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Zhang S, Chou LN, Swartz MD, Mehta HB, Goodwin JS, Kuo YF, Giordano SH, Tucker CA, Basen-Engquist KM, Lyons EJ, Downer B, Peterson SK, Cao T, Swartz MC. Association of cancer diagnosis with disability status among older survivors of colorectal cancer: a population-based retrospective cohort study. Front Oncol 2024; 14:1283252. [PMID: 38559557 PMCID: PMC10978737 DOI: 10.3389/fonc.2024.1283252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 01/29/2024] [Indexed: 04/04/2024] Open
Abstract
Background Older cancer survivors likely experience physical function limitations due to cancer and its treatments, leading to disability and early mortality. Existing studies have focused on factors associated with surgical complications and mortality risk rather than factors associated with the development of poor disability status (DS), a proxy measure of poor performance status, in cancer survivors. We aimed to identify factors associated with the development of poor DS among older survivors of colorectal cancer (CRC) and compare poor DS rates to an age-sex-matched, non-cancer cohort. Methods This retrospective cohort study utilized administrative data from the Texas Cancer Registry Medicare-linked database. The study cohort consisted of 13,229 survivors of CRC diagnosed between 2005 and 2013 and an age-sex-matched, non-cancer cohort of 13,225 beneficiaries. The primary outcome was poor DS, determined by Davidoff's method, using predictors from 12 months of Medicare claims after cancer diagnosis. Multivariable Cox proportional hazards regression was used to identify risk factors associated with the development of poor DS. Results Among the survivors of CRC, 97% were 65 years or older. After a 9-year follow-up, 54% of survivors of CRC developed poor DS. Significant factors associated with future poor DS included: age at diagnosis (hazard ratio [HR] = 3.50 for >80 years old), female sex (HR = 1.50), race/ethnicity (HR = 1.34 for Hispanic and 1.21 for Black), stage at diagnosis (HR = 2.26 for distant metastasis), comorbidity index (HR = 2.18 for >1), and radiation therapy (HR = 1.21). Having cancer (HR = 1.07) was significantly associated with developing poor DS in the pooled cohorts; age and race/ethnicity were also significant factors. Conclusions Our findings suggest that a CRC diagnosis is independently associated with a small increase in the risk of developing poor DS after accounting for other known factors. The study identified risk factors for developing poor DS in CRC survivors, including Hispanic and Black race/ethnicity, age, sex, histologic stage, and comorbidities. These findings underscore the importance of consistent physical function assessments, particularly among subsets of older survivors of CRC who are at higher risk of disability, to prevent developing poor DS.
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Affiliation(s)
- Shiming Zhang
- Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, United States
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Lin-Na Chou
- Department of Biostatistics and Data Science, The University of Texas Medical Branch, Galveston, TX, United States
| | - Michael D. Swartz
- Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, United States
| | - Hemalkumar B. Mehta
- Department of Epidemiology, John Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - James S. Goodwin
- Department of Internal Medicine, The University of Texas Medical Branch, Galveston, TX, United States
| | - Yong-Fang Kuo
- Department of Biostatistics and Data Science, The University of Texas Medical Branch, Galveston, TX, United States
| | - Sharon Hermes Giordano
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Carole A. Tucker
- Department of Physical Therapy, The University of Texas Medical Branch, Galveston, TX, United States
| | - Karen M. Basen-Engquist
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Elizabeth J. Lyons
- Department of Nutrition, Metabolism and Rehabilitation Sciences, The University of Texas Medical Branch, Galveston, TX, United States
| | - Brian Downer
- Department of Population Health and Health Disparities, The University of Texas Medical Branch, Galveston, TX, United States
| | - Susan K. Peterson
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Tru Cao
- Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, United States
| | - Maria C. Swartz
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
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Abstract
OBJECTIVES This study identifies differences in unmet mobility needs among older adults living in rural versus urban areas. METHODS We used data from Round 9 of the National Health and Aging Trends Study (NHATS), limiting our analyses to respondents who had not moved since baseline (average housing tenure of 27 years; n = 3343). We conducted bivariate and multivariate analyses to detect rural/urban differences in unmet mobility needs, adjusting for socio-demographics, health status, and housing characteristics. RESULTS Rural residence was associated with higher odds of any unmet mobility needs for older adults aging in place (adjusted odds ratio: 1.64, 95% confidence interval: 1.10-2.44, p < .05). The relationship between rurality and unmet needs for help with mobility limitations remained significant in fully adjusted models. DISCUSSION Rural older adults aging in place have greater unmet needs for help with mobility limitations. This study highlights several important gaps in supporting rural older adults aging in place.
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Affiliation(s)
- Carrie Henning-Smith
- Rural Health Research Center, Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Megan Lahr
- Rural Health Research Center, Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - John Mulcahy
- Rural Health Research Center, Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
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Harrison TC, Taylor JL, Johnson A, Ortega LC, Lowe J, Blozis S. The Life-Course Perspectives of Mexican American Men With Mobility Limitation. Qual Health Res 2023; 33:897-910. [PMID: 37420336 PMCID: PMC10564382 DOI: 10.1177/10497323231170157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/09/2023]
Abstract
The life-history narratives of 10 Mexican American men with mobility limitations, age 55-77 years (mean = 63.8, SD = 5.8), were explored using a qualitatively driven, life-history mixed-methods study to understand perceptions of mobility limitations over the life course. Within that methodological and paradigmatic framework, conceptualizations of alterity and masculinity guided interpretation of data. Through an iterative, thematic analysis, we detail the way the men's lives were influenced by growing familial responsibility with age. Quantitative data were integrated into themes of narrative inheritance, family, and masculinity. It was posited that masculinity with mobility limitations shaped and was shaped by ethnic identity and responsibility. This has implications for understanding the experience of Mexican American men over the life course.
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Ortiz-Corredor F, Sandoval-Salcedo A, Soto D, Camacho M, Perico H, Gil-Salcedo A. Physical capacity tests as a complement in the evaluation of the level of disability in women with fibromyalgia: A cross-sectional study. Int J Rheum Dis 2023. [PMID: 37098716 DOI: 10.1111/1756-185x.14715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 03/22/2023] [Accepted: 04/16/2023] [Indexed: 04/27/2023]
Abstract
INTRODUCTION The association between motor capacity and the level of disability in patients with fibromyalgia remains underexplored. This study aims to explore the association between physical capacity tests explored in the consultation and the level of disability in women with fibromyalgia. METHODS There were 484 women diagnosed with fibromyalgia who were evaluated with 7 physical capacity tests: 10-m walk, 2-minute walk, 5-repetition getting up from a chair and sitting (G&S), 30-second chair stand, monopodal balance (right and left), and up-and-go. Functional performance was assessed with the Revised Fibromyalgia Impact Questionnaire (FIQR). Evaluation of the association between the physical capacity tests and the FIQR was initially performed using a principal component analysis (PCA). Subsequently, agglomerative hierarchical clustering (AHC) was performed in order to characterize groups of patients. RESULTS Results show than FIQR and the tests 10-m walk, 2-minute walk, 5-repetition G&S, 30-second chair stand, and up-and-go test were correlated. The results of the AHC determined 3 groups of patients mainly on one motor dimension with significant differences in both the FIQR and the physical capacity tests retained in the PCA (P < 0.001 for all). CONCLUSION The application of these physical tests is simple, fast and can be a complement to the FIQR questionnaire when determining the level of disability of patients with fibromyalgia, in addition to providing information on the evolution of the patients when these tests are administered in the clinical consultation.
