Validation of the Saskatoon Falls Prevention Consortium's Falls Screening and Referral Algorithm

KINECAL: A Dataset for Falls-Risk Assessment and Balance Impairment Analysis

The field of human action recognition has made great strides in recent years, much helped by the availability of a wide variety of datasets that use Kinect to record human movement. Conversely, progress towards the use of Kinect in clinical practice has been hampered by the lack of appropriate data. In particular, datasets that contain clinically significant movements and appropriate metadata. This paper proposes a dataset to address this issue, namely KINECAL. It contains the recordings of 90 individuals carrying out 11 movements, commonly used in the clinical assessment of balance. The dataset contains relevant metadata, including clinical labelling, falls history labelling and postural sway metrics. KINECAL should be of interest to researchers interested in the clinical use of motion capture and motion analysis.

Falls risk screening tools intended to reduce fall risk among independent community‐dwelling older adults: A systematic review

AIMS

The aim of this study is to evaluate an evidence-based fall risk screening tool to predict the risk of falls suitable for independent community-dwelling older adults guided by the World Health Organization's International Classification of Functioning, Disability and Health (WHO-ICF) components, and to examine the reliability and validity of the fall risk screening tool to predict fall risks, and to examine the feasibility of tools among independent community-dwelling older adults.

METHODS

A systematic literature search guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was performed using the EBSCOHost® platform, ScienceDirect, Scopus and Google Scholar between July and August 2021. Studies from January 2010 to January 2021 were eligible for review. Nine articles were eligible and included in this systematic review. The risk of bias assessment used the National Institutes of Health quality assessment tool for observational cohort and cross-sectional studies. The WHO-ICF helped to guide the categorization of fall risk factors.

RESULTS

Seven screening tools adequately predicted fall risk among community-dwelling older adults. Six screening tools covered most of the components of the WHO-ICF, and three screening tools omitted the environmental factors. The modified 18-item Stay Independent Brochure demonstrated most of the predictive values in predicting fall risk. All tools are brief and easy to use in community or outpatient settings.

CONCLUSION

The review explores the literature evaluating fall risk screening tools for nurses and other healthcare providers to assess fall risk among independent community-dwelling older adults. A fall risk screening tool consisting of risk factors alone might be able to predict fall risk. However, further refinements and validations of the tools before use are recommended.

Factors associated with screening positive for high falls risk in fragility fracture patients: a cross-sectional study

Background

We sought to report the prevalence of fragility fracture patients who were screened at high falls risk using a large provincial database, and to determine the characteristics associated with being screened at high falls risk.

Methods

The study population included fragility fracture patients 50+ years of age who were screened at 35 hospital fracture clinics in Ontario over a 3.5 year period. The outcome was based on two screening questions measuring the risk of falling, both adapted from the STEADI (Stopping Elderly Accidents, Deaths & Injuries) tool. Multivariable associations of sociodemographic, fracture-related, and health-related characteristics were evaluated using logistic regression.

Results

Of the sample, 9735 (44.5%) patients were classified as being at high falls risk, and 12,089 (55.3%) were not. In the multivariable logistic regression, being 80+ years of age (vs. 50–64 years of age), non-community dwelling (vs. living with spouse, family member, roommate), having a mental/physical impairment (vs. none), and taking multiple medications, were all strongly associated with being screened at high falls risk.

Conclusions

Living in a non-community dwelling and taking 4+ medications were the variables most strongly associated with being screened at high falls risk. These are potentially modifiable characteristics that should be considered when assessing falls risk in fragility fracture patients, and particularly when designing interventions for preventing subsequent falls. Ongoing work to address the higher risk of falls in the fragility fracture population is warranted.

Fall Prevention Program Characteristics and Experiences of Older Adults and Program Providers in Canada: A Thematic Content Analysis

Objectives: To document the characteristics of fall prevention programs in specific regions in two Canadian provinces and to explore older adults' and program providers' experiences with these programs. Methods: Semi-structured interviews were conducted with 16 program providers/managers from 12 different programs. Ten semi-structured focus groups were conducted with 59 older adults. Data were analyzed using thematic content analysis. Results: Older adults reported functional and social benefits. Program providers identified barriers to program success, including cognitive impairment, frailty, and lack of motivation. The need for general attitudinal changes toward older adults' needs and broader community changes were identified as important by the older adults. Discussion: Easily accessible information about fall prevention programs for older adults and no-cost, ongoing initiatives were critical. Health care providers play keys roles in disseminating information, facilitating referrals, and advocating for initiatives that best meet the needs of older adults in their communities.

