Test-retest reliability of the functional reach test and the hand grip strength test in older adults using nursing home services

The validity and reliability of the 10-meter walk test with obstacles in community-dwelling older adults

The aim of this study was to determine the validity and reliability of the 10-meter walk test modified by adding 5 and 17 cm obstacles (10MWT-O) in community-dwelling older adults and to examine its ability to differentiate between older and younger adults. The study included 65 older adults and 55 younger adults. 10MWT-O (obstacle height: 0, 5, 17 cm) was performed on two different days (day 1 and day 2). All participants were assessed by the same assessor on days 1 and 2. Berg Balance Scale (BBS), Time Up and Go (TUG) test, Mini Mental State Test, and Functional Reach Test (FRT) assessments were performed on day 1. 10MWT-O speed for all obstacle heights showed moderate to good correlations with FRT distance ( r  = 0.474-0.539, P  < 0.001), TUG Test time ( r  = -0.722 to -0.671, P  < 0.001), and BBS score ( r  = 0.619-0.660, P  < 0.001). Test-retest reliability (intraclass correlation coefficient = 0.924-0.960) was found to be within the excellent range for 10MWT-O speed across all obstacle heights. For obstacle heights of 0, 5, and 17 cm, the minimum detectable change for 10MWT-O speed was 0.16, 0.19, and 0.20 m/s, and the optimal cutoff values for differentiating older from young adults were 1.12, 0.98, and 0.85 m/s, respectively. The 10MWT-O is a reliable and valid clinical measure for assessing walking ability and adaptability in older adults. ClinicalTrials.gov identifier: NCT06307769.

Effects of structured positive feedback intervention on standing reach ability among older adults admitted to a convalescent rehabilitation ward: a small-sample pilot randomized controlled trial

PURPOSE

Interventions to improve the standing reach ability of older adults are essential for full functional independence, and structured positive feedback (PF) may be an effective intervention strategy. The purposes of this pilot randomized controlled trial (RCT) are to investigate the preliminary efficacy of structured PF for improving the standing reach ability of older patients admitted to a convalescent rehabilitation ward and evaluate the feasibility of a future full-scale RCT.

METHODS

Thirty-two eligible older adults (83.3 ± 5.9 years, 23 women) out of 587 potential participants were randomly assigned 1:1 to structured PF (experimental) and conventional rehabilitation (control) groups. Only the experimental group received PF intervention for standing reach ability once every 3 days. Both groups engaged in conventional rehabilitation programs for 2-3 h every day. The primary outcome was change in Functional Reach Test (FRT) performance after 5 weeks of the indicated intervention compared to baseline. Secondary outcomes were change in Short Falls Efficacy Scale International (Short FES-I), a self-reported measure of fear of falling, and Functional Independence Measure (FIM) scores after the 5-week intervention.

RESULTS

The estimated difference in mean FRT change (∆) between experimental and control groups was - 4.1 cm (P = 0.07) according to a linear mixed model, supporting the potential efficacy of PF for improving standing reach ability. Further, Hedge's g value was 0.71, consistent with a moderate effect size. However, the estimated mean change in Short FES-I between groups also indicated greater fear of falling in the experimental group (∆ = - 4.5, P = 0.009, g = 1.0). In contrast, the intervention effect on FIM was negligible (∆ = 2.0, P = 0.66, g = - 0.1).

CONCLUSIONS

These results support the preliminary effectiveness of structured PF for improving the standing reach ability of older adults. A larger-sample RCT is warranted for validation and optimization of the structured PF protocol.

TRIAL REGISTRATION

The University Hospital Medical Information Network (UMIN) Registered 31 May 2022 (UMIN000047647).

