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Studer M, Jacobson K. Commentary on: "Generalization of In-Place Balance Perturbation Training in People With Parkinson Disease". J Neurol Phys Ther 2024:01253086-990000000-00066. [PMID: 38797879 DOI: 10.1097/npt.0000000000000484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Affiliation(s)
- Mike Studer
- Physical Therapy, Touro University, Henderson, Nevada (M.S.); Cleveland Clinic Lou Ruvo Center for Brain Health (K.J.) Center for Neurorehabilitation Sciences, Sargent College of Health & Rehabilitation Sciences, Boston University, Boston, Massachusetts (K.J.)
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2
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McArthur C, Duhaime G, Gonzalez D, Notthoff N, Theou O, Kehler S, Quigley A. Older adults, clinicians, and researchers' preferences for measuring adherence to resistance and balance exercises. BMC Geriatr 2023; 23:530. [PMID: 37648973 PMCID: PMC10470185 DOI: 10.1186/s12877-023-04237-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/16/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Resistance and balance training are important exercise interventions for older populations living with chronic diseases. Accurately measuring if an individual is adhering to exercises as prescribed is important to determine if lack of improvement in health outcomes is because of issues with adherence. Measuring adherence to resistance and balance exercises is limited by current methods that depend heavily on self-report and are often better at and tailored towards capturing aerobic training parameters (e.g., step count, minutes of moderate to vigorous physical activity). Adherence measures must meet users' needs to be useful. METHODS Using a Dillman tailored study design, we surveyed researchers who conduct exercise trials, clinicians who prescribe exercise for older adults, and older adults to determine: (1) how they are currently measuring adherence; (2) barriers and facilitators they have experienced to measurement; and (3) the information they would like collected about adherence (e.g., repetitions, sets, intensity, duration, frequency, quality). Surveys were disseminated internationally through professional networks, professional organizations, and social media. Participants completed an online survey between August 2021 and April 2022. RESULTS Eighty-eight older adults, 149 clinicians, and 41 researchers responded to the surveys. Most clinicians and researchers were between the ages of 30 and 39 years, and 70.0% were female. Most older adults were aged 70-79 years, and 46.6% were female. Diaries and calendars (either analog or digital) were the most common current methods of collecting adherence data. Users would like information about the intensity and quality of exercises completed that are presented in clear, easy to use formats that are meaningful for older adults where all data can be tracked in one place. Most older adults did not measure adherence because they did not want to, while clinicians most frequently reported not having measurement tools for adherence. Time, resources, motivation, and health were also identified as barriers to recording adherence. CONCLUSIONS Our work provides information about current methods of measuring exercise adherence and suggestions to inform the design of future adherence measures. Future measures should comprehensively track adherence data in one place, including the intensity and quality of exercises.
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Affiliation(s)
- Caitlin McArthur
- Dalhousie University, 5869 University Avenue, B3H 1X7, Halifax Nova Scotia, Canada.
- , 5869 University Avenue, B3H 1X7, Halifax Nova Scotia, Canada.
