Development of a Clinical Multiple-Lunge Test to Predict Falls in Older Adults

Preact to lower the risk of falling by customized rehabilitation across Europe: the feasibility study protocol of the PRECISE project in Italy

Introduction

Falls are a major worldwide health problem in older people. Several physical rehabilitation programs with home-based technologies, such as the online DigiRehab platform, have been successfully delivered. The PRECISE project combines personalized training delivered through the application with an artificial intelligence-based predictive model (AI-DSS platform) for fall risk assessment. This new system, called DigiRehab, will enable early identification of significant risk factors for falling and propose an individualized physical training plan to attend to these critical areas.

Methods

The study will test the usability of the DigiRehab platform in generating personalized physical rehabilitation programs at home. Fifty older adults participants will be involved, 20 of them testing the beta version prototype, and 30 participants testing the updated version afterwards. The inclusion criteria will be age ≥65, independent ambulation, fall risk (Tinetti test), Mini Mental State Examination ≥24, home residents, familiarity with web applications, ability and willingness to sign informed consent. Exclusion criteria will be unstable clinical condition, severe visual and/or hearing impairment, severe impairment in Activities of Daily Living and absence of primary caregiver.

Discussion

The first part of the screening consists in a structured questionnaire of 10 questions regarding the user's limitations, including the risk of falling, while the second consists in 10 physical tests to assess the functional status. Based on the results, the program will help define the user's individual profile upon which the DSS platform will rate the risk of falling and design the personalized exercise program to be carried out at home. All measures from the initial screening will be repeated and the results will be used to optimize the predictive algorithms in order to prepare the tool in its final version. For the usability assessment, the System Usability Scale will be administered. The follow-up will take place after the 12-week intervention at home. A semi-structured satisfaction questionnaire will also be administered to verify whether the project will meet the needs of older adults and their family caregiver.

Conclusion

We expect that personalized training prescribed by DigiRehab platform could help to reduce the need for care in older adults subjects and the care burden.Clinical trial registration: [https://clinicaltrials.gov/], identifier [NCT05846776].

A Narrative Review on the Tests Used in Biomechanical Functional Assessment of the Foot and Leg: Diagnostic Tests of Deformities and Compensations

BACKGROUND

To date, scientific literature has not as yet come up with any review showing the diagnostic tests used for functional assessment of the foot and leg.

METHODS

A literature review was conducted of electronic databases (MEDLINE, PEDro, DOAJ, BioMed Central, PLOS, and Centre for Reviews and Dissemination at the University of York) up to December 8, 2018. The biomechanical tests, which have adequate supportive literature, were divided into qualitative tests that provide a dichotomy/trichotomy-type answer to clinical diagnostic questions; semiquantitative tests that provide numerical data to clinical diagnostic questions; and quantitative tests that record continuous numerical data (in analogue or digital form).

RESULTS

These tests produce a useful functional evaluation model of the foot and leg for different purposes: evaluation of lower limb deficits or abnormalities in healthy patients and in athletes (in sports or other physical activities); assessment of tissue stress syndromes caused by pathomechanics; evaluation of lower limb deficits or abnormalities in rheumatic disease and diabetic foot patients; and to determine the appropriate functional or semifunctional foot orthotic therapy and therapeutic path used in gait rehabilitation.

CONCLUSIONS

Many of these tests have adequate diagnostic reliability and reproducibility and therefore can be considered diagnostic. Few of these are validated, and some have initiated the validation process by determining their sensitivity and specificity. The widespread use of these tools in clinical practice (diagnosis of function) lacks scientific evidence and in-depth analysis of their limitations.

Hip and knee kinematics of the forward lunge one year after unicondylar and total knee arthroplasty

Patients with unicondylar knee arthroplasty (UKA) report higher functionality compared to those with total knee arthroplasty (TKA). However, these patients should also be assessed during more demanding tasks in order to appreciate their true functionality. The forward lunge (FL) is a motor task commonly used in clinics to evaluate functional recovery after knee replacement surgery. Unfortunately, clear evidence comparing FL kinematics between patients with UKA and TKA is still missing. The purpose of this study was to compare hip and knee joint kinematics during the FL between patients with UKA, TKA and controls. Twenty subjects (8 TKA, 6 UKA, 6 controls) underwent 3D motion analysis during a FL. Differences in hip and knee kinematics between groups were identified using statistical parametric mapping. We concluded that patients with TKA demonstrated reduced knee and hip flexion angles during the loaded phase of the FL, which could have been an attempt to unload the knee joint. This is in contrast to patients with UKA, who showed similar knee and hip joint kinematics compared to controls throughout the entire FL. It seems that retaining the cruciate ligaments is beneficial for the execution of a complex motor task such as the FL.