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Affiliation(s)
- Fernando Ortiz-Corredor
- Departamento de Rehabilitación, Instituto Roosevelt, Bogota, Colombia
- Departamento de Medicina Física y Rehabilitación, Universidad Nacional de Colombia, Bogota, Colombia
| | - Andrés Sandoval-Salcedo
- Departamento de Medicina Física y Rehabilitación, Universidad Nacional de Colombia, Bogota, Colombia
| | - Diana Soto
- Departamento de Rehabilitación, Instituto Roosevelt, Bogota, Colombia
| | - María Camacho
- Departamento de Rehabilitación, Instituto Roosevelt, Bogota, Colombia
| | - Hugo Perico
- Departamento de Rehabilitación, Instituto Roosevelt, Bogota, Colombia
- Departamento de Medicina Física y Rehabilitación, Universidad Nacional de Colombia, Bogota, Colombia
| | - Andres Gil-Salcedo
- Epidemiology of Ageing & Neurodegenerative Diseases, Inserm UMR 1153: CREES, Université de Paris, Paris, France
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Schmidt LI, Wagner M, Büßecker HA, Franke AA. Who uses technical aids in old age? Exploring the implementation of technology-based home modifications in Europe. Front Public Health 2023; 11:1130177. [PMID: 37064714 PMCID: PMC10099246 DOI: 10.3389/fpubh.2023.1130177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 02/28/2023] [Indexed: 04/18/2023] Open
Abstract
Introduction Home modifications and features, e.g., handrails or ramps for people using wheelchairs, should allow residents with functional limitations to maintain social participation, health, and wellbeing for aging in place. However, there is little evidence in relation to the individual characteristics shaping this implementation of technology-based home modifications. Current studies often focus on describing the distribution of certain implementations in households but do not provide information on factors predicting the implementation or detailed and multifaceted data on associations with characteristics of the older user. This article, therefore, examines the use of well-established technological aids and home modifications (e.g., ramps, handrails, automatic doors, bathroom or kitchen modifications, chair lifts, and alerting devices) in the households of older adults in Europe. We refer to Lawton's and Nahemow's concept of personal-environment fit and describe the use of technical aids across 18 countries, analyze associations with individual characteristics and social resources, and compare those associations and variance explanation between older adults in their third age ("young-old", 65-79 years) and older adults in their fourth age ("old-old", 80+). Methods Drawing on representative data from the Survey of Health, Ageing, and Retirement in Europe (SHARE), wave 6, a total of N = 38,553 older adults aged 65-105 years (M = 74.4 years, SD = 7.1; 55% women) were analyzed by performing hierarchical logistic regression analyses. Results Indicators of functioning explained the highest proportion of variance, followed by social resources, and variance explanation was higher for the fourth age than for the third age. In particular, older adults with physical limitations, a larger social network, and those who received care from a child outside the household were more likely to have home modifications installed. Discussion The study provides an overview of associations of diverse variables with assistive devices and modifications in the home and can serve as a starting point for public health activities concerning the heterogeneity of people aged 65 years and older.
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Affiliation(s)
- Laura I. Schmidt
- Institute of Psychology, Heidelberg University, Heidelberg, Germany
- Laura I. Schmidt
| | - Melanie Wagner
- Max Planck Institute for Social Law and Social Policy, Max Planck Society Munich, Munich, Germany
| | | | - Annette A. Franke
- Department of Social Work, Protestant University of Applied Sciences Ludwigsburg, Ludwigsburg, Germany
- *Correspondence: Annette A. Franke
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Bansal K, Clark DJ, Fox EJ, Conroy C, Freeborn P, Rose DK. Spatiotemporal strategies adopted to walk at fast speed in high- and low-functioning individuals post-stroke: a cross-sectional study. Top Stroke Rehabil 2023; 30:1-10. [PMID: 36524626 DOI: 10.1080/10749357.2021.2008593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Walking at fast speed is a gait training strategy post-stroke. It is unknown how faster-than-preferred pace impacts spatiotemporal gait characteristics in survivors with different functional abilities. OBJECTIVE To test the hypothesis that compared to high-functioning individuals, low-functioning individuals will be limited in modifying spatiotemporal gait parameters for walking at faster-than-preferred speed, and these limitations are associated with fear of falling. METHODS Forty-two adults, 17.6 ± 14.6 months post-stroke, traversed an instrumented walkway at preferred and fast speeds. Participants were categorized to a low-functioning group (LFG) (n = 20; <0.45 m/s) and high-functioning group (HFG) (n = 22; ≥0.45 m/s). Cadence, step length, stance time and spatiotemporal asymmetry measures were calculated. The Modified Falls-efficacy Scale examined fear of falling. Multivariate and correlational analysis tested hypotheses. RESULTS Increased speed from preferred to fast pace was significantly greater for HFG (0.27 ± 0.03 m/s) than LFG (0.10 ± 0.02 m/s) (p ≤ 0.001). Cadence gain from preferred to fast pace did not differ between groups. However, HFG exhibited greater change in paretic (∆6.1 ± 1.37 cm; p < .001) and non-paretic step lengths (∆4.5 ± 1.37 cm; p = .003) than LFG. Spatiotemporal asymmetry did not change for either group. Fear of falling had moderately positive correlation with ∆paretic step length (r = 0.43; p = .004) and ∆non-paretic step length (r = 0.32; p = .035). CONCLUSIONS While both low- and high-functioning individuals used a step-lengthening strategy to walk at faster-than-preferred speeds, the gain in step lengths was limited in low-functioning individuals and was partially explained by falls-efficacy.
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Affiliation(s)
- Kanika Bansal
- Department of Physical Therapy, University of Florida, Gainesville, FL.,Brooks Rehabilitation, Clinical Research Center, Jacksonville, FL
| | - David J Clark
- Department of Physical Therapy, University of Florida, Gainesville, FL.,Malcom Randall VAMC, Brain Rehabilitation Center, Gainesville, FL
| | - Emily J Fox
- Department of Physical Therapy, University of Florida, Gainesville, FL.,Brooks Rehabilitation, Clinical Research Center, Jacksonville, FL
| | - Christy Conroy
- Brooks Rehabilitation, Clinical Research Center, Jacksonville, FL
| | | | - Dorian K Rose
- Department of Physical Therapy, University of Florida, Gainesville, FL.,Brooks Rehabilitation, Clinical Research Center, Jacksonville, FL.,Malcom Randall VAMC, Brain Rehabilitation Center, Gainesville, FL
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Appleby R, Wright S, Williams L, Stanley M. Australian parents' experiences of owning an autism assistance dog. Health Soc Care Community 2022; 30:e4113-e4121. [PMID: 35352418 PMCID: PMC10084065 DOI: 10.1111/hsc.13805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 01/14/2022] [Accepted: 03/10/2022] [Indexed: 06/14/2023]
Abstract
Autism assistance dogs (AADs) increase safety for children with autism and their families. Autism assistance dogs can also decrease familial stress and the isolation which families may experience due to fear for their child's safety and judgement from others within the community. Currently there is a paucity of literature on parents' experiences of AADs. Therefore, this study aimed to develop a rich understanding of parents' experiences of owning an AAD. A mixed methods design was utilised, with a qualitative descriptive design and the use of occupational mapping. Eight families were recruited through an Australian AAD programme and participated in semi-structured in-depth interviews throughout 2017. The interviews were analysed thematically. Mobility in the community before and after introduction of the dog was measured using occupational mapping. Families plotted on Google Map printouts the places they frequented before and after placement of their dog. Five major themes emerged from the analysis of the interviews: freedom through restraint; expanding our world; a calming/sensory tool (AAD); "at the end of the day they're dogs"; and, friendship and personal growth. The occupational maps demonstrated a median increase of 8.5 more places and 20.50 km further travelled from home after having the dog for over a year. Families with an AAD experienced an expanded world for the child and their family. Families experienced freedom in the places they could go, decreased isolation due to the safety which the dog provides. Occupational mapping supported the qualitative data, showing increased mobility and decreased isolation of the family. The paradox of freedom through restraint is a new and key finding which requires further exploration. The results provide support for funding and increased awareness of AAD programmes. Future longitudinal comparative studies are needed to explore the long-term impact of AADs on the child and family.
