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Pock EML, Lohrmann C, Hoffmann M, Schwarz CM, Schoberer D. Evaluation of the usefulness and understandability of information leaflets on fall prevention from the perspective of hospital patients and their relatives. Health Info Libr J 2024. [PMID: 38686953 DOI: 10.1111/hir.12531] [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] [Received: 10/06/2022] [Revised: 09/11/2023] [Accepted: 04/09/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Falls are a major problem among adults over 60 years. Multiple preventive measures must be taken. Written information leaflets can support the knowledge transfer and positively influence recall of the information provided. OBJECTIVE The aim was to ensure usefulness and understandability of the information leaflets on home fall prevention from the target groups' perspective. METHODS A cross-sectional survey study with a feedback questionnaire for patients and relatives was conducted at a university hospital in Austria. Quantitative data analysis and qualitative content analysis according to Schreier were performed. RESULTS The majority (63.9%) of patients rated the overall impression as "very good". 44.2% of the relatives rated it as "very good" and 23% as "good". The question "appealing design" was the only one with a statistically significant difference between patients and relatives. Subgroup analysis has shown a statistically significant difference between educational groups regarding the questions "easy to read" and "easy to understand". CONCLUSION It could be shown that the information leaflets were already well tailored to the target group. The few comments regarding understandability were considered to improve the content of the information leaflets. A further evaluation regarding the benefit of the fall prevention leaflets in discharge management should be performed.
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Affiliation(s)
| | - Christa Lohrmann
- Institute of Nursing Science, Medical University of Graz, Graz, Austria
| | - Magdalena Hoffmann
- Executive Department for Quality and Risk Management, University Hospital Graz, Graz, Austria
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Research Unit for Safety and Sustainability in Health, c/o Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Christine Maria Schwarz
- Executive Department for Quality and Risk Management, University Hospital Graz, Graz, Austria
- Research Unit for Safety and Sustainability in Health, c/o Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Daniela Schoberer
- Institute of Nursing Science, Medical University of Graz, Graz, Austria
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2
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Daniels AH, Park AM, Lee DJ, Daher M, Diebo BG, Carayannopoulos A. Impact of Sacroiliac Belt Utilization on Balance in Patients with Low Back Pain. Orthop Rev (Pavia) 2024; 16:116960. [PMID: 38699080 PMCID: PMC11062887 DOI: 10.52965/001c.116960] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 04/05/2024] [Indexed: 05/05/2024] Open
Abstract
Background Low back pain (LBP) is a common problem which can affect balance and, in turn, increase fall risk. The aim of this investigation was to evaluate the impact of a Sacroiliac Belt (SB) on balance and stability in patients with LBP. Methods Subjects with LBP and without LBP ("Asymptomatic") were enrolled. Baseline balance was assessed using the Berg Balance Scale. In a counterbalanced crossover design, LBP and Asymptomatic subjects were randomized to one of two groups: 1) start with wearing the SB (Serola Biomechanics, Inc.) followed by not wearing the SB or 2) start without wearing the SB followed by wearing the SB. For subjects in both groups, dynamic balance was then assessed using the Star Excursion Balance Test (SEBT) with each leg planted. Results Baseline balance was worse in LBP subjects (Berg 51/56) than Asymptomatic subjects (Berg 56/56) (p<0.01). SB significantly improved SEBT performance in LBP subjects regardless of which leg was planted (p<0.01). SB positively impacted Asymptomatic subjects' SEBT performance with the left leg planted (p=0.0002). Conclusion The Serola Sacroiliac Belt positively impacted dynamic balance for subjects with low back pain. Further research is needed to examine additional interventions and outcomes related to balance in patients with back pain, and to elucidate the mechanisms behind improvements in balance related to sacroiliac belt utilization.
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Affiliation(s)
- Alan H Daniels
- Warren Alpert Medical School Brown University
- Division of Spine Surgery, Department of Orthopaedic Surgery Rhode Island Hospital
| | | | | | | | - Bassel G Diebo
- Warren Alpert Medical School Brown University
- Division of Spine Surgery, Department of Orthopaedic Surgery Rhode Island Hospital
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González-Castro A, Leirós-Rodríguez R, Prada-García C, Benítez-Andrades JA. The Applications of Artificial Intelligence for Assessing Fall Risk: Systematic Review. J Med Internet Res 2024; 26:e54934. [PMID: 38684088 DOI: 10.2196/54934] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/30/2024] [Accepted: 02/13/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Falls and their consequences are a serious public health problem worldwide. Each year, 37.3 million falls requiring medical attention occur. Therefore, the analysis of fall risk is of great importance for prevention. Artificial intelligence (AI) represents an innovative tool for creating predictive statistical models of fall risk through data analysis. OBJECTIVE The aim of this review was to analyze the available evidence on the applications of AI in the analysis of data related to postural control and fall risk. METHODS A literature search was conducted in 6 databases with the following inclusion criteria: the articles had to be published within the last 5 years (from 2018 to 2024), they had to apply some method of AI, AI analyses had to be applied to data from samples consisting of humans, and the analyzed sample had to consist of individuals with independent walking with or without the assistance of external orthopedic devices. RESULTS We obtained a total of 3858 articles, of which 22 were finally selected. Data extraction for subsequent analysis varied in the different studies: 82% (18/22) of them extracted data through tests or functional assessments, and the remaining 18% (4/22) of them extracted through existing medical records. Different AI techniques were used throughout the articles. All the research included in the review obtained accuracy values of >70% in the predictive models obtained through AI. CONCLUSIONS The use of AI proves to be a valuable tool for creating predictive models of fall risk. The use of this tool could have a significant socioeconomic impact as it enables the development of low-cost predictive models with a high level of accuracy. TRIAL REGISTRATION PROSPERO CRD42023443277; https://tinyurl.com/4sb72ssv.
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Affiliation(s)
- Ana González-Castro
- Nursing and Physical Therapy Department, Universidad de León, Ponferrada, Spain
| | - Raquel Leirós-Rodríguez
- SALBIS Research Group, Nursing and Physical Therapy Department, Universidad de León, Ponferrada, Spain
| | - Camino Prada-García
- Department of Preventive Medicine and Public Health, Universidad de Valladolid, Valladolid, Spain
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Iida H, Takegami Y, Osawa Y, Funahashi H, Ozawa Y, Ido H, Asamoto T, Otaka K, Tanaka S, Nakashima H, Ishizuka S, Seki T, Hasegawa Y, Imagama S. Association between advanced glycation end-products and fall risk in older adults: The Yakumo Study. Geriatr Gerontol Int 2024. [PMID: 38644665 DOI: 10.1111/ggi.14871] [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] [Received: 02/16/2024] [Revised: 03/18/2024] [Accepted: 03/24/2024] [Indexed: 04/23/2024]
Abstract
AIM Advanced glycation end-products (AGEs) are irreversibly and heterogeneously formed compounds during the non-enzymatic modification of macromolecules, such as proteins. Aging and lifestyle habits, such as high-fat and high-protein diets, and smoking, promote AGEs accumulation. This study aimed to investigate the relationship between fall risk and AGEs in community-dwelling older adults. METHODS This cross-sectional study included patients from the 2022 Yakumo Study who were evaluated for fall risk index 5-items version, locomotive syndrome stage and AGEs. AGEs were evaluated using Skin autofluorescence (SAF) measured by the AGE reader (DiagnOptics Technologies BV, Groningen, the Netherlands). We divided the participants into two groups according to the presence or absence of fall risk (fall risk index 5-items version ≥6 or not), and investigated the factors associated with fall risk. RESULTS The fall risk group had a higher age and SAF, and a higher proportion of locomotive syndrome stage >2 than the without fall risk group in patients aged ≥65 years (P < 0.01). The multivariate logistic regression analysis after adjustment of age, sex and body mass index showed that locomotive syndrome stage ≥2 and SAF were independent associators of fall risk in older adults (odds ratio 3.26, P < 0.01, odds ratio 2.96, P < 0.05, respectively). The optimal cutoff value of the SAF for fall risk was 2.4 (area under the curve 0.631; 95% CI 0.53-0.733; sensitivity 0.415; specificity 0.814; P < 0.05). CONCLUSION The accumulation of AGEs in skin tissues can be used to screen for fall risk comprehensively. Geriatr Gerontol Int 2024; ••: ••-••.
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Affiliation(s)
- Hiroki Iida
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuhiko Takegami
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yusuke Osawa
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroto Funahashi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuto Ozawa
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroaki Ido
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takamune Asamoto
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Keiji Otaka
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shinya Tanaka
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroaki Nakashima
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shinya Ishizuka
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Taisuke Seki
- Department of Orthopedic Surgery, Aichi Medical University Medical Center, Okazaki, Japan
| | - Yukiharu Hasegawa
- Department of Rehabilitation, Kansai University of Welfare Sciences, Kashihara, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Choudhury R, Park JH, Banarjee C, Coca MG, Fukuda DH, Xie R, Stout JR, Thiamwong L. Associations between monitor-independent movement summary (MIMS) and fall risk appraisal combining fear of falling and physiological fall risk in community-dwelling older adults. Front Aging 2024; 5:1284694. [PMID: 38660534 PMCID: PMC11040232 DOI: 10.3389/fragi.2024.1284694] [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] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 03/20/2024] [Indexed: 04/26/2024]
Abstract
Introduction: Fall Risk Appraisal (FRA), a process that integrates perceived and objective fall risk measures, serves as a crucial component for understanding the incongruence between fear of falling (FOF) and physiological fall risk in older adults. Despite its importance, scant research has been undertaken to investigate how habitual physical activity (PA) levels, quantified in Monitor-Independent Movement Summary (MIMS), vary across FRA categories. MIMS is a device-independent acceleration summary metric that helps standardize data analysis across studies by accounting for discrepancies in raw data among research-grade and consumer devices. Objective: This cross-sectional study explores the associations between MIMS (volume and intensity) and FRA in a sample of older adults in the United States. Methods: We assessed FOF (Short Falls Efficacy Scale-International), physiological fall risk (balance: BTrackS Balance, leg strength: 30-s sit-to-stand test) and 7-day free-living PA (ActiGraph GT9X) in 178 community-dwelling older adults. PA volume was summarized as average daily MIMS (MIMS/day). PA intensity was calculated as peak 30-min MIMS (average of highest 30 non-consecutive MIMS minutes/day), representing a PA index of higher-intensity epochs. FRA categorized participants into following four groups: Rational (low FOF-low physiological fall risk), Irrational (high FOF-low physiological fall risk), Incongruent (low FOF-high physiological fall risk) and Congruent (high FOF-high physiological fall risk). Results: Compared to rational group, average MIMS/day and peak 30-min MIMS were, respectively, 15.8% (p = .025) and 14.0% (p = .004) lower in irrational group, and 16.6% (p = .013) and 17.5% (p < .001) lower in congruent group. No significant differences were detected between incongruent and rational groups. Multiple regression analyses showed that, after adjusting for age, gender, and BMI (reference: rational), only irrational FRA was significantly associated with lower PA volume (β = -1,452.8 MIMS/day, p = .034); whereas irrational and congruent FRAs were significantly associated with lower "peak PA intensity" (irrational: β = -5.40 MIMS/day, p = .007; congruent: β = -5.43 MIMS/day, p = .004). Conclusion: These findings highlight that FOF is a significant barrier for older adults to participate in high-intensity PA, regardless of their balance and strength. Therefore, PA programs for older adults should develop tailored intervention strategies (cognitive reframing, balance and strength exercises, or both) based on an individual's FOF and physiological fall risk.
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Affiliation(s)
- Renoa Choudhury
- Department of Mechanical Engineering, University of Central Florida, Orlando, FL, United States
| | - Joon-Hyuk Park
- Department of Mechanical Engineering, University of Central Florida, Orlando, FL, United States
- Disability, Aging and Technology Cluster, University of Central Florida, Orlando, FL, United States
| | - Chitra Banarjee
- College of Medicine, University of Central Florida, Orlando, FL, United States
| | - Miguel Grisales Coca
- Department of Mechanical Engineering, University of Central Florida, Orlando, FL, United States
| | - David H. Fukuda
- School of Kinesiology and Rehabilitation Sciences, College of Health Professions and Sciences, University of Central Florida, Orlando, FL, United States
| | - Rui Xie
- Department of Statistics and Data Science, University of Central Florida, Orlando, FL, United States
- College of Nursing, University of Central Florida, Orlando, FL, United States
| | - Jeffrey R. Stout
- Disability, Aging and Technology Cluster, University of Central Florida, Orlando, FL, United States
- School of Kinesiology and Rehabilitation Sciences, College of Health Professions and Sciences, University of Central Florida, Orlando, FL, United States
| | - Ladda Thiamwong
- Disability, Aging and Technology Cluster, University of Central Florida, Orlando, FL, United States
- College of Nursing, University of Central Florida, Orlando, FL, United States
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Joo HH, Huang EY, Schoo D, Ward B, Chen JX. Association Between Hearing Difficulty and Mobility in Adults of All Ages: National Health Interview Survey. Otolaryngol Head Neck Surg 2024; 170:1059-1065. [PMID: 38037415 DOI: 10.1002/ohn.593] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/21/2023] [Accepted: 11/04/2023] [Indexed: 12/02/2023]
Abstract
OBJECTIVE To investigate the relationship between hearing difficulty and measures of mobility for US adults. STUDY DESIGN Cross-sectional study. SETTING 2021 National Health Interview Survey. METHODS The survey asked US adults about hearing difficulty and mobility measures, including difficulty walking 100 yards, difficulty climbing 12 steps, and injury from falling within the past 3 months. Multivariable logistic regressions examined the associations between hearing and mobility outcomes, controlling for visual difficulty, medical comorbidities, and various demographic characteristics (age [18-39, 40-64, 65+], race/ethnicity, sex, socioeconomic status). RESULTS The 2021 NHIS surveyed 29,467 adults, representing 253 million people in weighted responses (52% female; mean age 48.3, standard deviation = 18.6). Controlling for covariates, hearing difficulty was associated with increased odds of difficulty walking 100 yards (odds ratio, OR = 1.47, P < .001), difficulty climbing stairs (OR = 1.62, P < .001), and injury from falling in the past 3 months (OR = 1.51, P < .001). There was a significant interaction between age and hearing difficulty for injurious falls; stratifying by age revealed that younger adults (ages 18-39) with hearing difficulty were more likely to report recent harmful falls than their normal hearing peers; this increased risk was greater in magnitude than that observed comparing older adults with and without hearing difficulty. CONCLUSION The hearing difficulty is associated with worsened mobility for US adults and may be a stronger independent predictor of injury from falls for younger adults as compared to older adults. These findings can inform interventions to reduce the burden of declining mobility in adults with hearing difficulty.
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Affiliation(s)
- Henry H Joo
- Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Emily Y Huang
- Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Desi Schoo
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Bryan Ward
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Jenny X Chen
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medicine, Baltimore, Maryland, USA
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Whitten J, Barrett R, Carty CP, Tarabochia D, MacDonald D, Graham D. Baseline Measures of Physical Activity and Function Do Not Predict Future Fall Incidence in Sedentary Older Adults: A Prospective Cohort Study. J Aging Phys Act 2024; 32:207-212. [PMID: 38016462 DOI: 10.1123/japa.2022-0355] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 08/16/2023] [Accepted: 08/27/2023] [Indexed: 11/30/2023]
Abstract
Physical activity (PA) and physical function (PF) are modifiable risk factors for falls in older adults, but their ability to predict future fall incidence is unclear. The purpose of this study was to determine the predictive ability of baseline measures of PA, PF, and lower limb strength on future falls. A total of 104 participants underwent baseline assessments of PA, PF, and lower limb strength. Falls were monitored prospectively for 12 months. Eighteen participants fell at least once during the 12-month follow-up. Participants recorded almost exclusively sedentary levels of activity. PA, PF, and lower limb strength did not differ between fallers and nonfallers. Twelve participants, who reported a minor musculoskeletal injury in the past 6 months, experienced a fall. The results of this study suggest that in a cohort of highly functioning, sedentary older adults, PA does not distinguish fallers from nonfallers and that the presence of a recent musculoskeletal injury appears to be a possible risk factor for falling.
