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Hao Q, Kuspinar A, Griffith L, D'Amore C, Mayhew AJ, Wolfson C, Guyatt G, Raina P, Beauchamp M. Measuring physical performance in later life: reliability of protocol variations for common performance-based mobility tests. Aging Clin Exp Res 2023; 35:1087-1096. [PMID: 37004707 DOI: 10.1007/s40520-023-02384-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 03/04/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUND AND AIMS Performance-based tests of mobility or physical function such as the Timed Up and Go (TUG), gait speed, chair-rise, and single-leg stance (SLS) are often administered using different protocols in aging populations, however, the reliability of their assessment protocols is not often considered. The purpose of this study was to examine the reliabilities of frequently used assessment protocols for the TUG, gait speed, chair-rise, and SLS in different age groups. METHODS We administered the following assessment protocols in an age-stratified (50-64, 65-74, 75+ years) sample of participants (N = 147) from the Canadian Longitudinal Study on Aging (CLSA): TUG fast pace and TUG normal pace: TUG-cognitive counting backwards by ones and counting back by threes, gait speed with 3-m and 4-m course, chair-rise with arms crossed and allowing the use of arms, and SLS using preferred leg or both legs-on two occasions within 1 week. We assessed the relative (intra-class correlation) and absolute reliability (standard error of measurement, SEM and minimal detectable change, MDC) for each protocol variation and provided recommendations based on relative reliability. RESULTS For participants aged 50-64 years, our results suggest better reliability for TUG fast-pace compared with normal-pace (ICC and 95% CI 0.70; 0.41-0.85 versus 0.38; 0.12-0.59). The reliability values for 3-m gait speed were potentially higher than for 4-m gait speed (ICC 0.75; 0.67-0.82 versus 0.64; 0.54-0.73) and values for chair-rise suggested better reliability allowing participants to use their arms than with arms crossed (ICC 0.79; 0.66-0.86 versus 0.64; 0.45-0.77) for participants overall. For participants aged 75+ years, ICCs for SLS with the preferred leg showed better reliability than for both legs (ICC = 0.62-0.79 versus 0.30-0.39). CONCLUSIONS AND DISCUSSION These reliability data and the recommendations can help guide the selection of the most appropriate performance-based test protocols for measuring mobility in middle-aged and older community-dwelling adults.
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Affiliation(s)
- Qiukui Hao
- School of Rehabilitation Science, Institute of Applied Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Ayse Kuspinar
- School of Rehabilitation Science, Institute of Applied Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Lauren Griffith
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Cassandra D'Amore
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Alexandra J Mayhew
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Christina Wolfson
- Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, McGill University, Montreal, QC, Canada
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Parminder Raina
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Marla Beauchamp
- School of Rehabilitation Science, Institute of Applied Health Sciences, McMaster University, Hamilton, ON, Canada.
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Sadeghian F, Zolaktaf V, Shigematsu R. A comparison between effects of Square-Stepping Exercise and Tai Chi Chuan on functional fitness and fear of falling in older women. Aging Clin Exp Res 2023; 35:827-834. [PMID: 36853504 DOI: 10.1007/s40520-023-02367-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 02/06/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND It is challenging to find exercise programs that are safe, effective, attractive, and feasible to reduce the risk of falls and fall-related injuries in older adults. AIMS We compared the effects of SSE (Square-Stepping Exercise) versus TCC (Tai Chi Chuan) on functional fitness and fear of falling in older women aged 60 years and above. METHODS It was a single blind randomized control trial. We purposefully selected 36 older women (aged 65.2 ± 3.82 years). They were then paired based on the criterion of functional reach test and randomly assigned to two groups (18 people) of TTC and SSE. The exercise program included 8 weeks of three 1-h-session training. We measured functional fitness and fear of falling. Functional fitness was assessed using the following tests: Single Leg-Stance-Eyes Open/Closed, Timed Up and Go, Functional Reach Test, Chair Stand, Arm Curl, and Back Scratch. Fear of falling was assessed using the Falls Efficacy Scale-International. RESULTS We analyzed the data using repeated measure ANOVA. Within-group comparisons revealed significant improvements for both groups in all nine measures of functional tests as well as fear of falling [Formula: see text]. Interaction comparisons revealed that improvements in measures of functional fitness were greater in the TTC group [Formula: see text]. Nevertheless, the groups were not significantly different in fear of falling [Formula: see text]. CONCLUSION Our findings showed that both TCC and SSE interventions improved functional fitness and fear of falling. The TCC is more effective than SSE, though the latter is easier to learn and perform.
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Affiliation(s)
- Farzaneh Sadeghian
- Department of Sport Injuries and Therapeutic Exercises, Faculty of Exercise Sciences, University of Isfahan, Isfahan, Iran
| | - Vahid Zolaktaf
- Department of Sport Injuries and Therapeutic Exercises, Faculty of Exercise Sciences, University of Isfahan, Isfahan, Iran.
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Leizerowitz GM, Gabai R, Plotnik M, Keren O, Karni A. Improving old tricks as new: Young adults learn from repeating everyday activities. PLoS One 2023; 18:e0285469. [PMID: 37167235 PMCID: PMC10174589 DOI: 10.1371/journal.pone.0285469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 04/24/2023] [Indexed: 05/13/2023] Open
Abstract
The notion that young healthy adults can substantially improve in activities that are part of their daily routine is often overlooked because it is assumed that such activities have come to be fully mastered. We followed, in young healthy adults, the effects of repeated executions of the Timed-Up-and-Go (TUG) task, a clinical test that assesses the ability to execute motor activities relevant to daily function-rising from a seated position, walking, turning and returning to a seated position. The participants (N = 15) performed 18 consecutive trials of the TUG in one session, and were retested on the following day and a week later. The participants were video recorded and wore inertial measurement units. Task execution times improved robustly; performance was well fitted by a power function, with large gains at the beginning of the session and nearing plateau in later trials, as one would expect in the learning of a novel task. Moreover, these gains were well retained overnight and a week later, with further gains accruing in the subsequent test-sessions. Significant intra-session and inter-session changes occurred in step kinematics as well; some aspects underwent inter-sessions recalibrations, but other aspects showed delayed inter-session changes, suggesting post-practice memory consolidation processes. Even common everyday tasks can be improved upon by practice; a small number of consecutive task repetitions can trigger lasting gains in young healthy individuals performing highly practiced routine tasks. This new learning in highly familiar tasks proceeded in a time-course characteristic of the acquisition of novel 'how to' (procedural) knowledge.
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Affiliation(s)
- Gil Meir Leizerowitz
- Sagol Department of Neurobiology, University of Haifa, Haifa, Israel
- The Rehabilitation Hospital, C. Sheba Medical Center, Ramat Gan, Israel
| | - Ran Gabai
- Technion-Israel Institute of Technology, Haifa, Israel
| | - Meir Plotnik
- Center of Advanced Technologies in Rehabilitation, C. Sheba Medical Center, Ramat Gan, Israel
- Faculty of Medicine & Sagol School of Neuroscience, Department of Physiology and Pharmacology, Tel Aviv University, Tel Aviv, Israel
| | - Ofer Keren
- The Rehabilitation Hospital, C. Sheba Medical Center, Ramat Gan, Israel
- Galilee Rehabilitation Center, Karmiel, Israel
| | - Avi Karni
- Sagol Department of Neurobiology, University of Haifa, Haifa, Israel
- The E. J. Safra Brain Research Center for the Study of Learning Disabilities, University of Haifa, Haifa, Israel
- Department of Diagnostic Imaging, C. Sheba Medical Center, Ramat Gan, Israel
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4
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Ibeneme SC, Eze JC, Okonkwo UP, Ibeneme GC, Fortwengel G. Evaluating the discriminatory power of the velocity field diagram and timed-up-and-go test in determining the fall status of community-dwelling older adults: a cross-sectional observational study. BMC Geriatr 2022; 22:658. [PMID: 35948869 PMCID: PMC9367093 DOI: 10.1186/s12877-022-03282-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 07/08/2022] [Indexed: 11/10/2022] Open
Abstract
Background Systematic reviews demonstrated that gait variables are the most reliable predictors of future falls, yet are rarely included in fall screening tools. Thus, most tools have higher specificity than sensitivity, hence may be misleading/detrimental to care. Therefore, this study aimed to determine the validity, and reliability of the velocity field diagram (VFD -a gait analytical tool), and the Timed-up-and-go test (TUG)-commonly used in Nigeria as fall screening tools, compared to a gold standard (known fallers) among community-dwelling older adults. Method This is a cross-sectional observational study of 500 older adults (280 fallers and 220 non-fallers), recruited by convenience sampling technique at community health fora on fall prevention. Participants completed a 7-m distance with the number of steps and time it took determined and used to compute the stride length, stride frequency, and velocity, which regression lines formed the VFD. TUG test was simultaneously conducted to discriminate fallers from non-fallers. The cut-off points for falls were: TUG times ≥ 13.5 s; VFD’s intersection point of the stride frequency, and velocity regression lines (E1) ≥ 3.5velots. The receiver operating characteristic (ROC) area under the curves (AUC) was used to explore the ability of the E1 ≥ 3.5velots to discriminate between fallers and non-fallers. The VFD’s and TUG’s sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were determined. Alpha was set at p < 0.05. Results The VFD versus TUG sensitivity, specificity, PPV and NPV were 71%, 27%, 55%, and 42%, versus 39%, 59%, 55%, and 43%, respectively. The ROC’s AUC were 0.74(95%CI:0.597,0.882, p = 0.001) for the VFD. The optimal categorizations for discrimination between fallers/non-fallers were ≥ 3.78 versus ≤ 3.78 for VFD (fallers versus non-fallers prevalence is 60.71% versus 95.45%, respectively), with a classification accuracy or prediction rate of 0.76 unlike TUG with AUC = 0.53 (95% CI:0.353,0.700, p = 0.762), and a classification accuracy of 0.68, and optimal characterization of ≥ 12.81 s versus ≤ 12.81 (fallers and non-fallers prevalence = 92.86% versus 36.36%, respectively). Conclusion The VFD demonstrated a fair discriminatory power and greater reliability in identifying fallers than the TUG, and therefore, could replace the TUG as a primary tool in screening those at risk of falls.