| | - Gabriella Duhaime
- Dalhousie University, 5869 University Avenue, B3H 1X7, Halifax Nova Scotia, Canada
| | - David Gonzalez
- Dalhousie University, 5869 University Avenue, B3H 1X7, Halifax Nova Scotia, Canada
| | - Nanna Notthoff
- Faculty of Sport Science, Leipzig University, Jahnalleee 59, 04109, Leipzig, Germany
| | - Olga Theou
- Dalhousie University, 5869 University Avenue, B3H 1X7, Halifax Nova Scotia, Canada
| | - Scott Kehler
- Dalhousie University, 5869 University Avenue, B3H 1X7, Halifax Nova Scotia, Canada
| | - Adria Quigley
- Dalhousie University, 5869 University Avenue, B3H 1X7, Halifax Nova Scotia, Canada
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3
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Ferris J, Zwier J, Carender WJ, Sienko KH. Differences between physical therapist ratings, self-ratings, and posturographic measures when assessing static balance exercise intensity. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1096171. [PMID: 37250428 PMCID: PMC10213890 DOI: 10.3389/fresc.2023.1096171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 03/22/2023] [Indexed: 05/31/2023]
Abstract
Introduction In order for balance therapy to be successful, the training must occur at the appropriate dosage. However, physical therapist (PT) visual evaluation, the current standard of care for intensity assessment, is not always effective during telerehabilitation. Alternative balance exercise intensity assessment methods have not previously been compared to expert PT evaluations. The aim of this study was therefore to assess the relationship between PT participant ratings of standing balance exercise intensity and balance participant self-ratings or quantitative posturographic measures. Methods Ten balance participants with age or vestibular disorder-related balance concerns completed a total of 450 standing balance exercises (three trials each of 150 exercises) while wearing an inertial measurement unit on their lower back. They provided per-trial and per-exercise self-ratings of balance intensity on a scale from 1 (steady) to 5 (loss of balance). Eight PT participants reviewed video recordings and provided a total of 1,935 per-trial and 645 per-exercise balance intensity expert ratings. Results PT ratings were of good inter-rater reliability and significantly correlated with exercise difficulty, supporting the use of this intensity scale. Per-trial and per-exercise PT ratings were significantly correlated with both self-ratings (r = 0.77-0.79) and kinematic data (r = 0.35-0.74). However, the self-ratings were significantly lower than the PT ratings (difference of 0.314-0.385). Resulting predictions from self-ratings or kinematic data agreed with PT ratings approximately 43.0-52.4% of the time, and agreement was highest for ratings of a 5. Discussion These preliminary findings suggested that self-ratings best indicated two intensity levels (i.e., higher/lower) and sway kinematics were most reliable at intensity extremes.
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Affiliation(s)
- Jamie Ferris
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, United States
| | - Jonathan Zwier
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, United States
| | - Wendy J. Carender
- Michigan Balance Vestibular Testing and Rehabilitation, Department of Otolaryngology, Michigan Medicine, Ann Arbor, MI, United States
| | - Kathleen H. Sienko
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, United States
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4
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Brincks J, Dalgas U, Franzén E, Callesen J, Wallin A, Johansson S. Unwrapping the "black box" of balance training in people with multiple sclerosis - A descriptive systematic review of intervention components, progression, and intensity. Mult Scler Relat Disord 2023; 69:104412. [PMID: 36399965 DOI: 10.1016/j.msard.2022.104412] [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: 09/24/2022] [Revised: 10/26/2022] [Accepted: 11/11/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Delineating the specific components of the existing balance training interventions in people with multiple sclerosis (PwMS) may contribute to a framework for future design and reporting of such interventions. Thus, we aimed to systematically synthesize how balance training frequency, intensity, time, type, duration, and progression are reported in balance training interventions for PwMS. METHODS A systematic literature search was conducted in Medline, Embase, Web of Science, and Cinahl. Search terms were MS, postural balance, walking, gait, and randomized/quasi-randomized controlled or clinical trials. Articles including ambulatory PwMS and interventions designed to challenge the balance control system were eligible. Two investigators screened, selected, and extracted data independently. Data on study characteristics such as design, population, and balance training content were extracted. Categorization of balance training based on balance control components was performed. RESULTS We included 40 studies grouped under five balance training categories. Balance interventions were well described regarding frequency, session time, and duration, but only two interventions described training intensity, and no systematic, gradual progression approach was reported for balance training adaptation over time. However, the balance training interventions included many sensory and motor components of the balance control system. Still, little focus was on reactive motor strategies, vestibular sense, and cognitive dual-tasking. CONCLUSIONS Existing balance training interventions in PwMS primarily consist of practicing sensory and motor strategies. Future balance training interventions are encouraged to systematically monitor individual advancements in balance training adaptations and to apply the progressive overload principle (i.e. continuous increase in balance exercise stimulus over time). Furthermore, we suggest that balance training in PwMS is performed with high intensity near an individual's balance capacity limits. Finally, individualized balance training is recommended to cover all relevant components of balance control using the proposed framework.