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Affiliation(s)
- Rebecca Appleby
- Allied Health and Human PerformanceUniversity of South AustraliaAdelaideSouth AustraliaAustralia
- Present address:
Novita422 Salisbury HighwayParafield GardensSouth AustraliaAustralia
| | - Shelley Wright
- Allied Health and Human PerformanceUniversity of South AustraliaAdelaideSouth AustraliaAustralia
| | - Lindy Williams
- Allied Health and Human PerformanceUniversity of South AustraliaAdelaideSouth AustraliaAustralia
| | - Mandy Stanley
- Allied Health and Human PerformanceUniversity of South AustraliaAdelaideSouth AustraliaAustralia
- Present address:
Occupational TherapySchool of Medical and Health SciencesEdith Cowan UniversityPerthWestern AustraliaAustralia
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Thalmann M, Ringli L, Adcock M, Swinnen N, de Jong J, Dumoulin C, Guimarães V, de Bruin ED. Usability Study of a Multicomponent Exergame Training for Older Adults with Mobility Limitations. Int J Environ Res Public Health 2021; 18:ijerph182413422. [PMID: 34949028 PMCID: PMC8705921 DOI: 10.3390/ijerph182413422] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 12/08/2021] [Accepted: 12/14/2021] [Indexed: 11/28/2022]
Abstract
The global population aged 60 years and over rises due to increasing life expectancy. More older adults suffer from “geriatric giants”. Mobility limitations, including immobility and instability, are usually accompanied by physical and cognitive decline, and can be further associated with gait changes. Improvements in physical and cognitive functions can be achieved with virtual reality exergame environments. This study investigated the usability of the newly developed VITAAL exergame in mobility-impaired older adults aged 60 years and older. Usability was evaluated with a mixed-methods approach including a usability protocol, the System Usability Scale, and a guideline-based interview. Thirteen participants (9 female, 80.5 ± 4.9 years, range: 71–89) tested the exergame and completed the measurement. The System Usability Scale was rated in a marginal acceptability range (58.3 ± 16.5, range: 30–85). The usability protocol and the guideline-based interview revealed general positive usability. The VITAAL exergame prototype received positive feedback and can be considered usable by older adults with mobility limitations. However, minor improvements to the system in terms of design, instructions, and technical aspects should be taken into account. The results warrant testing of the feasibility of the adapted multicomponent VITAAL exergame, and its effects on physical and cognitive functions, in comparison with conventional training, should be studied.
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Affiliation(s)
- Melanie Thalmann
- Department of Health Sciences and Technology, Institute of Human Movement Science and Sport, ETH Zürich, 8093 Zurich, Switzerland; (M.T.); (L.R.); (M.A.)
| | - Lisa Ringli
- Department of Health Sciences and Technology, Institute of Human Movement Science and Sport, ETH Zürich, 8093 Zurich, Switzerland; (M.T.); (L.R.); (M.A.)
| | - Manuela Adcock
- Department of Health Sciences and Technology, Institute of Human Movement Science and Sport, ETH Zürich, 8093 Zurich, Switzerland; (M.T.); (L.R.); (M.A.)
| | - Nathalie Swinnen
- Department of Rehabilitation Sciences, KU Leuven, 3001 Leuven, Belgium;
- University Psychiatric Centre, KU Leuven, 3070 Kortenberg, Belgium
| | | | - Chantal Dumoulin
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, QC H3T 1J4, Canada;
| | | | - Eling D. de Bruin
- Department of Health Sciences and Technology, Institute of Human Movement Science and Sport, ETH Zürich, 8093 Zurich, Switzerland; (M.T.); (L.R.); (M.A.)
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, 171 77 Stockholm, Sweden
- Department of Health, OST—Eastern Swiss University of Applied Sciences, 9001 St. Gallen, Switzerland
- Correspondence: ; Tel.: +41-44-632-40-18
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Wang F, Qin W, Yu J. Neighborhood Social Cohesion and Mobility Limitations Among Community-dwelling Older Americans: The Mediating Roles of Depressive Symptoms and Mastery. Int J Aging Hum Dev 2021; 94:290-311. [PMID: 34409865 DOI: 10.1177/00914150211037657] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Neighborhood environment plays an important role in late-life health; yet, the social aspect of neighborhood environment and its impact on mobility limitations have rarely been examined. This nonexperimental, cross-sectional study examines the relationship between neighborhood social cohesion and mobility limitations and the potential mediators (i.e., depressive symptoms, mastery) of this relationship. A total of 8,317 Americans aged 65 years and older were selected from the Health and Retirement Study. Using ordinary least squares regressions, this study shows that neighborhood social cohesion was negatively associated with mobility limitations (B = -0.04, p < .01). A Sobel test of mediation indicated that this relationship was significantly mediated by depressive symptoms (z = -9.10, p < .001) and mastery (z = -8.86, p < .001). Findings suggest that neighborhood cohesion can reduce mobility limitations through mitigating depressive symptoms and increasing mastery. Future research should disentangle the temporal ordering of the mediators.
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Affiliation(s)
- Fei Wang
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, 114588Case Western Reserve University, Cleveland, OH, USA
| | - Weidi Qin
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, 114588Case Western Reserve University, Cleveland, OH, USA
| | - Jiao Yu
- Department of Sociology, College of Arts and Sciences, 142585Case Western Reserve University, Cleveland, OH, USA
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Cheng JM, Batten GP, Cornwell T, Yao N. A qualitative study of health-care experiences and challenges faced by ageing homebound adults. Health Expect 2020; 23:934-942. [PMID: 32476232 PMCID: PMC7495080 DOI: 10.1111/hex.13072] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The ageing of the global population is associated with an increasing prevalence of chronic diseases and functional impairments, resulting in a greater proportion of homebound individuals. OBJECTIVE To examine the health-care experiences of older homebound adults who have not previously received home-based primary care (HBPC). To explore their impressions of this method of care. DESIGN Cross-sectional qualitative study using semi-structured interviews. SETTING AND PARTICIPANTS 18 older homebound individuals in Central Virginia. RESULTS Our findings revealed that homebound individuals faced significant health challenges, including pain resulting from various comorbidities. They felt that their mobility was restricted by their physical conditions and transportation challenges. These were major barriers to social outings and health-care access. Participants left their homes infrequently and typically with assistance. Regarding office-based care, participants were concerned about long wait times and making timely appointments. Some thought that HBPC would be convenient and could result in better quality care; however, others believed that the structure of the health-care system and its focus on efficiency would not permit routine HBPC. DISCUSSION AND CONCLUSIONS Older homebound adults in this study faced high burdens of disease, a lack of mobility and difficulty accessing quality health care. Our observations may help researchers and clinicians better understand the health-care experiences and personal opinions of older homebound individuals, informing the development of effective and empathetic home-based care. Participant responses illuminated a need for education about HBPC. We must improve health-care delivery and develop comprehensive, patient-centered HBPC to meet the needs of homebound individuals.
