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Murayama A, Higuchi D, Saida K, Tanaka S, Shinohara T. Fall Risk Prediction for Community-Dwelling Older Adults: Analysis of Assessment Scale and Evaluation Items without Actual Measurement. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:224. [PMID: 38397713 PMCID: PMC10888445 DOI: 10.3390/ijerph21020224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/11/2024] [Accepted: 02/12/2024] [Indexed: 02/25/2024]
Abstract
The frequency of falls increases with age. In Japan, the population is aging rapidly, and fall prevention measures are an urgent issue. However, assessing fall risk during the coronavirus disease pandemic was complicated by the social distancing measures implemented to prevent the disease, while traditional assessments that involve actual measurements are complicated. This prospective cohort study predicted the risk of falls in community-dwelling older adults using an assessment method that does not require actual measurements. A survey was conducted among 434 community-dwelling older adults to obtain data regarding baseline attributes (age, sex, living with family, use of long-term care insurance, and multimorbidity), Frailty Screening Index (FSI) score, and Questionnaire for Medical Checkup of Old-Old (QMCOO) score. The participants were categorized into fall (n = 78) and non-fall (n = 356) groups. The binomial logistic regression analysis showed that it is better to focus on the QMCOO sub-item score, which focuses on multiple factors. The items significantly associated with falls were Q5 (odds ratio [OR] 1.95), Q8 (OR 2.33), and Q10 (OR 3.68). Our results were similar to common risk factors for falls in normal times. During the pandemic, being able to gauge the risk factors for falls without actually measuring them was important.
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Affiliation(s)
- Akihiko Murayama
- Department of Physical Therapy, Faculty of Rehabilitation, Gunma University of Health and Welfare, Maebashi Plaza Genki 21 6-7F, 2-12-1 Hon-machi, Maebashi-shi 371-0023, Japan
| | - Daisuke Higuchi
- Department of Physical Therapy, Faculty of Health Care, Takasaki University of Health and Welfare, 501 Naka Orui-machi, Takasaki-shi 370-0033, Japan; (D.H.); (K.S.); (S.T.); (T.S.)
| | - Kosuke Saida
- Department of Physical Therapy, Faculty of Health Care, Takasaki University of Health and Welfare, 501 Naka Orui-machi, Takasaki-shi 370-0033, Japan; (D.H.); (K.S.); (S.T.); (T.S.)
| | - Shigeya Tanaka
- Department of Physical Therapy, Faculty of Health Care, Takasaki University of Health and Welfare, 501 Naka Orui-machi, Takasaki-shi 370-0033, Japan; (D.H.); (K.S.); (S.T.); (T.S.)
| | - Tomoyuki Shinohara
- Department of Physical Therapy, Faculty of Health Care, Takasaki University of Health and Welfare, 501 Naka Orui-machi, Takasaki-shi 370-0033, Japan; (D.H.); (K.S.); (S.T.); (T.S.)
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Duc M, Mittaz Hager AG, Zemp D, Roulet G, Bridel A, Hilfiker R. Current practices of physiotherapists in Switzerland regarding fall risk-assessment for community-dwelling older adults: A national cross-sectional survey. F1000Res 2023; 11:513. [PMID: 38131051 PMCID: PMC10733665 DOI: 10.12688/f1000research.73636.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/04/2023] [Indexed: 12/23/2023] Open
Abstract
Background Falls can strongly impact older people's quality of life, health, and lifestyle. Multifactorial assessment can determine an individual's risk of falling as the first step for fall prevention intervention. Physiotherapists have an essential role to play in assessing fall risk by older adults living in the community. In the absence of published data on this topic in Switzerland, this study investigated the current practices of physiotherapists to determine whether those are in line with recommendations. Methods An anonymous cross-sectional survey was undertaken among physiotherapists practising in Switzerland between the 21st of November and the 31st of December 2020. A priori and exploratory hypotheses were tested. Responses to open-ended questions were grouped into themes for analysis. Results A total of 938 questionnaires from all three language regions of Switzerland was analysed. Participants worked in different settings, with a higher representation of private practice self-employees (56%). Standardised fall risk assessments or instruments were used by 580 (62%) participants, while 235 (25%) preferred subjective assessment of fall risk only. Differences in fall risk assessment were observed according to the workplace setting (adjusted OR 1.93, 95% CI 1.37 to 2.7) and education level (trend test, p<0.001). The standardised assessments most frequently employed were the Berg Balance Scale (58%), the Timed-Up-and-Go (57%) and the Tinetti Balance Assessment tool (47%). Risk factors for falls were frequently queried, particularly history of falls (88%), home hazards (84%), and functional ability (81%). Technical resources (40%), knowledge (30%), and time (22%) were common barriers to implement a systematic fall risk assessment. Conclusions This study provides an overview of the current practices of physiotherapists in Switzerland in fall risk assessment. There is still room to optimise the standardisation and systematisation of this assessment to implement a best practice strategy and prevent avoidable falls.