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Affiliation(s)
- John Brincks
- Faculty of Health Science, Research Centre for Health and Welfare Technology, Programme for Rehabilitation, VIA University College, Hedeager 2, Aarhus N 8200, Denmark.
| | - Ulrik Dalgas
- Department of Public Health - Exercise Biology, Aarhus University, Dalgas Avenue 4, Aarhus 8000, Denmark
| | - Erika Franzén
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden; Women's Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Jacob Callesen
- Faculty of Health Science, Research Centre for Health and Welfare Technology, Programme for Rehabilitation, VIA University College, Hedeager 2, Aarhus N 8200, Denmark
| | - Andreas Wallin
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden; Rehab Station Stockholm, Research and Development Unit, Solna, Sweden
| | - Sverker Johansson
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden; Women's Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
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5
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Jagroop D, Houvardas S, Danells CJ, Kochanowski J, French E, Salbach NM, Musselman K, Inness EL, Mansfield A. Rehabilitation clinicians' perspectives of reactive balance training. Disabil Rehabil 2022; 44:7967-7973. [PMID: 34812700 DOI: 10.1080/09638288.2021.2004246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE Reactive balance training (RBT) aims to improve reactive balance control. However, because RBT involves clients losing balance, clinicians may view that it is unsafe or not feasible for some clients. We aimed to explore how clinicians implement RBT to treat balance and mobility issues. MATERIALS AND METHODS Physiotherapists and kinesiologists across Canada who reported that they include RBT in their practices were invited to complete telephone interviews about their experiences with RBT. Interviews were transcribed verbatim, and analysed using a deductive thematic analysis. RESULTS Ten participants completed telephone interviews, which lasted between 30-60 min. Participants primarily worked in a hospital setting (inpatient rehabilitation (n = 3); outpatient rehabilitation (n = 2)), and were treated clients with neurological conditions (n = 5). Four main themes were identified: 1) there is variability in RBT approaches; 2) knowledge can be a barrier and facilitator to RBT; 3) reactive balance control is viewed as an advanced skill; and 4) RBT experience builds confidence. CONCLUSIONS Our findings suggest a need for resources to make clinical implementation of RBT more feasible.Implications for rehabilitationTrust between the therapist and client improves self-efficacy and feelings of apprehension/fear when conducting reactive balance training.Being creative and improvising with equipment that is readily available in clinics enables reactive balance training, without the need for high-tech equipment.Clinicians should consider using standardized tools with reactive balance control components, such as the Balance Evaluation Systems Test or Performance Oriented Mobility Assessment, to assess balance control.
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Affiliation(s)
- David Jagroop
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | | | - Cynthia J Danells
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Canada
| | | | - Esmé French
- Northwestern Ontario Regional Stroke Network, Thunder Bay, Canada
| | - Nancy M Salbach
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Kristin Musselman
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Elizabeth L Inness
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.,Faculty of Kinesiology, University of Toronto, Toronto, Canada
| | - Avril Mansfield
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Canada.,Evaluative Clinical Sciences, Hurvtiz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Canada
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Shenoy A, Peng TH, Todd RM, Eng JJ, Silverberg ND, Tembo T, Pollock CL. Rate of perceived stability as a measure of balance exercise intensity in people post-stroke. Disabil Rehabil 2022; 44:8480-8486. [PMID: 35104173 DOI: 10.1080/09638288.2021.2022777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE This study investigates the reproducibility and concurrent validity of the Rate of Perceived Stability (RPS) Scale in people with stroke. METHODS On two separate days (2-10 days apart), participants provided their RPS ratings during clinical measures: 1)16 tasks from Community Balance and Mobility Scale (CB&M), 2)6-minute walk test (6MWT), and 3)self-paced gait speed. Intraclass correlations (ICCs) assessed between day test-retest reliability of RPS ratings. Standard error of measurement (SEM) and smallest detectable change (SDC) addressed level of between day agreement. Spearman rank correlations (rs) quantified relationships between RPS, and