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Affiliation(s)
- Joyce M. Cheng
- University of Virginia College of Arts and SciencesCharlottesvilleVAUnited States
- Shandong University School of Health Care Management (NHC Key Laboratory of Health Economics and Policy Research)JinanChina
| | - George P. Batten
- University of Virginia Cancer CenterCharlottesvilleVAUnited States
| | | | - Nengliang Yao
- Shandong University School of Health Care Management (NHC Key Laboratory of Health Economics and Policy Research)JinanChina
- Home Centered Care InstituteSchaumburgILUnited States
- University of Virginia School of MedicineCharlottesvilleVAUnited States
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Koenders N, Weenk M, van de Belt TH, van Goor H, Hoogeboom TJ, Bredie SJH. Exploring barriers to physical activity of patients at the internal medicine and surgical wards: a retrospective analysis of continuously collected data. Disabil Rehabil 2019; 43:1883-1889. [PMID: 31691603 DOI: 10.1080/09638288.2019.1685013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE To analyse physical activity of patients during their hospital stay and to explore the relationship between physical activity and barriers to physical activity. METHODS This was a secondary analysis of physical activity data for patients admitted to the internal medicine and surgical wards. Physical activity data, collected with a wireless patch sensor, was operationalized as time spent lying, sitting/standing, and walking. Barriers to physical activity included patients' pain levels, the use of urinary catheters, intravenous tubing, oxygen lines, drains, and level of dependence. Regression analysis explored the relationship between physical activity and barriers to physical activity. RESULTS Physical activity data were collected in 39 patients (aged 27-88, mean 54 years) during hospital stay. Patients were admitted for a median of 10 d (interquartile range [IQR]: 7-15 d). These patients were lying for a median of 12.1 h (7.6-17.7), sitting/standing 11.8 h (6.3-15.7), and walking 0.1 h (0-0.3) per day. Time lying during the day related to pain levels (β = 0.4 h per unit increase in pain, p < 0.01) and drain use (β = 3.1 h, p < 0.01). CONCLUSIONS Patients spent the most time during the hospital stay lying in bed. Improved pain management and decreased drain use may be worth exploring to increase inpatient physical activity.Implications for rehabilitationContinuous monitoring of physical activity in patients during hospital stay is an important tool for health care professionals to improve multidisciplinary care and rehabilitation.Health care professionals should be aware of the necessity of adequate pain management and critically review the use of drains in order to improve physical activity of patients during hospital stay.Patients need extra support of health care professionals to increase physical activity during consecutive days of their hospital stay.
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Affiliation(s)
- Niek Koenders
- Department of Rehabilitation - Physical Therapy, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mariska Weenk
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tom H van de Belt
- Radboud Reshape Innovation Centre, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Harry van Goor
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Thomas J Hoogeboom
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sebastian J H Bredie
- Department of Internal Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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Camp PG, Sima CA, Kirkham A, Inskip JA, Parappilly B. The de Morton mobility index is a feasible and valid mobility assessment tool in hospitalized patients with an acute exacerbation of chronic obstructive pulmonary disease. Chron Respir Dis 2019; 16:1479973119872979. [PMID: 31526037 PMCID: PMC6747857 DOI: 10.1177/1479973119872979] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
There is no accepted standard for measuring mobility in hospitalized patients with an acute exacerbation of chronic obstructive pulmonary disease (AECOPD). The objective of this study was to assess convergent, discriminant, and known-group validity and floor/ceiling effects of the de Morton Mobility Index (DEMMI) in hospitalized patients with AECOPD. Individuals with AECOPD (n = 22) admitted to an acute care hospital medical ward were recruited. Data on the DEMMI, gait speed, daytime energy expenditure, step counts, 6-minute walk distance (6MWD), dyspnea, respiratory and heart rates, quality of life, and oxygen supplementation were collected on day 3 of admission. The DEMMI demonstrated convergent validity with the 6MWD and gait velocity measures (Spearman's ρ 0.69 and 0.61, respectively; p < 0.003) but not with measures of physical activity or respiratory impairment. Discriminant validity was present, with no correlation between the DEMMI and quality of life and resting heart rate. Known-group validity (gait aids vs. no gait aids) was demonstrated (p = 0.009). There was no floor effect but there was evidence of a possible ceiling effect (14% of participants received a perfect score). The DEMMI is feasible and showed moderate to strong validity with measures of observed physical function in hospitalized patients with AECOPD.
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Affiliation(s)
- Pat G Camp
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, Canada.,Department of Physical Therapy, Vancouver, Canada
| | - Carmen A Sima
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, Canada
| | - Ashley Kirkham
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, Canada
| | - Jessica A Inskip
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, Canada
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Jacobs SS, Lindell KO, Collins EG, Garvey CM, Hernandez C, McLaughlin S, Schneidman AM, Meek PM. Patient Perceptions of the Adequacy of Supplemental Oxygen Therapy. Results of the American Thoracic Society Nursing Assembly Oxygen Working Group Survey. Ann Am Thorac Soc 2018; 15:24-32. [PMID: 29048941 DOI: 10.1513/AnnalsATS.201703-209OC] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE Pulmonary clinicians and patients anecdotally report barriers to home supplemental oxygen services including inadequate supply, unacceptable portable options, and equipment malfunction. Limited evidence exists to describe or quantify these problems. OBJECTIVES To describe the frequency and type of problems experienced by supplemental oxygen users in the United States. METHODS The Patient Supplemental Oxygen Survey, a self-report questionnaire, was posted on the American Thoracic Society Public Advisory Roundtable and patient and health care-affiliated websites. Respondents were invited to complete the questionnaire, using targeted e-mail notifications. Data were analyzed using descriptive statistics, paired t tests, and χ2 analysis. RESULTS In total, 1,926 responses were analyzed. Most respondents reported using oxygen 24 h/d, for 1-5 years, and 31% used high flow with exertion. Oxygen use varied, with only 29% adjusting flow rates based on oximeter readings. The majority (65%) reported not having their oxygen saturation checked when equipment was delivered. Sources of instruction included the delivery person (64%), clinician (8%), and no instruction (10%). Approximately one-third reported feeling "very" or "somewhat" unprepared to operate their equipment. Fifty-one percent of the patients reported oxygen problems, with the most frequent being equipment malfunction, lack of physically manageable portable systems, and lack of portable systems with high flow rates. Most respondents identified multiple problems (average, 3.6 ± 2.3; range, 1-12) in addition to limitations in activities outside the home because of inadequate portable oxygen systems (44%). Patients living in Competitive Bidding Program areas reported oxygen problems more often than those who did not (55% [389] vs. 45% [318]; P = 0.025). Differences in sample characteristics and oxygen problems were noted across diagnostic categories, with younger, dyspneic, high-flow users, and respondents who did not receive oxygen education, relating more oxygen problems. Respondents reporting oxygen problems also experienced increased health care resource utilization. CONCLUSIONS Supplemental oxygen users experience frequent and varied problems, particularly a lack of access to effective instruction and adequate portable systems. Initiatives by professional and patient organizations are needed to improve patient education, and to promote access to equipment and services tailored to each patient's needs.
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Abstract
As life expectancy and obesity increase in low and middle-income countries, the relationship of weight status to functional outcomes in older adults in these settings requires attention. We examined how overweight (BMI > 25 kg/m2), obesity (BMI > 30 kg/m2), and high waist circumference (WC > 80 cm) related to grip strength, timed up-and-go, and development of limitations in mobility, activities of daily living (ADL), and instrumental activities of daily living (IADL) among Filipino women. We analyzed data from seven rounds of the Cebu Longitudinal Health and Nutrition Survey (1994, n = 2279 to 2015, n = 1568, age 49–78 years) to examine how women’s reports of functional limitations related to their prior WC, and how their grip strength and timed up-and-go related to concurrently measured overweight and obesity, adjusted for age, socioeconomic status, and urbanicity. High WC was associated with higher odds of subsequent mobility and IADL limitations. Chronic disease morbidity (sum of self-reported arthritis, high blood pressure, heart disease, diabetes, and cancer) fully mediated the association of high WC with ADL and IADL limitations, but not physical/mobility limitations. Longer up-and-go times, and higher grip strength were related to overweight and obesity. Results emphasize the need for obesity prevention to reduce chronic diseases and maintain good functional status as women age.