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Affiliation(s)
- Sam Chidi Ibeneme
- Department of Medical Rehabilitation, Faculty of Health Sciences, University of Nigeria, Enugu Campus, Enugu, Enugu State, Nigeria. .,Department of Physiotherapy, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria. .,Department of Nursing Sciences, Ebonyi State University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria. .,Faculty III/Mid-Research Group, Hochschule Hannover - University of Applied Sciences and Arts, Hannover, Expo Plaza 12, 30539, Hannover, Germany. .,Department of Physiotherapy, Faculty of Health Sciences, School of Therapeutic Studies, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa.
| | - Joy Chinyere Eze
- Department of Medical Rehabilitation, Faculty of Health Sciences, University of Nigeria, Enugu Campus, Enugu, Enugu State, Nigeria
| | | | | | - Gerhard Fortwengel
- Department of Physiotherapy, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
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Automatic and Efficient Fall Risk Assessment Based on Machine Learning. SENSORS 2022; 22:s22041557. [PMID: 35214471 PMCID: PMC8875808 DOI: 10.3390/s22041557] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/11/2022] [Accepted: 02/14/2022] [Indexed: 01/04/2023]
Abstract
Automating fall risk assessment, in an efficient, non-invasive manner, specifically in the elderly population, serves as an efficient means for implementing wide screening of individuals for fall risk and determining their need for participation in fall prevention programs. We present an automated and efficient system for fall risk assessment based on a multi-depth camera human motion tracking system, which captures patients performing the well-known and validated Berg Balance Scale (BBS). Trained machine learning classifiers predict the patient’s 14 scores of the BBS by extracting spatio-temporal features from the captured human motion records. Additionally, we used machine learning tools to develop fall risk predictors that enable reducing the number of BBS tasks required to assess fall risk, from 14 to 4–6 tasks, without compromising the quality and accuracy of the BBS assessment. The reduced battery, termed Efficient-BBS (E-BBS), can be performed by physiotherapists in a traditional setting or deployed using our automated system, allowing an efficient and effective BBS evaluation. We report on a pilot study, run in a major hospital, including accuracy and statistical evaluations. We show the accuracy and confidence levels of the E-BBS, as well as the average number of BBS tasks required to reach the accuracy thresholds. The trained E-BBS system was shown to reduce the number of tasks in the BBS test by approximately 50% while maintaining 97% accuracy. The presented approach enables a wide screening of individuals for fall risk in a manner that does not require significant time or resources from the medical community. Furthermore, the technology and machine learning algorithms can be implemented on other batteries of medical tests and evaluations.
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Overgaard JA, Kallemose T, Mangione KK, Kristensen MT. Six Versus 12 Weeks of Outpatient Physical Therapy Including Progressive Resistance Training in Cognitively Intact Older Adults After Hip Fracture: A Multicenter Randomized Controlled Trial. J Gerontol A Biol Sci Med Sci 2021; 77:1455-1462. [PMID: 34460897 DOI: 10.1093/gerona/glab256] [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: 01/29/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Recovery of function and regaining muscle strength is challenging after hip fracture. We compared the effectiveness of a 12 versus 6-weeks outpatient physical therapy program with progressive resistive training (PRT) to increase strength and physical performance. METHODS This parallel, superiority, 2-group randomized controlled trial was conducted in 4 clinics enrolled community-dwelling, cognitively intact older adults (+60 years) with a surgical repair of a hip fracture and no major medical conditions. Participants received 12 or 6-weeks of PRT and standardized physical therapy, twice weekly. Pain was monitored throughout. Primary outcome was the change in the 6-minute walk test (6MWT) from baseline to 12-weeks follow-up. Randomization via a computer-generated allocation sequence was implemented using sealed, sequentially numbered opaque envelopes and assessors were blinded to group assignment. RESULTS Participants (81% women) with a mean (SD) age of 77 (8.1) years were enrolled at an average of 18 days post-hip fracture surgery and randomized into a 12-week group (n=50) or a 6-week group (n=50). A mean (SD) change score in the 6MWT of 143.8 (81.1) and 161.5 (84.1) meters found in the 12 and 6-week group, respectively (both exceeding the minimal clinically important difference of 55 meters). The mean between-group difference was -17.7 (95%CI -50.1, 14.8) meter. Pain during training did not exceed moderate levels nor increase as training intensity increased. CONCLUSION Twelve weeks of physical therapy with PRT was not superior to 6-weeks in improving walking distance. Hip fracture-related pain was relatively low and indicated strength testing and training was well tolerated.
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Affiliation(s)
- Jan Arnholtz Overgaard
- Department of Rehabilitation, Lolland Municipality, Maribo, Denmark.,Physical Medicine and Rehabilitation Research - Copenhagen (PMR-C), Copenhagen, Denmark
| | - Thomas Kallemose
- Department of Clinical Research, Amager-Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
| | | | - Morten Tange Kristensen
- Physical Medicine and Rehabilitation Research - Copenhagen (PMR-C), Copenhagen, Denmark.,Departments of Physical Therapy and Orthopedic Surgery, Copenhagen University Hospital - Amager-Hvidovre, Hvidovre, Denmark.,Department of Physical and Occupational Therapy, Copenhagen University Hospital, Bispebjerg-Frederiksberg & Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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7
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Luque-Casado A, Novo-Ponte S, Sanchez-Molina JA, Sevilla-Sanchez M, Santos-Garcia D, Fernandez-Del-Olmo M. Test-Retest Reliability of the Timed Up and Go Test in Subjects with Parkinson's Disease: Implications for Longitudinal Assessments. JOURNAL OF PARKINSONS DISEASE 2021; 11:2047-2055. [PMID: 34334420 DOI: 10.3233/jpd-212687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Despite the frequent use of the Timed Up and Go (TUG) test in clinical trials, evaluation of longitudinal test-retest reliability is generally lacking and still inconclusive for patients with Parkinson's disease (PD). OBJECTIVE We aimed to further investigate long-term reliability and sensitivity of the TUG test among this population. Furthermore, we explored alternative assessment strategies of the test aimed at elucidating whether the inclusion or combination of timed trials may have potential implications on outcome measure. METHODS Relative and absolute reliability of the TUG performance were obtained in forty-three subjects with PD over three timed trials in two different testing sessions separated by a two-months period. RESULTS Our results reported excellent intra-session and moderate inter-session reliability coefficients. The use of different assessment strategies of the TUG was found to have an important impact on outcome measure, highlighting the averaging of several timed trials in each testing session as a recommended alternative to minimize measurement error and increase reliability in longitudinal assessments. Nevertheless, beyond acceptable reliability, poor trial-to-trial stability of the measure appears to exist, since the ranges of expected variability upon retesting were wide and the incidence of spurious statistical effects was not negligible, especially in longitudinal repeated testing. CONCLUSION Limitations may exist in the interpretation of the TUG outputs as part of longitudinal assessments aimed at evaluating treatment effectiveness in PD population. Researchers and practitioners should be aware of these concerns to prevent possible misrepresentations of functional ability in patients for a particular intervention.
