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Langston ME, Cawthon PM, Lu K, Scherzer R, Newman JC, Covinsky K, Ferrucci L, Simonsick EM, Bauer SR. Associations of Lower Extremity Muscle Strength, Area, and Specific Force With Lower Urinary Tract Symptoms in Older Men: The Baltimore Longitudinal Study of Aging. J Gerontol A Biol Sci Med Sci 2024; 79:glae008. [PMID: 38195151 PMCID: PMC11071681 DOI: 10.1093/gerona/glae008] [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: 04/15/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Lower urinary tract symptoms (LUTS) in older men are associated with an increased risk of mobility limitations. Lower extremity muscle quality may represent a novel shared mechanism of both LUTS and mobility limitations. METHODS We evaluated associations of thigh skeletal muscle measures (strength, area, and specific force) with total LUTS severity (American Urologic Association Symptom Index; AUASI) and voiding and storage subscores among 352 men aged ≥60 years enrolled in the Baltimore Longitudinal Study of Aging. Thigh muscle strength (Nm) was defined as maximum concentric 30°/s knee extensor torque, area (cm2), and specific force (Nm/cm2) defined as strength/area. Associations with AUASI score were estimated using multivariable linear regression and linear mixed models. RESULTS Mean thigh muscle strength at baseline was 139.7Nm. In cross-sectional multivariable models, each 39Nm increment in thigh muscle strength and 0.28Nm/cm2 increment in specific force was associated with -1.17 point (95% CI: -1.93 to -.41) and -0.95 point (95% CI: -1.63 to -0.27) lower AUASI score, respectively. Similar associations were observed for voiding and storage subscores, although somewhat attenuated. In longitudinal analyses, baseline muscle measures were not associated with annual change in AUASI, and current changes in muscle measures and AUASI were unrelated. CONCLUSIONS Cross-sectionally, higher thigh muscle strength and specific force were associated with decreased LUTS severity in older men. However, we did not observe concurrent worsening LUTS severity with declining thigh muscle strength, area, or specific force in longitudinal analyses.
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Affiliation(s)
- Marvin E Langston
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Palo Alto, California, USA
| | - Peggy M Cawthon
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
- Research Institute, California Pacific Medical Center, San Francisco, California, USA
| | - Kaiwei Lu
- Department of Medicine, University of California, San Francisco, California, USA
| | - Rebecca Scherzer
- Department of Medicine, University of California, San Francisco, California, USA
- San Francisco VA Medical Center, Division of General Internal Medicine, San Francisco, California, USA
| | - John C Newman
- Buck Institute for Research on Aging, Novato, California, USA
| | - Kenneth Covinsky
- Department of Medicine, University of California, San Francisco, California, USA
- San Francisco VA Medical Center, Division of General Internal Medicine, San Francisco, California, USA
| | - Luigi Ferrucci
- National Institute on Aging, Intramural Research Program, Baltimore, Maryland, USA
| | - Eleanor M Simonsick
- National Institute on Aging, Intramural Research Program, Baltimore, Maryland, USA
| | - Scott R Bauer
- San Francisco VA Medical Center, Division of General Internal Medicine, San Francisco, California, USA
- Department of Medicine, Urology, Epidemiology and Biostatistics, University of California, San Francisco, California, USA
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Bauer SR, Parker-Autry C, Lu K, Cummings SR, Hepple RT, Scherzer R, Covinsky K, Cawthon PM. Skeletal Muscle Health, Physical Performance, and Lower Urinary Tract Symptoms in Older Adults: The Study of Muscle, Mobility, and Aging. J Gerontol A Biol Sci Med Sci 2024; 79:glad218. [PMID: 37694941 PMCID: PMC11083634 DOI: 10.1093/gerona/glad218] [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: 04/13/2023] [Indexed: 09/12/2023] Open
Abstract
BACKGROUND Lower urinary tract symptoms (LUTS) and mobility limitations are bidirectionally associated among older adults, but the role of skeletal muscle remains unknown. We evaluated cross-sectional associations of muscle health and physical performance with LUTS. METHODS We used data from 377 women and 264 men aged >70 years in the Study of Muscle, Mobility and Aging (SOMMA). LUTS and urinary bother were assessed using the LURN Symptom Index-10 (SI-10; higher = worse symptoms). Muscle mass and volume were assessed using D3-creatine dilution (D3Cr) and magnetic resonance imaging. Grip strength and peak leg power assessed upper/lower extremity physical performance. 400-m walk, Short Physical Performance Battery (SPPB), and Four Square Step Test (FSST) assessed global physical performance. Mobility Assessment Tool-short form (MAT-sf) assessed self-reported mobility. We calculated Spearman correlation coefficients adjusted for age, body mass index, multimorbidity, and polypharmacy, chi-square tests, and Fisher's Z-test to compare correlations. RESULTS Among women, LURN SI-10 total scores were inversely correlated with FSST (rs = 0.11, p = .045), grip strength (rs = -0.15, p = .006), and MAT-sf (rs = -0.18, p = .001), but not other muscle and physical performance measures in multivariable models. LURN SI-10 was not associated with any of these measures among men. Forty-four percent of women in the lowest tertile of 400-m walk speed versus 24% in the highest tertile reported they were at least "somewhat bothered" by urinary symptoms (p < .001), whereas differences among men were not significant. CONCLUSIONS Balance and grip strength were associated with LUTS severity in older women but not men. Associations with other muscle and physical performance measures varied by LUTS subtype but remained strongest among women.
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Affiliation(s)
- Scott R Bauer
- Department of Medicine, University of California and the San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
- Department of Urology, University of California, San Francisco, California, USA
| | - Candace Parker-Autry
- Department of Urology, Section on Female Pelvic Health, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Kaiwei Lu
- Department of Urology, Section on Female Pelvic Health, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Steven R Cummings
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Russell T Hepple
- Department of Physical Therapy, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
| | - Rebecca Scherzer
- Department of Medicine, University of California and the San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Kenneth Covinsky
- Department of Medicine, University of California and the San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA
| | - Peggy M Cawthon
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
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Savio SD, Kawiyana IKS, Wiratnaya IGE, Sumadi IWJ, Suyasa IK. Low Hand Grip Strength, Mid-Upper Arm Muscle Area, Calf Circumference, Serum Albumin Level, and Muscle Fiber Diameter as Risk Factors for Independent Walking Inability in Patients with Hip Fracture 6 Weeks after Bipolar Hemiarthroplasty Surgery. Clin Orthop Surg 2024; 16:230-241. [PMID: 38562634 PMCID: PMC10973617 DOI: 10.4055/cios23256] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/06/2023] [Accepted: 11/20/2023] [Indexed: 04/04/2024] Open
Abstract
Background Bipolar hemiarthroplasty, one of the main treatment modalities for hip fracture, does not always promise the ability to walk independently after surgery. Patients with the same fracture characteristics and comorbidities, implants, and operators may also have different outcomes. Sarcopenia is thought to be one of the causes of the inability to walk independently after this operation; however, it has not been widely studied and is often overlooked. Methods This study used a case-control design with 23 patients in the case group (patients unable to walk independently) and 23 patients in the control group (patients able to walk independently). Sampling was carried out consecutively according to the inclusion and exclusion criteria based on the medical records of patients with hip fractures after bipolar hemiarthroplasty at our hospital. In the preoperative period, hand grip strength (HGS), mid-upper arm muscle area (MUAMA), calf circumference (CC), serum albumin level, and total lymphocyte count were measured. A muscle biopsy was performed intraoperatively from the gluteus muscle with the amount of 200-350 mg. The patient's walking ability was assessed in the polyclinic using the Timed Up and Go test 6 weeks postoperatively. The statistical tests used were descriptive statistics, proportion comparison analysis with the chi-square test, and multiple logistic regression test. Results Univariate analysis using chi-square test proved HGS, MUAMA, CC, serum albumin level, and muscle fiber diameter as risk factors for inability to walk independently 6 weeks after bipolar hemiarthroplasty (p = 0.003, p = 0.003, p = 0.006, p = 0.044, and p = 0.000, respectively). Logistic regression test proved 3 direct risk factors for the inability to walk independently 6 weeks after bipolar hemiarthroplasty, namely MUAMA, serum albumin level, and muscle fiber diameter, as the strongest predictive factor (adjusted odds ratio, 63.12). Conclusions Low MUAMA, serum albumin levels, and muscle fiber diameter are direct risk factors for the inability to walk independently in hip fracture patients 6 weeks after bipolar hemiarthroplasty.