Reliability and validity of five balance assessments battery in individuals with schizophrenia

Purpose: This study examines the test-retest reliability, concurrent and discriminant validity of Star excursion balance test (SEBT), One-leg stance (OLS), Functional reach test (FRT), Timed up-and-go test (TUG), and Tandem walking test (TW) in individuals with schizophrenia. Methods: Thirteen participants with schizophrenia who had a history of falls and 13 age-matched controls with schizophrenia who had no history of falls received the five balance assessments battery to establish test-retest reliability. A force platform was administered to examine concurrent validity, while balance assessment performance between fallers and non-fallers was examined for discriminant validity. Conventional receiver operating characteristic curve analysis was used to estimate the optimal cutoff scores. Results: Based on the 95% confidence interval of the intraclass correlation coefficients (ICC), the test-retest reliability was good for SEBT and TUG (ICC = .92 -.99) but poor for TW (eyes open) (ICC = .15 -.74). Concurrent validity with force platform parameters showed a larger amount of significant correlations for SEBT (with rs = -.738∼-.392) and TUG (with rs = .401-.771) and low for OLS (with rs = -.494∼-.398). The discriminant validity was established for SEBT and TUG. The highest area under the curves (AUC >.8) was noted for SEBT and TUG, demonstrating better sensitivity and specificity. The cutoff score for specific assessment was also provided. Conclusion: The SEBT and TUG demonstrated better reliability and validity for examining the balance functions of individuals with schizophrenia. Furthermore, with the larger AUC, the SEBT and TUG showed superior performance in identifying fall risks.

A web step-based digital solution's impact on physical, cognitive and psychosocial functioning of community-dwelling older adults: A mixed methods randomized and controlled trial

Background

As the population ages, innovative responses are urgently needed to promote physical activity at scale. Thus, this study investigated whether a step-based activity mediated by a digital solution impacts the physical functioning of community-dwelling older adults. The secondary aims were to assess whether the same activity impacts cognitive and psychosocial functioning and explore participants' views towards the activity.

Methods

A mixed method, randomized, and controlled study with one group performing a step-based activity using DanceMove (recommended dosage: twice a week for 20 to 30 min for eight weeks) and the other their usual activities. DanceMove was used at the individuals' homes without any direct supervision. Clinical tests and questionnaires administered in person were used to assess participants at baseline, post-intervention, and three-month follow-up. The primary outcome of interest was gait velocity. Secondary outcomes were balance, pain intensity, cognitive functioning, self-efficacy, social support, loneliness, and quality of life. Also, at the end of the intervention, a semi-structured individual interview was conducted with participants in the experimental group.

Results

Seventy participants were randomized to the control (n = 37) and experimental (n = 33) groups. Of the 33 participants in the experimental group, four did not use the DanceMove at all and two used it for only 3 min. The remaining 26 participants used it for a total time over the eight weeks that varied between 15 and 991 min (mean ± SD = 306.55 ± 258.83 min). The step-based activity was not more effective than usual activities for any of the variables assessed (P > .05). Difficulties, positive and negative aspects regarding the digital solution, and reasons for not using it were identified in the interviews.

Conclusions

Eight weeks of a step-based activity mediated by a digital solution did not impact the physical, cognitive, and psychosocial functioning of community-dwelling healthy older adults. However, the activity was enjoyable and safe to be performed at home without direct supervision. Further studies are needed to explore aspects that could modulate the impact of this type of technology-mediated activity.

Trial registration

The study was registered at clinialtrials.gov (NCT05460039) before the enrolment of the first participant.

Reliability and validity of balance tests for community-dwelling older adults with musculoskeletal ambulation disability symptom complex

INTRODUCTION

Physical performance-based tests are useful indices for identifying and managing fall risk in community-dwelling older adults. However, measurement errors in these tests have not been examined. This study aimed to clarify the reliability and validity of balance tests in community-dwelling older adults with musculoskeletal ambulation disability symptom complex.

METHODS

This cross-sectional study used a test-retest design and included 52 participants from three medical facilities. The participants reported demographic and medical information using a questionnaire. Primary outcomes were the timed up-and-go test, five-times sit-to-stand test, one-leg standing test, and functional reach test results.

