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Myers B, Hanks J. Hip Strength, Change of Direction, and Falls in Recreational Pickleball Players. Int J Sports Phys Ther 2024; 19:1116-1125. [PMID: 39229448 PMCID: PMC11368447 DOI: 10.26603/001c.122490] [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: 02/19/2024] [Accepted: 07/29/2024] [Indexed: 09/05/2024] Open
Abstract
Background While a high incidence of pickleball-related falls is reported, little is known regarding factors differentiating persons with and without a fall history during play. Purpose This study aimed to determine differences between recreational pickleball players who fell while playing and those who did not. Additional aims were to determine reasons for falling and to investigate associations among assessed factors. Study design Cross-sectional study. Methods Participants completed a survey reporting age, fall history, and reasons for falling during play. Hip abduction strength, single leg squat form, ankle dorsiflexion, and change of direction time using a modified T-test on a pickleball court (i.e. pickleball T-test) were assessed. Results Among the 92 individuals participating in the study, 42% reported a fall while playing and 30% reported falling more than once. Leading reasons for reported falls were lunging and moving backward. Participants who reported falling were significantly older (z = -2.60, p = 0.009) and slower on the pickleball T-test (z = -2.10, p = 0.036) than those who did not report falling. Hip abduction strength was not associated with fall history but was associated with faster time on the pickleball T-test (left rs = -.41, p < 0.001, right rs = -.48, p < 0.001). Single leg squat form and dorsiflexion were not related to fall history. Conclusion Falls are common among recreational pickleball players, particularly older players. Fall prevention programs for pickleball players should be considered including multi-directional lunging, lower extremity strength and power development, and change of direction training that includes moving backward. Level of evidence 2.
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Affiliation(s)
- Betsy Myers
- Department of Physical TherapyUniversity of Tennessee at Chattanooga
| | - June Hanks
- Department of Physical TherapyUniversity of Tennessee at Chattanooga
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2
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Gemikonakli G, Mach J, Tran T, Wu H, Hilmer SN. Probing polypharmacy, ageing and sex effects on physical function using different tests. Fundam Clin Pharmacol 2024; 38:561-574. [PMID: 38247119 DOI: 10.1111/fcp.12978] [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: 06/24/2023] [Revised: 12/01/2023] [Accepted: 12/14/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND Ageing, sex and polypharmacy affect physical function. OBJECTIVES This mouse study investigates how ageing, sex and polypharmacy interact and affect grip strength, balance beam and wire hang, correlating and comparing the different test results between and within subgroups. METHODS Young (2.5 months) and old (21.5 months) C57BL/6 J male and female mice (n = 10-6/group) were assessed for physical function at baseline on grip strength, balance beam and wire hang with three trials of 60 s (WH60s) and one trial of 300 s (WH300s). Mice were randomised to control or diet containing a high Drug Burden Index (DBI, total anticholinergic and sedative drug exposure) polypharmacy regimen (metoprolol, simvastatin, citalopram, oxycodone and oxybutynin at therapeutic oral doses). Following 6-8 weeks of treatment, mice were reassessed. RESULTS High DBI polypharmacy and control mice both showed age group differences on all tests (p < 0.05). Only control mice showed sex differences, with females outperforming males on the WH60s and balance beam for old mice, WH300s for young mice (p < 0.05). Polypharmacy reduced grip strength in all subgroups (p < 0.05) and only in old females reduced wire hang time and cumulative behaviour and balance beam time and %walked (p < 0.05). Physical function assessments were all correlated with each other, with differences between subgroups (p < 0.05), and mice within subgroups showed interindividual variability in performance. CONCLUSION Age, sex and polypharmacy have variable effects on different tests, and behavioural measures are useful adjuvants to assessing performance. There was considerable within-group variability in change in measures over time. These findings can inform design and sample size of future studies.
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Affiliation(s)
- Gizem Gemikonakli
- Laboratory of Ageing and Pharmacology, Kolling Institute, Faculty of Medicine and Health, The University of Sydney and the Northern Sydney Local Health District, Sydney, New South Wales, Australia
| | - John Mach
- Laboratory of Ageing and Pharmacology, Kolling Institute, Faculty of Medicine and Health, The University of Sydney and the Northern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Trang Tran
- Laboratory of Ageing and Pharmacology, Kolling Institute, Faculty of Medicine and Health, The University of Sydney and the Northern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Harry Wu
- Laboratory of Ageing and Pharmacology, Kolling Institute, Faculty of Medicine and Health, The University of Sydney and the Northern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Sarah N Hilmer
- Laboratory of Ageing and Pharmacology, Kolling Institute, Faculty of Medicine and Health, The University of Sydney and the Northern Sydney Local Health District, Sydney, New South Wales, Australia
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3
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Zafar U, Habib SH, Raza SS. Identification of appropriate tools to gauge brain functions in a clinical setup of a developing country: A pilot study. Pak J Med Sci 2023; 39:1840-1846. [PMID: 37936739 PMCID: PMC10626111 DOI: 10.12669/pjms.39.6.7489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/15/2023] [Accepted: 07/31/2023] [Indexed: 11/09/2023] Open
Abstract
Objective To identify the most appropriate tools to measure functions of the brain that can be utilized in the clinical setups of developing countries. Methods This qualitative research with a three-step approach was carried out from January 2022 to May 2022 at the Institute of Basic Medical Sciences, Khyber Medical University, Pakistan. Firstly, literature was searched to identify main brain faculties, then interviews were conducted with regional field experts to identify appropriate scales for the selected functions. Lastly a rubric was filled using interview transcripts and literature. Results The identified functions were vision, hearing, cognition, motor and emotions. Based on the rubric the best tests were visual fields (17/24), pure tone audiometry (16/24), Mini-Mental State Exam (20/24), Trait Emotional Intelligence Questionnaire (18/24), Romberg's test (19/24) and Manual Muscle Testing (18/24). Conclusion The clinicians in developing countries can utilize the visual fields, pure tone audiometry, Mini-Mental State Exam, Trait Emotional Intelligence Questionnaire, Romberg's test and Manual Muscle Testing for most efficient, feasible, accurate and cost-effective measurement of brain functions.
