Threshold Berg balance scale scores for gait-aid use in elderly subjects: a secondary analysis

Hand Grip Strength as a Predictive Tool for Upper Extremity Functionality, Balance, and Quality of Life in People With Multiple Sclerosis

BACKGROUND

Upper extremity strength and function are rarely assessed in routine multiple sclerosis (MS) care. This study aimed to evaluate hand muscle strength and functionality in individuals with MS and investigate correlations with upper extremity function, cognitive status, health-related quality of life (HRQOL), and balance.

METHODS

A cross-sectional study was conducted with 45 consecutive individuals with MS between the ages of 18 and 65. Upper limb motor strength was evaluated using a hand grip strength dynamometer. Upper limb functional capacity was assessed using the Nine-Hole Peg Test (9HPT) and the Duruoz Hand Index (DHI). Balance, coordination, and falls were measured with the Berg Balance Scale (BBS), Falls Efficacy Scale (FES), and the 30-Second Chair Stand Test (30CST). Cognitive function was evaluated using the Montreal Cognitive Assessment instrument and the Symbol Digit Modalities Test. Level of HRQOL was assessed using the self-reported 54-item MS Quality of Life-54 questionnaire.

RESULTS

Out of the 45 participants (80% women, mean age 36.6 ± 8.6 years), higher hand grip dynamometer measures were strongly correlated with better DHI, 9HPT, BBS, FES, and 30CST scores. In the regression analysis, a 1-unit increase in dynamometer measures led to a 0.383 increase in overall HRQOL score.

CONCLUSIONS

This study demonstrates that increased hand grip strength (HGS) is associated with better hand functionality, balance, and HRQOL in individuals with MS. It provides evidence to support more systematic measurement of HGS in the care of people with MS.

Improved Physical Health in Middle-Older Aged Golf Caddies Following 24 Weeks of High-Volume Physical Activity

BACKGROUND

The physical demands of golf caddying, including walking while carrying a golf bag, may potentially affect body composition, and markers of metabolic, cardiovascular, and musculoskeletal health. Therefore, this study examined the impact of 24 weeks of caddying on physical health in middle-older aged males.

METHODS

Eleven full-time experienced male caddies (age: 59 [8] y; caddying experience: 14 [12] y) were recruited from a local golf course. The following were assessed at preseason and after 24 weeks of caddying (March-September 2022): body composition, heart rate, blood pressure, blood lipids, and performance tests (static and dynamic balance, strength, and submaximal fitness). Physical activity (PA) levels were assessed at preseason and at the mid-point of the caddying season. Across the caddying season, participants completed a monthly average of 24.0 (3.8) rounds.

RESULTS

Following the caddying season, improvements in static balance (Δ = 13.5 s), dynamic balance (Δ = -1.8 s), and lower back absolute strength (Δ = 112.8 N), and muscle quality (Δ = 2.0 N·kg-1) were observed (all P < .05). Additionally, blood lipids, including total cholesterol (Δ = -0.6 mmol·L-1), high-density lipoprotein cholesterol (Δ = 0.1 mmol·L-1), low-density lipoprotein cholesterol (Δ = -0.6 mmol·L-1) (all P < .05), and body composition, including body mass (Δ = -2.7 kg), fat mass (Δ = -1.9 kg), fat percentage (Δ = -1.4%), fat-to-muscle ratio (Δ = -0.03), and body mass index (Δ = -0.9 kg·m-2) (all P < .05) improved. Caddying did not offer beneficial changes to cardiovascular variables or cardiorespiratory fitness (P > .05), while coronary heart disease risk score decreased (Δ = -3.3%) (P < .05). In relation to PA, light- (Δ = 145 min) and moderate-intensity (Δ = 71 min) PA, moderate to vigorous PA (Δ = 73 min), and total PA (Δ = 218 min) between preseason and the mid-point of the caddying season increased, while sedentary time (Δ = -172 min) decreased (all P < .05).

