimer's disease (AD). Therefore, the aim of this study was to compare trunk control between people with AD and healthy older adults, and investigate the relationship between trunk control and balance, gait, functional mobility, and fear of falling in people with AD.

METHODS

The study was completed with 35 people with AD and 33 healthy older adults with matching age and gender. Trunk control was evaluated with Trunk Impairment Scale (TIS); balance with Berg Balance Scale (BBS), Functional Reach Test (FRT), One-Leg Standing Test (OLST) and Five-Repeat Sit-and-Stand Test (5STS); gait with Dynamic Gait Index (DGI); functional mobility with Timed Up and Go (TUG) Test; fear of falling with Falls Efficacy Scale-International (FES-I).

RESULTS

BBS, FRT, OLST, and DGI scores were lower and 5STS and TUG Test scores were higher in people with AD compared to healthy older adults (p < 0.05). There was no difference in FES-I score between people with AD and healthy older adults (p > 0.05). TIS was associated with BBS, FRT, OLST, 5STS, DGI, TUG Test, and FES-I (r between - 0.341 and 0.738; p < 0.05 for all).

CONCLUSION

Trunk control is affected and related with balance, gait, functional mobility, and fear of falling in people with AD. For this reason, we think that trunk control should be evaluated in the early period, and applications for trunk control should be included in rehabilitation approaches in order to improve balance, gait, functional mobility, and reduce fear of falling.

Physical activity monitoring in Alzheimer's disease during sport interventions: a multi-methodological perspective

Introduction

Assessment methods for physical activity and fitness are of upmost importance due to the possible beneficial effect of physical conditioning on neurodegenerative diseases. The implementation of these methods can be challenging when examining elderly or cognitively impaired participants. In the presented study, we compared three different assessment methods for physical activity from the Dementia-MOVE trial, a 6-months intervention study on physical activity in Alzheimer's disease. The aim was to determine the comparability of physical activity assessments in elderly participants with cognitive impairment due to Alzheimer's disease.

Material or methods

38 participants (mean age 70 ± 7 years) with early-stage Alzheimer's disease (mean MoCA 18.84 ± 4.87) were assessed with (1) fitness trackers for an average of 12 (± 6) days, (2) a written diary on daily activities and (3) a questionnaire on physical activity at three intervention timepoints. For comparison purposes, we present a transformation and harmonization method of the physical assessment output parameters: Metabolic equivalent of task (MET) scores, activity intensity minutes, calorie expenditure and moderate-to-vigorous physical activity (MVPA) scores were derived from all three modalities. The resulting parameters were compared for absolute differences, correlation, and their influence by possible mediating factors such as cognitive state and markers from cerebrospinal fluid.

Results

Participants showed high acceptance and compliance to all three assessment methods. MET scores and MVPA from fitness trackers and diaries showed high overlap, whilst results from the questionnaire suggest that participants tended to overestimate their physical activity in the long-term retrospective assessment. All activity parameters were independent of the tested Alzheimer's disease parameters, showing that not only fitness trackers, but also diaries can be successfully applied for physical activity assessment in a sample affected by early-stage Alzheimer's disease.

Discussion

Our results show that fitness trackers and physical activity diaries have the highest robustness, leading to a highly comparable estimation of physical activity in people with Alzheimer's disease. As assessed parameters, it is recommendable to focus on MET, MVPA and on accelerometric sensor data such as step count, and less on activity calories and different activity intensities which are dependent on different variables and point to a lower reliability.

Conventional video-based system for measuring the subtask speed of the Timed Up and Go Test in older adults: Validity and reliability study

The Timed Up and Go Test (TUG) is a simple fall risk screening test that covers basic functional movement; thus, quantifying the subtask movement ability may provide a clinical utility. The video-based system allows individual's movement characteristics assessment. This study aimed to investigate the concurrent validity and test-retest reliability of the video-based system for assessing the movement speed of TUG subtasks among older adults. Twenty older adults participated in the validity study, whilst ten older adults participated in the reliability study. Participant's movement speed in each subtask of the TUG under comfortable and fast speed conditions over two sessions was measured. Pearson correlation coefficient was used to identify the validity of the video-based system compared to the motion analysis system. Intraclass correlation coefficient (ICC3,2) was used to determine the reliability of the video-based system. The Bland-Altman plots were used to quantify the agreement between the two measurement systems and two repeatable sessions. The validity analysis demonstrated a moderate to very high relationship in all TUG subtask movement speeds between the two systems under the comfortable speed (r = 0.672-0.906, p < 0.05) and a moderate to high relationship under the fast speed (r = 0.681-0.876, p < 0.05). The reliability of the video-based system was good to excellent for all subtask movement speeds in both the comfortable speed (ICCs = 0.851-0.967, p < 0.05) and fast speed (ICCs = 0.720-0.979, p < 0.05). The Bland-Altman analyses showed that almost all mean differences of the subtask speed of the TUG were close to zero, within 95% limits of agreement, and symmetrical distribution of scatter plots. The video-based system was a valid and reliable tool that may be useful in measuring the subtask movement speed of TUG among healthy older adults.

Women's Involvement in Steady Exercise (WISE): Study Protocol for a Randomized Controlled Trial

BACKGROUND

Physical inactivity is a serious public health problem for people of all ages and is currently the fourth highest global risk factor for mortality. The transition period from adolescence to adulthood coincides with a marked reduction in participation in physical activity, with more than 50% (and up to 80%) of young adults stopping physical activity. This decrease in physical activity is more evident in women than in men. Despite efforts, existing programs face challenges in effectively initiating and maintaining physical activity among individuals, particularly women, for extended durations. To address these limitations, the Women's Involvement in Steady Exercise (WISE) randomized controlled trial (RCT) seeks to assess the efficacy of a digital high-intensity training intervention complemented by nutritional plans and other health-related advice.