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Affiliation(s)
- Antonio Luque-Casado
- Area of Sport Sciences, Faculty of Sports Sciences and Physical Education. Center for Sport Studies, King Juan Carlos University, Madrid, Spain
| | - Sabela Novo-Ponte
- Area of Sport Sciences, Faculty of Sports Sciences and Physical Education. Center for Sport Studies, King Juan Carlos University, Madrid, Spain.,Department of Neurology, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Jose Andres Sanchez-Molina
- Department of Physical Education and Sport, Faculty of Sports Sciences and Physical Education, University of A Coruna, A Coruna, Spain
| | - Marta Sevilla-Sanchez
- Department of Physical Education and Sport, Faculty of Sports Sciences and Physical Education, University of A Coruna, A Coruna, Spain
| | - Diego Santos-Garcia
- Department of Neurology, CHUAC, Complejo Hospitalario Universitario de A Coruna, A Coruna, Spain
| | - Miguel Fernandez-Del-Olmo
- Area of Sport Sciences, Faculty of Sports Sciences and Physical Education. Center for Sport Studies, King Juan Carlos University, Madrid, Spain
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Akehurst E, Scott D, Rodriguez JP, Gonzalez CA, Murphy J, McCarthy H, Dorgo S, Hayes A. Associations of sarcopenia components with physical activity and nutrition in Australian older adults performing exercise training. BMC Geriatr 2021; 21:276. [PMID: 33902464 PMCID: PMC8077926 DOI: 10.1186/s12877-021-02212-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 04/11/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The risk of progressive declines in skeletal muscle mass and strength, termed sarcopenia, increases with age, physical inactivity and poor diet. The purpose of this study was to explore and compare associations of sarcopenia components with self-reported physical activity and nutrition in older adults participating in resistance training at Helsinki University Research [HUR] and conventional gyms for over a year, once a week, on average. METHODS The study looked at differences between HUR (n = 3) and conventional (n = 1) gyms. Muscle strength (via handgrip strength and chair stands), appendicular lean mass (ALM; via dual energy X-ray absorptiometry) and physical performance (via gait speed over a 4-m distance, short physical performance battery, timed up and go and 400-m walk tests) were evaluated in 80 community-dwelling older adults (mean ± SD 76.5 ± 6.5 years). Pearson correlations explored associations for sarcopenia components with self-reported physical activity (via Physical Activity Scale for the Elderly [PASE]) and nutrition (via Australian Eating Survey). RESULTS No differences in PASE and the Australian Recommended Food Score (ARFS) were observed between HUR and conventional gyms, however HUR gym participants had a significantly higher self-reported protein intake (108 ± 39 g vs 88 ± 27 g; p = 0.029) and a trend to have higher energy intake (9698 ± 3006 kJ vs 8266 ± 2904 kJ; p = 0.055). In both gym groups, gait speed was positively associated with self-reported physical activity (r = 0.275; p = 0.039 and r = 0.423; p = 0.044 for HUR and conventional gyms, respectively). ALM was positively associated with protein (p = 0.047, r = 0.418) and energy (p = 0.038, r = 0.435) intake in the conventional gym group. Similar associations were observed for ALM/h2 in the HUR group. None of the sarcopenia components were associated with ARFS in either gym group. CONCLUSION Older adults attending HUR and conventional gyms had similar self-reported function and nutrition (but not protein intake). Inadequate physical activity was associated with low gait speed and inadequate nutrition and low protein ingestion associated with low lean mas, even in older adults participating in exercise programs. Optimal physical activity and nutrition are important for maintaining muscle mass and function in older adults.
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Affiliation(s)
- Ewelina Akehurst
- Institute for Health and Sport, Victoria University, Footscray, Victoria, Australia
| | - David Scott
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), St Albans, Victoria, Australia
| | - Juan Peña Rodriguez
- Faculty of Physiotherapy, The National University of Colombia, Bogota, Colombia
| | | | - Jasmaine Murphy
- Institute for Health and Sport, Victoria University, Footscray, Victoria, Australia
| | - Helen McCarthy
- Institute for Health and Sport, Victoria University, Footscray, Victoria, Australia
| | - Sandor Dorgo
- College of Health Sciences, University of Texas at El Paso, El Paso, TX, USA
| | - Alan Hayes
- Institute for Health and Sport, Victoria University, Footscray, Victoria, Australia.
- Australian Institute for Musculoskeletal Science (AIMSS), St Albans, Victoria, Australia.
- Department of Medicine-Western Health, Melbourne Medical School, The University of Melbourne, St Albans, Victoria, Australia.
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Dulfikar A, Koh ES, Lwin Z, Hovey E, Dhillon H, Arundell J, Pinkham E, Pinkham MB, Holland J, Trajano G, Naumann F. Physical functional capacity of patients with glioma prior to adjuvant radiation: preliminary descriptive study. Neurooncol Pract 2021; 8:290-298. [PMID: 34055376 DOI: 10.1093/nop/npab015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background Few studies have assessed physical functioning in glioma patients with grade II, III, and IV glioma prior to undergoing adjuvant radiation with or without chemotherapy. The aim of this study was to describe the baseline physical functioning capacity of patients with glioma prior to adjuvant therapy compared to validated cutoffs required to maintain independence. Methods This study is a cross-sectional study that recruited patients with grade II, III, and IV glioma (n = 33) undergoing adjuvant radiation with or without chemotherapy. The six-minute walk, thirty-second sit-to-stand, and timed "Up & Go" assessments were used to describe baseline physical functioning. Perceived quality of life from the European Organisation for Research and Treatment of Cancer (EORTC) quality of life questionnaire (QLQ-C30) version 3.0 was used to quantify the quality of life. Results Mean distance walked in the six-minute walk test was 416.2 m (SD 137.6 m) with a mean of 12.2 stands (SD 3.4 stands) achieved during the thirty-second sit-to-stand. Median time to complete the timed "Up & Go" assessment was 7 s (interquartile range: 3 s). One-sample t tests suggest walking distance and chair stands were significantly lower than cutoff criterions to maintain independent living, t(32) = -5.96, P < .001, bias-corrected accelerated 95% CI [370.7-460.4], and t(32) = -4.60, P < .01, bias-corrected accelerated 95% CI [11.0-13.4], respectively. Wilcoxon signed-rank test identified significantly shorter median time taken to complete the timed "Up & Go" test compared to the cutoff criterion (z = -4.43, n = 33, P < .01). Conclusion This study suggests glioma patient's aerobic endurance and lower limb strength are below criterion cutoffs recommended to maintain independent living. Timed "Up & Go" scores did not exceed the criterion cutoff, indicating respectable levels of mobility.
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Affiliation(s)
- Ali Dulfikar
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Kelvin Grove, Australia
| | - Eng-Siew Koh
- Radiation oncology, Liverpool Hospital, Liverpool, Australia.,University of New South Wales, Randwick, Australia
| | - Zarnie Lwin
- Department of Medical Oncology, Royal Brisbane and Womens Hospital, Herston, Australia.,School of Medicine, University of Queensland, St Lucia, Australia
| | - Elizabeth Hovey
- Department of Medical Oncology, Nelune Comprehensive Cancer Centre, Prince of wales Hospital, Randwick, Australia.,University of New South Wales, Randwick, Australia
| | - Haryana Dhillon
- Centre for Medical Psychology & Evidence-Based Decision-Making, School of Psychology Faculty of Science, The University of Sydney, Camperdown, Australia
| | - Jesica Arundell
- Radiation oncology, Liverpool Hospital, Liverpool, Australia
| | - Elizabeth Pinkham
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Kelvin Grove, Australia.,Physiotherapy, Clinical Support Services, Princess Alexandra Hospital, Woollongabba, Australia
| | - Mark B Pinkham
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Kelvin Grove, Australia.,Radiation Oncology, Cancer Services, Princess Alexandra Hospital, Woolloongabba, Australia
| | - Justin Holland
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Kelvin Grove, Australia
| | - Gabriel Trajano
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Kelvin Grove, Australia
| | - Fiona Naumann
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Kelvin Grove, Australia
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Abstract
Hip fracture is a leading cause of profound morbidity in individuals aged 65 years and older, ranking in the top 10 causes of loss of disability-adjusted life-years for older adults. Worldwide, the number of people with hip fracture is expected to rise significantly due to the aging population and other factors. Physical therapist management is recommended within medical, surgical, and multidisciplinary clinical practice guideline (CPGs) and is considered to be the standard of care in rehabilitation for people with hip fracture. The goal of this CPG was to review the evidence relevant to physical therapist management and to provide evidence-based recommendations for physical therapy diagnosis, prognosis, intervention, and assessment of outcome in adults with hip fracture. J Orthop Sports Phys Ther 2021;51(2):CPG1-CPG81. doi:10.2519/jospt.2021.0301.