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Affiliation(s)
- Justin Whitten
- Department of Health and Human Development, Montana State University, Bozeman, MT, USA
| | - Rod Barrett
- School of Health Sciences and Social Work and Griffith Center for Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Christopher P Carty
- School of Health Sciences and Social Work and Griffith Center for Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
- Department of Orthopedics, Children's Health Queensland Hospital and Health Service, Brisbane, QLD, Australia
| | - Dawn Tarabochia
- Department of Health and Human Development, Montana State University, Bozeman, MT, USA
| | - David MacDonald
- School of Health Sciences and Social Work and Griffith Center for Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - David Graham
- Department of Health and Human Development, Montana State University, Bozeman, MT, USA
- School of Health Sciences and Social Work and Griffith Center for Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
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Xinrui H, Min X, Min C, Chenyi X. Development and internal validation of a prediction model for patients with hematologic diseases of fall risk: a cohort study. Expert Rev Hematol 2024; 17:135-143. [PMID: 38465408 DOI: 10.1080/17474086.2024.2329596] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 02/19/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND To develop and internally validate a prediction model for identifying patients with hematologic diseases of fall risk. RESEARCH DESIGN AND METHODS This is a prospective cohort study from a prospective collection of data for 6 months. We recruited 412 patients with hematologic diseases in medical institutions and home environment of China. The outcome of the prediction model was fall or not. These variables were filtered via univariable logistic analysis, LASSO, and multivariable logistic analysis. We adopt an internal validation method of K-fold cross validation. The area under the ROC curve and the H-L test were used to evaluate the discrimination and calibration of the model. RESULTS Five influencing factors were identified multivariable logistic regression analysis. The established model equation is as follows: the H-L goodness-of-fit test of the model p > 0.05. The area under the ROC curve of train is 0.957 (95% CI: 0.936 ~ 0.978), and the area under the ROC curve of test is 0.962 (95% CI: 0.884 ~ 1), so the model calibration and discriminant validity are good. CONCLUSION Our equation has good sensitivity and specificity in predicting the fall risk of patients with hematologic diseases, and has certain positive significance for clinical assessment of their fall risk. TRIAL REGISTRATION NUMBER ChiCTR2200063940.
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Affiliation(s)
- Huang Xinrui
- Nursing Department Office, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, Zhejiang, China
| | - Xu Min
- Vice President's Office, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, Zhejiang, China
| | - Cao Min
- Nursing Department, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Xu Chenyi
- Nursing Department, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
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Rein DB, Hackney ME, Haddad YK, Sublett FA, Moreland B, Imhof L, Peterson C, Legha JK, Mark J, Vaughan CP, Johnson Ii TM, Bergen G. Telemedicine-Based Risk Program to Prevent Falls Among Older Adults: Protocol for a Randomized Quality Improvement Trial. JMIR Res Protoc 2024; 13:e54395. [PMID: 38346180 PMCID: PMC11005432 DOI: 10.2196/54395] [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] [Received: 11/09/2023] [Revised: 02/08/2024] [Accepted: 02/09/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND The Center for Disease Control and Prevention's Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative offers health care providers tools and resources to assist with fall risk screening and multifactorial fall risk assessment and interventions. Its effectiveness has never been evaluated in a randomized trial. OBJECTIVE This study aims to describe the protocol for the STEADI Options Randomized Quality Improvement Trial (RQIT), which was designed to evaluate the impact on falls and all-cause health expenditures of a telemedicine-based form of STEADI implemented among older adults aged 65 years and older, within a primary care setting. METHODS STEADI Options was a pragmatic RQIT implemented within a health system comparing a telemedicine version of the STEADI fall risk assessment to the standard of care (SOC). Before screening, we randomized all eligible patients in participating clinics into the STEADI arm or SOC arm based on their scheduled provider. All received the Stay Independent screener (SIS) to determine fall risk. Patients were considered at risk for falls if they scored 4 or more on the SIS or answered affirmatively to any 1 of the 3 key questions within the SIS. Patients screened at risk for falls and randomized to the STEADI arm were offered a registered nurse (RN)-led STEADI assessment through telemedicine; the RN provided assessment results and recommendations to the providers, who were advised to discuss fall-prevention strategies with their patients. Patients screened at risk for falls and randomized to the SOC arm were asked to participate in study data collection only. Data on recruitment, STEADI assessments, use of recommended prevention services, medications, and fall occurrences were collected using electronic health records and patient surveys. Using staff time diaries and administrative records, the study prospectively collected data on STEADI implementation costs and all-cause outpatient and inpatient charges incurred over the year following enrollment. RESULTS The study enrolled 720 patients (n=307, 42.6% STEADI arm; n=353, 49% SOC arm; and n=60, 8.3% discontinued arm) from September 2020 to December 2021. Follow-up data collection was completed in January 2023. As of February 2024, data analysis is complete, and results are expected to be published by the end of 2025. CONCLUSIONS The STEADI RQIT evaluates the impact of a telemedicine-based, STEADI-based fall risk assessment on falls and all-cause health expenditures and can provide information on the intervention's effectiveness and cost-effectiveness. TRIAL REGISTRATION ClinicalTrials.gov NCT05390736, http://clinicaltrials.gov/ct2/show/NCT05390736. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR1-10.2196/54395.
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Affiliation(s)
- David B Rein
- Department of Public Health, NORC at the University of Chicago, Atlanta, GA, United States
| | - Madeleine E Hackney
- Department of Medicine, Division of Geriatrics and Gerontology, Emory University School of Medicine, Atlanta, GA, United States
- Atlanta Veterans Affairs Center for Visual & Neurocognitive Rehabilitation, Atlanta, GA, United States
- Birmingham/Atlanta VA Geriatric Research Education Clinical Center, Atlanta, GA, United States
- Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Yara K Haddad
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Farah A Sublett
- Department of Public Health, NORC at the University of Chicago, Atlanta, GA, United States
| | - Briana Moreland
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Laurie Imhof
- Department of Health Sciences, NORC at the University of Chicago, Chicago, IL, United States
| | - Cora Peterson
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Jaswinder K Legha
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Janice Mark
- School of Nursing and Health Professions, University of San Francisco, San Francisco, CA, United States
| | - Camille P Vaughan
- Department of Medicine, Division of Geriatrics and Gerontology, Emory University School of Medicine, Atlanta, GA, United States
- Atlanta Veterans Affairs Center for Visual & Neurocognitive Rehabilitation, Atlanta, GA, United States
- Birmingham/Atlanta VA Geriatric Research Education Clinical Center, Atlanta, GA, United States
| | - Theodore M Johnson Ii
- Birmingham/Atlanta VA Geriatric Research Education Clinical Center, Atlanta, GA, United States
- Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, GA, United States
- Department of Medicine, Division of General Internal Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Gwen Bergen
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States
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Haag S, Kepros J. Head Protection Device for Individuals at Risk for Head Injury due to Ground-Level Falls: Single Trauma Center User Experience Investigation. JMIR Hum Factors 2024; 11:e54854. [PMID: 38502170 PMCID: PMC10988374 DOI: 10.2196/54854] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 02/08/2024] [Accepted: 02/18/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Falls represent a large percentage of hospitalized patients with trauma as they may result in head injuries. Brain injury from ground-level falls (GLFs) in patients is common and has substantial mortality. As fall prevention initiatives have been inconclusive, we changed our strategy to injury prevention. We identified a head protection device (HPD) with impact-resistant technology, which meets head impact criteria sustained in a GLF. HPDs such as helmets are ubiquitous in preventing head injuries in sports and industrial activities; yet, they have not been studied for daily activities. OBJECTIVE We investigated the usability of a novel HPD on patients with head injury in acute care and home contexts to predict future compliance. METHODS A total of 26 individuals who sustained head injuries, wore an HPD in the hospital, while ambulatory and were evaluated at baseline and 2 months post discharge. Clinical and demographic data were collected; a usability survey captured HPD domains. This user experience design revealed patient perceptions, satisfaction, and compliance. Nonparametric tests were used for intragroup comparisons (Wilcoxon signed rank test). Differences between categorical variables including sex, race, and age (age group 1: 55-77 years; age group 2: 78+ years) and compliance were tested using the chi-square test. RESULTS Of the 26 patients enrolled, 12 (46%) were female, 18 (69%) were on anticoagulants, and 25 (96%) were admitted with a head injury due to a GLF. The median age was 77 (IQR 55-92) years. After 2 months, 22 (85%) wore the device with 0 falls and no GLF hospital readmissions. Usability assessment with 26 patients revealed positive scores for the HPD post discharge regarding satisfaction (mean 4.8, SD 0.89), usability (mean 4.23, SD 0.86), effectiveness (mean 4.69, SD 0.54), and relevance (mean 4.12, SD 1.10). Nonparametric tests showed positive results with no significant differences between 2 observations. One issue emerged in the domain of aesthetics; post discharge, 8 (30%) patients had a concern about device weight. Analysis showed differences in patient compliance regarding age (χ12=4.27; P=.04) but not sex (χ12=1.58; P=.23) or race (χ12=0.75; P=.60). Age group 1 was more likely to wear the device for normal daily activities. Patients most often wore the device ambulating, and protection was identified as the primary benefit. CONCLUSIONS The HPD intervention is likely to have reasonably high compliance in a population at risk for GLFs as it was considered usable, protective, and relevant. The feasibility and wearability of the device in patients who are at risk for GLFs will inform future directions, which includes a multicenter study to evaluate device compliance and effectiveness. Our work will guide other institutions in pursuing technologies and interventions that are effective in mitigating injury in the event of a fall in this high-risk population.
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Affiliation(s)
- Susan Haag
- Scottsdale Osborn Medical Center, Scottsdale, AZ, United States
| | - John Kepros
- Scottsdale Osborn Medical Center, Scottsdale, AZ, United States
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11
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Ma CZH, Zhu RTL, Huang M, Lee WCC, Yang Y, He C. Editorial: Balance-controlling mechanism and fall-prevention strategy. Front Neurol 2024; 15:1385917. [PMID: 38504798 PMCID: PMC10949366 DOI: 10.3389/fneur.2024.1385917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 02/19/2024] [Indexed: 03/21/2024] Open
Affiliation(s)
- Christina Zong-Hao Ma
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
- Research Institute for Smart Ageing, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Ringo Tang-Long Zhu
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
- Research Institute for Smart Ageing, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Meizhen Huang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Winson Chiu-Chun Lee
- School of Mechanical, Materials, Mechatronic and Biomedical Engineering, University of Wollongong, Wollongong, NSW, Australia
| | - Yonghong Yang
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Chengqi He
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
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12
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Choi J, Lee S, Park E, Ku S, Kim S, Yu W, Jeong E, Park S, Park Y, Kim SR. Congruency and its related factors between patients' fall risk perception and nurses' fall risk assessment in acute care hospitals. J Nurs Scholarsh 2024. [PMID: 38402575 DOI: 10.1111/jnu.12964] [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: 09/24/2023] [Revised: 01/27/2024] [Accepted: 02/13/2024] [Indexed: 02/26/2024]
Abstract
INTRODUCTION Inpatients need to recognize their fall risk accurately and objectively. Nurses need to assess how patients perceive their fall risk and identify the factors that influence patients' fall risk perception. PURPOSE This study aims to explore the congruency between nurses' fall risk assessment and patients' perception of fall risk and identify factors related to the non-congruency of fall risk. DESIGNS A descriptive and cross-sectional design was used. The study enrolled 386 patients who were admitted to an acute care hospital. Six nurses assessed the participants' fall risk. Congruency was classified using the Morse Fall Scale for nurses and the Fall Risk Perception Questionnaire for patients. FINDINGS The nurses' fall risk assessments and patients' fall risk perceptions were congruent in 57% of the participants. Underestimation of the patient's risk of falling was associated with gender (women), long hospitalization period, department (orthopedics), low fall efficacy, and history of falls before hospitalization. Overestimation of fall risk was associated with age group, gender (men), department, and a high health literacy score. In the multiple logistic regression, the factors related to the underestimation of fall risk were hospitalization period and department, and the factors related to the overestimation of fall risk were health literacy and department. CONCLUSIONS Nurses should consider the patient's perception of fall risk and incorporate it into fall prevention interventions. CLINICAL RELEVANCE Nurses need to evaluate whether patients perceive the risk of falling consistently. For patients who underestimate or overestimate their fall risk, it may be helpful to consider clinical and fall-related characteristics together when evaluating their perception of fall risk.
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Affiliation(s)
- Jieun Choi
- Department of Nursing, Asan Medical Center, Seoul, South Korea
| | - Sujin Lee
- Department of Nursing, Asan Medical Center, Seoul, South Korea
| | - Eunjin Park
- Department of Nursing, Asan Medical Center, Seoul, South Korea
| | - Sangha Ku
- Department of Nursing, Asan Medical Center, Seoul, South Korea
| | - Sunhwa Kim
- Department of Nursing, Asan Medical Center, Seoul, South Korea
| | - Wonhye Yu
- Department of Nursing, Asan Medical Center, Seoul, South Korea
| | - Eunmi Jeong
- Department of Nursing, Asan Medical Center, Seoul, South Korea
| | - Sookhee Park
- Department of Nursing, Asan Medical Center, Seoul, South Korea
| | - Yusun Park
- College of Nursing, Korea University Nursing Research Institute, Korea University, Seoul, South Korea
| | - Sung Reul Kim
- College of Nursing, Korea University Nursing Research Institute, Korea University, Seoul, South Korea
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13
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Madsalae T, Thongprong T, Chaikeeree N, Boonsinsukh R. Changes in gait performances during walking with head movements in older adults with chronic neck pain. Front Med (Lausanne) 2024; 11:1324375. [PMID: 38384408 PMCID: PMC10879294 DOI: 10.3389/fmed.2024.1324375] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 01/26/2024] [Indexed: 02/23/2024] Open
Abstract
Background Chronic neck pain (CNP) can lead to altered gait which is worse when combined with head movement. Gait parameters for indicating speed and symmetry have not been thoroughly investigated in older adults with CNP. This study aimed to compare gait performance in term of speed and symmetry in older adults with and without CNP during walking with head movement. Methods Fifty young older adults, consisting of 36 healthy controls without neck pain (OLDs) and 14 older adults with CNP, participated in the study. Participants completed the Neck Disability Index and Activities-specific Balance Confidence Scale. The 10-Meter Walk Test (10MWT) was used to assess gait performance. Participants were instructed to walk at preferred speed under three different head movement patterns: no head movement (NM), horizontal head movement (HM), and vertical head movement (VM). The Inertial Measurement Unit was used to capture gait performance, and its software was used to analyze gait variables; gait speed, Locomotor Rehabilitation Index (LRI), gait asymmetry index, Phase Coordination Index (PCI). Results The CNP group reported moderate neck pain with mild disability in activities of daily living, and less balance confidence than the OLD group (p < 0.05). The CNP group showed significantly slower gait speed and lower LRI during walking with both the HM and VM (p < 0.05), which corresponded to lower stride length and cadence. The gait asymmetry index in the CNP group was significantly higher than the OLD group during walking with VM (p < 0.05), whereas the PCI was significantly higher than the OLD group during walking with both HM and VM (p < 0.05). Conclusion Chronic neck pain affects both speed and symmetry when walking with head movement. Gait parameters in this study could be implemented to identify changes in speed and symmetry of gait in older adults with CNP who have mild disability and high physical functioning.