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Affiliation(s)
- Linda S. Adair
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Correspondence: (L.S.A.); (J.B.B.); Tel.: +1-919-962-6154 (L.S.A.); +63-32-346-0102 (J.B.B.); Fax: +1-919-966-9159 (L.S.A.)
| | - Paulita Duazo
- USC-Office of Population Studies Foundation, Inc., University of San Carlos, Nasipit, Talamban, Cebu City 6000, The Philippines;
| | - Judith B. Borja
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- USC-Office of Population Studies Foundation, Inc., University of San Carlos, Nasipit, Talamban, Cebu City 6000, The Philippines;
- Department of Nutrition and Dietetics, University of San Carlos, Nasipit, Talamban, Cebu City 6000, The Philippines
- Correspondence: (L.S.A.); (J.B.B.); Tel.: +1-919-962-6154 (L.S.A.); +63-32-346-0102 (J.B.B.); Fax: +1-919-966-9159 (L.S.A.)
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Bishop NJ, Zuniga KE, Lucht AL. Latent Profiles of Macronutrient Density and their Association with Mobility Limitations in an Observational Longitudinal Study of Older U.S. Adults. J Nutr Health Aging 2018; 22:645-654. [PMID: 29806853 DOI: 10.1007/s12603-017-0986-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVES Our first objective was to estimate empirically-derived subgroups (latent profiles) of observed carbohydrate, protein, and fat intake density in a nationally representative sample of older U.S. adults. Our second objective was to determine whether membership in these groups was associated with levels of, and short term change in, physical mobility limitations. DESIGN AND SETTING Measures of macronutrient density were taken from the 2013 Health Care and Nutrition Study, an off-year supplement to the Health and Retirement Study, which provided indicators of physical mobility limitations and sociodemographic and health-related covariates. PARTICIPANTS 3,914 community-dwelling adults age 65 years and older. MEASUREMENTS Percent of daily calories from carbohydrate, protein, and fat were calculated based on responses to a modified Harvard food frequency questionnaire. Latent profile analysis was used to describe unobserved heterogeneity in measures of carbohydrate, protein, and fat density. Mobility limitation counts were based on responses to 11 items indicating physical limitations. Poisson regression models with autoregressive controls were used to identify associations between macronutrient density profile membership and mobility limitations. Sociodemographic and health-related covariates were included in all Poisson regression models. RESULTS Four latent subgroups of macronutrient density were identified: "High Carbohydrate", "Moderate with Fat", "Moderate", and "Low Carbohydrate/High Fat". Older adults with the lowest percentage of daily calories coming from carbohydrate and the greatest percentage coming from fat ("Low Carbohydrate/High Fat") were found to have greater reported mobility limitations in 2014 than those identified as having moderate macronutrient density, and more rapid two-year increases in mobility limitations than those identified as "Moderate with Fat" or "Moderate". CONCLUSION Older adults identified as having the lowest carbohydrate and highest fat energy density were more likely to report a greater number of mobility limitations and experience greater increases in these limitations than those identified as having moderate macronutrient density. These results suggest that the interrelation of macronutrients must be considered by those seeking to reduce functional limitations among older adults through dietary interventions.
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Affiliation(s)
- N J Bishop
- Nicholas Joseph Bishop, Texas State University, San Marcos, Texas, USA, (512) 245-7051,
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Beltrán-Sánchez H, Pebley A, Goldman N. Links between Primary Occupation and Functional Limitations among Older Adults in Mexico. SSM Popul Health 2017; 3:382-392. [PMID: 29085879 PMCID: PMC5659182 DOI: 10.1016/j.ssmph.2017.04.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 03/31/2017] [Accepted: 04/03/2017] [Indexed: 10/27/2022] Open
Abstract
Social inequalities in health and disability are often attributed to differences in childhood adversity, access to care, health behavior, residential environments, stress, and the psychosocial aspects of work environments. Yet, disadvantaged people are also more likely to hold jobs requiring heavy physical labor, repetitive movement, ergonomic strain, and safety hazards. We investigate the role of physical work conditions in contributing to social inequality in mobility among older adults in Mexico, using data from the Mexican Health and Aging Survey (MHAS) and an innovative statistical modeling approach. We use data on categories of primary adult occupation to serve as proxies for jobs with more or less demanding physical work requirements. Our results show that more physically demanding jobs are associated with mobility limitations at older ages, even when we control for age and sex. Inclusion of job categories attenuates the effects of education and wealth on mobility limitations, suggesting that physical work conditions account for at least part of the socioeconomic differentials in mobility limitations in Mexico.
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Affiliation(s)
- Hiram Beltrán-Sánchez
- Department of Community Health Sciences, Fielding School of Public Health, California Center for Population Research, University of California, Los Angeles, 650 Charles E. Young Dr, 41-257 CHS, Los Angeles, CA 90095-1772, USA
| | - Anne Pebley
- Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, 650 Charles E. Young Dr, Los Angeles, CA 90095-1772, USA
| | - Noreen Goldman
- Office of Population Research, Princeton University, 243 Wallace Hall, Princeton, NJ 08544, USA
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Rafferty MR, Schmidt PN, Luo ST, Li K, Marras C, Davis TL, Guttman M, Cubillos F, Simuni T. Regular Exercise, Quality of Life, and Mobility in Parkinson's Disease: A Longitudinal Analysis of National Parkinson Foundation Quality Improvement Initiative Data. J Parkinsons Dis 2017; 7:193-202. [PMID: 27858719 DOI: 10.3233/jpd-160912] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Research-based exercise interventions improve health-related quality of life (HRQL) and mobility in people with Parkinson's disease (PD). OBJECTIVE To examine whether exercise habits were associated with changes in HRQL and mobility over two years. METHODS We identified a cohort of National Parkinson Foundation Quality Improvement Initiative (NPF-QII) participants with three visits. HRQL and mobility were measured with the Parkinson's Disease Questionnaire (PDQ-39) and Timed Up and Go (TUG). We compared self-reported regular exercisers (≥2.5 hours/week) with people who did not exercise 2.5 hours/week. Then we quantified changes in HRQL and mobility associated with 30-minute increases in exercise, across PD severity, using mixed effects regression models. RESULTS Participants with three observational study visits (n = 3408) were younger, with milder PD, than participants with fewer visits. After 2 years, consistent exercisers and people who started to exercise regularly after their baseline visit had smaller declines in HRQL and mobility than non-exercisers (p < 0.05). Non-exercisers worsened by 1.37 points on the PDQ-39 and a 0.47 seconds on the TUG per year. Increasing exercise by 30 minutes/week was associated with slower declines in HRQL (-0.16 points) and mobility (-0.04 sec). The benefit of exercise on HRQL was greater in advanced PD (-0.41 points) than mild PD (-0.14 points; p < 0.02). CONCLUSIONS Consistently exercising and starting regular exercise after baseline were associated with small but significant positive effects on HRQL and mobility changes over two years. The greater association of exercise with HRQL in advanced PD supports improving encouragement and facilitation of exercise in advanced PD.