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11
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Kristensen MT, Hulsbæk S, Faber LL, Kronborg L. Knee Extension Strength Measures Indicating Probable Sarcopenia Is Associated with Health-Related Outcomes and a Strong Predictor of 1-Year Mortality in Patients Following Hip Fracture Surgery. Geriatrics (Basel) 2021; 6:geriatrics6010008. [PMID: 33467771 PMCID: PMC7839049 DOI: 10.3390/geriatrics6010008] [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: 11/23/2020] [Revised: 01/05/2021] [Accepted: 01/12/2021] [Indexed: 12/20/2022] Open
Abstract
To examine if knee-extension strength (KES) measures indicating probable sarcopenia are associated with health-related outcomes and if KES and hand grip strength (HGS) measures are associated with 1-year mortality after hip fracture. Two groups of older patients with hip fracture had either HGS (n = 32) or KES (n = 150) assessed during their acute hospital stay. Cut-points for HGS (<27 kg for men and <16 kg for women), and cut-points for maximal isometric KES (non-fractured limb), being the lowest sex-specific quintile (<23.64 kg for men and <15.24 kg for women), were used to examine association with health-related outcomes and 1-year mortality. Overall, 1-year mortality was 12.6% in the two strength groups, of which 47% (HGS) and 46% (KES) respectively, were classified as probable sarcopenia. Probable sarcopenia patients (KES) had lower prefracture function, performed poorly in mobility measures and expressed a greater concern of falling compared to their stronger counterparts. Hazard ratio for 1-year mortality was 2.7 (95%CI = 0.49–14.7, p = 0.3) for HGS and 9.8 (95%CI = 2.2–43.0, p = 0.002) for KES for probable sarcopenia patients compared to those not. Sex-specific KES measures indicating sarcopenia is associated with health-related outcomes and a strong predictor of 1-year mortality after hip fracture.
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Affiliation(s)
- Morten Tange Kristensen
- Physical Medicine and Rehabilitation Research—Copenhagen (PMR-C), Departments of Physical Therapy and Orthopedic Surgery, Amager-Hvidovre Hospital, University of Copenhagen, 2650 Hvidovre, Denmark;
- Institute of Clinical Medicine, University of Copenhagen, Nørrebro, 2200 Copenhagen, Denmark
- Correspondence:
| | - Signe Hulsbæk
- Physical Medicine and Rehabilitation Research—Copenhagen (PMR-C), Departments of Physical Therapy and Orthopedic Surgery, Amager-Hvidovre Hospital, University of Copenhagen, 2650 Hvidovre, Denmark;
| | - Louise Lohmann Faber
- Department of Management and Quality, The Greenlandic Health System, Queen Ingrids Hospital, 3900 Nuuk, Greenland, Denmark;
| | - Lise Kronborg
- Department of Midwifery, Physiotherapy, Occupational Therapy and Psychomotor Therapy, Education in Physiotherapy, Faculty of Health, University College Copenhagen, Nørrebro, 2200 Copenhagen, Denmark;
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12
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Fabiani E, Herc M, Šimunič B, Brix B, Löffler K, Weidinger L, Ziegl A, Kastner P, Kapel A, Goswami N. Correlation between timed up and go test and skeletal muscle tensiomyography in female nursing home residents. JOURNAL OF MUSCULOSKELETAL & NEURONAL INTERACTIONS 2021; 21:247-254. [PMID: 34059569 PMCID: PMC8185258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Tensiomyography (TMG) derived contraction time (Tc) and amplitude (Dm) are related to muscle fibre composition and to muscle atrophy/tone, respectively. However, the link between mobility and TMG-derived skeletal muscle contractile properties in older persons is unknown. The aim of the study was to correlate lower limb skeletal muscle contractile properties with balance and mobility measures in senior female residents of retirement homes in Austria. METHODS Twenty-eight female participants (aged from 67-99 years) were included in measurements of contractile properties (TMG) of four skeletal muscles: vastus lateralis, vastus medialis, biceps femoris and gastrocnemius medialis. Their balance and mobility performance was measured using a timed up and go test (TUG). RESULTS Time needed to complete TUG is negatively correlated to biceps femoris (r= -0.490; p= 0.008), vastus lateralis (r= -0.414; p=0.028) and vastus medialis (r= -0.353; p=0.066) Dm and positively correlated to vastus lateralis Tc (r=0.456; p=0.015). Overall, vastus lateralis Tc and vastus medialis Dm explained 37% of TUG time variance. CONCLUSIONS Our study demonstrates that TMG-derived quadriceps muscle contractile parameters are correlated with the balance and mobility function in female nursing home residents.
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Affiliation(s)
- Ester Fabiani
- Alma Mater Europaea ECM, Maribor, Slovenia,Department of Infectious Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | | | - Boštjan Šimunič
- Alma Mater Europaea ECM, Maribor, Slovenia,Science and Research Centre Koper, Koper, Slovenia,Corresponding authors: Boštjan Šimunič, Science and Research Centre Koper, Garibaldijeva 1, Koper, Slovenia E-mail:
| | - Bianca Brix
- Head of Gravitational Physiology and Medicine Research Unit, Physiology Division, Medical University of Graz, Graz, Austria
| | - Kerstin Löffler
- Geriatrische Gesundheitszentren der Stadt Graz, Graz Austria
| | - Lisa Weidinger
- Geriatrische Gesundheitszentren der Stadt Graz, Graz Austria
| | - Andreas Ziegl
- AIT Austrian Institute of Technology GmbH, Graz, Austria,Institute of Neural Engineering, Graz University of Technology, Graz, Austria
| | - Peter Kastner
- AIT Austrian Institute of Technology GmbH, Graz, Austria
| | - Alen Kapel
- Alma Mater Europaea ECM, Maribor, Slovenia,Modus Medical, Maribor, Slovenia
| | - Nandu Goswami
- Alma Mater Europaea ECM, Maribor, Slovenia,Head of Gravitational Physiology and Medicine Research Unit, Physiology Division, Medical University of Graz, Graz, Austria,Nandu Goswami, Medical University of Graz, Neue Stitftingtalstrasse 6, 5-D, Graz, Austria E-mail:
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13
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Soulard J, Vaillant J, Balaguier R, Baillet A, Gaudin P, Vuillerme N. Foot-Worn Inertial Sensors Are Reliable to Assess Spatiotemporal Gait Parameters in Axial Spondyloarthritis under Single and Dual Task Walking in Axial Spondyloarthritis. SENSORS (BASEL, SWITZERLAND) 2020; 20:E6453. [PMID: 33198119 PMCID: PMC7697708 DOI: 10.3390/s20226453] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/06/2020] [Accepted: 11/09/2020] [Indexed: 02/07/2023]
Abstract
The aim of this study was (1) to evaluate the relative and absolute reliability of gait parameters during walking in single- and dual-task conditions in patients with axial spondyloarthritis (axSpA), (2) to evaluate the absolute and relative reliability of dual task effects (DTE) parameters, and (3) to determine the number of trials required to ensure reliable gait assessment, in patients with axSpA. Twenty patients with axSpa performed a 10-m walk test in single- and dual-task conditions, three times for each condition. Spatiotemporal, symmetry, and DTE gait parameters were calculated from foot-worn inertial sensors. The relative reliability (intraclass correlation coefficients-ICC) and absolute reliability (standard error of measurement-SEM and minimum detectable change-MDC) were calculated for these parameters in each condition. Spatiotemporal gait parameters showed good to excellent reliability in both conditions (0.59 < ICC < 0.90). The reliability of symmetry and DTE parameters was low. ICC, SEM, and MDC were better when using the mean of the second and the third trials. Spatiotemporal gait parameters obtained from foot-worn inertial sensors assessed in patients with axSpA in single- and dual-task conditions are reliable. However, symmetry and DTE parameters seem less reliable and need to be interpreted with caution. Finally, better reliability of gait parameters was found when using the mean of the 2nd and the 3rd trials.
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Affiliation(s)
- Julie Soulard
- University Grenoble Alpes, AGEIS, 38000 Grenoble, France; (J.V.); (R.B.); (N.V.)