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Affiliation(s)
- Morgane Duc
- Department of Health Professions, Bern University of Applied Sciences, Bern, Bern, 3008, Switzerland
- School of Health Sciences, University of Applied Sciences and Arts Western Switzerland, HES-SO Valais-Wallis, Leukerbad, Valais, 3954, Switzerland
| | - Anne-Gabrielle Mittaz Hager
- School of Health Sciences, University of Applied Sciences and Arts Western Switzerland, HES-SO Valais-Wallis, Leukerbad, Valais, 3954, Switzerland
| | - Damiano Zemp
- Geriatric Service, Ospedale Regionale di Mendrisio (EOC), Mendrisio, Ticino, 6850, Switzerland
| | - Guillaume Roulet
- Service of Geriatrics and Geriatric Rehabilitation, Lausanne University Hospital (CHUV), Lausanne, Vaud, 1011, Switzerland
| | - Alice Bridel
- Department of Health Professions, Bern University of Applied Sciences, Bern, Bern, 3008, Switzerland
- School of Health Sciences, University of Applied Sciences and Arts Western Switzerland, HES-SO Valais-Wallis, Leukerbad, Valais, 3954, Switzerland
| | - Roger Hilfiker
- School of Health Sciences, University of Applied Sciences and Arts Western Switzerland, HES-SO Valais-Wallis, Leukerbad, Valais, 3954, Switzerland
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Melo RS, Cardeira CSF, Rezende DSA, Guimarães-do-Carmo VJ, Lemos A, de Moura-Filho AG. Effectiveness of the aquatic physical therapy exercises to improve balance, gait, quality of life and reduce fall-related outcomes in healthy community-dwelling older adults: A systematic review and meta-analysis. PLoS One 2023; 18:e0291193. [PMID: 37683025 PMCID: PMC10490910 DOI: 10.1371/journal.pone.0291193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Opting to use aquatic or land-based physical therapy exercises to improve balance, gait, quality of life and reduce fall-related outcomes in community-dwelling older adults (CDOAs) is still a questionable clinical decision for physiotherapists. OBJECTIVE Assess the quality of evidence from randomized or quasi-randomized controlled trials that used aquatic physical therapy exercises to improve balance, gait, quality of life and reduce fall-related outcomes in CDOAs. METHODS Articles were surveyed in the following databases: MEDLINE/PubMed, EMBASE, SCOPUS, LILACS, Web of Science, CENTRAL (Cochrane Central Register of Controlled Trials), PEDro, CINAHL, SciELO and Google Scholar, published in any language, up to July 31, 2023. Two independent reviewers extracted the data and assessed evidence quality. The risk of bias of the trials was evaluated by the Cochrane tool and evidence quality by GRADE approach. Review Manager software was used to conduct the meta-analyses. RESULTS 3007 articles were identified in the searches, remaining 33 studies to be read in full, with 11 trials being eligible for this systematic review. The trials included presented low evidence quality for the balance, gait, quality of life and fear of falling. Land-based and aquatic physical therapy exercises improved the outcomes analyzed; however, aquatic physical therapy exercises were more effective in improving balance, gait, quality of life and reducing fear of falling in CDOAs. The meta-analysis showed that engaging in aquatic physical therapy exercises increases the functional reach, through of the anterior displacement of the center of pressure of CDOAs by 6.36cm, compared to land-based physical therapy exercises, assessed by the Functional Reach test: [CI:5.22 to 7.50], (p<0.00001), presenting low quality evidence. CONCLUSIONS Aquatic physical therapy exercises are more effective than their land-based counterparts in enhancing balance, gait, quality of life and reducing the fear of falling in CDOAs. However, due to methodological limitations of the trials, this clinical decision remains inconclusive. It is suggested that new trials be conducted with greater methodological rigor, in order to provide high-quality evidence on the use of the aquatic physical therapy exercises to improve the outcomes analyzed in CDOAs.
