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Nadkarni AN, Mukamal KJ, Zhu X, Siscovick D, Brach JS, Jacob M, Seshadri S, Abe T, Rosano C, Djousse L, Rosso AL. Associations of Neurological Biomarkers in Serum With Gait Measures: The Cardiovascular Health Study. J Gerontol A Biol Sci Med Sci 2024; 79:glae043. [PMID: 38334311 PMCID: PMC11005783 DOI: 10.1093/gerona/glae043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Gait impairment leads to increased mobility decline and may have neurological contributions. This study explores how neurological biomarkers are related to gait in older adults. METHODS We studied participants in the Cardiovascular Health Study, a population-based cohort of older Americans, who underwent a serum biomarker assessment from samples collected in 1996-1997 for neurofilament light chain (NfL), glial fibrillary acidic protein, ubiquitin carboxy-terminal hydrolase L1, and total tau (n = 1 959, mean age = 78.0 years, 60.8% female). In a subsample (n = 380), cross-sectional associations with quantitative gait measures were explored. This subsample was assessed on a mat for gait speed, step length, double support time, step time, step length variability, and step time variability. Gait speed was also measured over a 15-ft walkway annually from 1996-1997 to 1998-1999 for longitudinal analyses. Linear regression models assessed cross-sectional associations of biomarkers with gait measures, whereas mixed effects models assessed longitudinal gait speed change from baseline to 1998-1999. RESULTS Neurofilament light chain was significantly associated with annual gait speed decline (standardized β = -0.64 m/s, 95% CI: [-1.23, -0.06]) after adjustment for demographic and health factors. Among gait mat-assessed phenotypes, NfL was also cross-sectionally associated with gait speed (β = 0.001 m/s [0.0003, 0.002]) but not with other gait measures. None of the remaining biomarkers were significantly related to gait in either longitudinal or cross-sectional analyses. CONCLUSIONS Higher NfL levels were related to greater annual gait speed decline. Gait speed decline may be related to axonal degeneration. The clinical utility of NfL should be explored.
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Affiliation(s)
- Abhijay N Nadkarni
- School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Xiaonan Zhu
- School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Jennifer S Brach
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mini Jacob
- University of Washington School of Medicine, Seattle, Washington, USA
| | - Sudha Seshadri
- University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Temidayo Abe
- Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Caterina Rosano
- School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Luc Djousse
- Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Andrea L Rosso
- School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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2
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Rosso AL, Baillargeon EM, Perera S, VanSwearingen J, Rosano C, Huppert TJ, Brach JS. Prefrontal cortex activation while walking did not change but gait speed improved after a randomized physical therapy intervention. Aging Clin Exp Res 2024; 36:43. [PMID: 38367207 PMCID: PMC10874329 DOI: 10.1007/s40520-023-02666-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 11/21/2023] [Indexed: 02/19/2024]
Abstract
BACKGROUND Higher prefrontal cortex (PFC) activation while walking may indicate reduced gait automaticity. AIM We examine whether PFC activation during walking improves after training in older adults at risk for mobility disability. METHODS Forty-two adults aged ≥ 65 participated in a randomized clinical trial (NCT026637780) of a 12-week timing and coordination physical therapy intervention to improve walking (n = 20 intervention, n = 22 active control). PFC activation was measured by functional near-infrared spectroscopy (fNIRS) during four walking tasks over 15 m, each repeated 4 times: even surface walking, uneven surface walking, even dual-task, uneven dual-task; dual-task was reciting every other letter of the alphabet while walking. Gait speed and rate of correct letter generation were recorded. Linear mixed models tested between arm differences in change of fNIRS, gait speed, and letter generation from baseline to follow-up (12-week, 24-week, and 36-week). RESULTS Intervention arms were similar in mean age (74.3 vs. 77.0) and baseline gait speed (0.96 vs. 0.93 m/s). Of 24 comparisons of between arm differences in the fNIRS signals, only two were significant which were not supported by differences at other follow-up times or on other tasks. Gait speed, particularly during dual-task conditions, and correct letter generation did improve post-intervention but improvements did not differ by arm. DISCUSSION AND CONCLUSIONS After training, PFC activation during walking generally did not improve and did not differ by intervention arm. Improvements in gait speed without increased PFC activation may point toward more efficient neural control of walking.
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Affiliation(s)
- Andrea L Rosso
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Emma M Baillargeon
- Division of Geriatric Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Subashan Perera
- Division of Geriatric Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Caterina Rosano
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Theodore J Huppert
- Department of Electrical and Computer Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jennifer S Brach
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
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3
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Suri A, Hubbard ZL, VanSwearingen J, Torres-Oviedo G, Brach JS, Redfern MS, Sejdic E, Rosso AL. Fear of falling in community-dwelling older adults: What their gait acceleration pattern reveals. Comput Methods Programs Biomed 2024; 244:108001. [PMID: 38199138 DOI: 10.1016/j.cmpb.2023.108001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 12/08/2023] [Accepted: 12/26/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Fear of Falling (FOF) is common among community-dwelling older adults and is associated with increased fall-risk, reduced activity, and gait modifications. OBJECTIVE In this cross-sectional study, we examined the relationships between FOF and gait quality. METHODS Older adults (N=232; age 77±6; 65 % females) reported FOF by a single yes/no question. Gait quality was quantified as (1) harmonic ratio (smoothness) and other time-frequency spatiotemporal variables from triaxial accelerometry (Vertical-V, Mediolateral-ML, Anterior-Posterior -AP) during six-minute walk; (2) gait speed, step-time CoV (variability), and walk-ratio (step-length/cadence) on a 4-m instrumented walkway. Mann Whitney U-tests and Random forest classifier compared gait between those with and without FOF. Selected gait variables were used to build Support Vector Machine (SVM) classifier and performance was evaluated using AUC-ROC. RESULTS Individuals with FOF had slower gait speed (103.66 ± 17.09 vs. 110.07 ± 14.83 cm/s), greater step time CoV (4.17 ± 1.66 vs. 3.72 ± 1.24 %), smaller walk-ratio (0.53 ± 0.08 vs. 0.56 ± 0.07 cm/steps/minute), smaller standard deviation V (0.15 ± 0.06 vs. 0.18 ± 0.09 m/s2), and smaller harmonic-ratio V (2.14 ± 0.73 vs. 2.38 ± 0.58), all p<.01. Linear SVM yielded an AUC-ROC of 67 % on test dataset, coefficient values being gait speed (-0.19), standard deviation V (-0.23), walk-ratio (-0.36), and smoothness V (-0.38) describing associations with presence of FOF. CONCLUSION Older adults with FOF have reduced gait speed, acceleration adaptability, walk-ratio, and smoothness. Disrupted gait patterns during fear of falling could provide insights into psychosocial distress in older adults. Longitudinal studies are warranted.
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Affiliation(s)
- Anisha Suri
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Zachary L Hubbard
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jessie VanSwearingen
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Gelsy Torres-Oviedo
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jennifer S Brach
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mark S Redfern
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ervin Sejdic
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Department of Electrical and Computer Engineering, University of Toronto, Toronto, Ontario, Canada; North York General Hospital, Toronto, Ontario, Canada
| | - Andrea L Rosso
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
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Coyle P, Tripken J, Perera S, Juarez GA, Spencer-Brown L, Cameron K, Brach JS. Dissemination and implementation of evidence-based programs for people with chronic disease: the impact of the COVID-19 pandemic. Front Public Health 2024; 11:1276387. [PMID: 38274541 PMCID: PMC10808618 DOI: 10.3389/fpubh.2023.1276387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 12/15/2023] [Indexed: 01/27/2024] Open
Abstract
Background Using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework, we describe the implementation of evidence-based chronic disease self-management education (CDSME) programs by the Administration for Community Living CDSME Grantees during 2016-2022 and we also explore the impact of the COVID-19 pandemic on implementation. Methods Grantees collected data before and after the implementation of the CDSME programs and contributed to the national data repository. Data components included workshop information, participant information, and organizational data. Results The cohort consisted of 175,973 individuals who participated in 34 CDSME programs across 45 states. Participants had a mean ± SD age of 66.1 ± 14.8 years, were primarily female (65.9%) and had a mean ± SD of 2.6 ± 2.3 chronic conditions. Compared to the pre-COVID-19 strata, those who participated during COVID-19 were on average 1.5 years younger and had slightly less comorbidities. For individuals who had pre and post program self-reported health, 65.3% stayed the same, 24.4% improved, and 10.3% worsened (p < 0.001) after participating in CDSME programs. Conclusion CDSME offers a variety of programs across a broad geographic area to a diverse set of older adults in the US, underscoring the expansive reach of this public health initiative. COVID-19 appears to have shifted participant reach toward a slightly younger and healthier population. Finally, these programs appear to be effective in improving participants' self-rated health. However, these results should be interpreted with caution, given limitations due to missing data and the observational nature of this study design.
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Affiliation(s)
- Peter Coyle
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, United States
| | - Jennifer Tripken
- National Council on Aging Center for Healthy Aging, Arlington, VA, United States
| | - Subashan Perera
- Department of Medicine and Biostatistics, University of Pittsburgh, Pittsburgh, PA, United States
| | - Gardenia A. Juarez
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, United States
| | | | - Kathleen Cameron
- National Council on Aging Center for Healthy Aging, Arlington, VA, United States
| | - Jennifer S. Brach
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, United States
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Suri A, VanSwearingen J, Baillargeon EM, Crane BM, Moored KD, Carlson MC, Dunlap PM, Donahue PT, Redfern MS, Brach JS, Sejdic E, Rosso AL. Association of Gait Quality With Daily-Life Mobility: An Actigraphy and Global Positioning System Based Analysis in Older Adults. IEEE Trans Biomed Eng 2024; 71:130-138. [PMID: 37428666 PMCID: PMC10792545 DOI: 10.1109/tbme.2023.3293752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Abstract
OBJECTIVE Walking is a key component of daily-life mobility. We examined associations between laboratory-measured gait quality and daily-life mobility through Actigraphy and Global Positioning System (GPS). We also assessed the relationship between two modalities of daily-life mobility i.e., Actigraphy and GPS. METHODS In community-dwelling older adults (N = 121, age = 77±5 years, 70% female, 90% white), we obtained gait quality from a 4-m instrumented walkway (gait speed, walk-ratio, variability) and accelerometry during 6-Minute Walk (adaptability, similarity, smoothness, power, and regularity). Physical activity measures of step-count and intensity were captured from an Actigraph. Time out-of-home, vehicular time, activity-space, and circularity were quantified using GPS. Partial Spearman correlations between laboratory gait quality and daily-life mobility were calculated. Linear regression was used to model step-count as a function of gait quality. ANCOVA and Tukey analysis compared GPS measures across activity groups [high, medium, low] based on step-count. Age, BMI, and sex were used as covariates. RESULTS Greater gait speed, adaptability, smoothness, power, and lower regularity were associated with higher step-counts (0.20<|ρp| < 0.26, p < .05). Age(β = -0.37), BMI(β = -0.30), speed(β = 0.14), adaptability(β = 0.20), and power(β = 0.18), explained 41.2% variance in step-count. Gait characteristics were not related to GPS measures. Participants with high (>4800 steps) compared to low activity (steps<3100) spent more time out-of-home (23 vs 15%), more vehicular travel (66 vs 38 minutes), and larger activity-space (5.18 vs 1.88 km2), all p < .05. CONCLUSIONS Gait quality beyond speed contributes to physical activity. Physical activity and GPS-derived measures capture distinct aspects of daily-life mobility. Wearable-derived measures should be considered in gait and mobility-related interventions.
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Dunlap PM, Crane BM, Perera S, Moored KD, Carlson MC, Brach JS, Klatt BN, Rosso AL. Global Positioning System Indicators of Community Mobility and Future Health Outcomes Among Older Adults. J Gerontol A Biol Sci Med Sci 2024; 79:glad209. [PMID: 37725132 PMCID: PMC10733187 DOI: 10.1093/gerona/glad209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND We examined the relationship between global positioning system (GPS) indicators of community mobility and incident hospitalizations, emergency department (ED) visits, and falls over 1-year in community-dwelling older adults. METHODS We performed a secondary analysis of a randomized trial investigating a physical therapy intervention to improve mobility in older adults. One hundred and forty-eight participants (mean age: 76.9 ± 6.2 years; 65% female) carried a GPS device following the postintervention visit. Over 1-year, new hospitalizations, falls, and ED visits were reported. GPS indicators of community mobility included the median area and compactness of the standard deviation ellipse (SDE), the median percentage of time spent outside of home (TOH), and median maximum distance from home. Generalized linear models assessed the association between 1-year risk of outcomes and GPS measures adjusted for age, race, gender, body mass index, comorbidity burden, and fall history. RESULTS The mean ± standard deviation of the median SDE area was 4.4 ± 8.5 km2, median SDE compactness 0.7 ± 0.2, median percentage TOH 14.4 ± 12.0%, and median maximum distance from home was 38 ± 253 km. Each 5% increase in median percentage TOH was associated with a 24% lower risk of hospitalization (incident rate ratio = IRR = 0.76, 95%CI: 0.61-0.95; p = .01). The association persisted after covariate adjustment (IRR = 0.78, 95%CI: 0.63-0.98; p = .03). No significant associations appeared for any GPS indicators with incident falls or ED visits. CONCLUSIONS Increased TOH was associated with a lower risk of incident hospitalization over 1 year among community-dwelling older adults. Restricted community mobility may be an indicator of activity limitations related to future health outcomes, but further study is warranted.
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Affiliation(s)
- Pamela M Dunlap
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Breanna M Crane
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Subashan Perera
- Division of Geriatric Medicine and Department of Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kyle D Moored
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Michelle C Carlson
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jennifer S Brach
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Brooke N Klatt
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Andrea L Rosso
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Brach JS, Schrodt LA, Vincenzo JL, Perera S, Hergott C, Sidelinker J, Rohrer B, Tripken J, Shubert TE. Knowledge and Use of Evidence-Based Programs for Older Adults in the Community: A Survey of Physical Therapy Professionals. J Geriatr Phys Ther 2023; 46:196-206. [PMID: 35947486 PMCID: PMC9911552 DOI: 10.1519/jpt.0000000000000359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE The Agency for Healthcare Research and Quality highlights the need for sustainable linkages between clinical and community settings to enhance prevention and improve care of people with chronic conditions. The first step in promoting linkages is understanding the knowledge and use of evidence-based programs by physical therapy (PT) professionals. Therefore, the objective of this study was to describe the knowledge of and referral to evidence-based programs in the community by a convenience sample of PT professionals and to examine the characteristics of those who refer to evidence-based programs. METHODS A cross-sectional web-based survey containing 36 questions regarding respondents' demographics and evidence-based program knowledge and referral practices was disseminated to a convenience sample of PT professionals via email, news-blasts, social media, and word of mouth. RESULTS AND DISCUSSION A total of 459 PT professionals completed the survey. Approximately half reported practicing for more than 20 years and 75% are members of the American Physical Therapy Association (APTA). The majority (74%) are aware of evidence-based programs; however, fewer (56%) refer to these programs. Compared with individuals who do not refer to evidence-based programs, individuals who refer are more likely to be involved in PT organizations and be an APTA Geriatrics member. Of the individuals who do not refer to evidence-based programs, 21.5% reported not knowing they existed and 33% reported not knowing where the programs are located. CONCLUSIONS Most survey respondents reported knowing about evidence-based programs and more than half reported being aware of the evidence-based programs available in their communities. These results indicate many PT professionals already have a knowledge of evidence-based programs to support clinic-community linkages. As survey respondents were a sample of convenience and likely do not represent all PT professionals in the United States, the results should be interpreted with caution. Additional research on a more representative sample is needed to fully understand the current utilization of evidence-based programs, which will enable us to design efforts to improve the clinic to community transition. Improving linkages between PT professionals and community resources has the potential to benefit both patients and clinicians and lessen the burden on the health care system.