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Affiliation(s)
| | | | | | - Rumpa Boonsinsukh
- Faculty of Physical Therapy, Division of Physical Therapy, Srinakharinwirot University, Nakhonnayok, Thailand
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14
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Cooray N, Ho C, Bestman A, Adams S, Nassar N, Keay L, Brown J. Exploring the Potential of a Behavior Theory-Informed Digital Intervention for Infant Fall Prevention: Mixed Methods Longitudinal Study. JMIR Pediatr Parent 2024; 7:e47361. [PMID: 38170580 PMCID: PMC10794959 DOI: 10.2196/47361] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 10/16/2023] [Accepted: 10/17/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Falls are the most common hospitalized injury mechanism in children aged ≤1 years, and currently, there are no targeted prevention interventions. The prevention of falls in children of this age requires changes in the behavior of their caregivers, and theoretically informed digital behavior change interventions (DBCIs) may provide a unique mechanism for achieving effective intervention. However, user acceptance and the ability of DBCIs to effect the required changes in behavior are critical to their likelihood of success. OBJECTIVE This study aims to evaluate a behavior theory-informed digital intervention developed following a user-centered approach for user experience, the potential for this intervention to prevent infant falls, and its impact on behavioral drivers underpinning fall risk in young children. METHODS Parents of infants aged <1 year were recruited and asked to use the intervention for 3 months. A pre-post longitudinal design was used to examine the change in the potential to reduce the risk of falls after a 3-month exposure to the intervention. Postintervention data on behavioral drivers for fall prevention, user acceptability, and engagement with the app were also collected. Interviews were conducted to explore user experiences and identify areas for further improvement of the intervention. RESULTS A total of 62 parents participated in the study. A statistically significant effect on the potential to reduce falls was observed after the intervention. This effect was higher for new parents. Parents agreed that the intervention targeted most of the target behavior drivers. The impact of behavior drivers and intervention on the potential for fall prevention had a positive correlation. The intervention demonstrated good levels of acceptability. Feedback from participants was mostly positive, and the primary area identified for further improvement was widening the scope of the intervention. CONCLUSIONS This study demonstrated the promise of a newly developed digital intervention to reduce the risk of infant falls, particularly among new parents. It also showed a positive influence of the DBCI on the drivers of parental behaviors that are important for fall reduction among infants. The acceptability of the app was high, and important insights were gained from users about how to further improve the app.
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Affiliation(s)
- Nipuna Cooray
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales Sydney, Barangaroo, Australia
| | - Catherine Ho
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales Sydney, Barangaroo, Australia
| | - Amy Bestman
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales Sydney, Barangaroo, Australia
| | - Susan Adams
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales Sydney, Barangaroo, Australia
- Department of Paediatric Surgery, Sydney Children's Hospital, Randwick, Australia
| | - Natasha Nassar
- Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Lisa Keay
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales Sydney, Barangaroo, Australia
- School of Optometry and Vision Science, Faculty of Medicine and Health, University of New South Wales Sydney, Sydney, Australia
| | - Julie Brown
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales Sydney, Barangaroo, Australia
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15
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Turkoglu NM, Shang J. Fall risk factors in hospitalized bone marrow transplant patients: A systematic review. Int J Nurs Knowl 2024; 35:4-12. [PMID: 36415109 DOI: 10.1111/2047-3095.12407] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 10/25/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Certain types of cancer and treatment increase the risk of falls among cancer patients, particularly patients with hematologic cancer undergoing bone marrow transplant (BMT). Nurses are integral to preventing falls and maintaining patient safety. Understanding patients undergoing BMT fall risk factors may help nurses identify high fall risk patients and develop fall prevention interventions. PURPOSE This systematic review aims to identify risk factors for falls among hospitalized adult patients receiving BMT treatment. METHODS Guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, a systematic review of the literature was conducted by searching databases PubMed and CINAHL. Study quality was evaluated using the Crowe Critical Appraisal Tool form (v1.4). FINDINGS An initial search yielded 829 articles; six were included for final review after removing duplicates and screening for inclusion criteria: specific to patients undergoing BMT, measure fall outcome, in hospital, and original research. The identified risk factors include age of 65 and older, leukemia diagnosis, days of diarrhea, incontinence of urine or stool, increased pulse rate, muscle weakness, hypnotic, anxiolytic medication, recent steroid use, allogenic transplant, and post-engraftment period. CONCLUSIONS Risk factors for falls among patients undergoing BMT are multifactorial and are related to muscle weakness, medication administration, pulse rate, type of transplant, age, engraftment period, and bathroom use. IMPLICATIONS FOR NURSING Nurses providing care to patients undergoing BMT need to assess and increase nurse surveillance on allogeneic transplant patients, specifically those on anxiolytic, hypnotic, and steroid medications. Nurses providing care to patients undergoing BMT should implement more fall prevention strategies in patients undergoing BMT who develop diarrhea and urine or stool incontinence. Identifying specific patients undergoing BMT fall risk factors and applying multifaceted individualized fall prevention strategies has the potential to improve allogeneic transplant patient care and prevent fall-related complications.
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Affiliation(s)
- Nicole M Turkoglu
- School of Nursing, Columbia University, New York City, New York, USA
- New York-Presbyterian, New York City, New York, USA
| | - Jingjing Shang
- School of Nursing, Columbia University, New York City, New York, USA
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Kim T, Yu X, Xiong S. A multifactorial fall risk assessment system for older people utilizing a low-cost, markerless Microsoft Kinect. Ergonomics 2024; 67:50-68. [PMID: 37079340 DOI: 10.1080/00140139.2023.2202845] [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] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 03/29/2023] [Indexed: 05/03/2023]
Abstract
Falls among older people are a major health concern. This study aims to develop a multifactorial fall risk assessment system for older people using a low-cost, markerless Microsoft Kinect. A Kinect-based test battery was designed to comprehensively assess major fall risk factors. A follow-up experiment was conducted with 102 older participants to assess their fall risks. Participants were divided into high and low fall risk groups based on their prospective falls over a 6-month period. Results showed that the high fall risk group performed significantly worse on the Kinect-based test battery. The developed random forest classification model achieved an average classification accuracy of 84.7%. In addition, the individual's performance was computed as the percentile value of a normative database to visualise deficiencies and targets for intervention. These findings indicate that the developed system can not only screen out 'at risk' older individuals with good accuracy, but also identify potential fall risk factors for effective fall intervention.Practitioner summary: Falls are the leading cause of injuries in older people. We newly developed a multifactorial fall risk assessment system for older people utilising a low-cost, markerless Kinect. Results showed that the developed system can screen out 'at risk' individuals and identify potential risk factors for effective fall intervention.
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Affiliation(s)
- Taekyoung Kim
- Human Factors and Ergonomics Laboratory, Department of Industrial and Systems Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejoen, Republic of Korea
- KT R&D Center, Seoul, Republic of Korea
| | - Xiaoqun Yu
- Human Factors and Ergonomics Laboratory, Department of Industrial and Systems Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejoen, Republic of Korea
| | - Shuping Xiong
- Human Factors and Ergonomics Laboratory, Department of Industrial and Systems Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejoen, Republic of Korea
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17
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Tomita T, Yuminaga H, Takashima H, Masuda T, Mano T. Image Findings as Predictors of Fall Risk in Patients with Cerebrovascular Disease. Brain Sci 2023; 13:1690. [PMID: 38137138 PMCID: PMC10742017 DOI: 10.3390/brainsci13121690] [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: 11/15/2023] [Revised: 12/04/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
This study examined computed tomography findings in patients with cerebrovascular disease and determined predictors for falls. Images of the head were divided into 13 regions, and the relationships between computed tomography findings and the presence or absence of falls were investigated. A total of 138 patients with cerebrovascular disease (66% men, aged 73.8 ± 9.6 years) were included. A comparison between the fall and non-fall groups revealed a significant difference in the total functional independence measure scores and imaging findings at admission. Logistic regression analysis showed that the thalamus (p < 0.001), periventricular lucency (p < 0.001), lateral hemisphere room enlargement (p < 0.05), and age (p < 0.05) were related to the presence or absence of falls. For the 42 patients with cerebral hemorrhage, the thalamus (p < 0.01), periventricular lucency (p < 0.05), lateral ventricle vicinity (p < 0.05), and posterior limb of the internal capsule (p < 0.05) were extracted as factors related to the presence or absence of falls. For the 96 patients with cerebral infarction, the thalamus (p < 0.001), periventricular lucency (p < 0.01), and anterior limb of the internal capsule (p < 0.05) were extracted as factors related to the presence or absence of falls. This study found a relationship between the thalamus, lateral ventricle enlargement, periventricular lucency, and falls. Fall prognosis can potentially be predicted from computed tomography findings at admission.
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Affiliation(s)
- Tatsuya Tomita
- Department of Rehabilitation, Nara Prefectural General Medical Center, Nara 630-8054, Japan; (T.T.); (H.T.); (T.M.)
| | - Hisanori Yuminaga
- Department of Physical Therapy, Kansai Vocational College of Medicine, Osaka 558-0011, Japan;
| | - Hideki Takashima
- Department of Rehabilitation, Nara Prefectural General Medical Center, Nara 630-8054, Japan; (T.T.); (H.T.); (T.M.)
| | - Takashi Masuda
- Department of Rehabilitation, Nara Prefectural General Medical Center, Nara 630-8054, Japan; (T.T.); (H.T.); (T.M.)
| | - Tomoo Mano
- Department of Rehabilitation, Nara Prefectural General Medical Center, Nara 630-8054, Japan; (T.T.); (H.T.); (T.M.)
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18
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Petriceks AH, Appel LJ, Miller ER, Mitchell CM, Schrack JA, Mukamal KJ, Lipsitz LA, Wanigatunga AA, Plante TB, Michos ED, Juraschek SP. Timing of orthostatic hypotension and its relationship with falls in older adults. J Am Geriatr Soc 2023; 71:3711-3720. [PMID: 37668347 PMCID: PMC10842425 DOI: 10.1111/jgs.18573] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 06/22/2023] [Accepted: 07/01/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND There is inconsistent evidence on the optimal time after standing to assess for orthostatic hypotension. We determined the prevalence of orthostatic hypotension at different time points after standing in a population of older adults, as well as fall risk and symptoms associated with orthostatic hypotension. METHODS We performed a secondary analysis of the Study to Understand Fall Reduction and Vitamin D in You (STURDY), a randomized clinical trial funded by the National Institute on Aging, testing the effect of differing vitamin D3 doses on fall risk in older adults. STURDY occurred between July 2015 and May 2019. Secondary analysis occurred in 2022. Participants were community-dwelling adults, 70 years or older. In the orthostatic hypotension assessment, participants stood upright from supine position and underwent six standing blood pressure measurements (M1-M6) in two clusters of three measurements (immediately and 3 min after standing). Cox proportional hazard models were used to examine the relationship between orthostatic hypotension at each measurement and subsequent falls. Participants were followed until the earlier of their 24-month visit or study completion. RESULTS Orthostatic hypotension occurred in 32% of assessments at M1, and only 16% at M5 and M6. Orthostatic hypotension from average immediate (M1-3) and average delayed (M4-6) measurements, respectively, predicted higher fall risk (M1-3 = 1.65 [1.08, 2.52]; M4-6 = 1.73 [1.03, 2.91]) (hazard ratio [95% confidence interval]). However, among individual measurements, only orthostatic hypotension at M5 (1.84 [1.16, 2.93]) and M6 (1.85 [1.17, 2.91]) predicted higher fall risk. Participants with orthostatic hypotension at M1 (3.07 [1.48, 6.38]) and M2 (3.72 [1.72, 8.03]) were more likely to have reported orthostatic symptoms. CONCLUSIONS Orthostatic hypotension was most prevalent and symptomatic immediately within 1-2 min after standing, but more informative for fall risk after 4.5 min. Clinicians may consider both intervals when assessing for orthostatic hypotension.
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Affiliation(s)
- Aldis H. Petriceks
- Harvard Medical School, Boston, Massachusetts, USA
- Columbia University Mailman School of Public Health, New York, New York, USA
| | - Lawrence J. Appel
- The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- The Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Edgar R. Miller
- The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- The Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Christine M. Mitchell
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jennifer A. Schrack
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Kenneth J. Mukamal
- Harvard Medical School, Boston, Massachusetts, USA
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Lewis A. Lipsitz
- Harvard Medical School, Boston, Massachusetts, USA
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA
| | - Amal A. Wanigatunga
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Timothy B. Plante
- The Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA
- Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA
| | - Erin D. Michos
- The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Stephen P. Juraschek
- Harvard Medical School, Boston, Massachusetts, USA
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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Clark E, Podschun L, Church K, Fleagle A, Hull P, Ohree S, Springfield M, Wood S. Use of accelerometers in determining risk of falls in individuals post-stroke: A systematic review. Clin Rehabil 2023; 37:1467-1478. [PMID: 37067051 DOI: 10.1177/02692155231168303] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
OBJECTIVE The aim of this systematic review was to determine if the diagnostic capabilities of wearable accelerometers enhanced, provided earlier detection, or improved fall risk assessment when evaluating individuals with chronic stroke. DATA SOURCES CINAHL and PubMed databases were searched for articles from 2015 to 2023 utilizing key terms. REVIEW METHODS A team of researchers reviewed articles for bias via the Quality in Prognostic Studies tool, and further analyzed the data to answer the research question. RESULTS Four studies were included in the systematic review. When utilizing an accelerometer, the vertical axis was most predictive of falls, followed by the medio-lateral axis and the anterior-posterior axis. L2-3 was the most common accelerometer placement for fall risk assessment, however no uniformity existed in the literature on placement, number of accelerometers, or type. It was determined that gait symmetry, the Timed Up and Go, Berg Balance Scale, and Longitudinal Aging Study Amsterdam best predicted falls risk. CONCLUSION Based on limited available evidence, clinicians should continue to perform a comprehensive examination and evaluation for fall risk, that includes the use of a combination of evidence-based outcome measures and gait characteristics to develop an individualized plan of care for individuals post-stroke. However, further research is necessary to determine the added value of accelerometers as well as type, applicability of data, and placement.
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Affiliation(s)
| | | | | | | | - Paige Hull
- AdventHealth University, Orlando, FL, USA
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Almeida LRS, Valenca GT, Canning CG, Carvalho K, Silva AC, Oliveira-Filho J, Pinto EB. Cross-cultural adaptation and psychometric properties of the Brazilian-Portuguese version of the Falls Behavioral (FaB-Brazil) Scale. Disabil Rehabil 2023; 45:3922-3929. [PMID: 36373004 DOI: 10.1080/09638288.2022.2141356] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 10/18/2022] [Accepted: 10/25/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE To develop and cross-culturally adapt a Brazilian-Portuguese version of the Falls Behavioral Scale (FaB-Brazil) and to verify its psychometric properties. MATERIAL AND METHODS The translation and cross-cultural adaptation process of the scale followed standard guidelines. The FaB-Brazil scale was applied to 93 community-dwelling older people. Cronbach's alpha was calculated to evaluate internal consistency and the intraclass correlation coefficient (ICC) to evaluate interrater and test-retest reliability. The standard error of measurement (SEM), minimal detectable change (MDC), ceiling and floor effects, convergent and discriminative validity were evaluated. A significance level of .05 was set for statistical analyses. RESULTS Internal consistency was moderate (α = 0.73). An excellent inter-rater (ICC = 0.93; p < 0.001) and a good test-retest (ICC = 0.79; p < 0.001) reliability were found. The SEM was 0.27 and MDC was 0.53. Neither ceiling nor floor effects were found. Convergent validity was established by the positive correlations between the FaB-Brazil scale, age, and functional mobility, and by the negative correlations between the FaB-Brazil scale and balance confidence, community mobility and EuroQol-5D (p < 0.05). No significant differences were found between males and females and between non-fallers and fallers. CONCLUSIONS Our results offer evidence for the reliability and validity of the FaB-Brazil scale for community-dwelling older people.Implications for RehabilitationFall-related behaviors should be part of the fall risk assessment of community-dwelling older people.The Brazilian-Portuguese version of the Falls Behavioral Scale (FaB-Brazil) is reliable and valid for assessing fall-related behaviors in community-dwelling older people.The FaB-Brazil scale may be used to raise awareness about potential fall hazards and to guide fall prevention programs.