general rating of perceived challenge, task-performance scores. RESULTS Thirty participants with stroke (50% female) participated. ICC ranged from 0.46 to 0.93 across tasks with 12/19 tasks showing ICCs above 0.75 (good test-retest reliability). SEM was 1-point for each task and SDC ranged from 2 to 4 across tasks. Concurrent validity between RPS and ratings of perceived challenge was good-to-excellent (rs ranged 0.78-0.94, p < 0.01). Higher RPS (indicative of feeling less stable) was associated with lower balance performance scores on CB&M tasks, negative relationships ranged in strength from fair to good-to-excellent in 10/16 tasks (rs ranged -0.46 to -0.81, p ≤ 0.01). CONCLUSIONS RPS shows promise as a measure of balance intensity in people with stroke.IMPLICATIONS FOR REHABILITATIONThe RPS is a reliable and valid measure of balance intensity in ambulatory people with stroke.The RPS scale may be a useful clinical tool to address the gap in practice of measuring balance intensity during rehabilitation of walking balance post-stroke.
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Affiliation(s)
- Aishwarya Shenoy
- Cognitive Systems Program, University of British Columbia, Vancouver, Canada.,Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, Canada
| | - Tzu-Hsuan Peng
- Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, Canada.,Graduate Program in Rehabilitation Science, University of British Columbia, Vancouver, Canada
| | - Rebecca M Todd
- Cognitive Systems Program, University of British Columbia, Vancouver, Canada.,Department of Psychology, University of British Columbia, Vancouver, Canada
| | - Janice J Eng
- Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, Canada.,Department of Physical Therapy, University of British Columbia, Vancouver, Canada
| | - Noah D Silverberg
- Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, Canada.,Department of Psychology, University of British Columbia, Vancouver, Canada
| | - Towela Tembo
- Cognitive Systems Program, University of British Columbia, Vancouver, Canada.,Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, Canada
| | - Courtney L Pollock
- Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, Canada.,Department of Physical Therapy, University of British Columbia, Vancouver, Canada
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7
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Soh SE. Critically appraised paper: Fall prevention program delivered electronically to community-dwelling older people can reduce fall rate over 24 months [commentary]. J Physiother 2022; 68:279. [PMID: 36244960 DOI: 10.1016/j.jphys.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 09/16/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Sze-Ee Soh
- Physiotherapy, Monash University, Melbourne, Australia
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8
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Tekin F, Cetisli-Korkmaz N. Effectiveness of a Telerehabilitative Home Exercise Program on Elder Adults’ Physical Performance, Depression and Fear of Falling. Percept Mot Skills 2022; 129:714-730. [DOI: 10.1177/00315125221087026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Our aim in this study was to analyze the effects of a home exercise program of calisthenic exercises delivered through telerehabilitation on physical performance, depression, and risk of falling in elder adults. Our participants were elder adults aged 65 and over, divided into exercise and control groups. We initiated a 4-week telerehabilitation calisthenic exercise program in the exercise group following initial assessments, while our control group received no formal exercise training. Both groups were evaluated online before and after this 4-week period with the Geriatric Depression Scale (GDS), Modified Falls Efficacy Scale (MFES), and Short Physical Performance Battery (SPPB). In total, 255 elder adults participated, with 132 (males = 72, females = 60) allocated to calisthenic exercise and 123 (males = 66, females = 57) allocated to the control group. While the groups did not differ significantly on any of our parameters before the exercise, there were statistically significant post-exercise group differences in GDS ( p ≤ .001) and MFES ( p ≤ .001) scores related to remarkable physical improvements achieved in the calisthenic exercise group. The exercise group showed significant increases in their scores on the SPPB Balance Test ( p = .049), SPPB Chair Test ( p = .009), and SPPB Total ( p = .002) while there was no significant increase in any of these scores among control group participants ( p > .05). Thus, calisthenic exercises performed via telerehabilitation significantly improved elder adults’ physical performance, fear of falling, and depression. Telerehabilitation is a useful remote means of assessing, inducing, and following-up exercise training, particularly during the ongoing COVID-19 pandemic.