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Affiliation(s)
- Renato S. Melo
- Department of Physical Therapy, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil
- Post-Graduate Program in Physical Therapy, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil
| | | | | | | | - Andrea Lemos
- Department of Physical Therapy, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil
- Post-Graduate Program in Physical Therapy, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil
| | - Alberto Galvão de Moura-Filho
- Department of Physical Therapy, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil
- Post-Graduate Program in Physical Therapy, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil
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Frisendahl N, Ek S, Rosendahl E, Franzén E, Boström AM, Welmer AK. Can the 1-Leg Standing Test Be Replaced by Self-reported Balance in the First-Time Injurious Fall Screening Tool? J Geriatr Phys Ther 2023; 46:103-109. [PMID: 35947043 PMCID: PMC10032368 DOI: 10.1519/jpt.0000000000000362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE The First-time Injurious Fall (FIF) screening tool was created to identify fall risk in community-living older men and women, who may be targets for primary preventive interventions. The FIF tool consists of 3 self-reported questions and 1 physical test (1-leg standing balance). The purpose of this study was to examine the predictive ability of the FIF tool and a modified FIF tool (in which 1-leg standing is replaced by self-reported balance) for first-time injurious falls. METHODS A cohort of 1194 community-living people 60 years and older from the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K), Sweden, was followed longitudinally for 5 years. Data on injurious falls were collected from registered data and were defined as receipt of care after a fall. The predictive ability of the FIF tool and the m-FIF tool was explored using Harrell's C statistic, stratified by sex. RESULTS AND DISCUSSION The injurious fall rate per 1000 person-years was 54.9 (95% CI: 47.22-63.78) for women and 36.3 (95% CI: 28.84-45.78) for men. The predictive ability for women and men according to Harrell's C statistic was 0.70 and 0.71 for the FIF tool and the m-FIF tool. The predictive ability was 0.70 and 0.69 for 1-leg standing, and 0.65 and 0.60 for self-reported balance problems. CONCLUSIONS The m-FIF tool presented similar predictive ability as the FIF tool regarding first-time injurious falls. This finding could extend the usefulness of the tool to other settings, such as to electronic health (eHealth). A quickly and easily administered screening tool can help physical therapists to identify people with a high risk of falling who may need to undergo a more comprehensive fall risk assessment.