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Affiliation(s)
- Lorena Rosa S Almeida
- Movement Disorders and Parkinson's Disease Clinic, Roberto Santos General Hospital/SESAB, Salvador, Brazil
- Bahiana School of Medicine and Public Health, Motor Behavior and Neurorehabilitation Research Group, Salvador, Brazil
| | - Guilherme T Valenca
- Movement Disorders and Parkinson's Disease Clinic, Roberto Santos General Hospital/SESAB, Salvador, Brazil
- Bahiana School of Medicine and Public Health, Salvador, Brazil
| | - Colleen G Canning
- Discipline of Physiotherapy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Kárin Carvalho
- Bahiana School of Medicine and Public Health, Motor Behavior and Neurorehabilitation Research Group, Salvador, Brazil
- Postgraduate Program in Health Sciences, Federal University of Bahia School of Medicine, Salvador, Brazil
| | - Adriana Campos Silva
- Bahiana School of Medicine and Public Health, Motor Behavior and Neurorehabilitation Research Group, Salvador, Brazil
- Bahiana School of Medicine and Public Health, Salvador, Brazil
| | - Jamary Oliveira-Filho
- Postgraduate Program in Health Sciences, Federal University of Bahia School of Medicine, Salvador, Brazil
| | - Elen Beatriz Pinto
- Bahiana School of Medicine and Public Health, Motor Behavior and Neurorehabilitation Research Group, Salvador, Brazil
- Department of Life Sciences (DCV), Bahia State University, Salvador, Brazil
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Scarabel L, Scarpina F, Ruggieri G, Schiavone N, Limoni C. Predicting Falls in Musculoskeletal Rehabilitation: A Retrospective Multisite Study. Healthcare (Basel) 2023; 11:2805. [PMID: 37893879 PMCID: PMC10606819 DOI: 10.3390/healthcare11202805] [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] [Received: 09/18/2023] [Revised: 10/16/2023] [Accepted: 10/20/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Fall represents one of the highest concerns in the healthcare system, especially in medical rehabilitation settings. However, there is a lack of instruments for the assessment of risk falls in the context of musculoskeletal rehabilitation. METHODS This retrospective multisite study aimed to assess the sensitivity and specificity of four fall risk assessment tools (the Functional Independence Measure, the Fall Risk Assessment, the Schmid Fall Risk Assessment Tool, and the ePA-AC) in predicting falls in patients admitted to musculoskeletal rehabilitation in Swiss inpatient facilities. RESULTS The data relative to 6970 individuals (61.5% females) were analyzed and 685 (9.83% of patients) fall events were registered. The area under the curve (AUC) relative to the Functional Independence Measure was 0.689, 0.66 for the Fall Risk Assessment, 0.641 for the Schmid Fall Risk Assessment Tool, and 0.675 for the ePA-AC. Among the four tools, the Functional Independence Measure had an acceptable discriminatory power in distinguishing between significant events (i.e., patients' falls) and non-events (no falls). CONCLUSION None of the assessed tools showed highly satisfying levels of statistical sensitivity or sensibility. However, the Functional Independence Measure could be used to assess the fall risk assessment in musculoskeletal rehabilitation settings, although with some caution, since this questionnaire was not designed for this diagnostic purpose. We strongly suggest urgently designing a tool for risk assessment that is specific to this population and the rehabilitative setting.
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Affiliation(s)
- Luca Scarabel
- Clinica Hildebrand, Centro di Riabilitazione, via Crodolo 18, 6614 Brissago, Switzerland;
- Cliniche di Riabilitazione Ente Ospedaliero Cantonale (CREOC), 6986 Novaggio, Switzerland;
| | - Federica Scarpina
- “Rita Levi Montalcini” Department of Neurosciences, University of Turin, 10126 Turin, Italy;
- I.R.C.C.S. Istituto Auxologico Italiano, U.O. di Neurologia e Neuroriabilitazione, Ospedale San Giuseppe, 28824 Piancavallo, Italy
| | - Graziano Ruggieri
- Clinica Hildebrand, Centro di Riabilitazione, via Crodolo 18, 6614 Brissago, Switzerland;
| | - Nicola Schiavone
- Cliniche di Riabilitazione Ente Ospedaliero Cantonale (CREOC), 6986 Novaggio, Switzerland;
| | - Costanzo Limoni
- Department of Economics, Health and Social Sciences, University of Applied Sciences and Arts of Southern Switzerland, 6928 Manno, Switzerland;
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22
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Matos Queirós A, von Gunten A, Rosselet Amoussou J, Martins MM, Verloo H. Relationship Between Depression and Falls Among Nursing Home Residents: Protocol for an Integrative Review. JMIR Res Protoc 2023; 12:e46995. [PMID: 37856175 PMCID: PMC10623236 DOI: 10.2196/46995] [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] [Received: 03/05/2023] [Revised: 09/09/2023] [Accepted: 09/20/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Aging exposes individuals to new health disorders and debilitating chronic diseases, yet most older adults, even in functional decline, do not want to leave their homes. Nevertheless, for many, institutionalization in a nursing home (NH) may become essential to ensure their continued safety and health. Depression is one of the most common psychiatric disorders among older adults, especially among those who are institutionalized. Depressed NH residents face a high risk of future functional decline and falls, decreasing their quality of life. The relationship between depression and falls is complex and bidirectional. Previous reviews have focused on home-dwelling older adults or explored the relationship between antidepressant drugs and falls. To the best of our knowledge, no integrative literature reviews have explored the relationship between depression and falls among NH residents. OBJECTIVE Analyze studies on the relationship between depression and falls among NH residents. METHODS We will conduct an integrative literature review of published articles in relevant scientific journals on the relationship between depression and depressive symptomatology and falls among NH residents. As usually defined, we will consider NH residents to be people aged 65 years and older who can no longer live safely and independently in their homes. We will also consider older adults on short-term stays in an NH for rehabilitation after hospital discharge. Retrieved articles will be screened for eligibility and analyzed following previously reported steps. The most pertinent bibliographical databases will be examined for qualitative, quantitative, and mixed methods studies, from inception until August 31, 2023, thus ensuring that all relevant literature is included. We will also hand-search the bibliographies of all the relevant articles found and search for unpublished studies in any language. If appropriate, we will consider conducting a meta-analysis of the studies retrieved. RESULTS A first round of data collection was completed in March 2023. We retrieved a total of 2276 references. A supplementary literature search to ensure the most up-to-date evidence is ongoing. We anticipate that the review will be completed in late September 2023, and we expect to publish results at the end of December 2023. CONCLUSIONS This integrative review will increase knowledge and understanding of the complex relationship between depression and falls in NH environments. Its findings will be important for developing integrated, multidisciplinary models and care recommendations, adaptable to each NH resident's situation and health status, and for creating preventive interventions to help them maintain or recover optimal health stability. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/46995.
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Affiliation(s)
- Alcina Matos Queirós
- Department of Health and Social Welfare, University of Lausanne, Lausanne, Switzerland
- Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
| | - Armin von Gunten
- Service of Old Age Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Joëlle Rosselet Amoussou
- Medical Library-Cery, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | | | - Henk Verloo
- Service of Old Age Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- School of Nursing Sciences, HES-SO Valais-Wallis, University of Applied Sciences and Arts Western Switzerland, Sion, Switzerland
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VanNostrand M, Emberley K, Cairns E, Shanahan K, Kasser SL. Mobility and Dual Tasking in the Everyday Lives of Adults with Multiple Sclerosis: A Qualitative Exploration. Adapt Phys Activ Q 2023; 40:723-738. [PMID: 37072123 DOI: 10.1123/apaq.2022-0161] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 02/14/2023] [Accepted: 02/15/2023] [Indexed: 04/20/2023] Open
Abstract
OBJECTIVE The purpose of the study was to understand how people with multiple sclerosis experience dual-tasking situations in their everyday lives. METHODS Focus groups involving a total of 11 individuals with multiple sclerosis (eight females and three males) participated in this qualitative inquiry. Participants were asked open-ended questions focused on the nature of and consequences around dual tasking when standing or walking. Reflexive thematic analysis was employed to examine the data. RESULTS Three themes were generated from the data: (a) Life Is a Dual Task, (b) The Social Divide, and (c) Sacrifices for Stability. CONCLUSIONS This study highlights the significance and impact of dual tasking on the lived experience of adults with multiple sclerosis, furthering the need to more fully examine this phenomenon and potentially improve fall-prevention interventions and facilitate community participation.
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Affiliation(s)
- Michael VanNostrand
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, VT,USA
| | - Katie Emberley
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, VT,USA
| | - Erin Cairns
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, VT,USA
| | - Kristina Shanahan
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, VT,USA
| | - Susan L Kasser
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, VT,USA
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Chieffe DJ, Zuniga SA, Marmor S, Adams ME. Nationwide Utilization of Computerized Dynamic Posturography in an Era of Deimplementation. Otolaryngol Head Neck Surg 2023; 169:1090-1093. [PMID: 36994931 PMCID: PMC10782839 DOI: 10.1002/ohn.333] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 03/02/2023] [Accepted: 03/05/2023] [Indexed: 03/31/2023]
Abstract
Computerized dynamic posturography (CDP) provides multisensory assessment of balance. Consensus is lacking regarding CDP utility and coverage determinations vary. To inform best practices and policy, this cross-sectional study quantifies provider use of CDP among Medicare beneficiaries over time (2012-2017), by geographic region (hospital referral region [HRR]), and specialty. We observed 195,267 beneficiaries underwent 212,847 CDP tests totaling $15,780,001 in payments. Number of CDPs billed per 100,000 beneficiaries varied 534-fold across HRRs. Over 6 years, CDP use grew by 84% despite stagnant reimbursement. More utilization was attributable to primary care clinicians than specialties focused on care for dizziness and balance disorders. The observed growth and variation illustrate the potential for policy and provider preferences to drive unexpected practice patterns and underscore the need to engage a broad network of providers to develop optimal guidelines for use. CDP may offer a use case for deimplementation of low-value diagnostic services.
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Affiliation(s)
- Douglas J. Chieffe
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Steven A. Zuniga
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Schelomo Marmor
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA
- Department of Surgery, Center for Quality Outcomes and Discovery (C-QODE), University of Minnesota, Minnesota, Minneapolis, USA
| | - Meredith E. Adams
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA
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25
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Martinez A, Baxley J, Bergey E, Jennings R, Vonnes C. Interprofessional Approach to Fall Risk Screening in Patients Undergoing Radiation Therapy. Clin J Oncol Nurs 2023; 27:565-570. [PMID: 37729459 DOI: 10.1188/23.cjon.565-570] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
Patients receiving radiation therapy (RT) for cancer are at greater risk for falls because of age, treatment, pharmacologic side effects, and cognitive or motor deficits. The Timed Up and Go (TUG) Test is a validated, objecti.
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Affiliation(s)
- Amy Martinez
- H. Lee Moffit Cancer Center and Research Institute
| | - Jason Baxley
- H. Lee Moffit Cancer Center and Research Institute
| | - Emery Bergey
- H. Lee Moffit Cancer Center and Research Institute
| | - Ron Jennings
- H. Lee Moffit Cancer Center and Research Institute
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26
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Wu S, Ye Z, Yan Y, Zhan X, Ren L, Zhou C, Chen T, Yao Y, Zhu J, Wu S, Ma F, Liu L, Fan B, Liu C. The causal relationship between autoimmune diseases and osteoporosis: a study based on Mendelian randomization. Front Endocrinol (Lausanne) 2023; 14:1196269. [PMID: 37693362 PMCID: PMC10484226 DOI: 10.3389/fendo.2023.1196269] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 07/17/2023] [Indexed: 09/12/2023] Open
Abstract
Objective The relationship between different autoimmune diseases and bone mineral density (BMD) and fractures has been reported in epidemiological studies. This study aimed to explore the causal relationship between autoimmune diseases and BMD, falls, and fractures using Mendelian randomization (MR). Methods The instrumental variables were selected from the aggregated statistical data of these diseases from the largest genome-wide association study in Europe. Specifically, 12 common autoimmune diseases were selected as exposure. Outcome variables included BMD, falls, and fractures. Multiple analysis methods were utilized to comprehensively evaluate the causal relationship between autoimmune diseases and BMD, falls, and fractures. Additionally, sensitivity analyses, including Cochran's Q test, MR-Egger intercept test, and one analysis, were conducted to verify the result's reliability. Results Strong evidence was provided in the results of the negatively association of ulcerative colitis (UC) with forearm BMD. UC also had a negatively association with the total body BMD, while inflammatory bowel disease (IBD) depicted a negatively association with the total body BMD at the age of 45-60 years. Horizontal pleiotropy or heterogeneity was not detected through sensitivity analysis, indicating that the causal estimation was reliable. Conclusion This study shows a negative causal relationship between UC and forearm and total body BMD, and between IBD and total body BMD at the age of 45-60 years. These results should be considered in future research and when public health measures and osteoporosis prevention strategies are formulated.
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Affiliation(s)
- Shaofeng Wu
- Department of Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Zhen Ye
- Department of Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yi Yan
- Department of Operating Room, Taixing People’s Hospital, Taixing, China
| | - Xinli Zhan
- Department of Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Liang Ren
- Reproductive Medicine Center, The First Afliated Hospital of Guangxi Medical University, Nanning, China
| | - Chenxing Zhou
- Department of Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Tianyou Chen
- Department of Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yuanlin Yao
- Department of Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jichong Zhu
- Department of Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Siling Wu
- Department of Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Fengzhi Ma
- Department of Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Lu Liu
- Department of Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Binguang Fan
- Department of Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Chong Liu
- Department of Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
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Leodori G, Santilli M, Modugno N, D’Avino M, De Bartolo MI, Fabbrini A, Rocchi L, Conte A, Fabbrini G, Belvisi D. Postural Instability and Risk of Falls in Patients with Parkinson's Disease Treated with Deep Brain Stimulation: A Stabilometric Platform Study. Brain Sci 2023; 13:1243. [PMID: 37759844 PMCID: PMC10526843 DOI: 10.3390/brainsci13091243] [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] [Received: 08/03/2023] [Revised: 08/21/2023] [Accepted: 08/24/2023] [Indexed: 09/29/2023] Open
Abstract
Postural instability (PI) in Parkinson's disease (PD) exposes patients to an increased risk of falls (RF). While dopaminergic therapy and deep brain stimulation (DBS) improve motor performance in advanced PD patients, their effects on PI and RF remain elusive. PI and RF were assessed using a stabilometric platform in six advanced PD patients. Patients were evaluated in OFF and ON dopaminergic medication and under four DBS settings: with DBS off, DBS bilateral, and unilateral DBS of the more- or less-affected side. Our findings indicate that dopaminergic medication by itself exacerbated PI and RF, and DBS alone led to a decline in RF. No combination of medication and DBS yielded a superior improvement in postural control compared to the baseline combination of OFF medication and the DBS-off condition. Yet, for ON medication, DBS significantly improved both PI and RF. Among DBS conditions, DBS bilateral provided the most favorable outcomes, improving PI and RF in the ON medication state and presenting the smallest setbacks in the OFF state. Conversely, the more-affected side DBS was less beneficial. These preliminary results could inform therapeutic strategies for advanced PD patients experiencing postural disorders.