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Affiliation(s)
- Fatih Tekin
- Pamukkale University, School of Physical Therapy and Rehabilitation, Denizli, Turkey
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9
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Lima CA, Perracini MR, Funabashi M, Weber S, Beaupre L. Domains of Balance Training Delivered in Rehabilitation Programs Following Hip Fracture Surgery in Older Adults: A Systematic Review. J Geriatr Phys Ther 2022; 45:90-106. [PMID: 33534338 DOI: 10.1519/jpt.0000000000000286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE The aim of this systematic review was to assess the domains and characteristics of balance training (BT) interventions delivered in rehabilitation programs following hip fracture to identify potential treatment gaps. METHODS Manual and electronic searches (Web of Science, Medline, EMBASE, CINAHL, and ProQuest) were conducted. We selected randomized controlled trials with older adults following hip fracture surgery that included either specific BT or gait, mobility, or transfer training. Two independent reviewers extracted data and rated the methodological quality using the Physiotherapy Evidence Database scale. A third reviewer provided consensus. Extracted BT data included balance domain, progression, frequency, duration, intensity, level of supervision, setting, and rehabilitation phase. RESULTS AND DISCUSSION We included 17 trials from 19 studies; 11 studies were rated as moderate to high methodological quality, but only 8 were considered to have high-quality BT components. Half of the interventions included only one balance domain, with stability during movement being the most commonly included domain. The primary balance progression utilized was reducing hand support. Dual task, anticipatory postural adjustment, reactive strategies, and perceptual training domains were rarely included. Balance training duration and intensity were poorly described. Although most programs were home-based with minimal levels of supervision, a few extended beyond postacute phase of rehabilitation. CONCLUSION Further consideration should be given to include more challenging BT domains with planned progressions to maximize patient recovery through hip fracture rehabilitation programs.
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Affiliation(s)
- Camila Astolphi Lima
- Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
| | - Monica Rodrigues Perracini
- Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
- Master's and Doctoral Programs in Gerontology, Faculty of Medicine, Universidade Estadual de Campinas, Campinas, São Paulo, Brazil
| | - Martha Funabashi
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
- Division of Research and Innovation, Canadian Memorial Chiropractic College, Ontario, Toronto, Canada
| | - Sydnie Weber
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Lauren Beaupre
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
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10
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Wang R, Han L. Analysis of the Model for Sports Enhancing Human Health Using Data Mining. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:3416255. [PMID: 35186228 PMCID: PMC8856809 DOI: 10.1155/2022/3416255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 01/26/2022] [Indexed: 11/29/2022]
Abstract
The problems of low reliability and the high fitting degree of mutual information feature extraction of traditional sports to human health enhancement model are analyzed. We analyze and study the sports to human health enhancement model using data mining. The model consists of a data layer, a logic layer, and a presentation layer. Sports project data, real-time sports data, and health monitoring data are collected in the data layer, and the collected data are transmitted to the logic layer. The logical layer uses the dynamic difference feature classification algorithm of data mining to fuse human health data, extract the mutual information features of human health, and input the features into the long short-term memory (LSTM) neural network, which outputs the pattern recognition results of sports health after forward and reverse operations. The results of sports health pattern recognition are input into the display layer, and the enhancing effect of sports on human health is presented for users by constructing a model of sports on human health. The results show that the effect of sports on human health enhancement analyzed by the model in this paper is extremely accurate, which can significantly improve the health level of community residents and college students. When the number of data is about 600, it remains at about 0.05, indicating that this model has high reliability, and the fitting degree of mutual information feature extraction is up to 99.82%. It has certain practical application value.