METHODS

The study will be a three-center, randomized (1:1), controlled, parallel-group trial with a six-month intervention period. A total of 300 participants will be recruited at three study sites in Spain, Serbia and Italy. The participants will be randomized to one of the two groups and will follow a six-month program. The primary outcome of the study is the daily step count. Self-reported physical activity, the adherence to the exercise program, body composition, physical activity enjoyment, quality of sleep and physical capacities will also be evaluated.

Characterization of Balance Control and Postural Stability in Patients With Alzheimer Disease

Balance in Alzheimer disease (AD) patients is not rigorously understood. In this study, we characterize balance using qualitative [Berg Balance Scale (BBS)] and quantitative measures (posturography) and assess relationships between qualitative and quantitative balance measures in AD. Patients with mild-moderate AD (n=48) were recruited. BBS scores and posturography metrics, including medial-lateral sway range, anterior-posterior sway range, sway area, and sway velocity, were assessed in eyes-open and eyes-closed conditions. Adjusted linear regressions were used to assess relationships between posturography and BBS score. Mean BBS score was 50.4±5.3. In eyes-open conditions, posturography and BBS score were not significantly associated. In eyes-closed conditions, better BBS score was significantly associated with lower sway area (β=-0.91; P =0.006). Better scores of BBS items involving turning and reduced base of support were associated with greater eyes-closed sway area. Posturography in the more challenging eyes-closed condition may predict functional balance deficits in AD patients.

An elusive consensus definition of sarcopenia impedes research and clinical treatment: A narrative review

The definition of sarcopenia, the age-related loss of muscle mass, has evolved since the term's inception and yet there is no consensus. Many of the identified definitions of sarcopenia centre their criteria around the loss of muscle mass, loss of function, and weakness. Common variables to various definitions of sarcopenia are appendicular lean soft tissue mass (often called muscle mass), grip strength, and gait speed. However, a lack of consensus remains among operational definitions and diagnostics for this newly recognized disease and may be attributed to the absence of appropriate tools that accurately measure the outcomes of interest, such as skeletal muscle instead of lean mass. In this narrative review, we describe the evolution of the consensus groups' definition of sarcopenia, address the need for more accurate measures of muscle mass and function, and effective, low-cost treatments (i.e., resistance training and diet) for this disease. Consensus on what constitutes sarcopenia is critical to propel research in the field and, importantly, provide what prognostic value a sarcopenia diagnosis provides and how such a patient would be treated.

Self-performed Five Times Sit-To-Stand test at home as (pre-)screening tool for frailty in cancer survivors: Reliability and agreement assessment

AIMS AND OBJECTIVES

The self-performance of a Five-Times-Sit-To-Stand (FTSTS)-test, without the usual supervision by a medical professional, provides valuable opportunities for clinical practice and research. This study aimed: (1) to determine the validity of the self-performed FTSTS test in comparison to a supervised reference test and (2) to determine the reliability of a self-performed FTSTS test by cancer survivors.

BACKGROUND

Early detection of frailty in cancer survivors may enable prehabilitation interventions before surgery or intensive treatment, improving cancer outcomes.

DESIGN

A repeated measures reliability and agreement study, with one week in between measures, was performed.

METHODS

Cancer survivors (n = 151) performed two FTSTS tests themselves. One additional reference FTSTS test was supervised by a physical therapist. The intraclass correlation coefficient (ICC), structural error of measurement (SEM) and minimally important clinical difference (MID) were calculated comparing a self-performed FTSTS test to the reference test, and comparing two self-performed FTSTS tests. The Guidelines for Reporting Reliability and Agreement Studies (GRASS) have been used.

RESULTS

Mean age of cancer survivors was 65.6 years (SD = 9.3), 54.6% were female, median time since diagnosis was 2 years [IQR = 1], and tumour type varied (e.g., breast cancer (31.8%), prostate cancer (17.2%), gastrointestinal cancer (11.9%) and haematological cancer (11.9%)). Validity of the self-performed FTSTS test at home was acceptable in comparison with the reference test (ICC = .74; SEM = 3.2; MID = 3.6) as was the reliability of the self-performed FTSTS test (ICC = .70; SEM = 2.2; MID = 3.8).

CONCLUSIONS

The self-performed FTSTS test is a valid and reliable measure to assess lower body function and has potential to be used as objective (pre-)screening tool for frailty in cancer survivors.

RELEVANCE TO CLINICAL PRACTICE

The self-performed FTSTS test at home may indicate the cancer survivors in need of prehabilitation in advance of surgery or intensive treatment. The feasibility, short amount of time needed and potential cost-effectiveness of the self-performed FTSTS test can make it a valuable contribution to personalised care and precision medicine.

Use of Physical Activity Measures in Rehabilitation Interventions Following Lower Extremity Amputation

Purpose of Review

This systematic review aims to evaluate physical performance outcome tools that are used most frequently to assess rehabilitation interventions. The scope of this paper focused on outcomes used with established lower limb amputees when assessing interventions such as exercise programs or changes in prescription published in the last 5 years.

Recent Findings

The most recorded outcome measures used across all the papers were timed walk tests and the Activity Balance Confidence Scale. Many outcomes did not produce statistically significant results with established amputee cohorts. Understanding the minimal important clinical difference is key.

Summary

The use of outcome measures is essential. Training and education are likely to increase the use of outcome measures. Quality of life measures are important in conjunction with physical outcomes. Simple timed walk tests are commonly used. These are in general easy to administer requiring a small space, limited equipment, and a short time frame.

Effectiveness of physical exercise at improving functional capacity in older adults living with Alzheimer's disease: a systematic review of randomized controlled trials

PURPOSE

To investigate the effects of physical exercise at improving functional capacity in older adults living with Alzheimer's disease (AD).

METHODS

Medline, Embase, Web of Science, The Cochrane Library, Lilacs, and PEDro were searched from inception until January 2021. Randomized controlled trials (RCTs) that reported functional capacity outcomes were included. The evidence was assessed using the GRADE approach.