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Affiliation(s)
- Giorgio Leodori
- IRCCS Neuromed, 86077 Pozzilli, Italy; (G.L.); (M.S.); (N.M.); (M.D.); (A.C.); (D.B.)
- Department of Human Neuroscience, University of Rome “Sapienza”, 00185 Rome, Italy; (M.I.D.B.); (A.F.)
| | - Marco Santilli
- IRCCS Neuromed, 86077 Pozzilli, Italy; (G.L.); (M.S.); (N.M.); (M.D.); (A.C.); (D.B.)
| | - Nicola Modugno
- IRCCS Neuromed, 86077 Pozzilli, Italy; (G.L.); (M.S.); (N.M.); (M.D.); (A.C.); (D.B.)
| | - Michele D’Avino
- IRCCS Neuromed, 86077 Pozzilli, Italy; (G.L.); (M.S.); (N.M.); (M.D.); (A.C.); (D.B.)
| | - Maria Ilenia De Bartolo
- Department of Human Neuroscience, University of Rome “Sapienza”, 00185 Rome, Italy; (M.I.D.B.); (A.F.)
| | - Andrea Fabbrini
- Department of Human Neuroscience, University of Rome “Sapienza”, 00185 Rome, Italy; (M.I.D.B.); (A.F.)
| | - Lorenzo Rocchi
- Department of Medical Sciences and Public Health, University of Cagliari, 09042 Cagliari, Italy;
| | - Antonella Conte
- IRCCS Neuromed, 86077 Pozzilli, Italy; (G.L.); (M.S.); (N.M.); (M.D.); (A.C.); (D.B.)
- Department of Human Neuroscience, University of Rome “Sapienza”, 00185 Rome, Italy; (M.I.D.B.); (A.F.)
| | - Giovanni Fabbrini
- IRCCS Neuromed, 86077 Pozzilli, Italy; (G.L.); (M.S.); (N.M.); (M.D.); (A.C.); (D.B.)
- Department of Human Neuroscience, University of Rome “Sapienza”, 00185 Rome, Italy; (M.I.D.B.); (A.F.)
| | - Daniele Belvisi
- IRCCS Neuromed, 86077 Pozzilli, Italy; (G.L.); (M.S.); (N.M.); (M.D.); (A.C.); (D.B.)
- Department of Human Neuroscience, University of Rome “Sapienza”, 00185 Rome, Italy; (M.I.D.B.); (A.F.)
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Xie L, Cho S. Ankle Strategies for Step-Aside Movement during Straight Walking. J Clin Med 2023; 12:5215. [PMID: 37629258 PMCID: PMC10455850 DOI: 10.3390/jcm12165215] [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] [Received: 07/05/2023] [Revised: 08/02/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
The step-aside movement, also known as the dodging step, is a common maneuver for avoiding obstacles while walking. However, differences in neural control mechanisms and ankle strategies compared to straight walking can pose a risk of falling. This study aimed to examine the differences in tibialis anterior (TA), peroneus longus (PL), and soleus (SOL) muscle contractions, foot center of pressure (CoP) displacement, and ground reaction force (GRF) generation between step-aside movement and straight walking to understand the mechanism behind step-aside movement during walking. Twenty healthy young male participants performed straight walking and step-aside movements at comfortable walking speeds. The participants' muscle contractions, CoP displacement, and GRF were measured. The results show significant greater bilateral ankle muscle contractions during the push and loading phases of step-aside movement than during straight walking. Moreover, the CoP displacement, GRF generation mechanism, and timing differed from those observed during straight walking. These findings provide valuable insights for rehabilitation professionals in the development of clinical decisions for populations at a risk of falls and lacking gait stability.
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Affiliation(s)
| | - Sanghyun Cho
- Department of Physical Therapy, Yonsei University, Wonju 26493, Republic of Korea;
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Hellmers S, Krey E, Gashi A, Koschate J, Schmidt L, Stuckenschneider T, Hein A, Zieschang T. Comparison of machine learning approaches for near-fall-detection with motion sensors. Front Digit Health 2023; 5:1223845. [PMID: 37564882 PMCID: PMC10410450 DOI: 10.3389/fdgth.2023.1223845] [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: 05/16/2023] [Accepted: 07/06/2023] [Indexed: 08/12/2023] Open
Abstract
Introduction Falls are one of the most common causes of emergency hospital visits in older people. Early recognition of an increased fall risk, which can be indicated by the occurrence of near-falls, is important to initiate interventions. Methods In a study with 87 subjects we simulated near-fall events on a perturbation treadmill and recorded them with inertial measurement units (IMU) at seven different positions. We investigated different machine learning models for the near-fall detection including support vector machines, AdaBoost, convolutional neural networks, and bidirectional long short-term memory networks. Additionally, we analyzed the influence of the sensor position on the classification results. Results The best results showed a DeepConvLSTM with an F1 score of 0.954 (precision 0.969, recall 0.942) at the sensor position "left wrist." Discussion Since these results were obtained in the laboratory, the next step is to evaluate the suitability of the classifiers in the field.
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Affiliation(s)
- Sandra Hellmers
- Assistance Systems and Medical Device Technology, Department for Health Services Research, Carl von Ossietzky University, Oldenburg, Germany
| | - Elias Krey
- Assistance Systems and Medical Device Technology, Department for Health Services Research, Carl von Ossietzky University, Oldenburg, Germany
| | - Arber Gashi
- Geriatric Medicine, Department for Health Services Research, Carl von Ossietzky University, Oldenburg, Germany
| | - Jessica Koschate
- Geriatric Medicine, Department for Health Services Research, Carl von Ossietzky University, Oldenburg, Germany
| | - Laura Schmidt
- Geriatric Medicine, Department for Health Services Research, Carl von Ossietzky University, Oldenburg, Germany
| | - Tim Stuckenschneider
- Geriatric Medicine, Department for Health Services Research, Carl von Ossietzky University, Oldenburg, Germany
| | - Andreas Hein
- Assistance Systems and Medical Device Technology, Department for Health Services Research, Carl von Ossietzky University, Oldenburg, Germany
| | - Tania Zieschang
- Geriatric Medicine, Department for Health Services Research, Carl von Ossietzky University, Oldenburg, Germany
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Zhang K, Ju Y, Yang D, Cao M, Liang H, Leng J. Correlation analysis between body composition, serological indices and the risk of falls, and the receiver operating characteristic curve of different indexes for the risk of falls in older individuals. Front Med (Lausanne) 2023; 10:1228821. [PMID: 37559927 PMCID: PMC10409486 DOI: 10.3389/fmed.2023.1228821] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 07/12/2023] [Indexed: 08/11/2023] Open
Abstract
Objective This study assessed the risk factors for falls and evaluated the correlation between body composition, serological indices, and the risk of falls in older individuals. Method This cross-sectional study included 387 individuals ≥60 years of age in the cadre ward of the First Hospital of Jilin University. The information used in this study was obtained from the comprehensive geriatric assessment database of the cadre ward. The body composition of the individuals was measured by bioelectrical impedance analysis using an InBody S10 device. We assessed fall risk using the fall risk assessment tool. Individuals with ≤2 points were placed in the low-risk group, those with 3-9 points were placed in the medium-risk group, and those with ≥10 points were placed in the high-risk group. Results Differences in age, educational background, height, cognitive impairment, malnutrition, ability of daily living, depression, diastolic blood pressure, heart rate, intracellular water, total body moisture, water ratio, limb moisture (right and left, upper and lower), trunk moisture, fat-free weight, arm girth, body cell mass, skeletal muscle mass, limb muscle (right and left, upper and lower), appendicular skeletal muscle mass index (ASMI), sarcopenia, hemoglobin level, hematocrit level, aspartate aminotransferase level, albumin level, anemia, and hypoproteinemia were observed among the three groups (p < 0.001, p = 0.002, p = 0.006, p < 0.001, p < 0.001, p < 0.001, p < 0.001, p < 0.001, p = 0.008, p = 0.010). Ordinal logistic regression analysis showed that the probability of the fall risk increasing by one level was 1.902 times higher for each unit of decrease in educational background, respectively. In addition, the probability of the fall risk increasing by one level was 2.971, 3.732, 3.804, 1.690 and 2.155 times higher for each additional unit of age, cognitive impairment, lower limb edema, decreased skeletal muscle mass, and sarcopenia, respectively. Conclusion Our findings suggest that educational background, age, cognitive impairment, lower limb edema, decreased skeletal muscle mass, and sarcopenia were associated with falls in older individuals. Body composition and serological indices can assist in the early identification of falls in the older people.
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Affiliation(s)
| | | | | | | | | | - Jiyan Leng
- Department of Cadre Ward, The First Hospital of Jilin University, Changchun, China
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Pedrero-Sánchez JF, De-Rosario-Martínez H, Medina-Ripoll E, Garrido-Jaén D, Serra-Añó P, Mollà-Casanova S, López-Pascual J. The Reliability and Accuracy of a Fall Risk Assessment Procedure Using Mobile Smartphone Sensors Compared with a Physiological Profile Assessment. Sensors (Basel) 2023; 23:6567. [PMID: 37514860 PMCID: PMC10385364 DOI: 10.3390/s23146567] [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] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 07/03/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023]
Abstract
Falls in older people are a major health concern as the leading cause of disability and the second most common cause of accidental death. We developed a rapid fall risk assessment based on a combination of physical performance measurements made with an inertial sensor embedded in a smartphone. This study aimed to evaluate and validate the reliability and accuracy of an easy-to-use smartphone fall risk assessment by comparing it with the Physiological Profile Assessment (PPA) results. Sixty-five participants older than 55 performed a variation of the Timed Up and Go test using smartphone sensors. Balance and gait parameters were calculated, and their reliability was assessed by the (ICC) and compared with the PPAs. Since the PPA allows classification into six levels of fall risk, the data obtained from the smartphone assessment were categorised into six equivalent levels using different parametric and nonparametric classifier models with neural networks. The F1 score and geometric mean of each model were also calculated. All selected parameters showed ICCs around 0.9. The best classifier, in terms of accuracy, was the nonparametric mixed input data model with a 100% success rate in the classification category. In conclusion, fall risk can be reliably assessed using a simple, fast smartphone protocol that allows accurate fall risk classification among older people and can be a useful screening tool in clinical settings.
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Affiliation(s)
- José-Francisco Pedrero-Sánchez
- Instituto de Biomecánica (IBV), Universitat Politècnica de València, Edificio 9C, Camino de Vera S/N, 46022 Valencia, Spain
| | - Helios De-Rosario-Martínez
- Instituto de Biomecánica (IBV), Universitat Politècnica de València, Edificio 9C, Camino de Vera S/N, 46022 Valencia, Spain
| | - Enrique Medina-Ripoll
- Instituto de Biomecánica (IBV), Universitat Politècnica de València, Edificio 9C, Camino de Vera S/N, 46022 Valencia, Spain
| | - David Garrido-Jaén
- Instituto de Biomecánica (IBV), Universitat Politècnica de València, Edificio 9C, Camino de Vera S/N, 46022 Valencia, Spain
| | - Pilar Serra-Añó
- Unidad de Biomecánica Clínica (UBIC), Department of Physiotherapy, Faculty of Physiotherapy, Universitat de València, Carrer Gascó Oliag 5, 46010 Valencia, Spain
| | - Sara Mollà-Casanova
- Unidad de Biomecánica Clínica (UBIC), Department of Physiotherapy, Faculty of Physiotherapy, Universitat de València, Carrer Gascó Oliag 5, 46010 Valencia, Spain
| | - Juan López-Pascual
- Instituto de Biomecánica (IBV), Universitat Politècnica de València, Edificio 9C, Camino de Vera S/N, 46022 Valencia, Spain
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Hepp J, Shiraishi M, Tran M, Henson E, Ananthanarayanan M, Soangra R. Exploring Teslasuit's Potential in Detecting Sequential Slip-Induced Kinematic Changes among Healthy Young Adults. Sensors (Basel) 2023; 23:6258. [PMID: 37514552 PMCID: PMC10383312 DOI: 10.3390/s23146258] [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] [Received: 05/28/2023] [Revised: 06/22/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023]
Abstract
This study aimed to assess whether the Teslasuit, a wearable motion-sensing technology, could detect subtle changes in gait following slip perturbations comparable to an infrared motion capture system. A total of 12 participants wore Teslasuits equipped with inertial measurement units (IMUs) and reflective markers. The experiments were conducted using the Motek GRAIL system, which allowed for accurate timing of slip perturbations during heel strikes. The data from Teslasuit and camera systems were analyzed using statistical parameter mapping (SPM) to compare gait patterns from the two systems and before and after slip. We found significant changes in ankle angles and moments before and after slip perturbations. We also found that step width significantly increased after slip perturbations (p = 0.03) and total double support time significantly decreased after slip (p = 0.01). However, we found that initial double support time significantly increased after slip (p = 0.01). However, there were no significant differences observed between the Teslasuit and motion capture systems in terms of kinematic curves for ankle, knee, and hip movements. The Teslasuit showed promise as an alternative to camera-based motion capture systems for assessing ankle, knee, and hip kinematics during slips. However, some limitations were noted, including kinematics magnitude differences between the two systems. The findings of this study contribute to the understanding of gait adaptations due to sequential slips and potential use of Teslasuit for fall prevention strategies, such as perturbation training.
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Affiliation(s)
- Jacob Hepp
- Crean College of Health and Behavioral Sciences, Chapman University, Orange, CA 92866, USA; (J.H.); (M.S.); (M.T.); (E.H.); (M.A.)
| | - Michael Shiraishi
- Crean College of Health and Behavioral Sciences, Chapman University, Orange, CA 92866, USA; (J.H.); (M.S.); (M.T.); (E.H.); (M.A.)
| | - Michelle Tran
- Crean College of Health and Behavioral Sciences, Chapman University, Orange, CA 92866, USA; (J.H.); (M.S.); (M.T.); (E.H.); (M.A.)
| | - Emmy Henson
- Crean College of Health and Behavioral Sciences, Chapman University, Orange, CA 92866, USA; (J.H.); (M.S.); (M.T.); (E.H.); (M.A.)
| | - Mira Ananthanarayanan
- Crean College of Health and Behavioral Sciences, Chapman University, Orange, CA 92866, USA; (J.H.); (M.S.); (M.T.); (E.H.); (M.A.)
| | - Rahul Soangra
- Crean College of Health and Behavioral Sciences, Chapman University, Orange, CA 92866, USA; (J.H.); (M.S.); (M.T.); (E.H.); (M.A.)
- Fowler School of Engineering, Chapman University, Orange, CA 92866, USA
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Lee CH, Mendoza T, Huang CH, Sun TL. Comparative Analysis of Fall Risk Assessment Features in Community-Elderly and Stroke Survivors: Insights from Sensor-Based Data. Healthcare (Basel) 2023; 11:1938. [PMID: 37444772 PMCID: PMC10341555 DOI: 10.3390/healthcare11131938] [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: 04/30/2023] [Revised: 06/27/2023] [Accepted: 06/29/2023] [Indexed: 07/15/2023] Open
Abstract
Fall-risk assessment studies generally focus on identifying characteristics that affect postural balance in a specific group of subjects. However, falls affect a multitude of individuals. Among the groups with the most recurrent fallers are the community-dwelling elderly and stroke survivors. Thus, this study focuses on identifying a set of features that can explain fall risk for these two groups of subjects. Sixty-five community dwelling elderly (forty-nine female, sixteen male) and thirty-five stroke-survivors (twenty-two male, thirteen male) participated in our study. With the use of an inertial sensor, some features are extracted from the acceleration data of a Timed Up and Go (TUG) test performed by both groups of individuals. A short-form berg balance scale (SFBBS) score and the TUG test score were used for labeling the data. With the use of a 100-fold cross-validation approach, Relief-F and Extra Trees Classifier algorithms were used to extract sets of the top 5, 10, 15, 20, 25, and 30 features. Random Forest classifiers were trained for each set of features. The best models were selected, and the repeated features for each group of subjects were analyzed and discussed. The results show that only the stand duration was an important feature for the prediction of fall risk across all clinical tests and both groups of individuals.