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Affiliation(s)
- Jennifer S Brach
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Lori A Schrodt
- Department of Physical Therapy, Western Carolina University, Cullowhee, North Carolina
| | - Jennifer L Vincenzo
- Department of Physical Therapy, University of Arkansas for Medical Sciences, Fayetteville
| | - Subashan Perera
- Division of Geriatric Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Colleen Hergott
- Department of Physical Therapy, Augusta University, Augusta, Georgia
| | | | | | - Jennifer Tripken
- Center for Healthy Aging, National Council on Aging, Washington, District of Columbia
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Suri A, VanSwearingen J, Rosano C, Brach JS, Redfern MS, Sejdić E, Rosso AL. Uneven surface and cognitive dual-task independently affect gait quality in older adults. Gait Posture 2023; 106:34-41. [PMID: 37647710 PMCID: PMC10591986 DOI: 10.1016/j.gaitpost.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 07/07/2023] [Accepted: 08/21/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Real-world mobility involves walking in challenging conditions. Assessing gait during simultaneous physical and cognitive challenges provides insights on cognitive health. RESEARCH QUESTION How does uneven surface, cognitive task, and their combination affect gait quality and does this gait performance relate to cognitive functioning? METHODS Community-dwelling older adults (N = 104, age=75 ± 6 years, 60 % females) performed dual-task walking paradigms (even and uneven surface; with and without alphabeting cognitive task (ABC)) to mimic real-world demands. Gait quality measures [speed(m/s), rhythmicity(steps/minute), stride time variability (%), adaptability (m/s2), similarity, smoothness, power (Hz) and regularity] were calculated from an accelerometer worn on the lower back. Linear-mixed modelling and Tukey analysis were used to analyze independent effects of surface and cognitive task and their interaction on gait quality. Partial Spearman correlations compared gait quality with global cognition and executive function. RESULTS No interaction effects between surface and cognitive task were found. Uneven surface reduced gait speed(m/s) (β = -0.07). Adjusted for speed, uneven surface reduced gait smoothness (β = -0.27) and increased regularity (β = 0.09), Tukey p < .05, for even vs uneven and even-ABC vs uneven-ABC. Cognitive task reduced gait speed(m/s) (β = -0.12). Adjusted for speed, cognitive task increased variability (β = 7.60), reduced rhythmicity (β = -6.68) and increased regularity (β = 0.05), Tukey p < .05, for even vs even-ABC and uneven vs uneven-ABC. With demographics as covariates, gait speed was not associated with cognition. Gait quality [lower variability during even-ABC (ρp =-.31) and uneven-ABC (ρp =-.28); greater rhythmicity (ρp between.22 and.29) and greater signal-adaptability AP (ρp between.22 and.26) during all walking tasks] was associated with better global cognition. Gait adaptability during even (ρp =-0.21, p = 0.03) and uneven(ρp =-0.19, p = 0.04) walking was associated with executive function. SIGNIFICANCE Surface and cognitive walking tasks independently affected gait quality. Our study with high-functioning older adults suggests that task-related changes in gait quality are related to subtle changes in cognitive functioning.
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Affiliation(s)
- Anisha Suri
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, PA, USA
| | - Jessie VanSwearingen
- Department of Physical Therapy, School of Rehabilitation Sciences, University of Pittsburgh, PA, USA
| | - Caterina Rosano
- Department of Epidemiology, School of Public Health, University of Pittsburgh, PA, USA
| | - Jennifer S Brach
- Department of Physical Therapy, School of Rehabilitation Sciences, University of Pittsburgh, PA, USA
| | - Mark S Redfern
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, PA, USA
| | - Ervin Sejdić
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, PA, USA; The Edward S. Rogers Department of Electrical and Computer Engineering, University of Toronto, Toronto, ON, Canada; North York General Hospital, Toronto, ON, Canada
| | - Andrea L Rosso
- Department of Epidemiology, School of Public Health, University of Pittsburgh, PA, USA.
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Dunlap PM, Crane BM, Perera S, Moored KD, Carlson MC, Brach JS, Klatt BN, Rosso AL. Effects of a Physical Therapist Intervention on GPS Indicators of Community Mobility in Older Adults: A Secondary Analysis of a Randomized Controlled Trial. Phys Ther 2023; 103:pzad071. [PMID: 37364044 PMCID: PMC10471202 DOI: 10.1093/ptj/pzad071] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 12/22/2022] [Accepted: 05/04/2023] [Indexed: 06/28/2023]
Abstract
OBJECTIVE The authors compared the effects of a standard strength and endurance intervention with a standard plus timing and coordination training intervention on community mobility measured using global positioning systems (GPS) among community-dwelling older adults in this secondary analysis of a randomized controlled trial. METHODS Participants were randomized to a standard or a standard plus timing and coordination training program. Community mobility was measured using the Life Space Assessment (LSA) and GPS indicators of community mobility at baseline, as well as at 12 (immediately after the intervention), 24, and 36 weeks. Linear mixed models were used for analysis. RESULTS There were 166 participants with GPS data at baseline, including 81 in the standard plus group and 85 in the standard group. The groups did not differ in participant characteristics or GPS measures at baseline. There were no significant within-group changes in GPS indicators of community mobility or LSA score over time, nor between-group differences of the same. CONCLUSION There were no significant changes in community mobility with either intervention or between-intervention differences. These findings suggest that interventions targeting physical function alone may not be sufficient to improve community mobility or participation in older adults. Future research should focus on the development of multifaceted interventions targeted to improve real-world participation. IMPACT The studied interventions did not significantly change community mobility measured using GPS-derived community mobility measures or self-report measures in older adults, suggesting that more comprehensive interventions may be needed to target improvements in community mobility.
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Affiliation(s)
- Pamela M Dunlap
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Breanna M Crane
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Subashan Perera
- Division of Geriatric Medicine and Department of Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kyle D Moored
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Michelle C Carlson
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Jennifer S Brach
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Brooke N Klatt
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Andrea L Rosso
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Hortobágyi T, Vetrovsky T, Brach JS, van Haren M, Volesky K, Radaelli R, Lopez P, Granacher U. Effects of Exercise Training on Muscle Quality in Older Individuals: A Systematic Scoping Review with Meta-Analyses. Sports Med Open 2023; 9:41. [PMID: 37278947 DOI: 10.1186/s40798-023-00585-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 05/21/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND The quantity and quality of skeletal muscle are important determinants of daily function and metabolic health. Various forms of physical exercise can improve muscle function, but this effect can be inconsistent and has not been systematically examined across the health-neurological disease continuum. The purpose of this systematic scoping review with meta-analyses was to determine the effects and potential moderators of exercise training on morphological and neuromuscular muscle quality (MMQ, NMQ) in healthy older individuals. In addition and in the form of a scoping review, we examined the effects of exercise training on NMQ and MMQ in individuals with neurological conditions. METHODS A systematic literature search was performed in the electronic databases Medline, Embase, and Web of Science. Randomized controlled trials were included that examined the effects of exercise training on muscle quality (MQ) in older individuals with and without neurological conditions. Risk of bias and study quality were assessed (Cochrane Risk of Bias Tool 2.0). We performed random-effects models using robust variance estimation and tested moderators using the approximate Hotelling-Zhang test. RESULTS Thirty studies (n = 1494, 34% females) in healthy older individuals and no studies in individuals with neurological conditions were eligible for inclusion. Exercise training had small effects on MMQ (g = 0.21, 95% confidence interval [CI]: 0.03-0.40, p = 0.029). Heterogeneity was low (median I2 = 16%). Training and demographic variables did not moderate the effects of exercise on MMQ. There was no association between changes in MMQ and changes in functional outcomes. Exercise training improved NMQ (g = 0.68, 95% CI 0.35-1.01, p < 0.000) across all studies, in particular in higher-functioning older individuals (g = 0.72, 95% CI 0.38-1.06, p < 0.001), in lower extremity muscles (g = 0.74, 95% CI 0.35-1.13, p = 0.001), and after resistance training (g = 0.91; 95% CI 0.42-1.41, p = 0.001). Heterogeneity was very high (median I2 = 79%). Of the training and demographic variables, only resistance training moderated the exercise-effects on NMQ. High- versus low-intensity exercise moderated the exercise-effects on NMQ, but these effects were considered unreliable due to a low number of studies at high intensity. There was no association between changes in NMQ and changes in functional outcomes. CONCLUSION Exercise training has small effects on MMQ and medium-large effects on NMQ in healthy older individuals. There was no association between improvements in MQ and increases in muscle strength, mobility, and balance. Information on dose-response relations following training is currently lacking. There is a critical gap in muscle quality data for older individuals with lower function and neurological conditions after exercise training. Health practitioners should use resistance training to improve muscle function in older individuals. Well-designed studies are needed to examine the relevance of exercise training-induced changes in MQ in daily function in older individuals, especially to those with lower function and neurological conditions.
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Affiliation(s)
- Tibor Hortobágyi
- Department of Kinesiology, Hungarian University of Sports Science, Budapest, Hungary
- Institute of Sport Sciences and Physical Education, University of Pécs, Pecs, Hungary
- Somogy County Kaposi Mór Teaching Hospital, Kaposvár, Hungary
- Center for Human Movement Sciences, University of Groningen Medical Center, Groningen, The Netherlands
- Institute of Sport Research, Sports University of Tirana, Tirana, Albania
| | - Tomas Vetrovsky
- Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Jennifer S Brach
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Martijn van Haren
- Center for Human Movement Sciences, University of Groningen Medical Center, Groningen, The Netherlands
| | - Krystof Volesky
- Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Regis Radaelli
- Faculty of Human Kinetics, CIPER, University of Lisboa, Cruz Quebrada, Dafundo, Portugal
| | - Pedro Lopez
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Urs Granacher
- Department of Sport and Sport Science, Exercise and Human Movement Science, University of Freiburg, Freiburg, Germany.
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Vincenzo JL, Brach JS, Bean J, Curran GM. Developing and Testing Implementation Strategies to support the Centers for Disease Control and Prevention's Initiative for Falls Risk Management in Outpatient Physical Therapy: A Protocol. Arch Rehabil Res Clin Transl 2023; 5:100268. [PMID: 37312984 PMCID: PMC10258383 DOI: 10.1016/j.arrct.2023.100268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
Abstract
Objectives To develop and test implementation strategies to support implementing the Centers for Disease Control and Preventions' Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative for falls prevention and falls risk management in a novel setting, outpatient physical therapy. Design A feasibility implementation study engaging key partners involved in or affected by the implementation throughout the study. Setting Five outpatient physical therapy clinics embedded in a health system. Participants Key partners (physical therapists, physical therapist assistants, referring physicians, administrative clinic staff, older adults, and caregivers) involved in or affected by the implementation (N=48) will participate in surveys and interviews to identify barriers and facilitators prior to implementation and post implementation. Twelve key partners representing at least 1 of each group will participate in evidence-based quality improvement panels to identify which barriers and facilitators are most important and feasible to address and to assist in choosing and designing implementation strategies to support the uptake of STEADI in outpatient rehabilitation. STEADI will be implemented in 5 outpatient physical therapy clinics as a standard of care for the ∼1200 older adults attending those clinics annually. Outcomes Primary outcomes include clinic- and provider-level (physical therapists and physical therapist assistant) adoption and fidelity to STEADI screening, multifactorial assessment, and falls risk interventions for older adults (65 years or older) attending outpatient physical therapy. Key partners' perceived feasibility, acceptability, and appropriateness of STEADI in outpatient physical therapy will also be measured using validated implementation science questionnaires. Exploratory clinical outcomes of older adults' falls risk pre- and post rehabilitation will be investigated.
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Affiliation(s)
- Jennifer L. Vincenzo
- Department of Physical Therapy, University of Arkansas for Medical Sciences, Fayetteville, Arkansas
| | - Jennifer S. Brach
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jonathan Bean
- New England Geriatric Research, Education and Clinical Center, VA Boston Healthcare System, Boston, Massachusetts
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Cambridge, Massachusetts
| | - Geoffrey M. Curran
- Center for Implementation Research, University of Arkansas for Medical Sciences, Little Rock, Arkansas
- Department of Pharmacy Practice, University of Arkansas for Medical Sciences, Little Rock, Arkansas
- Central Arkansas Veterans Healthcare System, Little Rock, Arkansas
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12
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Shuman V, Brach JS, Bean JF, Freburger JK. Prevalence and Predictors of Ambulatory Care Physicians' Documentation of Mobility Limitations in Older Adults. Arch Phys Med Rehabil 2023; 104:719-727. [PMID: 36731767 PMCID: PMC10164109 DOI: 10.1016/j.apmr.2022.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/15/2022] [Accepted: 11/21/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine how often physicians document mobility limitations in visits with older adults, and which patient, physician, and practice characteristics associate with documented mobility limitations. DESIGN We completed a cross-sectional analysis of National Ambulatory Medical Care Surveys, years 2012-2016. Multivariate analyses were conducted to identify patient, physician, and practice-level factors associated with mobility limitation documentation. SETTING Ambulatory care visits. PARTICIPANTS We analyzed visits with adults 65 years and older. Final sample size represented 1.3 billion weighted visits. INTERVENTION Not applicable. MAIN OUTCOME MEASURE We defined the presence/absence of a mobility limitation by whether any International Classification of Diseases (ICD)-9 or ICD-10 code related to mobility limitations, injury codes, or the patient's "reasons for visit" were documented in the visits. RESULTS The overall prevalence of mobility limitation documentation was 2.4%. The most common codes were falls-related. Patient-level factors more likely to be associated with mobility limitation documentation were visits by individuals over 85 years of age, relative to 65-69 years, (odds ratio 2.32, 95% confidence interval 1.76-3.07]; with a comorbid diagnosis of arthritis (odds ratio 1.35, 1.18-2.01); and with a comorbid diagnosis of cerebrovascular disease (odds ratio 1.60, 1.13-2.26). Patient-level factors less likely to be associated with mobility limitation documentation were visits by men (odds ratio 0.80, 0.64-0.99); individuals with a cancer diagnosis (odds ratio 0.76, 0.58-0.99); and by individuals seeking care for a chronic problem (relative to a new problem [odds ratio 0.36, 0.29-0.44]). Physician-level factors associated with an increased likelihood of mobility limitation documentation were visits to neurologists (odds ratios 4.48, 2.41-8.32) and orthopedists (odds ratio 2.67, 1.49-4.79) compared with primary care physicians. At the practice-level, mobility documentation varied based on the percentage of practice revenue from Medicare. CONCLUSIONS Mobility limitations are under-documented and may be primarily captured when changes in function are overt.