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Affiliation(s)
- Sherly Desnita Savio
- Department of Orthopaedics and Traumatology, Faculty of Medicine Udayana University, Prof. Dr. IGNG Ngoerah General Hospital, Denpasar, Indonesia
| | - I Ketut Siki Kawiyana
- Department of Orthopaedics and Traumatology, Faculty of Medicine Udayana University, Prof. Dr. IGNG Ngoerah General Hospital, Denpasar, Indonesia
| | - I Gede Eka Wiratnaya
- Department of Orthopaedics and Traumatology, Faculty of Medicine Udayana University, Prof. Dr. IGNG Ngoerah General Hospital, Denpasar, Indonesia
| | - I Wayan Juli Sumadi
- Department of Anatomical Pathology, Faculty of Medicine Udayana University, Prof. Dr. IGNG Ngoerah General Hospital, Denpasar, Indonesia
| | - I Ketut Suyasa
- Department of Orthopaedics and Traumatology, Faculty of Medicine Udayana University, Prof. Dr. IGNG Ngoerah General Hospital, Denpasar, Indonesia
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Rhim HC, Ward RE, Travison TG, Latham N, Bean JF. Defining Clinically Meaningful Cut Points for Leg Power Impairment Using Physical Performance in Older Adults: A Secondary Analysis From Boston RISE. Arch Phys Med Rehabil 2024; 105:690-695. [PMID: 37769931 PMCID: PMC10965500 DOI: 10.1016/j.apmr.2023.09.010] [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] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 09/05/2023] [Accepted: 09/06/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVE To identify clinically meaningful thresholds of leg power impairment identified by the stair climb power test (SCPT). DESIGN Cross-sectional analysis using the baseline data from an observational cohort study. SETTING The Boston Rehabilitative Impairment Study of the Elderly. PARTICIPANTS Community-dwelling older adults (N=413). MAIN OUTCOME MEASURES SCPT and the Short Physical Performance Battery (SPPB). RESULTS Using the receiver operating characteristic curves and Youden's J statistics, the optimal threshold for the SCPT associated with mobility limitation as defined by an SPPB score ≤9 was 3.07 Watts/kg for men with a sensitivity of 74%, a specificity of 73% and, an area under the curve (AUC) value of 0.78. For women, the optimal threshold was 2.59 Watts/kg with a sensitivity of 83%, a specificity of 69%, and an AUC value of 0.81. The classification and regression tree sensitivity analysis demonstrated similar thresholds, 2.88 Watts/kg and 2.53 Watts/kg for men and women, respectively. CONCLUSIONS The study identified clinically meaningful thresholds of impairment for the SCPT for mobility limited older primary care patients. These thresholds may be used to inform rehabilitation care to improve functional mobility of older adults and should be validated in larger more representative clinical trials.
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Affiliation(s)
- Hye Chang Rhim
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA 02115; Spaulding Rehabilitation Hospital, Charlestown, MA
| | - Rachel E Ward
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA 02115; New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, MA; Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, MA
| | - Thomas G Travison
- Center for Analytic Sciences in Aging, Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, MA
| | - Nancy Latham
- Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Jonathan F Bean
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA 02115; Spaulding Rehabilitation Hospital, Charlestown, MA; New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, MA.
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Batista PP, Perracini MR, do Carmo Correia de Lima M, de Amorim JSC, Pereira DS, Pereira LSM. Risk of sarcopenia and mobility of older adults during the COVID-19 pandemic: the longitudinal data from the REMOBILIZE study. Aging Clin Exp Res 2024; 36:80. [PMID: 38546804 PMCID: PMC10978643 DOI: 10.1007/s40520-024-02720-y] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 02/01/2024] [Indexed: 04/01/2024]
Abstract
BACKGROUND We assessed whether clinical, functional and behavioral factors were associated with the decrease in mobility trajectories reported in older people at risk of sarcopenia (RS) and without risk of sarcopenia (NRS) during COVID-19 pandemic. METHODS We prospectively analyzed mobility trajectories reported in older adults with RS and NRS over 16-month follow-up (Remobilize study). The self-perceived risk of sarcopenia and mobility were assessed using the SARC-F and the Life-Space Assessment (LSA) tools, respectively. Gender, age, comorbidities, pain, functional limitation, physical activity (time spent in walking; min/week), and sitting time (ST; hours/day) were assessed. We used a multilevel model to determine changes in mobility between groups and over time. RESULTS Mobility was lower in RS than in NRS. Older people at RS, who were women, aged 70-79 years and 80 years or older, inactive, and with moderate to severe functional limitation experienced reduced mobility trajectories reported over the pandemic. For older people at NRS, trajectories with reduce mobility reported were experienced by women with comorbidities, for those with insufficient walking time and aged 70-79 years; aged 70-79 years and with ST between 5 and 7 hours/day; for those with insufficient walking time and increased ST; and for those with pain and increased ST. CONCLUSION Mobility trajectories reported in older people at risk of sarcopenia were negatively influenced by insufficient level of physical inactivity and pre-existing moderate to severe functional limitation. Health and social interventions should be target to avoid mobility limitation during and after the COVID-19 pandemic.
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Affiliation(s)
- Patricia Parreira Batista
- Postgraduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais (UFMG), Av. Pres. Antônio Carlos, 6.627. Pampulha, Belo Horizonte, MG, Brazil.
| | - Monica Rodrigues Perracini
- Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo, SP, Brazil
- Master's and Doctoral Programs in Gerontology, Faculty of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
| | - Maria do Carmo Correia de Lima
- Master's and Doctoral Programs in Gerontology, Faculty of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
| | | | - Daniele Sirineu Pereira
- Postgraduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais (UFMG), Av. Pres. Antônio Carlos, 6.627. Pampulha, Belo Horizonte, MG, Brazil
| | - Leani Souza Máximo Pereira
- Postgraduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais (UFMG), Av. Pres. Antônio Carlos, 6.627. Pampulha, Belo Horizonte, MG, Brazil
- Postgraduate Program in Health Sciences, Faculdade Ciências Médicas de Minas Gerais (FCMMG), Belo Horizonte, MG, Brazil
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Hong I, Norman RS, Woo HS, Jin Y, Reistetter TA. Dysphagia and Functional Limitations Among Adults in the United States: Findings from the 2022 National Health Interview Survey. Dysphagia 2024:10.1007/s00455-024-10680-8. [PMID: 38502346 DOI: 10.1007/s00455-024-10680-8] [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: 09/19/2023] [Accepted: 02/01/2024] [Indexed: 03/21/2024]
Abstract
Dysphagia or swallowing dysfunction is associated with reduced quality of life and poor long term outcomes. While standard dysphagia treatment focuses on improving swallowing function, it is not clear if people with dysphagia also have difficulties performing daily tasks. This study aimed to determine if individuals with dysphagia had difficulties with participating in daily tasks requiring physical function, as compared to those with no dysphagia. We conducted a secondary data analysis using the responses of 24,107 adults aged 18 years or older who completed the 2022 National Health Interview Survey. The independent variable was report of swallowing problem during the past 12 months, and the dependent variables were report of difficulty in physical function tasks (e.g., self-care, mobility, working, social participation). We utilized propensity score methods to balance demographic and clinical variables between groups, and examined if individuals with dysphagia had more difficulties with the physical function tasks. The propensity score methods balanced the demographic and clinical variables (absolute standardized differences < 0.1). People with dysphagia had significantly higher odds ratios (ranged from 1.23 to 1.70, all p < 0.05) of having difficulties in physical function tasks than those without dysphagia. The findings revealed an association between experiencing dysphagia and encountering difficulties in self-care, mobility, working, and social participation in the general adult population in the US. Results of our study indicate that during the course of rehabilitation, healthcare professionals should consider the potential impact of dysphagia symptoms on clients' ability to partake in independent activities in their community settings.
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Affiliation(s)
- Ickpyo Hong
- Department of Occupational Therapy, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju, Korea
| | - Rocío S Norman
- Department of Communication Sciences and Disorders, University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - Hee-Soon Woo
- Department of Occupational Therapy, Wonkwang University, Iksan, Korea.
| | - Yeonju Jin
- Graduate School, Yonsei University, Wonju, Korea
| | - Timothy A Reistetter
- Department of Occupational Therapy, University of Texas Health Science Center San Antonio, San Antonio, TX, USA
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Ramos IR, Santos JS, Pires Dos Santos MC, da Silva DF, Alves IGN, Neto MG, Martinez BP. Development, reliability, and validity of the mobility assessment scale in hospitalized patients (HMob). Braz J Phys Ther 2024; 28:101047. [PMID: 38522390 PMCID: PMC10973779 DOI: 10.1016/j.bjpt.2024.101047] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 11/03/2023] [Accepted: 02/22/2024] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND Existing mobility scales for hospitalized patients do not include assessment of tasks for the right and left side, ability to transfer from sitting to lying and from standing to sitting, ability to climbing steps and pick up an object from the floor in the same instrument. OBJECTIVE Evaluate the reliability and validity of the hospital mobility assessment scale (HMob) according to the Consensus-based standards for the selection of health measurement instruments (COSMIN). METHODS Study conducted in three inpatient units (cardiology, neurology, and gastrohepatology) and one adult intensive care unit in a hospital. Patients of both sexes were included; age >18 years; collaborative and who obeyed commands, with different medical diagnoses and clinical release to leave their bed (provided by the doctor). Special populations such as those with burns and orthopedics were excluded. RESULTS The sample consisted of 130 patients; 20 from the pilot study and 110 to assess the clinimetric properties of the HMob. Cronbach alpha coefficient was 0.949. Relative intra- (A1-A2) and inter-rater (A1-B; A2-B) reliability was excellent (A1-A2: ICC = 0.982, p-value < 0.0001; A1-B: ICC = 0.993, p-value < 0.0001; A2-B: ICC = 0.986, p-value < 0.0001.) The convergent criterion validity of HMob in relation to the ICU Functional Status Score was 0.967 (p-value < 0.0001) and for Functional Independence measure (MIF) was 0.926 (p-value < 0.0001). CONCLUSION The HMob scale showed excellent internal consistency, intra- and inter-rater reliability, and concurrent validity in the motor domain, which suggests that it can be used in daily practice to measure mobility in hospitalized patients.
