The reliability and validity of the Timed Up and Go as a clinical tool in individuals with and without disabilities across a lifespan: a systematic review

How vertebral fractures effect balance in postmenopausal women

OBJECTIVES

To evaluate the effect of the presence of a vertebral fracture on balance and physical performance and its contribution to fall and fracture risk in patients with postmenopausal osteoporosis.

PATIENTS AND METHODS

Ninety-five individuals with postmenopausal osteoporosis were included in this study. Patients were divided into 2 groups with a history of vertebral fracture (n = 45) and those without (n = 50). The control group consisted of patients without fractures while the study group was subdivided into 2 subgroups: single-level (n = 29) and multiple-level vertebral fractures (n = 16). None of the study participants had a history of non-vertebral fracture. All patients with a history of vertebral fracture were in the chronic phase without any complaints of pain. Thoracolumbar radiograph, computed static posturography, FRAX (fracture risk assessment tool) scores, DXA (Dual-energy x-ray absorptiometry) measurements, serum 25(OH)D values, tandem test, timed up and go test (TUG), Berg balance scale (BBS) were performed.

RESULTS

The probability of FRAX-major osteoporotic fracture, lumbar total T-score and TUG time were significantly higher and the BBS score was lower in the study group. The mean TUG time was 11.69 ± 3.81 s in the study group and 9.87 ± 2.57 s in the controls, while the mean BBS score was 52.73 ± 3.80 s in the study group and 55,28 ± 1,59 s in the control group (p < 0,005). The probability of FRAX-major osteoporotic fractures was significantly higher in patients with multiple level fractures compared to the patients with a single level fracture. There was also a moderately negative correlation between TUG and BBS, and between the BBS and fall index. The fall index was 43.73% ± 26.34% in the study group and 34.14 % ± 24.04% in the controls (p: 0.058).

CONCLUSION

This study showed that the presence of a vertebral fracture may have a negative impact on balance and physical performance, leading an increase in the risk of falls and fractures in patients with postmenopausal osteoporosis. The risk factors should be evaluated cautiously to prevent the patients from this vicious circle.

Interdisciplinary Fall Prevention Education in the Community: Nurses Making an Impact

PURPOSE

The purpose of this 8-week interdisciplinary educational program was to provide evidence-based fall prevention information to adults aged ≥65 years residing in an assisted living community.

METHOD

Eight 1-hour sessions on fall education were performed by interdisciplinary experts at an assisted living community. Control and intervention groups completed four assessments at baseline and completion of the program.

RESULTS

Both groups had decreased Timed Up and Go (TUG) and Fear of Falling scores. The intervention group had increased scores on the knowledge of falling questionnaire, whereas the control group had decreased scores, indicating the education was effective in increasing knowledge of falls. Although not statistically significant, these results are clinically significant and reveal the positive effects of the interdisciplinary program.

CONCLUSION

Fall prevention education was successful in increasing older adults' knowledge about fall risk factors. There were decreases in TUG and Fear of Falling scores, revealing a positive impact of the program. [Journal of Gerontological Nursing, 51(5), 13-16.].

Role of Maximum and Explosive Strength in the Relationship Between the Expanded Disability Status Scale (EDSS) and Functional Capacity in People with Multiple Sclerosis: A Mediation Analysis

The relationship between functional capacity and disability status in individuals with Multiple Sclerosis (MS) is well established. However, to date, the interference of lower limb strength in this classic correlation has not been studied. Therefore, this study aimed to investigate the mediating role of muscle lower limb strength variables, including maximum strength (MVIC) and explosive strength (RFD), in the relationship between the disability status, measured by Expanded Disability Status Scale (EDSS), and functional test outcomes in a MS sample. A total of 49 patients performed 4 functional tests: timed up-and-go test (TUG), sit-to-stand (STS), 10-meter walk test (10MWT), and 6-minute walk test (6MWT), as well as the measurement of MVIC and RFD. A statistical mediation analysis was conducted to examine the influence of maximum and explosive strength on the relationship between EDSS and functional capacity. Regarding MVIC, the effect of EDSS on the 6MWT (indirect effect = 48%, p = .013), 10MWT (indirect effect = 18.1%, p = .015) and TUG test (indirect effect = 27.2%, p = .003) decreased. Regarding RFD late (0-200), the effect of EDSS on the 6MWT (indirect effect = 34.8% p = .0048), 10MWT (indirect effect = 18.0%, p = .021) and TUG test (indirect effect = 25.0%, p = .014) decreased. MVIC and RFD late variables play a significant role and influence the relationship between the EDSS and functional capacity.

A Prospective Controlled Study on the Longitudinal Effects of Rehabilitation in Older Women with Primary Sarcopenia

Sarcopenia, defined as a progressive loss of skeletal muscle mass, strength, and function, is a leading contributor to disability, dependence, and reduced quality of life (HRQoL) in older adults. This study aimed to evaluate the impact of a personalized six-month rehabilitation program, centered on tailored kinetic therapy, on physical performance and HRQoL in older women with primary sarcopenia.

METHODS

This prospective controlled study included 80 women aged ≥65 years, allocated into a Study Group (SG, n = 40), who followed a supervised personalized kinetic program, and a control group (CG, n = 40), who received general advice regarding physical activity and nutrition. Physical performance was measured using the short physical performance battery (SPPB), while HRQoL was assessed with the disease-specific SarQoL questionnaire. Evaluations were conducted at baseline and after six months.

RESULTS

At baseline, both groups had comparable scores (SPPB: SG = 5.75 ± 0.86 vs. CG = 5.8 ± 0.88, p = 0.798; SarQoL: SG = 54.42 ± 8.76 vs. CG = 55.59 ± 4.61, p = 0.457). After six months, the SG showed significant improvements (SPPB = 8.05 ± 0.90, p < 0.001; SarQoL = 62.55 ± 7.00, p < 0.001). Significant gains were observed in domains related to physical and mental health, locomotion, functionality, and leisure activities (p < 0.05). In contrast, the CG showed only minor, non-significant changes (SPPB = 6.17 ± 0.78; SarQoL = 56.51 ± 5.51).

CONCLUSIONS

A structured, personalized kinetic program significantly improves physical performance and HRQoL in older women with primary sarcopenia. These results support the need for individualized, supervised rehabilitation programs in optimizing functional recovery and enhancing patient-centered outcomes in sarcopenia management.

The role of NLRP3 inflammasome in multiple sclerosis: pathogenesis and pharmacological application

Multiple sclerosis (MS) is widely acknowledged as a chronic inflammatory autoimmune disorder characterized by central nervous system (CNS) demyelination and neurodegeneration. The hyperactivation of immune and inflammatory responses is recognized as a pivotal factor contributing to the pathogenesis and progression of MS. Among various immune and inflammatory reactions, researchers have increasingly focused on the inflammasome, a complex of proteins. The initiation and activation of the inflammasome are intricately involved in the onset of MS. Notably, the NLRP3 inflammasome, the most extensively studied member of the inflammasome complex, is closely linked with MS. This review will delve into the roles of the NLRP3 inflammasome in the pathogenesis and progression of MS. Additionally, therapeutic strategies targeting the NLRP3 inflammasome for the treatment of MS, including natural compounds, autophagy regulators, and other small molecular compounds, will be detailed in this review.

Effect of sensorimotor training on stability, mobility, and quality of life after lower extremity thermal burns: A prospective randomised controlled trial

ObjectiveTo determine the effect of sensorimotor training on stability, balance, mobility, quality of life, and muscle strength after lower extremity and trunk thermal burns.DesignA prospective, randomised controlled trial.SettingPhysiotherapy outpatient setting.ParticipantsSixty participants with lower extremity and trunk thermal burns, aged 20-50 years, were randomly allocated to either the Sensorimotor Training group or the Control group.InterventionThe Sensorimotor Training group received both a sensorimotor training programme and a traditional physiotherapy programme, while the Control group received only the traditional physiotherapy programme. The intervention was applied three days per week for eight weeks.Outcome measuresThe anteroposterior stability index was the primary outcome, while secondary outcomes included the overall stability index, mediolateral stability index, Timed Up and Go Test, Berg Balance Scale, and the Short Form-36 questionnaire, all measured at baseline and after eight weeks.ResultsSignificant differences were identified between groups after eight weeks, favouring the Sensorimotor Training group. Mean differences (95% CI) between groups were: -0.89 (-1.23, -0.54) for the anteroposterior stability index; 6.67 (4.48, 8.86) for the Berg Balance Scale; -1.7 (-2.82, -0.59) for the Timed Up and Go Test; 11.22 (7.03, 15.40) for knee extensor torque; and 7.98 (4.62, 11.35) for physical function.ConclusionSensorimotor training, when added to a conventional physiotherapy programme, can significantly improve stability, balance, mobility, quality of life, and muscle strength compared to conventional physiotherapy alone in participants with lower extremity and trunk thermal burns.

