Use of a fracture prevention screening algorithm predicts self-reported falls in postmenopausal women

Background and Purpose: The prevention of falls and fall-related fractures following menopause is an important health initiative. The Fracture Prevention Screening Algorithm (FPSA) uniquely uses fracture risk to prompt fall risk assessment to classify both fall and fracture risk in individuals. The purpose of this study was to determine whether use of the FPSA accurately predicted self-reported falls in post-menopausal women over one year. Methods: 142 postmenopausal women were recruited. Based on Fracture Risk Assessment Tool (FRAX®) scores, women with a ≥3% 10-year probability of hip fracture (high risk), or who self-identified as having balance problems or a fall history, underwent the Functional Gait Assessment (FGA) to estimate fall risk (high risk = ≤22/30). This allowed classification on the FPSA into one of four risk categories: low fall/low fracture risk; low fall/high fracture risk; high fall/low fracture risk; high fall/high fracture risk. Participants were contacted monthly for one year to determine fall and injury occurrence. Results: Fall/injury surveillance was conducted with 136 subjects over one year. Compared to women in the low fall/low fracture risk group, both high fall risk groups demonstrated significantly greater fall rates. Falls were 81-89% more likely in women with FGA scores of 22/30 or less. All injuries were rare events across all risk strata and did not differ between risk groups. Conclusion: These findings support the use of fracture risk as a trigger for fall screening to comprehensively classify risk in post-menopausal women as proposed by the FPSA.

Screening postmenopausal women for fall and fracture prevention

Fragility fracture prevention has been historically associated with the diagnosis and treatment of osteoporosis. Given that the strongest determinant of fracture is falls, it is critical to add fall risk into clinical decision-making guidelines for fracture prevention. This special interest paper proposes an algorithm based on 2 validated tools: (1) World Health Organization's Fracture Risk Assessment Tool, which evaluates probability of fracture and (2) Functional Gait Assessment, which evaluates fall risk. Physical therapists can use this algorithm to better identify patients at greatest risk for fracture in order to customize interventions designed to promote bone health, minimize falls, and ultimately prevent fractures. Recommendations for referral, patient education, and exercise are provided for categories of varying fall and fracture risk.

Continence and quality-of-life outcomes 6 months following an intensive pelvic-floor muscle exercise program for female stress urinary incontinence: a randomized trial comparing low- and high-frequency maintenance exercise

BACKGROUND AND OBJECTIVES

Few studies have examined the effectiveness of pelvic-floor muscle (PFM) exercises to reduce female stress urinary incontinence (SUI) over the long term. This study: (1) evaluated continence and quality-of-life outcomes of women 6 months following formalized therapy and (2) determined whether low- and high-frequency maintenance exercise programs were equivalent in sustaining outcomes.

SUBJECTS AND METHODS

Thirty-six women with SUI who completed an intensive PFM exercise intervention trial were randomly assigned to perform a maintenance exercise program either 1 or 4 times per week. Urine leaks per week, volume of urine loss, quality of life (Incontinence Impact Questionnaire [IIQ] score), PFM strength (Brink score), and prevalence of urodynamic stress incontinence (USI) were measured at a 6-month follow-up for comparison with postintervention status. Parametric and nonparametric statistics were used to determine differences in outcome status over time and between exercise frequency groups.

RESULTS

Twenty-eight women provided follow-up data. Postintervention status was sustained at 6 months for all outcomes (mean [SD] urine leaks per week=1.2+/-2.1 versus 1.4+/-3.1; mean [SD] urine loss=0.2+/-0.5 g versus 0.2+/-0.8 g; mean [SD] IIQ score=17+/-20 versus 22+/-30; mean [SD] Brink score=11+/-1 versus 11+/-1; and prevalence of USI=48% versus 35%). Women assigned to perform exercises once or 4 times per week similarly sustained their postintervention status.

DISCUSSION AND CONCLUSION

Benefits of an initial intensive intervention program for SUI were sustained over 6 months. However, only 15 of the 28 women provided documentation of their exercise adherence, limiting conclusions regarding the need for continued PFM exercise during follow-up intervals of Collapse

Key Words Collapse

MESH Headings

• Adult
• Aged
• Exercise Therapy
• Female
• Humans
• Middle Aged
• Parity
• Patient Compliance
• Pelvic Floor/physiopathology
• Postmenopause
• Pregnancy
• Quality of Life
• Treatment Outcome
• Urinary Incontinence, Stress/rehabilitation

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Grants

• R15 AG15488-03 NIA NIH HHS

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Craniosacral therapy: the effects of cranial manipulation on intracranial pressure and cranial bone movement

STUDY DESIGN

Quasi-experimental design.