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Affiliation(s)
- Valerie Shuman
- Department of Physical Therapy, School of Health and Rehabilitation Science, University of Pittsburgh, Pittsburgh, PA.
| | - Jennifer S Brach
- Department of Physical Therapy, School of Health and Rehabilitation Science, University of Pittsburgh, Pittsburgh, PA
| | - Jonathan F Bean
- New England Geriatric Research and Education Clinical Center (GRECC), VA Boston Healthcare System, Boston, MA; Department of PM&R, Harvard Medical School, Boston, MA; Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - Janet K Freburger
- Department of Physical Therapy, School of Health and Rehabilitation Science, University of Pittsburgh, Pittsburgh, PA
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13
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Sukoff Rizzo SJ, Finkel T, Greenspan SL, Resnick NM, Brach JS. Speaking the Same Language: Team Science Approaches in Aging Research for Integrating Basic and Translational Science With Clinical Practice. Innov Aging 2023; 7:igad035. [PMID: 37213324 PMCID: PMC10198772 DOI: 10.1093/geroni/igad035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Indexed: 05/23/2023] Open
Abstract
Research on aging is at an important inflection point, where the insights accumulated over the last 2 decades in the basic biology of aging are poised to be translated into new interventions to promote health span and improve longevity. Progress in the basic science of aging is increasingly influencing medical practice, and the application and translation of geroscience require seamless integration of basic, translational, and clinical researchers. This includes the identification of new biomarkers, novel molecular targets as potential therapeutic agents, and translational in vivo studies to assess the potential efficacy of new interventions. To facilitate the required dialog between basic, translational, and clinical investigators, a multidisciplinary approach is essential and requires the collaborative expertise of investigators spanning molecular and cellular biology, neuroscience, physiology, animal models, physiologic and metabolic processes, pharmacology, genetics, and high-throughput drug screening approaches. In an effort to better enable the cross-talk of investigators across the broad spectrum of aging-related research disciplines, a goal of our University of Pittsburgh Claude D. Pepper Older Americans Independence Center has been to reduce the barriers to collaborative interactions by promoting a common language through team science. The culmination of these efforts will ultimately accelerate the ability to conduct first-in-human clinical trials of novel agents to extend health span and life span.
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Affiliation(s)
- Stacey J Sukoff Rizzo
- Aging Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Pittsburgh Claude D. Pepper Older Americans Independence Center, Division of Geriatrics and Gerontology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Toren Finkel
- Aging Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Pittsburgh Claude D. Pepper Older Americans Independence Center, Division of Geriatrics and Gerontology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Susan L Greenspan
- Pittsburgh Claude D. Pepper Older Americans Independence Center, Division of Geriatrics and Gerontology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Neil M Resnick
- Pittsburgh Claude D. Pepper Older Americans Independence Center, Division of Geriatrics and Gerontology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jennifer S Brach
- Pittsburgh Claude D. Pepper Older Americans Independence Center, Division of Geriatrics and Gerontology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Boyer KA, Hayes KL, Umberger BR, Adamczyk PG, Bean JF, Brach JS, Clark BC, Clark DJ, Ferrucci L, Finley J, Franz JR, Golightly YM, Hortobágyi T, Hunter S, Narici M, Nicklas B, Roberts T, Sawicki G, Simonsick E, Kent JA. Age-related changes in gait biomechanics and their impact on the metabolic cost of walking: Report from a National Institute on Aging workshop. Exp Gerontol 2023; 173:112102. [PMID: 36693530 PMCID: PMC10008437 DOI: 10.1016/j.exger.2023.112102] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 01/09/2023] [Accepted: 01/19/2023] [Indexed: 01/22/2023]
Abstract
Changes in old age that contribute to the complex issue of an increased metabolic cost of walking (mass-specific energy cost per unit distance traveled) in older adults appear to center at least in part on changes in gait biomechanics. However, age-related changes in energy metabolism, neuromuscular function and connective tissue properties also likely contribute to this problem, of which the consequences are poor mobility and increased risk of inactivity-related disease and disability. The U.S. National Institute on Aging convened a workshop in September 2021 with an interdisciplinary group of scientists to address the gaps in research related to the mechanisms and consequences of changes in mobility in old age. The goal of the workshop was to identify promising ways to move the field forward toward improving gait performance, decreasing energy cost, and enhancing mobility for older adults. This report summarizes the workshop and brings multidisciplinary insight into the known and potential causes and consequences of age-related changes in gait biomechanics. We highlight how gait mechanics and energy cost change with aging, the potential neuromuscular mechanisms and role of connective tissue in these changes, and cutting-edge interventions and technologies that may be used to measure and improve gait and mobility in older adults. Key gaps in the literature that warrant targeted research in the future are identified and discussed.
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Affiliation(s)
- Katherine A Boyer
- Department of Kinesiology, University of Massachusetts Amherst, MA, USA; Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Medical School, Worcester, MA, USA.
| | - Kate L Hayes
- Department of Kinesiology, University of Massachusetts Amherst, MA, USA
| | | | | | - Jonathan F Bean
- New England GRECC, VA Boston Healthcare System, Boston, MA, USA; Department of PM&R, Harvard Medical School, Boston, MA, USA; Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - Jennifer S Brach
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Brian C Clark
- Ohio Musculoskeletal and Neurological Institute and the Department of Biomedical Sciences, Ohio University, Athens, OH, USA
| | - David J Clark
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, FL, USA; Department of Physiology and Aging, University of Florida, Gainesville, FL, USA
| | - Luigi Ferrucci
- Intramural Research Program of the National Institute on Aging, NIH, Baltimore, MD, USA
| | - James Finley
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Jason R Franz
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC, USA
| | - Yvonne M Golightly
- College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, USA; Thurston Arthritis Research Center, Division of Rheumatology, Allergy, and Immunology, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Tibor Hortobágyi
- Hungarian University of Sports Science, Department of Kinesiology, Budapest, Hungary; Institute of Sport Sciences and Physical Education, University of Pécs, Hungary; Somogy County Kaposi Mór Teaching Hospital, Kaposvár, Hungary; Center for Human Movement Sciences, University of Groningen Medical Center, Groningen, the Netherlands
| | - Sandra Hunter
- Department of Physical Therapy, Marquette University, Milwaukee, WI, USA
| | - Marco Narici
- Neuromuscular Physiology Laboratory, Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - Barbara Nicklas
- Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, USA
| | - Thomas Roberts
- Department of Ecology and Evolutionary Biology, Brown University, USA
| | - Gregory Sawicki
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, USA
| | - Eleanor Simonsick
- Intramural Research Program of the National Institute on Aging, NIH, Baltimore, MD, USA
| | - Jane A Kent
- Department of Kinesiology, University of Massachusetts Amherst, MA, USA
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15
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Harris RJ, Parimi N, Cawthon PM, Strotmeyer ES, Boudreau RM, Brach JS, Kwoh CK, Cauley JA. Response letter to "sarcopenia, osteoporosis and fractures: what we see". Osteoporos Int 2023; 34:427. [PMID: 36469084 DOI: 10.1007/s00198-022-06620-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 11/02/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Rebekah J Harris
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
- VA Boston Healthcare System, 150 South Huntington Ave, Boston, MA, 02130, USA.
| | - Neeta Parimi
- Research Institute, California Pacific Medical Center, San Francisco, CA, USA
| | - Peggy M Cawthon
- Research Institute, California Pacific Medical Center, San Francisco, CA, USA
| | - Elsa S Strotmeyer
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Robert M Boudreau
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jennifer S Brach
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - C Kent Kwoh
- Department of Medicine, University of Arizona, Tucson, AZ, USA
| | - Jane A Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
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16
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Harris R, Strotmeyer ES, Sharma L, Kwoh CK, Brach JS, Boudreau R, Cauley JA. The Association Between Severity of Radiographic Knee OA and Recurrent Falls in Middle and Older Aged Adults: The Osteoarthritis Initiative. J Gerontol A Biol Sci Med Sci 2023; 78:97-103. [PMID: 35184161 PMCID: PMC9879744 DOI: 10.1093/gerona/glac050] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Knee osteoarthritis (KOA) is the most prevalent type of OA and a leading cause of disability in the United States. Falls are a major public health concern in older adults. Our aim was to examine how the severity of radiographic KOA affects recurrent falls in a cohort of middle-aged and older individuals enrolled in the Osteoarthritis Initiative. METHODS About 3 972 participants, mean age of 63 years, 58% female were included. Participants were divided into 5 mutually exclusive groups based on their worst Kellgren-Lawrence grade of radiographic KOA from annual x-rays from baseline to 36 months. Generalized estimating equations for repeated logistic regression were used to model the association between KOA severity and the likelihood of recurrent falls (≥2 falls/year) over 5 years of follow-up (>36 to 96 months). RESULTS Older adults (≥age 65) with KOA were at higher odds of recurrent falls in comparison to individuals without KOA in multivariate models (possible OA odds ratio [OR] = 2.22, 95% CI = 1.09-4.52; mild OA OR = 2.48, 95% CI = 1.34-4.62; unilateral moderate-severe OA OR = 2.84, 95% CI = 1.47-5.50; bilateral moderate-severe OA OR = 2.52, 95% CI = 1.13-5.62). Middle-aged adults (aged 45-64) with KOA did not have increased odds of recurrent falls in comparison to those without KOA except for possible KOA (OR = 1.86, 95% CI = 1.01-2.78; KOA severity × Age interaction = 0.025). CONCLUSION Older adults with radiographic evidence of KOA have an increased likelihood of experiencing recurrent falls in comparison to those without KOA independent of established risk factors. Our results suggest that fall prevention efforts should include older adults with all stages of KOA.
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Affiliation(s)
- Rebekah Harris
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- VA Boston Healthcare System, Boston, MA, USA
| | - Elsa S Strotmeyer
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Leena Sharma
- Department of Medicine, Northwestern University, Chicago, Illinois, USA
| | - C Kent Kwoh
- Department of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Jennifer S Brach
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Robert Boudreau
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jane A Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Wingood M, Peters DM, Gell NM, Brach JS, Bean JF. Physical Activity and Physical Activity Participation Barriers Among Adults 50 Years and Older During the COVID-19 Pandemic. Am J Phys Med Rehabil 2022; 101:809-815. [PMID: 35473919 PMCID: PMC9377368 DOI: 10.1097/phm.0000000000002041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We examined changes in physical activity from pre-COVID-19 to during the COVID-19 pandemic and the factors associated with reduced physical activity levels among adults 50 yrs and older. DESIGN Participants of a validation study were stratified into being "less active than before" or "equally or more active than before" COVID-19. Multivariable manual backward analyses were used to identify self-reported barriers associated with the reduction in physical activity. RESULTS Reduced physical activity levels during COVID-19 were reported among 244 of 503 participants (43%). After adjusting for demographics and health conditions, factors that increased the odds of reduced physical activity levels during COVID-19 were lacking access to workout places, feeling too anxious, and difficulty committing to physical activity. Factors that decreased the odds of reduced physical activity levels during COVID-19 were self-identifying a heart- or lung-associated diagnosis that impacts physical activity and having a 12-mo retrospective history of falling. CONCLUSIONS The physical activity participation barriers identified to be associated with a reduction in physical activity can be used as a starting point for a conversation regarding physical activity participation during COVID-19. TO CLAIM CME CREDITS Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME. CME OBJECTIVES Upon completion of this article, the reader should be able to: (1) Describe the changes in physical activity levels among adults 50 yrs and older from pre-COVID-19 to during the COVID-19 pandemic; (2) Differentiate between the COVID-19 related factors associated with reduced physical activity levels among adults 50 yrs and older and younger adults; and (3) Identify the physical activity-related factor that decreased the odds of reduced physical activity levels during COVID-19 among adults 50 yrs and older. LEVEL Advanced. ACCREDITATION The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s) ™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
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Harris R, Brach JS, Moye J, Ogawa E, Ward R, Halasz I, Bean J. The Live Long Walk Strong Rehabilitation Program Study: Design and Methods. Arch Rehabil Res Clin Transl 2022; 4:100205. [PMID: 36123980 PMCID: PMC9482036 DOI: 10.1016/j.arrct.2022.100205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective To identify attributes targeted by rehabilitative treatment within which improvements lead to short- and long-term changes in mobility. Maintaining independence in mobility is important to many older adults and is associated with critical outcomes such as aging in place, morbidity, and mortality. Design The Live Long Walk Strong rehabilitation study is a phase 2 single-blind, randomized controlled trial. Setting Veterans Affairs Boston Healthcare System, outpatient physical therapy. Participants 198 community-dwelling middle- and older-aged veterans (aged 50 years and older) will be recruited from primary care practices (N=198). Interventions Comparing a moderate-vigorous intensity physical therapy program of 10 sessions with a waitlist control group. Main Outcome Measure The primary outcome measure is gait speed. Secondary outcomes include leg strength and power, trunk muscle endurance, gait smoothness, and exercise self-efficacy. Results Outcomes will be assessed within 2 weeks of intervention completion, at 8 weeks postintervention, and at 16 weeks postintervention. Two-sample t tests will compare mean change in gait speed and target attributes (leg power, trunk muscle endurance, gait smoothness, and exercise self-efficacy) between treatment and control groups. Paired t tests will examine within-person change at subsequent follow-up visits. Multivariable regression analyses will evaluate relationships between dependent and independent variables and potential mediation adjusting for relevant covariates. Conclusions Results of this study are expected to advance and refine the design of Live Long Walk Strong rehabilitative care and demonstrate its proof of concept and efficacy.
