Continuously declining incidence of fall injuries in older adults: nationwide statistics from Finland between 1970 and 2016

Systematic Review of the Importance of Hip Muscle Strength, Activation, and Structure in Balance and Mobility Tasks

OBJECTIVE

The aim of this systematic review was to identify the associations of the hip abductor muscle strength, structure, and neuromuscular activation on balance and mobility in younger, middle-aged, and older adults.

DATA SOURCES

We followed PRISMA guidelines and performed searches in PubMed, Embase, CINAHL, and Physiotherapy Evidence Database.

STUDY SELECTION

Study selection included: (1) studies with patients aged 18 years or older and (2) studies that measured hip abduction torque, surface electromyography, and/or muscle structure and compared these measures with balance or mobility outcomes.

DATA EXTRACTION

The extracted data included the study population, setting, sample size, sex, and measurement evaluated.

DATA SYNTHESIS

The present systematic review is composed of 59 research articles including a total of 2144 young, middle-aged, and older adults (1337 women). We found that hip abductor strength is critical for balance and mobility function, independent of age. Hip abductor neuromuscular activation is also important for balance and mobility, although it may differ across ages depending on the task. Finally, the amount of fat inside the muscle appears to be one of the important factors of muscle structure influencing balance.

CONCLUSIONS

In conclusion, a change in all investigated variables (hip abduction torque, neuromuscular activation, and intramuscular fat) appears to have an effect during balance or mobility tasks across age ranges and may elicit better performance. Future studies are necessary to confirm the effect of these variables across age ranges and the effects of interventions.

Kinetic, muscle structure, and neuromuscular determinants of weight transfer phase prior to a lateral choice reaction step in older adults

The present study aimed to investigate the association between rate of torque development (RTD), rate of activation (RoA), and muscle structure [muscle cross-sectional area (CSA), intramuscular fat (IMAT) and high density lean muscle (HDL)] with the weight transfer phase (WTP) during a choice reaction step test (CST) in older adults. Fifteen healthy older adults (7 females) participated in this study. Stance leg hip adductors RTD at 100, 150, and 200 ms, showed a significant inverse correlation with WTP (r ≥ 0.658, P ≤ 0.010). There was a significant inverse relationship between WTP and adductor magnus and tensor fascia latae RoA at all time points (RoA0-50-RoA0-200; r ≥ 0.707, P ≤ 0.033). In contrast, the WTP was not significantly associated with the hip abductor RTD, gluteus medius RoA, or muscle structure (CSA, IMAT, and HDL). Swing leg showed no significant relationship between WTP and RTD, RoA or muscle structure of the hip abductor or adductor muscles. In conclusion, the present study showed that hip adductor torque-time capacity, as well as neuromuscular activation of the adductor magnus and tensor fascia latae of the stance leg during a maximal isometric test, is associated with the ability to transfer body weight before a step to the side occurs.

Routine follow-up is unnecessary after intramedullary fixation of trochanteric femoral fractures-Analysis of 995 cases

BACKGROUND AND PURPOSE

Approximately 2000 trochanteric fractures are operated in Finland annually. These fractures make a major burden to health care system and affected individuals. The role of routine follow-up has been questioned in multiple fracture types.

PATIENTS AND METHODS

We analyzed routine follow-up visits after intramedullary fixation of trochanteric fractures (n = 995). Patients were followed up from patient registries until 2 years or death. Planned and unplanned follow-up visits were analyzed.

RESULTS

Altogether 9 patients (0.9%) had a change in treatment at planned outpatient visit. 6 of these were due to mechanical complication, 1 due to refracture and 2 due to delayed unions. 64 (6.4%) patients had a change in treatment plan because of an unplanned visit: 28 infections, 6 pressure sores, 15 mechanic complications and 14 refractures and 1 AVN, respectively.

INTERPRETATION

Routine follow-up visits are a burden both to the patients and health care system, with less than 1% leading to changes in treatment. Our suggestion is to give good instructions to patients and rehabilitation facilities instead of routine follow-up.