RESULTS

Significant correlations were found between each balance test and fear of falling and between the four balance tests. Each balance test demonstrated discriminant validity with intraclass correlation coefficients (1,1) ≥0.81. The minimal detectable change was 1.4 s, 1.6 s, 3.3 s, and 4.0 cm for the timed up-and-go test, five-time sit-to-stand test, one-leg standing test, and functional reach test, respectively.

CONCLUSION

Changes exceeding the minimal detectable change95 in balance tests can be used to judge improvement or decline in physical function, which may inform clinical decision-making. The minimal detectable change95 of balance tests should be used when implementing or modifying fall prevention programs.

Outcomes of Home Emergency Physical Readiness Education for Older Adults

Emergency preparedness initiatives are a Medicare condition of participation in home healthcare, yet limited evidence on the impact of associated programming is available. The purpose of this exploratory pilot study was to examine the outcomes of an individualized emergency preparedness educational program provided by a physical therapist (PT) in the homes of older adults. The investigators recruited older adults (n = 30) using convenience sampling. An emergency preparedness education module was developed. Demographics, functional and environmental outcome measures, a pre- and post-education confidence survey, and learning outcomes were ascertained and analyzed. Participants reported being female (n = 23), 70 to 79 years (n = 15), and 19 individuals reported 35 different lifetime emergency events. Hearing and vision impairments, inability to change a battery or navigate stairs, and environmental deficits including clutter and poor lighting were identified. Closing bedroom doors at nighttime, functioning carbon monoxide and smoke detectors, creating an evacuation plan, and assembling first aid kits were learning outcomes. Trends toward increased confidence were identified, with statistically significant improvements in the ability to respond to a fire (P = .01), a heat wave (P = .03), and to crawl on hands and knees (P = .05) identified. This study provides emerging evidence that PTs have a role in improving an older adult's confidence to prepare for and respond to an emergency event.

Effectiveness of tele-exercise training on physical fitness, functional capacity, and health-related quality of life in non-hospitalized individuals with COVID-19: The COFIT-HK study

Background

The use of tele-exercise programs as an option for post-COVID-19 rehabilitation has been suggested, but its effectiveness in non-hospitalized individuals is not well understood.

Objective

This study aimed to determine the effectiveness of an 8-week tele-exercise training program (COFIT-HK) on physical fitness, functional capacity, and health-related quality of life (HRQoL) in non-hospitalized post-COVID-19 individuals.

Methods

Forty-one non-hospitalized individuals (age:47.4 ± 7.8 yrs) who had COVID-19 history were divided into two groups: the tele-exercise training group (TELE; n = 21) and the non-intervention control group (CON; n = 20). TELE engaged in online supervised multicomponent low-to-moderate intensity exercise training (including respiratory muscle, aerobic, and resistance training) three times per week, whereas CON received standardized educational leaflets based on World Health Organization (WHO) guidelines for post-COVID-19-related illness rehabilitation only. Various components of physical fitness, functional capacity, and HRQoL were assessed at baseline and after the 8-week intervention.

Results

TELE showed significant improvements in handgrip strength, arm flexibility, functional lower extremity endurance, and HRQoL after the 8-week intervention (all p < 0.05, ES = 0.50-1.10). When comparing the groups, TELE demonstrated significantly greater improvements in both the physical and mental component summary scores of HRQoL compared to CON (both p < 0.05). Other outcomes did not reveal significant group differences.

Conclusion

Our tele-exercise intervention was effective in improving physical fitness, functional capacity and HRQoL among non-hospitalized post-COVID-19 individuals. Further research is needed to explore the utility and limitations of tele-exercise programs for post-COVID-19 rehabilitation and beyond.

The reliability and validity of the balance tests in hearing-impaired athletes

BACKGROUND

It is known that balance is affected in hearing-impaired athletes and its effects on performance. However, studies on the reliability and validity of scales evaluating balance are insufficient.