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Affiliation(s)
- Nathalie Frisendahl
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Stina Ek
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Erik Rosendahl
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Erika Franzén
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Allied Health Professionals, Medical Unit Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
- Research and Development Unit, Stockholms Sjukhem, Stockholm, Sweden
| | - Anne-Marie Boström
- Research and Development Unit, Stockholms Sjukhem, Stockholm, Sweden
- Division of Nursing, Department of Neurobiology, Care Science and Society, Karolinska Institutet, Huddinge, Sweden
- Theme Aging, Karolinska University Hospital, Huddinge, Sweden
| | - Anna-Karin Welmer
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
- Women's Health and Allied Health Professionals Theme, Medical Unit Medical Psychology, Karolinska University Hospital, Stockholm, Sweden
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Association between vertebral fragility fractures, muscle strength and physical performance: A cross-sectional study. Ann Phys Rehabil Med 2022; 66:101680. [PMID: 35667627 DOI: 10.1016/j.rehab.2022.101680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 04/25/2022] [Accepted: 04/29/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND Few studies have investigated the association between vertebral fragility fractures and lower limb muscle strength and physical performance in women with low bone mass. OBJECTIVES To explore whether the presence of vertebral fracture is independently associated with poor physical performance and decreased lower limb muscle strength. To understand whether lower limb muscle strength is associated with physical performance in women with vertebral fracture. METHODS Older women with low bone mass were divided into 2 groups: no vertebral fracture (NF) and presence of vertebral fragility fracture (VFF). Physical performance was evaluated using the Five Times Sit to Stand (5TSS) test, the Timed Up and Go (TUG) test and a 5m walk test (5MWT). Lower limb muscle strength was assessed using an isokinetic dynamometer. RESULTS We included 94 women with low bone mass (mean age 71.6 [SD 5.7] years, time since menopause 24.4 [7.1] years, mean BMI 27.5 [5.1] kgm-2). VFF was only associated with low peak hip abductor torque (p = 0.001) after adjustments. In the VFF group (n= 47), each 1 Nmkg-1 increase: in knee extensor torque was associated with improved 5MWT (p = 0.005), TUG (p = 0.002) and 5TSS (p = 0.005) performances; in knee flexor torque was associated with improved 5MWT speed (p = 0.003) and TUG time (p = 0.006); in hip abductor torque was associated with improved 5MWT speed (p = 0.003); and in hip extensor torque with improved TUG time (p = 0.046). CONCLUSION VFF was associated with reduced hip abductor strength in older women. However, the number of vertebral fractures influenced the association. Additionally, lower limb muscle strength was associated with physical performance, regardless of the clinical characteristics of the fractures. Therefore, strength and power training programs for the lower limbs could improve physical performance.
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Blodgett JM, Ventre JP, Mills R, Hardy R, Cooper R. A systematic review of one-legged balance performance and falls risk in community-dwelling adults. Ageing Res Rev 2022; 73:101501. [PMID: 34748974 DOI: 10.1016/j.arr.2021.101501] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/20/2021] [Accepted: 10/20/2021] [Indexed: 01/11/2023]
Abstract
OBJECTIVE The aim of this systematic review was to synthesise all published evidence on associations between one-legged balance performance and falls. METHODS Medline, EMBASE, CINAHL and Web of Science were systematically searched (to January 2021) to identify peer-reviewed, English language journal articles examining the association between one-legged balance performance and falls in community-dwelling adults. RESULTS Of 4310 records screened, 55 papers were included (n = 36954 participants). There was considerable heterogeneity between studies including differences in study characteristics, ascertainment of balance and falls, and analytical approaches. A meta-analysis of the time that individuals could maintain the one-legged balance position indicated that fallers had worse balance times than non-fallers (standardised mean difference: -0.29 (95%CI:-0.38,-0.20) in cross-sectional analyses; -0.19 (-0.28, -0.09) in longitudinal analyses), although there was no difference in the pooled median difference. Due to between-study heterogeneity, regression estimates between balance and fall outcomes could not be synthesised. Where assessed, prognostic accuracy indicators suggested that one-legged balance was a poor discriminator of fall risk; for example, 5 of 7 studies demonstrated poor prognostic accuracy (Area Under the Curve <0.6), with most studies demonstrating poor sensitivity. CONCLUSIONS This systematic review identified 55 papers that examined associations between balance and fall risk, the majority in older aged adults. However, the evidence was commonly of low quality and results were inconsistent. This contradicts previous perceptions of one-legged balance as a useful fall risk tool and highlights crucial gaps that must be addressed in order to translate such assessments to clinical settings.