- CHU Grenoble Alpes, 38000 Grenoble, France
| | - Jacques Vaillant
- University Grenoble Alpes, AGEIS, 38000 Grenoble, France; (J.V.); (R.B.); (N.V.)
| | - Romain Balaguier
- University Grenoble Alpes, AGEIS, 38000 Grenoble, France; (J.V.); (R.B.); (N.V.)
| | - Athan Baillet
- University Grenoble Alpes, CNRS, CHU Grenoble Alpes, Grenoble INP, TIMC-IMAG UMR5525, 38000 Grenoble, France; (A.B.); (P.G.)
| | - Philippe Gaudin
- University Grenoble Alpes, CNRS, CHU Grenoble Alpes, Grenoble INP, TIMC-IMAG UMR5525, 38000 Grenoble, France; (A.B.); (P.G.)
| | - Nicolas Vuillerme
- University Grenoble Alpes, AGEIS, 38000 Grenoble, France; (J.V.); (R.B.); (N.V.)
- Institut Universitaire de France, 75000 Paris, France
- LabCom Telecom4Health, University Grenoble Alpes & Orange Labs, 38000 Grenoble, France
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Jørgensen SL, Bohn MB, Aagaard P, Mechlenburg I. Efficacy of low-load blood flow restricted resistance EXercise in patients with Knee osteoarthritis scheduled for total knee replacement (EXKnee): protocol for a multicentre randomised controlled trial. BMJ Open 2020; 10:e034376. [PMID: 33004382 PMCID: PMC7534706 DOI: 10.1136/bmjopen-2019-034376] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Up to 20% of patients undergoing total knee replacement (TKR) surgery report no or suboptimal pain relief after TKR. Moreover, despite chances of recovering to preoperative functional levels, patients receiving TKR have demonstrated persistent deficits in quadriceps strength and functional performance compared with healthy age-matched adults. We intend to examine if low-load blood flow restricted exercise (BFRE) is an effective preoperative method to increase functional capacity, lower limb muscle strength and self-reported outcomes after TKR. In addition, the study aims to investigate to which extent preoperative BFRE will protect against surgery-related atrophy 3 months after TKR. METHODS In this multicentre, randomised controlled and assessor blinded trial, 84 patients scheduled for TKR will be randomised to receive usual care and 8 weeks of preoperative BFRE or to follow usual care-only. Data will be collected before randomisation, 3-4 days prior to TKR, 6 weeks, 3 months and 12 months after TKR. Primary outcome will be the change in 30 s chair stand test from baseline to 3-month follow-up. Key secondary outcomes will be timed up and go, 40 me fast-paced walk test, isometric knee extensor and flexor strength, patient-reported outcome and selected myofiber properties.Intention-to-treat principle and per-protocol analyses will be conducted. A one-way analysis of variance model will be used to analyse between group mean changes. Preintervention-to-postintervention comparisons will be analysed using a mixed linear model. Also, paired Student's t-test will be performed to gain insight into the potential pretraining-to-post-training differences within the respective training or control groups and regression analysis will be used for analysation of associations between selected outcomes. ETHICAL APPROVAL The trial has been accepted by the Central Denmark Region Committee on Biomedical Research Ethics (Journal No 10-72-19-19) and the Danish Data Protection Agency (Journal No 652164). All results will be published in international peer-reviewed scientific journals regardless of positive, negative or inconclusive results. TRIAL REGISTRATION NUMBER NCT04081493.
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Affiliation(s)
- Stian Langgård Jørgensen
- Department of Occupantional and Physical Therapy, Horsens Regional Hospital, Horsens, Denmark
- H-HIP, Horsens Regional Hospital, Horsens, Denmark
- Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Marie Bagger Bohn
- Department of Orthopedic Surgery, Horsens Regional Hospital, Horsens, Denmark
| | - Per Aagaard
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Inger Mechlenburg
- Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Orthopedics, Aarhus University Hospital, Aarhus, Denmark
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Continuous Compared to Accumulated Walking-Training on Physical Function and Health-Related Quality of Life in Sedentary Older Persons. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176060. [PMID: 32825509 PMCID: PMC7503248 DOI: 10.3390/ijerph17176060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 08/17/2020] [Accepted: 08/18/2020] [Indexed: 01/29/2023]
Abstract
The present study aimed to analyze the impact of overground walking interval training (WIT) in a group of sedentary older adults, comparing two different dose-distributions. In this quasi-experimental and longitudinal study, we recruited twenty-three sedentary older adults (71.00 ± 4.10 years) who were assigned to two groups of WIT. The continuous group (CWIT) trained for 60 min/session in the morning, while the accumulated group (AWIT) performed the same duration and intensity of exercise, but it was distributed twice a day (30 min in the morning and 30 more in the afternoon). After 15 weeks of an equal external-load training (3 days/week), Bonferroni post-hoc comparisons revealed significant (p < 0.050) and similar large improvements in both groups in cardiorespiratory fitness and lower limb strength; even larger gains in preferred walking speed and instrumental daily life activity, which was slightly superior for CWIT; and improvements in agility, which were moderate for CWIT and large for AWIT. However, none of the training protocols had an impact on the executive function in the individuals, and only the AWIT group improved health-related quality of life. Although both training protocols induced a general significant improvement in physical function in older adults, our results showed that the accumulative strategy should be recommended when health-related quality of life is the main target, and the continuous strategy should be recommended when weakness may be a threat in the short or medium term.
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Oliveira GSD, Iraci L, Pinheiro GS, Casal MZ, Haas AN, Pochmann D, Martinez FG, Elsner V, Dani C. Effect of exercise and grape juice on epigenetic modulation and functional outcomes in PD: A randomized clinical trial. Physiol Behav 2020; 227:113135. [PMID: 32798568 DOI: 10.1016/j.physbeh.2020.113135] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 08/10/2020] [Accepted: 08/11/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE This study aimed to investigate the impact of an aquatic physical training program associated with grape juice (Vitis labrusca) consumption on functional outcomes, Brain-Derived Neurotrophic Factor (BDNF) and global histone H4 acetylation levels in peripheral blood from individuals with Parkinson's disease. METHODS Nineteen participants were randomized to Aquatic Exercise (AQ, n = 9) and Aquatic Exercise + Grape Juice (AQ+GJ, n = 10) groups and performed to 4 weeks of an aquatic intervention (twice a week, approximately 60 min/session). The AQ+GJ groups also consumed 400 mL of grape juice per day during this period. Functional capacity (six-min walk test, 6MWT), mobility (The Timed Up and Go, TUG) and the risk of falls (Berg Balance Scale, BBS) were evaluated before and after intervention. In addition, blood collections were carried out for biomarker analysis (e.g. BDNF and global histone H4). RESULTS The aquatic exercise program induced functional improvement in individuals with Parkinson's disease, specifically ameliorating their mobility and functional capacity. In addition, enhanced levels of BDNF and histone H4 acetylation were found after the intervention. Grape juice consumption did not potentiate these effects, since any significant differences between the AQ and AQ+GJ groups were not found in all analysed variables. CONCLUSIONS The present study provides important insights about aquatic exercise-modulated BDNF levels in individuals with Parkinson's disease in combination with functional improvements, suggesting that histone acetylation status may interact to dictate the molecular mechanisms involved in this response. Parkinson disease, aquatic exercise, BDNF, epigenetic, grape juice.
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Affiliation(s)
| | - Lucio Iraci
- Curso de Fisioterapia do Centro Universitário Metodista-IPA, Porto Alegre, RS-Brasil
| | | | - Marcela Zimmermann Casal
- Laboratório de Pesquisa do Exercício, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS-Brasil
| | - Aline Nogueira Haas
- Laboratório de Pesquisa do Exercício, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS-Brasil
| | - Daniela Pochmann
- Programa de Pós-Graduação em Biociências e Reabilitação do Centro Universitário Metodista -IPA. Rua Coronel Joaquim Pedro Salgado, 80 - Rio Branco, Porto Alegre - RS, CEP 90420-060, Brasil
| | - Flavia Gomes Martinez
- Laboratório de Pesquisa do Exercício, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS-Brasil
| | - Viviane Elsner
- Curso de Fisioterapia do Centro Universitário Metodista-IPA, Porto Alegre, RS-Brasil; Programa de Pós-Graduação em Biociências e Reabilitação do Centro Universitário Metodista -IPA. Rua Coronel Joaquim Pedro Salgado, 80 - Rio Branco, Porto Alegre - RS, CEP 90420-060, Brasil; Programa de Pós-Graduação em Ciências Biológicas: Fisiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS-Brasil
| | - Caroline Dani
- Programa de Pós-Graduação em Biociências e Reabilitação do Centro Universitário Metodista -IPA. Rua Coronel Joaquim Pedro Salgado, 80 - Rio Branco, Porto Alegre - RS, CEP 90420-060, Brasil.