Physical Therapy Management of Fall Risk in Community-Dwelling Older Adults: An Evidence-Based Clinical Practice Guideline From the American Physical Therapy Association - Geriatrics

APTA-Geriatrics, an Academy of the American Physical Therapy Association, appointed a guideline development group (GDG) to develop a clinical practice guideline (CPG) synthesizing the evidence for physical therapy management of fall risk in community-dwelling older adults. The GDG consisted of five physical therapists with clinical expertise in the management of fall risk in older adults and methodological expertise in evidence-based document development. The CPG includes a systematic review of existing literature, and stringent methodology developed by the American Physical Therapy Association to form the evidence-based recommendations. The CPG content, including methodology, recommendations and algorithm were externally reviewed by clinical providers and academicians with expertise in fall risk management for older adults. These recommendations are intended to assist physical therapists and physical therapist assistants who are engaged in fall risk management for community-dwelling older adults.

The impact of ankle-foot orthoses on mobility of dual-task walking in stroke patients? A cross-sectional two-factor factorial design clinical trial

ABSTRACTTo assess the impact of ankle-foot orthoses (AFOs) on mobility and gait during dual-task walking in post-stroke survivors. In this cross-sectional, factorial design trial, stroke survivors performed four randomized tasks: (1) dual-task walking with AFOs, (2) single-task walking with AFOs, (3) dual-task walking without AFOs, and (4) single-task walking without AFOs. Primary outcome was the Timed Up and Go (TUG) test, with secondary outcomes including gait metrics, Tinetti scores, and auditory N-back tests. In the results, 48 subjects (38 males and 10 females; 19-65 years) completed the trial. Patients had a greater TUG score with AFOs compared with non-AFOs conditions (95% CI: 7.22-14.41, P < 0.001) in single-task and dual-task conditions. Secondary outcomes showed marked enhancement with AFOs during dual-task walking, with significant interaction effects in gait metrics, balance, and cognitive function (P < 0.05). Although not statistically significant, dual-task effects of TUG and walking speed were more pronounced during dual-task walking. In conclusion, AFOs enhance mobility and gait during both single and dual-task walking in post-stroke survivors.

Xbox Kinect Sports Effects on Cognition Status and Physical Performance in Physically Inactive Older Females: A Randomized Controlled Trial

Background/Objectives: This study aimed to compare the effects of Xbox Kinect Sports (XKS) relative to an inactive control group (CG) on cognitive status and physical performance in physically inactive older females. Methods: A randomized controlled trial study was conducted with the following groups: XKS (n = 15) and CG (n = 15), considering three weekly sessions of 60 min for 24 weeks. A two-way mixed analysis of variance with repeated measures was performed. Results: A two-way mixed ANOVA revealed significant time × group interactions for the Mini-Mental State Examination (MMSE) (F(2,18) = 14.8, p = 0.000, ηp2 = 0.292, large effect), Timed Up-and-Go (TUG) (F(2,18) = 19.5, p = 0.000, ηp2 = 0.351, large effect), and Falls Efficacy Scale-International (FES-I) (F(2,18) = 6.55, p = 0.015, ηp2 = 0.154, large effect). No significant interactions were observed for the Berg Balance Scale (BBS) (F(2,18) = 0.998, p = 0.324, ηp2 = 0.027, small effect), Maximal Isometric Handgrip Strength (MIHS) (dominant: F(2,18) = 0.163, p = 0.688, ηp2 = 0.005; non-dominant: F(2,18) = 0.012, p = 0.912, ηp2 = 0.000, small effects), or Maximal Isometric Pinch Strength (MIPS) (dominant: F(2,18) = 0.099, p = 0.756, ηp2 = 0.003; non-dominant: F(2,18) = 0.233, p = 0.632, ηp2 = 0.006, small effects). Conclusions: XKS significantly improves cognitive status measured by the MMSE and physical performance through reduced time in TUG and fear of falling through the FES-I in physically inactive older females.

Reliability and Validity of Instrumented Timed Up and Go Test in Typical Adults and Elderly: A Systematic Review

OBJECTIVE

To summarize the available literature investigating the reliability and validity of the instrumented Timed Up and Go (iTUG) in typical adults and elderly.

DATA SOURCES

Data were collected from PubMed, Web of Science, and hand searching up until July 15, 2024.

STUDY SELECTION

English-language studies investigating the reliability and validity of the 3-meter version of the iTUG in typical adults and elderly were included. Eligibility was blindly reviewed by 2 reviewers.

DATA EXTRACTION

Data on demographics, settings, reliability, and validity of the iTUG were independently extracted by 2 reviewers. The methodological quality was blindly assessed by 2 reviewers using the Consensus-Based Standards for the Selection of Health Status Measurement Instruments tools, and the certainty of evidence was evaluated by the modified Grading of Recommendations Assessment, Developement and Evaluation (GRADE) approach.

DATA SYNTHESIS

Nineteen studies were included investigating 1729 participants, of which 334 were typical adults and 1395 typical elderly. For intrarater reliability (n=1 study), intraclass correlation coefficient ranged from 0.39 (95% CI, 0.30-0.50) to 0.97 (95% CI, 0.95-0.98), test-retest reliability (n=2 studies) from 0.27 (95% CI, -0.47 to 0.63) to 0.89 (95% CI, 0.78-0.95), and interrater reliability (n=1 study) generally sufficient from 0.929 to 0.99 (CI not reported). One study on criterion validity showed sufficient agreement (intraclass correlation coefficient >0.7) with the criterion standard for most outcome measures, except for 3 outcome measures measuring time of turn. Moreover, 12 studies used iTUG to predict cognitive decline (area under the curve [AUC] = 0.80), maximal mobility performance (R2=0.278), physical function (AUC ≤0.75), or falls [(AUC ≤0.853 (95% CI, 0.759-0.948)].

CONCLUSIONS

iTUG can be a reliable and valid tool for assessing mobility in adults and elderly. However, the complexity and nonstandardization of outcome measures reduce the reliability and validity of iTUG, which needs to be addressed in future research.

Factors Associated With Depression in Caregivers of Adults With Down Syndrome

BACKGROUND

Family caregivers of those with developmental disabilities have higher rates of depression and anxiety compared with caregivers of those without development disability. Few studies have examined factors that contribute to caregiver depression, including the appraisal of caregiving responsibilities and the physical fitness and daily function of the care recipient. The purpose of this study was to identify intrapersonal (caregiver) and interpersonal (care recipient) factors associated with depressive symptoms in caregivers of adults with Down syndrome (DS).

METHODS

Twenty-four adults with DS participating in a 12-month physical activity trial completed physical fitness and function tests (VO2peak, hand grip strength, timed up and go, five times sit to stand) and activities of daily living (ADL) surveys at their baseline visit. Caregivers (n = 24) of the adults with DS completed surveys on caregiving distress, quality of life (QoL) and depressive symptoms. We evaluated the associations of these assessments on caregiver depressive symptoms using Mann-Whitney U tests and Spearman correlations.

RESULTS

Adults with DS were 23 ± 7.5 years, 58% female; caregivers were 54 ± 10 years, 100% female, 96% family members. Caregiver depressive symptoms were significantly associated with caregiving distress (p = 0.024) and caregiving QoL (r = -0.58, p = 0.003). Hand grip strength of care recipients was inversely correlated with caregiver depressive symptoms (r = -0.45, p = 0.03), but other assessments of physical function and ADL were not associated with caregiver depressive symptoms.

CONCLUSIONS

Caregiver depressive symptoms were related to modifiable factors related to the caregiver and care recipient. Intervening to improve caregiving appraisal and functional strength of the care recipient may positively impact caregiver mental health.

Reliability and validity of the L test in people with multiple sclerosis

OBJECTIVES

Functional mobility is an essential factor affecting the activities of daily living in people with multiple sclerosis (PwMS). The L test is a comprehensive assessment tool for functional mobility that incorporates sit-to-stand, transfers and bidirectional turning. The purpose of this study was to determine the psychometric properties of the L test in PwMS.

DESIGN

Cross-sectional study.

PARTICIPANTS

Thirty-four PwMS [Expanded Disability Status Scale (EDSS) score 0 to 5] and 34 healthy controls were included in this study.

MAIN OUTCOME MEASURES

The L test was administered along with the timed up and go (TUG) test, 10-m walk test (10-MWT), 6-minute walk test (6-MWT), timed 360 degree turn test, and EDSS by the same rater. Fall history was recorded to categorize PwMS with and without a history of falls. The L test was repeated after 1 week to determine test-retest reliability.

RESULTS

The L test showed excellent test-retest reliability (intraclass correlation coefficient 0.995). The minimum detectable change for the L test time was 1.4 seconds. The L test demonstrated significant positive correlations with the TUG test, timed 360 degree turn test and EDSS score, and significant negative correlations with the 10-MWT and 6-MWT (P < 0.001). Significant differences in the L test times were found between PwMS and healthy controls, and between PwMS with a history of falls and those without a history of falls (P < 0.05). The cut-off time of 14.7 seconds on the L test was found to best discriminate between PwMS and healthy people, while 16.4 seconds was found to best discriminate between PwMS with a history of falls and those without a history of falls.

CONCLUSION

The L test is a reliable and valid tool for the assessment of functional mobility in PwMS.

CLINICAL TRIAL REGISTRATION NUMBER

NCT05641714. CONTRIBUTION OF THE PAPER.

Implementing reablement for community dwelling people with dementia: A formative evaluation using single-case experimental design

BACKGROUND

Reablement is recommended to maximise functioning in people with dementia, yet in Australia, is not routinely available. This study aimed to provide insight into the implementation and program outcomes of reablement in real-world practice for a person living with dementia.