RESULTS

Thirteen RCTs were included, involving 811 older adults living with AD. Multimodal exercise (ME), aerobic exercise (AE), and resistance exercise (RE) were used. The interventions were mainly supervised by caregivers. The evidence was low and with effect for activities of daily living (ADLs), moderate and with no effect for mobility and very low and with no effect for muscle strength, postural balance and flexibility after treatment with ME, moderate and with no effect for cardiorespiratory function and ADLs after treatment with AE. It was not possible to synthesize any type of evidence for RE.

CONCLUSIONS

Multimodal exercise promotes improvements in functional capacity (ADLs). Therefore, the practice of physical exercise can be recommended for older adults living with AD. The involvement of the caregiver in the physical exercises should also be considered, as it could enhance the benefits of exercise for these older adults.Implications for rehabilitationHealthcare providers with clinical knowledge regarding physical exercise should promote, prescribe and support the daily practice of physical exercises for older adults living with Alzheimer's disease (AD).The involvement of caregivers in home-based physical exercise programs should be considered, as it could enhance the benefits of such programs for these older adults.It is important to consider the degree of cognitive impairment in older adults living with AD when outlining goals for the improvement in functional capacity through physical exercise.Multimodal exercise involving aerobic training, postural balance, muscle strengthening, and flexibility is capable of promoting an improvement in functional capacity (activities of daily living) for these older adults.

Sex-Specific associations between hip muscle strength and foot progression angle

The foot progression angle (FPA) influences knee loading during gait, but its determinants are unclear. The purpose of this study was to compare FPA between males and females and also examine the association between lower extremity kinematics during gait, hip strength, and the FPA. 25 males and 25 females completed 5 gait trials while FPA and frontal and transverse plane hip and knee angles were calculated from the dominant limb during the foot flat portion of stance. Hip extensor/flexor, abductor/adductor, and internal/external rotator strength were evaluated using maximum voluntary isometric contractions. One-way MANOVAs compared gait and strength outcomes. Stepwise regression assessed the association between FPA, and MVIC and kinematics after accounting for speed in males and females. There was no difference in FPA between sexes (p > 0.05), but females had greater frontal and transverse plane hip angles compared with males (all p < 0.05). Greater hip abduction (p = 0.02) strength was associated with greater FPA, but only in males. In males, greater hip abductor strength may contribute to a more neutral position of the foot during gait, which could help maintain an equal knee loading distribution. Our results suggest that there are sex specific control strategies to achieve a similar FPA during gait.

Plasma Biomarkers of Alzheimer's Disease Are Associated with Physical Functioning Outcomes Among Cognitively Normal Adults in the Multiethnic HABS-HD Cohort

In this study, we examined the link between plasma Alzheimer's disease (AD) biomarkers and physical functioning outcomes within a community-dwelling, multiethnic cohort. Data from 1 328 cognitively unimpaired participants (n = 659 Mexican American and n = 669 non-Hispanic White) from the ongoing Health & Aging Brain Study-Health Disparities (HABS-HD) cohort were examined. Plasma AD biomarkers (amyloid beta [Aβ]40, Aβ42, total tau [t-tau], and neurofilament light chain [NfL]) were assayed using the ultra-sensitive Simoa platform. Physical functioning measures were the Timed Up and Go (TUG) and the Short Physical Performance Battery (SPPB). Cross-sectional linear regression analyses revealed that plasma Aβ 40 (p < .001), Aβ 42 (p = .003), and NfL (p < .001) were each significantly associated with TUG time in seconds. Plasma Aβ 40 (p < .001), Aβ 42 (p < .001), t-tau (p = .002), and NfL (p < .001) were each significantly associated with SPPB Total Score. Additional analyses demonstrate that the link between plasma AD biomarkers and physical functioning outcomes were strongest among Mexican Americans. Plasma AD biomarkers are receiving a great deal of attention in the literature and are now available clinically including use in clinical trials. The examination of AD biomarkers and physical functioning may allow for the development of risk profiles, which could stratify a person's risk for neurodegenerative diseases, such as AD, based on plasma AD biomarkers, physical functioning, ethnicity, or a combination of these measures prior to the onset of cognitive impairment.

Effects of a Physical Activity Program that Incorporates Exercises Targeting Balance, Strength, and Proprioception on Cognitive Functions and Physical Performance in Old Adults with Mild Cognitive Impairment

BACKGROUND

Aging often leads to cognitive function decline, sensory structure deterioration, and musculoskeletal system weakening. This impacts postural control during static and dynamic activities like walking, increasing the fall risk among the elderly. Older adults with mild cognitive impairment (MCI) face an elevated fall risk and cognitive decline, magnifying the public health concern.

OBJECTIVE

This study aimed to explore solutions by investigating the effects of a multi-component physical activity program on cognitive and motor functions in MCI patients.

METHODS

Twenty-three participants were enrolled in the study and assigned into two groups: an intervention group (n = 13; age = 85.7±5.5 years) and a control group (n = 9; age = 85±6.7 years). The study spanned two months, with participants engaging in three 60-minute weekly physical exercise sessions. The intervention focused on improving proprioception, muscle strength, and balance.

RESULTS

Results demonstrated significant enhancements in physical performance, fall risk reduction, and balance (p < 0.05). Various tests, including the timed up and go test, Unipedal Stance test, Tinetti test, Short Physical Performance Battery, and 6-minute walking test, indicated these improvements. Cognitive function was evaluated with the Mini-Mental State Examination, revealing non-significant progress (p > 0.05). Predictive models for outcomes were developed using linear regression analysis during the follow-up stage.

CONCLUSIONS

This study underscores the effectiveness of a multi-component physical activity program encompassing balance, proprioception, and muscle-strengthening exercises as a non-pharmaceutical approach in improving balance skills and playing a key role in mitigating the risk of falls among old adults with MCI.