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17
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Søndergaard K, Petersen LE, Pedersen MK, Svendsen AB, Juhl CB. The responsiveness and predictive validity of the de Morton Mobility Index in geriatric rehabilitation. Disabil Rehabil 2020; 44:478-486. [PMID: 32529855 DOI: 10.1080/09638288.2020.1771438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: The de Morton Mobility Index (DEMMI) is a unidimensional clinical instrument proven reliable and valid for measuring mobility in the elderly, but its responsiveness has not been evaluated when applying the methodology recommended by COSMIN.Purpose: To evaluate the responsiveness and the predictive validity of the DEMMI.Materials and methods: Elderly people, referred for municipality-based rehabilitation, were consecutively included. Eight hypotheses regarding the relationship between the change scores in the DEMMI and other functional measures of mobility were tested by assessing the participants before and after rehabilitation. Three months after completing the rehabilitation, the participants' functional status was evaluated.Results: 250 elderly people (mean age 85 years, 63% women) were included. The change scores in the DEMMI and the other measures correlated (r = 0.422 to 0.547), but only three out of the eight hypotheses were confirmed. A DEMMI score of less than 48 and less than 67 can predict inability of ambulating close to the participant's residence and using public transport, respectively.Conclusions: We found a moderate responsiveness and a high predictive validity of the DEMMI score. The DEMMI appears to be an appropriate instrument for monitoring change in mobility and predicting functional status among elderly patients undergoing rehabilitation.Implications for rehabilitationThe de Morton Mobility Index (DEMMI) is a clinical instrument for measuring mobility.This study shows that the DEMMI was responsive to change in mobility and predicted disability among a diverse group of elderly individuals referred to rehabilitation after hospital discharge.The DEMMI is applicable as an outcome measure in trials investigating the effect of rehabilitation and for clinical decision-making concerning geriatric rehabilitation.
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Affiliation(s)
- Kasper Søndergaard
- Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev and Gentofte, Hellerup, Denmark
| | | | | | | | - Carsten Bogh Juhl
- Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev and Gentofte, Hellerup, Denmark.,Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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Kristensen MT. Factors influencing performances and indicating risk of falls using the true Timed Up and Go test time of patients with hip fracture upon acute hospital discharge. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2020; 25:e1841. [PMID: 32363803 DOI: 10.1002/pri.1841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 02/28/2020] [Accepted: 03/23/2020] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To examine the influence and risk of falls of individual factors on timed up and go test (TUG) times using standardized instructions in patients with hip fracture upon discharge from an acute orthopaedic hip fracture unit. METHODS Following instructions, the TUG was performed three times with a rollator (standardized aid), as fast as safely possible. Up to a 1-min rest was given after the first and second TUG trial. Multivariable linear regression analysis was used to investigate the factors influencing TUG-times and corresponding logistic analysis was used to investigate factors indicating risk of falls, using a cut-off of 24 s for TUG. RESULTS A total of 181 patients (122 women), 60 years or older, with a mean (SD) age of 78.1 (9.1) years were studied. The fastest of three TUG trials performed within a mean of 10.0 (5.2) post-surgery days and used in analyses reached a mean of 25.6 (11.0) s. Multivariable regression analysis showed that greater age (B = 0.24; 2.4s more per decade older), a low pre-fracture function level (New Mobility Score <7 points, B = 6.4s more than high level), having a trochanteric fracture (B = 6.2 s, vs. cervical), and the post-surgery day of testing (B = 0.42, 4.2s per 10 days later) were independently associated with using more time for performing the TUG. Correspondingly, the same four factors indicated an increased risk of falls in the logistic analysis. The linear model explained 28% of the variance on TUG, while the accuracy of the logistic model to predict patients having TUG≥24 s was 69%. CONCLUSION The age, pre-fracture function, fracture type and post-surgery day of TUG testing were identified as strong factors influencing TUG performances and TUG-times indicating risk of falls in patients with hip fracture. We suggest that these factors be considered when interpreting TUG test results and in further rehabilitation and fall prevention efforts.
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Affiliation(s)
- Morten T Kristensen
- Physical Medicine and Rehabilitation Research - Copenhagen (PMR-C), Departments of Physical Therapy and Orthopedic Surgery, Amager-Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
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19
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Hulsbæk S, Ban I, Aasvang TK, Jensen JEB, Kehlet H, Foss NB, Bandholm T, Kristensen MT. Preliminary effect and feasibility of physiotherapy with strength training and protein-rich nutritional supplement in combination with anabolic steroids in cross-continuum rehabilitation of patients with hip fracture: protocol for a blinded randomized controlled pilot trial (HIP-SAP1 trial). Trials 2019; 20:763. [PMID: 31870451 PMCID: PMC6929304 DOI: 10.1186/s13063-019-3845-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 10/24/2019] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND A 2014 Cochrane review evaluating the effect of anabolic steroids after hip fracture concluded that the quality of the studies was insufficient to draw conclusions on the effects and recommended further high-quality trials in the field. Therefore, the aim of this pilot trial is to determine the preliminary effect and feasibility of a 12-week multimodal intervention consisting of physiotherapy (with strength training), protein-rich nutritional supplement and anabolic steroid on knee-extension muscle strength and function 14 weeks after hip fracture surgery. METHODS We plan to conduct a randomized, placebo-controlled pilot trial with 48 patients operated for acute hip fracture. The patients are randomized (1:1) to either (1) physiotherapy with protein-rich nutritional supplement plus anabolic steroid or (2) physiotherapy with protein-rich nutritional supplement plus placebo. Outcome assessments will be carried out blinded at baseline (3-10 days after surgery) and at 14 weeks after entering the trial. Primary outcome is the change from baseline to follow-up in maximal isometric knee-extension muscle strength in the fractured limb. Secondary outcomes are physical performance test, patient-reported outcomes, and measures of body composition. DISCUSSION If the trial is found feasible and the results show an indication of anabolic steroid being a relevant addition to further enhance the recovery of muscle strength and function in an enhanced recovery after surgery program, this trial will constitute the basis of a larger confirmatory trial. TRIAL REGISTRATION ClinicalTrials.gov, NCT03545347. Preregistered on 4 June 2018.