METHODS

Reablement was implemented for a client with dementia. In parallel, a formative mixed-methods pilot evaluation was performed, using single-case experimental A-B-A design (n = 1), supplemented by routinely collected pre-post program clinical measures. Implementation was evaluated qualitatively via clinical notes for fidelity, feasibility and client engagement.

RESULTS

Single-case experimental design outcomes indicated the program positively impacted the participant's physical functioning. Additionally, most routinely collected pre-post clinical measures demonstrated improvement. Intervention fidelity varied, with differences in length and client engagement.

CONCLUSION

Implementation of evidence-informed reablement has been shown to be feasible in real-world practice for a community-dwelling person living with dementia. Larger implementation trials are needed to build on preliminary outcomes to ultimately improve access to these important programs.

Impact of physical activity on physical function, mitochondrial energetics, ROS production, and Ca2+ handling across the adult lifespan in men

Aging-related muscle atrophy and weakness contribute to loss of mobility, falls, and disability. Mitochondrial dysfunction is widely considered a key contributing mechanism to muscle aging. However, mounting evidence positions physical activity as a confounding factor, making unclear whether muscle mitochondria accumulate bona fide defects with aging. To disentangle aging from physical activity-related mitochondrial adaptations, we functionally profiled skeletal muscle mitochondria in 51 inactive and 88 active men aged 20-93. Physical activity status confers partial protection against age-related decline in physical performance. Mitochondrial respiration remains unaltered in active participants, indicating that aging per se does not alter mitochondrial respiratory capacity. Mitochondrial reactive oxygen species (ROS) production is unaffected by aging and higher in active participants. In contrast, mitochondrial calcium retention capacity decreases with aging regardless of physical activity and correlates with muscle mass, performance, and the stress-responsive metabokine/mitokine growth differentiation factor 15 (GDF15). Targeting mitochondrial calcium handling may hold promise for treating aging-related muscle impairments.

Face validity of standardized assessments for wheeled mobility & seating evaluations

A problem in the Complex Rehabilitation Technology industry is the lack of standardization in the assessment for wheeled mobility and seating (WMS). The aim of this paper was to identify assessment tools commonly used by clinicians during WMS evaluations. After the tools were identified by a panel of 12 subject matter experts, a presentation at the 2018 International Seating Symposium in Vancouver, Canada and the 2018 European Seating Symposium in Dublin, Ireland polled attendees via the Sli.do polling application to determine professional opinions of each tool, resulting in face validity for use in wheelchair evaluations. The Lawshe Content Validity Ratio was used to convert this anecdotal data into numerical data, indicating which tools were most and least used by attendees. Finally, a literature search was conducted to determine the reliability, validity, and International Classification of Functioning, Disability, & Health domain for each measure. The findings indicate that while there are many standardized and reliable assessment tools available for wheeled mobility and seating evaluations, most clinicians use only a few standardized assessment tools during WMS evaluations.

Profiling the persistent and episodic nature of long COVID symptoms and the impact on quality of life and functional status: a cohort observation study

Background

Post-viral issues following acute infection with coronavirus disease 2019 (COVID-19), referred to widely as long COVID, are associated with episodic, persistent, and disabling symptoms affecting quality of life and functional status. Evidence demonstrates a significant impairment and long disease course, but there remains limited empirical data to profile and determine the fluctuating symptom profile of long COVID.

Methods

We devised a 16-week, multicentre prospective cohort observation study to profile changes in patient-reported outcomes, and biological, physiological, psychological, and cognitive parameters following diagnosis and/or referral to an established long COVID clinic. Following baseline assessments, participants completed four face-to-face visits interspersed with telephone consultations. Face-to-face visits included physiological assessment, patient-reported outcome measures (PROMs), functional status, and respiratory function. Telephone consultations involved PROMs and symptom profiling.

Results

Patient-reported outcomes improved from baseline to week sixteen, but demonstrated between visit fluctuations in frequency and severity. Further findings highlight the severity and frequency of long COVID symptom profiles and the extent of quality of life and functional status impairment.

Conclusions

The data presented here highlight the episodic and relapsing nature and should be used to help characterise long COVID disability. They can inform the development of long COVID-specific guidelines and support services that can adequately respond to the reductions in patient well-being.

Revisiting the "Timed Up and Go" test: a 12-s cut-off can predict Hospitalization Associated Functional Decline in older adults

Early detection of functional decline, a major risk among hospitalized older adults, can facilitate interventions that could significantly reduce it. We aimed to examine the contribution of the Timed Up and Go (TUG) test in predicting Hospitalization Associated Functional Decline (HAFD) among older adults, able to independently ambulate before admission. We used a cross-sectional study design; a total of 310 older adults (age ≥ 65) hospitalized in internal medicine wards between December 2018 and August 2020 were included; exclusion criteria were inability to ambulate, a diagnosis restricting mobility, hospitalization for end-of-life care, or impaired cognition. The Modified Barthel Index was used to assess HAFD; it was administered at admission to evaluate patients' independence in activities of daily living 2 weeks prior hospitalization, and at discharge. The TUG test was performed on admission and to predict significant functional decline (defined by a reduction of three points or more in the Modified Barthel Index), while accounting for demographics, length of hospitalization, comorbidity burden (Charlson's comorbidity index), and cognitive function (ALFI-MMSE). Participants were divided into three groups according to their TUG score-under or over a cut-off score of 12 s, or inability to complete the test. Adjusting for age, comorbidity, cognitive ability, and duration of hospitalization, the group that performed the test in less than 12 s showed no statistically significant change in the Modified Barthel Index, therefore no significant HAFD. The other groups showed a statistically significant decline in function. Risk for significant HAFD is currently underestimated in clinical settings, limited to subjective assessment, and underused in the context of implementing early interventions to prevent HAFD. The TUG may support screening for those at risk of hospitalizing-associated functional decline and could help identify patients suitable for preventative interventions.

Tofersen treatment leads to sustained stabilization of disease in SOD1 ALS in a "real-world" setting

OBJECTIVE

Patients with amyotrophic lateral sclerosis (ALS) caused by superoxide dismutase 1 (SOD1) gene mutations (SOD1 ALS) treated with tofersen have shown slowing of disease progression, and disease stabilization with recovery of function in some patients. We report our clinical experience with treating patients with SOD1 ALS and the effects of tofersen on outcome measures.

METHODS

This was a single-center observational study of patients with SOD1 ALS receiving treatment with tofersen. The effects of tofersen treatment on neurofilament levels, muscle strength, and clinical outcome measures were assessed. Several patients had outpatient neuromuscular rehabilitation in addition to tofersen treatment and we report changes in functional outcomes.

RESULTS

Seven SOD1 ALS patients received treatment at our institution. All patients showed robust and sustained declines in serum NfL and CSF pNFH (mean change serum NfL: -57.9%; mean change CSF pNFH: -67.6%). There was apparent disease stabilization as assessed by the ALSFRS-R total score, mean change 1.1 (SD = 0.7). There was notable improvement in functional independence measured by the FIM motor score, mean change 5.13 points (SD = 3.85).

INTERPRETATION

This study provides evidence that tofersen treatment in SOD1 ALS can lead to meaningful preservation of function and suggestions of sustained improvement in neurologic function in some patients, and strongly supports the role of neurofilaments as therapeutic biomarkers.

Relationship between handgrip strength and timed up-and-go test on hospitalization costs in older adults: a population-based study

BACKGROUND

Weak handgrip strength and slow timed up-and-go (TUG) time are known risk factors for hospitalization among older adults; however, few studies have investigated the relationships between these physical tests and future hospitalization costs.

METHODS

We used data from 13,613 participants in the population-based Singapore Chinese Health Study who underwent assessment for handgrip strength and TUG time at a mean age of 74 years. Hospitalization costs for the subsequent year, among those who survived for at least one year thereafter, were ascertained via linkage with administrative healthcare finance data. We analyzed costs using a two-part model that contained a probit regression model in the first part, and a generalized linear regression model with gamma distribution and log link in the second.

RESULTS

Handgrip strength showed a dose-dependent inverse relationship with hospitalization costs (Ptrend<0.001). Compared to the strongest quartile, participants in the weakest quartile experienced a 38.2% (95% CI: 18.0-58.5%) increase of US$599 (US$281-US$917) in mean costs. Conversely, TUG time demonstrated a dose-dependent positive association with hospitalization costs (Ptrend<0.001). Compared to the fastest quartile, participants in the slowest quartile had a 103.0% (72.1-133.9%) increase of US$1431 (US$1002-US$1859) in mean costs. We then examined combinations of handgrip strength and TUG time. Compared to participants who were both strong and fast, participants who were either weak or slow only had 12.9-48.7% higher mean costs. Meanwhile, participants who were both weak and slow experienced a 99.9% (68.5-131.4%) increase of US$1630 (US$1116-US$2144) in mean costs.

CONCLUSIONS

Weak handgrip strength and slow TUG time were independently associated with increased hospitalization costs among older adults.

An augmented reality dual-task intervention improves postural stability in individuals with Parkinson's disease

BACKGROUND

The Dual-task Augmented Reality Treatment (DART) trial recently established that dual-task training (DTT) delivered by a physical therapist or the augmented reality DART platform was effective in improving spatiotemporal gait parameters under single- and dual-task conditions in individuals with Parkinson's disease (PD). Data regarding postural stability were not reported in the primary outcome manuscript.