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Affiliation(s)
- Isis Resende Ramos
- Program in Medicine and Health, Universidade Federal da Bahia (UFBA), Salvador, Bahia, Brazil
| | - Joice Sousa Santos
- Course in Physical Therapy, Universidade Federal da Bahia (UFBA), Salvador, Bahia, Brazil
| | | | | | - Iura Gonzalez Nogueira Alves
- Course in Physical Therapy, Universidade Federal da Bahia (UFBA), Salvador, Bahia, Brazil; Department of Medicine, Escola Bahiana de Medicina e Saúde Pública (EBMSP), Salvador, Bahia, Brazil
| | - Mansueto Gomes Neto
- Program in Medicine and Health, Universidade Federal da Bahia (UFBA), Salvador, Bahia, Brazil; Course in Physical Therapy, Universidade Federal da Bahia (UFBA), Salvador, Bahia, Brazil
| | - Bruno Prata Martinez
- Program in Medicine and Health, Universidade Federal da Bahia (UFBA), Salvador, Bahia, Brazil; Course in Physical Therapy, Universidade Federal da Bahia (UFBA), Salvador, Bahia, Brazil; Department of Physical Therapy, Universidade do Estado da Bahia (UNEB), Salvador, Bahia, Brazil.
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Wang G, Zhou Y, Zhang L, Li J, Liu P, Li Y, Ma L. Prevalence and incidence of mobility limitation in Chinese older adults: evidence from the China health and retirement longitudinal study. J Nutr Health Aging 2024; 28:100038. [PMID: 38280833 DOI: 10.1016/j.jnha.2024.100038] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/04/2024] [Accepted: 01/04/2024] [Indexed: 01/29/2024]
Abstract
BACKGROUND Mobility limitation, a manifestation of impaired intrinsic capacity, is the first obvious sign of functional decline. However, few studies have been conducted on the prevalence and incidence of mobility limitation. This study aimed to estimate the prevalence and incidence of mobility limitation in Chinese older adults (over 60 years old) and evaluate its impact on mortality. METHODS The study used two waves of data from China Health and Retirement Longitudinal Study (CHARLS) in 2011 and 2013. The prevalence and incidence of mobility limitation were assessed using the methods recommended by the World Health Organization in the integrated care for older people guidelines, using the five-time sit-to-stand test as a screening and then the Short Physical Performance Battery assessment for diagnosis. Multivariable logistic regression was used to analyze the association between mobility limitation and death. RESULTS Of the 5507 participants with complete baseline data, 1486 had limited mobility, and 4021 had intact mobility at baseline; 4093 participants completed follow-up assessment 2 years later, and 189 died between the baseline and follow-up assessments. Of the 2828 participants with intact mobility at baseline who completed the follow-up mobility assessment, 408 developed mobility limitation. The standardized prevalence was 30.4% (95% CI = 28.8-32.1 %). The standardized incidence of mobility limitation in 2 years was 18.1% (95% CI = 15.8-20.4 %). A total of 189 patients died during the follow-up period. After adjusting for sociodemographic factors and chronic diseases, mobility limitation was associated with an increased risk of death (odds ratio = 1.84, 95% CI = 1.33-2.55, P < .001). CONCLUSIONS The standardized prevalence of mobility limitation in Chinese older adults living in the community was 30.4%, and the standardized incidence was 18.1%. Mobility limitation significantly predicts 2-year death in older adults. This suggests that early screening, assessment of intrinsic capacity (particularly locomotion domain) as well as tailored interventions to tackle mobility limitation in older adults might reduce mortality.
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Affiliation(s)
- Guanzhen Wang
- Department of Geriatrics, Xuanwu Hospital Capital Medical University, National Clinical Research Center for Geriatric Disorders, Beijing, China
| | - Yaru Zhou
- Department of Geriatrics, Xuanwu Hospital Capital Medical University, National Clinical Research Center for Geriatric Disorders, Beijing, China
| | - Li Zhang
- Department of Geriatrics, Xuanwu Hospital Capital Medical University, National Clinical Research Center for Geriatric Disorders, Beijing, China
| | - Jiatong Li
- Department of Geriatrics, Xuanwu Hospital Capital Medical University, National Clinical Research Center for Geriatric Disorders, Beijing, China
| | - Pan Liu
- Department of Geriatrics, Xuanwu Hospital Capital Medical University, National Clinical Research Center for Geriatric Disorders, Beijing, China
| | - Yun Li
- Department of Geriatrics, Xuanwu Hospital Capital Medical University, National Clinical Research Center for Geriatric Disorders, Beijing, China.
| | - Lina Ma
- Department of Geriatrics, Xuanwu Hospital Capital Medical University, National Clinical Research Center for Geriatric Disorders, Beijing, China.
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Suto A, Fujii K, Nakatani T, Ogawa K, Ichihara T, Li S, Sato K, Miura K, Funayama T, Yamazaki M. Correlation between preoperative CT scan of the paraspinal, psoas, and gluteus muscles and postoperative ambulatory status in patients with femoral neck fractures. BMC Musculoskelet Disord 2024; 25:132. [PMID: 38347481 PMCID: PMC10860248 DOI: 10.1186/s12891-024-07251-1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 02/02/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND This study aimed to investigate the relationship between femoral neck fractures and sarcopenia. METHODS This was a retrospective analysis of 92 patients with femoral neck fractures, from September 2017 to March 2020, who were classified into high ambulatory status (HG) and low ambulatory status (LG) groups. Ambulatory status was assessed before surgery, one week after surgery, at discharge, and during the final follow-up. To evaluate sarcopenia, muscle mass and fatty degeneration of the muscles were measured using preoperative CT. An axial slice of the superior end of the L5 vertebra was used to evaluate the paraspinal and psoas muscles, a slice of the superior end of the femoral head for the gluteus maximus muscle, and a slice of the inferior end of the sacroiliac joint for the gluteus medius muscle. The degeneration of the muscles was evaluated according to the Goutallier classification. RESULTS The cross-sectional area of the gluteus medius and paraspinal muscles was significantly correlated with ambulatory status before the injury, at discharge, and during the final follow-up. CONCLUSIONS Measurement of the gluteus medius and paraspinal muscles has the potential to evaluate sarcopenia and predict ambulatory status after femoral neck fractures.
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Affiliation(s)
- Akihito Suto
- Department of Orthopaedic Surgery, Showa General Hospital, 8-1-1 Hanakoganei, Kodaira, Tokyo, Japan
| | - Kengo Fujii
- Department of Orthopaedic Surgery, Showa General Hospital, 8-1-1 Hanakoganei, Kodaira, Tokyo, Japan
| | - Takushi Nakatani
- Department of Orthopaedic Surgery, Showa General Hospital, 8-1-1 Hanakoganei, Kodaira, Tokyo, Japan
| | - Kaishi Ogawa
- Department of Orthopaedic Surgery, Showa General Hospital, 8-1-1 Hanakoganei, Kodaira, Tokyo, Japan
| | - Takumi Ichihara
- Department of Orthopaedic Surgery, Showa General Hospital, 8-1-1 Hanakoganei, Kodaira, Tokyo, Japan
| | - Sayori Li
- Department of Orthopaedic Surgery, Showa General Hospital, 8-1-1 Hanakoganei, Kodaira, Tokyo, Japan
| | - Kosuke Sato
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 3058575, Japan
| | - Kousei Miura
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 3058575, Japan
| | - Toru Funayama
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 3058575, Japan.
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 3058575, Japan
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Hanff AM, Pauly C, Pauly L, Rauschenberger A, Leist AK, Krüger R, Zeegers MP, McCrum C. Determinants of patient-reported functional mobility in people with Parkinson's disease: A systematic review. Gait Posture 2024; 108:97-109. [PMID: 38029483 DOI: 10.1016/j.gaitpost.2023.11.013] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 08/27/2023] [Accepted: 11/19/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Information on determinants of patient-reported functional mobility is lacking but would inform the planning of healthcare, resources and strategies to promote functional mobility in people with Parkinson's disease (PD). RESEARCH QUESTION To identify the determinants of patient-reported functional mobility of people with PD. METHODS Eligible: Randomized Controlled Trials, cohort, case-control, or cross-sectional analyses in people PD without date or setting restrictions, published in English, German, or French. Excluded: instruments with under 50 % of items measuring mobility. On August 9th 2023 we last searched Medline, CINAHL and PsychInfo. We assessed risk of bias using the mixed-methods appraisal tool. Results were synthesized by tabulating the determinants by outcomes and study designs. RESULTS Eleven studies published 2012-2023 were included (most in Swedish outpatient settings). Samples ranged from 9 to 255 participants. Follow-up varied from 1.5 to 36 months with attrition of 15-42 %. Heterogenic study designs complicated results synthesis. However, determinants related to environment seem to associate the strongest with patient-reported functional mobility, although determinants related to body structures and functions were most investigated. We identified disease duration, the ability to drive, caregiving, sex, age, cognitive impairment, postural instability and social participation as determinants of patient-reported functional mobility. DISCUSSION Methodological quality of the studies was limited. No study reported an a priori power calculation. Three studies controlled for confounders. The included studies lack representativeness of the population of people living with PD. Standardized sets of outcomes could enable more systematic research synthesis. CONCLUSIONS Future research should focus on activities, participation and environmental factors and improve methodological quality.