CONCLUSION

Golf caddying can provide several physical health benefits such as improvements in various markers of cardiometabolic health, lower back absolute strength, and static and dynamic balance. The physical health improvements that caddying offers is likely contributed to by increased PA volume and intensity through walking on the golf course. Therefore, caddying may represent a feasible model for increasing PA volume and intensity and achieve physical health-related benefits.

Advances in mobility aid use reporting: situational context and objective measurement improve understanding of daily aid use in older adults

BACKGROUND

Understanding mobility aid use has implications for falls risk reduction and aid prescription. However, aid use in daily life is understudied and more complex than revealed by commonly used yes/no self-reporting.

AIMS

To advance approaches for evaluating mobility aid use among older adults using a situational (context-driven) questionnaire and wearable sensors.

METHODS

Data from two cross-sectional observational studies of older adults were used: (1) 190 participants (86 ± 5 years) completed tests of standing, sit-to-stand, walking, grip strength, and self-reported fear of falling and (2) 20 participants (90 ± 4 years) wore two body-worn and one aid-mounted sensors continuously for seven days to objectively quantify aid use during walking. Situational and traditional binary reporting stratified participants into aid dependency levels (0-4) and aid-user groups, respectively. Physical performance and fear of falling were compared between aid users, and dependency levels and sensor-derived walking behaviors were compared to reported aid use.

RESULTS

Physical performance and fear of falling differed between aid-user groups (P < 0.05). Sensor-derived outputs revealed differences in walking behaviors and aid use when categorized by dependency level and walking bout length (P < 0.05). Walking bout frequency (rho(18) = - 0.47, P = 0.038) and aid use time (rho(13) = .72, P = 0.002) were associated with dependency level.

DISCUSSION

Comparisons of situational aid dependency revealed heterogeneity between aid users suggesting binary aid use reporting fails to identify individual differences in walking and aid use behaviors.

CONCLUSIONS

Enhanced subjective aid use reporting and objective measurements of walking and aid use may improve aid prescription and inform intervention to support safe and effective mobility in older adults.

Cut-off values and sub-items of the Berg Balance Scale for walking-aid use in hospitalized older adults with a hip fracture: a retrospective analysis

OBJECTIVE

To identify the Berg Balance Scale (BBS) values that can be used to discriminate the use of a walking aid and the BBS sub-items that reveal the differences in the use of walking aids among hospitalized older adults with a hip fracture.

METHODS

The cases of 77 older adults (age 80.8 ± 7.5 years) with a hip fracture who were able to walk independently in the hospital were retrospectively analyzed. A receiver operating characteristic curve (AUC) analysis was used to identify BBS scores that optimized the identification of subjects with different levels of aids. The BBS sub-items identifying differing among the walking aids were identified by a classification and regression tree analysis.

RESULTS

The BBS scores were highest for no aid, a cane, and a walker, in that order. The ability to walk without an aid and the ability to walk without a walker showed moderate AUCs (0.824 and 0.865) with cutoff values of 51.5 and 45.5 points, respectively. The sub-items identified were Turning 360° (4 vs. < 4 points) as the best discriminator for using/not using a cane and Stool Stepping (≥ 2 vs. < 2 points) for using a cane or walker.

CONCLUSION

The BBS is useful for determining whether to discontinue the use of a walker in individuals with a hip fracture.

Do attentional focus instructions affect real-time reinvestment during level-ground walking in older adults?

This study represents the first attempt in exploring whether attentional focus instructions could affect real-time reinvestment (conscious movement processing) in older adults during level-ground walking. Forty-five community-dwelling older adults were instructed to walk at a self-selected pace along a 6-m level-ground walkway under three randomized attentional focus conditions (i.e., Internal, External, and Control) for a total of fifteen trials (five trials for each condition). Electroencephalography (EEG) T3-Fz coherence was utilized as an objective measurement of real-time reinvestment during walking. The Chinese version of the Movement-Specific Reinvestment Scale (MSRS-C) was used to measure the trait reinvestment propensity. Results revealed that the EEG T3-Fz coherence did not differ among the three conditions. The EEG T3-Fz coherence at the Control condition was not correlated with the scores of the MSRS-C. Our findings suggest that the measurement of trait reinvestment propensity (MSRS-C) may not be sensitive enough to reflect real-time reinvestment. Moreover, attentional focus instructions do not affect real-time reinvestment during level-ground walking, possibly due to the low level of motor task difficulty in level-ground walking for healthy older adults. Future studies should investigate this influential issue with a more challenging walking task.