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Affiliation(s)
- Chia-Hsuan Lee
- Department of Data Science, Soochow University, No. 70, Linxi Road, Shilin District, Taipei 111, Taiwan;
| | - Tomas Mendoza
- Department of Industrial Engineering and Management, Yuan Ze University, 135 Yuan Tung Road, Chungli District, Taoyuan 320, Taiwan;
| | - Chien-Hua Huang
- Department of Eldercare, Central Taiwan University of Science and Technology, Taichung 40601, Taiwan;
| | - Tien-Lung Sun
- Department of Industrial Engineering and Management, Yuan Ze University, 135 Yuan Tung Road, Chungli District, Taoyuan 320, Taiwan;
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Almeida LRS, Vasconcelos L, Valenca GT, Carvalho K, Pinto EB, Oliveira-Filho J, Canning CG. Psychometric properties of the Brazilian-Portuguese version of the Falls Behavioral Scale in people with Parkinson's disease. Disabil Rehabil 2023:1-7. [PMID: 37403370 DOI: 10.1080/09638288.2023.2230132] [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] [Indexed: 07/06/2023]
Abstract
PURPOSE To verify the psychometric properties of the Brazilian-Portuguese version of the Falls Behavioral (FaB-Brazil) Scale in Parkinson's disease (PD). MATERIAL AND METHODS Participants (n = 96) were assessed by disease-specific, self-report and functional mobility measures. Internal consistency of the FaB-Brazil scale was evaluated using Cronbach's alpha and inter-rater and test-retest reliability using intraclass correlation coefficients (ICC). The standard error of measurement (SEM), minimal detectable change (MDC), ceiling and floor effects, and convergent and discriminative validity were evaluated. RESULTS Internal consistency was moderate (α = 0.77). Excellent inter-rater (ICC = 0.90; p < 0.001) and test-retest (ICC = 0.91; p < 0.001) reliability were found. The SEM was 0.20 and MDC was 0.38. Ceiling and floor effects were not found. Convergent validity was established by the positive correlations between the FaB-Brazil scale and age, modified Hoehn and Yahr, PD duration, Movement Disorders Society-Unified Parkinson's Disease Rating Scale, Motor Aspects of Experiences of Daily Living, Timed Up & Go and 8-item Parkinson's Disease Questionnaire, and negative correlations between the FaB-Brazil scale and community mobility, Schwab & England, and Activities-specific Balance Confidence scale. Females showed greater protective behaviors than males; recurrent fallers showed greater protective behaviors than non-recurrent fallers (p < 0.05). CONCLUSIONS The FaB-Brazil scale is reliable and valid for assessing people with PD.
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Affiliation(s)
- Lorena Rosa S Almeida
- Movement Disorders and Parkinson's Disease Clinic, Roberto Santos General Hospital/SESAB, Salvador, Bahia, Brazil
- Bahiana School of Medicine and Public Health, Motor Behavior and Neurorehabilitation Research Group, Salvador, Bahia, Brazil
| | - Lara Vasconcelos
- Postgraduate Program in Health Sciences, Federal University of Bahia School of Medicine, Salvador, Bahia, Brazil
| | - Guilherme T Valenca
- Movement Disorders and Parkinson's Disease Clinic, Roberto Santos General Hospital/SESAB, Salvador, Bahia, Brazil
- Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil
| | - Kárin Carvalho
- Bahiana School of Medicine and Public Health, Motor Behavior and Neurorehabilitation Research Group, Salvador, Bahia, Brazil
- Postgraduate Program in Health Sciences, Federal University of Bahia School of Medicine, Salvador, Bahia, Brazil
| | - Elen Beatriz Pinto
- Bahiana School of Medicine and Public Health, Motor Behavior and Neurorehabilitation Research Group, Salvador, Bahia, Brazil
- Department of Life Sciences (DCV), Bahia State University, Salvador, Bahia, Brazil
| | - Jamary Oliveira-Filho
- Discipline of Physiotherapy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Colleen G Canning
- Discipline of Physiotherapy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Soangra R, Smith JA, Rajagopal S, Yedavalli SVR, Anirudh ER. Classifying Unstable and Stable Walking Patterns Using Electroencephalography Signals and Machine Learning Algorithms. Sensors (Basel) 2023; 23:6005. [PMID: 37447852 DOI: 10.3390/s23136005] [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] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/21/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023]
Abstract
Analyzing unstable gait patterns from Electroencephalography (EEG) signals is vital to develop real-time brain-computer interface (BCI) systems to prevent falls and associated injuries. This study investigates the feasibility of classification algorithms to detect walking instability utilizing EEG signals. A 64-channel Brain Vision EEG system was used to acquire EEG signals from 13 healthy adults. Participants performed walking trials for four different stable and unstable conditions: (i) normal walking, (ii) normal walking with medial-lateral perturbation (MLP), (iii) normal walking with dual-tasking (Stroop), (iv) normal walking with center of mass visual feedback. Digital biomarkers were extracted using wavelet energy and entropies from the EEG signals. Algorithms like the ChronoNet, SVM, Random Forest, gradient boosting and recurrent neural networks (LSTM) could classify with 67 to 82% accuracy. The classification results show that it is possible to accurately classify different gait patterns (from stable to unstable) using EEG-based digital biomarkers. This study develops various machine-learning-based classification models using EEG datasets with potential applications in detecting unsteady gait neural signals and intervening by preventing falls and injuries.
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Affiliation(s)
- Rahul Soangra
- Fowler School of Engineering, Chapman University, Orange, CA 92866, USA
- Crean College of Health and Behavioral Sciences, Chapman University, Orange, CA 92866, USA
| | - Jo Armour Smith
- Crean College of Health and Behavioral Sciences, Chapman University, Orange, CA 92866, USA
| | - Sivakumar Rajagopal
- School of Electronics Engineering, Vellore Institute of Technology, Vellore 632014, India
| | - Sai Viswanth Reddy Yedavalli
- School of Electronics Engineering, Vellore Institute of Technology, Vellore 632014, India
- School of Electrical and Computer Science, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Erandumveetil Ramadas Anirudh
- School of Electronics Engineering, Vellore Institute of Technology, Vellore 632014, India
- Department of Electrical and Computer Engineering, University of Windsor, Windsor, ON N9B 3P4, Canada
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Minta K, Colombo G, Taylor WR, Schinazi VR. Differences in fall-related characteristics across cognitive disorders. Front Aging Neurosci 2023; 15:1171306. [PMID: 37358956 PMCID: PMC10289027 DOI: 10.3389/fnagi.2023.1171306] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 05/25/2023] [Indexed: 06/28/2023] Open
Abstract
Approximately 40-60% of falls in the elderly lead to injuries, resulting in disability and loss of independence. Despite the higher prevalence of falls and morbidity rates in cognitively impaired individuals, most fall risk assessments fail to account for mental status. In addition, successful fall prevention programmes in cognitively normal adults have generally failed in patients with cognitive impairment. Identifying the role of pathological aging on fall characteristics can improve the sensitivity and specificity of fall prevention approaches. This literature review provides a thorough investigation into fall prevalence and fall risk factors, the accuracy of fall risk assessments, and the efficacy of fall prevention strategies in individuals with diverse cognitive profiles. We show that fall-related characteristics differ between cognitive disorders and fall risk assessment tools as well as fall prevention strategies should critically consider each patient's cognitive status to facilitate the identification of fallers at an earlier stage and support clinical decision-making.
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Affiliation(s)
- Karolina Minta
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Giorgio Colombo
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
| | - William R. Taylor
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
- Department of Health Sciences and Technology, Institute for Biomechanics, ETH Zürich, Zürich, Switzerland
| | - Victor R. Schinazi
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
- Department of Psychology, Bond University, Gold Coast, QLD, Australia
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Nagai T, Miyagami M, Okano I, Nakamura S, Okazaki Y, Sakamoto K, Kasai F, Kudo Y, Kawate N. Association of Spinal Alignment and Abdominal Circumference with Sarcopenia Status and Fall Risk in Patients with Osteoporosis: A Retrospective Study. Nutrients 2023; 15:nu15112571. [PMID: 37299534 DOI: 10.3390/nu15112571] [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] [Received: 04/08/2023] [Revised: 05/26/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023] Open
Abstract
Since vertebral kyphosis and abdominal circumference are thought to influence sarcopenia and fall risk in osteoporosis, we evaluated sarcopenia and fall risk in patients with different measurements of abdominal circumference and sagittal longitudinal axis (SVA). In this post hoc study, 227 patients aged 65 years or more who visited an outpatient osteoporosis clinic were included in the analysis. Sarcopenia was determined from lean body mass, grip strength, and walking speed by dual energy X-ray absorptiometry; SVA (median 40 mm) and abdominal circumference (median 80 cm) were compared between the four groups, each divided into two groups. Nutritional management, falls, and fall anxiety scores were also examined. The incidence of sarcopenia was significantly increased in those with abdominal circumference < 80 cm in both the SVA < 40 mm and SVA ≥ 40 mm groups (p < 0.05). Nonetheless, the fall scores of those with SVA < 40 mm were lower than those of individuals with SVA ≥ 40 mm (p < 0.01). Based on the results of this study, SVA and abdominal circumference values may predict the risk of sarcopenia and falls. More research is needed before our results can be translated into clinical practice.
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Affiliation(s)
- Takashi Nagai
- Department of Rehabilitation Medicine, Showa University School of Medicine, Tokyo 142-866, Japan
- Department of Orthopedic Surgery, Showa University School of Medicine, Tokyo 142-866, Japan
| | - Makoto Miyagami
- Department of Orthopedic Surgery, Showa University School of Medicine, Tokyo 142-866, Japan
| | - Ichiro Okano
- Department of Orthopedic Surgery, Showa University School of Medicine, Tokyo 142-866, Japan
| | - Shota Nakamura
- Department of Orthopedic Surgery, Showa University School of Medicine, Tokyo 142-866, Japan
| | - Yuichiro Okazaki
- Department of Orthopedic Surgery, Showa University School of Medicine, Tokyo 142-866, Japan
| | - Keizo Sakamoto
- Department of Orthopedic Surgery, Showa University School of Medicine, Tokyo 142-866, Japan
| | - Fumihito Kasai
- Department of Rehabilitation Medicine, Showa University School of Medicine, Tokyo 142-866, Japan
| | - Yoshifumi Kudo
- Department of Orthopedic Surgery, Showa University School of Medicine, Tokyo 142-866, Japan
| | - Nobuyuki Kawate
- Department of Rehabilitation Medicine, Showa University School of Medicine, Tokyo 142-866, Japan
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You L, Guo L, Li N, Zhong J, Er Y, Zhao M. Association between multimorbidity and falls and fear of falling among older adults in eastern China: a cross-sectional study. Front Public Health 2023; 11:1146899. [PMID: 37275486 PMCID: PMC10234124 DOI: 10.3389/fpubh.2023.1146899] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 01/18/2023] [Accepted: 04/18/2023] [Indexed: 06/07/2023] Open
Abstract
Background Growing evidence has reported an association between multimorbidity and falls and fear of falling (FOF) in older adults, however, the results regarding this association from China are limited. Our study aimed to investigate the association between multimorbidity and falls and FOF in older adults in eastern China. Methods We conducted a cross-sectional study in Zhejiang Province, Eastern China, which recruited a provincial representative sample of adults aged ≥ 60 years. A structured questionnaire including demographic characteristics, chronic diseases, history of falls in the past 12 months, and FOF, was administered by all participants. The exposure variable was multimorbidity, which was defined as the presence of two or more chronic diseases and medical conditions in the same individual. The outcomes included a history of falls and FOF. Multivariate logistic regression was used to evaluate the association between multimorbidity and falls and FOF in older adults. Results In total of 7,774 participants were included in the analysis, among whom 3,898 (50.1%) were female, with a mean ± standard deviation age is 72.9 ± 8.4 years. Multimorbidity was associated with the increased risk of falling in older adults [adjusted odds ratio (OR), 1.99; 95% confidence interval (CI):1.55-2.36]. The ORs for having experienced single fall and repeated falls were 1.85 (95% CI: 1.42-2.42) and 3.45 (95% CI: 1.47-6.97), respectively, with multimorbidity compared with those without chronic diseases. The older adults with multimorbidity were more likely to report FOF compared with those without chronic diseases (adjusted OR, 1.49; 95%CI:1.30-1.70). Moreover, the association between multimorbidity and FOF remained significant in the older adults with a history of fall (OR, 1.57; 95%CI:1.04-2.38). Conclusion The association between multimorbidity and falls and FOF is significant in the Chinese population and the effects of multimorbidity on falls and FOF do not vary according to the frequency and history of falls in older adults.
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Affiliation(s)
- Liuqing You
- Zhejiang Provincial Center for Disease Control and Prevention, Zhejiang, China
| | - Lihua Guo
- Zhejiang Provincial Center for Disease Control and Prevention, Zhejiang, China
| | - Na Li
- Zhejiang Provincial Center for Disease Control and Prevention, Zhejiang, China
| | - Jieming Zhong
- Zhejiang Provincial Center for Disease Control and Prevention, Zhejiang, China
| | - Yuliang Er
- National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Ming Zhao
- Zhejiang Provincial Center for Disease Control and Prevention, Zhejiang, China
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Sczuka KS, Schneider M, Schellenbach M, Kerse N, Becker C, Klenk J. Evaluating the Effect of Activity and Environment on Fall Risk in a Paradigm-Depending Laboratory Setting: Protocol for an Experimental Pilot Study. JMIR Res Protoc 2023; 12:e46930. [PMID: 37163327 DOI: 10.2196/46930] [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: 03/02/2023] [Revised: 04/14/2023] [Accepted: 04/17/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Knowledge about the causal factors leading to falls is still limited, and fall prevention interventions urgently need to be more effective to limit the otherwise increasing burden caused by falls in older people. To identify individual fall risk, it is important to understand the complex interplay of fall-related factors. Although fall events are common, they are seldom observed, and fall reports are often biased. Due to the rapid development of wearable inertial sensors, an objective approach to capture fall events and the corresponding circumstances is provided. OBJECTIVE The aim of this work is to operationalize a prototypical dynamic fall risk model regarding 4 ecologically valid real-world scenarios (opening a door, slipping, tripping, and usage of public transportation). We hypothesize that individual fall risk is associated with an interplay of intrinsic risk factors, activity, and environmental factors that can be estimated by using data measured within a laboratory simulation setting. METHODS We will recruit 30 community-dwelling people aged 60 years or older. To identify several fall-related intrinsic fall risk factors, appropriate clinical assessments will be selected. The experimental setup is adaptable so that the level of fall risk for each activity and each environmental factor is adjustable. By different levels of difficulty, the effect on the risk of falling will be investigated. An 8-camera motion tracking system will be used to record absolute body motions and limits of stability. All laboratory experiments will also be recorded by inertial sensors (L5, dominant leg) and video camera. Logistic regression analyses will be used to model the association between risk factors and falls. Continuous fall risk will be modeled by generalized linear regression models using margin of stability as outcome parameter. RESULTS The results of this project will prove the concept and establish methods to further use the dynamic fall risk model. Recruitment and measurement initially began in October 2020 but were halted because of the COVID-19 pandemic. Recruitment and measurements recommenced in October 2022, and by February 2023, a total of 25 of the planned 30 subjects have been measured. CONCLUSIONS In the field of fall prevention, a more precise fall risk model will have a significant impact on research leading to more effective prevention approaches. Given the described burden related to falls and the high prevalence, considerable improvements in fall prevention will have a significant impact on individual quality of life and also on society in general by reducing institutionalization and health care costs. The setup will enable the analysis of fall events and their circumstances ecologically valid in a laboratory setting and thereby will provide important information to estimate the individual instantaneous fall risk. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/46930.