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Affiliation(s)
- Umema Zafar
- Umema Zafar, MBBS, MPhil, CHPE Department of Physiology, Rehman Medical College, Peshawar, Pakistan
| | - Syed Hamid Habib
- Syed Hamid Habib, MBBS, PhD, PGD, DHPE, CHR, CRSM, CME Department of Physiology. Institute of Basic Medical Sciences, Khyber Medical University, Peshawar, Pakistan
| | - Syed Shahmeer Raza
- Syed Shahmeer Raza, MBBS, MPhil, CRSM, ATC Department of Physiology, Gajju Khan Medical College, Swabi, Pakistan
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Wapp C, Biver E, Ferrari S, Zysset P, Zwahlen M. Development of a personalized fall rate prediction model in community-dwelling older adults: a negative binomial regression modelling approach. BMC Geriatr 2023; 23:200. [PMID: 36997882 PMCID: PMC10064572 DOI: 10.1186/s12877-023-03922-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 03/24/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Around a third of adults aged 65 and older fall every year, resulting in unintentional injuries in 30% of the cases. Fractures are a frequent consequence of falls, primarily caused in individuals with decreased bone strength who are unable to cushion their falls. Accordingly, an individual's number of experienced falls has a direct influence on fracture risk. The aim of this study was the development of a statistical model to predict future fall rates using personalized risk predictors. METHODS In the prospective cohort GERICO, several fall risk factor variables were collected in community-dwelling older adults at two time-points four years apart (T1 and T2). Participants were asked how many falls they experienced during 12 months prior to the examinations. Rate ratios for the number of reported falls at T2 were computed for age, sex, reported fall number at T1, physical performance tests, physical activity level, comorbidity and medication number with negative binomial regression models. RESULTS The analysis included 604 participants (male: 122, female: 482) with a median age of 67.90 years at T1. The mean number of falls per person was 1.04 and 0.70 at T1 and T2. The number of reported falls at T1 as a factor variable was the strongest risk factor with an unadjusted rate ratio [RR] of 2.60 for 3 falls (95% confidence interval [CI] 1.54 to 4.37), RR of 2.63 (95% CI 1.06 to 6.54) for 4 falls, and RR of 10.19 (95% CI 6.25 to 16.60) for 5 and more falls, when compared to 0 falls. The cross-validated prediction error was comparable for the global model including all candidate variables and the univariable model including prior fall numbers at T1 as the only predictor. CONCLUSION In the GERICO cohort, the prior fall number as single predictor information for a personalized fall rate is as good as when including further available fall risk factors. Specifically, individuals who have experienced three and more falls are expected to fall multiple times again. TRIAL REGISTRATION ISRCTN11865958, 13/07/2016, retrospectively registered.
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Affiliation(s)
- Christina Wapp
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland.
| | - Emmanuel Biver
- Division of Bone Diseases, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Serge Ferrari
- Division of Bone Diseases, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Philippe Zysset
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Marcel Zwahlen
- Institute for Social and Preventive Medicine, University of Bern, Bern, Switzerland
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5
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Can We Predict Imbalance in Patients? Analysis of the CDC National Health and Nutrition Examination Survey. J Clin Med 2023; 12:jcm12051943. [PMID: 36902730 PMCID: PMC10004139 DOI: 10.3390/jcm12051943] [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: 01/07/2023] [Revised: 02/06/2023] [Accepted: 02/16/2023] [Indexed: 03/06/2023] Open
Abstract
Understanding global body balance can optimize the postoperative course for patients undergoing spinal or lower limb surgical realignment. This observational cohort study aimed to characterize patients with reported imbalance and identify predictors. The CDC establishes a representative sample annually via the NHANES. All participants who said "yes" (Imbalanced) or "no" (Balanced) to the following question were identified from 1999-2004: "During the past 12 months, have you had dizziness, difficulty with balance or difficulty with falling?" Univariate analyses compared Imbalanced versus Balanced subjects and binary logistic regression modeling predicted for Imbalance. Of 9964 patients, imbalanced (26.5%) were older (65.4 vs. 60.6 years), with more females (60% vs. 48%). Imbalanced subjects reported higher rates of comorbidities, including osteoporosis (14.4% vs. 6.6%), arthritis (51.6% vs. 31.9%), and low back pain (54.4% vs 32.7%). Imbalanced patients had more difficulty with activities, including climbing 10 steps (43.8% vs. 21%) and stooping/crouching/kneeling (74.3% vs. 44.7%), and they needed greater time to walk 20 feet (9.5 vs. 7.1 s). Imbalanced subjects had significantly lower caloric and dietary intake. Regression revealed that difficulties using fingers to grasp small objects (OR: 1.73), female gender (OR: 1.43), difficulties with prolonged standing (OR: 1.29), difficulties stooping/crouching/kneeling (OR: 1.28), and increased time to walk 20 feet (OR: 1.06) were independent predictors of Imbalance (all p < 0.05). Imbalanced patients were found to have identifiable comorbidities and were detectable using simple functional assessments. Structured tests that assess dynamic functional status may be useful for preoperative optimization and risk-stratification for patients undergoing spinal or lower limb surgical realignment.