Berg balance scale as a tool for choosing the walking aid for patients with Guillain-Barré syndrome or polyneuropathy

Berg balance scale (BBS) is a widely used outcome measure in rehabilitation. We wanted to check if it can discriminate among levels of use of walking aid in patients with Guillain-Barré syndrome or polyneuropathy. A retrospective audit of 109 such patients (aged 16-85 years) who had completed inpatient rehabilitation in the period 2012-2017 was conducted. Receiver operating characteristic curve analysis was used to estimate the thresholds that optimise the prediction of the patient's walking aid. Statistically, significant threshold BBS score was estimated for the ability to walk without walking aid (≥49 points, yielding 88% sensitivity, 68% specificity and 83% classification accuracy) and the necessity to walk with a walker (≤37 points, yielding 62% sensitivity, 83% specificity and 78% classification accuracy). BBS score thresholds can therefore help clinicians choose the appropriate walking aid for patients with Guillain-Barré syndrome or polyneuropathy undergoing rehabilitation.

Conscious Postural Control During Standing on Compliant Surface by Older Adults

This study examined the real-time objective measurement of conscious postural control ("reinvestment") in older adults when standing on a compliant surface using electroencephalogram (EEG) coherence. Twenty-nine older adults participated in the study and their Alpha2 T3-Fz and Alpha2 T4-Fz EEG coherence during standing at three different positions on foam including wide-base standing on foam (WBF), narrow-base standing on foam (NBF) and tandem standing on foam (TAF) were measured. Participants were also required to respond to a Visual Analog Scale (VAS) to determine their perceived task difficulty after each standing position. Three 2 × 3 (Groups[low reinvestor, high reinvestor] × Standing positions[WBF, NBF, TAF]) analysis of variance (ANOVA) with repeated measures were conducted to determine differences between high and low reinvestors in three standing positions (WBF, NBF, TAF) at the primary outcome measures. The main effects of standing positions at VAS and Alpah2 T3-Fz EEG coherence were discovered but without interaction. The results suggested that when standing task difficulty increased, older adults generally elevated their real-time conscious postural control together with perceived task difficulty. It implicates that Alpha2 T3-Fz EEG coherence can be considered as a real-time objective conscious postural control measurement during balance assessment and rehabilitation if further large-scale studies could find its discriminative power between high and low reinvestors.

Efficacy of ankle control balance training on postural balance and gait ability in community-dwelling older adults: a single-blinded, randomized clinical trial

[Purpose] This study was conducted to investigate the effects of ankle control balance training (ACBT) on postural balance and gait ability in community-dwelling older adults. [Subjects and Methods] Fifty-four subjects were randomly divided into two groups, with 27 subjects in the ACBT group and 27 subjects in the control group. Subjects in the ACBT group received ACBT for 60 minutes, twice per week for 4 weeks, and all subjects had undergone fall prevention education for 60 minutes, once per week for 4 weeks. The main outcome measures, including the Berg balance scale; the functional reach test and one leg stance test for postural balance; and the timed up-and-go test and 10-meter walking test for gait ability, were assessed at baseline and after 4 weeks of training. [Results] The postural balance and gait ability in the ACBT group improved significantly compared to those in the control group, except BBS. [Conclusion] The results of this study showed improved postural balance and gait abilities after ACBT and that ACBT is a feasible method for improving postural balance and gait ability in community-dwelling older adults.