ACE and UCP2 gene polymorphisms and their association with baseline and exercise-related changes in the functional performance of older adults

Maintaining high levels of physical function is an important aspect of successful ageing. While muscle mass and strength contribute to functional performance in older adults, little is known about the possible genetic basis for the heterogeneity of physical function in older adults and in how older adults respond to exercise. Two genes that have possible roles in determining levels of muscle mass, strength and function in young and older adults are angiotensin-converting enzyme (ACE) and mitochondrial uncoupling protein 2 (UCP2). This study examined whether polymorphisms in these two individual genes were associated with baseline functional performance levels and/or the training-related changes following exercise in previously untrained older adults. Five-eight Caucasian older adults (mean age 69.8 years) with no recent history of resistance training enrolled in a 12 week program of resistance, balance and cardiovascular exercises aimed at improving functional performance. Performance in 6 functional tasks was recorded at baseline and after 12 weeks. Genomic DNA was assayed for the ACE intron 16 insertion/deletion (I/D) and the UCP2 G-866A polymorphism. Baseline differences among genotype groups were tested using analysis of variance. Genotype differences in absolute and relative changes in physical function among the exercisers were tested using a general linear model, adjusting for age and gender. The genotype frequencies for each of the studied polymorphisms conformed to the Hardy-Weinberg equilibrium. The ACE I/D genotype was significantly associated with mean baseline measures of handgrip strength (II 30.9 ± 3.01 v. ID 31.7 ± 1.48 v. DD 29.3 ± 2.18 kg, p < 0.001), 8ft Up and Go time (II 6.45 ± 0.48 v. ID/DD 4.41 ± 0.19 s, p < 0.001) and 6 min walk distance (II 458 ± 28.7 v. ID/DD 546 ± 12.1m, p = 0.008). The UCP2 G-866A genotype was also associated with baseline 8ft Up and Go time (GG 5.45 ± 0.35 v. GA 4.47 ± 0.26 v. AA 3.89 ± 0.71 s, p = 0.045). After 12 weeks of training, a significant difference between UCP2 G-886A genotype groups for change in 8ft Up and Go time was detected (GG −0.68 ± 0.17 v. GA −0.10 ± 0.14 v. AA +0.05 ± 0.31 s, p = 0.023). While several interesting and possibly consistent associations with older adults’ baseline functional performance were found for the ACE and UCP2 polymorphisms, we found no strong evidence of genetic associations with exercise responses in this study. The relative equivalence of some of these training-response findings to the literature may have reflected the current study’s focus on physical function rather than just strength, the relatively high levels of baseline function for some genotype groups as well as the greater statistical power for detecting baseline differences than the training-related changes.

Clinical profile of fallers with femoral neck fractures

OBJECTIVE

To describe the most common characteristics of elderly people who fell and fractured their femoral neck and who were admitted to our rehabilitation setting after surgery by an orthopedic surgeon.

SETTING

A rehabilitation department in a general regional hospital.

PARTICIPANTS

A cohort of 100 patients, 37 men and 63 women, hospitalized for rehabilitation after surgery for a fracture in the femoral neck.

METHODS

All the patients were interviewed by a physician from the rehabilitation department about the circumstances of their fall injuries, examined by an ophthalmologist for ocular problems, and evaluated by an occupational therapist for cognitive function. Data about background diseases were retrieved from the patients' medical records.

MAIN OUTCOME MEASUREMENTS

Age of the patients, place and time of the fall, the circumstances of the fall event, the footwear used at the time of the fall, ophthalmic problems, cognitive disorders, eyeglasses use, walking aids use, medication used that may affect the central nervous system, and the presence of diseases that may influence patients' equilibrium.

RESULTS

The mean age of the patients was 78 years, with a mean weight of 69 kg. Seventy-eight percent had 1-5 diseases that could influence their balance during weight bearing; 67% had an ophthalmic disease. For 70% of the patients, the cause of the fall appeared to be intrinsic (personal). Seventy-two percent wore socks or slippers, or were barefoot at the time of the fall. Sixty-four percent of the patients who used a walking aid did not use it during the fall event. Seventy-one percent of falls occurred indoors and 29% outdoors. Fifty-five percent of the patients were with another person when they fell. Fifty-one percent were taking tranquilizers or medications for sleep disorders. Sixty-eight percent fell during the daylight hours, between 6 AM and 6 PM. Of the patients who wore eyeglasses, 77.6% were not wearing them when they fell. Seventy percent had a short-term memory disorder, 57% had a concentration disorder, and 49% had an orientation disorder.

CONCLUSIONS

Characteristics common to patients who fell and fractured their femoral neck included age older than 78 years, cognitive impairment, nonuse of eyeglasses that were prescribed, and inappropriate footwear.

Community integration after traumatic brain injury: a systematic review of the clinical implications of measurement and service provision for older adults

OBJECTIVE

To explore the scope, reliability, and validity of community integration measures for older adults after traumatic brain injury (TBI).

DATA SOURCES

A search of peer-reviewed articles in English from 1990 to April 2011 was conducted using the EBSCO Health and Scopus databases. Search terms included were community integration, traumatic brain injury or TBI, 65 plus or older adults, and assessment.

STUDY SELECTION

Forty-three eligible articles were identified, with 11 selected for full review using a standardized critical review method.

DATA EXTRACTION

Common community integration measures were identified and ranked for relevance and psychometric properties. Of the 43 eligible articles, studies reporting community integration outcomes post-TBI were identified and critically reviewed. Older adults' community integration needs post-TBI from high quality studies were summarized.

DATA SYNTHESIS

There is a relative lack of evidence pertaining to older adults post-TBI, but indicators are that older adults have poorer outcomes than their younger counterparts. The Community Integration Questionnaire (CIQ) is the most widely used community integration measurement tool used in research for people with TBI. Because of some limitations, many studies have used the CIQ in conjunction with other measures to better quantify and/or monitor changes in community integration.

CONCLUSIONS

Enhancing integration of older adults after TBI into their community of choice, with particular emphasis on social integration and quality of life, should be a primary rehabilitation goal. However, more research is needed to inform best practice guidelines to meet the needs of this growing TBI population. It is recommended that subjective tools, such as quality of life measures, are used in conjunction with well-established community integration measures, such as the CIQ, during the assessment process.