AIM

To analyze and demonstrate the effectiveness of various clinical tests using assessment balance for hearing-impaired athletes.

METHOD

The study included 60 elite athletes (aged between 18 and 25) with (n = 30) and without (n = 30) hearing impairment. The static balance was evaluated with the Flamingo Test (FT) and the dynamic balance with the Functional Reach Test (FRT), Four-Step Square Test (FSST), Star Excursion Balance Test (SEBT), and Y Balance Test (YBT). All balance tests were repeated at 1-week intervals. Test-retest reliability, known-group validity, and predictive validity of the scales were investigated.

RESULT

All balancing tests demonstrated strong test-retest reliability. FT and FSST had known-group and predictive validity. While FRT and the components of both YBT and SEBT involving anterior reaching were not valid tests for hearing-impaired individuals, YBT and SEBT had validity considering the composite score and other components.

CONCLUSION

It was revealed that the balance of hearing-impaired athletes was comparable to the balance of healthy athletes in test conditions in which visual information could be used effectively. For this reason, it is important to consider the visual information factor when evaluating the balance of hearing-impaired athletes. Additionally, taking into account time and tiredness, FT for static balance and FSST for dynamic balance may be helpful to evaluate hearing-impaired athletes.

Oblique, forward, and lateral directions reach test distances in young adults, and concurrent validity of these tests with the center of pressure excursion in assessing the limits of stability

Limits of stability is required to perform functional activities and other advanced tasks of life without losing balance, and assessment of limits of stability is essential in clinical practice. Forward, Lateral, and Oblique direction reach tests are clinical balance tests that assess limits of stability, and these reach distances in various directions may be symmetrical or asymmetrical. The aim was to establish the symmetry between various reach distances on three reach tests and to establish the concurrent validity of oblique, forward, and lateral direction reach test distances with limits of stability measured by the Iso Free machine of TecnoBody company.

METHODS

The measurements of oblique, forward, and lateral reach tests and limits of stability excursions of center of pressure were taken in eight directions on Iso Free machine of Techno Body in fifty typical college-going young adults who were recruited through convenience sampling. Pearson correlation test was used to find the relationship between forward, lateral, and oblique direction reaches and limits of stability in forward, lateral, and oblique directions. Regression analysis was used to find the factors influencing the forward, lateral, and oblique reach tests.

RESULTS

The reach distances were symmetrical, and out of the three tests, the lateral and oblique direction reach tests have a moderate positive correlation with limits of stability test in lateral and oblique directions with an r-value of 0.569 (p < 0.001) and 0.50 (p < 0.001) respectively. A Significant standardized beta value of 0.49 (p < 0.05) for the oblique direction reach test with total stability limits.

CONCLUSIONS

The oblique and lateral direction reach tests are correlated with their respective center of pressure excursion. However, the oblique direction reach test moderately correlated with the total limits of stability scores. Forward reach distances were more in number followed by oblique and lateral reach distances among young Saudi adults.

The reliability and agreement of scores in a novel balance measure for older adults: Specific Training According to BaLance Evaluation (STABLE)

PURPOSE

Falls are the leading cause of injury and premature death among community dwelling elderly but can be prevented through comprehensive balance rehabilitation which ideally targets the patient's specific needs. In this study, we evaluate the reliability and agreement of six novel clinical measures of different balance domains which applied in a patient-specific balance profile guides exercise prescription in balance rehabilitation.

MATERIALS AND METHODS

The intra-rater reliability and agreement of the six measures were evaluated on the same day in six different cohorts of elderly with balance disability (n = 65-100). Further, the inter-day intra-rater and inter-rater and test-retest reliability and agreement of the measures and the balance profile were evaluated (n = 100).