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Affiliation(s)
- Rebekah Harris
- New England Geriatric Research, Education and Clinical Center, VA Boston Healthcare System, Boston, MA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Cambridge, MA
| | - Jennifer S. Brach
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA
| | - Jennifer Moye
- New England Geriatric Research, Education and Clinical Center, VA Boston Healthcare System, Boston, MA
- Department of Psychiatry, VA Boston Healthcare System, Boston, MA
- Department of Psychiatry, Harvard Medical School, Cambridge, MA
| | - Elisa Ogawa
- New England Geriatric Research, Education and Clinical Center, VA Boston Healthcare System, Boston, MA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Cambridge, MA
| | - Rachel Ward
- New England Geriatric Research, Education and Clinical Center, VA Boston Healthcare System, Boston, MA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Cambridge, MA
- Massachusetts Veterans Epidemiology and Research Information Center, VA Boston Healthcare System, Boston, MA
| | - Ildiko Halasz
- Department of Medicine, VA Boston Healthcare System, Boston, MA
| | - Jonathan Bean
- New England Geriatric Research, Education and Clinical Center, VA Boston Healthcare System, Boston, MA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Cambridge, MA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA
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Harris RJ, Parimi N, Cawthon PM, Strotmeyer ES, Boudreau RM, Brach JS, Kwoh CK, Cauley JA. Associations of components of sarcopenia with risk of fracture in the Osteoporotic Fractures in Men (MrOS) study. Osteoporos Int 2022; 33:1815-1821. [PMID: 35380213 PMCID: PMC10011872 DOI: 10.1007/s00198-022-06390-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 03/28/2022] [Indexed: 10/18/2022]
Abstract
Our aim was to evaluate the associations between the individual components of sarcopenia and fracture types. In this cohort, the risk of experiencing any clinical, hip, or major osteoporotic fracture is greater in men with slow walking speed in comparison to normal walking speed. INTRODUCTION The association between the components of sarcopenia and fractures has not been clearly elucidated and has hindered the development of appropriate therapeutic interventions. Our aim was to evaluate the associations between the individual components of sarcopenia, specifically lean mass, strength, and physical performance and fracture (any fracture, hip fracture, major osteoporotic fracture) in the Osteoporotic Fractures in Men (MrOS) study. METHODS The Osteoporotic Fractures in Men study (MrOS) recruited 5995 men ≥ 65 years of age. We measured appendicular lean mass (ALM) by dual-energy X-ray absorptiometry (low as residual value < 20th percentile for the cohort), walking speed (fastest trial of usual pace, values < 0.8 m/s were low), and grip strength (max score of 2 trials, values < 30 kg were low). Information on fractures was assessed tri-annually over an average follow-up of 12 years and centrally adjudicated. Cox proportional hazard models estimated the hazard ratio (HR) (95% confidence intervals) for slow walking speed, low grip strength, and low lean mass. RESULTS Overall, 1413 men had a fracture during follow-up. Slow walking speed was associated with an increased risk for any HR = 1.39, 1.05-1.84; hip HR = 2.37, 1.54-3.63; and major osteoporotic, HR = 1.89, 1.34-2.67 in multi-variate-adjusted models. Low lean mass and low grip strength were not significantly associated with fracture. CONCLUSIONS In this cohort of older adult men, the risk of experiencing any, hip, or major osteoporotic fracture is greater in men with slow walking speed in comparison to men with normal walking speed, but low grip strength and low lean mass were not associated with fracture.
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Affiliation(s)
- R J Harris
- Department of Epidemiology Graduate School of Public Health University of Pittsburgh, Pittsburgh, PA, USA.
- VA Boston Healthcare System, Boston, MA, USA.
| | - N Parimi
- Research Institute, California Pacific Medical Center, San Francisco, CA, USA
| | - P M Cawthon
- Research Institute, California Pacific Medical Center, San Francisco, CA, USA
| | - E S Strotmeyer
- Department of Epidemiology Graduate School of Public Health University of Pittsburgh, Pittsburgh, PA, USA
| | - R M Boudreau
- Department of Epidemiology Graduate School of Public Health University of Pittsburgh, Pittsburgh, PA, USA
| | - J S Brach
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - C K Kwoh
- Department of Medicine, University of Arizona, Tucson, AZ, USA
| | - J A Cauley
- Department of Epidemiology Graduate School of Public Health University of Pittsburgh, Pittsburgh, PA, USA
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20
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Wingood M, Jones S, Gell NM, Brach JS, Peters DM. Evaluation of Electronic and Pen-and-Paper Formats of the Inventory of Physical Activity Barriers: A Randomized Crossover Study. J Phys Act Health 2022; 19:540-547. [PMID: 35894970 PMCID: PMC10080583 DOI: 10.1123/jpah.2021-0821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 06/01/2022] [Accepted: 06/21/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND The Inventory of Physical Activity Barriers (IPAB) assesses physical activity participation barriers. Development, refinement, and psychometric evaluation of the IPAB occurred via an electronic format. However, various circumstances may require using a pen-and-paper format. As instrument formats are not always interchangeable, the authors aimed to establish whether 2 different formats (electronic and pen and paper) can be used interchangeably for the IPAB. METHODS This randomized crossover study included 66 community-dwelling adults aged 50 years and older (mean age = 73 [SD = 7.6]). Half the sample completed the electronic format of the IPAB first and the pen-and-paper format second, and the other half completed them in reverse order. Tests of equivalence and a Bland-Altman plot were performed. RESULTS The intraclass correlation coefficient between formats was .94, and kappa was .68. The mean difference between the 2 administration forms of the IPAB was 0.002 (P = .96). Both administration formats had high internal consistency (Cronbach alpha = .92 and .93) and illustrated construct validity (P ≤ .001 for both administration formats). CONCLUSION Pen-and-paper and electronic formats of the IPAB are equivalent and, thus, can be used interchangeably among non-Hispanic whites who are highly educated. The format should be used consistently if completing preintervention and postintervention evaluations or comparing scores.
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Affiliation(s)
- Mariana Wingood
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, VT,USA
| | - Salene Jones
- Public Health Science Division, Fred Hutchinson Cancer Research Center, Seattle, WA,USA
| | - Nancy M Gell
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, VT,USA
| | - Jennifer S Brach
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA,USA
| | - Denise M Peters
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, VT,USA
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21
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Brach JS, Perera S, Shuman V, Gil AB, Kriska A, Nadkarni NK, Rockette-Wagner B, Cham R, VanSwearingen JM. Effect of Timing and Coordination Training on Mobility and Physical Activity Among Community-Dwelling Older Adults: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2212921. [PMID: 35604689 PMCID: PMC9127558 DOI: 10.1001/jamanetworkopen.2022.12921] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 03/31/2022] [Indexed: 11/21/2022] Open
Abstract
Importance Standard exercise interventions targeting underlying physiologic system impairments have limited success in improving walking. Augmenting standard interventions with timing and coordination training, which incorporates the principles of motor learning and integrates multiple systems, may be more successful. Objective To determine whether a standard strength and endurance program incorporating timing and coordination training (standard-plus) improves gait speed more than strength and endurance training alone. Design, Setting, and Participants The Program to Improve Mobility in Aging (PRIMA) study was an assessor-blinded, randomized, 2-group intervention trial that included a 12-week intervention and 24-week follow-up period. The trial was conducted at a university research clinic from 2016 to 2020. Participants included 249 community-dwelling older adults (aged ≥65 years) with gait speed between 0.60 and 1.20 m/s. Statistical analysis was performed from December 2020 to March 2021. Interventions Participants were randomized to standard strength and endurance (n = 125) or standard-plus, including timing and coordination training (n = 124), 50 to 60 minutes, twice a week for 12 weeks. Main Outcomes and Measures Primary outcome of gait speed and secondary outcomes representing components of the intervention (leg strength and power, 6-minute walk test, chair sit-and-reach test, and figure of 8 walk test) and activity and participation (Late Life Function and Disability Instrument and daily physical activity measured by accelerometry) were measured at 12, 24, and 36 weeks. Results Among 249 randomized participants, 163 (65.5%) were female, 22 (8.8%) were Black, 219 (88.0%) were White; mean (SD) age was 77.4 (6.6) years; mean (SD) gait speed was 1.07 (0.16) m/s; and 244 (98.0%) completed the intervention. The 2 groups did not have significantly different improvements in gait speed or secondary outcomes representing the components of the intervention at any time point. For gait speed, individuals in the standard-plus group had a mean (SD) improvement of 0.079 (0.135) m/s over 12 weeks, 0.065 m/s (0.141) over 24 weeks, and 0.059 (0.150) m/s over 36 weeks; individuals in the standard group improved gait speed by 0.081 (0.124) m/s over 12 weeks, 0.051 (0.129) m/s over 24 weeks, and 0.065 (0.148) m/s over 36 weeks. Conclusions and Relevance This randomized clinical trial found no difference in gait speed change between the standard and standard-plus intervention groups, and both groups showed sustained improvements in mobility 24 weeks after the intervention. Trial Registration ClinicalTrials.gov Identifier: NCT02663778.
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Affiliation(s)
- Jennifer S. Brach
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Subashan Perera
- Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Valerie Shuman
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Alexandra B. Gil
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Andrea Kriska
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Neelesh K. Nadkarni
- Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Rakie Cham
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania
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22
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Brach JS, Juarez G, Perera S, Cameron K, Vincenzo JL, Tripken J. Dissemination and Implementation of Evidence-Based Falls Prevention Programs: Reach and Effectiveness. J Gerontol A Biol Sci Med Sci 2022; 77:164-171. [PMID: 34244780 PMCID: PMC8751789 DOI: 10.1093/gerona/glab197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Using the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework, we describe the implementation of evidence-based fall prevention programs (EBFPPs) by Administration for Community Living grantees during 2014-2019. METHOD Forty-four grantees contributed to the national data repository. Data components include workshop information, participant information, attendance records, and organizational data. Data were collected before and after implementation of the EBFPPs. RESULTS Ten different programs were offered in 35 states with the most common settings being senior centers (25.3%), residential facilities (16.8%), health care organizations (12.5%), and faith-based organizations (11.1%). Individuals who participated in the programs (N = 85 848) had an age of 75.5 ± 9.7 years and were primarily female (79.7%), and the majority (86.2%) reported at least some fear of falling. At the postprogram assessment, 31.8% reported less fear of falling, 21.6% reported fewer falls, and 10.1% reported fewer injurious falls (all p < .0001). CONCLUSIONS EBFPPs implemented by Administration for Community Living grantees reached over 85 000 older adults. Participation in the EBFPPs resulted in improved confidence, decreased fear of falling, and fewer falls and injurious falls. Future efforts should focus on reaching specific underserved minorities and examining the effectiveness of individual programs.
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Affiliation(s)
- Jennifer S Brach
- Department of Physical Therapy, University of Pittsburgh, Pennsylvania, USA
| | - Gardenia Juarez
- Department of Physical Therapy, University of Pittsburgh, Pennsylvania, USA
| | - Subashan Perera
- Department of Medicine, University of Pittsburgh, Pennsylvania, USA
- Department of Biostatistics, University of Pittsburgh, Pennsylvania, USA
| | - Kathleen Cameron
- National Council on Aging Center for Healthy Aging, Arlington, Virginia, USA
| | - Jennifer L Vincenzo
- Department of Physical Therapy, University of Arkansas Medical Sciences, Fayetteville, USA
| | - Jennifer Tripken
- National Council on Aging Center for Healthy Aging, Arlington, Virginia, USA
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23
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Wingood M, Jones SMW, Gell NM, Brach JS, Peters DM. The Inventory of Physical Activity Barriers for Adults 50 Years and Older: Refinement and Validation. Gerontologist 2021; 62:e555-e563. [PMID: 34794173 PMCID: PMC9710241 DOI: 10.1093/geront/gnab165] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Due to health consequences associated with insufficient physical activity (PA), particularly among aging adults, health care providers should assess and address lack of PA participation. Addressing lack of PA means developing individualized PA prescriptions that incorporate solutions to PA participation barriers. Assessing PA participation barriers can be done through the Social Ecological Model-based Inventory of Physical Activity Barriers Scale (IPAB). This study aimed to refine the initial 40-item IPAB and determine its reliability and validity. RESEARCH DESIGN AND METHODS Five hundred and three community-dwelling adults 50 years and older completed a demographic and health questionnaire, the Physical Activity Vital Sign, the IPAB, and a feedback questionnaire. For scale refinement, half of the data were used for exploratory factor analysis and the other half for confirmatory factor analysis. The refined scale underwent reliability and validity assessment, including internal consistency, test-retest reliability, and construct validity. RESULTS The refined scale contains 27 items consisting of 7 factors and 1 stand-alone item: (a) environmental, (b) physical health, (c) PA-related motivation, (d) emotional health, (e) time, (f) skills, (g) social, and (h) energy (a stand-alone item). The 27-item IPAB has good internal consistency (alpha = 0.91) and high test-retest reliability (intraclass correlation coefficient = 0.99). The IPAB's mean scores were statistically different between those who met the recommended levels of PA and those who did not (p < .001). DISCUSSION AND IMPLICATIONS The information gathered through the IPAB can guide discussions related to PA participation barriers and develop individualized PA prescriptions that incorporate solutions to the identified barriers.
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Affiliation(s)
- Mariana Wingood
- Address correspondence to: Mariana Wingood, PhD, Department of Rehabilitation and Movement Science, University of Vermont, 106 Carrigan Drive, Rowell Building, Burlington, VT 05405, USA. E-mail:
| | - Salene M W Jones
- Public Health Science Division, Fred Hutch, Seattle, Washington, USA
| | - Nancy M Gell
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, Vermont, USA
| | - Jennifer S Brach
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Denise M Peters
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, Vermont, USA
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24
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Bove AM, Hausmann LR, Piva SR, Brach JS, Lewis A, Fitzgerald GK. Race Differences in Post-Acute Physical Therapy Utilization and Patient-Reported Function after Total Knee Arthroplasty. Arthritis Care Res (Hoboken) 2021; 74:79-88. [PMID: 34553507 DOI: 10.1002/acr.24792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 09/09/2021] [Accepted: 09/21/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This observational cohort study included patients of Black and White race and non-Hispanic ethnicity with end-stage knee osteoarthritis who were scheduled to receive total knee arthroplasty (TKA) surgery. We examined whether there are race differences in (1) use of physical therapy (PT) across all post-acute settings and (2) patient-reported physical function following TKA. METHODS We collected pre- and post-operative physical function data and post-operative rehabilitation data on 104 Black and White individuals undergoing TKA. Regression analyses and independent samples t-tests were used to explore the predictive value of race on post-operative functional outcome and compare PT utilization within each post-acute setting and across all post-acute rehabilitation settings. RESULTS Total PT received was similar between White and Black participants, but there were significant race differences in PT utilization within specific settings. Race did not significantly predict function after TKA, but Black participants had slightly lower self-reported function both before and after surgery than White participants. CONCLUSION This is the first study to examine both PT utilization and functional outcomes in a sample of individuals undergoing TKA, and results indicate differences in where post-operative PT is received between Black and White patients.