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Affiliation(s)
- Anne-Marie Hanff
- Transversal Translational Medicine, Luxembourg Institute of Health, Strassen, Luxembourg; Faculty of Science, Technology and Medicine, University of Luxembourg, Esch-sur-Alzette, Luxembourg; Department of Epidemiology, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre+, Maastricht, the Netherlands; Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, the Netherlands.
| | - Claire Pauly
- Translational Neuroscience, Luxembourg Centre for Systems Biomedicine, University of Luxembourg, Esch-sur-Alzette, Luxembourg; Parkinson Research Clinic, Centre Hospitalier de Luxembourg, Strassen, Luxembourg.
| | - Laure Pauly
- Transversal Translational Medicine, Luxembourg Institute of Health, Strassen, Luxembourg; Faculty of Science, Technology and Medicine, University of Luxembourg, Esch-sur-Alzette, Luxembourg; Translational Neuroscience, Luxembourg Centre for Systems Biomedicine, University of Luxembourg, Esch-sur-Alzette, Luxembourg; Parkinson Research Clinic, Centre Hospitalier de Luxembourg, Strassen, Luxembourg.
| | - Armin Rauschenberger
- Biomedical Data Science, Luxembourg Centre for Systems Biomedicine, University of Luxembourg, Esch-sur-Alzette, Luxembourg.
| | - Anja K Leist
- Department of Social Sciences, Faculty of Humanities, Education and Social Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg.
| | - Rejko Krüger
- Transversal Translational Medicine, Luxembourg Institute of Health, Strassen, Luxembourg; Translational Neuroscience, Luxembourg Centre for Systems Biomedicine, University of Luxembourg, Esch-sur-Alzette, Luxembourg; Parkinson Research Clinic, Centre Hospitalier de Luxembourg, Strassen, Luxembourg.
| | - Maurice P Zeegers
- Department of Epidemiology, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre+, Maastricht, the Netherlands; Department of Epidemiology, NUTRIM School of Nutrition and Translational Research in Metabolism, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands.
| | - Christopher McCrum
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, the Netherlands; Department of Rehabilitation Sciences, Neurorehabilitation Research Group, KU Leuven, Leuven, Belgium.
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11
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Werner C, Bauknecht L, Heldmann P, Hummel S, Günther-Lange M, Bauer JM, Hauer K. Mobility outcomes and associated factors of acute geriatric care in hospitalized older patients: results from the PAGER study. Eur Geriatr Med 2024; 15:139-152. [PMID: 37777992 PMCID: PMC10876756 DOI: 10.1007/s41999-023-00869-9] [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: 07/15/2023] [Accepted: 09/13/2023] [Indexed: 10/03/2023]
Abstract
PURPOSE To examine distinct mobility outcomes (locomotor capacity, physical activity, life-space mobility) of acute geriatric care (AGC) in acutely hospitalized older adults and identify predictors associated with these outcomes. METHODS The PAGER study was designed as a prospective observational study. Mobility outcomes of 107 hospitalized older patients (age = 83.2 ± 6.4 years, female: n = 68, 63.6%) receiving AGC were measured at hospital admission and discharge. Locomotor capacity was assessed with the Short Physical Performance Battery (SPPB), 24-h physical activity (step count) with an activity monitor, and life-space mobility with the Life-Space Assessment in Institutionalized Settings (LSA-IS). Baseline demographical, clinical, physical, cognitive, and psychological characteristics were analyzed as candidate predictors of mobility outcomes. RESULTS SPPB (median [interquartile range] 4.0 [2.8-5.0] pt. vs. 5.0 [3.0-6.3] pt.), step count (516 [89-1806] steps vs. 1111 [228-3291] steps), and LSA-IS total score (10.5 [6.0-15.0] pt. vs. 16.3 [12.0-24.1] pt.) significantly improved during AGC (all p < 0.001). Adjusting for baseline status, frailty was identified as an independent negative predictor of SPPB, step count, and LSA-IS at discharge (p = 0.003-0.005). Barthel Index was also independently positively associated with step count (p = 0.017) at discharge, as was the mean daily PA level with SPPB (p = 0.027) at discharge, both independent of baseline status. CONCLUSION AGC improves distinct mobility outcomes in hospitalized older patients. Frailty was consistently found to be an independent negative predictor of all mobility outcomes. Frailty assessment in AGC may be important to identify patients at risk for decreased treatment gains in mobility. Early PA promotion in AGC seems to be beneficial in improving patients' locomotor capacity.
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Affiliation(s)
- Christian Werner
- Geriatric Center, Heidelberg University Hospital, Agaplesion Bethanien Hospital Heidelberg, Rohrbacher Str. 149, 69216, Heidelberg, Germany.
| | - Laura Bauknecht
- Medical Faculty Heidelberg, Heidelberg University, Im Neuenheimer Feld 672, 69120, Heidelberg, Germany
| | - Patrick Heldmann
- Network Aging Research (NAR), Heidelberg University, Bergheimer Str. 20, 69115, Heidelberg, Germany
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801, Bochum, Germany
| | - Saskia Hummel
- Medical Faculty Heidelberg, Heidelberg University, Im Neuenheimer Feld 672, 69120, Heidelberg, Germany
| | - Michaela Günther-Lange
- Geriatric Center, Heidelberg University Hospital, Agaplesion Bethanien Hospital Heidelberg, Rohrbacher Str. 149, 69216, Heidelberg, Germany
| | - Jürgen M Bauer
- Geriatric Center, Heidelberg University Hospital, Agaplesion Bethanien Hospital Heidelberg, Rohrbacher Str. 149, 69216, Heidelberg, Germany
- Network Aging Research (NAR), Heidelberg University, Bergheimer Str. 20, 69115, Heidelberg, Germany
| | - Klaus Hauer
- Geriatric Center, Heidelberg University Hospital, Agaplesion Bethanien Hospital Heidelberg, Rohrbacher Str. 149, 69216, Heidelberg, Germany
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstraße 110, 70376, Stuttgart, Germany
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Parsaei M, Amanollahi M, TaghaviZanjani F, Khanmohammadi S, Jameie M, Naser Moghadasi A. Effects of non-pharmacological interventions on gait and balance of persons with Multiple Sclerosis: A narrative review. Mult Scler Relat Disord 2024; 82:105415. [PMID: 38211505 DOI: 10.1016/j.msard.2023.105415] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 12/15/2023] [Accepted: 12/27/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND Multiple Sclerosis (MS) is among the most common reasons for disability in young adults. Mobility impairment, primarily related to gait and balance, is ranked as the preeminent concern among persons with MS (PwMS). Gait and balance dysfunction can directly affect the quality of life and activities of daily life in PwMS, hence the importance of effective treatment strategies. Previous studies have demonstrated the positive effect of various non-pharmacological rehabilitation methods, including physiotherapy and electrical stimulation, on gait and mobility in PwMS. Non-pharmacological methods can be tailored to the individual needs and abilities of each patient, allowing healthcare providers to create personalized training programs. Furthermore, these methods typically result in minimal or no side effects. PURPOSE This review provides a comprehensive overview of an array of non-pharmacological treatment approaches aimed at enhancing ambulatory performance in PwMS. METHODS We performed a narrative review of the original papers available in PubMed, investigating the effects of different nonmedical approaches on the gait and balance performance of the PwMS. Reviewed treatment approaches include "exercise, physical rehabilitation, dual-task (DT) rehabilitation, robot-assisted rehabilitation, virtual reality-assisted rehabilitation, game training, electrical stimulation devices, auditory stimulation, visual feedback, and shoe insoles". RESULTS AND CONCLUSIONS Eighty articles were meticulously reviewed. Our study highlights the positive effects of non-pharmacological interventions on patients' quality of life, reducing disability, fatigue, and muscle spasticity. While some methods, including exercise and physiotherapy, showed substantial promise, further research is needed to evaluate whether visual biofeedback and auditory stimulation are preferable over conventional approaches. Additionally, approaches such as functional electrical stimulation, non-invasive brain stimulation, and shoe insoles demonstrate substantial short-term benefits, prompting further investigation into their long-term effects. Non-pharmacological interventions can serve as a valuable complement to medication-based approaches.
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Affiliation(s)
- Mohammadamin Parsaei
- Maternal, Fetal, and Neonatal Research Center, Family Health Research Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Mobina Amanollahi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Melika Jameie
- Neuroscience Research Center, Iran University of Medical Sciences, Tehran, Iran; Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Abdorreza Naser Moghadasi
- Multiple Sclerosis Research Center, Neuroscience Institute, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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Zhang ZY, Huang L, Gao M, Zhang TQ, Zhang FY, Yi J, Liu ZL. Parallel-Forms Reliability and Minimal Detectable Change of the Four Telerehabilitation Version Mobility-Related Function Scales in Stroke Survivors. Arch Phys Med Rehabil 2024:S0003-9993(24)00059-5. [PMID: 38307318 DOI: 10.1016/j.apmr.2024.01.016] [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: 08/15/2023] [Revised: 11/25/2023] [Accepted: 01/15/2024] [Indexed: 02/04/2024]
Abstract
OBJECTIVE To investigate the parallel-forms reliability, minimal detectable change with 95% confidence interval (MDC95), and feasibility of the 4 telerehabilitation version mobility-related function scales: Fugl-Meyer Assessment-lower extremity subscale (Tele-FMA-LE), Berg Balance Scale (Tele-BBS), Tinetti Performance Oriented Mobility Assessment-Gait subscale (Tele-POMA-G), and Rivermead Mobility Index (Tele-RMI). DESIGN Reliability and agreement study and cross-sectional study. SETTING Medical center. PARTICIPANTS Stroke survivors' ability to independently walk 3 meters with assistive devices, age of ≥18 years for participants and their partners, stable physical condition, and absence of cognitive impairment (N=60). INTERVENTIONS Not applicable. MAIN OUTCOMES MEASURES Parallel-forms reliability and MDC95 of Tele-FMA-LE, Tele-BBS, Tele-POMA-G, and Tele-RMI. RESULTS No significant differences (P>.05) were observed among the mean scores of the telerehabilitation version and face-to-face version mobility-related function scales. Intraclass correlation coefficients (ICCs) indicated good reliability for most scales, with Tele-FMA-LE, Tele-BBS, and Tele-RMI scores achieving values of 0.81, 0.78, and 0.84. Tele-POMA-G scores demonstrated moderate reliability (ICC=0.72). Weighted kappa (κw) showed good-to-excellent reliability for most individual items (κw>0.60). The MDCs of the Tele-FMA-LE, Tele-BBS, Tele-POMA-G, and Tele-RMI were 5.84, 8.10, 2.74, and 1.31, respectively. Bland-Altman analysis showed adequate agreement between tele-assessment and face-to-face assessment for all scales. The 5 dimensions affirm the robust feasibility of tele-assessment: assessment time, subjective fatigue perception, overall preference, participant satisfaction, and system usability. CONCLUSIONS The study demonstrates good parallel-forms reliability, MDC, and promising feasibility of the 4 telerehabilitation version mobility-related function scales (Tele-FMA-LE, Tele-BBS, Tele-POMA-G, and Tele-RMI) in survivors of stroke.