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Grabowska W, Burton W, Kowalski MH, Vining R, Long CR, Lisi A, Hausdorff JM, Manor B, Muñoz-Vergara D, Wayne PM. A systematic review of chiropractic care for fall prevention: rationale, state of the evidence, and recommendations for future research. BMC Musculoskelet Disord 2022; 23:844. [PMID: 36064383 PMCID: PMC9442928 DOI: 10.1186/s12891-022-05783-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 08/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Falls in older adults are a significant and growing public health concern. There are multiple risk factors associated with falls that may be addressed within the scope of chiropractic training and licensure. Few attempts have been made to summarize existing evidence on multimodal chiropractic care and fall risk mitigation. Therefore, the broad purpose of this review was to summarize this research to date. BODY: Systematic review was conducted following PRISMA guidelines. Databases searched included PubMed, Embase, Cochrane Library, PEDro, and Index of Chiropractic Literature. Eligible study designs included randomized controlled trials (RCT), prospective non-randomized controlled, observational, and cross-over studies in which multimodal chiropractic care was the primary intervention and changes in gait, balance and/or falls were outcomes. Risk of bias was also assessed using the 8-item Cochrane Collaboration Tool. The original search yielded 889 articles; 21 met final eligibility including 10 RCTs. One study directly measured the frequency of falls (underpowered secondary outcome) while most studies assessed short-term measurements of gait and balance. The overall methodological quality of identified studies and findings were mixed, limiting interpretation regarding the potential impact of chiropractic care on fall risk to qualitative synthesis. CONCLUSION Little high-quality research has been published to inform how multimodal chiropractic care can best address and positively influence fall prevention. We propose strategies for building an evidence base to inform the role of multimodal chiropractic care in fall prevention and outline recommendations for future research to fill current evidence gaps.
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Affiliation(s)
- Weronika Grabowska
- Brigham and Women's Hospital and Harvard Medical School Division of Preventive Medicine, Osher Center for Integrative Medicine, 900 Commonwealth Avenue, 3rd Floor, Boston, MA, 02215, USA
| | - Wren Burton
- Brigham and Women's Hospital and Harvard Medical School Division of Preventive Medicine, Osher Center for Integrative Medicine, 900 Commonwealth Avenue, 3rd Floor, Boston, MA, 02215, USA.
| | - Matthew H Kowalski
- Osher Clinical Center for Integrative Medicine, Brigham and Women's Healthcare Center, 850 Boylston Street, Suite 422, Chestnut Hill, MA, 02445, USA
| | - Robert Vining
- Palmer Center for Chiropractic Research, 1000 Brady Street, Davenport, IA, 52803, USA
| | - Cynthia R Long
- Palmer Center for Chiropractic Research, 1000 Brady Street, Davenport, IA, 52803, USA
| | - Anthony Lisi
- Yale University Center for Medical Informatics, 300 George Street, Suite 501, New Haven, CT, USA
| | - Jeffrey M Hausdorff
- Center for the Study of Movement Cognition and Mobility, Tel Aviv Sourasky Medical Center, Dafna St 5, Tel Aviv-Yafo, Israel
| | - Brad Manor
- Hinda and Arthur Marcus Institute for Aging Research, 1200 Centre Street, Boston, MA, 02131, USA
| | - Dennis Muñoz-Vergara
- Brigham and Women's Hospital and Harvard Medical School Division of Preventive Medicine, Osher Center for Integrative Medicine, 900 Commonwealth Avenue, 3rd Floor, Boston, MA, 02215, USA
| | - Peter M Wayne
- Brigham and Women's Hospital and Harvard Medical School Division of Preventive Medicine, Osher Center for Integrative Medicine, 900 Commonwealth Avenue, 3rd Floor, Boston, MA, 02215, USA
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Kozinc Ž, Smajla D, Šarabon N. Relationship between hip abductor strength, rate of torque development scaling factor and medio-lateral stability in older adults. Gait Posture 2022; 95:264-269. [PMID: 33243521 DOI: 10.1016/j.gaitpost.2020.11.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 11/09/2020] [Accepted: 11/11/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Recently, the rate of torque development scaling factor (RTD-SF) has been proposed as a useful tool that could contribute to a more comprehensive insight into muscular capacity. While lower RTD-SF is associated with ageing and certain neuromuscular diseases, it remains unknown whether this novel measure is associated with the postural control in the older adults. RESEARCH QUESTION Are hip abductor muscle strength, RTD and RTD-SF associated with responses to external postural perturbations in medio-lateral direction in older adults? METHODS Twenty healthy older adults (14 females, 6 males) were assessed for hip abductor muscle strength, RTD and RTD-SF, using a custom-built dynamometer. Perturbations were applied at waist level (4 perturbation intensities, 15 repetitions each) using a wire-pull paradigm, with centre-of-pressure (CoP) being recorded with force plates. For each condition (i.e. perturbation intensity), medio-lateral displacement and velocity of the CoP were computed. For both parameters, within-individual variation (representing consistency of the responses), expressed by the standard deviation (SD) of CoP parameters was also considered. Pearson correlation coefficients were computed between parameters of hip muscle capacity and CoP responses and SD values of CoP responses. RESULTS RTD-SF was moderately positively related to the consistency of the responses of both CoP displacement and velocity (r = 0.53-0.56; p = 0.011-0.016) at the lowest level of the perturbation magnitude (15 N). No other statistically significant relationships were found (all r < 0.35). SIGNIFICANCE RTD-SF could play a role in preserving postural balance in older adults when low-intensity perturbations are applied. RTD-SF is a novel outcome measure that could represent an important alternative clinical tool to traditional strength assessments. It could represent a supplementary tool to assess the risk of falls, however, several limitations and ambiguities need to be resolved by future research before it can be utilized in practice.
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Affiliation(s)
- Žiga Kozinc
- University of Primorska, Faculty of Health Sciences, Polje 42, SI-6310 Izola, Slovenia; University of Primorska, Andrej Marušič Institute, Muzejski trg 2, SI-6000 Koper, Slovenia
| | - Darjan Smajla
- University of Primorska, Faculty of Health Sciences, Polje 42, SI-6310 Izola, Slovenia; InnoRenew CoE, Human Health Department, Livade 6, SI6310 Izola, Slovenia
| | - Nejc Šarabon
- University of Primorska, Faculty of Health Sciences, Polje 42, SI-6310 Izola, Slovenia; InnoRenew CoE, Human Health Department, Livade 6, SI6310 Izola, Slovenia; S2P, Science to Practice, Ltd., Laboratory for Motor Control and Motor Behavior, Tehnološki Park 19, SI-1000 Ljubljana, Slovenia.