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Affiliation(s)
- Allyn M Bove
- Department of Physical Therapy, University of Pittsburgh School of Health and Rehabilitation Sciences, 100 Technology Drive, Suite 210, Pittsburgh, PA, 15219, USA
| | - Leslie Rm Hausmann
- University of Pittsburgh, School of Medicine and Core Investigator, VA Pittsburgh Center for Health Equity Research and Promotion, USA
| | - Sara R Piva
- Department of Physical Therapy, University of Pittsburgh School of Health and Rehabilitation Sciences, 100 Technology Drive, Suite 210, Pittsburgh, PA, 15219, USA
| | - Jennifer S Brach
- Department of Physical Therapy, University of Pittsburgh School of Health and Rehabilitation Sciences, 100 Technology Drive, Suite 210, Pittsburgh, PA, 15219, USA
| | - Allen Lewis
- School of Health Professions, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - G Kelley Fitzgerald
- Department of Physical Therapy, University of Pittsburgh School of Health and Rehabilitation Sciences, 100 Technology Drive, Suite 210, Pittsburgh, PA, 15219, USA
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25
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Dunlap PM, Rosso AL, Zhu X, Klatt BN, Brach JS. The Association of Mobility Determinants and Life Space Among Older Adults. J Gerontol A Biol Sci Med Sci 2021; 77:2320-2328. [PMID: 34529773 DOI: 10.1093/gerona/glab268] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND It is important to understand the factors associated with life space mobility so that mobility disability can be prevented/treated. The purpose of this study was to identify the association between mobility determinants and life space among older adults. METHODS This study was a cross-sectional analysis of 249 community-dwelling older adults (mean age=77.4 years, 65.5% female, 88% white) who were recruited for a randomized, controlled, clinical intervention trial. Associations between cognitive, physical, psychosocial, financial, and environmental mobility determinants and the Life Space Assessment (LSA) at baseline were determined using Spearman's correlation coefficients and one-way analysis of variance. Multivariate analysis was performed using multivariable linear regression models. RESULTS The mean LSA score for the sample was 75.3 (SD=17.8). Personal factors (age, gender, education, comorbidities), cognitive (Trail Making Test A and B), physical (gait speed, lower extremity power, Six Minute Walk Test, Figure of 8 Walk Test, tandem stance, energy cost of walking, and Late Life Function and Disability Function Scale), psychosocial (Modified Gait Efficacy Scale), and financial (neighborhood socio-economic status) domains of mobility were significantly associated with LSA score. In the final regression model, age (β=-0.43), lower extremity power (β=0.03), gait efficacy (β=0.19), and energy cost of walking (β=-57.41) were associated with life space (R 2=0.238). CONCLUSIONS Younger age, greater lower extremity power, more confidence in walking, and lower energy cost of walking were associated with greater life space. Clinicians treating individuals with mobility disability should consider personal, physical, and psychosocial factors assessing barriers to life space mobility.
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Affiliation(s)
- Pamela M Dunlap
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Andrea L Rosso
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Xiaonan Zhu
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Brooke N Klatt
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jennifer S Brach
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
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26
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Vincenzo JL, Hergott C, Schrodt L, Perera S, Tripken J, Shubert TE, Brach JS. Physical Therapists as Partners for Community Fall Risk Screenings and Referrals to Community Programs. Front Public Health 2021; 9:672366. [PMID: 34249840 PMCID: PMC8267879 DOI: 10.3389/fpubh.2021.672366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 05/04/2021] [Indexed: 12/18/2022] Open
Abstract
Objectives: Physical therapists (PTs) are integral team members in fall prevention in clinical settings; however, few studies have investigated PTs' engagement in pro-bono community-based falls prevention. Therefore, we aimed to describe the characteristics of PTs and physical therapist assistants (PTAs) in the United States who conduct community-based fall screenings, the reach of screenings, their knowledge and utilization of the Centers for Disease Control and Prevention's fall-risk screening toolkit (STEADI, Stopping Elderly Accidents, Deaths, and Injuries), and therapists' knowledge and referrals to evidence-based programs (EBPs) and community resources. Methods: A cross-sectional survey distributed to a convenience sample of PTs/PTAs in the United States through news-blasts, and social media. Results: Four hundred and forty-four therapists who worked with older adults completed the survey. Approximately 40% of the respondents (n = 180) conduct screenings, most frequently annually. People who screen tend to be PTs with >20 years of experience, work in outpatient/wellness or academia, and be involved in the least amount of direct patient care. The majority (n = 344, 77.5%) of survey respondents were somewhat to very familiar with the STEADI, and ~84% (n = 114) of respondents who were very familiar with the STEADI (n = 136) use the toolkit to conduct community-based, pro-bono fall risk screenings. Twenty-six percent (n = 14) out of the 53 PTAs who responded to the survey conduct falls screenings in the community. Of the PTs/PTAs who conduct community-based fall screenings (n = 180), ~ 75% (n = 136) are aware of and refer older adults to EBPs. Over half also refer to Silver Sneakers and/or senior centers. Discussion: PTs and PTAs are key partners in evidence-based multifactorial fall prevention in the community. Data helps inform community organizations that most PTs who engage in community-based fall risk screening utilize the STEADI toolkit and refer to community-based programs. Community organizations seeking PT partners to engage in fall risk screenings and promote referrals to local resources or EBPs will likely have the most success collaborating with local physical therapy education programs or physical therapy clinic managers.
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Affiliation(s)
- Jennifer L Vincenzo
- Department of Physical Therapy, University of Arkansas for Medical Sciences, Fayetteville, AR, United States
| | - Colleen Hergott
- Department of Physical Therapy, Augusta University, Augusta, GA, United States
| | - Lori Schrodt
- Department of Physical Therapy, Western Carolina University, Cullowhee, NC, United States
| | - Subashan Perera
- Department of Physical Therapy, University of Pittsburg, Pittsburg, PA, United States
| | - Jennifer Tripken
- Center for Healthy Aging, National Council on Aging, Washington, DC, United States
| | - Tiffany E Shubert
- University of North Carolina Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill, NC, United States
| | - Jennifer S Brach
- Department of Physical Therapy, University of Pittsburg, Pittsburg, PA, United States
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27
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Barone Gibbs B, Sternfeld B, Whitaker KM, Brach JS, Hergenroeder AL, Jacobs DR, Reis JP, Sidney S, White D, Pettee Gabriel K. Bidirectional associations of accelerometer-derived physical activity and stationary behavior with self-reported mental and physical health during midlife. Int J Behav Nutr Phys Act 2021; 18:74. [PMID: 34090471 PMCID: PMC8180096 DOI: 10.1186/s12966-021-01145-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 05/27/2021] [Indexed: 12/05/2022] Open
Abstract
Background Moderate-to-vigorous intensity physical activity (MVPA) is associated with favorable self-rated mental and physical health. Conversely, poor self-rated health in these domains could precede unfavorable shifts in activity. We evaluated bidirectional associations of accelerometer-estimated time spent in stationary behavior (SB), light intensity physical activity (LPA), and MVPA with self-rated health over 10 years in in the CARDIA longitudinal cohort study. Methods Participants (n = 894, age: 45.1 ± 3.5; 63% female; 38% black) with valid accelerometry wear and self-rated health at baseline (2005–6) and 10-year follow-up (2015–6) were included. Accelerometry data were harmonized between exams and measured mean total activity and duration (min/day) in SB, LPA, and MVPA; duration (min/day) in long-bout and short-bout SB (≥30 min vs. < 30 min) and MVPA (≥10 min vs. < 10 min) were also quantified. The Short-Form 12 Questionnaire measured both a mental component score (MCS) and physical component score (PCS) of self-rated health (points). Multivariable linear regression associated baseline accelerometry variables with 10-year changes in MCS and PCS. Similar models associated baseline MCS and PCS with 10-year changes in accelerometry measures. Results Over 10-years, average (SD) MCS increased 1.05 (9.07) points, PCS decreased by 1.54 (7.30) points, and activity shifted toward greater SB and less mean total activity, LPA, and MVPA (all p < 0.001). Only baseline short-bout MVPA was associated with greater 10-year increases in MCS (+ 0.92 points, p = 0.021), while baseline mean total activity, MVPA, and long-bout MVPA were associated with greater 10-year changes in PCS (+ 0.53 to + 1.47 points, all p < 0.005). In the reverse direction, higher baseline MCS and PCS were associated with favorable 10-year changes in mean total activity (+ 9.75 cpm, p = 0.040, and + 15.66 cpm, p < 0.001, respectively) and other accelerometry measures; for example, higher baseline MCS was associated with − 13.57 min/day of long-bout SB (p < 0.001) and higher baseline PCS was associated with + 2.83 min/day of MVPA (p < 0.001) in fully adjusted models. Conclusions The presence of bidirectional associations between SB and activity with self-rated health suggests that individuals with low overall activity levels and poor self-rated health are at high risk for further declines and supports intervention programming that aims to dually increase activity levels and improve self-rated health. Supplementary Information The online version contains supplementary material available at 10.1186/s12966-021-01145-4.
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Affiliation(s)
- Bethany Barone Gibbs
- Department of Health and Human Development, University of Pittsburgh, 32 Oak Hill Court, Room 220, Pittsburgh, PA, 15216, USA.
| | | | | | - Jennifer S Brach
- Department of Health and Human Development, University of Pittsburgh, 32 Oak Hill Court, Room 220, Pittsburgh, PA, 15216, USA
| | - Andrea L Hergenroeder
- Department of Health and Human Development, University of Pittsburgh, 32 Oak Hill Court, Room 220, Pittsburgh, PA, 15216, USA
| | | | - Jared P Reis
- National Heart Lung and Blood Institute, Bethesda, USA
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Suri A, Rosso AL, VanSwearingen J, Coffman LM, Redfern MS, Brach JS, Sejdić E. Mobility of Older Adults: Gait Quality Measures are associated with Life-Space Assessment Scores. J Gerontol A Biol Sci Med Sci 2021; 76:e299-e306. [PMID: 34038537 DOI: 10.1093/gerona/glab151] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The relation of gait quality to real-life mobility among older adults is poorly understood. This study examined the association between gait quality, consisting of step variability, smoothness, regularity, symmetry and gait speed with the Life-Space Assessment (LSA). METHODS In community-dwelling older adults (N=232, age 77.5±6.6, 65% females), gait quality was derived from: a) an instrumented walkway: gait speed, variability and walk-ratio; and b) accelerometer: signal variability, smoothness, regularity, symmetry, and time-frequency spatiotemporal variables during 6-minute walk. In addition to collecting LSA scores, cognitive functioning, walking-confidence, and falls were recorded. Spearman correlations (speed as covariate) and Random Forest Regression were used to assess associations between gait quality and LSA, and Gaussian-mixture modeling (GMM) was used to cluster participants. RESULTS Spearman correlations of ρp=0.11 (signal amplitude variability ML), ρp=0.15, ρp=-0.13 (symmetry AP-V, ML-AP), ρp=0.16 (power V) and ρ=0.26 (speed), all p<0.05 and marginally related, ρp=-0.12 (regularity V), ρp=0.11 (smoothness AP) and ρp=-0.11 (step-time variability), p<0.1 were obtained. The cross-validated Random Forest model indicated good fit LSA prediction error of 17.77; gait and cognition were greater contributors than age and gender. GMM indicated two clusters. Group-1(N=189) had better gait quality than Group-2(N=43): greater smoothness AP (2.94±0.75 vs 2.30±0.71); greater similarity AP-V (0.58±0.13 vs 0.40±0.19); lower regularity V (0.83±0.08 vs 0.87±0.10); greater power V (1.86±0.18 vs 0.97±1.84); greater speed (1.09±0.16 vs 1.00±0.16 m/s); lower step time CoV (3.70±1.09 vs 5.09±2.37) and better LSA (76±18 vs 67±18), padjusted<0.004. CONCLUSIONS Gait quality measures taken in the clinic are associated with real-life mobility in the community.
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Affiliation(s)
- Anisha Suri
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh
| | - Andrea L Rosso
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh
| | - Jessie VanSwearingen
- Department of Physical Therapy, School of Rehabilitation Sciences, University of Pittsburgh, Pittsburgh
| | - Leslie M Coffman
- Department of Physical Therapy, School of Rehabilitation Sciences, University of Pittsburgh, Pittsburgh
| | - Mark S Redfern
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh
| | - Jennifer S Brach
- Department of Physical Therapy, School of Rehabilitation Sciences, University of Pittsburgh, Pittsburgh
| | - Ervin Sejdić
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh.,Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh
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Bove AM, Dong ER, Hausmann LRM, Piva SR, Brach JS, Lewis A, Fitzgerald GK. Exploring Race Differences in Satisfaction with Rehabilitation Following Total Knee Arthroplasty: a Qualitative Study. J Gerontol A Biol Sci Med Sci 2021; 77:e48-e55. [PMID: 33978153 DOI: 10.1093/gerona/glab132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The purpose of this qualitative focus group study was to explore race differences in the rehabilitation experience and satisfaction with rehabilitation following total knee arthroplasty (TKA). METHODS We conducted a series of qualitative focus group discussions with groups of Non-Hispanic White and Non-Hispanic Black older adults who recently underwent TKA. We used grounded theory approach, which asks the researcher to develop theory from the data that are collected. Participants discussed barriers and facilitators to accessing rehabilitation after surgery, opinions regarding their physical therapists, the amount of post-operative physical therapy received, and overall satisfaction with the post-operative rehabilitation process. RESULTS Thirty-six individuals participated in focus groups. Three major themes emerged: (1) Participants reported overall positive views of their post-TKA rehabilitation experience. They particularly enjoyed one-on-one care, the ability to participate in "prehabilitation", and often mentioned specific interventions they felt were most helpful in their recovery. (2) Despite this, substantial barriers to accessing physical therapy exist. These include suboptimal pain management, copayments and other out-of-pocket costs, and transportation to visits. (3) There were minor differences in the rehabilitation experiences between Black and White participants. Black participants reported longer paths toward surgery and occasional difficulty interacting with rehabilitation providers. CONCLUSIONS Individuals undergoing TKA can largely expect positive rehabilitation experiences post-operatively. However, some barriers to post-operative physical therapy exist and may differ between Black and White patients. Physical therapists should increase their awareness of these barriers and work to minimize them whenever possible.
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Affiliation(s)
- Allyn M Bove
- Department of Physical Therapy, University of Pittsburgh School of Health and Rehabilitation Sciences; Pittsburgh, PA, USA
| | - Erin R Dong
- Penn Presbyterian Medical Center; Philadelphia, PA, USA
| | - Leslie R M Hausmann
- Department of Medicine, Division of General Internal Medicine, University of Pittsburgh School of Medicine; Pittsburgh, PA, USA.,Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System; Pittsburgh, PA, USA
| | - Sara R Piva
- Department of Physical Therapy, University of Pittsburgh School of Health and Rehabilitation Sciences; Pittsburgh, PA, USA
| | - Jennifer S Brach
- Department of Physical Therapy, University of Pittsburgh School of Health and Rehabilitation Sciences; Pittsburgh, PA, USA
| | - Allen Lewis
- School of Health Professions, SUNY Downstate Health Sciences University; Brooklyn, NY, USA
| | - G Kelley Fitzgerald
- Department of Physical Therapy, University of Pittsburgh School of Health and Rehabilitation Sciences; Pittsburgh, PA, USA
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Ogawa EF, Harris R, DeGutis JM, Ward RE, Brach JS, Halasz I, Travison TG, Bean JF. Evaluating the Feasibility and Effects of a Short-Term Task Specific Power Training With and Without Cognitive Training Among Older Adults With Slow Gait Speed: A Pilot Study. Arch Rehabil Res Clin Transl 2021; 3:100118. [PMID: 34179754 PMCID: PMC8211979 DOI: 10.1016/j.arrct.2021.100118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective: To investigate the feasibility and efficacy of short-term functional power training and further examine whether the addition of cognitive training targeting sustained attention and inhibitory control would augment the effect on the outcomes. Design: Randomized pilot study. Setting: Clinical research facility. Participants: Community-dwelling primary care patients (N=25) aged >65 years with mobility limitation within the VA Boston Healthcare System. Interventions: Participants were randomly assigned to either functional power training (n=14) or functional power+cognitive training (n=11), offered 3 times a week for 6 weeks. Session durations were either 70 minutes (functional power+cognitive training) or 40 minutes (functional power training). Main Outcome Measures: We evaluated feasibility (dropouts, attendance), mobility performance (Short Physical Performance Battery [SPPB]), leg power [stair climb test]), dynamic balance [figure-of-8], and gait characteristics [gait speed, stance time, step width, swing time, step length, variabilities under single-task and dual-task conditions]). Nonparametric analyses were used to compare overall pre-post changes and between-group differences. Results: Of the 39 veterans screened, 25 were randomized and enrolled. Twenty-one men with a mean age 76±7 years completed the study; 86% were white. Participants had a mean SPPB score of 8.3±1.6 out of 12. For those completing the study, overall attendance was 79%. Among all participants, clinically relevant and/or statistically significant median change in mobility performance (∆1 point), leg power (∆25.0W), dynamic balance (∆-1.1s), and gait characteristics (gait speed [∆0.08s, ∆0.09s], step length [∆1.9cm, ∆3.8cm], and stance time [∆-0.02s, ∆-0.05s] under single- and dual-task, respectively) were observed after 6 weeks of training. There were no statistically significant group differences in dropouts, attendance rate, or any of the outcomes based on cognitive training status. Conclusions: Short-term functional power training with or without a cognitive training led to clinically meaningful improvements in mobility performance, leg power, dynamic balance, and gait characteristics. These findings add to the body of evidence supporting the benefits of functional power training on clinically relevant outcomes. Additional cognitive training did not have an added effect on the study outcomes from our study. Further research is needed.