Relative and absolute reliability of somatosensory evoked potentials in response to non-noxious electrical stimulation of the paraspinal muscles in healthy participants at an interval of 3-months

BACKGROUND

Somatosensory evoked potentials (SEPs) are used extensively to quantify cortical activity in response to noxious and/or non-noxious sensory stimuli. However, data demonstrating the reliability of SEP measures in response to non-noxious stimulation over time are scarce.

AIM

We investigated the relative and absolute reliability, and the smallest detectable change at 95% confidence (SDC₉₅) for SEPs evoked by non-noxious electrical stimulation of the paraspinal muscles in thirty-nine healthy participants at a 3-month interval.

METHODS

SEPs were evoked at an intensity three-times that of each participant's perceptual threshold and recorded from a single electrode placed over the primary somatosensory cortex (S1).

RESULTS

Our analyses reveal that i) latency, as a measure of activity onset, has poor relative reliability but good absolute reliability; ii) area, as a measure of cortical activity, has good relative and absolute reliability (except for the N₁₅₀ component) and iii) perceptual threshold and stimulation intensity was not reliable over time.

CONCLUSION

These findings suggest that the area of the N₈₀ and P₂₆₀ SEP components, and the area of the N₈₀-N₁₅₀-P₂₆₀ SEP complex, can be utilised in future studies as reliable markers of cortical activity.

Effects of a Home-Based Physical Training and Activity Promotion Program in Community-Dwelling Older Persons with Cognitive Impairment after Discharge from Rehabilitation: A Randomized Controlled Trial

BACKGROUND

Older people with cognitive impairment (CI) are at high risk for mobility limitations and adverse outcomes after discharge from geriatric rehabilitation settings. The aim was to estimate the effects of a specifically designed home-based physical training and activity promotion program on physical capacity, different aspects of physical activity (PA), and psychosocial status.

METHODS

Patients with mild to moderate CI (Mini-Mental State Examination [MMSE]: 17-26 points) discharged home after rehabilitation were included in this randomized, double-blind, placebo-controlled trial with a 12-week intervention and 12-week follow-up period. The intervention group performed a CI-specific, autonomous, home-based strength, balance, and walking training supported by tailored motivational strategies to foster training adherence and promote PA. The control group participated in an unspecific motor placebo activity. Primary outcomes were physical capacity (Short Physical Performance Battery [SPPB]) and PA (sensor-based activity time).

RESULTS

Among 118 randomized participants (82.3 ± 6.0 years) with CI (MMSE: 23.3 ± 2.4) and high levels of multimorbidity, those participants undergoing home-based training demonstrated superior outcomes to the control group in SPPB (mean difference between groups 1.9 points; 95% CI: 1.0-2.8; p < .001), with persistent benefits over the follow-up (1.3 points; 95% CI: 0.4-2.2; p < .001). There were no differences in PA across any time points. Among secondary outcomes, fear of falling and activity avoidance behavior were reduced in the intervention group at all time points, life-space mobility improved short-term.

CONCLUSIONS

The results demonstrate clinically important benefits of an individually tailored autonomous physical training and activity promotion program on physical capacity and secondary outcomes in different domains in a vulnerable, multimorbid population.

CLINICAL TRIAL REGISTRATION

ISRCTN82378327.

Comparing the use of mathematical calculation to a measuring wheel to determine distance walked in three different course configurations of the 6 minute Walk Test in healthy adults

INTRODUCTION

A recent clinical practice guideline set forth recommendations for the administration of the 6 Minute Walk Test, including course set-up and using mathematical calculation to obtain the distance walked. In clinical practice and research, however, deviations from these protocols exist.

PURPOSE

To assess for differences in total distance walked between use of mathematical calculation and a measuring wheel during three different course configurations of the 6 Minute Walk Test.

METHODS

Fifty healthy adults (18 males, 32 females) completed this study. The mean age was 37.04 (13.76) years ranging from 23 to 61 years. Each participant completed three course configurations of the 6 Minute Walk Test: a 12-meter straight walkway representing the Academy of Neurologic Physical Therapy Core Set of Outcome Measures Clinical Practice Guideline protocol, a 30-meter straight walkway, representing the American Thoracic Society's recommended protocol, and a 1.2-meter by 12-meter rectangular walkway, of which the Core Set of Outcome Measures Clinical Practice Guideline was derived. For mathematical calculation, the total number of laps counted, and this total number was multiplied by the distance of one lap with any partial lap added. Additionally, a research assistant followed behind each participant with a measuring wheel to capture distance walked.

RESULTS

For all configurations, there were statistically significant differences between mathematical calculation and a measuring wheel, with mathematical calculation producing significantly less total distance. Additionally, there were statistically significant differences between all course configurations, despite the method of measurement.

CONCLUSION

Adhering to 6 Minute Walk Test protocols, including the method of measuring the distance, is imperative to accurately interpret results and compare to existing data.Key messagesDespite recommendations for standardized administration of the 6 Minute Walk Test, deviations exist, including the method of which to obtain the total distance walked; either by use of mathematical calculation or a measuring wheel.In three different 6 minute walk test course configurations, including the American Thoracic Society's recommended protocol and the Academy of Neurologic Physical Therapy recommended protocol, the measuring wheel resulted in significantly larger distances than use of the mathematical calculation.Despite the measuring wheel able to account for the turns during the 6 Minute Walk Test, it is imperative for clinicians to utilize standardized procedures such as using mathematical calculation, in order to accurately track progress and compare to existing data, of which mathematical calculation was used to derive.

Reliability of the Wii Balance Board for measurement of steady state balance in children aged 6-9 years

PURPOSE

The Wii Balance Board (WBB) can be used for assessment of steady state balance (SSB), but its reliability has not been studied in children aged 6-9 years. This study aimed to determine the test-retest reliability of the WBB for measuring SSB in this population. A secondary aim was to determine the minimum detectable change (MDC) and standard error of measurement (SEM) of the WBB in children aged 6-9 years.