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Affiliation(s)
- Zhi-Yuan Zhang
- Department of Rehabilitation Medicine, The Second Hospital of Jilin University, Chang Chun, China
| | - Lu Huang
- Department of Rehabilitation Medicine, The Second Hospital of Jilin University, Chang Chun, China
| | - Min Gao
- Department of Rehabilitation Medicine, The Second Hospital of Jilin University, Chang Chun, China
| | - Tian-Qi Zhang
- Department of Rehabilitation Medicine, The Second Hospital of Jilin University, Chang Chun, China
| | - Feng-Yue Zhang
- Department of Rehabilitation Medicine, The Second Hospital of Jilin University, Chang Chun, China
| | - Jiang Yi
- Department of Rehabilitation Medicine, The Second Hospital of Jilin University, Chang Chun, China
| | - Zhong-Liang Liu
- Department of Rehabilitation Medicine, The Second Hospital of Jilin University, Chang Chun, China.
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Seth M, Horne JR, Pohlig RT, Sions JM. Pain, Balance-Confidence, Functional Mobility, and Reach Are Associated With Risk of Recurrent Falls Among Adults With Lower-Limb Amputation. Arch Rehabil Res Clin Transl 2023; 5:100309. [PMID: 38163037 PMCID: PMC10757173 DOI: 10.1016/j.arrct.2023.100309] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
Objective The study evaluated whether pain intensity and extent, balance-confidence, functional mobility, and balance (eg, functional reach) are potential risk factors for recurrent falls among adults with a lower-limb amputation. Design Cross-sectional study. Setting Research laboratory. Participants Eighty-three adults with unilateral lower-limb amputation that occurred >1 year prior (26 transfemoral- and 57 transtibial-level amputation; 44.6% women; 51.8% traumatic cause of amputation; N=83). Intervention Not applicable. Main Outcome Measures Participants reported on the number of falls in the past year, as well as pain intensity in the low back, residual, and sound limbs. Balance-confidence (per the Activities-Specific Balance-Confidence Scale [ABC]), functional mobility (per the Prosthetic Limb Users Survey of Mobility ([PLUS-M]), and balance (per the Functional Reach and modified Four Square Step Tests) were obtained. Results After considering non-modifiable covariates, greater extent of pain, less balance-confidence, worse self-reported mobility, and reduced prosthetic-side reach were factors associated with recurrent fall risk. Adults reporting pain in the low back and both lower-limbs had 6.5 times the odds of reporting recurrent falls as compared with peers without pain. A 1-point increase in ABC score or PLUS-M T score, or 1-cm increase in prosthetic-side reaching distance, was associated with a 7.3%, 9.4%, and 7.1% decrease in odds of reporting recurrent falls in the past year, respectively. Conclusions Of the 83 adults, 36% reported recurrent falls in the past year. Presence of pain in the low back and both lower-limbs, less balance-confidence, worse PLUS-M score, and less prosthetic-side reaching distance were identified as modifiable factors associated with an increased odd of recurrent falls.
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Affiliation(s)
- Mayank Seth
- Department of Physical Therapy, Delaware Limb Loss Studies, University of Delaware, Newark, DE
- Children's Specialized Hospital, Research Department, Union, NJ
| | | | - Ryan Todd Pohlig
- Biostatistics Core, University of Delaware, Newark, DE
- Epidemiology Program, University of Delaware, Newark, DE
| | - Jaclyn Megan Sions
- Department of Physical Therapy, Delaware Limb Loss Studies, University of Delaware, Newark, DE
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Wagner V, Gravesen P, Ghaziani E, Olsen MH, Riberholt CG. Mapping physical activity patterns in hospitalised patients with moderate to severe acquired brain injury - MAP-ABI: Protocol for an observational study. Heliyon 2023; 9:e21927. [PMID: 38034693 PMCID: PMC10682202 DOI: 10.1016/j.heliyon.2023.e21927] [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: 02/09/2023] [Revised: 08/28/2023] [Accepted: 10/31/2023] [Indexed: 12/02/2023] Open
Abstract
Introduction The physical activity level in patients hospitalised for rehabilitation across multiple diagnoses is low. Moderate to severe acquired brain injury further reduces activity levels as impaired physical and cognitive functioning affect mobility independence. Therefore, supervised out-of-bed mobilisation and physical activity training are essential rehabilitation strategies. Few studies have measured the physical activity patterns in the early phases of rehabilitation after moderate to severe brain injury. Objectives To map and quantify physical activity patterns in patients admitted to brain injury rehabilitation. Further, to investigate which factors are associated with activity and if the early physical activity level is associated with functional outcome at discharge. Methods This observational study includes patients admitted to rehabilitation after moderate to severe acquired brain injury. Mobility and physical activity patterns are measured continuously during rehabilitation at two separate seven-day periods using a wearable activity tracker. Activity will be categorised into four levels and presented descriptively. Linear and logistic regression models will analyse associations between descriptive variables and activity levels. Discussion This protocol describes an observational study investigating patients' mobility and physical activity patterns with moderate to severe acquired brain injury during in-hospital rehabilitation. The ability to increase the amount of mobilisation and physical activity in subgroups may have profound consequences on the rehabilitation outcome. Furthermore, data from this study may be used to inform a large variety of trials investigating physical rehabilitation interventions. (NCT05571462).
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Affiliation(s)
- Vibeke Wagner
- Department of Brain and Spinal Cord Injury, The Neuroscience Centre, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
| | - Pi Gravesen
- Department of Brain and Spinal Cord Injury, The Neuroscience Centre, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
| | - Emma Ghaziani
- Department of Brain and Spinal Cord Injury, The Neuroscience Centre, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
| | - Markus Harboe Olsen
- Department of Neuroanaesthesiology, The Neuroscience Centre, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
| | - Christian Gunge Riberholt
- Department of Brain and Spinal Cord Injury, The Neuroscience Centre, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
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Kim H, Kim J, Ha J. Factors influencing mobility in community-dwelling older adults during the early COVID-19 pandemic: a cross-sectional study. BMC Public Health 2023; 23:1649. [PMID: 37641017 PMCID: PMC10464251 DOI: 10.1186/s12889-023-16553-3] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 08/17/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND In older adults, mobility is important for maintaining their independence and quality of life, and it influences their physical, cognitive, and social health. This study aimed to identify the physical and psychosocial factors that affected the mobility of community-dwelling older adults, aged 65 years or older, who were socially isolated during the coronavirus disease 2019 (COVID-19) pandemic due to stay-at-home policies. METHODS The participants in this study were 214 community-dwelling older adults in Korea, and a cross-sectional survey was conducted from December 2020 to January 2021. Variables included participants' general characteristics, mobility, sitting time, depression, social support, and cognitive function. RESULTS Multiple linear regression analysis showed that the factors influencing older adults' mobility during the COVID-19 pandemic were depression (β=-0.29, p < .001), age (65-74 years old) (β = 0.19, p = .002), a lower level of education (β=-0.17, p = .006), two or more comorbidities (β=-0.18, p = .001), sitting time (β=-0.17, p = .004), and the ability to drive a vehicle (β = 0.14, p = .017). CONCLUSIONS Home healthcare interventions are needed to limit psychosocial issues and improve mobility for older adults who had limited mobility during the COVID-19 pandemic.
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Affiliation(s)
- Hyori Kim
- College of Nursing, Seoul National University, Seoul, Republic of Korea
| | - Juah Kim
- Department of Nursing, Korean Bible University, Seoul, Republic of Korea
| | - Jiyeon Ha
- College of Nursing, Research Institute of Nursing Science, Ajou University, 164 World cup-ro, Yeongtong-gu, Suwon-si, 16499, Gyeonggi-do, Republic of Korea.