OBJECTIVE

The aim of this secondary analysis was to compare the effects of a Traditional DTT intervention delivered by a physical therapist and DTT delivered by the DART platform on postural stability, functional mobility, and turning in individuals with PD. It was hypothesized that both groups would experience similar improvements.

METHODS

Forty-seven individuals with PD were randomized to an 8-week (16 sessions) Traditional DTT or DART intervention. The limits of stability test and the instrumented Timed Up and Go (TUG) under single- and dual-task conditions were gathered at Baseline, End of Treatment (EOT), and 8-weeks after EOT.

RESULTS

At EOT, the Traditional DTT and DART groups experienced a 9 % and 14 % improvement in maximal excursion area and a 7 % and 12 % improvement in total TUG time under dual-task conditions, respectively (p<0.05). Turn duration and average and peak turn velocity during the TUG improved for both groups under single- and dual-task conditions at EOT. Improvements in turn duration (dual-task) and average turn velocity (single- and dual-task) persisted 8-weeks after intervention cessation.

CONCLUSION

Improvements in postural stability, functional mobility, and turning under single- and dual-task conditions following traditional and DART DTT in individuals with PD indicate that cognitive-motor training can be used to effectively treat postural instability in this population. Improvements in the DART group were similar to traditional DTT, supporting our previous data demontrating that DART is an effective digital therapeutic to improve gait and postural instability in individuals with PD.

Effects of Combination Taping Technique on Disability, Functional Capacity, and Knee Isokinetic Torque in Patients with Knee Osteoarthritis: A Blinded Randomized Controlled Study

BACKGROUND

Treatments that combine both elastic and rigid taping in knee osteoarthritis have not yet been investigated in the literature. Thus, the purpose of the present study is to investigate how the combination taping technique affects functional status, disability, and quadricep isokinetic torque in cases of knee osteoarthritis. Patient Methods: A total of fifty-four patients were assigned to the experimental group or control group. Conventional physical therapy was provided to both groups, in addition, participants in the experimental group also received combination taping. Disability, functional status, and isokinetic quadriceps torque were assessed at baseline, six weeks (post-intervention), and twelve weeks (follow-up).

RESULTS

MANOVA showed that post-intervention measurements were significantly better than baseline measurements of both groups, except for isokinetic quadriceps torque, which showed a nonsignificant difference in the control group. The control group's follow-up measurements revealed nonsignificant differences from those taken after the intervention, whereas the experimental group's differences were significant excluding isokinetic quadriceps torque. Measurements taken at post-intervention and follow-up revealed that the experimental group had significantly improved compared to the control groups.

CONCLUSIONS

Combination taping was found to be more beneficial when used in addition to conventional physical therapy than when used alone in knee OA.

Development and validation of a nomogram for predicting motoric cognitive risk syndrome among community-dwelling older adults in China: a cross-sectional study

Background

Motoric cognitive risk (MCR) syndrome is characterized by slow gait speed and subjective cognitive complaints (SCC) and increases the risk of dementia and mortality.

Objective

This study aimed to examine the clinical risk factors and prevalence of MCR in community-dwelling older adults, with the goal of developing and validating a nomogram model for developing prevention strategies against MCR.

Methods

We enrolled community-dwelling participants aged 60-85 years at Guangwai Community Health Service Center between November 2023 and January 2024. A total of 1,315 older adults who met the criteria were randomly divided into a training set (n = 920) and a validation set (n = 395). By using univariate and stepwise logistic regression analysis in the training set, the MCR nomogram prediction model was developed. The area under the receiver operator characteristic curve (AUC), calibration plots, and Hosmer-Lemeshow goodness of fit test were used to evaluate the nomogram model's predictive performance, while decision curve analysis (DCA) was used to evaluate the model's clinical utility.

Results

Education, physical exercise, hyperlipoidemia, osteoarthritis, depression, and Time Up and Go (TUG) test time were identified as independent risk factors and were included to develop a nomogram model. The model exhibited high accuracy with AUC values of 0.909 and 0.908 for the training and validation sets, respectively. Calibration curves confirmed the model's reliability, and DCA highlighted its clinical utility.

Conclusion

This study constructs a nomogram model for MCR with high predictive accuracy, which provides a reference for large-scale early identification and screening of high-risk groups for MCR.

Home physical therapy versus telerehabilitation in improving motor function and quality of life in Parkinson's disease: a randomized controlled trial

BACKGROUND

Over the past few years, the development of telerehabilitation has advanced rapidly. Patients with Parkinson's disease (PwPD) often have difficulty with mobility, making it challenging for them to perform centre-based exercise.This study aims to compare the effectiveness and adherence of home physical therapy (HPT) and telerehabilitation (TR) in mitigating motor symptoms and improving the quality of life in patients with mild to moderate Parkinson's disease.

METHODS

This randomized controlled trial included a total of 190 patients who underwent in-person eligibility assessment, with 100 allocated to the HPT group and 90 to the TR group. Both interventions consisted of home-based training sessions lasting 40-60 min and were conducted five times a week for 4 weeks. The primary outcome was the Unified Parkinson's Disease Rating Scale motor section (UPDRS3) score. Secondary outcomes included balance function, assessed using the Berg Balance Scale (BBS); risk of fall, evaluated through the Timed Up-and-Go test (TUG) and the Five Times Sit-to-Stand test (FTSST); gait, measured using the Freezing of Gait Questionnaire (FOGQ) and IDEEA activity monitor; muscle strength, evaluated using the isokinetic dynamometry; motor aspects of experiences of daily living (UPDRS2); and quality of life, assessed by Parkinson's Disease Questionnaire-39 (PDQ-39).

RESULTS

There was a significant difference in the UPDRS3, BBS, TUG, FTSST, FOGQ,step length, step velocity,preswing angle, UPDRS2 and PDQ-39 between baseline and 4 weeks in both groups. The decrease in the UPDRS3 score was significantly greater in the HPT group (-3.38 points) than in the RE group (-1.45 points) in the older age group (P = 0.021), but there was no significant between-group difference in the younger age group (P = 0.416). Similar changes favouring the HPT group were observed in the BBS, TUG, step velocity, and extension average torque. 7 (7%) patients in the HPT group and 12 (13%) patients in the TR group did not complete their daily exercise plan.

CONCLUSIONS

Both HPT and TR have demonstrated effectiveness, safety, and feasibility in PwPD. However, the HPT program exhibited greater effectiveness among older patients and higher patient compliance compared to TR.

TRIAL REGISTRATION

Chictr.org.cn, ChiCTR2300071648. Registered on 22 May 2023-retrospectively registered, https://www.chictr.org.cn/showproj.html?proj=196313 .

Validation of a 3D Markerless Motion Capture Tool Using Multiple Pose and Depth Estimations for Quantitative Gait Analysis

Gait analysis is essential for evaluating walking patterns and identifying functional limitations. Traditional marker-based motion capture tools are costly, time-consuming, and require skilled operators. This study evaluated a 3D Marker-less Motion Capture (3D MMC) system using pose and depth estimations with the gold-standard Motion Capture (MOCAP) system for measuring hip and knee joint angles during gait at three speeds (0.7, 1.0, 1.3 m/s). Fifteen healthy participants performed gait tasks which were captured by both systems. The 3D MMC system demonstrated good accuracy (LCC > 0.96) and excellent inter-session reliability (RMSE < 3°). However, moderate-to-high accuracy with constant biases was observed during specific gait events, due to differences in sample rates and kinematic methods. Limitations include the use of only healthy participants and limited key points in the pose estimation model. The 3D MMC system shows potential as a reliable tool for gait analysis, offering enhanced usability for clinical and research applications.

Physical Health and Socioeconomic Status in Ambulatory Adults With Bilateral Spastic Cerebral Palsy

Socioeconomic status (SES) tends to influence an individual's access to health care. It is commonly assumed that a poorer SES is associated with a weaker physical health status, especially in disadvantaged populations such as people with cerebral palsy (CP). However, to our knowledge, no study has looked at this assumption. Therefore, the aim of this study was to describe and compare the physical health status of ambulant adults with bilateral CP with different SES backgrounds. In addition, the physical health status of the ambulatory adults with CP was compared to well-matched, typically developing adults. Twenty-eight ambulatory adults with CP (gross motor functional classification system Level I/II/III: n = 11/12/5; SES low/middle/high: n = 10/9/9), and 28 matched typically developing adults were recruited for this study. No differences were observed between adults with CP from different SES backgrounds. Differences in physical health status between typically developing adults and ambulatory adults with CP in all SES backgrounds were found in passive range of motion (p < 0.05), muscle strength (p < 0.001), selectivity (p < 0.001), and muscle tone (p < 0.001) and balance (p < 0.05). The main finding of this study is that physical health status did not differ between ambulatory adults with CP from different SES backgrounds. This finding shows that SES does not always directly impact physical health status in ambulatory adults with CP and highlights the importance of an individual approach. Future research should determine the impact of SES on nonambulatory adults with CP.