METHODS

52 children between 6-9 years of age participated. "One leg stand balance" was used to assess center of pressure velocity (COPV) and center of pressure area (COPA) on three occasions by the same tester. Two tests were conducted on the same day (Day 1) and the third test was performed on another day (Day 2), with a period of 5-13 days between the two test days. Intraclass correlation coefficient (ICC 3,1), SEMs, and MDC were calculated.

RESULTS

Intra-day test-retest reliability of COPA was found to be good (ICC3,1 =0.86; 95% confidence interval [CI]: 0.75, 0.92) and that of COPV was also found to be good (ICC3,1 =0.87; 95% CI: 0.77, 0.92). Inter-day test-retest reliability was found to be good for COPA (ICC3,1 = 0.87; 95% CI: 0.75, 0.93) and COPV (ICC3,1 = 0.89; 95% CI: 0.81, 0.94). SEM for COPA in intra-day testing was 18.90 mm2 (15.78%), and in inter-day testing it was 16.44 mm2 (13.61%). SEM for COPV in intra-day testing was 1.12 mm/s (7.6%), and in inter-day testing it was 1.01 mm/s (6.9%). MDC for COPA in intra-day testing was 52.41mm2 (42.75%), and in inter-day testing was 45.58 mm2 (35.75%). MDC for COPV in intra-day testing was 3.11 mm/s (21.2%), and in inter-day testing it was 2.80 mm/s (18.9%).

CONCLUSION

The WBB has good test-retest reliability for assessing SSB of children between 6-9 years. COPA measurements appear to be less sensitive to clinical changes in SSB when compared to COPV. Assessment of validity of the WBB in this age group is recommended before it can be considered as a potential balance assessment tool in children.

Reference equations for the six-minute walking distance in obese Chinese subjects more than 40 years old

BACKGROUND

Studies have shown that the reference equations for the six-minute walking distance (6MWD), which were mainly derived from healthy, normal-weight people, are not suitable for individuals with obesity. The main purpose of this study was to establish reference equations for the 6MWD in obese Chinese subjects.

METHODS

In our study, a total of 214 individuals with obesity performed the six-minute walking tests (6MWTs) according to the American thoracic society (ATS) guidelines, and the longer 6MWD was used for further analysis. The reference equations for the 6MWD were developed using stepwise multiple regression analysis. The newly established equations for the 6MWD were compared to the existing prediction equations.

RESULTS

The mean 6MWD for the cohort was 523 ± 56 m. We found that the reliability of two 6MWTs was good. Age and BMI were identified as independent factors, and explained 31% and 27% of the variance in the 6MWD for the male and female participants, respectively. Thus, the reference equations reported in the previous studies did not accurately predict the 6MWD in our subjects.

CONCLUSION

Our study was the first to describe the 6MWD in obese Chinese subjects and to propose new predictive equations. These established equations can improve the assessment of the health of obese Chinese patients whose exercise capacity is affected by the disease.

LEVEL OF EVIDENCE

III, Cohort study.

A Proposed Method of Converting Gait Speed and TUG Test in Older Subjects

Sarcopenia is one of the most important health problems in advanced age. In 2019, the European Working Group of Sarcopenia in Older People (EWGSOP) updated the operational diagnostic criteria for identification of people with sarcopenia (EWGSOP2). Among the two proposed low performance measures of sarcopenia are gait speed and the Timed Up and Go (TUG) test. Usage of any of those tools requires recalculation for the second one for eventual comparisons. The simple linear regression has been used for such comparisons in several previous studies, but the appropriateness of such an approach has not been verified. The aim of this study is to find the most appropriate model describing the relationship between these two popular measures of physical function. The study was performed in 450 consecutive outpatients of the Geriatric Clinic of the Medical University of Lodz, Poland, aged 70 to 92 years who volunteered to participate in the study. The TUG test and gait speed at 4 m to assess physical function were used. Different alternative models were compared to obtain the highest R-squared values. A Reciprocal-Y model (R-squared = 71.9%) showed the highest performance, followed by a Logarithmic-Y square root-X model (R-squared = 69.3%) and a Reciprocal-Y square root-X model (R-squared = 69.1%). The R-squared for the linear model was 49.5%. For the selected reciprocal model, the correlation coefficient was 0.85 and the equation of the fitted model was: Gait speed (m/s) = 1/(-0.0160767 + 0.101386 × TUG). In conclusion, in independent community-dwelling older adults, the relationship between gait speed and the TUG test in older subjects is nonlinear. The proposed reciprocal model may be useful for recalculations of gait speed or TUG in future studies.

Impact of Daycare Service Interruption during COVID-19 Pandemic on Physical and Mental Functions and Nutrition in Older People with Dementia

This study evaluated changes of cognitive, physical, and nutritional status before and after the interruption and resumption of daycare services during the COVID-19 pandemic in older dementia people in a daycare center. Comprehensive geriatric assessment data were analyzed before and after the lockdown of daycare center services, including mini-mental state examination, activities of daily living (ADL) scores, mini-nutritional assessment-short forms (MNA-SF), and timed up-and-go (TUG) tests. Among 19 dementia people participating in daycare services, 17 participants were enrolled in the study with, finally, two excluded because of incomplete follow-ups. They had a median age of 81 years; their MNA-SF scores and TUG values deteriorated significantly after a 3-month closure of daycare services (p < 0.05), and after resumption of daycare services the MNA-SF scores and TUG values recovered to near the pre-lockdown levels (p < 0.05). Besides, baseline ADL scores predicted a decline and recovery of TUG and MNA-SF values. Our findings suggest that planning continuous support for older dementia adults is important for daycare facilities during COVID-19 pandemic confinement.

Safety and efficacy of plasma transfusion from exercise-trained donors in patients with early Alzheimer's disease: protocol for the ExPlas study

INTRODUCTION

Given that exercise training reduces the risk of developing Alzheimer's disease (AD), induces changes in the blood composition and has widespread systemic benefits, it is reasonable to hypothesise that exercised plasma (ExPlas) may have rejuvenative properties. The main objective is to test safety and tolerability of transfusing ExPlas from young, healthy, fit adults to patients with mild cognitive impairment (MCI) or early AD. The study is a pilot for a future efficacy study. The key secondary objectives are examining the effect of plasma transfusions on cognitive function, fitness level, vascular risk profile, assessment of cerebral blood flow and hippocampal volume, quality of life, functional connectivity assessed by resting state functional MRI and biomarkers in blood and cerebrospinal fluid.