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Affiliation(s)
- Elisa F Ogawa
- New England Geriatric Research, Education and Clinical Center, VA Boston Healthcare System, Boston, MA
| | - Rebekah Harris
- New England Geriatric Research, Education and Clinical Center, VA Boston Healthcare System, Boston, MA
| | - Joseph M DeGutis
- Department of Psychiatry, Harvard Medical School, Boston, MA.,Boston Attention and Learning Laboratory, VA Boston Healthcare System, Boston, MA
| | - Rachel E Ward
- New England Geriatric Research, Education and Clinical Center, VA Boston Healthcare System, Boston, MA.,Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA.,Harvard Medical School, Cambridge, MA.,Spaulding Rehabilitation Hospital, Boston, MA
| | - Jennifer S Brach
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA
| | - Ildiko Halasz
- Department of Medicine, VA Boston Healthcare System, Boston, MA
| | - Thomas G Travison
- Harvard Medical School, Cambridge, MA.,Marcus Institute for Aging Research, Hebrew Senior Life, Boston, MA
| | - Jonathan F Bean
- New England Geriatric Research, Education and Clinical Center, VA Boston Healthcare System, Boston, MA.,Harvard Medical School, Cambridge, MA.,Spaulding Rehabilitation Hospital, Boston, MA
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Coyle PC, Perera S, Shuman V, VanSwearingen J, Brach JS. Development and Validation of Person-Centered Cut-Points for the Figure-of-8-Walk Test of Mobility in Community-Dwelling Older Adults. J Gerontol A Biol Sci Med Sci 2020; 75:2404-2411. [PMID: 32006022 DOI: 10.1093/gerona/glaa035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The Figure-of-8-Walk test (F8WT) is a performance measure of the motor skill of walking. Unlike walking speed over a straight path, it captures curved path walking, which is essential to real-world activity, but meaningful cut-points have yet to be developed for the F8WT. METHODS A secondary analysis of 421 community-dwelling older adults (mean age 80.7 ± 7.8), who participated in a community-based exercise clinical trial, was performed. Area under receiver operating characteristic curves (AUROCC) were calculated using baseline data, with F8WT performance discriminating different self-reported global mobility and balance dichotomies. Cut-points for the F8WT were chosen to optimize sensitivity and specificity. For validation, F8WT cut-points were applied to postintervention F8WT data. Participants were called monthly for 12 months after intervention completion to record self-reported incident falls, emergency department visits, and hospitalizations; risks of the outcomes were compared between those who performed well and poorly on the F8WT. RESULTS F8WT performance times of ≤9.09 seconds and ≤9.27 seconds can discriminate those with excellent (sensitivity = 0.647; specificity = 0.654) and excellent/very good global mobility (sensitivity = 0.649; specificity = 0.648), respectively. A total number of steps ≤17 on the F8WT can discriminate those with excellent/very good/good global balance (sensitivity = 0.646; specificity = 0.608). Compared to those who performed poorly, those who performed well had a lower incidence of negative outcomes: F8WT time ≤9.09 seconds = 46%-59% lower; F8WT time ≤9.27 seconds = 46%-56% lower; F8WT steps ≤17 = 44%-50% lower. CONCLUSIONS Clinicians may consider these preliminary cut-points to aid in their clinical decision making, but further study is needed for definitive recommendations.
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Affiliation(s)
- Peter C Coyle
- Department of Physical Therapy, University of Pittsburgh, Pennsylvania.,Department of Physical Therapy, University of Delaware, Newark
| | - Subashan Perera
- Department of Medicine, Division of Geriatric Medicine, University of Pittsburgh, Pennsylvania
| | - Valerie Shuman
- Department of Physical Therapy, University of Pittsburgh, Pennsylvania
| | | | - Jennifer S Brach
- Department of Physical Therapy, University of Pittsburgh, Pennsylvania
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Shuman V, Coyle PC, Perera S, Van Swearingen JM, Albert SM, Brach JS. Association Between Improved Mobility and Distal Health Outcomes. J Gerontol A Biol Sci Med Sci 2020; 75:2412-2417. [PMID: 32270185 DOI: 10.1093/gerona/glaa086] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We examined the association between improved mobility and distal health outcomes in older adults using secondary analysis of data from a cluster-randomized controlled group exercise trial. METHODS Participants were 303 men and women aged ≥65 and older in 32 independent living facilities, senior apartments, and community centers who participated in 12-week group exercise interventions. Included were those who completed ≥1 follow-up phone call regarding outcomes assessment in the following year. Gait speed and 6-minute walk distance (6MWD) were assessed at baseline and immediately after 12-week interventions to determine mobility performance change status. Falls, emergency department (ED) visits, and hospitalizations were assessed monthly for 12 months following the end of interventions via interactive voice response phone calls. Incident rate ratios (IRRs) were calculated to quantify incidence of adverse outcomes with respect to mobility performance change. RESULTS Each 0.05 m/s increase in gait speed resulted in an 11% reduction in falls (IRR = 0.89; 95% confidence interval [CI], 0.84-0.94; p < .0001); a similar decrease was seen for each 20 m increase in 6MWD (IRR = 0.89; 95% CI, 0.83-0.93; p = .0003). Those who improved gait speed had 61 falls per 1,000 person-months versus 135 in those who had no change/a decline. Those who improved 6MWD had 67 falls per 1,000 person-months versus 110 per 1,000 person-months in those who had no change/a decline. Differences in ED visits and hospitalizations were not statistically significant. CONCLUSION Improvements in mobility performance are associated with lower incidence of future falls. Given the exploratory nature of the findings, further investigation is warranted.
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Affiliation(s)
- Valerie Shuman
- Department of Physical Therapy, University of Pittsburgh, Pennsylvania
| | - Peter C Coyle
- Department of Physical Therapy, University of Delaware, Newark
| | - Subashan Perera
- Department of Medicine, University of Pittsburgh, Pennsylvania.,Department of Biostatistics, University of Pittsburgh, Pennsylvania
| | | | - Steve M Albert
- Department of Behavioral and Community Health Sciences, University of Pittsburgh, Pennsylvania
| | - Jennifer S Brach
- Department of Physical Therapy, University of Pittsburgh, Pennsylvania
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33
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Kotlarczyk MP, Hergenroeder AL, Gibbs BB, Cameron FDA, Hamm ME, Brach JS. Personal and Environmental Contributors to Sedentary Behavior of Older Adults in Independent and Assisted Living Facilities. Int J Environ Res Public Health 2020; 17:ijerph17176415. [PMID: 32899196 PMCID: PMC7504320 DOI: 10.3390/ijerph17176415] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 08/31/2020] [Accepted: 09/01/2020] [Indexed: 01/13/2023]
Abstract
Sedentary behavior is associated with negative health outcomes and unhealthy aging. Older adults are the most sedentary age group, and decreasing sitting time represents an intervention target for improving health. Determinants of sedentary behavior have been examined in older adults living in their own homes, yet less is known about sedentary behavior of older adults in residential care facilities. The purpose of this study was to explore factors contributing to sedentary behavior among residents of independent and assisted living facilities. We conducted eight focus groups with residents (n = 44) and semi-structured interviews with staff (n = 6) across four living facilities. Audio recordings were transcribed and analyzed using an iterative, inductive approach. Three salient themes were identified. Residents and staff both viewed sedentary behavior negatively unless it was in the context of social engagement. Additionally, fear of falling was discussed as a significant contributor to sedentary behavior. Finally, residents felt the community living environment contributed to their sedentary behavior while staff did not. Our findings provide valuable insight for designing targeted interventions for older adults in residential facilities and suggest thinking beyond the individual and considering environmental influences on sedentary behavior in the residential care setting.
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Affiliation(s)
- Mary P. Kotlarczyk
- Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15260, USA
- Correspondence:
| | - Andrea L. Hergenroeder
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA 15260, USA; (A.L.H.); (J.S.B.)
| | - Bethany Barone Gibbs
- Department of Health and Human Development, University of Pittsburgh, Pittsburgh, PA 15260, USA;
| | - Flor de Abril Cameron
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15260, USA; (F.d.A.C.); (M.E.H.)
| | - Megan E. Hamm
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15260, USA; (F.d.A.C.); (M.E.H.)
| | - Jennifer S. Brach
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA 15260, USA; (A.L.H.); (J.S.B.)
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Alqahtani BA, Sparto PJ, Whitney SL, Greenspan SL, Perera S, VanSwearingen J, Brach JS. Effect of Community-Based Group Exercise Interventions on Standing Balance and Strength in Independent Living Older Adults. J Geriatr Phys Ther 2020; 42:E7-E15. [PMID: 31592997 DOI: 10.1519/jpt.0000000000000221] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE Many interventions to improve mobility in older adults often include exercises to address underlying impairments such as strength deficits. Task-oriented exercise interventions that focus more on walking and stepping tasks that may be encountered in the community have been considered for improving mobility in older adults. The main purpose was to examine the effect of task-oriented and impairment-based group exercise interventions on standing balance and lower extremity muscle strength. METHODS This is an ancillary study to a cluster-randomized clinical trial. Participants included 107 older adults. Participants were randomized by facility to 1 of 2 different interventions, or a waitlist control group. The On the Move (OTM) task-oriented intervention consisted of warm-up, timing and coordination (stepping and walking patterns), strengthening, and stretching exercises. The standard of care impairment-based exercise intervention (STD) consisted of warm-up, strength, endurance, and stretching exercises. Postural sway and balance measures were recorded before and after the 12-week interventions. An accelerometer was used to collect postural sway for 6 different standing balance conditions. A portable load cell was used to assess lower extremity muscle strength for 3 muscle groups. RESULTS AND DISCUSSION The OTM group had a significant reduction in sway acceleration during most of the balance conditions over the 12-week period, whereas the STD had smaller, nonsignificant reductions. Both exercise interventions had a significant reduction in sway compared with the waitlist control group in at least 1 balance condition. The OTM and STD groups had significant increases in hip abduction strength during the intervention and the STD group also had an increase in knee extension strength. The waitlist group had a significant reduction in strength in all muscle groups during the 12-week period. Strength changes in both exercise groups were significantly different from the waitlist group but not from each other. CONCLUSION Both exercise intervention groups had an improvement in standing balance and lower extremity strength when compared with a waitlist group that did not receive exercise. Although the exercise groups did not significantly differ from each other, the OTM exercise group showed a trend toward improvement in static standing balance conditions.
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Affiliation(s)
- Bader A Alqahtani
- Department of Physical Therapy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Patrick J Sparto
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Susan L Whitney
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Susan L Greenspan
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Subashan Perera
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jessie VanSwearingen
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jennifer S Brach
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania
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Coyle PC, Perera S, Albert SM, Freburger JK, VanSwearingen JM, Brach JS. Potential long-term impact of "On The Move" group-exercise program on falls and healthcare utilization in older adults: an exploratory analysis of a randomized controlled trial. BMC Geriatr 2020; 20:105. [PMID: 32178633 PMCID: PMC7075006 DOI: 10.1186/s12877-020-1506-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 03/04/2020] [Indexed: 11/30/2022] Open
Abstract
Background Wellness program participation may reduce the risk of falling, emergency department-use, and hospitalization among older adults. “On the Move” (OTM), a community-based group exercise program focused on the timing and coordination of walking, improved mobility in older adults, but its impact on falls, emergency department-use, and hospitalizations remains unclear. The aim of this preliminary study was to investigate the potential long-term effects that OTM may have on downstream, tertiary outcomes. Methods We conducted a secondary analysis of a cluster-randomized, single-blind intervention trial, which compared two community-based, group exercise programs: OTM and a seated exercise program on strength, endurance, and flexibility (i.e. ‘usual-care’). Program classes met for 50 min/session, 2 sessions/week, for 12 weeks. Older adults (≥65 years), with the ability to ambulate independently at ≥0.60 m/s were recruited. Self-reported incidence of falls, emergency department visitation, and hospitalization were assessed using automated monthly phone calls for the year following intervention completion. Participants with ≥1 completed phone call were included in the analyses. Incidence rate ratios (IRRs) and 95% confidence intervals (CIs) were calculated (reference = usual-care). Results Participants (n = 248) were similar on baseline characteristics and number of monthly phone calls completed. Participants in the seated exercise program attended an average of 2.9 more classes (p = .017). Of note, all results were not statistically significant (i.e. 95% CI overlapped a null value of 1.0). However, point estimates suggest OTM participation resulted in a decreased incidence rate of hospitalization compared to usual-care (IRR = 0.88; 95% CI = 0.59–1.32), and the estimates strengthened when controlling for between-group differences in attendance (adjusted IRR = 0.82; 95% CI = 0.56–1.21). Falls and emergency department visit incidence rates were initially greater for OTM participants, but decreased after controlling for attendance (adjusted IRR = 1.08; 95% CI = 0.72–1.62 and adjusted IRR = 0.96; 95% CI = 0.55–1.66, respectively). Conclusion Compared to a community-based seated group exercise program, participation in OTM may result in a reduced risk of hospitalization. When OTM is adhered to, the risk for falling and hospitalizations are attenuated. However, definitive conclusions cannot be made. Nevertheless, it appears that a larger randomized trial, designed to specifically evaluate the impact of OTM on these downstream health outcomes is warranted. Trial registration Clinical trials.gov (NCT01986647; prospectively registered on November 18, 2013).