Elastic Band Training Versus Multicomponent Training and Group-Based Dance on Morphological Variables and Physical Performance in Older Women: A Randomized Controlled Trial

BACKGROUND

This study aimed to analyze the effects of elastic band training (EBT) versus multicomponent training (MCT) and group-based dance (GBD) on waist circumference, body composition (body fat percentage and fat-free mass), and physical performance (handgrip strength, HGS; 30-s chair stand; timed up-and-go, TUG) in Chilean older women.

METHODS

This is a randomized controlled trial with three parallel groups: EBT (n = 10), MCT (n = 10), and GBD (n = 10). Two 60-min sessions per week for 8 weeks were dedicated to the interventions with pre- and post-assessments. A two-factor mixed ANOVA model with repeated measures was performed to measure the time × group effect.

RESULTS

Multiple comparisons revealed significant differences between EBT and MCT in the body fat percentage (p = 0.001; ES = 2.488, large effect) in favor of MCT, while HGS in the non-dominant hand (p = 0.044; ES = 0.158) was in favor of EBT. In the intragroup results, only the MCT significantly decreased the body fat percentage (p = 0.044; ES = 0.426, small effect), and EBT significantly increased HGS in the dominant (p < 0.001; ES = 0.977, large effect) and non-dominant (p < 0.001; ES = 0.583, moderate effect) hands and improved the 30-s chair stand (p = 0.003; ES = 1.612, large effect) test. The GBD did not report significant changes.

CONCLUSIONS

MCT significantly reduced the body fat percentage regarding EBT, and EBT significantly improved HGS in the non-dominant hand regarding MCT, with no differences reported in the rest of the analyzed variables between the groups.

Timed up and go and 30-S chair-stand tests applied via video call are reliable and provide results similar to face-to-face assessment of older adults with different musculoskeletal conditions

BACKGROUND

Remote assessments are promising for coping with adverse situations, such as those imposed by the COVID-19 pandemic. Measurement properties must be specific to the characteristics of the population and the context in which the instruments are used.

PURPOSE

s: 1) To evaluate the parallel reliability of the timed up and go (TUG) and 30-s chair-stand test (30CST) performed in-person and remotely and 2) to analyze the intra-rater, inter-rater, and test-retest reliability of these tests assessed remotely in older adults with different musculoskeletal conditions.

METHODS

The sample included 50 older adults. Parallel reliability was determined by comparing in-person and remote data. Bland-Altman plots displayed differences between tests (TUG and 30CST) performed in-person and remotely, showing the mean scores of each participant. The intra-rater, inter-rater, and test-retest reliability for remote assessments were analyzed using the intraclass correlation coefficient (ICC) with a 95% confidence interval.

RESULTS

Parallel reliability was high between in-person and remote assessments (ICC >0.82). Intra-rater, inter-rater, and test-retest reliability were very high for remote assessments (ICC >0.90). The minimal detectable change for the remote assessment of TUG (MDC <1.95) and 30CST (MDC <2.39) indicated adequate sensitivity. In both tests, the standard error of the measurement was acceptable (SEM% < 10%) and Bland-Altman limits of agreement were solid.

CONCLUSIONS

The remote assessment of TUG and 30CST in older adults with different musculoskeletal conditions was as reliable as those performed in person and may be considered when in-person assessments are impossible.

Profiling iNPH features through cluster analysis: an aid for clinical suspicion and diagnosis

PURPOSE

Idiopathic Normal Pressure Hydrocephalus (iNPH) is a neurological syndrome defined by gait disturbance, cognitive impairment and urinary incontinence. However, its clinical presentation can vary widely due to overlapping syndromes and common comorbidities in older adults. This study aims to provide practical guidance to aid in the clinical suspicion and support the diagnostic and therapeutic processes for these patients.

METHODS

Six quantitative variables regarding clinical, functional, and demographic aspects were considered for a large sample of patients with diagnosed iNPH. Principal component analysis (PCA) was adopted to define the main dimensions explaining the variability of the phenomenon. Then, two clusters of iNPH patients were described.

RESULTS

178 patients were included in the analysis. The PCA produced two dimensions covering 61.8% of the total variability. The first one relied mainly on both clinical (mRS, iNPHGs) and functional (TUG, Tinetti) variables, while the second one was represented mainly on the demographic pattern (age and education). Cluster analysis depicted two main groups of patients. Cluster n.1 is composed of individuals who are older, more disabled, with poor functional performances, and highly symptomatic. Cluster n.2 patients are slightly younger, more educated, fitter, and with more nuanced clinical aspects.

CONCLUSIONS

Profiling iNPH patients using quantitative variables and cluster analysis can help identify distinct characteristics of these patients, aiding in the guidance of both medical and surgical interventions.

Investigating the impact of multidisciplinary prehabilitation on deconditioning in patients eligible for haematopoietic allogenic stem cell transplantation: protocol for a feasibility trial

BACKGROUND

Assessing multidisciplinary prehabilitation strategies becomes crucial to pre-emptively counter the physical, psychological and social negative impacts experienced during an allogenic haematopoietic stem cell transplant (allo-HSCT) among acute myeloid leukaemia (AML) and myelodysplastic syndrome (MDS) patients. Current evidence is restricted to studies during induction chemotherapy, omitting rehabilitation interventions and predominantly using exercise-only approaches without a multidisciplinary framework. The aim of this study is to investigate the feasibility, safety and preliminary efficacy of multidisciplinary prehabilitation in adults offered allo-HSCT.

METHODS AND ANALYSIS

This 8-week single-group pre-post feasibility study aims to pilot a multidisciplinary prehabilitation intervention for participants undergoing allo-HSCT, with a focus on feasibility and safety. Participants, aged 18 or older, diagnosed with AML or MDS, and offered allo-HSCT, will be recruited between June 2023 and July 2024. The multidisciplinary prehabilitation intervention, conducted by the cancer allied health team at the Royal Adelaide Hospital, includes exercise physiology, physiotherapy, dietetics, social work, occupational therapy and psychology interventions. Consistent with a multidisciplinary treatment approach, each component is tailored to address different aspects of patient care, and adherence calculations will assess patient engagement and compliance. In addition, participants will continue to receive usual care from cancer allied health staff. The primary outcome of the study is to assess the feasibility of a multidisciplinary prehabilitation intervention by evaluating intervention uptake, retention, adherence, acceptability and safety. Secondary outcomes are leg strength, upper-body strength, aerobic fitness, falls risk, anthropometry, nutritional status, quality of life, anxiety, depression, self-efficacy for coping with cancer and distress.

ETHICS AND DISSEMINATION

Ethics approval for this study has been provided by the Central Adelaide Local Health Network (HREC 2022/HRE00284). Recruitment for the study commenced in June 2023 and will continue until July 2024. The methods have been designed and are reported according to the SPIRIT and CONSORT-pilot study checklist.

TRIAL REGISTRATION NUMBER

The Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12623000052639.

Xbox Kinect Sports vs. Nintendo Switch Sports and Their Effects on Body Composition and Physical Performance in Older Females: A Randomized Controlled Trial

Background/Objectives: This study aimed to compare the effects of Xbox Kinect Sports (XKS) regarding Nintendo Switch Sports (NSS) and an inactive control group (CG) on body composition (body fat percentage, BFP; and fat-free mass) and physical performance (maximal isometric handgrip strength, MIHS; 30-s chair stand, 30-S; timed up-and-go, TUG; sit-and-reach; and 2-min step) in physically inactive older females. Methods: A randomized controlled trial study was conducted with three parallel groups: XKS (n = 13), NSS (n = 14), and CG (n = 16) considering three weekly 60-min sessions for 12 weeks with pre- and post-assessments. Results: A two-factor mixed analysis of variance (ANOVA) model with repeated measures was performed to measure the time × group effect. Multiple comparisons revealed significant differences in BFP (F(2,18) = 6.12; p = 0.005; ηp2 = 0.226, large effect), 30-S (F(2,18) = 20.7; p = 0.000; ηp2 = 0.496, large effect), TUG (F(2,18) = 10.0; p = 0.000; ηp2 = 0.323, large effect), sit-and-reach (F(2,18) = 37.3; p = 0.000; ηp2 = 0.640, large effect), and 2-min step (F(2,18) = 9.85; p = 0.000; ηp2 = 0.319, large effect) in favor of XKS regarding NSS and CG. The intragroup results only present in XKS a significant decrease in BFP (p = 0.02; d = 0.98) and significant improvements in the 30-S (p = 0.000; d = 1.88), TUG (p < 0.01; d = 2.00), sit-and-reach (p = 0.003; d = 2.58), and 2-min step (p = 0.004; d = 1.05). Conclusions: training using XKS significantly decreases BFP and improves 30-S, TUG, sit-and-reach, and 2-min step in physically inactive older females.