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Affiliation(s)
- Joanna M Blodgett
- Institute of Sport, Exercise & Health, Division of Surgery & Interventional Science, University College London, 170 Tottenham Court Road, W1T 7HA, London, UK.
| | - Jodi P Ventre
- Department of Sport and Exercise Sciences, Musculoskeletal Science and Sports Medicine Research Centre, Manchester Metropolitan University, Oxford Road, M15 6BH, Manchester, UK; Department of Psychology, Health, Psychology and Communities Research Centre, Manchester Metropolitan University, Bonsall Street, M15 6GX, Manchester, UK
| | - Richard Mills
- Department of Sport and Exercise Sciences, Musculoskeletal Science and Sports Medicine Research Centre, Manchester Metropolitan University, Oxford Road, M15 6BH, Manchester, UK
| | - Rebecca Hardy
- CLOSER, Social Research Institute, University College London, 55-59 Gordon Square, WC1H 0NU, London, UK
| | - Rachel Cooper
- Department of Sport and Exercise Sciences, Musculoskeletal Science and Sports Medicine Research Centre, Manchester Metropolitan University, Oxford Road, M15 6BH, Manchester, UK
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Vieira FT, Porto JM, Martins PP, Capato LL, Suetake FS, de Abreu DCC. Hip muscle strength, dynamic balance and functional capacity of community-dwelling older adults aged 60 and older: A cross-sectional study. J Biomech 2021; 129:110753. [PMID: 34560343 DOI: 10.1016/j.jbiomech.2021.110753] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 09/09/2021] [Accepted: 09/12/2021] [Indexed: 11/16/2022]
Abstract
The objective of the present study was to evaluate the association of hip muscle strength, dynamic balance and functional capacity in the older adults aged 60 to 79 years and older adults aged 80 years and older. A total of 191 community-dwelling older adults participated in this study. Isometric muscle strength was quantified as the peak torque (PT), measured using an isokinetic dynamometer. Functional capacity was determined by the forward step test (ST) and the dynamic balance by the tandem gait (TG) test. The hip flexor, extensor, abductor and adductor PT in the older adults aged 60 to 79 years had a positive influence on the execution of the step test (p < 0.05). The peak adductor torque did not show a significant association with tandem gait (p = 0.649). In older adults aged 80 years and older, the peak adductor torque was the only one that showed an association with the performance of the ST (p = 0.001) and TG (p = 0.024) tests. The hip adductors may have a higher contribution in adults aged 80 years and older during the execution of clinical tests. These findings are relevant to clinical practice as they can help in the development of appropriate physical exercise programs targeting older adults of different age groups.
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Affiliation(s)
- Flávio Tavares Vieira
- Physiotherapy Course, Department of Health Sciences, Rehabilitation and Functional Performance Program, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brasil - Address: Avenida Bandeirantes, 3900Ribeirão Preto CEP, 14049-900 SP, Brazil.
| | - Jaqueline Mello Porto
- Physiotherapy Course, Department of Health Sciences, Rehabilitation and Functional Performance Program, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brasil - Address: Avenida Bandeirantes, 3900Ribeirão Preto CEP, 14049-900 SP, Brazil
| | - Pâmela Precinotto Martins
- Physiotherapy Course, Department of Health Sciences, Rehabilitation and Functional Performance Program, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brasil - Address: Avenida Bandeirantes, 3900Ribeirão Preto CEP, 14049-900 SP, Brazil
| | - Luana Letícia Capato
- Physiotherapy Course, Department of Health Sciences, Rehabilitation and Functional Performance Program, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brasil - Address: Avenida Bandeirantes, 3900Ribeirão Preto CEP, 14049-900 SP, Brazil
| | - Fernanda Saori Suetake
- Physiotherapy Course, Department of Health Sciences, Rehabilitation and Functional Performance Program, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brasil - Address: Avenida Bandeirantes, 3900Ribeirão Preto CEP, 14049-900 SP, Brazil.
| | - Daniela Cristina Carvalho de Abreu
- Physiotherapy Course, Department of Health Sciences, Rehabilitation and Functional Performance Program, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brasil - Address: Avenida Bandeirantes, 3900Ribeirão Preto CEP, 14049-900 SP, Brazil.