RESULTS

The intra-day intra-rater reliability and agreement was moderate to excellent (ICC2.1 = 0.525-0.968, with SDC% = 6.5-284.9%) but poor to good for the inter-day conditions (ICC2.1 = 0.123-0.832, with SDC% = 6.6-229.2%). The reliability of classifying the lower domain in the balance profile was fair, with kappa = 0.56 (95%CI 0.36-0.76).

CONCLUSIONS

Five of the six measures may reliably be applied to measure balance disability and to guide rehabilitation.

Implications for rehabilitationBalance disability is the primary reason for accidental falls among elderly but can be prevented through comprehensive individualized balance rehabilitation.Specific Training According to BaLance Evaluation (STABLE) is a novel approach for designing effective balance exercises based on clinical measurements.Five of the six measures are reliable when applied in a patient-specific balance profile to guide rehabilitation following the STABLE approach.

Comparison of physical function, proprioception, muscle strength, postural balance, and walking in older women with and without total knee arthroplasty

The benefit of total knee arthroplasty (TKA) is that it alleviates pain caused by osteoarthritis; however, other postoperative effects on physical function are unclear. This study aimed to investigate the differences in physical function, proprioception, muscle strength, postural balance, and walking in older women with and without TKA. A total of 36 participants were included in this study; the TKA group comprised older women who underwent TKA (n = 18) and the non TKA group comprised older women who did not undergo TKA (n = 18). All the participants were evaluated for physical function, proprioception, muscle strength, postural balance, and walking. The outcome measures were compared between the 2 groups using an independent t test. Correlations were assessed using Pearson correlation coefficients. Participants in the TKA group had significantly reduced physical function, postural balance, and walking ability compared with those in the non TKA group (P < .05). In the TKA group, physical function was statistically correlated with proprioception, postural balance, and walking (P < .05); in particular, it had a strong correlation with proprioception (R > .60). In the non TKA group, postural balance was significantly associated with muscle strength and walking (P < .05). In particular, it was strongly correlated with walking (R > .90). This study demonstrated that older women undergoing TKA need to actively perform interventions to improve physical function, postural balance, and walking compared with older women with osteoarthritis.

Integrated Effects of Thai Essential Oil and Balance Exercise on Parameters associated with Falls in Older Adults at Risk of Falling: A Randomized Controlled Study

BACKGROUND

Reducing the risk of falling by improving balance and leg strength may be a preventive strategy. This study evaluated the integrated effects of Thai essential oil and balance exercises on parameters associated with Falls in community-dwelling older adults at risk of falling.

METHODS

Fifty-six participants were randomly allocated to either the intervention group (IG), which performed balance exercises while smelling Thai essential oil scents of Zanthoxylum limonella (Dennst.) Alston, or the control group (CG), which performed balance exercises while receiving a control patch. Balance exercises were practiced for 12, 30-minute sessions over 4 weeks. Static and dynamic balance with eyes open and eyes closed (EC), leg muscle strength, agility, and fear of falling were assessed at baseline, after the 4-week intervention, and at 1 month after the last intervention session.

RESULTS

Both groups showed significant improvements in static and dynamic balance, ankle plantarflexor strength, and agility after the 4-week intervention (p&lt;0.05), which persisted at the 1-month follow-up (p&lt;0.05). Compared to the CG, the IG demonstrated significantly better static balance in terms of elliptical sway area (p=0.04) and center of pressure (CoP) velocity (p=0.001) during EC, as well as ankle plantarflexor strength (p=0.01). The IG also maintained a significantly greater improvement in CoP velocity during EC (p=0.01).

CONCLUSION

Integrated Thai essential oil and balance exercises improved static balance and ankle plantarflexor strength compared to the balance exercise with a control patch in older adults at risk of falling.

Acute effect of kinesiotaping on pain, balance and gait performance in patients with knee osteoarthritis: A randomized controlled study

BACKGROUND

Kinesiotape application is one of the non-pharmacological methods frequently used in patients with knee OA. Guidelines do not have a consensus on its use in knee osteoarthritis (OA).