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Affiliation(s)
- Miriam R Rafferty
- Center for Education in Health Sciences Northwestern University, Chicago, IL, USA
| | | | - Sheng T Luo
- Department of Biostatistics, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Kan Li
- Department of Biostatistics, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Connie Marras
- Morton and Gloria Shulman Movement Disorders Centre and the Edmond J Safra Program in Parkinson's disease, Toronto Western Hospital, University of Toronto, Toronto, Canada
| | - Thomas L Davis
- Thomas L. Davis, Division of Movement Disorders, Department of Neurology, Vanderbilt University, Nashville, TN, USA
| | - Mark Guttman
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Canada
| | | | - Tanya Simuni
- Department of Neurology, Northwestern University, Chicago, IL, USA
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Alinia P, Cain C, Fallahzadeh R, Shahrokni A, Cook D, Ghasemzadeh H. How Accurate Is Your Activity Tracker? A Comparative Study of Step Counts in Low-Intensity Physical Activities. JMIR Mhealth Uhealth 2017; 5:e106. [PMID: 28801304 PMCID: PMC5572056 DOI: 10.2196/mhealth.6321] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 02/07/2017] [Accepted: 05/11/2017] [Indexed: 11/23/2022] Open
Abstract
Background As commercially available activity trackers are being utilized in clinical trials, the research community remains uncertain about reliability of the trackers, particularly in studies that involve walking aids and low-intensity activities. While these trackers have been tested for reliability during walking and running activities, there has been limited research on validating them during low-intensity activities and walking with assistive tools. Objective The aim of this study was to (1) determine the accuracy of 3 Fitbit devices (ie, Zip, One, and Flex) at different wearing positions (ie, pants pocket, chest, and wrist) during walking at 3 different speeds, 2.5, 5, and 8 km/h, performed by healthy adults on a treadmill; (2) determine the accuracy of the mentioned trackers worn at different sites during activities of daily living; and (3) examine whether intensity of physical activity (PA) impacts the choice of optimal wearing site of the tracker. Methods We recruited 15 healthy young adults to perform 6 PAs while wearing 3 Fitbit devices (ie, Zip, One, and Flex) on their chest, pants pocket, and wrist. The activities include walking at 2.5, 5, and 8 km/h, pushing a shopping cart, walking with aid of a walker, and eating while sitting. We compared the number of steps counted by each tracker with gold standard numbers. We performed multiple statistical analyses to compute descriptive statistics (ie, ANOVA test), intraclass correlation coefficient (ICC), mean absolute error rate, and correlation by comparing the tracker-recorded data with that of the gold standard. Results All the 3 trackers demonstrated good-to-excellent (ICC>0.75) correlation with the gold standard step counts during treadmill experiments. The correlation was poor (ICC<0.60), and the error rate was significantly higher in walker experiment compared to other activities. There was no significant difference between the trackers and the gold standard in the shopping cart experiment. The wrist worn tracker, Flex, counted several steps when eating (P<.01). The chest tracker was identified as the most promising site to capture steps in more intense activities, while the wrist was the optimal wearing site in less intense activities. Conclusions This feasibility study focused on 6 PAs and demonstrated that Fitbit trackers were most accurate when walking on a treadmill and least accurate during walking with a walking aid and for low-intensity activities. This may suggest excluding participants with assistive devices from studies that focus on PA interventions using commercially available trackers. This study also indicates that the wearing site of the tracker is an important factor impacting the accuracy performance. A larger scale study with a more diverse population, various activity tracker vendors, and a larger activity set are warranted to generalize our results.
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Affiliation(s)
- Parastoo Alinia
- School of Electrical Engineering and Computer Science, Washington State University, Pullman, WA, United States
| | - Chris Cain
- School of Electrical Engineering and Computer Science, Washington State University, Pullman, WA, United States
| | - Ramin Fallahzadeh
- School of Electrical Engineering and Computer Science, Washington State University, Pullman, WA, United States
| | - Armin Shahrokni
- Geriatrics / Gastrointestinal Oncology Service, Memorial Sloan-Kettering Cancer Center, New York, NY, United States
| | - Diane Cook
- School of Electrical Engineering and Computer Science, Washington State University, Pullman, WA, United States
| | - Hassan Ghasemzadeh
- School of Electrical Engineering and Computer Science, Washington State University, Pullman, WA, United States
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Smith EM, Fuller D, Mahmood H, Miller WC. Differences in outcomes between the JoyBar control and standard wheelchair joystick control on two maneuverability tasks: a pilot study. Disabil Rehabil Assist Technol 2017; 13:523-526. [PMID: 28792791 DOI: 10.1080/17483107.2017.1344885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To determine if older adult, novice wheelchair users who drive a power wheelchair with a JoyBar control complete maneuverability tasks in less time and with less error than those who drive a power wheelchair with a standard joystick control. MATERIALS AND METHODS A parallel randomized controlled trial design conducted at a medical rehabilitation and research centre with ambulatory older adults aged 60 and above (n = 27). The intervention was the JoyBar alternative wheelchair control. The primary outcome measure was total time to complete each of the two maneuverability tasks. The secondary outcome measure was total number of errors during each of the maneuverability tasks. RESULTS An independent, two sampled t-test was conducted and revealed that the JoyBar group took a greater amount of time to complete both maneuverability tasks than the control group (p < .05). No significant differences (p < .05) were found in rates of error on either task between the JoyBar and joystick groups. CONCLUSIONS Maneuverability of a powered wheelchair by novice wheelchair users was not improved through the use of the JoyBar when compared to a standard wheelchair joystick, as measured by rates of error and time to complete maneuverability tasks. Implications for rehabilitation Clients who are new to powered wheelchair use may perform maneuverability tasks faster, with equivalent accuracy, using a standard joystick versus the JoyBar. Clients who use a JoyBar may require adjustments to the programming of their wheelchair to ensure optimal performance. Additional training may be required to achieve proficiency in maneuverability tasks with a JoyBar versus a standard joystick.
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Affiliation(s)
- Emma M Smith
- a Graduate Program in Rehabilitation Sciences, Faculty of Medicine , University of British Columbia , Vancouver , Canada.,b Rehabilitation Research Program , Vancouver Coastal Health Research Institute , Vancouver , Canada
| | - Danelle Fuller
- c Department of Occupational Sciences and Occupational Therapy, Faculty of Medicine , University of British Columbia , Vancouver , Canada
| | - Hina Mahmood
- c Department of Occupational Sciences and Occupational Therapy, Faculty of Medicine , University of British Columbia , Vancouver , Canada
| | - William C Miller
- a Graduate Program in Rehabilitation Sciences, Faculty of Medicine , University of British Columbia , Vancouver , Canada.,b Rehabilitation Research Program , Vancouver Coastal Health Research Institute , Vancouver , Canada.,c Department of Occupational Sciences and Occupational Therapy, Faculty of Medicine , University of British Columbia , Vancouver , Canada
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Kang SH, Yong V, Chan A, Saito Y. Revisiting Mobility Limitations of Seniors in Singapore, 1995 to 2011. Gerontol Geriatr Med 2017; 2:2333721416645034. [PMID: 28138497 PMCID: PMC5119869 DOI: 10.1177/2333721416645034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Revised: 01/25/2016] [Accepted: 03/14/2016] [Indexed: 11/26/2022] Open
Abstract
Singapore’s life expectancy at birth and at age 65 continues to improve. Although this is a positive development, it is necessary to understand how much of this increased life expectancy is spent with and without mobility limitations. This research uses the latest round of the National Survey of Senior Citizens to examine the situation in 2011 and the possible changes that may have occurred since the last survey in 2005. It seeks to add to earlier research in this area in Singapore and uses the prevalence-based Sullivan method to calculate lifetime free of mobility limitations for this population. Pertinent conclusions drawn from this research include evidence pointing to changing prevalence rates among the older adult population and observations that suggest the possibility of a compression of morbidity for this population in 2011 compared with an expansion of morbidity observed in the previous survey conducted in 2005. The research also shows that women continue to be disadvantaged as they age compared with men.