OBJECTIVES

To determine if physical manipulation of the cranial vault sutures will result in changes of the intracranial pressure (ICP) along with movement at the coronal suture.

BACKGROUND

Craniosacral therapy is used to treat conditions ranging from headache pain to developmental disabilities. However, the biological premise for this technique has been theorized but not substantiated in the literature.

METHODS

Thirteen adult New Zealand white rabbits (oryctolagus cuniculus) were anesthetized and microplates were attached on either side of the coronal suture. Epidural ICP measurements were made using a NeuroMonitor transducer. Distractive loads of 5, 10, 15, and 20 g (simulating a craniosacral frontal lift technique) were applied sequentially across the coronal suture. Baseline and distraction radiographs and ICP were obtained. One animal underwent additional distractive loads between 100 and 10,000 g. Plate separation was measured using a digital caliper from the radiographs. Two-way analysis of variance was used to assess significant differences in ICP and suture movement.

RESULTS

No significant differences were noted between baseline and distraction suture separation (F = 0.045; P>.05) and between baseline and distraction ICP (F = 0.279; P>.05) at any load. In the single animal that underwent additional distractive forces, movement across the coronal suture was not seen until the 500-g force, which produced 0.30 mm of separation but no corresponding ICP changes.

CONCLUSION

Low loads of force, similar to those used clinically when performing a craniosacral frontal lift technique, resulted in no significant changes in coronal suture movement or ICP in rabbits. These results suggest that a different biological basis for craniosacral therapy should be explored.

Effect of pelvic-floor muscle exercise position on continence and quality-of-life outcomes in women with stress urinary incontinence

BACKGROUND AND PURPOSE

Pelvic-floor muscle (PFM) exercises are effective in reducing stress urinary incontinence (SUI), but few studies have investigated the effect of specific exercise variables on treatment outcomes. This study explored the effect of exercise position on treatment outcomes in women with SUI.

SUBJECTS AND METHODS

Forty-four women were randomly assigned to exercise in the supine position only or in both supine and upright positions. Bladder diary, pad test, urodynamic test, quality-of-life (Incontinence Impact Questionnaire [IIQ]), and PFM strength outcomes were obtained at baseline and after treatment.

RESULTS

Exercise position did not affect outcomes. After data from both groups were collapsed, statistically significant improvements with treatment were observed in bladder diary, IIQ, PFM strength, and urodynamic test results.

DISCUSSION AND CONCLUSION

Exercise position did not differentially affect treatment outcomes. However, women in this study achieved a mean 67.9% reduction in the frequency of SUI episodes and improvements in other study outcomes.

Bone biology and the clinical implications for osteoporosis

Bone biology is a complex and vastly growing area of study. It brings together the traditional fields of anatomy, physiology, and biomechanics with the increasingly complex fields of developmental biology and molecular genetics. For clinicians who treat bone disorders such as osteoporosis, developing a working knowledge of this topic is essential. This article discusses bone from a structural, anatomical, and functional perspective. It reviews skeletogenesis as a developmental process and from a regulatory perspective and presents biomechanical principles and theories. Osteoporosis is reviewed, including recent literature related to the role of exercise in prevention and treatment of this disease.

The Spinal Cord Injury Functional Ambulation Inventory (SCI-FAI)

The development and testing of an observational gait assessment instrument, the Spinal Cord Injury Functional Ambulation Inventory (SCI-FAI) is described. To assess validity and reliability, 22 subjects with incomplete spinal cord injury were scored by four raters. Raters scored each subject three times, once live (LS) and twice from videotaped records (VS1, VS2). A moderate-good negative correlation (r = -0.742 and -0.700, for VS1 and VS2, respectively) was found between the gait score and time required to walk a demarcated path. Inter-rater reliability was moderate-good for the live score and the videotaped records (ICC = 0.703, 0.800, and 0.840, respectively). Intra-rater reliability was good (ICC = 0.903, 0.960, 0.942, and 0.850 for Raters 1-4, respectively). To assess sensitivity, another group of 19 subjects with SCI were assessed prior to and following participation in an intensive walking program. A moderate correlation was found between change in gait score and change in lower extremity strength (Pearson r = 0.58). These results indicate that the SCI-FAI is a reliable, valid and sensitive measure of walking ability in individuals with spinal cord injury. In addition, the results suggest that gait analysis using this instrument is equally reliable whether the observation is performed live or from videotaped records.