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Affiliation(s)
- Signe Hulsbæk
- Physical Medicine and Rehabilitation Research - Copenhagen (PMR-C), Department of Physiotherapy, Copenhagen University Hospital, Amager-Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark
| | - Ilija Ban
- Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark
| | - Tobias Kvanner Aasvang
- Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark
| | - Jens-Erik Beck Jensen
- Department of Endocrinology, Copenhagen University Hospital, Amager-Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Kehlet
- Section for Surgical Pathophysiology 721, Copenhagen University Hospital, Rigshospitalet Ole Maaløes vej 26, 2100 Copenhagen Ø, Denmark
| | - Nicolai Bang Foss
- Department of Anesthesiology, Copenhagen University Hospital, Amager-Hvidovre and Institute of Clinical Medicine, University of Copenhagen, Kettegård Alle 30, 2650 Hvidovre, Denmark
| | - Thomas Bandholm
- Physical Medicine and Rehabilitation Research - Copenhagen (PMR-C), Department of Physiotherapy, Copenhagen University Hospital, Amager-Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark
- Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark
- Clinical Research Centre, Copenhagen University Hospital, Amager-Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark
| | - Morten Tange Kristensen
- Physical Medicine and Rehabilitation Research - Copenhagen (PMR-C), Department of Physiotherapy, Copenhagen University Hospital, Amager-Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark
- Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark
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Langeard A, Houdeib R, Saillant K, Kaushal N, Lussier M, Bherer L. Switching Ability Mediates the Age-Related Difference in Timed Up and Go Performance. J Alzheimers Dis 2019; 71:S23-S28. [DOI: 10.3233/jad-181176] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Antoine Langeard
- Department of Medicine, University of Montreal, Montreal, Quebec, Canada
- Research Centre, Montreal Heart Institute, Montréal, Quebec, Canada
- Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Montréal, Quebec, Canada
| | - Ramzi Houdeib
- Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Montréal, Quebec, Canada
- Concordia University, Department of Psychology, Montreal, Quebec, Canada
| | - Kathia Saillant
- Department of Medicine, University of Montreal, Montreal, Quebec, Canada
- Research Centre, Montreal Heart Institute, Montréal, Quebec, Canada
- Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Montréal, Quebec, Canada
| | - Navin Kaushal
- Department of Medicine, University of Montreal, Montreal, Quebec, Canada
- Research Centre, Montreal Heart Institute, Montréal, Quebec, Canada
- Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Montréal, Quebec, Canada
| | - Maxime Lussier
- Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Montréal, Quebec, Canada
- School of Rehabilitation Sciences, University of Montreal, Montréal, Quebec, Canada
| | - Louis Bherer
- Department of Medicine, University of Montreal, Montreal, Quebec, Canada
- Research Centre, Montreal Heart Institute, Montréal, Quebec, Canada
- Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Montréal, Quebec, Canada
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Gait as predictor of physical function in axial spondyloarthritis: the prospective longitudinal FOLOMI (Function, Locomotion, Measurement, Inflammation) study protocol. Rheumatol Int 2019; 39:1681-1688. [PMID: 31392500 DOI: 10.1007/s00296-019-04396-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 07/26/2019] [Indexed: 12/23/2022]
Abstract
Axial spondyloarthritis (axSpA) is a chronic inflammatory rheumatic disease affecting predominantly sacroiliac joints and axial skeleton. axSpA progression being irregular and hardly predictable, identifying functional decline is particularly important in patient with axSpA to allow delivery of timely and targeted interventions. Pain, reduced range of motion or altered posture can have adverse consequences on gait. Although gait has previously been used as a sensitive measure of physical outcomes in elderly and pathological populations, to the best of our knowledge, no study has used gait as a predictor of physical function in patients with axSpA. The objective of our study is hence to determine if gait parameters measured in patients with axSpA could predict the evaluation at 18 months of physical function as assessed by the Bath Ankylosing Spondylitis Functional Index (BASFI). This is a prospective and longitudinal study. Sixty patients with axSpA and 30 healthy age- and sex-matched controls will be included. Patients should be aged 18-65 years at time of their first evaluation, followed at Grenoble Alpes University Hospital for axSpA or ankylosing spondylitis, able to walk 180 m without technical help and with stable treatment for at least 12 months. Clinical characteristics, BASFI, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), clinical and laboratory measurements of gait will be assessed during four visits (at baseline and at months 6, 12, and 18). Similar assessments will be performed once for the healthy control group. A linear mixed model at 6, 12 and 18 months will be constructed to answer to the first objective, with the BASFI as dependent variable and gait parameters as explanatory variables. The data collection started in August 2018 and will be completed with the inclusion and follow-up of all the participants. We believe that the combination of clinical and laboratory measurements of gait in patients with axSpA could strengthen the capacity to monitor disease's evolution and to predict changes in patients' physical function. Results of the present study could ultimately allow delivering targeted, timely, personalized interventions and treatment in patients with axSpA.Trial registration: The study was approved by local ethic committee (CPP Ile De France 1, RCB: 2017-A03468-45, date of agreement: July 17th, last version: V4.0, 2018, March 5th, 2019) and is retrospectively registered in Clinical trials (NCT03761212).
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Sawers A, Hafner BJ. Conventional administration and scoring procedures suppress the diagnostic accuracy of a performance-based test designed to assess balance ability in lower limb prosthesis users. Prosthet Orthot Int 2019; 43:402-408. [PMID: 31117888 DOI: 10.1177/0309364619848274] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Practice effects have been observed among performance-based clinical tests administered to prosthesis-users. Their impact on test applications remains unknown. OBJECTIVE To determine whether scoring a clinical balance test using conventional procedures that do not accommodate practice effects reduces its diagnostic accuracy relative to scoring it using recommended procedures that do accommodate practice effects. STUDY DESIGN Cross-sectional study. METHODS Narrowing Beam Walking Test data from 40 prosthesis users was scored using recommended methods (i.e. average of trials 3-5) and conventional methods applied to other tests (i.e. mean or best of trials 1-3). Area under the receiver operating characteristic curve for each method was compared to 0.50, to determine if it was better than chance at identifying prosthesis-users with a history of falls, and to 0.80, to determine if it surpassed a threshold recommended for diagnostic accuracy. RESULTS Receiver operating characteristic curve area decreased when the Narrowing Beam Walking Test was scored using conventional rather than recommended procedures. Furthermore, when scored using conventional procedures, the NBWT no longer discriminated between prosthesis-users with and without a history of falls with a probability greater than chance, or exceeded recommended diagnostic thresholds. CONCLUSION Scoring the Narrowing Beam Walking Test using conventional procedures that do not accommodate practice effects decreased its diagnostic accuracy among prosthesis-users relative to recommended procedures. Conventional scoring procedures may limit the effectiveness of performance-based tests used to screen for fall risk in prosthesis-users because they do not mitigate practice effects. The influence of practice effects on other tests, and test applications (e.g. clinical evaluation and prediction), is warranted. CLINICAL RELEVANCE Scoring a clinical balance test using conventional procedures that do not mitigate practice effects reduced its diagnostic accuracy. Changing administration and scoring procedures to accommodate practice effects should be considered to improve the diagnostic accuracy of other performance-based balance tests.
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Affiliation(s)
- Andrew Sawers
- 1 Department of Kinesiology, University of Illinois at Chicago, Chicago, IL, USA
| | - Brian J Hafner
- 2 Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
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Andersen CW, Kristensen MT. Performance Stability and Interrater Reliability of Culturally Adapted 10-Meter Walking Test for Danes with Neurological Disorders. J Stroke Cerebrovasc Dis 2019; 28:2459-2467. [PMID: 31281111 DOI: 10.1016/j.jstrokecerebrovasdis.2019.06.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 06/15/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The 10-meter Walking Test (10MWT) is often used to assess people with, e.g., stroke, but often using different procedures. The aims of this study were to translate the 10MWT into Danish, to determine the number of trials needed to achieve performance stability, and to examine the interrater reliability and agreement of the 10MWT in people with neurological disorders. METHODS Translation followed international recommendations, and evaluated in a consecutive sample of 50 people with a neurological disorder. All participants performed 5 timed 10MWT trials (usual speed) with 20-seconds rest intervals between trials, supervised by a physical therapist. A second session was conducted with another physical therapist, separated with a mean (SD) of 2.7 (0.9) hours. The order of raters was randomized and they were blinded to each other's ratings. Repeated measures ANOVA determined performance stability, while ICC1.1, standard error of measurement (SEM), and minimal detectable change (MDC95) determined reproducibility. RESULTS Participant's improved their 10MWT scores significantly between the first and second trial only. The faster of the 2 trials took a mean of 11.95 (5.40) seconds, and significantly (P < 0.001) faster than the slowest; mean of 12.80 (6.13) seconds. The intraclass correlation coefficient (ICC; 95% confidence interval), SEM, and MDC, based on the fastest of 2 trials, were 0.97 (0.95-0.98), 0.06 m/s, and 0.17 m/s, respectively, and with no systematic between rater's bias. CONCLUSIONS We suggest that the faster of 2 timed trials be recorded for the 10MWT in people with neurological disorders, as we found excellent interrater reliability and low measurement error using this score.
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Affiliation(s)
| | - Morten Tange Kristensen
- Physical Medicine and Rehabilitation Research - Copenhagen (PMR-C), Departments of Physical Therapy and Orthopedic Surgery, Amager-Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark.
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Kristensen MT, Bloch ML, Jønsson LR, Jakobsen TL. Interrater reliability of the standardized Timed Up and Go Test when used in hospitalized and community‐dwelling older individuals. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2019; 24:e1769. [DOI: 10.1002/pri.1769] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 11/07/2018] [Accepted: 12/17/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Morten Tange Kristensen
- Physical Medicine and Rehabilitation Research—Copenhagen (PMR‐C), Department of Physical and Occupational TherapyCopenhagen University Hospital Amager‐Hvidovre Hvidovre Denmark
- Department of Orthopedic SurgeryCopenhagen University Hospital Amager‐Hvidovre Hvidovre Denmark
| | - Mette Linding Bloch
- Department of Physiotherapy and Occupational Therapy, Faculty of Health and TechnologyUniversity College Copenhagen Copenhagen Denmark
- The Specialized Hospital for Polio and Accident Victims Rødovre Denmark
| | - Line Rokkedal Jønsson
- Physical Medicine and Rehabilitation Research—Copenhagen (PMR‐C), Department of Physical and Occupational TherapyCopenhagen University Hospital Amager‐Hvidovre Hvidovre Denmark
| | - Thomas Linding Jakobsen
- Section for Orthopaedic and Sports Rehabilitation (SOS‐R)Health Center Nørrebro Copenhagen Denmark
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Sawers A, Hafner BJ. Narrowing beam-walking is a clinically feasible approach for assessing balance ability in lower-limb prosthesis users. J Rehabil Med 2018; 50:457-464. [PMID: 29616279 DOI: 10.2340/16501977-2329] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Challenging clinical balance tests are needed to expose balance deficits in lower-limb prost-hesis users. This study examined whether narrowing beam-walking could overcome conceptual and practical limitations identified in fixed-width beam-walking. DESIGN Cross-sectional. PARTICIPANTS Unilateral lower-limb prosthesis users. METHODS Participants walked 10 times along a low, narrowing beam. Performance was quantified using the normalized distance walked. Heuristic rules were applied to determine whether the narrowing beam task was "too easy," "too hard," or "appropriately challenging" for each participant. Linear regression and Bland-Altman plots were used to determine whether combinations of the first 5 trials could predict participants' stable beam-walking performance. RESULTS Forty unilateral lower-limb prosthesis users participated. Narrowing beam-walking was appropriately challenging for 98% of participants. Performance stabilized for 93% of participants within 5 trials, while 62% were stable across all trials. The mean of trials 3-5 accurately predicted stable performance. CONCLUSION A clinical narrowing beam-walking test is likely to challenge a range of lower-limb prosthesis users, have minimal administrative burden, and exhibit no floor or ceiling effects. Narrowing beam-walking is therefore a clinically viable method to evaluate lower-limb prosthesis users' balance ability, but requires psychometric testing before it is used to assess fall risk.