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Affiliation(s)
- Soon-Hock Kang
- School of Arts and Social Sciences, SIM University, Singapore
| | - Vanessa Yong
- Population Research Institute, Nihon University, Japan
| | - Angelique Chan
- Centre of Ageing Research and Education, DukeNUS Medical School, Singapore; Health Services and Systems Research, DukeNUS Medical School, Singapore; Department of Sociology, National University of Singapore, Singapore
| | - Yasuhiko Saito
- University Research Center, Nihon University, Japan; Population Research Institute, Nihon University, Japan; Health Services and Systems Research, DukeNUS Medical School, Singapore
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Fielding RA, Travison TG, Kirn DR, Koochek A, Reid KF, von Berens Å, Zhu H, Folta SC, Sacheck JM, Nelson ME, Liu CK, Åberg AC, Nydahl M, Lilja M, Gustafsson T, Cederholm T. Effect of Structured Physical Activity and Nutritional Supplementation on Physical Function in Mobility-Limited Older Adults: Results from the VIVE2 Randomized Trial. J Nutr Health Aging 2017; 21:936-942. [PMID: 29083433 PMCID: PMC6751564 DOI: 10.1007/s12603-017-0936-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The interactions between nutritional supplementation and physical activity on changes in physical function among older adults remain unclear. The primary objective of this study was to examine the impact of nutritional supplementation plus structured physical activity on 400M walk capacity in mobility-limited older adults across two sites (Boston, USA and Stockholm, Sweden). DESIGN All subjects participated in a physical activity program (3x/week for 24 weeks), involving walking, strength, balance, and flexibility exercises. Subjects were randomized to a daily nutritional supplement (150kcal, 20g whey protein, 800 IU vitamin D) or placebo (30kcal, non-nutritive). SETTING Participants were recruited from urban communities at 2 field centers in Boston MA USA and Stockholm SWE. PARTICIPANTS Mobility-limited (Short Physical Performance Battery (SPPB) ≤9) and vitamin D insufficient (serum 25(OH) D 9 - 24 ng/ml) older adults were recruited for this study. MEASUREMENTS Primary outcome was gait speed assessed by the 400M walk. RESULTS 149 subjects were randomized into the study (mean age=77.5±5.4; female=46.3%; mean SPPB= 7.9±1.2; mean 25(OH)D=18.7±6.4 ng/ml). Adherence across supplement and placebo groups was similar (86% and 88%, respectively), and was also similar across groups for the physical activity intervention (75% and 72%, respectively). Both groups demonstrated an improvement in gait speed with no significant difference between those who received the nutritional supplement compared to the placebo (0.071 and 0.108 m/s, respectively (p=0.06)). Similar effects in physical function were observed using the SPPB. Serum 25(OH)D increased in supplemented group compared to placebo 7.4 ng/ml versus 1.3 ng/ml respectively. CONCLUSION Results suggest improved gait speed following physical activity program with no further improvement with added nutritional supplementation.
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Affiliation(s)
- R A Fielding
- Roger A. Fielding, Ph.D., Nutrition, Exercise Physiology, and Sarcopenia Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, 711 Washington Street, Boston, MA. Phone: (617) 556-3016
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22
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Eitzen A, Finlayson M, Carolan-Laing L, Nacionales AJ, Walker C, O'Connor J, Asano M, Coote S. The development of an observational screening tool to assess safe, effective and appropriate walking aid use in people with multiple sclerosis. Disabil Rehabil Assist Technol 2016; 12:641-646. [PMID: 27762151 DOI: 10.1080/17483107.2016.1217085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE The purpose of this study was to identify potential items for an observational screening tool to assess safe, effective and appropriate walking aid use among people with multiple sclerosis (MS). Such a tool is needed because of the association between fall risk and mobility aid use in this population. METHODS Four individuals with MS were videotaped using a one or two straight canes, crutches or a rollator in different settings. Seventeen health care professionals from Canada, Ireland and the United States were recruited, and viewed the videos, and were then interviewed about the use of the devices by the individuals in the videos. Interview questions addressed safety, effectiveness and appropriateness of the device in the setting. Data were analyzed qualitatively. Coding consistency across raters was evaluated and confirmed. RESULTS Nineteen codes were identified as possible items for the screening tool. The most frequent issues raised regardless of setting and device were "device used for duration/abandoned", "appropriate device", "balance and stability", "device technique", "environmental modification" and "hands free." CONCLUSION With the identification of a number of potential tool items, researchers can now move forward with the development of the tool. This will involve consultation with both healthcare professionals and people with MS. Implications for rehabilitation Falls among people with multiple sclerosis are associated with mobility device use and use of multiple devices is associated with greater falls risk. The ability to assess for safe, effective and efficient use of walking aids is therefore important, no tools currently exist for this purpose. The codes arising from this study will be used to develop a screening tool for safe, effective and efficient walking aid use with the aim of reducing falls risk.
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Affiliation(s)
- Abby Eitzen
- a School of Rehabilitation Therapy , Queen's University , Kingston , ON , Canada
| | - Marcia Finlayson
- a School of Rehabilitation Therapy , Queen's University , Kingston , ON , Canada
| | - Leanne Carolan-Laing
- a School of Rehabilitation Therapy , Queen's University , Kingston , ON , Canada
| | | | - Christie Walker
- a School of Rehabilitation Therapy , Queen's University , Kingston , ON , Canada
| | - Josephine O'Connor
- b Department of Clinical Therapies , Health Research Institute, University of Limerick , Limerick , Ireland
| | - Miho Asano
- a School of Rehabilitation Therapy , Queen's University , Kingston , ON , Canada
| | - Susan Coote
- b Department of Clinical Therapies , Health Research Institute, University of Limerick , Limerick , Ireland
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Hafner BJ, Morgan SJ, Abrahamson DC, Amtmann D. Characterizing mobility from the prosthetic limb user's perspective: Use of focus groups to guide development of the Prosthetic Limb Users Survey of Mobility. Prosthet Orthot Int 2016; 40:582-90. [PMID: 25944625 PMCID: PMC4635102 DOI: 10.1177/0309364615579315] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 02/15/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND Input from target respondents in the development of patient-reported outcome measures is necessary to ensure that the instrument is meaningful. OBJECTIVES To solicit perspectives of prosthetic limb users about their mobility experiences and to inform development of the Prosthetic Limb Users Survey of Mobility. STUDY DESIGN Qualitative study. METHODS Four focus groups of lower limb prosthesis users were held in different regions of the United States. Focus group transcripts were coded, and themes were identified. Feedback from participants was used to develop a framework for measuring mobility with a lower limb prosthesis. RESULTS Focus group participants (N = 37) described mobility as a confluence of factors that included characteristics of the individual, activity, and environment. Identified themes were defined as individual characteristics, forms of movement, and environmental situations. Prosthetic mobility was conceptualized as movement activities performed in an environmental or situational context. CONCLUSION Respondent feedback used to guide development of Prosthetic Limb Users Survey of Mobility established a foundation for a new person-centered measure of mobility with a prosthetic limb. CLINICAL RELEVANCE Perspectives of target respondents are needed to guide development of instruments intended to measure health outcomes. Focus groups of prosthetic limb users were conducted to solicit experiences related to mobility with a lower limb prosthesis. Results were used to inform development of a clinically meaningful, person-centered instrument.
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Rahimi F, Bee C, Duval C, Boissy P, Edwards R, Jog M. Using ecological whole body kinematics to evaluate effects of medication adjustment in Parkinson disease. J Parkinsons Dis 2015; 4:617-27. [PMID: 25055960 DOI: 10.3233/jpd-140370] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Functional motor impairments including mobility are major reasons for clinical intervention and medication adjustment in symptomatic therapy for Parkinson's disease (PD). Outcome measures used to assess the impact of medication are mostly based on patients' memory or diaries which, considering the gaps between visits, are neither objective nor very reliable. OBJECTIVE Investigating the feasibility of using movement features extracted from ecological whole-body kinematics recordings to measure the quantitative and qualitative changes in multiple aspects of mobility after medication changes in PD. METHODS Eleven patients with PD (PwPD) performed mobility tasks in their own home, wearing a full body wireless inertial sensing based motion capture system. Three scripted walking tasks (walking, fast walking, and walk turns) were examined at baseline and two weeks after medication changes. Clinical scales, including investigator-rated clinical global impression of improvement (CGI-I), were collected at both visits. RESULTS Out of 59 recorded body joint variables, five were identified as pertinent. Changes were represented in vector space as a plot of mean versus peak amplitude. Regression analysis was used to predict clinical improvement or worsening based on these vector features. The predictors were able to explain (>98.5% of variance) patients' clinical global impression of improvement, thus correctly predicting 5 cases of improvement and 2 cases of worsening. CONCLUSIONS This study provided a method of extracting clinically meaningful reports from ecological kinematic data showing changes after drug adjustments. The results are presented using a novel concept called change space that may be more understandable for clinical staff.