Assessing gait and balance impairment in elderly residents of nursing homes

[Purpose] The risk of falls in the elderly is an important public health problem. Suitable tests may help detect those at risk of falling. This study determined which balance test for older adults generates the most reliable results in terms of fall risk assessment, based on the number of falls over the last 12 months. [Subjects and Methods] A total of 153 individuals (31 males, 122 females, aged 76.67 ± 8.3 years; median 76.5, range 65–94) were investigated. The subjects were subdivided between fallers (a fall over the last 12 months) and non-fallers (no falls over the last 12 months). All participants were assessed with the following: Barthel Scale, Mini-Mental State Examination, Timed Up and Go, Tinetti Performance-Oriented Mobility Assessment), Berg Balance Test, and One-Legged Stance Test. [Results] Statistically significant differences were detected between fallers and non-fallers in TUG, POMA, BBS, and OLST scores. The number of falls correlated positively with the results for TUG, POMA, and OLST. [Conclusion] TUG and POMA were the most useful screening tests for balance and gait impairment in elderly nursing home residents. Two or more tests should be performed for more precise assessment of the risk of falling.

Are Changes in Gait and Balance Across the Disease Step Rating Scale in Multiple Sclerosis Statistically Significant and Clinically Meaningful?

OBJECTIVES

To explore differences in gait endurance, speed, and standing balance in people with multiple sclerosis (MS) across the Disease Step Rating Scale, and to determine if differences are statistically significant and clinically meaningful.

DESIGN

Observational study.

SETTING

Community rehabilitation - primary health care center.

PARTICIPANTS

Community-dwelling people with MS (N=222; mean age, 48±12y; 32% men).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Participants were categorized using the Disease Step Rating Scale. Demographics and clinical measures of gait endurance (6-minute walk test [6MWT]), gait speed (10-m walk test [10MWT] and 25-foot walk test [25FWT]), and balance (Berg Balance Scale [BBS]) were recorded in 1 session. Differences in these parameters across categories of the Disease Step Rating Scale were explored, and clinically meaningful differences were identified.

RESULTS

The 6MWT showed a greater number of significant differences across adjacent disease steps in those with less disability (P<.001), whereas the 10MWT and 25FWT demonstrated more significant changes in those with greater disability (P<.001). The BBS demonstrated significant differences across the span of the Disease Step Rating Scale categories (P<.001). Differences in gait and balance between adjacent Disease Step Rating Scale categories met most previously established levels of minimally detectable change and all minimally important change scores.

CONCLUSIONS

Our findings support the Disease Step Rating Scale is an observational tool that can be used by health professionals to categorize people with MS, with the categories reflective of statistically significant and clinically meaningful differences in gait and balance performance.

Influence of selective comorbidity predictors on functional recovery after hip fracture in an older population

AIM

The purpose of the study was to evaluate the influence of four comorbidities from the Cumulative Illness Rating Scale for Geriatrics (CIRS-G) and their severity on functional status outcome after a rehabilitation program measured by the Berg Balance Scale (BBS) in patients with hip fracture.

METHODS

The study included 203 patients whose functional status was evaluated by the BBS at admission (Group 1), at discharge (Group 2) and 3 months after discharge (Group 3). Further comorbidity parameters from the CIRS-G were assessed: musculoskeletal impairment, neurological, vascular and cognitive impairment. For the evaluation of CIRS-G severity degree we used the range 0-4.

RESULTS

At admission there were non-significant differences in mean values of BBS between parameters for the same CIRS-G severity degree. Significant differences between BBS values were noticed in the period after discharge (Group 2((musculoskeletal)); P<0.05, Group 2((neurological and cognitive)); P<0.01) and after 3 months of follow-up (Group 3((musculoskeletal, neurological and cognitive)); P<0.01). Higher effects of CIRS-G severity degree on BBS values in Group 2 and Group 3 for neurological impairment (η(2)(Group2)=29.76 and η(2)(Group3)=28.35) and even higher for cognitive impairment (η(2)(Group2)=34.35 and η(2)(Group3)=40.63) were noticed.

CONCLUSION

Increase in CIRS-G severity degree of cognitive and neurological impairment in patients after hip fracture that were included in the rehabilitation program correlates closely with functional status after discharge and after 3 months of follow-up. Rehabilitation of patients after hip fracture should be mandatory for functional recovery regardless of the comorbidity and functional status.