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Lin WS, Hsu NW, Lee MJ, Lin YY, Tsai CC, Pan PJ. Correlation analysis of physical fitness and its impact on falls in 2130 community- dwelling older adults: a retrospective cross-sectional study. BMC Geriatr 2022; 22:447. [PMID: 35606737 PMCID: PMC9125933 DOI: 10.1186/s12877-022-03138-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 05/13/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND As the community-dwelling population ages in Taiwan, concerns regarding long-term care have grown more urgent. Physical fitness plays a key role in enabling community-dwelling older adults to independently complete daily tasks and avoid falling accidents. However, the effect of physical fitness on falls and other fitness-related factors remains poorly understood. METHODS In this retrospective cross-sectional study, 2130 community-dwelling older adults were recruited from a rural region of Taiwan. Each of these participants completed a demographics interview and frailty questionnaire and reported their history of falls. We evaluated each participant's height and body weight measurements, calf circumference, bone mass density, and results on the grip strength, single-leg standing, chair sit-and-reach, 8-ft up-and-go, 30-second chair stand, 2-minute step, 30-second arm curl, 6-m walk, and back scratch tests to determine their overall physical fitness, which consisted of their body composition, muscular strength and endurance, flexibility, and cardiopulmonary fitness. RESULTS The prevalence of falls in the preceding year among the older adults surveyed was 20.8%, and the resultant hospitalization rate was 10.9%. The older adults who were more physically active in the past week, had regular exercise habits, lived with family, and had no history of hospitalization due to falls, exhibited greater performance on the physical fitness tests. Three time fallers exhibited lower levels of overall physical fitness than did those who had not fallen. The nonfallers outperformed the fallers in grip strength (participants who had not fallen and those who had fallen once, twice, or three times in the preceding year: 24.66 ± 0.19 vs. 23.66 ± 0.35 vs. 20.62 ± 0.71 vs. 22.20 ± 0.90 kg) and single-leg standing duration (19.38 ± 0.39 vs. 16.33 ± 0.78 vs. 13.95 ± 1.67 vs. 12.34 ± 1.82 seconds). CONCLUSIONS Exercise habits, living status, hospitalization due to falls, and amount of exercise were all associated with physical fitness in community-dwelling older adults. The results of all of the assessments indicated that the participants who had fallen three times exhibited lower levels of physical fitness than did those who had not fallen in the previous year. Physical measurements, including grip strength and single-leg standing duration, are associated with an individual's risk of falling, which indicates that they should be considered in the development of geriatric physical fitness and fall-prevention programs.
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Affiliation(s)
- Wang-Sheng Lin
- Department of Physical Medicine & Rehabilitation, Taipei Veterans General Hospital, Yuan-Shan/Su-Ao Branch, Yilan, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Nai-Wei Hsu
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Public Health Bureau, Yilan County, Taiwan.,Community Medicine Research Center & Institute of Public Health, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Meng-Jer Lee
- Department of Physical Medicine & Rehabilitation, National Yang Ming Chiao Tung University Hospital, Yilan, Taiwan
| | - You-Yuan Lin
- Department of Physical Medicine & Rehabilitation, National Yang Ming Chiao Tung University Hospital, Yilan, Taiwan
| | - Chih-Chun Tsai
- Department of Mathematics, Tamkang University, Taipei, Taiwan
| | - Po-Jung Pan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan. .,Department of Physical Medicine & Rehabilitation, National Yang Ming Chiao Tung University Hospital, Yilan, Taiwan. .,Center of Community Medicine, National Yang Ming Chiao Tung University Hospital, Yilan, Taiwan.
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Gafner SC, Allet L, Hilfiker R, Bastiaenen CHG. Reliability and Diagnostic Accuracy of Commonly Used Performance Tests Relative to Fall History in Older Persons: A Systematic Review. Clin Interv Aging 2021; 16:1591-1616. [PMID: 34483656 PMCID: PMC8409789 DOI: 10.2147/cia.s322506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 07/24/2021] [Indexed: 12/30/2022] Open
Abstract
Background/Objectives Early detection of fall risk is crucial for targeted fall prevention and rehabilitation. This systematic review facilitates decision-making concerning the optimal choice for a suitable fall risk assessment test for older persons in four different settings. This systematic review provides an overview of reliability and diagnostic accuracy (sensitivity [SE], specificity, likelihood ratios, and post-test probabilities) of commonly used performance measures to assess older persons' fall risk. Methods Two reviewers independently screened titles, abstracts, and full texts of all articles identified through a systematic search on the PubMed, Embase, CINAHL, and Web of Science databases. The methodological quality was critically appraised using the Quality Assessment of Diagnostic Accuracy Studies-2 tool and the COSMIN risk of bias tool. Due to a setting-dependent fall risk, four relevant settings were selected for the analyses: 1) community dwelling, 2) nursing home, 3) hospital, and 4) the combined setting of hospitalized and community-dwelling persons. Results Recommendations for diagnostic accuracy can be made for the specific settings: setting 1) mini-balance evaluation system test, timed up and go test with fast speed (TUG FAST), cognitive TUG FAST, functional reach test, and fast gait speed; 2) TUG at usual speed; 3) none of the included tests; and 4) some hip muscle strength and hand grip strength tests might be recommended. Conclusion The review's results are applicable for use in clinical practice, both on a population and on an individual level for patients and caregivers. Most measures' reliability is sufficient. However, the included tests' discriminative ability is not optimal for clinical use in relevant settings. The low sample sizes of most of the included studies and a limited amount of studies in all but the community-dwelling setting hinder us from making strong recommendations.