OBJECTIVE

In this study, we aimed to investigate the acute effect of kinesiotape application on pain, balance, and gait performance in patients with knee OA.

METHODS

We included 164 patients with grade 1-3 knee OA according to the Kellgren-Lawrence staging system in the study. Patients were evaluated with visual analog scale (VAS), 10-meter walking test (10MeWT), timed-up and go test (TUG-T), single leg stance test (SLST), and functional reach test (FRT) before and after taping.

RESULTS

There was a significant improvement in the post-taping scores of all evaluation parameters in the kinesiotaping group compared with pre-taping scores. Statistically significant improvement was found in all scores of evaluated parameters except FRT scores in the placebo taping group. We found a significant superiority in the mean recovery scores of the kinesiotaping group compared to the placebo-taping group in all parameters except for 10MeWT.

CONCLUSIONS

We found significant improvements in both groups. The mean improvement levels in pain and balance scores were better in the KT group than in the PT group.

Potential of Whole-Body Vibration in Parkinson’s Disease: A Systematic Review and Meta-Analysis of Human and Animal Studies

Simple Summary

Exercise has shown to have a positive impact on both motor and non-motor functions in Parkinson’s Disease patients. However, particularly in later stages of the disease, reduced cognitive function and motor capacity may lead to an inability to stay physically active. Therefore, alternative strategies for patients with Parkinson’s Disease are necessary to minimize burden for patients, their families and public health care. Whole-Body Vibration could be such an alternative. Whole-Body Vibration is an exercise or treatment method in which subjects are exposed to a mechanical vibration while sitting, standing or exercising on a vibrating platform. Whole-Body Vibration is currently used for physiotherapy, sports and rehabilitation purposes. Whole-Body Vibration treatment is interesting because it affects both the body and brain. The potential of Whole-Body Vibration for, specifically, Parkinson’s Disease patients should be clarified for further application. For this purpose, we conducted an extensive systematic review of the articles investigating the effects of Whole-Body Vibrations (1) on animals and humans with Parkinson’s Disease and (2) on neuropathological Parkinson’s Disease mechanisms. The results show some potential of Whole-Body Vibration for Parkinson’s Disease patients. The recommendations provided by this review can be used by researchers and rehabilitative practitioners implementing Whole-Body Vibration as a treatment for Parkinson’s Disease patients.

Abstract

(1) Background: When the severity of Parkinson’s Disease (PD) increases, patients often have difficulties in performing exercises. Whole-Body Vibration (WBV) may be a suitable alternative. This systematic review aims to clarify if WBV shows potential as rehabilitative therapy for PD patients. (2) Methods: We searched several databases for controlled trials investigating the effects of WBV (1) on PD populations and (2) PD neuropathological mechanisms. We included both human and animal studies and performed meta-analyses. (3) Results: The studies on PD populations (14 studies) show an overall significant, but small, effect in favor of WBV (Hedges’ g = 0.28), for which the effects on stability (Hedges’ g = 0.39) and balance (Hedges’ g = 0.30) are the most prominent. The studies on the neuropathological mechanisms (18 studies) show WBV effects on neuroinflammation (Hedges’ g = –1.12) and several specific WBV effects on neurotransmitter systems, growth factors, neurogenesis, synaptic plasticity and oxidative stress. (4) Conclusions: The effects of WBV on human PD patients remains inconclusive. Nevertheless, WBV protocols with sufficient duration (≥3 weeks), session frequency (≥3 sessions/week) and vibration frequency (≥20 Hz) show potential as a treatment method, especially for motor function. The potential of WBV for PD patients is confirmed by the effects on the neuropathological mechanisms in mostly non-PD populations. We recommend high-quality future studies on both PD patients and PD mouse models to optimize WBV protocols and to examine the neuropathological mechanisms in PD populations.