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Affiliation(s)
- Fariborz Rahimi
- London Health Sciences Centre, Department of Clinical Neurological Sciences, ON, Canada Department of Electrical Engineering, University of Bonab, Bonab, Iran
| | - Carina Bee
- London Health Sciences Centre, Department of Clinical Neurological Sciences, ON, Canada
| | - Christian Duval
- Centre de recherche Institut Universitaire de Gériatrie de Montréal (CRIUGM), Montréal, QC, Canada
| | - Patrick Boissy
- Department of Surgery, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Roderick Edwards
- Department of Mathematics and Statistics, University of Victoria, Victoria, BC, Canada
| | - Mandar Jog
- London Health Sciences Centre, Department of Clinical Neurological Sciences, ON, Canada
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Braun T, Marks D, Zutter D, Grüneberg C. The impact of rollator loading on gait and fall risk in neurorehabilitation - a pilot study. Disabil Rehabil Assist Technol 2014; 10:475-481. [PMID: 24936570 DOI: 10.3109/17483107.2014.926568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Rollator loading is an application used clinically sometimes to improve functional integrity and security of the patients' gait. As empirical evidence supporting this intervention is equivocal, the purpose of this study was to examine the effects of rollator loading on several gait parameters and fall risk. METHODS An explicatory experiment with a follow-up cohort study of falls was conducted. In the experimental part of the study, participants (n = 25) were evaluated three times by means of different gait and fall risk assessments, whereby each trial was carried out with different rollator loading (0, 4.5 and 9 kg, respectively). Participants were blinded towards the applied load. In addition, the odds ratio of falls with respect to rollator loading in all-day rehabilitation life was determined. RESULTS No changes in spatio-temporal gait parameters and fall risk in relation to a particular load could be identified by clinical measures in the tested sample. A separate sub-group analysis (Parkinson's disease, hemiparesis and ataxia) showed only little impact of the load in each case. Rollator loading had no impact on the odds ratio of inpatient fall risk. CONCLUSION On the basis of our findings, weighting of rollators can neither be discouraged nor recommended. Implications for Rehabilitation Unless more research is has been conducted on this topic, rollator loading can neither be recommended nor discouraged in individuals suffering from neurologic diseases. There is more research needed to examine the impact on ambulation in distinct conditions such as severe ataxia and fear of falling.
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Affiliation(s)
- Tobias Braun
- a Hochschule für Gesundheit, University of Applied Sciences, Department of Applied Health Sciences, Physiotherapy Program , Bochum , Germany and.,b Rehaklinik Zihlschlacht, Neurorehabilitation Center , Zihlschlacht , Switzerland
| | - Detlef Marks
- b Rehaklinik Zihlschlacht, Neurorehabilitation Center , Zihlschlacht , Switzerland
| | - Daniel Zutter
- b Rehaklinik Zihlschlacht, Neurorehabilitation Center , Zihlschlacht , Switzerland
| | - Christian Grüneberg
- a Hochschule für Gesundheit, University of Applied Sciences, Department of Applied Health Sciences, Physiotherapy Program , Bochum , Germany and
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Hansen ÅM, Darsø L, Manty M, Nilsson C, Christensen U, Lund R, Holtermann A, Avlund K. Psychosocial factors at work and the development of mobility limitations among adults in Denmark. Scand J Public Health 2014; 42:417-24. [PMID: 24637677 DOI: 10.1177/1403494814527526] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIM Psychosocial factors in the working environment have been shown to be associated with mobility limitations, but this has not yet been confirmed in a Danish population. We aimed to examine how psychosocial factors at work are related to developing mobility limitations in Denmark. METHODS This study is based on data from 2952 middle-aged men and women without mobility limitations in 2000. RESULTS We found increased risk of incident mobility limitations during 6-year follow up among men who often perceived high work pace (OR 5.45, 95% CI 1.21-24.52) vs. never, who only sometimes or/never perceived the work to be meaningful (OR 6.54, 95% CI 1.55-27.55) vs. always, and who sometimes perceived high emotional demands at work (OR 7.85, 95% CI 1.78-34.65) vs. never. Among women, lower risk of incident mobility limitations was observed among those who in 2000 perceived high work pace sometimes (OR 0.46, 95% CI 0.24-0.87) or often (OR 0.43, 95% CI 0.22-0.85) vs. never in 2000. Also, women who always or often experienced high emotional demands had an increased risk. CONCLUSIONS The most important finding was that high work pace was strongly associated with increased risk of mobility limitations among men, but associated with lower risk of mobility limitations among women. This knowledge may be used to better target interventions among men and women in midlife from physical deterioration later in life.
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Affiliation(s)
- Åse Marie Hansen
- Department of Public Health, University of Copenhagen, Denmark National Research Centre for Working Environment, Copenhagen, Denmark
| | - Lilie Darsø
- Department of Public Health, University of Copenhagen, Denmark
| | - Minna Manty
- Department of Public Health, University of Copenhagen, Denmark Center for Healthy Ageing, University of Copenhagen, Denmark
| | - Charlotte Nilsson
- Department of Public Health, University of Copenhagen, Denmark Center for Healthy Ageing, University of Copenhagen, Denmark
| | | | - Rikke Lund
- Department of Public Health, University of Copenhagen, Denmark Center for Healthy Ageing, University of Copenhagen, Denmark
| | | | - Kirsten Avlund
- Department of Public Health, University of Copenhagen, Denmark Center for Healthy Ageing, University of Copenhagen, Denmark Danish Aging Research Center, Universities of Aarhus, Southern Denmark (Odense) and Copenhagen, Denmark
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Inness EL, Howe JA, Niechwiej-Szwedo E, Jaglal SB, McIlroy WE, Verrier MC. Measuring Balance and Mobility after Traumatic Brain Injury: Validation of the Community Balance and Mobility Scale (CB&M). Physiother Can 2011; 63:199-208. [PMID: 22379260 DOI: 10.3138/ptc.2009-45] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To further investigate the construct validity of the Community Balance and Mobility Scale (CB&M), developed for ambulatory individuals with traumatic brain injury (TBI). METHODS A convenience sample of 35 patients with TBI (13 in-patients, 22 outpatients) was recruited. Analyses included a comparison of CB&M and Berg Balance Scale (BBS) admission and change scores and associations between the CB&M and measures of postural sway, gait, and dynamic stability; the Community Integration Questionnaire (CIQ); and the Activities-specific Balance Confidence (ABC) Scale. RESULTS Mean admission scores on the BBS and the CB&M were 53.6/56 (SD=4.3) and 57.8/96 (SD=23.3) respectively. Significant correlations were demonstrated between the CB&M and spatiotemporal measures of gait, including walking velocity, step length, step width, and step time; measures of dynamic stability, including variability in step length and step time; and the ABC (p<0.05). Significant correlations between the CB&M and CIQ were revealed with a larger data set (n=47 outpatients) combined from previous phases of research. CONCLUSIONS In patients with TBI, the CB&M is less susceptible to a ceiling effect than the BBS. The construct validity of the CB&M was supported, demonstrating associations with laboratory measures of dynamic stability, measures of community integration, and balance confidence.
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Affiliation(s)
- Elizabeth L Inness
- Elizabeth L. Inness, BScPT, MSc: Toronto Rehabilitation Institute, Toronto, Ontario; Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Ontario
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