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Affiliation(s)
- Simone Chantal Gafner
- Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Geneva, Switzerland.,Department of Epidemiology, Research Line Functioning, Participation and Rehabilitation, CAPHRI, Maastricht University, Maastricht, the Netherlands
| | - Lara Allet
- Department of Community Medicine, University Hospitals and University of Geneva, Geneva, Switzerland.,School of Health Sciences, HES-SO Valais-Wallis, University of Applied Sciences and Arts Western Switzerland, Valais, Switzerland
| | - Roger Hilfiker
- School of Health Sciences, HES-SO Valais-Wallis, University of Applied Sciences and Arts Western Switzerland, Valais, Switzerland
| | - Caroline Henrice Germaine Bastiaenen
- Department of Epidemiology, Research Line Functioning, Participation and Rehabilitation, CAPHRI, Maastricht University, Maastricht, the Netherlands
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Klima DW, Rabel M, Mandelblatt A, Miklosovich M, Putman T, Smith A. Community-Based Fall Prevention and Exercise Programs for Older Adults. CURRENT GERIATRICS REPORTS 2021. [DOI: 10.1007/s13670-021-00354-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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11
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Reliability and validity of an adapted hip abductor strength measure as a potential new fall risk assessment for older persons: a study protocol. BMC Geriatr 2021; 21:110. [PMID: 33546611 PMCID: PMC7866761 DOI: 10.1186/s12877-021-02048-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 01/21/2021] [Indexed: 11/16/2022] Open
Abstract
Background Persons aged ≥ 65 years are currently the world’s fastest growing age group. An important complication of age is the increasing risk of falls. Falls have multifactorial etiology and modifiable risk factors open for interventions in prevention and rehabilitation, are of high interest. In this context, strong hip abductors seem to be important to prevent falls. A newly adapted measurement device to measure hip abductor strength (HAS) in a closed chain position was developed. We aim to assess feasibility, intra- and inter-tester reliability and construct and criterion validity of the new measure. Methods In two subsequent parts a feasibility, reliability and validity study with an adapted measurement instrument for the assessment of HAS (index test) in a closed chain position in persons aged ≥ 65 years will be conducted. Part I investigates feasibility of the measure in clinical settings as well as reliability of the new HAS test (n = 26). Part II evaluates construct and criterion validity (n = 169). Construct validity will be assessed cross-sectional, criterion validity by comparison with prospectively followed up fall history for 12 months (external criterion) and other functional fall risk assessments (Short Physical Performance Battery, Timed Up and Go test, usual gait speed and hand grip strength). Discussion Results of feasibility, will give insight in its applicability in daily clinical life and clinimetric properties will show if measurements of HAS in a closed chain position should be encouraged to include in fall risk assessments in older adults.
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Valenzuela PL, Maffiuletti NA, Saner H, Schütz N, Rudin B, Nef T, Urwyler P. Isometric Strength Measures are Superior to the Timed Up and Go Test for Fall Prediction in Older Adults: Results from a Prospective Cohort Study. Clin Interv Aging 2020; 15:2001-2008. [PMID: 33149561 PMCID: PMC7602904 DOI: 10.2147/cia.s276828] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 09/23/2020] [Indexed: 11/23/2022] Open
Abstract
Background Isometric strength measures and timed up and go (TUG) tests are both recognized as valuable tools for fall prediction in older adults. However, results from direct comparison of these two tests are lacking. We aimed to assess the potential of isometric strength measures and the different modalities of the TUG test to detect individuals at risk of falling. Methods This is a prospective cohort study including 24 community-dwelling older adults (≥65 years, 19 females, 88±7 years). Participants performed three variations of the TUG test (standard, counting and holding a full cup) and three isometric strength tests (handgrip, knee extension and hip flexion) at several time points (at baseline and every ~6 weeks) during a one-year follow-up. The association between these tests and the incidence of falls during the follow-up was assessed. Results Twelve participants out of 24 participants experienced falls during the follow-up. Fallers showed a significantly lower handgrip strength (-5.7 kg, 95% confidence interval: -10.4 to -1.1, p=0.019) and knee extension strength (-4.9 kg, -9.6 to -0.2, p=0.042) at follow-up, while no significant differences were found for any TUG variation. Conclusions Handgrip and knee extension strength measures - particularly when assessed regularly over time - have the potential to serve as a simple and easy tool for detecting individuals at risk of falling as compared to functional mobility measures (ie, TUG test).
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Affiliation(s)
| | | | - Hugo Saner
- Institute for Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Gerontechnology & Rehabilitation Group, University of Bern, Bern, Switzerland
| | - Narayan Schütz
- Gerontechnology & Rehabilitation Group, University of Bern, Bern, Switzerland
| | - Beatrice Rudin
- Höhere Fachschule Pflege, Berufsbildungszentrum Olten, Olten, Switzerland
| | - Tobias Nef
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Prabitha Urwyler
- Gerontechnology & Rehabilitation Group, University of Bern, Bern, Switzerland.,ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland.,Department of Neurology, University Neurorehabilitation Unit, University Hospital Inselspital, Bern, Switzerland
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13
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Gafner SC, Bastiaenen CHG, Ferrari S, Gold G, Trombetti A, Terrier P, Hilfiker R, Allet L. The Role of Hip Abductor Strength in Identifying Older Persons at Risk of Falls: A Diagnostic Accuracy Study. Clin Interv Aging 2020; 15:645-654. [PMID: 32440107 PMCID: PMC7213876 DOI: 10.2147/cia.s246998] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 04/09/2020] [Indexed: 11/23/2022] Open
Abstract
Background/Objectives Early detection of fall risk in persons older than 65 is of clinical relevance, but the diagnostic accuracy of currently used functional tests (eg short physical performance battery [SPPB] and timed up and go test [TUG]) to assess older persons' fall risks remains moderate. Recent literature highlights the importance of strong hip abductors to prevent falls. We thus aimed to assess the diagnostic accuracy of hip abductor strength measures to assess older persons' fall risks. Methods Hip abductor maximum voluntary isometric strength (ABD MVIS), rate of force generation (ABD RFG), and the SPPB and TUG functional fall risk assessments were assessed in 60 persons aged over 65 years (82.0 ± 6.1 years). The diagnostic accuracy (area under the curve [AUC], sensitivity [sens], specificity [spec], positive predictive value [PPV], negative predictive value [NPV], and positive and negative likelihood ratios [LR+, LR-]) was evaluated at a clinically important 90% sensitivity level. Cut-off values for clinical use were calculated. Results In our population, hip ABD MVIS (AUC 0.8, sens 90.6%, spec 57.1%, PPV 70.7%, NPV 84.2%, LR+ 2.1, LR- 0.2, and cut-off value ≤ 1.1 N/kg) and hip ABD RFG (AUC 0.8, sens 90.6%, spec 46.4%, PPV 65.9%, NPV 81.3%, LR+ 1.7, LR- 0.2, and cut-off ≤ 8.47 N/kg/s) show diagnostic accuracy comparable to other fall risk assessments (SPPB and TUG) and a high net sensitivity when used in a test battery. Conclusion Hip ABD MVIS or RFG shows good diagnostic accuracy to differentiate between older fallers and nonfallers compared to the chosen external criterion history of falls. The high net sensitivity when hip ABD MVIS or RFG is combined with currently used fall risk assessments shows promise in contributing value to a test battery and should be investigated further in longitudinal studies.