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Rate of Torque Development and Torque Steadiness of the Lower Limb and Future Falls Among Community-Dwelling Older Adults Without Previous Falls: A Longitudinal 1-Year Study. J Aging Phys Act 2021; 30:168-176. [PMID: 34407502 DOI: 10.1123/japa.2020-0442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 02/16/2021] [Accepted: 03/11/2021] [Indexed: 11/18/2022]
Abstract
The objective was to investigate the association between rate of torque development (RTD) and torque steadiness (TS) of the lower limb and the occurrence of prospective falls in community-dwelling older adults without falls in the previous year. One hundred older adults performed the tests to obtain the RTD and TS of the hip, knee, and ankle. New episodes of falls were monitored through telephone contact for a prospective period of 12 months. The association of RTD and TS with the occurrence of prospective falls was verified by multiple logistic regression adjusted for confounding variables. There was no association between RTD of hip, knee, and ankle and prospective falls. Only the TS at 50% of the peak torque of the hip flexors was associated with the occurrence of future falls (p = .023). Identifying modifiable risk factors for the first fall in older adults is essential for the development of adequate prevention programs.
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Hohtari-Kivimäki U, Salminen M, Vahlberg T, Kivelä SL. Orthostatic Hypotension is a Risk Factor for Falls Among Older Adults: 3-Year Follow-Up. J Am Med Dir Assoc 2021; 22:2325-2330. [PMID: 34384767 DOI: 10.1016/j.jamda.2021.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/05/2021] [Accepted: 07/10/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To assess the prevalence of orthostatic hypotension (OH) and the association of OH with the risk of falls among community-dwelling older adults with a previous fall. DESIGN Longitudinal study. SETTING AND PARTICIPANTS The subjects (n = 561) were participants in fall prevention conducted in western Finland. METHODS Blood pressure (BP) was measured in supine position and at 30 seconds and 3 minutes after standing. The participants were divided according to the consensus definition to an OH group (OHG) and a non-OH group (non-OHG). Falls were recorded by fall diaries during 12 months. Falls requiring treatment were gathered from health center and hospital registers during 12 and 36 months. RESULTS The prevalence of OH was 23.4% (30 seconds) and 7.3% (3 minutes). The 30-second measurement showed that the incidence of falls and that of falls requiring treatment were significantly higher in OHG compared with non-OHG during 12 months. After adjustments, the incidence of falls remained higher in all 5 adjusted models whereas that of falls requiring treatment remained higher only after adjustment for functional balance. The 3-minute measurement showed that the incidence of falls was higher in OHG compared with non-OHG during 12 months and remained higher after adjustments for functional balance and for age and functional balance. During the 36-month follow-up, OH measured at 30 seconds or 3 minutes after standing was not associated with the occurrence of falls leading to treatment. CONCLUSIONS AND IMPLICATIONS OH at 30 seconds or 3 minutes after standing is associated with a greater risk for falling within 12 months in older adults. The 30-second blood pressure measurement is more reliable to detect the risk than the 3-minute measurement. The results support the usability of 30-second measurement in determining OH and the risk for falling among older persons.
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Affiliation(s)
| | - Marika Salminen
- Faculty of Medicine, Unit of Family Medicine, University of Turku, Turku, Finland; City of Turku, Welfare Division/Turku City Hospital, Turku, Finland
| | - Tero Vahlberg
- Faculty of Medicine, Biostatistics, University of Turku, Turku, Finland
| | - Sirkka-Liisa Kivelä
- Faculty of Medicine, Unit of Family Medicine, University of Turku, Turku, Finland; Faculty of Pharmacy, University of Helsinki, Turku, Finland
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Accuracy of the step test to evaluate lower limb muscle strength in community-dwelling older women. J Bodyw Mov Ther 2020; 25:133-139. [PMID: 33714484 DOI: 10.1016/j.jbmt.2020.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 09/30/2020] [Accepted: 10/06/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE to investigate the accuracy of the step test (ST) to evaluate total lower limb muscle strength (LLMS) in older women. DESIGN observational cross-sectional study. METHODS 119 community-dwelling older women were submitted to the ST and LLMS evaluation (isometric peak torque of eight muscle groups of the dominant lower limb). The capacity of the ST to discriminate older women with reduced LLMS was measured using ROC curve, followed by the posttest probability (PoTP) calculation. RESULTS a ST score of 0.24 cm per cm of participant's height presents a sensitivity of 63.3%, specificity of 77%; enhances the PoTP from 48% to 72% for positive test and decreases the PoTP from 48% to 31% for negative test. CONCLUSION the ST may complement the clinical screening of reduced LLMS in older women, given that it is a simple and quick low-cost test and allows the evaluation of each lower limb separately.