METHODS AND ANALYSIS

ExPlas is a double-blinded, randomised controlled clinical single-centre trial. Patients up to 75 years of age with diagnosis early symptomatic phase AD will be recruited from two Norwegian hospitals. ExPlas is plasma drawn by plasmapheresis once a month for 4 months, from a total of 30 fit male donors (aged 18-40, BMI≤27 kg/m² and maximal oxygen uptake>55 mL/kg/min). All units will be virus inactivated by the Intercept method in accordance with procedures at St. Olavs University Hospital. Comparison with isotonic saline allows differentiation from a non-blood product. The main study consists of 6 rounds of examinations in addition to 12 plasma transfusions divided over three 4-week periods during study year-1. It is also planned to conduct follow-up examinations 2 and 5 years after baseline ETHICS AND DISSEMINATION: Written informed consent will be obtained from all participants and participation is voluntary. All participants have a next of kin who will follow them throughout the study to represent the patient's interest. The study is approved by the Regional Committee for Medical and Health Research Ethics (REK 2018/702) and the Norwegian Medicines Agency (EudraCT No. 2018-000148-24). The study will be published in an open access journal and results will be presented at numerous national and international meetings as well as on social media platforms.

TRIAL REGISTRATION NUMBER

EudraCT No. 2018-000148-24.

CLINICALTRIALS

gov, NCT05068830.

Vestibular therapy to reduce falls in people with Alzheimer's disease: study protocol for a pilot randomized controlled trial

BACKGROUND

Falls are highly common in patients with Alzheimer's disease (AD); around two-thirds of AD patients fall annually. Fall events are major drivers of injury, early institutionalization, and shorter survival. Balance and mobility impairment are among the most important fall risk factors in AD patients. Vestibular therapy (VT) is an effective rehabilitation intervention in improving balance and fall risk through vestibular function, but not often used in AD. We want to evaluate the feasibility of using VT to reduce falls and improve balance function in patients with AD and drive use of an existing, potentially beneficial therapy in a patient population whose high level of vestibular deficits is currently unaddressed.

METHODS

The proposed pilot clinical trial will be a parallel-group randomized controlled trial. Patients with a diagnosis of mild-moderate AD, age ≥ 60, and the presence of a caregiver will be recruited from the Johns Hopkins Memory and Alzheimer's Treatment Center. Eligible patients will be offered vestibular testing. Patients with vestibular loss will be offered participation in the VT trial. One-hundred AD patients with vestibular loss will be enrolled and randomized 1:1 into the control and intervention arms of the trial. All patients will undergo baseline balance and cognitive assessment, followed by 8 weeks of active control therapy or VT, consisting of ~25-min office sessions with a vestibular therapist. Patients will be tracked for falls and undergo follow-up balance and cognitive assessment at 8 and 52 weeks (1 year) to assess the potential short-term and longer-term effects, respectively, of VT on balance and cognition. The main outcomes of this trial are falls, balance (using the Berg Balance Scale and the Timed Up and Go test), and cognition (using the clock drawing test, the Card Rotations test, the Money Road Map test, and the triangle completion task).

DISCUSSION

As the population ages and the number of individuals with AD in the US grows to a projected 14 million in 2050, managing falls in AD will continue to grow as a critical public health concern; this trial assesses feasibility of a potential solution.

TRIAL REGISTRATION

ClinicalTrial.Gov identifier - NCT03799991 . Registered 01 August 2019.

Exploring Shared Effects of Multisensory Impairment, Physical Dysfunction, and Cognitive Impairment on Physical Activity: An Observational Study in a National Sample

Multisensory, physical, and cognitive dysfunction share age-related physiologic disturbances and may have common health effects. We determined whether the effect of multisensory impairment on physical activity (PA) is explained by physical (timed up and go) or cognitive (Short Portable Mental Status Questionnaire) dysfunction. A National Social Life, Health, and Aging Project participant subset (n = 507) underwent objective sensory testing in 2005-2006 and wrist accelerometry in 2010-2011. We related multisensory impairment to PA using multivariate mixed-effects linear regression and compared the effect magnitude after adjusting for physical then cognitive dysfunction. Worse multisensory impairment predicted lower PA across three scales (Global Sensory Impairment: β = -0.04, 95% confidence interval [-0.07, -0.02]; Total Sensory Burden: β = -0.01, 95% confidence interval [-0.03, -0.003]; and Number of Impaired Senses: β = -0.02, 95% confidence interval [-0.04, -0.004]). Effects were similar after accounting for physical and cognitive dysfunction. Findings suggest that sensory, physical, and cognitive dysfunction have unique mechanisms underlying their PA effects.

Assessment Tools to Evaluate Motor Function in People with Dementia: A Systematic Review

Background: In addition to cognitive changes, motor impairments have been observed in patients with dementia and are present early in the disease, even at the preclinical stage. Although it is difficult to assess motor function in this population, it is critical for monitoring disease progression and determining the efficacy of therapeutic interventions. However, the best measurement tools for assessing motor function in dementia patients have yet to be determined. Objective: We aimed to summarize and critically evaluate the measurement tools used to assess motor function indementia. Methods: A systematic review was conducted using the databases CENTRAL, MEDLINE, Embase, and PEDro from their inception to June 2021 to identify all experimental studies conducted in patients with dementia and that included an assessment of motor function. Two reviewers independently screened citations, extracted data, and assessed clinimetric properties. Results: We included 200 studies that assess motor function in dementia patients. Motor function was assessed using a total of 84 different measurement tools. Only nine (12% ) were used in over ten studies. The Timed-Up-and-Go test, 6MWT, Berg Balance Scale, and the Short Physical Performance Battery are all suggested. Conclusion: Currently, a wide variety of measurement instruments are used to assess motor performance in people with dementia, most instruments were not designed for this population and have not been validated for this use. We propose the development of an assessment protocol tailored to the different disease stages. We also recommend that future research continues to develop technological devices that can assist with this task.