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Affiliation(s)
- Simone Chantal Gafner
- Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Geneva, Switzerland.,Department of Epidemiology, Research Line Functioning and Rehabilitation, CAPHRI, Maastricht University, Maastricht, the Netherlands
| | | | - Serge Ferrari
- Department of Internal Medicine Specialties, University Hospitals and University of Geneva, Geneva, Switzerland
| | - Gabriel Gold
- Department of Internal Medicine, Rehabilitation and Geriatrics, University Hospitals and University of Geneva, Geneva, Switzerland
| | - Andrea Trombetti
- Division of Bone Diseases, Department of Medicine, University Hospitals and University of Geneva, Geneva, Switzerland
| | - Philippe Terrier
- School of Health Sciences, ARC Santé, HES-SO University of Applied Sciences and Arts Western Switzerland, Neuchâtel, Switzerland.,Department of Thoracic Surgery, University Hospitals and University of Geneva, Geneva, Switzerland
| | - Roger Hilfiker
- School of Health Sciences, HES-SO Valais-Wallis, University of Applied Sciences and Arts Western Switzerland, Valais, Switzerland
| | - Lara Allet
- Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Geneva, Switzerland.,School of Health Sciences, HES-SO Valais-Wallis, University of Applied Sciences and Arts Western Switzerland, Valais, Switzerland.,Department of Community Medicine, University Hospitals and University of Geneva, Geneva, Switzerland
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14
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Davis LA, Allen SP, Hamilton LD, Grabowski AM, Enoka RM. Differences in postural sway among healthy adults are associated with the ability to perform steady contractions with leg muscles. Exp Brain Res 2020; 238:487-497. [PMID: 31960103 DOI: 10.1007/s00221-019-05719-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 12/30/2019] [Indexed: 12/13/2022]
Abstract
Upright standing involves small displacements of the center of mass about the base of support. These displacements are often quantified by measuring various kinematic features of the center-of-pressure trajectory. The plantar flexors have often been identified as the key muscles for the control of these displacements; however, studies have suggested that the hip abductor and adductors may also be important. The purpose of our study was to determine the association between the force capabilities of selected leg muscles and sway-area rate across four balance conditions in young (25 ± 4 years; 12/19 women) and older adults (71 ± 5 years; 5/19 women). Due to the marked overlap in sway-area rate between the two age groups, the data were collapsed, and individuals were assigned to groups of low- and high-sway area rates based on a k-medoid cluster analysis. The number of participants assigned to each group varied across balance conditions and a subset of older adults was always included in the low-sway group for each balance condition. The most consistent explanatory variable for the variance in sway-area rate was force control of the hip abductors and ankle dorsiflexors as indicated by the magnitude of the normalized force fluctuations (force steadiness) during a submaximal isometric contraction. The explanatory power of the regression models varied across conditions, thereby identifying specific balance conditions that should be examined further in future studies of postural control.
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Affiliation(s)
- Leah A Davis
- Department of Integrative Physiology, University of Colorado Boulder, Campus Box 354, Boulder, CO, 80309, USA.
| | - Stephen P Allen
- Department of Integrative Physiology, University of Colorado Boulder, Campus Box 354, Boulder, CO, 80309, USA
| | - Landon D Hamilton
- Center for Orthopedic Biomechanics, Ritchie School of Mechanical Engineering and Computer Science, University of Denver, 2155 E. Wesley Ave., Denver, CO, 80210, USA
| | - Alena M Grabowski
- Department of Integrative Physiology, University of Colorado Boulder, Campus Box 354, Boulder, CO, 80309, USA
| | - Roger M Enoka
- Department of Integrative Physiology, University of Colorado Boulder, Campus Box 354, Boulder, CO, 80309, USA
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15
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Carrasco C, Tomas‐Carus P, Bravo J, Pereira C, Mendes F. Understanding fall risk factors in community‐dwelling older adults: A cross‐sectional study. Int J Older People Nurs 2019; 15:e12294. [DOI: 10.1111/opn.12294] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 10/31/2019] [Accepted: 11/12/2019] [Indexed: 01/10/2023]
Affiliation(s)
| | - Pablo Tomas‐Carus
- Department of Sports and Health University of Évora Évora Portugal
- Comprehensive Health Research Center (CHRC) University of Évora Évora Portugal
| | - Jorge Bravo
- Department of Sports and Health University of Évora Évora Portugal
- Comprehensive Health Research Center (CHRC) University of Évora Évora Portugal
| | - Catarina Pereira
- Department of Sports and Health University of Évora Évora Portugal
- Comprehensive Health Research Center (CHRC) University of Évora Évora Portugal
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16
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Carrasco-Poyatos M, Ramos-Campo DJ, Rubio-Arias JA. Pilates versus resistance training on trunk strength and balance adaptations in older women: a randomized controlled trial. PeerJ 2019; 7:e7948. [PMID: 31741786 PMCID: PMC6859004 DOI: 10.7717/peerj.7948] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 09/24/2019] [Indexed: 11/20/2022] Open
Abstract
Background The neuromuscular decline impact in the functional independence of older women is determining the necessity of implementing new strategies focused on core strength training and postural stability maintenance to promote healthy aging. Objectives To define whether Pilates or resistance training is better at improving (a) core isometric and isokinetic muscular strength, and (b) static and dynamic balance, in older women. Methods This was a cluster randomized controlled trial. Physically independent older women (60–80 years) from day centers were randomly allocated to Pilates, Muscular and Control Groups (PG, MG and CG) using a block randomization method. Only the research staff performing the assessment and statistical analysis were blinded. Exercise groups trained twice a week (1 h per session) for 18 weeks in a moderate-to-vigorous intensity. Core strength (primary outcome): trunk and hip isometric and hip isokinetic muscular strength (Biodex System III Pro Isokinetic Dynamometer), alongside one leg static balance (portable force platform Kistler 9286AA) and dynamic balance (timed up and go (TUG)) were assessed. Results A total of 60 participants were randomized (PG, n = 20; MG, n = 20; CG, n = 20) and 49 completed the trial (PG, n = 16; MG, n = 19; CG, n = 14). Regarding hip isometric extension strength, PG was statistically better than CG (P = 0.004). There were no differences between groups regarding isokinetic strength or balance. Intra-group comparisons showed significant improvements (P < 0.05) in the dynamic balance and trunk and hip isometric extension strength for PG and MG, whereas every hip isokinetic measurement was improved in MG. Exercise programs did not produce any adverse event. Conclusions The Pilates training program was more effective for improving isometric hip and trunk extension strength, while the Muscular training program generated greater benefits on trunk and hip isokinetic strength. Moreover, both training programs showed moderate effects for the TUG. Clinical Trial Registration The trial was registered at ClinicalTrials.gov (identifier: NCT02506491).