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Affiliation(s)
- Ruiqing Wang
- School of Physical Education, Harbin University, Harbin 150086, China
| | - Lei Han
- School of Environmental and Chemical Engineering, Dalian Jiaotong University, Dalian 116028, China
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11
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Feng C, Adebero T, DePaul VG, Vafaei A, Norman KE, Auais M. A Systematic Review and Meta-Analysis of Exercise Interventions and Use of Exercise Principles to Reduce Fear of Falling in Community-Dwelling Older Adults. Phys Ther 2022; 102:6383647. [PMID: 34636923 DOI: 10.1093/ptj/pzab236] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 06/14/2021] [Accepted: 08/30/2021] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Fear of falling (FOF) contributes to activity restriction and institutionalization among older adults, and exercise interventions are linked to reduction in FOF. Adhering to exercise principles and adapting optimal exercise parameters are fundamental to optimizing the effectiveness of exercise interventions. The purpose of this review was to describe FOF exercise interventions in community-dwelling older adults, evaluate the extent to which these interventions followed the exercise principles and reported exercise parameters, and quantify the effect of these interventions on reducing FOF. METHODS Randomized controlled trials (RCTs) of FOF exercise interventions in older adults (≥65 years) were identified from 4 databases. The methodological quality of RCTs was assessed using the Physiotherapy Evidence Database scale. A random-effect model was used in the meta-analysis. RESULTS Seventy-five RCTs were included in this review. With regard to reporting exercise principles, specificity was reported in 92% of trials, progression in 72%, reversibility in 32%, overload in 31%, diminished return in 21%, and initial value in 8%. For exercise parameters, 97% of RCTs reported exercise type; 89%, frequency; and 85%, time. Only 25% reported the intensity. The pooled effect of exercise interventions on FOF among all included studies was a standard mean difference of -0.34 (95% CI = -0.44 to -0.23). CONCLUSION This study showed a significant small to moderate effect size of exercise interventions in reducing FOF among community-dwelling older adults. Most exercise principles and intensity of exercises were not adequately reported in included trials. IMPACT These inadequate reports could undermine efforts to examine the optimal dosage for exercise prescription. More attention must be given to designing and reporting components of therapeutic exercise programs to facilitate evidence-based practice.
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Affiliation(s)
- Chengying Feng
- School of Rehabilitation Therapy, Queen's University, Faculty of Health Sciences, Kingston, Ontario, Canada
| | - Tony Adebero
- Department of Health and Rehabilitation Sciences, University of Western Ontario, London, Ontario, Canada
| | - Vincent G DePaul
- School of Rehabilitation Therapy, Queen's University, Faculty of Health Sciences, Kingston, Ontario, Canada
| | - Afshin Vafaei
- Department of Health Sciences, Lakehead University, Thunder Bay, Ontario, Canada
| | - Kathleen E Norman
- School of Rehabilitation Therapy, Queen's University, Faculty of Health Sciences, Kingston, Ontario, Canada
| | - Mohammad Auais
- School of Rehabilitation Therapy, Queen's University, Faculty of Health Sciences, Kingston, Ontario, Canada
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12
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Leavy B, Joseph C, Kwak L, Franzén E. Implementation of highly challenging balance training for Parkinson's disease in clinical practice: a process evaluation. BMC Geriatr 2021; 21:96. [PMID: 33526031 PMCID: PMC7852138 DOI: 10.1186/s12877-021-02031-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 01/14/2021] [Indexed: 11/18/2022] Open
Abstract
Background Process evaluations provide contextual insight into the way in which interventions are delivered. This information is essential when designing strategies to implement programs into wider clinical practice. We performed a process evaluation of the HiBalance effectiveness trial investigating the effects of a 10-week of highly challenging and progressive balance training for mild-moderate Parkinson’s disease (PD). Study aims were to investigate i) the quality and quantity of intervention delivery and ii) barriers and facilitators for implementation. Methods Process outcomes included; Fidelity; Dose (delivered and received) Recruitment and Reach. Investigation of barriers and facilitators was guided by the Consolidated Framework for Implementation Research. Program delivery was assessed across four neurological rehabilitation sites during a two-year period. Data collection was mixed-methods in nature and quantitative and qualitative data were merged during the analysis phase. Results Thirteen program trainers delivered the intervention to 12 