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Affiliation(s)
- Kim Sarah Sczuka
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Marc Schneider
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Michael Schellenbach
- Institute of Computer Science, University of Applied Science Ruhr West, Mülheim an der Ruhr, Germany
| | - Ngaire Kerse
- Department of General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand
| | - Clemens Becker
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
- Digital Geriatric Medicine, Heidelberg University, Heidelberg, Germany
| | - Jochen Klenk
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
- IB University of Health and Social Sciences, Study Center Stuttgart, Stuttgart, Germany
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Kung CF, Lai YR, Chiu WC, Lien CY, Huang CC, Cheng BC, Lin WC, Chen YS, Yu CC, Chiang YF, Guo YR, Chen YH, Lu CH. Effectiveness of Center of Pressure Trajectory as Anticipatory Postural Adjustment Measurement in Parkinson's Disease With Freezing of Gait History. Neurorehabil Neural Repair 2023; 37:240-250. [PMID: 37083157 DOI: 10.1177/15459683231166934] [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: 04/22/2023]
Abstract
BACKGROUND Evidence showed that patients with Parkinson's disease (PD) who have a history of freezing of gait (FOG) have hypometric anticipatory postural adjustment (APA) during gait initiation (GI) compared to PD without FOG. OBJECTIVES This study aimed to test the feasibility of center of pressure (COP) displacement during GI as the measure of APA in PD with and without a history of FOG. METHODS Patients with PD underwent COP trajectory measurements, including duration, length, velocity, and acceleration in different phases of APA (APA1, APA2a, APA2, and LOC), as well as evaluation of New Freezing of Gait Questionnaire (NFOG-Q), Tinetti balance and gait score, and Postural Instability and Gait Difficulty (PIGD) score in the on and off medication states. RESULTS The duration (seconds) of APA2a, APA2b, and LOC were highest while velocity in mediolateral direction (X) (m/s), including APA1, APA2a, APA2b, and LOC showed lowest in PD with FOG. Velocity in the mediolateral direction in different phases of APA increased in patients with FOG after dopaminergic therapy. APA2a (seconds) and APA2b (X) (m/s) were significantly associated with NFOG-Q part II, APA2b (X) (m/s) was significantly associated with NFOG-Q part III, and APA2a (seconds) was significantly associated with Tinetti balance and gait and PIGD score. CONCLUSIONS PD with FOG history showed a favorable response of APAs to dopaminergic replacement. The APA parameters by COP trajectory, especially lateral COP shift toward the stance foot (APA2b (X) (m/s) and APA2a (seconds)) are surrogate markers to assess PD with FOG history.
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Affiliation(s)
- Chien-Feng Kung
- Department of Intelligent Commerce, National Kaohsiung University of Science and Technology, Kaohsiung
| | - Yun-Ru Lai
- Departments of Neurology, Chang Gung University College of Medicine, Kaohsiung
- Departments of Hyperbaric Oxygen Therapy Center, Chang Gung University College of Medicine, Kaohsiung
| | - Wen-Chan Chiu
- Departments of Internal Medicine, Chang Gung University College of Medicine, Kaohsiung
| | - Chia-Yi Lien
- Departments of Neurology, Chang Gung University College of Medicine, Kaohsiung
| | - Chih-Cheng Huang
- Departments of Neurology, Chang Gung University College of Medicine, Kaohsiung
| | - Ben-Chung Cheng
- Departments of Internal Medicine, Chang Gung University College of Medicine, Kaohsiung
| | - Wei-Che Lin
- Departments of Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung
| | - Yueh-Sheng Chen
- Departments of Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung
| | - Chiun-Chieh Yu
- Departments of Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung
| | - Yi-Fang Chiang
- Departments of Neurology, Chang Gung University College of Medicine, Kaohsiung
| | - Yan-Ru Guo
- Department of Intelligent Commerce, National Kaohsiung University of Science and Technology, Kaohsiung
| | - Yin-Hong Chen
- Department of Intelligent Commerce, National Kaohsiung University of Science and Technology, Kaohsiung
| | - Cheng-Hsien Lu
- Department of Biological Science, National Sun Yat-Sen University, Kaohsiung
- Department of Neurology, Xiamen Chang Gung Memorial Hospital, Xiamen, Fujian, China
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Pitluk Barash M, Shuper Engelhard E, Elboim-Gabyzon M. Feasibility and Effectiveness of a Novel Intervention Integrating Physical Therapy Exercise and Dance Movement Therapy on Fall Risk in Community-Dwelling Older Women: A Randomized Pilot Study. Healthcare (Basel) 2023; 11:healthcare11081104. [PMID: 37107938 PMCID: PMC10137670 DOI: 10.3390/healthcare11081104] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 02/06/2023] [Revised: 03/15/2023] [Accepted: 04/02/2023] [Indexed: 04/29/2023] Open
Abstract
This pilot study presents a novel fall prevention intervention that integrates physical therapy exercise (PTE) and dance movement therapy (DMT) to address both physical and emotional fall risk factors, as well as factors influencing adherence to treatment. The aim of this study was to examine the feasibility and effectiveness of the intervention in a sample of eight older women (median = 86 [81.25-90.75] years) from a day center for senior citizens. The intervention, based on the Otago Exercise Program and DMT techniques, aimed to address the emotional experience during physical exercise. Participants were randomly assigned to either a PTE+DMT intervention group (n = 5) or a PTE control group (n = 3). A pre-post intervention battery of physical and emotional fall risk assessments, therapist-patient bond, and home exercise adherence was conducted. Non-parametric tests results showed significant improvement in the PTE+DMT group in measures of balance and fear of falling compared to the PTE group. However, no other significant differences were found between the groups in terms of falls-related psychological concerns, self-perceived health status, therapist-patient bond, and home exercise adherence. These findings demonstrate the feasibility and potential benefits of an intervention that integrates both physical and emotional aspects to reduce fall risk in older adults, and provide a basis for further studies and modifications in the research protocol.
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Affiliation(s)
- Michal Pitluk Barash
- The Graduate School of Creative Art Therapies, Faculty of Social Welfare & Health Sciences, Emili Sagol Creative Arts Therapies Research Center, University of Haifa, Haifa 3498838, Israel
| | - Einat Shuper Engelhard
- The Graduate School of Creative Art Therapies, Faculty of Social Welfare & Health Sciences, Emili Sagol Creative Arts Therapies Research Center, University of Haifa, Haifa 3498838, Israel
- The Graduate School of Creative Art Therapies, Faculty of Humanities & Social Sciences, Kibbutzim College of Education, Tel Aviv 6250769, Israel
| | - Michal Elboim-Gabyzon
- Physical Therapy Department, Faculty of Social Welfare & Health Sciences, University of Haifa, Haifa 3498838, Israel
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Blajovan MD, Arnăutu DA, Malița DC, Tomescu MC, Faur C, Arnăutu SF. Fall Risk in Elderly with Insomnia in Western Romania-A Retrospective Cross-Sectional Study. Medicina (Kaunas) 2023; 59:medicina59040718. [PMID: 37109678 PMCID: PMC10144438 DOI: 10.3390/medicina59040718] [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] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 04/01/2023] [Accepted: 04/04/2023] [Indexed: 04/29/2023]
Abstract
Background and Objectives: Falls are frequent among the elderly, imply large social and economic costs, and have serious outcomes. The purpose of this study was to investigate the links between insomnia, comorbidities, multisite pain, physical activity, and fall risk in the elderly. Materials and Methods: This retrospective cross-sectional study included persons recruited from nursing homes for the elderly in Timisoara. We separated the participants into two groups by the absence (group I) or presence of fractures (group II) starting with the age of 65 years. Participants were asked how they feel about their sleep using one item on a 4-point scale from the Assessment of Quality of Life questionnaire. The risk of fall was evaluated using the Falls Risk Assessment Tool. Results: The study enrolled 140 patients with a mean age of 78.4 ± 2.4 years (range 65-98 years), 55 of them being males (39%). By comparing the two groups, we found that the elderly with a history of fractures had a greater number of comorbidities, a higher risk of fall, and more severe sleep disturbances. When using univariate logistic regression, the occurrence of fractures in the elderly was significantly associated with the number of comorbidities, the risk of fall, and the presence of sleep disturbances (p < 0.0001). The multivariate regression analysis selected four independent parameters significantly linked to fractures, and these were the number of comorbidities (p < 0.03), the risk of fall score (p < 0.006), and the sleep disturbances of type 3 (p < 0.003) and 4 (p = 0.001). Conclusions: A fall-risk score over 14 and a number of comorbidities over 2 were notably associated with the occurrence of fractures. We also found strong positive correlations between the type of sleep disturbance and the risk of fall score, the number of comorbidities, and the number of fractures in the elderly.
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Affiliation(s)
- Marc-Dan Blajovan
- Multidisciplinary Heart Research Center, Victor Babes University of Medicine and Pharmacy, 2nd Eftimie Murgu Square, 340001 Timisoara, Romania
- Department XV-Orthopedics-Traumatology, Urology, Radiology and Medical Imagistics, Faculty of Medicine, University of Medicine and Pharmacy "Victor Babes" Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
- Timisoara County Clinical Emergency Hospital, L. Rebreanu Str., Nr. 156, 300723 Timisoara, Romania
| | - Diana-Aurora Arnăutu
- Multidisciplinary Heart Research Center, Victor Babes University of Medicine and Pharmacy, 2nd Eftimie Murgu Square, 340001 Timisoara, Romania
- Department of Internal Medicine I, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, 2nd Eftimie Murgu Square, 340001 Timisoara, Romania
| | - Daniel-Claudiu Malița
- Department XV-Orthopedics-Traumatology, Urology, Radiology and Medical Imagistics, Faculty of Medicine, University of Medicine and Pharmacy "Victor Babes" Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
- Timisoara Municipal Clinical Emergency Hospital, Hector Str., Nr. 1, 300040 Timisoara, Romania
| | - Mirela-Cleopatra Tomescu
- Multidisciplinary Heart Research Center, Victor Babes University of Medicine and Pharmacy, 2nd Eftimie Murgu Square, 340001 Timisoara, Romania
- Department of Internal Medicine I, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, 2nd Eftimie Murgu Square, 340001 Timisoara, Romania
- Timisoara Municipal Clinical Emergency Hospital, Hector Str., Nr. 1, 300040 Timisoara, Romania
| | - Cosmin Faur
- Department XV-Orthopedics-Traumatology, Urology, Radiology and Medical Imagistics, Faculty of Medicine, University of Medicine and Pharmacy "Victor Babes" Timisoara, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
- Timisoara County Clinical Emergency Hospital, L. Rebreanu Str., Nr. 156, 300723 Timisoara, Romania
| | - Sergiu-Florin Arnăutu
- Department of Internal Medicine I, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, 2nd Eftimie Murgu Square, 340001 Timisoara, Romania
- Timisoara Municipal Clinical Emergency Hospital, Hector Str., Nr. 1, 300040 Timisoara, Romania
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Bay AA, Ramachandran S, Ni L, Prusin T, Hackney ME. Differences in Balance Confidence, Fear of Falling, and Fall Risk Factors Among White and Black Community-Dwelling Older Adults. J Geriatr Phys Ther 2023; 46:122-131. [PMID: 35981334 PMCID: PMC10189616 DOI: 10.1519/jpt.0000000000000364] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE Falling among older adults is common and can cause chronic health complications. Fear of falling, a lasting concern about falling that can lead an individual to avoid activities he or she can perform, is strongly associated with falling and fall risk. Although White older adults fall more often, Black older adults have more fall risk factors. The purpose of this study was to investigate factors that explain fear of falling and differences between White and Black community-dwelling older adults in fear of falling, balance confidence, and fall risk factors. METHODS Using a cross-sectional, retrospective design, 84 community-dwelling older adults (mean age [SD] = 69.0 [5.2], range: 55-80; White, n = 37, 44%; Black, n = 47, 56%, M/F = 20/64) were assessed. Assessments were conducted in a laboratory for human studies. Fall history and risk factors, and subjective fear of falling, were collected. The Montreal Cognitive Assessment (MoCA), Activities-Specific Balance Confidence (ABC) score, preferred, backward, and fast Gait Speed, Short Form-12 Physical and Mental Component Scores, fear of falling rating scale, and demographics questionnaires were administered. Analyses included a proportional odds logistic regression model to examine which factors predicted ABC score and which factors were associated with subjective fear of falling, 1-way analysis of variance for continuous variables, the Fisher exact test for categorical variables, and the Mann-Whitney-Wilcoxon test for ordinal variables. RESULTS Black participants had significantly fewer years of education ( P = .007), lower MoCA scores ( P = .002), and slower fast gait speed ( P = .032) than White participants. Black participants reported less subjective fear of falling ( P = .043). In the final ABC model (Akaike information criterion 208.26), lower ABC scores were predicted by White race, slower preferred and fast gait speeds, and worse Short Form-12 Mental Composite Scores. DISCUSSION Despite Black participants demonstrating typical characteristics of higher fall risk including lower cognitive scores, slower gait speed, and lower ABC scores, Black participants reported fewer falls. Understanding racial differences is an important factor in fear of falling and balance confidence. CONCLUSION Reasons for racial differences should be examined further in fear of falling and balance confidence to facilitate the development of patient-centered falls prevention physical therapy programs.
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Affiliation(s)
- Allison A. Bay
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University, Atlanta, Georgia
| | | | - Liang Ni
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University, Atlanta, Georgia
| | - Todd Prusin
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University, Atlanta, Georgia
| | - Madeleine E. Hackney
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University, Atlanta, Georgia
- Atlanta Veterans Affairs Medical Center, Center for Visual and Neurocognitive Rehabilitation, Decatur, Georgia
- Geriatric Research, Education, and Clinical Center (GRECC), Birmingham/Atlanta Veterans Affairs Medical Centers, Birmingham, Alabama
- Emory University Department of Rehabilitation Medicine, Atlanta, Georgia
- Emory University School of Nursing, Atlanta, Georgia
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Zhu J, Liu Y, Jiang H, Liu Q, Yao Z, He Y, Xia L, Wu J. Analysis of factors associated with 6MWD among older patients with chronic heart failure. J Int Med Res 2023; 51:3000605231166275. [PMID: 37042184 PMCID: PMC10108424 DOI: 10.1177/03000605231166275] [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] [Indexed: 04/13/2023] Open
Abstract
OBJECTIVES To study the factors that influence the 6-minute walking distance (6MWD) among older patients with chronic heart failure. METHODS This was a single-center, retrospective, observational study. A total of 123 patients from the First Affiliated Hospital of Nanjing Medical University was selected. The factors associated with the 6MWD were analyzed using Pearson correlation analysis and multivariate linear regression. RESULTS The 6MWD of older patients was negatively correlated with age, fall risk, nutritional score, frailty, and depression but was positively correlated with educational level, fall efficacy, self-care ability, and plasma albumin. The results of independent variable multiple linear regression analysis showed that age (β = -0.098), fall risk (β = -0.262), fall efficacy (β = 0.011), self-care ability (β = -0.021), nutrition (β = -0.405), frailty (β = -0.653), and plasma albumin (β = 0.127) influenced the 6MWD. CONCLUSIONS The 6MWD of older patients with chronic heart failure was related to age, self-care ability, fall risk, nutrition, frailty, and depression.