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Affiliation(s)
- María Carrasco-Poyatos
- Department of Education, Health and Public Administration Research Center, Universidad de Almería, Almería, Spain
| | - Domingo J Ramos-Campo
- Department of Physical Activity and Sport Sciences, UCAM Research Centre for High Performance Sport, Universidad Católica San Antonio, Murcia, Spain
| | - Jacobo A Rubio-Arias
- Department of Physical Activity and Sport Sciences, UCAM Research Centre for High Performance Sport, Universidad Católica San Antonio, Murcia, Spain
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17
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Terrier P. Complexity of human walking: the attractor complexity index is sensitive to gait synchronization with visual and auditory cues. PeerJ 2019; 7:e7417. [PMID: 31396452 PMCID: PMC6679905 DOI: 10.7717/peerj.7417] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 07/05/2019] [Indexed: 11/24/2022] Open
Abstract
Background During steady walking, gait parameters fluctuate from one stride to another with complex fractal patterns and long-range statistical persistence. When a metronome is used to pace the gait (sensorimotor synchronization), long-range persistence is replaced by stochastic oscillations (anti-persistence). Fractal patterns present in gait fluctuations are most often analyzed using detrended fluctuation analysis (DFA). This method requires the use of a discrete times series, such as intervals between consecutive heel strikes, as an input. Recently, a new nonlinear method, the attractor complexity index (ACI), has been shown to respond to complexity changes like DFA, while being computed from continuous signals without preliminary discretization. Its use would facilitate complexity analysis from a larger variety of gait measures, such as body accelerations. The aim of this study was to further compare DFA and ACI in a treadmill experiment that induced complexity changes through sensorimotor synchronization. Methods Thirty-six healthy adults walked 30 min on an instrumented treadmill under three conditions: no cueing, auditory cueing (metronome walking), and visual cueing (stepping stones). The center-of-pressure trajectory was discretized into time series of gait parameters, after which a complexity index (scaling exponent alpha) was computed via DFA. Continuous pressure position signals were used to compute the ACI. Correlations between ACI and DFA were then analyzed. The predictive ability of DFA and ACI to differentiate between cueing and no-cueing conditions was assessed using regularized logistic regressions and areas under the receiver operating characteristic curves (AUC). Results DFA and ACI were both significantly different among the cueing conditions. DFA and ACI were correlated (Pearson’s r = 0.86). Logistic regressions showed that DFA and ACI could differentiate between cueing/no cueing conditions with a high degree of confidence (AUC = 1.00 and 0.97, respectively). Conclusion Both DFA and ACI responded similarly to changes in cueing conditions and had comparable predictive power. This support the assumption that ACI could be used instead of DFA to assess the long-range complexity of continuous gait signals. However, future studies are needed to investigate the theoretical relationship between DFA and ACI.
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Affiliation(s)
- Philippe Terrier
- Haute Ecole Arc Santé, HES-SO University of Applied Sciences and Arts Western Switzerland, Neuchâtel, Switzerland.,Clinique romande de réadaptation SUVA, Sion, Switzerland.,Department of Thoracic and Endocrine Surgery, University Hospitals of Geneva, Geneva, Switzerland
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18
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Martínez-Carbonell Guillamón E, Burgess L, Immins T, Martínez-Almagro Andreo A, Wainwright TW. Does aquatic exercise improve commonly reported predisposing risk factors to falls within the elderly? A systematic review. BMC Geriatr 2019; 19:52. [PMID: 30795740 PMCID: PMC6387499 DOI: 10.1186/s12877-019-1065-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 02/13/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND According to the World Health Organization, the elderly are at the highest risk of injury or death from a fall. Age-related changes in strength, balance and flexibility are degenerative factors that may increase the risk of falling, and an aquatic training may offer a favourable environment to improve these modifiable risk factors. METHODS A systematic review was conducted to assess the potential preventative role of aquatic exercise for reducing the risk of falls in the elderly by improving predisposing risk factors. Electronic databases and reference lists of pertinent articles published between 2005 and 2018 were searched. Randomized controlled trials (RCTs) that directly or indirectly addressed the effect of aquatic exercise for the prevention of falls in healthy participants were included within the synthesis. Studies were included if they were reported between January 2005 and May 2018 within a population aged between 60 and 90 years old that were without exercise-effecting comorbidities. Data related to participant demographics, study design, methodology, interventions and outcomes was extracted by one reviewer. Methodological quality assessment was independently performed by two reviewers using the PEDro (Physiotherapy Evidence Database) scale. RESULTS Fourteen trials met the inclusion criteria. Exercise intervention duration and frequency varied from 2 to 24 weeks, from 2 to 3 times per week, from 40 to 90 min per session. Fall rate was not reported in any of the studies analysed. However, aquatic exercise improved key predisposing physical fitness components that are modifiable and internal risk factors for falling. CONCLUSIONS There is limited, low-quality evidence to support the use of aquatic exercise for improving physiological components that are risk factors for falling. Although the evidence is limited, and many interventions are not well described, these results should be considered by health and exercise professionals when making evidence-based, clinical decisions regarding training programmes to reduce the risk of falling.