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Wang G, Zhang L, Ji T, Zhang W, Peng L, Shen S, Liu X, Shi Y, Chen X, Chen Q, Li Y, Ma L. A protocol for randomized controlled trial on multidisciplinary interventions for mobility limitation in the older adults (M-MobiLE). BMC Geriatr 2023; 23:476. [PMID: 37553604 PMCID: PMC10410791 DOI: 10.1186/s12877-023-04117-4] [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: 11/07/2022] [Accepted: 06/16/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Mobility limitation-the loss of exercise capacity or independent living ability-is a common geriatric syndrome in older adults. As a potentially reversible precursor to disability, mobility limitation is influenced by various factors. Moreover, its complex physiological mechanism hinders good therapeutic outcomes with a single-factor intervention. Most hospitals have not incorporated the diagnosis and evaluation of mobility limitation into medical routines nor developed a multidisciplinary team (MDT) treatment plan. We aim to conduct a clinical trial titled "A Multidisciplinary-team approach for management of Mobility Limitation in Elderly (M-MobiLE)" to explore the effect of the MDT decision-making intervention for mobility limitation. METHODS The M-MobiLE study will be a multicenter, randomized, and controlled trial. We will recruit a minimum of 66 older inpatients with mobility limitation from at least five hospitals. Older patients with mobility limitation admitted to the geriatrics department will be included. Short-Physical Performance Battery (SPPB), Activities of Daily Living (ADL), Function Impairment Screening Tool (FIST), Geriatric Depression Scale (GDS-15), Short Form - 12 (SF-12), Fried frailty phenotype, social frailty, Morse Fall Risk Scale, SARC-CalF, Mini-Mental State Examination (MMSE), Mini-Nutritional Assessment Short-Form (MNA-SF), and intrinsic capacity will be assessed. The intervention group will receive an exercise-centered individualized MDT treatment, including exercise, educational, nutritional, medical, and comorbidity interventions; the control group will receive standard medical treatment. The primary outcome is the change in the SPPB score, and the secondary outcomes include increased SF-12, ADL, FIST, MMSE, MNA-SF, and intrinsic capacity scores and decreased GDS-15 and SARC-CalF scores. CONCLUSION Our results will help develop a multidisciplinary decision-making clinical pathway for inpatients with mobility limitation, which can be used to identify patients with mobility limitation more effectively, improve mobility, and reduce the risk of falls, frailty, and death in older inpatients. The implementation of this MDT strategy may standardize the treatment of mobility limitation, reduce adverse prognosis, and improve quality of life. TRIAL REGISTRATION ChiCTR, ChiCTR2200056756, Registered 19 February 2022.
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Affiliation(s)
- Guanzhen Wang
- Department of Geriatrics, National Clinical Research Center for Geriatric Disorders, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Li Zhang
- Department of Geriatrics, National Clinical Research Center for Geriatric Disorders, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Tong Ji
- Department of Geriatrics, National Clinical Research Center for Geriatric Disorders, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Wanshu Zhang
- Department of Geriatrics, National Clinical Research Center for Geriatric Disorders, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Linlin Peng
- Department of Geriatrics, Xiangya Hospital Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Shanshan Shen
- Department of Geriatrics, Zhejiang hospital, Hangzhou, China
| | - Xiaolei Liu
- Department of Geriatrics, West China Hospital Sichuan University, Chengdu, China
| | - Yanqing Shi
- Department of Geriatrics, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xujiao Chen
- Department of Geriatrics, Zhejiang hospital, Hangzhou, China
| | - Qiong Chen
- Department of Geriatrics, Xiangya Hospital Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Yun Li
- Department of Geriatrics, National Clinical Research Center for Geriatric Disorders, Xuanwu Hospital Capital Medical University, Beijing, China.
| | - Lina Ma
- Department of Geriatrics, National Clinical Research Center for Geriatric Disorders, Xuanwu Hospital Capital Medical University, Beijing, China.
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Ahiawodzi P, Buzkova P, Lichtenstein A, Matthan N, Ix J, Kizer J, Tracy R, Arnold A, Newman A, Siscovick D, Djousse L, Mukamal K. The Associations of Individual and Subclasses of Nonesterified Fatty Acids With Disability, and Mobility Limitation in Older Adults: The Cardiovascular Health Study. J Gerontol A Biol Sci Med Sci 2023; 78:1155-1163. [PMID: 36156076 PMCID: PMC10329219 DOI: 10.1093/gerona/glac206] [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: 03/22/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We sought to determine the associations between individual nonesterified fatty acids (NEFAs) and disability and mobility limitation. METHODS We studied 1 734 participants in the Cardiovascular Health Study (CHS), an ongoing population-based cohort study of community-living older American adults. We measured 35 individual NEFA species in fasting serum samples obtained at the 1996-1997 clinic visit. Using yearly assessments of activities of daily living and self-reported mobility, we identified participants with incident disability or mobility limitation during 15 years of follow-up. Cox proportional hazards regression models were used to determine the associations between per SD increment in the individual NEFAs and incident disability and mobility limitations with adjustment for potential confounding factors. RESULTS Higher concentrations of total and a broad range of individual NEFA species were associated with risk of disability and mobility limitation (disability: HR per SD of total NEFA [SD = 174.70] = 1.11, 95% CI = 1.04-1.18, p = .001; mobility limitation: HR per SD of total NEFA = 1.09, 95% CI = 1.02-1.16, p = .01). Among individual saturated NEFAs (SFAs), myristic (14:0) and palmitic (16:0) acids were significantly associated with higher risk of both disability and mobility limitations, but longer-chain FAs were not. Most individual monounsaturated (MUFA), n-6 polyunsaturated fatty acids (PUFAs), and trans FAs were positively significantly associated with higher risks of both disability and mobility limitation. In contrast, most n-3 PUFA species were not associated with disability or mobility limitation. CONCLUSIONS Higher risks of disability and mobility limitation were observed for proinflammatory intermediate-chain SFAs, MUFAs, n-6 PUFAs, and trans FAs. Our findings indicated no significant association for anti-inflammatory n-3 PUFAs.
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Affiliation(s)
- Peter D Ahiawodzi
- Department of Public Health, Campbell University College of Pharmacy and Health Sciences, Buies Creek, North Carolina, USA
| | - Petra Buzkova
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Alice H Lichtenstein
- Cardiovascular Nutrition Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts, USA
| | - Nirupa R Matthan
- Cardiovascular Nutrition Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts, USA
| | - Joachim H Ix
- Divisions of Nephrology-Hypertension, University of California, San Diego, La Jolla, California, USA
| | - Jorge R Kizer
- Cardiology Section, San Francisco VA Health Care System, and Department of Medicine, Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California,USA
| | - Russell P Tracy
- Department of Pathology and Biochemistry, University of Vermont College of Medicine, Burlington, Vermont, USA
| | - Alice Arnold
- Department of a Biostatistics, University of Washington, Seattle, Washington, USA
| | - Anne B Newman
- Departments of Epidemiology and Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - David Siscovick
- Division of Research, Evaluation and Policy, The New York Academy of Medicine, New York, New York, USA
| | - Luc Djousse
- Division of Aging, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Kenneth J Mukamal
- Division of General Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
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Ferreira AP, Furtado SRC, Carceroni LL, Amâncio GPDO, Zuba PP, Pereira HMB, Pereira DAG. Variation in sociodemographic, clinical and functional characteristics of patients with chronic venous insufficiency in a single public health center. J Vasc Nurs 2023; 41:72-76. [PMID: 37356873 DOI: 10.1016/j.jvn.2023.05.001] [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: 08/31/2022] [Revised: 04/16/2023] [Accepted: 05/03/2023] [Indexed: 06/27/2023]
Abstract
OBJECTIVES Describe and analyze the sociodemographic, clinical and functional characteristics of individuals with chronic venous insufficiency (CVI) and compare the clinical severity with levels of mobility. METHODS Exploratory cross-sectional study in a single public health center. The study cohort comprised 99 individuals. INTERVENTIONS Clinical, sociodemographic and physical activity level questionnaires were applied; we also evaluated ankle amplitude and sural triceps function. Descriptive statistics, independent t test and one-way ANOVA with post hoc Least Significant Difference (LSD) were performed. RESULTS Ninety-nine participants (87.9% woman) with an average age with an average age of 60.6 ± 14 years who where recruited to the study. The cohort was composed of individuals were moderately active, 80% exhibited symptoms of the disease and approximately 40% reported reduced mobility. Individuals who had reduced mobility and less physical activity showed reduced ankle amplitude and muscle function (p <0.05). CONCLUSION CVI impacts on functional capacity, even in individuals with less severe disease.
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Affiliation(s)
- Ana Paula Ferreira
- Universidade Federal de Minas Gerais - UFMG, Department of Physical Therapy, Graduate Program in Rehabilitation Sciences, Belo Horizonte, MG, Brazil; Faculty of Medical and Health Sciences (SUPREMA), Juiz de Fora, MG, Brazil
| | - Sheyla Rossana Cavalcanti Furtado
- Universidade Federal de Minas Gerais - UFMG, Department of Physical Therapy, Graduate Program in Rehabilitation Sciences, Belo Horizonte, MG, Brazil
| | | | | | - Priscila Penasso Zuba
- Multiprofessional Health Residency - Clinical Hospital, Universidade Federal de Minas Gerais - UFMG, MG, Brazil
| | | | - Danielle Aparecida Gomes Pereira
- Universidade Federal de Minas Gerais - UFMG, Department of Physical Therapy, Graduate Program in Rehabilitation Sciences, Belo Horizonte, MG, Brazil.