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Affiliation(s)
- Jiao Zhu
- Department of Geriatric Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ying Liu
- Department of Geriatric Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Heng Jiang
- Department of Geriatric Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qianhui Liu
- Department of Geriatric Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zijun Yao
- Department of Geriatric Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yuli He
- Department of Geriatric Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lili Xia
- Department of Geriatric Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jun Wu
- Department of Geriatric Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Jiangsu Key Laboratory of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Kong L, Zhang X, Zhu X, Meng L, Zhang Q. Effects of Otago Exercise Program on postural control ability in elders living in the nursing home: A systematic review and meta-analysis. Medicine (Baltimore) 2023; 102:e33300. [PMID: 36930130 PMCID: PMC10019243 DOI: 10.1097/md.0000000000033300] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 02/24/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Losing postural control ability and related injuries are of particular concern for elders living in the nursing home (NH). The Otago Exercise Program (OEP) is a multimodal exercise training program initially designed as an individually tailored home exercise for community-dwelling elders, but whether its movement characteristics and exercise intensity meet NH elders' needs still needs to be clarified. This study aimed to determine the effects of the OEP in enhancing postural control ability among elders in the NH. METHODS A systematic literature search of English language databases (Cochrane Library, PubMed, EMBASE, CINAHL, and Web of Science) and Chinese language databases (China National Knowledge Infrastructure, Wanfang, and Chongqing VIP) until 15 April 2022 were performed by 2 reviewers on searching randomized controlled trial (RCT) and non-RCT. A meta-analysis was performed using Review Manager 5.3 software. Continuous data were expressed as mean difference (MD) with 95% confidence intervals (95% CI). Dichotomous data were presented as risk ratios (RRs) with 95% CI. Study methodological quality was assessed according to the Cochrane Handbook for Systematic Reviews of Interventions for RCTs and Risk Of Bias In Non-randomized Studies-of Interventions for non-RCTs by 3 reviewers. RESULTS Nine studies with 546 participants were included in this review. Two hundred and sixty-nine participants received OEP, and 277 only had conventional exercise training. Compared to the conventional exercise training group, the NH elders in the OEP group have considerably decreased in fall risk (MD = -0.84; 95% CI = -1.17, -0.51; P < .00001) and positively increased in postural balance (MD = 5.55; 95% CI = 3.60, 7.50; P < .00001), functional mobility in short-distance (MD = -6.39; 95% CI = -8.07, -4.70; P < .00001), lower-limb muscle strength (MD = 4.32; 95% CI = 3.71, 4.93; P < .00001), and health status (risk ratio = 0.35; 95% CI = 0.18, 0.66; P = .001). CONCLUSIONS Current evidence suggests that OEP is practical and feasible in NH. The nursing personnel can receive sufficient support for maintaining and enhancing these elders' postural control ability, especially during the COVID-19 pandemic.
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Affiliation(s)
- Lingyu Kong
- Physical Education and Sports School, Soochow University, Suzhou, PR China
| | - Xinwen Zhang
- School of Public Health, Suzhou Medical College of Soochow University, Suzhou, PR China
| | - Xinrui Zhu
- School of Rehabilitation Medicine, Weifang Medical University, Weifang, PR China
| | - Lingyue Meng
- Physical Education and Sports School, Soochow University, Suzhou, PR China
| | - Qiuxia Zhang
- Physical Education and Sports School, Soochow University, Suzhou, PR China
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Diebo BG, Stroud SG, Shah NV, Messina J, Hong JM, Alsoof D, Ansari K, Lafage R, Passias PG, Lafage V, Schwab FJ, Paulino CB, Aaron R, Daniels AH. Can We Predict Imbalance in Patients? Analysis of the CDC National Health and Nutrition Examination Survey. J Clin Med 2023; 12. [PMID: 36902730 DOI: 10.3390/jcm12051943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 02/06/2023] [Accepted: 02/16/2023] [Indexed: 03/06/2023] Open
Abstract
Understanding global body balance can optimize the postoperative course for patients undergoing spinal or lower limb surgical realignment. This observational cohort study aimed to characterize patients with reported imbalance and identify predictors. The CDC establishes a representative sample annually via the NHANES. All participants who said "yes" (Imbalanced) or "no" (Balanced) to the following question were identified from 1999-2004: "During the past 12 months, have you had dizziness, difficulty with balance or difficulty with falling?" Univariate analyses compared Imbalanced versus Balanced subjects and binary logistic regression modeling predicted for Imbalance. Of 9964 patients, imbalanced (26.5%) were older (65.4 vs. 60.6 years), with more females (60% vs. 48%). Imbalanced subjects reported higher rates of comorbidities, including osteoporosis (14.4% vs. 6.6%), arthritis (51.6% vs. 31.9%), and low back pain (54.4% vs 32.7%). Imbalanced patients had more difficulty with activities, including climbing 10 steps (43.8% vs. 21%) and stooping/crouching/kneeling (74.3% vs. 44.7%), and they needed greater time to walk 20 feet (9.5 vs. 7.1 s). Imbalanced subjects had significantly lower caloric and dietary intake. Regression revealed that difficulties using fingers to grasp small objects (OR: 1.73), female gender (OR: 1.43), difficulties with prolonged standing (OR: 1.29), difficulties stooping/crouching/kneeling (OR: 1.28), and increased time to walk 20 feet (OR: 1.06) were independent predictors of Imbalance (all p < 0.05). Imbalanced patients were found to have identifiable comorbidities and were detectable using simple functional assessments. Structured tests that assess dynamic functional status may be useful for preoperative optimization and risk-stratification for patients undergoing spinal or lower limb surgical realignment.
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Choudhury R, Park JH, Banarjee C, Thiamwong L, Xie R, Stout JR. Associations of Mutually Exclusive Categories of Physical Activity and Sedentary Behavior with Body Composition and Fall Risk in Older Women: A Cross-Sectional Study. Int J Environ Res Public Health 2023; 20:3595. [PMID: 36834290 PMCID: PMC9961100 DOI: 10.3390/ijerph20043595] [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] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/08/2023] [Accepted: 02/13/2023] [Indexed: 06/18/2023]
Abstract
The individual effects of physical activity (PA) and sedentary behavior (SB) on health are well-recognized. However, little is known about the extent to which different combinations of these behaviors are associated with body composition and fall risk in older adults. This cross-sectional study examined the associations of mutually exclusive categories of PA and SB with body composition and fall risk in older women. Accelerometer-measured PA, body composition and fall risk (static and dynamic balance) parameters were assessed among 94 community-dwelling older women. The participants were categorized into four groups: active-low sedentary, active-high sedentary, inactive-low sedentary and inactive-high sedentary (active: ≥150 min/week moderate-to-vigorous PA (MVPA); low sedentary: lowest tertile of SB and light PA ratio). Compared to the inactive-high sedentary group, more favorable body composition and dynamic balance results were found in the active-low sedentary (body fat mass index (BFMI): β = -4.37, p = 0.002; skeletal muscle mass index (SMI): β = 1.23, p = 0.017; appendicular lean mass index (ALMI): β = 1.89, p = 0.003; appendicular fat mass index (AFMI): β = -2.19, p = 0.003; sit-to-stand: β = 4.52, p = 0.014) and inactive-low sedentary (BFMI: β = -3.14, p = 0.007; SMI: β = 1.05, p = 0.014; AFMI: β = -1.74, p = 0.005, sit-to-stand: β = 3.28, p = 0.034) groups. Our results suggest that PA programs focusing on concurrently achieving sufficient MVPA and reduced SB might promote a healthy body composition and reduced fall risk among older adults.
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Affiliation(s)
- Renoa Choudhury
- Department of Mechanical Engineering, University of Central Florida, Orlando, FL 32816, USA
| | - Joon-Hyuk Park
- Department of Mechanical Engineering, University of Central Florida, Orlando, FL 32816, USA
- Disability, Aging and Technology Cluster, University of Central Florida, Orlando, FL 32816, USA
| | - Chitra Banarjee
- College of Medicine, University of Central Florida, Orlando, FL 32816, USA
| | - Ladda Thiamwong
- Disability, Aging and Technology Cluster, University of Central Florida, Orlando, FL 32816, USA
- College of Nursing, University of Central Florida, Orlando, FL 32816, USA
| | - Rui Xie
- Department of Statistics and Data Science, University of Central Florida, Orlando, FL 32816, USA
| | - Jeffrey R. Stout
- Disability, Aging and Technology Cluster, University of Central Florida, Orlando, FL 32816, USA
- School of Kinesiology and Physical Therapy, College of Health Professions and Sciences, University of Central Florida, Orlando, FL 32816, USA
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Ehn M, Kristoffersson A. Clinical Sensor-Based Fall Risk Assessment at an Orthopedic Clinic: A Case Study of the Staff's Views on Utility and Effectiveness. Sensors (Basel) 2023; 23:1904. [PMID: 36850500 PMCID: PMC9958653 DOI: 10.3390/s23041904] [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] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 01/27/2023] [Accepted: 02/02/2023] [Indexed: 06/18/2023]
Abstract
In-hospital falls are a serious threat to patient security and fall risk assessment (FRA) is important to identify high-risk patients. Although sensor-based FRA (SFRA) can provide objective FRA, its clinical use is very limited and research to identify meaningful SFRA methods is required. This study aimed to investigate whether examples of SFRA methods might be relevant for FRA at an orthopedic clinic. Situations where SFRA might assist FRA were identified in a focus group interview with clinical staff. Thereafter, SFRA methods were identified in a literature review of SFRA methods developed for older adults. These were screened for potential relevance in the previously identified situations. Ten SFRA methods were considered potentially relevant in the identified FRA situations. The ten SFRA methods were presented to staff at the orthopedic clinic, and they provided their views on the SFRA methods by filling out a questionnaire. Clinical staff saw that several SFRA tasks could be clinically relevant and feasible, but also identified time constraints as a major barrier for clinical use of SFRA. The study indicates that SFRA methods developed for community-dwelling older adults may be relevant also for hospital inpatients and that effectiveness and efficiency are important for clinical use of SFRA.
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Jones DL, Selfe TK, Wen S, Eicher JL, Wilcox S, Mancinelli C. Implementation of an Evidence-Based, Tai Ji Quan Fall Prevention Program in Rural West Virginia Churches: A RE-AIM Evaluation. J Aging Phys Act 2023; 31:33-47. [PMID: 35690393 DOI: 10.1123/japa.2021-0274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 03/23/2022] [Accepted: 04/03/2022] [Indexed: 02/03/2023]
Abstract
This study implemented a 16-week Tai Ji Quan: Moving for Better Balance® intervention for older adults in churches in hard-to-reach, medically underserved, rural communities, and evaluated the process using the RE-AIM Framework. Community-dwelling adults, aged 55 years, or older, were eligible. Data (N = 237) were collected at baseline, 16 weeks, and 32 weeks on falls efficacy, depression, physical/mental health-related quality of life, aerobic activity, gait speed, mobility, balance, and leg strength. Generalized/linear mixed models determined if outcomes improved. Eighteen churches sponsored 16 classes. Church adoption was 94%, instructor adoption was 86%, reach was 90%, and fidelity was good/fair. All outcomes improved except physical health-related quality of life and gait speed. Thirty-six percent of participants, 28% of churches, and 37% of instructors continued Tai Ji Quan: Moving for Better Balance at 32 weeks. Compared with two prior RE-AIM evaluations, adoption and reach rates, improvements in outcomes, and satisfaction were comparable; attendance, program completion, and continuation rates were lower.
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Chai Y, Chen J, Hou M, Zheng J, Liu L, Chen Y, Fu S, Ma Y, Hong T, Wang X. Gait strategies for individuals with knee osteoarthritis when transitioning between floor and stair walking. Front Physiol 2023; 14:1026299. [PMID: 36760532 PMCID: PMC9904770 DOI: 10.3389/fphys.2023.1026299] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 01/10/2023] [Indexed: 01/25/2023] Open
Abstract
Objective: Individuals with knee osteoarthritis are at higher risk for falls during transitions between floor and stair walking due to their reduced lower extremity function. However, the adjust gait characteristics of knee osteoarthritis subjects for dealing with stair transitions have not been explored. We aimed to investigate gait strategies in individuals with knee osteoarthritis compared to age-matched individuals without knee OA during the transition between walking on floor and stairs. Method: Gait of 30 individuals with knee osteoarthritis and 30 individuals without knee osteoarthritis during floor-to-stair and stair-to-floor walking transitions were accessed using a 3D motion capture system. Foot-tread clearance, and angles of lower extremity joints and trunk at Foot-tread clearance timepoint were analyzed by using biomechanical software (Visual 3D). Results: Compared with asymptomatic control group, the knee osteoarthritis group demonstrated no difference in vertical Foot-tread clearance and horizontal Foot-tread clearance during stair transitions. However, ankle dorsiflexion (p = 0.01) decreased, hip flexion (p = 0.02) and trunk lateral tilt (p = 0.02) increased in knee osteoarthritis group during the stair ascent transition. Moreover, trunk lateral tilt to the support side (p = 0.003) and pelvic rotation (p = 0.03) increased, while hip abduction of the swing leg (p = 0.03) decreased during the stair descent transition in individuals with knee osteoarthritis. Conclusion: Increased trunk lateral tilt and altered angle of hip may be a strategy utilized by individuals with knee OA to increase the foot clearance ability and compensate for the disease-related loss of lower extremity strength, range of motion, and balance. However, compensatory manifestations, such as the increased lateral tilt of the trunk and movement of the gravity center may enhance the risk of falls and result in more abnormal knee joint loading.
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Affiliation(s)
- Yatai Chai
- Fujian University of Traditional Chinese Medicine, Fuzhou, China,Key Laboratory of Orthopedics and Traumatology of Traditional Chinese Medicine and Rehabilitation Ministry of Education, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Jian Chen
- Rehabilitation Hospital affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Meijin Hou
- Key Laboratory of Orthopedics and Traumatology of Traditional Chinese Medicine and Rehabilitation Ministry of Education, Fujian University of Traditional Chinese Medicine, Fuzhou, China,National-Local Joint Engineering Research Center of Rehabilitation Medicine Technology, Fuzhou, China
| | - Jiaqi Zheng
- Key Laboratory of Orthopedics and Traumatology of Traditional Chinese Medicine and Rehabilitation Ministry of Education, Fujian University of Traditional Chinese Medicine, Fuzhou, China,College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Lu Liu
- Fujian University of Traditional Chinese Medicine, Fuzhou, China,Key Laboratory of Orthopedics and Traumatology of Traditional Chinese Medicine and Rehabilitation Ministry of Education, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Yongkang Chen
- Key Laboratory of Orthopedics and Traumatology of Traditional Chinese Medicine and Rehabilitation Ministry of Education, Fujian University of Traditional Chinese Medicine, Fuzhou, China,College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Shengxing Fu
- Key Laboratory of Orthopedics and Traumatology of Traditional Chinese Medicine and Rehabilitation Ministry of Education, Fujian University of Traditional Chinese Medicine, Fuzhou, China,National-Local Joint Engineering Research Center of Rehabilitation Medicine Technology, Fuzhou, China
| | - Ye Ma
- Key Laboratory of Orthopedics and Traumatology of Traditional Chinese Medicine and Rehabilitation Ministry of Education, Fujian University of Traditional Chinese Medicine, Fuzhou, China,National-Local Joint Engineering Research Center of Rehabilitation Medicine Technology, Fuzhou, China,Faculty of Sports Sciences, Research Academy of Grand Health, Ningbo University, Ningbo, China
| | | | - Xiangbin Wang
- Key Laboratory of Orthopedics and Traumatology of Traditional Chinese Medicine and Rehabilitation Ministry of Education, Fujian University of Traditional Chinese Medicine, Fuzhou, China,College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China,Rehabilitation Department of the Affiliated 3rd Peoples’ Hospital, Fujian University of Traditional Chinese Medicine, Fuzhou, China,*Correspondence: Xiangbin Wang,
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