Lower-Limb Exoskeletons for Gait Training in Parkinson's Disease: The State of the Art and Future Perspectives

Gait dysfunction (GD) is a common impairment of Parkinson's disease (PD), which negatively impacts patients' quality of life. Among the most recent rehabilitation technologies, a lower-limb powered exoskeleton (LLEXO) arises as a useful instrument for gait training in several neurological conditions, including PD. However, some questions relating to methods of use, achievable results, and usefulness compared to traditional rehabilitation methodologies still require clear answers. Therefore, in this review, we aim to summarise and analyse all the studies that have applied an LLEXO to train gait in PD patients. Literature research on PubMed and Scopus retrieved five articles, comprising 46 PD participants stable on medications (age: 71.7 ± 3.7 years, 24 males, Hoehn and Yahr: 2.1 ± 0.6). Compared to traditional rehabilitation, low-profile lower-limb exoskeleton (lp-LLEXO) training brought major improvements towards walking capacity and gait speed, while there are no clear major benefits regarding the dual-task gait cost index and freezing of gait symptoms. Importantly, the results suggest that lp-LLEXO training is more beneficial for patients with an intermediate-to-severe level of disease severity (Hoehn and Yahr > 2.5). This review could provide a novel framework for implementing LLEXO in clinical practise, highlighting its benefits and limitations towards gait training.

Fatigue in individuals with multiple sclerosis: Is there a relationship with walking speed and mobility?

BACKGROUND

Fatigue is a common symptom in patients with multiple sclerosis and it can lead to activity limitations. Thus, it is important to analyze the relationship between fatigue and activity outcomes, such as walking speed and mobility.

OBJECTIVES

To investigate the relationship between fatigue and walking speed and mobility in individuals with multiple sclerosis.

METHODS

A cross-sectional study was performed. Adults with multiple sclerosis, without cognitive impairments and who were able to walk were recruited. Fatigue was assessed with the Modified Fatigue Impact Scale (MFIS). Walking speed, usual and fast, was assessed with the 10-meter Walk Test (10MWT), and mobility with the Timed Up and Go Test (TUG). Pearson correlation analysis was performed. A significance level of 5 % was used.

RESULTS

Thirty participants were included, most of the relapsing-remitting multiple sclerosis (n = 24, 80 %). A mean age of 41 (11) years and the median Expanded Disability Status Scale (EDSS) score was 2.65 (2.18) points. Mean MFIS score was 41.87 ± 19.42 points, mean usual walking speed was 1.02 ± 0.28 m/s, mean fast walking speed was 1.55 ± 0.48 m/s, and the mean total time in the TUG was 10.07 ± 3.05 s. A significant negative correlation of moderate magnitude was found between fatigue and usual walking speed (r=₋0.51, p < 0.05). A significant negative correlation of moderate magnitude was found between fatigue and fast walking speed (r=₋0.54, p < 0.05). A significant, positive correlation of moderate magnitude was found between fatigue and mobility (r = 0.54, p < 0.05).

CONCLUSION

There was a correlation between fatigue and walking speed and mobility in individuals with multiple sclerosis. These results highlight the need to assess fatigue in individuals with multiple sclerosis, since the presence of fatigue is associated with reduced walking speed and mobility.

Reliability and validity of the 4-meter walk test in patients with multiple sclerosis

BACKGROUND

Walking speed is considered a vital sign of health and better functional outcomes. It is important to assess walking speed both for disease monitoring and before starting rehabilitation. The aim of this study was to examine the reliability, validity, minimal detectable change, and the ideal cutoff time for differentiating patients with multiple sclerosis (PwMS) who fall from PwMS who do not.

METHODS

This study included 43 PwMS (26 female and 17 male) and 36 healthy controls (23 female and 13 male). The 4-meter walk test (4-MWT) was conducted with the 10-meter walk test (10-MWT), timed up and go (TUG) test, dynamic gait index (DGI), timed 25-foot walk (T25-FW), multiple sclerosis walking scale-12 (MSWS-12), and the expanded disability status scale (EDSS).

RESULTS

Excellent test-retest reliability (ICC = 0.971) was found for the 4-MWT. The SEM value was 0.38 and MDC value was 1.05. The correlations with 4-MWT, 10-MWT, TUG, DGI, T25-FW, MSWS-12, and EDSS were found to be statistically significant (p < 0.001). PwMS had longer 4-MWT times than healthy controls, and PwMS fallers had longer 4-MWT times than non-fallers with PwMS (r between 0.668 and -0.858; p < 0.05 for all). In order to distinguish fallers from non-fallers with PwMS, a 4-MWT cutoff time of 4.14 s was shown to be optimal.

CONCLUSION

The 4-MWT was found to be valid and reliable for PwMS. It is concluded that the 4-MWT is a feasible assessment method for clinical and methodological studies of PwMS with mild to moderate disability.

Effects of transcutaneous vagus nerve stimulation on chronic low back pain: a systematic review

BACKGROUND

Chronic low back pain (CLBP) is a frequent disease. It is a critical health concern that can influence functional capacity by restricting living activities.

OBJECTIVES

The current study is to investigate the effects of transcutaneous vagus nerve stimulation (TVNs) in the management of CLBP.

METHODS

We searched the databases on Google Scholar, PubMed, Web of Science, Cochrane, and Pedro for randomized clinical trial (RCT) studies published in any language that looked at the effectiveness of TVNs in people with chronic LBP. The inclusion criteria were PICO. Participants in the research were people (≥ 18 years) diagnosed with persistent low back pain for more than 3 months. Study quality was assessed using Cochrane ROB 2.

RESULTS

Our database search found 1084 RCT. A number of studies that were not necessary for the issue were removed, and the overall outcome was six trials. Risk of bias (ROB) evaluations at the study level (derived from outcomes) are reported. In the six studies, two (33.3%) had an overall uncertain ROB (i.e., some concerns), whereas one (16.7%) had a high overall ROB. Three trials (50%) had a low overall RoB.

CONCLUSION

There is still no evidence to support the use of transcutaneous vagus nerve stimulation as a viable therapeutic rehabilitation strategy. Therefore, we recommend high-quality trials and long-term follow-up to evaluate disability, quality of life, and pain outcomes in these patients.

Age-specific comparisons in the rate of force development of toe pressure strength and its association with the timed up and go test

PURPOSE

It has recently been recommended that Rate of Force Development (RFD) be evaluated in addition to maximal muscle strength. There are no studies on RFD of toe pressure strength, and its importance in older adults and the extent to which it is associated with aging needs to be clarified. This study purpose was to examine the association between the RFD of toe pressure strength and timed up and go test (TUG) in an age-specific study.

METHODS

This study is a cross-sectional study. Participants in the study included 159 younger adults (26.3 ± 13.1 years, 52% male) and 88 older adults (75.0 ± 6.2 years, 26% male). The RFD of toe pressure strength was determined from the force-time curve obtained during the toe pressure strength assessment, and the ability to exert maximum muscle force in the shortest possible time was assessed. Regression analysis was performed for each group to test the association between RFD of toe pressure strength and TUG by age.

RESULTS

Younger adults showed no association between TUG and RFD of toe pressure strength, and significant association between TUG and RFD of toe pressure strength was found only in the older adults (standard regression coefficient =  - 0.19, p = 0.048).

CONCLUSION

This study showed a significant association between TUG and RFD of toe pressure strength in older adults. These findings show that RFD is one of the functions that should be assessed, particularly in older adults. Furthermore, it was suggested that approaching RFD could improve gait, standing, and sitting movements.

A systematic review of the psychometric properties of physical performance tests for sarcopenia in community-dwelling older adults

BACKGROUND

This review provides an overview of the psychometric properties of the short physical performance battery (SPPB), timed up and go test (TUG), 4 m gait speed test (4 m GST) and the 400 m walk test (400 m WT) in community-dwelling older adults.

METHODS

A systematic search was conducted in MEDLINE, CINAHL and EMBASE, resulting in the inclusion of 50 studies with data from in total 19,266 participants (mean age 63.2-84.3). Data were extracted and properties were given a sufficient or insufficient overall rating following the COSMIN guideline for systematic reviews of patient-reported outcome measures. Quality of evidence (QoE) was rated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

RESULTS

The SPPB was evaluated in 12 studies, TUG in 30, 4 m GST in 12 and 400 m WT in 2. Reliability of the SPPB, TUG and 4 m GST was rated sufficient (moderate to good QoE). The measurement error of the SPPB was rated insufficient (low QoE). Criterion validity for the SPPB was insufficient in indicating sarcopenia (moderate QoE), while the TUG was sufficient and insufficient for determining mobility limitations (low QoE) and activities of daily living disability (low QoE), respectively. Construct validity of the SPPB, TUG, 4 m GST and 400 m WT was rated insufficient in many constructs (moderate to high QoE). Responsiveness was rated as insufficient for SPPB (high QoE) and TUG (very low QoE), while 4 m GST was rated as sufficient (high QoE).

CONCLUSION

Overall, the psychometric quality of commonly used physical performance tests in community-dwelling older adults was generally rated insufficient, except for reliability. These tests are widely used in daily practice and recommended in guidelines; however, users should be cautious when drawing conclusions such as sarcopenia severity and change in physical performance due to limited psychometric quality of the recommended measurement instruments. There is a need for a disease-specific physical performance test for people with sarcopenia.This research received no specific grant from any funding agency and was registered a priori using the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42022359725).