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20
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Hinrichs T, Rössler R, Infanger D, Weibel R, Schär J, Peters EM, Portegijs E, Rantanen T, Schmidt-Trucksäss A, Engelter ST, Peters N. Self-reported life-space mobility in the first year after ischemic stroke: longitudinal findings from the MOBITEC-Stroke project. J Neurol 2023:10.1007/s00415-023-11748-5. [PMID: 37140729 PMCID: PMC10157571 DOI: 10.1007/s00415-023-11748-5] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/24/2023] [Accepted: 04/26/2023] [Indexed: 05/05/2023]
Abstract
BACKGROUND Life-space mobility is defined as the size of the area in which a person moves about within a specified period of time. Our study aimed to characterize life-space mobility, identify factors associated with its course, and detect typical trajectories in the first year after ischemic stroke. METHODS MOBITEC-Stroke (ISRCTN85999967; 13/08/2020) was a cohort study with assessments performed 3, 6, 9 and 12 months after stroke onset. We applied linear mixed effects models (LMMs) with life-space mobility (Life-Space Assessment; LSA) as outcome and time point, sex, age, pre-stroke mobility limitation, stroke severity (National Institutes of Health Stroke Scale; NIHSS), modified Rankin Scale, comorbidities, neighborhood characteristics, availability of a car, Falls Efficacy Scale-International (FES-I), and lower extremity physical function (log-transformed timed up-and-go; TUG) as independent variables. We elucidated typical trajectories of LSA by latent class growth analysis (LCGA) and performed univariate tests for differences between classes. RESULTS In 59 participants (mean age 71.6, SD 10.0 years; 33.9% women), mean LSA at 3 months was 69.3 (SD 27.3). LMMs revealed evidence (p ≤ 0.05) that pre-stroke mobility limitation, NIHSS, comorbidities, and FES-I were independently associated with the course of LSA; there was no evidence for a significant effect of time point. LCGA revealed three classes: "low stable", "average stable", and "high increasing". Classes differed with regard to LSA starting value, pre-stroke mobility limitation, FES-I, and log-transformed TUG time. CONCLUSION Routinely assessing LSA starting value, pre-stroke mobility limitation, and FES-I may help clinicians identify patients at increased risk of failure to improve LSA.
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Affiliation(s)
- Timo Hinrichs
- Division of Sport and Exercise Medicine, Department of Sport, Exercise, and Health, University of Basel, Grosse Allee 6, 4052, Basel, Switzerland.
| | - Roland Rössler
- Division of Sport and Exercise Medicine, Department of Sport, Exercise, and Health, University of Basel, Grosse Allee 6, 4052, Basel, Switzerland
- Basel Mobility Center, University Department of Geriatric Medicine Felix Platter, University of Basel, Basel, Switzerland
| | - Denis Infanger
- Division of Sport and Exercise Medicine, Department of Sport, Exercise, and Health, University of Basel, Grosse Allee 6, 4052, Basel, Switzerland
| | - Robert Weibel
- Department of Geography, University of Zurich, Zurich, Switzerland
- University Research Priority Program (URPP) Dynamics of Healthy Aging, University of Zurich, Zurich, Switzerland
| | - Janine Schär
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine Felix Platter, University of Basel, Basel, Switzerland
- Neurology and Stroke Center, Klinik Hirslanden, Zurich, Switzerland
| | - Eva-Maria Peters
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine Felix Platter, University of Basel, Basel, Switzerland
| | - Erja Portegijs
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Taina Rantanen
- Faculty of Sport and Health Sciences and Gerontology Research Center, University of Jyvaskyla, Jyväskylä, Finland
| | - Arno Schmidt-Trucksäss
- Division of Sport and Exercise Medicine, Department of Sport, Exercise, and Health, University of Basel, Grosse Allee 6, 4052, Basel, Switzerland
| | - Stefan T Engelter
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine Felix Platter, University of Basel, Basel, Switzerland
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Nils Peters
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine Felix Platter, University of Basel, Basel, Switzerland
- Neurology and Stroke Center, Klinik Hirslanden, Zurich, Switzerland
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
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21
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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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22
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Karpusenko T, Alfonsi M, Cirino NTDO, Ishigaki EY, Sanudo A, Paschoal SMP, Leme LEG, Perracini MR. Factors associated with unrecovered falls among older adults. Geriatr Nurs 2023; 51:323-329. [PMID: 37084686 DOI: 10.1016/j.gerinurse.2023.03.010] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 03/12/2023] [Accepted: 03/14/2023] [Indexed: 04/23/2023]
Abstract
This cross-sectional exploratory study investigated factors associated with unrecovered falls among older patients with a history of falls in the previous year participating in a clinical trial on fall prevention by asking them about their inability to get up independently after the fall. Participants' sociodemographic, clinical, functional (ADL/IADL, TUG, chair-stand test, hand grip, risk of falling) and fall location were investigated. We conducted a multivariate regression analysis adjusted for covariates to identify the main factors associated with unrecovered falls. Out of 715 participants (mean age: 73.4 years; 86% women), 51.6% (95% IC; 47.9 - 55.3%) experienced unrecovered falls. Depressive symptoms, ADL/IADL limitation, mobility limitation, undernutrition, and outdoor falls were associated with unrecovered falls. While assessing the risk of falling, professionals should consider preventive strategies and preparedness procedures for those who are more likely to experience unrecovered falls, such as training to get up from the floor, alarms, and support services.
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Affiliation(s)
- Tatiana Karpusenko
- PrevQuedas Brazil Research Group, Faculty of Medicine, Universidade de São Paulo, Rua Dr. Ovídio Pires de Campos, 333, Cerqueira Cesar, Zip code: 05403-010, São Paulo, Brazil
| | - Maynara Alfonsi
- PrevQuedas Brazil Research Group, Faculty of Medicine, Universidade de São Paulo, Rua Dr. Ovídio Pires de Campos, 333, Cerqueira Cesar, Zip code: 05403-010, São Paulo, Brazil.
| | - Nayara Tasse de Oliveira Cirino
- PrevQuedas Brazil Research Group, Faculty of Medicine, Universidade de São Paulo, Rua Dr. Ovídio Pires de Campos, 333, Cerqueira Cesar, Zip code: 05403-010, São Paulo, Brazil; Department of Physical Therapy, Universidade de Cuiabá, Avenida Virgílio Favetti, 1200, Zip code: 78.306-211, Tangará da Serra, Mato Grosso, Brazil
| | - Erika Yukie Ishigaki
- PrevQuedas Brazil Research Group, Faculty of Medicine, Universidade de São Paulo, Rua Dr. Ovídio Pires de Campos, 333, Cerqueira Cesar, Zip code: 05403-010, São Paulo, Brazil; Centro Universitário Faculdade de Medicina do ABC, Avenida Lauro Gomes, 2000, Zip code: 09060-870, Santo André, Brazil.
| | - Adriana Sanudo
- PrevQuedas Brazil Research Group, Faculty of Medicine, Universidade de São Paulo, Rua Dr. Ovídio Pires de Campos, 333, Cerqueira Cesar, Zip code: 05403-010, São Paulo, Brazil; Department of Preventive Medicine, Universidade Federal de São Paulo, Rua Botucatu, 740, Zip code: 04023-062, São Paulo, Brazil
| | - Sergio Marcio Pacheco Paschoal
- PrevQuedas Brazil Research Group, Faculty of Medicine, Universidade de São Paulo, Rua Dr. Ovídio Pires de Campos, 333, Cerqueira Cesar, Zip code: 05403-010, São Paulo, Brazil
| | - Luiz Eugênio Garcez Leme
- PrevQuedas Brazil Research Group, Faculty of Medicine, Universidade de São Paulo, Rua Dr. Ovídio Pires de Campos, 333, Cerqueira Cesar, Zip code: 05403-010, São Paulo, Brazil; Institute of Orthopedics and Traumatology, Faculty of Medicine, Universidade de São Paulo, Rua Dr. Ovídio Pires de Campos, 333, Cerqueira Cesar, Zip code: 05403-010, São Paulo, Brazil.
| | - Monica Rodrigues Perracini
- PrevQuedas Brazil Research Group, Faculty of Medicine, Universidade de São Paulo, Rua Dr. Ovídio Pires de Campos, 333, Cerqueira Cesar, Zip code: 05403-010, São Paulo, Brazil; Master's and Doctoral Programs in Physical Therapy, Rua Cesáreo Galeno, 448, Zip code: 03071-000, São Paulo, Brazil; Master's and Doctoral Programs in Gerontology, Rua Tessália Vieira de Camargo, 126, Zip code: 13083-887, Campinas, Brazil.
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23
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Reijnierse EM, Geelen SJG, van der Schaaf M, Visser B, Wüst RCI, Pijnappels M, Meskers CGM. Towards a core-set of mobility measures in ageing research: The need to define mobility and its constructs. BMC Geriatr 2023; 23:220. [PMID: 37024827 PMCID: PMC10080758 DOI: 10.1186/s12877-023-03859-5] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 02/28/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND Mobility is a key determinant and outcome of healthy ageing but its definition, conceptual framework and underlying constructs within the physical domain may need clarification for data comparison and sharing in ageing research. This study aimed to (1) review definitions and conceptual frameworks of mobility, (2) explore agreement on the definition of mobility, conceptual frameworks, constructs and measures of mobility, and (3) define, classify and identify constructs. METHODS A three-step approach was adopted: a literature review and two rounds of expert questionnaires (n = 64, n = 31, respectively). Agreement on statements was assessed using a five-point Likert scale; the answer options 'strongly agree' or 'agree' were combined. The percentage of respondents was subsequently used to classify agreements for each statement as: strong (≥ 80%), moderate (≥ 70% and < 80%) and low (< 70%). RESULTS A variety of definitions of mobility, conceptual frameworks and constructs were found in the literature and among respondents. Strong agreement was found on defining mobility as the ability to move, including the use of assistive devices. Multiple constructs and measures were identified, but low agreements and variability were found on definitions, classifications and identification of constructs. Strong agreements were found on defining physical capacity (what a person is maximally capable of, 'can do') and performance (what a person actually does in their daily life, 'do') as key constructs of mobility. CONCLUSION Agreements on definitions of mobility, physical capacity and performance were found, but constructs of mobility need to be further identified, defined and classified appropriately. Clear terminology and definitions are essential to facilitate communication and interpretation in operationalising the physical domain of mobility as a prerequisite for standardisation of mobility measures.