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Affiliation(s)
- Eduardo Martínez-Carbonell Guillamón
- Faculty of Health Science, Catholic University of Murcia, UCAM, Av. de los Jerónimos, 135, Guadalupe, 30107 Murcia, Spain
- Orthopaedic Research Institute, Bournemouth University, 6th Floor, Executive Business Centre, 89 Holdenhurst Road, Bournemouth, BH8 8EB UK
| | - Louise Burgess
- Orthopaedic Research Institute, Bournemouth University, 6th Floor, Executive Business Centre, 89 Holdenhurst Road, Bournemouth, BH8 8EB UK
| | - Tikki Immins
- Orthopaedic Research Institute, Bournemouth University, 6th Floor, Executive Business Centre, 89 Holdenhurst Road, Bournemouth, BH8 8EB UK
| | - Andrés Martínez-Almagro Andreo
- Faculty of Health Science, Catholic University of Murcia, UCAM, Av. de los Jerónimos, 135, Guadalupe, 30107 Murcia, Spain
| | - Thomas W. Wainwright
- Orthopaedic Research Institute, Bournemouth University, 6th Floor, Executive Business Centre, 89 Holdenhurst Road, Bournemouth, BH8 8EB UK
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19
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Yang NP, Hsu NW, Lin CH, Chen HC, Tsao HM, Lo SS, Chou P. Relationship between muscle strength and fall episodes among the elderly: the Yilan study, Taiwan. BMC Geriatr 2018; 18:90. [PMID: 29653515 PMCID: PMC5899404 DOI: 10.1186/s12877-018-0779-2] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Accepted: 04/03/2018] [Indexed: 11/24/2022] Open
Abstract
Background Fall episodes are not unusual among community residents, especially the elderly, and lower muscle strength is an important issue to address in order to prevent falls. Methods A community health survey was conducted in a suburban area of Taiwan, and 1067 older adults were selected for enrollment in the present study. All the enrolled subjects had been visited at their homes; the subjects’ strength of both hands and muscle mass of both legs were measured and well-established questionnaires were finished by certificated paramedic staffs. Results The incidence of fall episodes in the previous 1 year in the Yilan elderly population was 15.1%, and the female predominance was significant. A significantly higher prevalence of cataracts was found in group who experienced a fall in the past year (64% vs. 54.9% in the non-fall group). Mild or more severe dementia was much more prevalent in the group who experienced a recent fall (33.8% vs. 25.7% in the non-fall group). The strength of both hands tested as the physical function was 17.6 ± 8.0 kg in the recent fall group, significantly weaker than that in the non-fall group (20.7 ± 8.7 kg). Multivariate regression analysis revealed a greater weekly exercise duration and greater strength of both hands reduced the occurrence of falls among the whole and the female population. The standardized effect sizes of hand grip strength between both groups, not trivial, were 0.29 and 0.37 for the total population and the female subpopulation respectively. Conclusions Less weekly exercise duration and weaker muscle strength were f ound to be independent risk factors of fall episode(s) in an elderly Taiwanese population, especially in the female sub-population. Muscle strength, measured by average of both hands grip strength, was the most significantly factor of one-year fall episode(s) accessed retrospectively.
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Affiliation(s)
- Nan-Ping Yang
- Community Medicine Research Center & Institute of Public Health, National Yang-Ming University, No.155, Sec.2, Linong Street, Taipei, 112, Taiwan, Republic of China. .,Department of Orthopedics & Surgery, Keelung Hospital, Ministry of Health & Welfare, Keelung, Taiwan.
| | - Nai-Wei Hsu
- Community Medicine Research Center & Institute of Public Health, National Yang-Ming University, No.155, Sec.2, Linong Street, Taipei, 112, Taiwan, Republic of China.,Department of Intern Medicines, National Yang-Ming University Hospital, Yilan, Taiwan
| | - Ching-Heng Lin
- Community Medicine Research Center & Institute of Public Health, National Yang-Ming University, No.155, Sec.2, Linong Street, Taipei, 112, Taiwan, Republic of China.,Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Hsi-Chung Chen
- Community Medicine Research Center & Institute of Public Health, National Yang-Ming University, No.155, Sec.2, Linong Street, Taipei, 112, Taiwan, Republic of China.,Department of Psychiatry & Center of Sleep Disorders, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsuan-Ming Tsao
- Community Medicine Research Center & Institute of Public Health, National Yang-Ming University, No.155, Sec.2, Linong Street, Taipei, 112, Taiwan, Republic of China.,Department of Intern Medicines, National Yang-Ming University Hospital, Yilan, Taiwan
| | - Su-Shun Lo
- Community Medicine Research Center & Institute of Public Health, National Yang-Ming University, No.155, Sec.2, Linong Street, Taipei, 112, Taiwan, Republic of China.,Department of Surgery, National Yang-Ming University Hospital, Yilan, Taiwan
| | - Pesus Chou
- Community Medicine Research Center & Institute of Public Health, National Yang-Ming University, No.155, Sec.2, Linong Street, Taipei, 112, Taiwan, Republic of China.
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