Balance function in critical illness survivors and evaluation of psychometric properties of the Mini-BESTest

Critical illness survivors commonly face impairments, such as intensive care unit-acquired weakness (ICUAW) which is characterized by muscle weakness and sensory deficits. Despite these symptoms indicating potential balance deficits, systematic investigations and validated assessments are lacking. Therefore, we aimed to assess balance function using the Mini-BESTest, evaluate its psychometric properties, and identify associated variables. Balance was assessed post-ICU discharge (V1) and at discharge from inpatient neurorehabilitation (V2) in patients with ≥ 5 days of invasive ventilation. Mini-BESTest measurement characteristics were evaluated in an ambulatory subgroup. A multiple linear regression was conducted. The prospective cohort study comprised 250 patients (34% female, 62 ± 14 years, median ICU stay 55 days). Median Mini-BESTest scores improved significantly from V1 (5 (IQR 0-15)) to V2 (18.5 (10-23)) with a large effect size. Excellent inter-rater and test-retest reliabilities of the Mini-BESTest were observed (ICC = 0.981/0.950). Validity was demonstrated by a very high correlation with the Berg Balance Scale (ρ = 0.90). No floor or ceiling effects were detected. Muscle strength, cognitive function, cerebral disease, critical illness polyneuropathy/myopathy, and depression were significantly associated with balance. Despite significant improvements during the rehabilitation period, balance disorders were prevalent in critical illness survivors. Ongoing therapy is recommended. Due to its excellent psychometric properties, the Mini-BESTest is suitable for use in critical illness survivors.Registration: The study was registered at the German Clinical Trials Register (DRKS00021753, date of registration: 2020-09-03).

Dual Tasking Affects the Outcomes of Instrumented Timed up and Go, Sit-to-Stand, Balance, and 10-Meter Walk Tests in Stroke Survivors

Stroke can impair mobility, with deficits more pronounced while simultaneously performing multiple activities. In this study, common clinical tests were instrumented with wearable motion sensors to study motor-cognitive interference effects in stroke survivors (SS). A total of 21 SS and 20 healthy controls performed the Timed Up and Go (TUG), Sit-to-Stand (STS), balance, and 10-Meter Walk (10MWT) tests under single and dual-task (counting backward) conditions. Calculated measures included total time and gait measures for TUG, STS, and 10MWT. Balance tests for both open and closed eyes conditions were assessed using sway, measured using the linear acceleration of the thorax, pelvis, and thighs. SS exhibited poorer performance with slower TUG (16.15 s vs. 13.34 s, single-task p < 0.001), greater sway in the eyes open balance test (0.1 m/s2 vs. 0.08 m/s2, p = 0.035), and slower 10MWT (12.94 s vs. 10.98 s p = 0.01) compared to the controls. Dual tasking increased the TUG time (~14%, p < 0.001), balance thorax sway (~64%, p < 0.001), and 10MWT time (~17%, p < 0.001) in the SS group. Interaction effects were minimal, suggesting similar dual-task costs. The findings demonstrate exaggerated mobility deficits in SS during dual-task clinical testing. Dual-task assessments may be more effective in revealing impairments. Integrating cognitive challenges into evaluation can optimize the identification of fall risks and personalize interventions targeting identified cognitive-motor limitations post stroke.

Intra and Inter-Device Reliabilities of the Instrumented Timed-Up and Go Test Using Smartphones in Young Adult Population

The Timed-Up and Go (TUG) test is widely utilized by healthcare professionals for assessing fall risk and mobility due to its practicality. Currently, test results are based solely on execution time, but integrating technological devices into the test can provide additional information to enhance result accuracy. This study aimed to assess the reliability of smartphone-based instrumented TUG (iTUG) parameters. We conducted evaluations of intra- and inter-device reliabilities, hypothesizing that iTUG parameters would be replicable across all experiments. A total of 30 individuals participated in Experiment A to assess intra-device reliability, while Experiment B involved 15 individuals to evaluate inter-device reliability. The smartphone was securely attached to participants' bodies at the lumbar spine level between the L3 and L5 vertebrae. In Experiment A, subjects performed the TUG test three times using the same device, with a 5 min interval between each trial. Experiment B required participants to perform three trials using different devices, with the same time interval between trials. Comparing stopwatch and smartphone measurements in Experiment A, no significant differences in test duration were found between the two devices. A perfect correlation and Bland-Altman analysis indicated good agreement between devices. Intra-device reliability analysis in Experiment A revealed significant reliability in nine out of eleven variables, with four variables showing excellent reliability and five showing moderate to high reliability. In Experiment B, inter-device reliability was observed among different smartphone devices, with nine out of eleven variables demonstrating significant reliability. Notable differences were found in angular velocity peak at the first and second turns between specific devices, emphasizing the importance of considering device variations in inertial measurements. Hence, smartphone inertial sensors present a valid, applicable, and feasible alternative for TUG assessment.

Measurement properties of the backward walk test in people with balance and mobility deficits: A systematic review

BACKGROUND

Backward walking is an indispensable component of activities of daily living. The backward walk test has been used to assess balance, mobility, and fall risk in different populations. This systematic review aimed to identify and synthesize measurement properties of the backward walk test in people with balance and mobility deficits.

METHODS

Three bibliographic databases, PubMed, Embase, and Scopus, were searched on June 18th, 2023. Cross-sectional or cohort studies assessing the measurement properties (reliability, validity, responsiveness) of the backward walk test were included. The COSMIN risk of bias checklist was used for methodological quality assessment. Study selection, data extraction, and quality assessment were completed by two reviewers independently and in duplicate.

RESULTS

A total of 786 records were identified from three databases. Fourteen studies published from 2019 to 2023 with a total of 853 participants were included. Two studies were rated inadequate in quality assessment, all other studies demonstrated adequate to very good quality. The participants population included patients with cerebral palsy, stroke, multiple sclerosis, Parkinson's disease, fibromyalgia, hip and knee arthroplasty, dementia, and community-dwelling older adults. Good interrater and intrarater reliability, and moderate to good concurrent validity of the backward walk test were demonstrated.

SIGNIFICANCE

The review demonstrates that the backward walk test appears to be a valid and reliable tool in different patient populations. The 3-meter backward walk time and 3-meter backward walk speed can be used as outcome measures in clinical practice to assess balance and mobility and track progress throughout the course of physical rehabilitation. Future studies with a prospective cohort design are required to provide information regarding the predictive validity of the backward walk test for fall risk assessment.

Is functional mobility associated with quality of sitting in cerebral palsy? A cross-sectional study

Objectives

A group of neuromuscular system anomalies associated with non-progressive issues in the developing fetal or newborn brain are known as cerebral palsy (CP). These abnormalities are typified by poor posture and motor development, which limits the execution of functional activities. Consequently, to achieve the same goals as peers who are typically developing, children with CP employ a variety of compensatory postures and techniques. Given that both sitting and mobility are essential for functioning, assessing each skill alone and in relation to the other is necessary. This study aims to determine if a child's functional mobility affects their sitting ability.

Materials and Methods

Twenty CP (Gross Motor Function Classification System [GMFCS] levels I and II) children, aged 6-12, were enrolled in the research. The level of sitting scale (LSS) and the modified timed up and go (mTUG) test were utilized to evaluate sitting and functional mobility, respectively.

Results

The quality of sitting was shown to have a substantial effect on functional mobility, as a significant difference in mTUG durations was established between LSS levels (P < 0.001) and persisted when analyzed within the same GMFCS level (P = 0.007).

Conclusion

The importance of trunk control in functional mobility can be inferred from the link between sitting quality and mobility. To improve children with CP's functional mobility, this evidence may be utilized to design a well-informed and specific intervention program incorporating trunk control.

Routine outcomes and evaluation of an 8-week outpatient multidisciplinary rehabilitative therapy program for functional neurological disorder

OBJECTIVES

We report routinely collected outcome data from an 8-week outpatient rehabilitative therapy program. The aims of the intervention were to (1) reduce symptom severity and (2) improve functional mobility in adults with functional neurological disorder (FND).

METHODS

The program delivered individual physiotherapy, cognitive behavioral therapy (CBT) and self-management sessions, group physiotherapy, and psychoeducation. Outcome measures included the Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI-II), Work and Social Adjustment Scale (WSAS), 10-Meter Walk Test (10MWT), Timed Up and Go (TUG), and Berg Balance Scale (BBS). Data were analyzed retrospectively in accordance with routine service evaluation. Wilcoxon signed-rank tests assessed changes in outcomes between weeks 1 and 8 for all patients completing treatment (n = 45). For patients who attended the 3-month follow-up (n = 31), Friedman's ANOVA assessed overall change in outcomes over time. Post hoc Wilcoxon signed-rank tests compared pairs of time-points (Weeks 1, 8, and 3-month follow-up).

RESULTS

Analyses of patients completing the program revealed significant improvements in scores between week 1 and week 8. Excluding the BBS, there were statistically significant improvements in all outcomes between weeks 1 and 8 and between weeks 1 and 3-month follow-up.

DISCUSSION

This outpatient therapy program provided effective treatment for FND. Patients reported reduced anxiety, depression, and functional impairment, as well as improved performance on most physiotherapy measures.

Comparative analysis of postural stability and risk of falling and developing disability among overweight and obese women over 40 years

BACKGROUND

Increased body mass index (BMI) adversely affects the mechanics of the musculoskeletal system. It is known that obese people have poorer postural stability and mobility-related outcomes compared to normal weight people, but there is limited research comparing overweight and class 1 obese people, two consecutive and prevalent BMI categories.

AIMS

To compare postural stability, functional mobility, and risk of falling and developing disability between overweight and obese women, and to investigate the relationship of BMI and body weight with the outcomes.