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Affiliation(s)
- Andrew Sawers
- Kinesiology, University of Illinois at Chicago, 60612 Chicago, USA.
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Validation of the Narrowing Beam Walking Test in Lower Limb Prosthesis Users. Arch Phys Med Rehabil 2018; 99:1491-1498.e1. [PMID: 29653108 DOI: 10.1016/j.apmr.2018.03.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Revised: 02/23/2018] [Accepted: 03/19/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the content, construct, and discriminant validity of the Narrowing Beam Walking Test (NBWT), a performance-based balance test for lower limb prosthesis users. DESIGN Cross-sectional study. SETTING Research laboratory and prosthetics clinic. PARTICIPANTS Unilateral transtibial and transfemoral prosthesis users (N=40). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Content validity was examined by quantifying the percentage of participants receiving maximum or minimum scores (ie, ceiling and floor effects). Convergent construct validity was examined using correlations between participants' NBWT scores and scores or times on existing clinical balance tests regularly administered to lower limb prosthesis users. Known-groups construct validity was examined by comparing NBWT scores between groups of participants with different fall histories, amputation levels, amputation etiologies, and functional levels. Discriminant validity was evaluated by analyzing the area under each test's receiver operating characteristic (ROC) curve. RESULTS No minimum or maximum scores were recorded on the NBWT. NBWT scores demonstrated strong correlations (ρ=.70‒.85) with scores/times on performance-based balance tests (timed Up and Go test, Four Square Step Test, and Berg Balance Scale) and a moderate correlation (ρ=.49) with the self-report Activities-specific Balance Confidence scale. NBWT performance was significantly lower among participants with a history of falls (P=.003), transfemoral amputation (P=.011), and a lower mobility level (P<.001). The NBWT also had the largest area under the ROC curve (.81) and was the only test to exhibit an area that was statistically significantly >.50 (ie, chance). CONCLUSIONS The results provide strong evidence of content, construct, and discriminant validity for the NBWT as a performance-based test of balance ability. The evidence supports its use to assess balance impairments and fall risk in unilateral transtibial and transfemoral prosthesis users.
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Sawers A, Hafner BJ. A study to assess whether fixed-width beam walking provides sufficient challenge to assess balance ability across lower limb prosthesis users. Clin Rehabil 2017; 32:483-492. [PMID: 28948848 DOI: 10.1177/0269215517732375] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the feasibility of fixed-width beam walking for assessing balance in lower limb prosthesis users. DESIGN Cross-sectional. SETTING Laboratory. SUBJECTS Lower limb prosthesis users. METHODS Participants attempted 10 walking trials on three fixed-width beams (18.6, 8.60, and 4.01 wide; 5.5 m long; 3.8 cm high). MAIN MEASURES Beam-walking performance was quantified using the distance walked to balance failure. Heuristic rules applied to each participant's beam-walking distance to classify each beam as "too easy," "too hard," or "appropriately challenging" and determine whether any single beam provided an appropriate challenge to all participants. The number of trials needed to achieve stable beam-walking performance was quantified for appropriately challenging beams by identifying the last inflection point in the slope of each participant's trial-by-trial cumulative performance record. RESULTS In all, 30 unilateral lower limb prosthesis users participated in the study. Each of the fixed-width beams was either too easy or too hard for at least 33% of the sample. Thus, no single beam was appropriately challenging for all participants. Beam-walking performance was stable by trial 8 for all participants and by trial 6 for 90% of participants. There was no significant difference in the number of trials needed to achieve stable performance among beams ( P = 0.74). CONCLUSION Results suggest that a clinical beam-walking test would require multiple beams to evaluate balance across a range of lower limb prosthesis users, emphasizing the need for adaptive or progressively challenging balance tests. While the administrative burden of a multiple-beam balance test may limit clinical feasibility, alternatives to ease this administrative burden are proposed.
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Affiliation(s)
- Andrew Sawers
- 1 Department of Kinesiology, University of Illinois at Chicago, Chicago, IL, USA
| | - Brian J Hafner
- 2 Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
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Kronborg L, Bandholm T, Palm H, Kehlet H, Kristensen MT. Effectiveness of acute in-hospital physiotherapy with knee-extension strength training in reducing strength deficits in patients with a hip fracture: A randomised controlled trial. PLoS One 2017; 12:e0179867. [PMID: 28662153 PMCID: PMC5491058 DOI: 10.1371/journal.pone.0179867] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 06/06/2017] [Indexed: 12/20/2022] Open
Abstract
Question Is acute in-hospital physiotherapy with additional progressive knee-extension strength training (ST) of the fractured limb more effective in reducing knee-extension strength deficit at follow-up compared to physiotherapy without strength training in patients with a hip fracture? Design Assessor blinded, randomised controlled trial with intention-to-treat analysis. Participants 90 patients with a hip fracture admitted to an acute orthopaedic Hip Fracture Unit at a university hospital between October 2013 and May 2015. Intervention Daily physiotherapy with or without progressive knee-extension strength training (10RM), 3 x 10 repetitions, of the fractured limb using ankle weight cuffs conducted by ward physical therapists during hospital stay. Outcome measures Primary outcome was the change in maximal isometric knee-extension strength in the fractured limb in percentage of the non-fractured limb from inclusion to postoperative day 10 or discharge (follow-up). Secondary outcome was Timed Up and Go test measured early after surgery and at follow-up. Results In the intention-to-treat analysis of between-group differences, the primary outcome improved 8.1% (95% CI -2.3; 18.4) by additional strength training from baseline to follow-up. In the per-protocol analysis of non-missing data, significant between-group improvements by 10.5% (95% CI 0.3; 20.7) were found in favour of additional ST. No significant between-group differences were found in any secondary outcome. Conclusion Physiotherapy with addition of 5 sessions of ST yielded no additional improvements compared to physiotherapy without strength training in reducing the knee-extension strength deficit at follow-up in patients with a hip fracture. It is debatable whether larger improvements than the observed 8–10% can be expected given that only five exercise sessions, on average, were completed. In fragile patients with a hip fracture in the acute phase, where the ability to participate in functional exercise is compromised, we still consider early strength training a possibility to improve outcomes of clinical importance, given the results of the per-protocol analysis. The present data provides an important basis and call for future investigations including longer term interventions. Trial registration Clinicaltrials.gov NCT00848913
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Affiliation(s)
- Lise Kronborg
- Physical Medicine and Rehabilitation Research – Copenhagen (PMR-C), Department of Physio- & Occupational Therapy, Copenhagen University Hospital, Hvidovre, Denmark
- * E-mail:
| | - Thomas Bandholm
- Physical Medicine and Rehabilitation Research – Copenhagen (PMR-C), Department of Physio- & Occupational Therapy, Copenhagen University Hospital, Hvidovre, Denmark
- Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark
- Department of Orthopaedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark
| | - Henrik Palm
- Department of Orthopaedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark
| | - Henrik Kehlet
- Section for Surgical Pathophysiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | - Morten Tange Kristensen
- Physical Medicine and Rehabilitation Research – Copenhagen (PMR-C), Department of Physio- & Occupational Therapy, Copenhagen University Hospital, Hvidovre, Denmark
- Department of Orthopaedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark
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