Reliability and Variability of Lower Limb Muscle Activation as Indicators of Familiarity to Submaximal Eccentric Cycling

Submaximal eccentric (ECC) cycling exercise is commonly used in research studies. No previous study has specified the required time naïve participants take to familiarize with submaximal ECC cycling. Therefore, we designed this study to determine whether critical indicators of cycling reliability and variability stabilize during 15 min of submaximal, semi-recumbent ECC cycling (ECC cycling). Twenty-two participants, aged between 18–51 years, volunteered to complete a single experimental session. Each participant completed three peak eccentric torque protocol (PETP) tests, nine countermovement jumps and 15 min of submaximal (i.e., 10% peak power output produced during the PETP tests) ECC cycling. Muscle activation patterns were recorded from six muscles (rectus femoris, RF; vastus lateralis, VL; vastus medialis, VM; soleus, SOL; medial gastrocnemius, GM; tibialis anterior, TA), during prescribed-intensity ECC cycling, using electromyography (EMG). Minute-to-minute changes in the reliability and variability of EMG patterns were examined using intra-class correlation coefficient (ICC) and variance ratios (VR). Differences between target and actual power output were also used as an indicator of familiarization. Activation patterns for 4/6 muscles (RF, VL, VM and GM) became more consistent over the session, the RF, VL and VM increasing from moderate (ICC = 0.5–0.75) to good (ICC = 0.75–0.9) reliability by the 11th minute of cycling and the GM good reliability from the 1st minute (ICC = 0.79, ICC range = 0.70–0.88). Low variability (VR ≤ 0.40) was maintained for VL, VM and GM from the 8th, 8th and 1st minutes, respectively. We also observed a significant decrease in the difference between actual and target power output (χ214 = 30.895, p = 0.006, W = 0.105), expressed primarily between the 2nd and 3rd minute of cycling (Z = -2.677, p = 0.007). Indicators of familiarization during ECC cycling, including deviations from target power output levels and the reliability and variability of muscle activation patterns stabilized within 15 min of cycling. Based upon this data, it would be reasonable for future studies to allocate ∼ 15 min to familiarize naïve participants with a submaximal ECC cycling protocol.

Effects of multitask training on cognition and motor control in people with schizophrenia spectrum disorders

Schizophrenia spectrum disorder (SSD) is a disabling mental illness that causes considerable deficits in motor and cognitive functions. The purpose of this study was to examine the effects of combining traditional multitask training (TMT) and video games--a new form of multitask training (video game multitask training VGMT)--on cognition and motor control performance in people with SSD. This was a quasi-experimental, pretest-posttest design study. A total of 25 patients participated in this study voluntarily (13 males and 12 females, average age = 59.61 years, SD– 11.46 years). All participants underwent two stages of training. The first stage involved TMT, and the second stage involved VGMT. Each training stage was 12 weeks long, with sessions twice a week that lasted for 40 minutes. Cognition, upper extremity motor and postural control performance, and functional mobility and subjective balance confidence were measured at three times: before and after the first-stage training and after the second-stage training. The results revealed that TMT and the combination of TMT and VGMT improved SSD patient’s cognition, upper extremity motor control, functional mobility and postural control performance. The subjective confidence of balance during the performance of daily activities was also mildly improved. Training with multitasks in the form of video games tended to further improve the outcome measures. Patients with SSD could benefit from regular participation in various forms of multitasking activities. Whether video games training are better than TMT in improving the functional ability of people with SSD needs further investigation.

Study protocol registration: Clinicaltrials.gov, ID: NCT04629898. Registered brief title: Level of Immersion of Virtual Reality and Cognition and Motor Performance in Patients of Schizophrenia Spectrum Disorder.

Demographic and disease characteristics associated with pain intensity, kinesiophobia, balance, and fall self-efficacy among people with osteoarthritis: a cross-sectional study

BACKGROUND

Osteoarthritis (OA) is a common degenerative joint disease leading to significant pain, mobility limitation, economic burden, reduced quality of life, and disability among adults globally. Psychological factors related to pain intensity (PI), kinesiophobia, fall self-efficacy (FSE), and balance may lead to a poor OA prognosis. This study was designed to explore the association between PI, kinesiophobia, FSE, balance, and age, gender, marital status, site of OA, duration, symmetry, comorbidity, and adaptive behaviours among patients with knee or hip OA.

METHODS

This cross-sectional study involved 70 purposively selected participants aged 59.91 ± 11.12 years. Numeric pain rating scale, Tampa scale for kinesiophobia, fall-efficacy scale, and timed up and go test were used to measure PI, kinesiophobia, FSE, and balance, respectively. Statistical analyses were completed with the Pearson correlation test, independent samples t-test, and multiple linear regression.

RESULTS

The participants were mainly women (n = 59, 84.3%). However, there was no gender difference in the reported PI, kinesiophobia, FSE, and balance. There was a significant correlation between FSE and balance (r = 0.422, p<0.001). Kinesiophobia was significantly associated with the presence of comorbidity (β = 0.240, p = 0.001) and knee OA (β = 0.208, p<0.042). There was an association between FSE and the use of a walking aid (β = -0.442, p<0.042), stop-for-rest during walking (β = -0.292, p = 0.002), presence of comorbidity (β = 0.209, p = 0.014), and bilateral lower limb OA (β = 0.167, p = 0.057). Balance was associated with the use of a walking aid (β = -0.421, p<0.001) and stop-for-rest during walking (β = - 0.294, p = 0.006).