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Martins PP, Porto JM, Vieira FT, Trimer IR, Capato LL, de Abreu DCC. The effect of unilateral muscle fatigue of hip abductor muscles on balance and functional capacity in community-dwelling older women. Arch Gerontol Geriatr 2020; 91:104222. [PMID: 32784078 DOI: 10.1016/j.archger.2020.104222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 07/30/2020] [Accepted: 08/01/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Hip abductor muscles are important for the maintenance of postural stability, mainly on the mediolateral direction and unipodal support conditions. The objective of the present study was to evaluate the effect of unilateral induced fatigue of hip abductor muscles on balance and functional capacity of older women. METHODS The study included physically independent women aged 60-75 years. We assessed static balance with the single limb stance test (SLS) and evaluated functional capacity with the maximum gait speed (MGS) and step test (ST). We ran the protocol of hip abductor muscle fatigue with a Biodex isokinetic dynamometer. Assessment of balance and functional capacity happened before and after the muscle fatigue protocol. We applied the t-test for repeated measures to determine whether unilateral hip abductor muscle fatigue influences the performance in the tests (SLS, MGS and ST). RESULTS The protocol of hip abductor muscle fatigue negatively affected all three evaluated tasks: SLS (p = 0.000), ST (p = 0.000) and MGS (p = 0.000). However, the single limb stance test was the most task affected (effect size = 0.51, pre- and post-fatigue difference = 28.1 %). CONCLUSION After the unilateral muscle fatigue of hip abductors, we observed the worst performance on clinical tests, mainly regarding the SLS test, which shows the involvement of hip abductors during usual motor tasks. However, the small magnitude of the limitation of functional tests (MGS and ST) suggests the presence of postural compensations.
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Affiliation(s)
- Pâmela Precinotto Martins
- Physiotherapy Course, Department of Health Sciences, Rehabilitation and Functional Performance Program, Ribeirão Preto Medical School, University of São Paulo, Bandeirantes Avenue, 3900, Ribeirão Preto, 14049-900, SP Brazil.
| | - Jaqueline Mello Porto
- Physiotherapy Course, Department of Health Sciences, Rehabilitation and Functional Performance Program, Ribeirão Preto Medical School, University of São Paulo, Bandeirantes Avenue, 3900, Ribeirão Preto, 14049-900, SP Brazil.
| | - Flávio Tavares Vieira
- Physiotherapy Course, Department of Health Sciences, Rehabilitation and Functional Performance Program, Ribeirão Preto Medical School, University of São Paulo, Bandeirantes Avenue, 3900, Ribeirão Preto, 14049-900, SP Brazil.
| | - Isabella Ramirez Trimer
- Physiotherapy Course, Department of Health Sciences, Rehabilitation and Functional Performance Program, Ribeirão Preto Medical School, University of São Paulo, Bandeirantes Avenue, 3900, Ribeirão Preto, 14049-900, SP Brazil.
| | - Luana Letícia Capato
- Physiotherapy Course, Department of Health Sciences, Rehabilitation and Functional Performance Program, Ribeirão Preto Medical School, University of São Paulo, Bandeirantes Avenue, 3900, Ribeirão Preto, 14049-900, SP Brazil.
| | - Daniela Cristina Carvalho de Abreu
- Physiotherapy Course, Department of Health Sciences, Rehabilitation and Functional Performance Program, Ribeirão Preto Medical School, University of São Paulo, Bandeirantes Avenue, 3900, Ribeirão Preto, 14049-900, SP Brazil.
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