Fear of falling and postural reactivity in patients with glaucoma

Purpose

To investigate the relationship between postural metrics obtained by dynamic visual stimulation in a virtual reality environment and the presence of fear of falling in glaucoma patients.

Methods

This cross-sectional study included 35 glaucoma patients and 26 controls that underwent evaluation of postural balance by a force platform during presentation of static and dynamic visual stimuli with head-mounted goggles (Oculus Rift). In dynamic condition, a peripheral translational stimulus was used to induce vection and assess postural reactivity. Standard deviations of torque moments (SDTM) were calculated as indicative of postural stability. Fear of falling was assessed by a standardized questionnaire. The relationship between a summary score of fear of falling and postural metrics was investigated using linear regression models, adjusting for potentially confounding factors.

Results

Subjects with glaucoma reported greater fear of falling compared to controls (-0.21 vs. 0.27; P = 0.039). In glaucoma patients, postural metrics during dynamic visual stimulus were more associated with fear of falling (R² = 18.8%; P = 0.001) than static (R² = 3.0%; P = 0.005) and dark field (R² = 5.7%; P = 0.007) conditions. In the univariable model, fear of falling was not significantly associated with binocular standard perimetry mean sensitivity (P = 0.855). In the multivariable model, each 1 Nm larger SDTM in anteroposterior direction during dynamic stimulus was associated with a worsening of 0.42 units in the fear of falling questionnaire score (P = 0.001).

Conclusion

In glaucoma patients, postural reactivity to a dynamic visual stimulus using a virtual reality environment was more strongly associated with fear of falling than visual field testing and traditional balance assessment.

Evaluation of Postural Control in Patients with Glaucoma Using a Virtual Reality Environment

PURPOSE

To evaluate postural control using a dynamic virtual reality environment and the relationship between postural metrics and history of falls in patients with glaucoma.

DESIGN

Cross-sectional study.

PARTICIPANTS

The study involved 42 patients with glaucoma with repeatable visual field defects on standard automated perimetry (SAP) and 38 control healthy subjects.

METHODS

Patients underwent evaluation of postural stability by a force platform during presentation of static and dynamic visual stimuli on stereoscopic head-mounted goggles. The dynamic visual stimuli presented rotational and translational ecologically valid peripheral background perturbations. Postural stability was also tested in a completely dark field to assess somatosensory and vestibular contributions to postural control. History of falls was evaluated by a standard questionnaire.

MAIN OUTCOME MEASURES

Torque moments around the center of foot pressure on the force platform were measured, and the standard deviations of the torque moments (STD) were calculated as a measurement of postural stability and reported in Newton meters (Nm). The association with history of falls was investigated using Poisson regression models. Age, gender, body mass index, severity of visual field defect, best-corrected visual acuity, and STD on dark field condition were included as confounding factors.

RESULTS

Patients with glaucoma had larger overall STD than controls during both translational (5.12 ± 2.39 Nm vs. 3.85 ± 1.82 Nm, respectively; P = 0.005) and rotational stimuli (5.60 ± 3.82 Nm vs. 3.93 ± 2.07 Nm, respectively; P = 0.022). Postural metrics obtained during dynamic visual stimuli performed better in explaining history of falls compared with those obtained in static and dark field condition. In the multivariable model, STD values in the mediolateral direction during translational stimulus were significantly associated with a history of falls in patients with glaucoma (incidence rate ratio, 1.85; 95% confidence interval, 1.30-2.63; P = 0.001).

CONCLUSIONS

The study presented and validated a novel paradigm for evaluation of balance control in patients with glaucoma on the basis of the assessment of postural reactivity to dynamic visual stimuli using a virtual reality environment. The newly developed metrics were associated with a history of falls and may help to provide a better understanding of balance control in patients with glaucoma.