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Affiliation(s)
- Peter C Coyle
- Department of Physical Therapy, University of Delaware, Newark, DE, USA. .,Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Subashan Perera
- Department of Medicine (Division of Geriatric Medicine), University of Pittsburgh, Pittsburgh, PA, USA
| | - Steven M Albert
- Department of Behavioral and Community Health Science, University of Pittsburgh, Pittsburgh, PA, USA
| | - Janet K Freburger
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Jennifer S Brach
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
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Alqahtani BA, Sparto PJ, Whitney SL, Greenspan SL, Perera S, Brach JS. Psychometric properties of instrumented postural sway measures recorded in community settings in independent living older adults. BMC Geriatr 2020; 20:82. [PMID: 32111166 PMCID: PMC7048114 DOI: 10.1186/s12877-020-1489-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 02/24/2020] [Indexed: 11/09/2022] Open
Abstract
Background In the last few decades, research related to balance in older adults has been conducted in lab-based settings. The lack of portability and high cost that is associated with the current gold standard methods to quantify body balance limits their application to community settings such as independent living facilities. The purpose of the study was to examine the relative and absolute reliability and the convergent validity of static standing balance performance using an accelerometer device. Methods A total of 131 participants (85% female, mean age 80 ± 8 years) were included for the validity aim, and a subsample of 38 participants were enrolled in the reliability testing (89% female, mean age 76 ± 7 years). The root-mean-square (RMS) and normalized path length (NPL) for sway in antero-posterior (AP) and medio-lateral (ML) directions were calculated for different standing balance conditions. Test-retest reliability was assessed over two testing visits occurring 1 week apart using the intraclass correlation coefficient (ICC) for relative reliability, and the minimal detectable change (MDC) was calculated for the absolute reliability. Spearman’s rank correlation coefficient was used to test convergent validity at baseline between balance measurements and related mobility measures. Results Reliability of balance performance using accelerometers was good to excellent with ICC values ranging from 0.41 to 0.83 for RMS sway and from 0.49 to 0.82 for NPL sway. However, the ICC during semi-tandem stance in A-P direction was 0.35, indicating poor reliability. The MDC of the sway measurements ranged from 2.4 to 9.4 for the RMS and 5.2 to 13.8 for the NPL. Balance measurements were correlated with mobility measurements. Conclusions Using a portable accelerometer to quantify static standing postural control provides reliable measurements in community settings.
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Affiliation(s)
- Bader A Alqahtani
- Department of Health and Rehabilitation sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, 11942, Kingdom of Saudi Arabia.
| | - Patrick J Sparto
- Department of Physical Therapy, University of Pittsburgh, Bridgeside Point 1, 100 Technology Drive, Suite 210, Pittsburgh, PA, 15219, USA
| | - Susan L Whitney
- Department of Physical Therapy, University of Pittsburgh, Bridgeside Point 1, 100 Technology Drive, Suite 210, Pittsburgh, PA, 15219, USA
| | - Susan L Greenspan
- Department of Medicine, University of Pittsburgh, 3471 Fifth Avenue, Kaufmann Medical Building, Suite 500, Pittsburgh, PA, 15213, USA
| | - Subashan Perera
- Department of Medicine, University of Pittsburgh, 3471 Fifth Avenue, Kaufmann Medical Building, Suite 500, Pittsburgh, PA, 15213, USA
| | - Jennifer S Brach
- Department of Physical Therapy, University of Pittsburgh, Bridgeside Point 1, 100 Technology Drive, Suite 210, Pittsburgh, PA, 15219, USA
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Brach JS, VanSwearingen JM, Gil A, Nadkarni NK, Kriska A, Cham R, Perera S. Program to improve mobility in aging (PRIMA) study: Methods and rationale of a task-oriented motor learning exercise program. Contemp Clin Trials 2020; 89:105912. [PMID: 31838258 PMCID: PMC6945812 DOI: 10.1016/j.cct.2019.105912] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 11/27/2019] [Accepted: 12/10/2019] [Indexed: 01/01/2023]
Abstract
Walking difficulty is a common and costly problem in older adults. A potentially important yet unaddressed strategy to enhance walking ability through exercise intervention is to add a timing and coordination component in gait training (i.e. task specific timing and coordination exercise intervention) to the usual strength, endurance, and flexibility training. We describe the methods and rationale of a randomized single-blind, physical therapist supervised, exercise intervention trial to compare the effects of a standard strength, endurance, and flexibility program to a standard plus timing and coordination program in community-dwelling older adults walking slower than the desired gait speed of 1.2 m/s. Exercise sessions are twice weekly for 12 weeks. Participants are assessed at baseline, 12 weeks (post intervention), 24 weeks and 36 weeks. The primary outcome is gait speed, secondary outcomes represent components of the interventions (strength, endurance, flexibility, timing and coordination), and tertiary outcomes are measure of activity and participation (Late Life Function and Disability Instrument and physical activity). The findings of this trial will (1) establish if a standard-plus task specific timing and coordination program is superior to a standard strength and endurance program in improving mobility, activity and participation and (2) determine if the improvements are sustained over time. The information derived from this project will provide valuable insight into the prevention and management of walking difficulty, which is so common in older Americans.
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Affiliation(s)
- Jennifer S Brach
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, United States.
| | | | - Alexandra Gil
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, United States
| | - Neelesh K Nadkarni
- Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States; Department of Neurology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Andrea Kriska
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Rakie Cham
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States
| | - Subashan Perera
- Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States; Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, United States
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Rosso AL, Metti AL, Faulkner K, Brach JS, Studenski SA, Redfern M, Rosano C. Associations of Usual Pace and Complex Task Gait Speeds With Incident Mobility Disability. J Am Geriatr Soc 2019; 67:2072-2076. [PMID: 31318048 DOI: 10.1111/jgs.16049] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 05/29/2019] [Accepted: 05/30/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND/OBJECTIVES To assess whether gait speed under complex conditions predicts long-term risk for mobility disability as well as or better than usual-pace gait speed. DESIGN Longitudinal cohort study. SETTING/PARTICIPANTS Subsample of Health Aging and Body Composition study with follow-up from 2002 to 2003 to 2010 to 2011, including 337 community-dwelling adults (mean age = 78.5 years, 50.7% female, 26.1% black). MEASUREMENTS Associations of gait speed measured under usual-pace, fast-pace, dual-task, and narrow-path conditions with mobility disability, defined by any self-reported difficulty walking ¼ mile assessed annually, were tested by Cox proportional hazard models adjusted for demographic and health characteristics. Models were fitted for each walking condition, and R2 statistics were used to compare predictive value across models. Models were repeated for persistent mobility disability, defined as at least two consecutive years of mobility disability. RESULTS Mobility disability occurred in 204 (60.5%) participants over the 8-year follow-up. There was a lower hazard of developing mobility disability with faster gait speed under all conditions. Hazard ratios, confidence intervals, and R2 of gait speed predicting mobility disability were similar across all four walking conditions (R2 range = 0.22-0.27), but were strongest for dual-task gait speed (hazard ratio [95% confidence interval], R2 of fully adjusted models = 0.81 [0.75-0.88], 0.27). Results were comparable for persistent mobility disability (R2 range = 0.26-0.28). CONCLUSION Slower gait speed under both usual-pace and complex conditions may be a clinical indicator of future risk of mobility disability. These results support the call for increased use of gait speed measures in routine geriatric care. J Am Geriatr Soc 67:2072-2076, 2019.
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Affiliation(s)
- Andrea L Rosso
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Andrea L Metti
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kimberly Faulkner
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jennifer S Brach
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Stephanie A Studenski
- Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Mark Redfern
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Caterina Rosano
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
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Alqahtani BA, Sparto PJ, Whitney SL, Greenspan SL, Perera S, Brach JS. Psychometric Properties of Lower Extremity Strength Measurements Recorded in Community Settings in Independent Living Older Adults. Exp Aging Res 2019; 45:282-292. [PMID: 31014223 DOI: 10.1080/0361073x.2019.1609145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND A uniaxial load cell device provides an alternative, easy and inexpensive way to quantify muscle strength in different settings outside the clinic and research labs. So, the purpose of the study was to examine the test-retest reliability and the construct validity of lower extremity strength performance using an uniaxial load cell device. METHODS A total of 131 subjects (85% female, mean age 80 ± 8 years) were included for the validity aim, and a sample of 38 subjects were enrolled in the reliability testing (89% female, mean age 76 ± 7 years). For the strength measurements were assessed with a portable load cell for three consecutive trials. Test-retest reliability was assessed over two testing visits occurring one week apart. Spearman's rank correlation coefficient was used to test convergent validity with other mobility-related measurements construct validity at baseline. RESULTS Strength measurements showed good to excellent reliability in most of the measured parameters with intraclass correlation coefficients range from 0.89 to 0.99 and were correlated with mobility measurements with Spearman rho range from 0.21 to 0.38. CONCLUSION The portable uni-axial load cell to measure lower extremity strength provides reliable measurements in community settings.
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Affiliation(s)
- Bader A Alqahtani
- a Department of Rehabilitation Sciences , Prince Sattam Bin Abdulaziz University , Al-Kharj , Saudi Arabia
| | - Patrick J Sparto
- b Department of Physical Therapy , University of Pittsburgh , Pittsburgh USA
| | - Susan L Whitney
- b Department of Physical Therapy , University of Pittsburgh , Pittsburgh USA
| | - Susan L Greenspan
- c Department of Medicine , University of Pittsburgh , Pittsburgh USA
| | - Subashan Perera
- c Department of Medicine , University of Pittsburgh , Pittsburgh USA
| | - Jennifer S Brach
- b Department of Physical Therapy , University of Pittsburgh , Pittsburgh USA
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Perera S, Nadkarni NK, Wert D, VanSwearingen J, Brach JS. Intraclass Correlation Coefficients for Planning Cluster Randomized Trials in Community-Dwelling Older Adults. J Aging Health 2018; 32:252-258. [PMID: 30522389 DOI: 10.1177/0898264318816216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: With the emerging trends, more cluster randomized trials will be conducted in older adults, where facilities are randomized rather than individuals. Similarity of individuals from a facility (intraclass correlation coefficient/ICC) plays a critical role, but not readily available. We document ICCs for measures commonly used in community-dwelling older adults and discuss implications. Method: Secondary analysis of a range of baseline measures from the On the Move cluster randomized trial, whose ICCs were computed using a linear mixed model. Results: Self-reported disability measures related to facility characteristics and sense of community had the greatest ICCs (>0.10), while mobility performance measures had 0.05 to 0.10, and cognitive measure 0.11. Discussion: The ICCs for measures commonly used in older adults are of a sufficient magnitude to have a substantial impact on planned sample size of a study and credibility of results, and should be taken into consideration in study planning and data analysis.
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Sciamanna C, Ballentine NH, Bopp M, Brach JS, Chinchilli VM, Ciccolo JT, Conroy MB, Fisher A, Fox EJ, Greenspan SL, Jan De Beur Suzanne M, Kearcher K, Kraschnewski JL, McTigue KM, McAuley E, Morone NE, Paranjape A, Rodriguez-Colon S, Rosenzweig A, Smyth JM, Stewart KJ, Stuckey HL. Working to Increase Stability through Exercise (WISE): Study protocol for a pragmatic randomized controlled trial of a coached exercise program to reduce serious fall-related injuries. Contemp Clin Trials 2018; 74:1-10. [PMID: 30261294 PMCID: PMC6333097 DOI: 10.1016/j.cct.2018.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 08/31/2018] [Accepted: 09/18/2018] [Indexed: 12/14/2022]
Abstract
Approximately one-third of older adults fall each year and fall-related injuries are a leading cause of death and disability among this rapidly expanding age group. Despite the availability of bisphosphonates to reduce fractures, concerns over side effects have dramatically reduced use, suggesting that other treatment options are needed. Though many smaller studies have shown that physical activity programs can reduce falls, no study has been adequately powered to detect a reduction in fall-related injuries. We present the design of a three-year randomized controlled clinical trial of 1130 adults age 65 and older with a past history of fragility fractures (e.g., vertebral, fall-related). The main aim is to determine the impact of a community-based multicomponent (strength, balance, aerobic) physical activity program led by trained volunteers (or delivered via DVD) and accompanied by coaching and oversight, by telephone and in-person, by a fitness professional. The main outcome measure is serious fall-related injuries. Secondary outcomes include health care utilization, bone and muscle mass, loneliness, health-related quality of life and mood. The study represents the first large clinical trial of a comprehensive physical activity program to reduce secondary injuries among patients with a history of fragility fracture.
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Hergenroeder AL, Barone Gibbs B, Kotlarczyk MP, Kowalsky RJ, Perera S, Brach JS. Accuracy of Objective Physical Activity Monitors in Measuring Steps in Older Adults. Gerontol Geriatr Med 2018; 4:2333721418781126. [PMID: 29977979 PMCID: PMC6024488 DOI: 10.1177/2333721418781126] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 05/02/2018] [Accepted: 05/03/2018] [Indexed: 11/17/2022] Open
Abstract
Objective: The aim of this study is to evaluate accuracy of research activity monitors in measuring steps in older adults with a range of walking abilities. Method: Participants completed an initial assessment of gait speed. The accuracy of each monitor to record 100 steps was assessed across two walking trials. Results: In all, 43 older adults (age 87 ± 5.7 years, 81.4% female) participated. Overall, the StepWatch had the highest accuracy (99.0% ± 1.5%), followed by the ActivPAL (93.7% ± 11.1%) and the Actigraph (51.4% ± 35.7%). The accuracy of the Actigraph and ActivPAL varied according to assistive device use, and the accuracy of all three monitors differed by gait speed category (all p < .05). StepWatch was highly accurate (⩾97.7) across all conditions. Discussion: The StepWatch and ActivPAL monitor were reasonably accurate in measuring steps in older adults who walk slowly and use an assistive device. The Actigraph significantly undercounted steps in those who walk slow or use an assistive device. Researchers should consider gait speed and the use of assistive devices when selecting an activity monitor.
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Brach JS, Almeida GJ, Perera S, Hergenroeder A, Kotlarczyk M, Gibbs BB. The Role of the Environment on Sedentary Behavior in Community-Dwelling Older Adults. ACTA ACUST UNITED AC 2018; 33:31-40. [PMID: 31073258 DOI: 10.1080/02763893.2018.1451799] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Objectives To compare amounts of sedentary behavior and physical activity in adults residing in planned group residential settings to those residing in private homes. Methods Thirty-one older adults who resided in planned group residential settings (n=13) and in private homes (n=18) participated. Daily activities were measured using the Sensewear Armband for 7 days. Estimates of the duration of daily activities performed across sedentary, light, and moderate-to-vigorous intensities were captured. Results Participants in planned group residential settings were older (age 85.9±3.5 vs 78.3±7.2; p=0.001) and spent more time in sedentary behaviors (12.7±1.5 vs 11.3±1.6; p=0.02) than participants in private homes. The difference was attenuated slightly after controlling for age and wear time (adjusted difference 1.2±0.6 hours, p=0.06). Discussion Adults residing in planned group residential settings, which provide supportive services, were more sedentary than adults residing in private homes. The environment in which older adults live may contribute to sedentary behavior.