CONCLUSION

Osteoarthritis-related psychological distress affects both men and women. This study support integration of psychological outcomes in the assessment, management, and follow-up of people with lower limb osteoarthritis. Moreover, comorbidity worsened psychological distress among people with osteoarthritis. Therefore, the traditional biomedical management of osteoarthritis can be optimised by timely diagnosis and treatment of comorbidities, and the inclusion of psychotherapy.

Effects of Intermittent Hypoxia-Hyperoxia Exposure Prior to Aerobic Cycling Exercise on Physical and Cognitive Performance in Geriatric Patients—A Randomized Controlled Trial

Background: It was recently shown that intermittent hypoxic-hyperoxic exposure (IHHE) applied prior to a multimodal training program promoted additional improvements in cognitive and physical performance in geriatric patients compared to physical training only. However, there is a gap in the literature to which extent the addition of IHHE can enhance the effects of an aerobic training. Therefore, the aim of this study was to investigate the efficacy of IHHE applied prior to aerobic cycling exercise on cognitive and physical performance in geriatric patients.

Methods: In a randomized, two-armed, controlled, and single-blinded trial, 25 geriatric patients (77–94 years) were assigned to two groups: intervention group (IG) and sham control group (CG). Both groups completed 6 weeks of aerobic training using a motorized cycle ergometer, three times a week for 20 min per day. The IG was additionally exposed to intermittent hypoxic and hyperoxic periods for 30 min prior to exercise. The CG followed the similar procedure breathing sham hypoxia and hyperoxia (i.e., normoxia). Within 1 week before and after the interventions, cognitive performance was assessed with the Dementia-Detection Test (DemTect) and the Clock Drawing Test (CDT), while physical performance was measured using the Timed “Up and Go” Test (TUG) and the Short-Physical-Performance-Battery (SPPB).

Results: No interaction effect was found with respect to the DemTect (η_p² = 0.02). An interaction effect with medium effect size (η_p² = 0.08) was found for CDT performance with a higher change over time for IG (d = 0.57) compared to CG (d = 0.05). The ANCOVA with baseline-adjustment indicated between-group differences with a large and medium effect size at post-test for the TUG (η_p² = 0.29) and SPPB (η_p² = 0.06) performance, respectively, in favour of the IG. Within-group post-hoc analysis showed that the TUG performance was worsened in the CG (d = 0.65) and remained unchanged in the IG (d = 0.19). Furthermore, SPPB performance was increased (d = 0.58) in IG, but no relevant change over time was found for CG (d = 0.00).

Conclusion: The current study suggests that an additional IHHE prior to aerobic cycling exercise seems to be more effective to increase global cognitive functions as well as physical performance and to preserve functional mobility in geriatric patients in comparison to aerobic exercise alone after a 6-week intervention period.

Tolvaptan versus fluid restriction in acutely hospitalised patients with moderate-profound hyponatraemia (TVFR-HypoNa): design and implementation of an open-label randomised trial

Background

Current hyponatraemia guidelines are divided on the use of tolvaptan in hospitalised patients with moderate to severe hyponatraemia, due to an uncertain risk-benefit ratio. We will conduct a randomised trial to test the hypothesis that early use of tolvaptan improves the rate of serum sodium correction and clinical outcomes compared with current standard first-line therapy, restriction of fluid intake, without increasing the risk of serum sodium overcorrection.

Methods

We will enrol hospitalised patients with euvolaemic or hypervolaemic hyponatraemia and serum sodium of 115–130 mmol/L at Austin Health, a tertiary care centre in Melbourne, Australia. Participants will be randomised 1:1 to receive either tolvaptan (initial dose 7.5 mg) or fluid restriction (initial limit 1000 ml per 24 h), with titration of therapy based on serum sodium response according to a pre-determined protocol over a 72-h intervention period.

The primary endpoint will be the between-group change in serum sodium over time, from study day 1 to day 4. Secondary endpoints include serum sodium increment in the first 24 and 48 h, proportion of participants with normalised serum sodium, length of hospital stay, requirement for serum sodium re-lowering with intravenous dextrose or desmopressin, cognitive and functional measures (Confusion Assessment Method Short form, Timed Up and Go test, hyponatraemia symptom questionnaire), 30-day readmission rate, treatment satisfaction score and serum sodium 30 days after discharge. The trial will be overseen by an independent Data Safety Monitoring Board. Serum sodium will be monitored every 6–12 h throughout the study period, with pre-specified thresholds for commencing intravenous 5% dextrose if serum sodium rise targets are exceeded.

Discussion

We seek to inform future international guidelines with high-quality data regarding the utility and safety of tolvaptan compared to standard therapy fluid restriction in patients with moderate-severe hyponatraemia in hospital. If tolvaptan use in this patient group is endorsed by our findings, we will have established an evidence-based framework for tolvaptan initiation and monitoring to guide its use.

Trial registration

Australia and New Zealand Clinical Trials Registry ACTRN12619001683123. Registered on December 2 2019

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-022-06237-5.

Physical and Motor Fitness Tests for Older Adults Living in Nursing Homes: A Systematic Review

This systematic review aimed to identify the physical/motor fitness tests for nursing home residents and to examine their psychometric properties. Electronic databases were searched for articles published between January 2005 and October 2021 using MeSh terms and relevant keywords. Of the total of 4196 studies identified, 3914 were excluded based on title, abstracts, or because they were duplicates. The remaining 282 studies were full-text analyzed, and 41 were excluded, resulting in 241 studies included in the review. The most common physical component assessed was muscle strength; 174 (72.2%) studies assessed this component. Balance (138 studies, 57.3%) and agility (102 studies, 42.3%) were the second and third components, respectively, most widely assessed. In this review, we also describe the most used assessment tests for each physical/motor component. Some potentially relevant components such as manual dexterity and proprioception have been little considered. There are few studies assessing the psychometric properties of the tests for nursing home residents, although the data show that, in general, they are reliable. This review provides valuable information to researchers and health-care professionals regarding the physical/motor tests used in nursing home residences, helping them select the screening tools that could most closely fit their study objectives.