METHODS

Thirty women with class 1 obesity and 30 overweight women were included. Standing postural stability with eyes-open and eyes-closed and stability limits were assessed using the Prokin system. The Timed Up and Go Test (TUG) was used to assess functional mobility and risk of falling (≥11 s) and developing disability (≥9 s).

RESULTS

The average center of pressure displacements on the y-axis (COPY) obtained during quiet standing with both eyes-open and eyes-closed were higher in obese women than overweight women (p < 0.05) and the effect sizes were moderate for the results. The COPY values in the eyes-open and eyes-closed conditions were correlated with BMI (r = 0.295 and r = 0.285, p < 0.05). Furthermore, the COPX value in the eyes-open condition and the TUG score were correlated with body weight (r = 0.274 and r = 0.257, p < 0.05).

CONCLUSIONS

Obese women had poorer static standing stability in the anteroposterior direction than overweight women, while functional mobility and risk of falling and developing disability did not differ. Furthermore, BMI and body weight were related to poorer static standing stability.

Impact of depressive symptoms on medication adherence in older adults with chronic neurological diseases

BACKGROUND

Nonadherence to medication contributes substantially to worse health outcomes. Especially among older adults with chronic illness, multimorbidity leads to complex medication regimes and high nonadherence rates. In previous research, depressive symptomology has been identified as a major contributor to nonadherence, and some authors hypothesize a link via motivational deficits and low self-efficacy. However, the exact mechanisms linking depressive symptomology and nonadherence are not yet understood. This is in part because the often-employed sum scores cannot do justice to the complexity of depressive symptomology; instead, it is recommended to assess the influence of individual symptoms.

METHODS

Following this symptom-based approach, we performed correlation, network and regression analysis using depressive symptoms as depicted by the items of the revised Beck Depression Inventory II (BDI) to assess their influence with nonadherence in N = 731 older adults with chronic neurological diseases. Nonadherence was measured with the self-report Stendal Adherence to Medication Score (SAMS).

RESULTS

Even when controlling for sociodemographic and health-related covariates, the BDI remained the most influential contributor to nonadherence. Across different methods, Loss of Interest and Difficulty with Concentration were identified as particularly influential for nonadherence, linking nonadherence with other affective or somatic BDI items, respectively. Additionally, Fatigue, Problems with Decision Making, Suicidal Thoughts, and Worthlessness contribute to nonadherence.

CONCLUSION

Using a symptom-driven approach, we aimed to understand which depressive symptoms contribute to higher levels of nonadherence. Our results refine previous hypotheses about motivation and control beliefs by suggesting that it is not merely a lack of beliefs in the efficacy of medication that connects depressive symptoms and nonadherence, but rather an overall lack of interest in improving one's health due to feelings of worthlessness and suicidal tendencies. This lack of interest is further substantiated by already sparse resources caused by changes in concentration and fatigue. In order to improve health outcomes and reduce nonadherence, these associations between depressive symptoms must be further understood and targeted in tailored interventions.

Balancing act: Unraveling the link between muscle strength, proprioception, and stability in unilateral hip osteoarthritis

The objectives of this study are to compare hip muscle strength, hip joint proprioception, and functional balance between individuals with unilateral hip OA and asymptomatic individuals and to examine the relationships among these variables in the hip OA population. In a prospective cross-sectional study, 122 participants (unilateral Hip OA: n = 56, asymptomatic: n = 56) were assessed at the CAMS/KKU musculoskeletal Physical Therapy laboratory. Ethical standards were upheld throughout the research, with informed consent obtained. Hip muscle strength was measured using a hand-held dynamometer, hip joint proprioception with a digital inclinometer, and functional balance using the Berg Balance Scale (BBS) and Timed Up and Go (TUG) test. Hip OA individuals exhibited significantly lower muscle strength and proprioceptive accuracy, and poorer functional balance than controls (p < 0.003). Correlation analyses revealed a positive correlation between muscle strength and BBS scores (r = 0.38 to 0.42) and a negative correlation with TUG test times (r = -0.36 to -0.41). Hip joint reposition sense (JRS) in flexion showed a negative correlation with balance (r = -0.46), while JRS in abduction was positively correlated (r = 0.46). The study highlights the clinical importance of muscle strength and proprioception in functional balance among individuals with unilateral hip OA. The results support the incorporation of muscle strengthening and proprioceptive training in interventions to improve balance and mobility in this population.

Validity and Reliability of a Telehealth Physical Fitness and Functional Assessment Battery for Ambulatory Youth With and Without Mobility Disabilities: Observational Measurement Study

BACKGROUND

Youth (age 15-24 years) with and without disability are not adequately represented enough in exercise research due to a lack of time and transportation. These barriers can be overcome by including accessible web-based assessments that eliminate the need for on-site visitations. There is no simple, low-cost, and psychometrically sound compilation of measures for physical fitness and function that can be applied to youth with and without mobility disabilities.

OBJECTIVE

The first purpose was to determine the statistical level of agreement of 4 web-modified clinical assessments with how they are typically conducted in person at a laboratory (convergent validity). The second purpose was to determine the level of agreement between a novice and an expert rater (interrater reliability). The third purpose was to explore the feasibility of implementing the assessments via 2 metrics: safety and duration.

METHODS

The study enrolled 19 ambulatory youth: 9 (47%) with cerebral palsy with various mobility disabilities from a children's hospital and 10 (53%) without disabilities from a university student population. Participants performed a battery of tests via videoconferencing and in person. The test condition (teleassessment and in person) order was randomized. The battery consisted of the hand grip strength test with a dynamometer, the five times sit-to-stand test (FTST), the timed up-and-go (TUG) test, and the 6-minute walk test (6MWT) either around a standard circular track (in person) or around a smaller home-modified track (teleassessment version, home-modified 6-minute walk test [HM6MWT]). Statistical analyses included descriptive data, intraclass correlation coefficients (ICCs), and Bland-Altman plots.

RESULTS

The mean time to complete the in-person assessment was 16.9 (SD 4.8) minutes and the teleassessment was 21.1 (SD 5.9) minutes. No falls, injuries, or adverse events occurred. Excellent convergent validity was shown for telemeasured hand grip strength (right ICC=0.96, left ICC=0.98, P<.001) and the TUG test (ICC=0.92, P=.01). The FTST demonstrated good agreement (ICC=0.95, 95% CI 0.79-0.98; P=.01). The HM6MWT demonstrated poor absolute agreement with the 6MWT. However, further exploratory analysis revealed a strong positive correlation between the tests (r=0.83, P<.001). The interrater reliability was excellent for all tests (all ICCs>0.9, P<.05).

CONCLUSIONS

This study suggests that videoconference assessments are convenient and useful measures of fitness and function among youth with and without disabilities. This paper presents operationalized teleassessment procedures that can be replicated by health professionals to produce valid and reliable measurements. This study is a first step toward developing teleassessments that can bypass the need for on-site data collection visitations for this age group. Further research is needed to identify psychometrically sound teleassessment procedures, particularly for measures of cardiorespiratory endurance or walking ability.

Effects of non-invasive vagus nerve stimulation on clinical symptoms and molecular biomarkers in Parkinson's disease

Non-invasive vagus nerve stimulation (nVNS) is an established neurostimulation therapy used in the treatment of epilepsy, migraine and cluster headache. In this randomized, double-blind, sham-controlled trial we explored the role of nVNS in the treatment of gait and other motor symptoms in Parkinson's disease (PD) patients. In a subgroup of patients, we measured selected neurotrophins, inflammatory markers and markers of oxidative stress in serum. Thirty-three PD patients with freezing of gait (FOG) were randomized to either active nVNS or sham nVNS. After baseline assessments, patients were instructed to deliver six 2  min stimulations (12  min/day) of the active nVNS/sham nVNS device for 1  month at home. Patients were then re-assessed. After a one-month washout period, they were allocated to the alternate treatment arm and the same process was followed. Significant improvements in key gait parameters (speed, stance time and step length) were observed with active nVNS. While serum tumor necrosis factor- α decreased, glutathione and brain-derived neurotrophic factor levels increased significantly (p < 0.05) after active nVNS treatment. Here we present the first evidence of the efficacy and safety of nVNS in the treatment of gait in PD patients, and propose that nVNS can be used as an adjunctive therapy in the management of PD patients, especially those suffering from FOG. Clinical trial registration: identifier ISRCTN14797144.

Use of Virtual Reality in Physical Therapy as an Intervention and Diagnostic Tool

Within the past decade, the integration of computer-generated virtual realities (VRs) has witnessed a significant rise in the field of healthcare, particularly in diagnosis and treatment applications. These VR systems have found extensive use in physical therapy, rehabilitation, research, and assessment. This narrative review article is aimed at providing a comprehensive overview of the literature regarding the implementation of VR in the physical therapy profession. The primary objective of this review is to provide information to clinicians about the diverse applications of VR and its potential advantages in intervening across various patient populations and diagnoses during rehabilitation therapy. Through in-depth discussions with experts and a thorough review of pertinent literature, several significant aspects of the topic were identified. Subsequently, we carried out an online search to investigate the prevalent utilization of VR systems within healthcare, both as assessment tools and for therapeutic interventions. Our examination encompassed a total of 56 articles, with supplementary references incorporated as required.