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Affiliation(s)
- Jennifer S Brach
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA
| | - Gustavo J Almeida
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA
| | - Subashan Perera
- Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA.,Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA
| | | | - Mary Kotlarczyk
- Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Bethany Barone Gibbs
- Department of Health and Physical Activity, University of Pittsburgh, Pittsburgh, PA
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Almarwani M, Van Swearingen JM, Perera S, Sparto PJ, Brach JS. The Effect of Auditory Cueing on the Spatial and Temporal Gait Coordination in Healthy Adults. J Mot Behav 2017; 51:25-31. [PMID: 29281587 DOI: 10.1080/00222895.2017.1411330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Walk ratio, defined as step length divided by cadence, indicates the coordination of gait. During free walking, deviation from the preferential walk ratio may reveal abnormalities of walking patterns. The purpose of this study was to examine the impact of rhythmic auditory cueing (metronome) on the neuromotor control of gait at different walking speeds. Forty adults (mean age 26.6 ± 6.0 years) participated in the study. Gait characteristics were collected using a computerized walkway. In the preferred walking speed, there was no significant difference in walk ratio between uncued (walk ratio = .0064 ± .0007 m/steps/min) and metronome-cued walking (walk ratio = .0064 ± .0007 m/steps/min; p = .791). A higher value of walk ratio at the slower speed was observed with metronome-cued (walk ratio = .0071 ± .0008 m/steps/min) compared to uncued walking (walk ratio = .0068 ± .0007 m/steps/min; p < .001). The walk ratio was less at faster speed with metronome-cued (walk ratio = .0060 ± .0009 m/steps/min) compared to uncued walking (walk ratio = .0062 ± .0009 m/steps/min; p = .005). In healthy adults, the metronome cues may become an attentional demanding task, and thereby disrupt the spatial and temporal integration of gait at nonpreferred speeds.
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Affiliation(s)
- Maha Almarwani
- a Department of Rehabilitation Sciences , College of Applied Medical Sciences, King Saud University , Riyadh , Saudi Arabia
| | - Jessie M Van Swearingen
- b Department of Physical Therapy , University of Pittsburgh , Pittsburgh , Pennsylvania , USA
| | - Subashan Perera
- c Division of Geriatric Medicine, Department of Medicine , University of Pittsburgh , Pittsburgh , Pennsylvania , USA
| | - Patrick J Sparto
- b Department of Physical Therapy , University of Pittsburgh , Pittsburgh , Pennsylvania , USA
| | - Jennifer S Brach
- b Department of Physical Therapy , University of Pittsburgh , Pittsburgh , Pennsylvania , USA
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Brach JS, Perera S, Gilmore S, VanSwearingen JM, Brodine D, Nadkarni NK, Ricci E. Effectiveness of a Timing and Coordination Group Exercise Program to Improve Mobility in Community-Dwelling Older Adults: A Randomized Clinical Trial. JAMA Intern Med 2017; 177:1437-1444. [PMID: 28806436 PMCID: PMC5710210 DOI: 10.1001/jamainternmed.2017.3609] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
IMPORTANCE Timing and coordination exercises may be an important addition to community-based health promotion exercise programs to improve walking in older adults. OBJECTIVE To compare the effectiveness of the On the Move group exercise program, which focuses on the timing and coordination of movement, with a seated strength, endurance, and flexibility program (usual care) at improving function, disability, and walking ability of older adults. DESIGN, SETTING, AND PARTICIPANTS Cluster-randomized, single-blind intervention trial. Thirty-two independent living facilities, senior apartment buildings, and senior community centers were randomized to On the Move (16 sites; 152 participants) or usual care (16 sites; 146 participants). Participants were 65 years or older, able to ambulate independently with a gait speed of at least 0.60 m/s, able to follow 2-step commands, and were medically stable. INTERVENTIONS Exercise classes were 50 minutes, twice a week for 12 weeks and had 10 or fewer participants per class. On the Move consisted of warm-up, timing and coordination (stepping and walking patterns), strengthening, and stretching exercises. The usual-care program consisted of warm-up, strength, endurance, and stretching exercises. MAIN OUTCOMES AND MEASURES The primary outcomes were self-report of function and disability (Late Life Function and Disability Instrument) and mobility (6-minute walk distance and gait speed) assessed by blinded individuals. RESULTS Participants (mean [SD] age, 80.0 [8.1] years) were mostly female (251 [84.2%]) and white (249 [83.6%]) and had a mean (SD) of 2.8 (1.4) chronic conditions. Intervention groups were similar on baseline characteristics. Postintervention, 142 (93.4%) participants in On the Move and 139 (95.2%) participants in usual care completed testing. On the Move had greater mean (SD) improvements than the usual-care group in gait speed (0.05 [0.13] vs -0.01 [0.11] m/s; adjusted difference = 0.05 [0.02] m/s; P = .002) and 6-minute walk distance (20.6 [57.1] vs 4.1 [55.6] m; adjusted difference = 16.7 [7.4] m; P = .03). Attendance was greater in the usual-care program compared with On the Move (95 [65.1%] vs 76 [50.0%] attended ≥20 classes; P = .03). There were no significant differences in any of the other primary or secondary outcomes. CONCLUSIONS AND RELEVANCE The On the Move group exercise program was more effective at improving mobility than a usual-care exercise program, despite lower attendance. Additional research examining the impact of the intervention on long-term disability outcomes is needed before recommending routine implementation into clinical practice. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01986647.
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Affiliation(s)
- Jennifer S Brach
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Subashan Perera
- Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sandra Gilmore
- Community Provider Services, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | - Deborah Brodine
- Community Provider Services, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Neelesh K Nadkarni
- Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Edmund Ricci
- Department of Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
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Rosso AL, Studenski SA, Longstreth WT, Brach JS, Boudreau RM, Rosano C. Contributors to Poor Mobility in Older Adults: Integrating White Matter Hyperintensities and Conditions Affecting Other Systems. J Gerontol A Biol Sci Med Sci 2017; 72:1246-1251. [PMID: 27816937 PMCID: PMC5861865 DOI: 10.1093/gerona/glw224] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 10/18/2016] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Age-related mobility limitations are debilitating and common. Cerebral white matter hyperintensities (WMH) and conditions affecting other systems are known contributors, but have been studied in isolation. METHODS In 2,703 adults aged 65 years or older, we assessed cross-sectional and longitudinal gait speed and mobility disability (self-reported difficulty walking half mile) in those with and without high burden of MRI-defined WMH along with six other conditions (OCs) affecting mobility: gender-specific weak grip; poor self-reported vision; gender-specific lowest quartile of forced vital capacity; self-reported joint pain; ankle-arm index less than 0.9; and body mass index (BMI) greater than 30 kg/m2. Separate regression models adjusted for age, gender, and race were repeated for each OC and based on a 4-level predictor: -WMH/-OC; -WMH/+OC; +WMH/-OC; and +WMH/+OC. RESULTS Gait speed was fastest in those with -WMH/-OC and slowest for those with +WMH/+OC. Gait speed was similar for either WMH or one of the OC (p range: .07-.9), except for BMI. Those with a high BMI had slower gait speed than those with WMH (p = .01). Declines in gait speed over 6 years were similar for all groups. Results for both prevalent and incident mobility disability showed that associations for WMH and OC were similar for weak grip, poor vision, and low forced vital capacity (p range: .1-.7). Having joint pain, low ankle-arm index, or high BMI was associated with higher prevalent and incident mobility disability compared with having WMH (p range: <.001-.02). CONCLUSIONS Cerebral WMH should be considered along with conditions affecting mobility from other systems when considering risk and treatment for mobility limitations.
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Affiliation(s)
- Andrea L Rosso
- Department of Epidemiology, University of Pittsburgh, Pennsylvania
| | | | - W T Longstreth
- Department of Neurology
- Department of Epidemiology, University of Washington, Seattle
| | - Jennifer S Brach
- Department of Physical Therapy, University of Pittsburgh, Pennsylvania
| | | | - Caterina Rosano
- Department of Epidemiology, University of Pittsburgh, Pennsylvania
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Abstract
OBJECTIVES To examine the effect of self-reported daytime sleepiness on performance-based balance measures and self-reported balance confidence in community-dwelling older adults. DESIGN Cross-sectional secondary analysis of an observational cohort study designed to develop and refine measures of balance and mobility in community-dwelling older adults. SETTING Community. PARTICIPANTS Older adults (aged 78.2 ± 5.9) (n = 120). MEASUREMENTS The performance-based gait and balance measures included gait speed, double support time, and step width. Narrow walk, obstacle walk, and timed standing balance were also assessed. The Activities-Specific Balance Confidence Scale was included as a self-reported measure. Daytime sleepiness was defined as an Epworth Sleepiness Scale score of 9 or greater. Body mass index, fall-related comorbidities, and use of central nervous system (CNS) medications were considered as covariates. RESULTS Forty-five percent of participants reported daytime sleepiness. Participants reporting daytime sleepiness differed significantly from those without in gait speed (adjusted difference (standard error (SE)) -0.09 (0.04) m/s, P = .03), step width (adjusted difference (SE) 0.02 (0.01), P = .03), and self-reported balance confidence (adjusted difference (SE) -1.02 (0.38), P = .01) even after adjusting for covariates. Two-way analysis of variance of CNS medication use and daytime sleepiness showed no significant interaction effects. CONCLUSION Self-reported daytime sleepiness is associated with slower gait speed and poor balance confidence in community-dwelling older adults. Subjective sleep assessment should be considered when assessing balance and implementing interventions for improving balance in older adults. Further study is needed to examine the role of CNS medication use.
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Affiliation(s)
- Shachi Tyagi
- Division of Geriatrics and Gerontology, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Subashan Perera
- Division of Geriatrics and Gerontology, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jennifer S Brach
- Department of Physical Therapy, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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Zhang Z, VanSwearingen J, Brach JS, Perera S, Sejdić E. Most suitable mother wavelet for the analysis of fractal properties of stride interval time series via the average wavelet coefficient method. Comput Biol Med 2016; 80:175-184. [PMID: 27960102 DOI: 10.1016/j.compbiomed.2016.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 11/20/2016] [Accepted: 11/23/2016] [Indexed: 10/20/2022]
Abstract
Human gait is a complex interaction of many nonlinear systems and stride intervals exhibiting self-similarity over long time scales that can be modeled as a fractal process. The scaling exponent represents the fractal degree and can be interpreted as a "biomarker" of relative diseases. The previous study showed that the average wavelet method provides the most accurate results to estimate this scaling exponent when applied to stride interval time series. The purpose of this paper is to determine the most suitable mother wavelet for the average wavelet method. This paper presents a comparative numerical analysis of 16 mother wavelets using simulated and real fractal signals. Simulated fractal signals were generated under varying signal lengths and scaling exponents that indicate a range of physiologically conceivable fractal signals. The five candidates were chosen due to their good performance on the mean square error test for both short and long signals. Next, we comparatively analyzed these five mother wavelets for physiologically relevant stride time series lengths. Our analysis showed that the symlet 2 mother wavelet provides a low mean square error and low variance for long time intervals and relatively low errors for short signal lengths. It can be considered as the most suitable mother function without the burden of considering the signal length.
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Affiliation(s)
- Zhenwei Zhang
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Jessie VanSwearingen
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Jennifer S Brach
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Subashan Perera
- Department of Medicine, Division of Geriatrics, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Ervin Sejdić
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA 15261, USA.
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Brach JS, Perera S, Gilmore S, VanSwearingen JM, Brodine D, Wert D, Nadkarni NK, Ricci E. Stakeholder involvement in the design of a patient-centered comparative effectiveness trial of the "On the Move" group exercise program in community-dwelling older adults. Contemp Clin Trials 2016; 50:135-42. [PMID: 27521806 PMCID: PMC5035644 DOI: 10.1016/j.cct.2016.08.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 07/29/2016] [Accepted: 08/09/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Group exercise programs for older adults often exclude the timing and coordination of movement. Stakeholder involvement in the research process is strongly encouraged and improves the relevance and adoption of findings. We describe stakeholder involvement in the design of a clinical trial of a group-based exercise program that incorporates timing and coordination of movement into the exercises. METHODS The study was a cluster randomized, single-blind intervention trial to compare the effects on function, disability and mobility of a standard group exercise program and the "On the Move" group exercise program in older adults residing in independent living facilities and senior apartment buildings, and attending community centers. Exercise classes were twice weekly for 12weeks delivered by study exercise leaders and facility activity staff personnel. OUTCOMES The primary outcomes function, disability and mobility were assessed at baseline and post-intervention. Function and disability were assessed using the Late Life Function and Disability Instrument, and mobility using the Six-Minute Walk Test and gait speed. STAKEHOLDERS Patient and provider stakeholders had significant input into the study aims, design, sample, intervention, outcomes and operational considerations. SUMMARY A community-based exercise program to improve walking can be developed to address both investigator identified missing components in current exercise to improve walking and stakeholder defined needs and interest for the activity program. Involvement of stakeholders substantially improves the relevance of research questions, increases the transparency of research activities and may accelerate the adoption of research into practice.
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Affiliation(s)
- Jennifer S Brach
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, United States.
| | - Subashan Perera
- Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States; Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, United States
| | - Sandra Gilmore
- University of Pittsburgh Medical Center, Community Provider Services, Pittsburgh, PA, United States
| | | | - Deborah Brodine
- University of Pittsburgh Medical Center, Community Provider Services, Pittsburgh, PA, United States
| | - David Wert
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, United States
| | - Neelesh K Nadkarni
- Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Edmund Ricci
- Department of Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, PA, United States
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King WC, Brach JS, Belle S, Killingsworth R, Fenton M, Kriska AM. The Relationship between Convenience of Destinations and Walking Levels in Older Women. Am J Health Promot 2016; 18:74-82. [PMID: 13677965 DOI: 10.4278/0890-1171-18.1.74] [Citation(s) in RCA: 153] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose. To examine the relationship between physical activity and (1) convenience of destinations, measured by whether destinations (such as a park, trail, businesses, and services) are within walking distance of the home, and (2) participants' perception of the quality of their neighborhood surroundings for walking, captured with a global neighborhood “walkability” rating. Design. Cross-sectional analysis of data obtained in 1999. Setting. Community in southwest Pennsylvania. Subjects. Older Caucasian women (n = 149, mean age = 74.2 years). Response rate = 79%. Measures. Walking levels, leisure-time physical activity, and features of the neighborhood environment were measured with interviewer-administered questionnaires. Physical activity was also measured objectively with a pedometer. Results. Living within walking distance (defined as within a 20-minute walk of home) of a park; biking or walking trail; or department, discount, or hardware store was related to higher pedometer readings ( p < .01). In addition, there was a positive trend between the sum of destinations within walking distance of home and activity levels measured by pedometer and questionnaire ( p < .01). There was also a positive trend between participants' neighborhood “walkability” rating and activity levels measured by pedometer and questionnaire ( p < .01). Conclusion. These findings suggest that the ability to make utilitarian walking trips from home and the perception of having favorable neighborhood surroundings for walking are associated with increased physical activity levels in older women.
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Affiliation(s)
- Wendy C King
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15260, USA.
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