separate groups during 119 training sessions. Trainer fidelity to program core components was very high in 104 (87%) of the sessions. Participant responsiveness to the core components was generally high, although adherence to the home exercise program was low (50%). No significant context-specific differences were observed across sites in terms of fidelity, dose delivered/ received or participant characteristics, despite varying recruitment methods. Facilitators to program delivery were; PD-specificity, high training frequency and professional autonomy. Perceived barriers included; cognitive impairment, absent reactional balance among participants, as well a heterogeneous group in relation to balance capacity. Conclusion These findings provide corroborating evidence for outcome evaluation results and valuable information for the further adaptation and implementation of this program. Important lessons can also be learned for researchers and clinicians planning to implement challenging exercise training programs for people with mild-moderate PD. Trial registration ClinicalTrials.gov, NCT02727478, registered 30 march, 2016 − Retrospectively registered. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02031-1.
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Affiliation(s)
- Breiffni Leavy
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden. .,The Stockholm Sjukhem Foundation, Stockholm, Sweden.
| | - Conran Joseph
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden.,Department of Health and Rehabilitation Sciences, Division of Physiotherapy, Stellenbosch University, Cape Town, South Africa
| | - Lydia Kwak
- Unit of Intervention and Implementation Research for worker health, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Erika Franzén
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden.,The Stockholm Sjukhem Foundation, Stockholm, Sweden.,Function Area Occupational therapy & Physiotherapy, Allied Health Professionals Function, Karolinska University Hospital, Stockholm, Sweden
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13
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Touchette AJ, Oates AR, Menec VH, Sibley KM. Design characteristics and inclusion of evidence-based exercise recommendation in fall prevention community exercise programs for older adults in Canada: a national descriptive self-report study. BMC Geriatr 2021; 21:33. [PMID: 33422004 PMCID: PMC7796610 DOI: 10.1186/s12877-020-01949-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 12/08/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Training balance through exercise is an effective strategy to reduce falls in community-dwelling older adults. Evidence-based fall prevention exercise recommendations have been proposed, specifying that exercise programs should: (1) provide a high challenge to balance, (2) be offered for a least three hours per week, (3) be provided on an ongoing basis. Community exercise programs have the potential to deliver effective fall prevention exercise; however, current design characteristics and whether they include the recommendations is not known. This study described design characteristics of fall prevention community exercise programs for older adults (50 years and older) across Canada, and explored whether these programs included the three evidence-based exercise recommendations. METHODS Instructors of fall prevention community exercise programs completed electronic self-report questionnaires following a modified Dillman recruitment approach. Questions explored program characteristics, exercise content, target population, and program and instructor demographic information. Using a previously developed coding scheme based on recommendations, exercises were coded for balance challenge. RESULTS One hundred fourty completed eligible questionnaires were analyzed (74% response rate). One hundred thirty-three programs (95%) included the challenge recommendation by prescribing mostly moderate or high challenge balance exercises, 16 programs (11%) included at least three hours of exercise a week, and 59 programs (42%) were offered on an ongoing basis. Eight programs (6%) included all three recommendations. CONCLUSIONS Most programs included at least one recommendation for effective fall prevention exercise. Future studies should examine organizational barriers and facilitators to incorporating evidence-based exercise recommendations and explore the use of mixed home/in-class strategies to include the recommendations.
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Affiliation(s)
- Alexie J Touchette
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Alison R Oates
- College of Kinesiology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Verena H Menec
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Kathryn M Sibley
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada. .,George and Fay Yee Centre for Healthcare Innovation, 379 - 753 McDermot Avenue, Winnipeg, MB, R3E 0T6, Canada.
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