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Affiliation(s)
- Esmee M Reijnierse
- Department of Rehabilitation Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Ageing & Vitality, Amsterdam, The Netherlands
- Centre of Expertise Urban Vitality, Faculty of Sports and Nutrition, Amsterdam University of Applied Sciences, Dokter Meurerlaan 8, Amsterdam, 1067 SM, The Netherlands
| | - Sven J G Geelen
- Amsterdam Movement Sciences, Ageing & Vitality, Amsterdam, The Netherlands
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands
| | - Marike van der Schaaf
- Amsterdam Movement Sciences, Ageing & Vitality, Amsterdam, The Netherlands
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam Movement Sciences, Amsterdam University of Applied Sciences, Tafelbergweg 51, Amsterdam, 1105 BD, The Netherlands
| | - Bart Visser
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam Movement Sciences, Amsterdam University of Applied Sciences, Tafelbergweg 51, Amsterdam, 1105 BD, The Netherlands
| | - Rob C I Wüst
- Amsterdam Movement Sciences, Ageing & Vitality, Amsterdam, The Netherlands
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, Amsterdam, 1081 BT, The Netherlands
| | - Mirjam Pijnappels
- Amsterdam Movement Sciences, Ageing & Vitality, Amsterdam, The Netherlands
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, Amsterdam, 1081 BT, The Netherlands
| | - Carel G M Meskers
- Department of Rehabilitation Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands.
- Amsterdam Movement Sciences, Ageing & Vitality, Amsterdam, The Netherlands.
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24
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Hoyer EH, Friedman M, Lavezza A, Flanagan E, Kumble S, D'Alessandro M, Gutierrez M, Colantuoni E, Brotman DJ, Young DL. A unit-based, multi-center evaluation of adopting mobility measures and daily mobility goals in the hospital setting. Appl Nurs Res 2023; 70:151655. [PMID: 36933900 DOI: 10.1016/j.apnr.2022.151655] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 10/10/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Promoting patient mobility helps improve patient outcomes, but mobility status is not widely tracked nor do patients have specific individualized mobility goals. PURPOSE We evaluated nursing adoption of mobility measures and daily mobility goal achievement using the Johns Hopkins Mobility Goal Calculator (JH-MGC), a tool to guide an individualized patient mobility goal based on the level of mobility capacity. METHOD Built on a translating research into practice framework, the Johns Hopkins Activity and Mobility Promotion (JH-AMP) program was the vehicle to promote use of the mobility measures and the JH-MGC. We evaluated a large-scale implementation effort of this program on 23 units across two medical centers. FINDINGS Units significantly improved documentation compliance to mobility measures and achieving daily mobility goals. Units with the highest documentation compliance rates had higher rates of daily mobility goal achievement, especially for longer distance ambulation goals. DISCUSSION The JH-AMP program improved adoption of mobility status tracking and higher nursing inpatient mobility levels.
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Affiliation(s)
- Erik H Hoyer
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD, USA.
| | - Michael Friedman
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Annette Lavezza
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Eleni Flanagan
- Department of Nursing, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Sowmya Kumble
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Morning Gutierrez
- Department of Nursing, The Johns Hopkins Bayview Medical Campus, Baltimore, MD, USA
| | - Elizabeth Colantuoni
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Daniel J Brotman
- Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Daniel L Young
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Physical Therapy, University of Nevada Las Vegas, Las Vegas, NV, USA
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25
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Rössler R, Rommers N, Kim EK, Iendra L, Sofios A, Giannouli E, Portegijs E, Rantanen T, Infanger D, Bridenbaugh S, Engelter ST, Schmidt-Trucksäss A, Weibel R, Peters N, Hinrichs T. Timed up-and-go performance is associated with objectively measured life space in patients 3 months after ischemic stroke: a cross-sectional observational study. J Neurol 2023; 270:1999-2009. [PMID: 36547716 PMCID: PMC9772599 DOI: 10.1007/s00415-022-11524-x] [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: 11/16/2022] [Revised: 12/07/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Stroke is a common cause of mobility limitation, including a reduction in life space. Life space is defined as the spatial extent in which a person moves within a specified period of time. We aimed to analyze patients' objective and self-reported life space and clinical stroke characteristics. METHODS MOBITEC-Stroke is a prospective observational cohort study addressing poststroke mobility. This cross-sectional analysis refers to 3-month data. Life space was assessed by a portable tracking device (7 consecutive days) and by self-report (Life-Space Assessment; LSA). We analysed the timed up-and-go (TUG) test, stroke severity (National Institutes of Health Stroke Scale; NIHSS), and the level of functional outcome (modified Rankin Scale; mRS) in relation to participants' objective (distance- and area-related life-space parameters) and self-reported (LSA) life space by multivariable linear regression analyses, adjusted for age, sex, and residential area. RESULTS We included 41 patients, mean age 70.7 (SD11.0) years, 29.3% female, NIHSS score 1.76 (SD1.68). We found a positive relationship between TUG performance and maximum distance from home (p = 0.006), convex hull area (i.e. area enclosing all Global Navigation Satellite System [GNSS] fixes, represented as a polygon linking the outermost points; p = 0.009), perimeter of the convex hull area (i.e. total length of the boundary of the convex hull area; p = 0.008), as well as the standard ellipse area (i.e. the two-dimensional ellipse containing approximately 63% of GNSS points; p = 0.023), in multivariable regression analyses. CONCLUSION The TUG, an easily applicable bedside test, seems to be a useful indicator for patients' life space 3 months poststroke and may be a clinically useful measure to document the motor rehabilitative process.
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Affiliation(s)
- Roland Rössler
- Department of Sport, Exercise, and Health, University of Basel, Grosse Allee 6, 4052, Basel, Switzerland.
- Basel Mobility Center, Department of Geriatric Medicine Felix Platter, Basel, Switzerland.
| | - Nikki Rommers
- Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Eun-Kyeong Kim
- Department of Geography, University of Zurich, Zurich, Switzerland
- University Research Priority Program (URPP) Dynamics of Healthy Aging, University of Zurich, Zurich, Switzerland
- Department of Urban Development and Mobility, Luxembourg Institute of Socio-Economic Research (LISER), Esch-sur-Alzette, Luxembourg
| | - Laura Iendra
- Neurology und Neurorehabilitation, University Department of Geriatric Medicine Felix Platter, Basel, Switzerland
- Department of Neurology & Stroke Center, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Alexander Sofios
- Department of Geography, University of Zurich, Zurich, Switzerland
- University Research Priority Program (URPP) Dynamics of Healthy Aging, University of Zurich, Zurich, Switzerland
| | - Eleftheria Giannouli
- Department of Sport, Exercise, and Health, University of Basel, Grosse Allee 6, 4052, Basel, Switzerland
- Department of Health Sciences & Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland
| | - Erja Portegijs
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Taina Rantanen
- Faculty of Sport and Health Sciences & Gerontology Research Center, University of Jyvaskyla, Jyvaskyla, Finland
| | - Denis Infanger
- Department of Sport, Exercise, and Health, University of Basel, Grosse Allee 6, 4052, Basel, Switzerland
| | - Stephanie Bridenbaugh
- Basel Mobility Center, Department of Geriatric Medicine Felix Platter, Basel, Switzerland
| | - Stefan T Engelter
- Neurology und Neurorehabilitation, University Department of Geriatric Medicine Felix Platter, Basel, Switzerland
- Department of Neurology & Stroke Center, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Arno Schmidt-Trucksäss
- Department of Sport, Exercise, and Health, University of Basel, Grosse Allee 6, 4052, Basel, Switzerland
| | - Robert Weibel
- Department of Geography, University of Zurich, Zurich, Switzerland
| | - Nils Peters
- Neurology und Neurorehabilitation, University Department of Geriatric Medicine Felix Platter, Basel, Switzerland
- Department of Neurology & Stroke Center, University Hospital Basel, University of Basel, Basel, Switzerland
- Neurology and Stroke Center, Klinik Hirslanden, Zurich, Switzerland
| | - Timo Hinrichs
- Department of Sport, Exercise, and Health, University of Basel, Grosse Allee 6, 4052, Basel, Switzerland
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26
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Hsu TH, Tsai CL, Chi JY, Hsu CY, Lin YN. Effect of wearable exoskeleton on post-stroke gait: A systematic review and meta-analysis. Ann Phys Rehabil Med 2023; 66:101674. [PMID: 35525427 DOI: 10.1016/j.rehab.2022.101674] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 03/07/2022] [Accepted: 03/26/2022] [Indexed: 12/26/2022]
Abstract
BACKGROUND Wearable exoskeletons are a recently developed technology. OBJECTIVES The present systematic review aimed to investigate the effect of a wearable exoskeleton on post-stroke walking by considering its use in a gait training system and simply as an orthosis assisting walking. METHODS We systematically searched for randomised and quasi-randomised controlled trials in PubMed, Scopus, CINAHL and Embase databases from their earliest publication record to July 2021. We chose reports of trials investigating the effects of exoskeleton-assisted training or the effects of wearing an exoskeleton to assist walking. A meta-analysis was conducted to explore the benefits of the wearable exoskeleton on mobility capacity, walking speed, motor function, balance, endurance and activities of daily living. RESULTS We included 13 studies (492 participants) comparing exoskeleton-assisted training with dose-matched conventional gait training. Studies addressing the effect of wearing a wearable exoskeleton were unavailable. As compared with conventional gait training at the end of the intervention, exoskeleton-assisted training was superior for walking speed (mean difference [MD] 0.13 m/s, 95% CI 0.05; 0.21) and balance (standardized MD [SMD] 0.3, 95% CI 0.07; 0.54). The subgroup with chronic stroke (i.e., > 6 months) presented the outcome favouring exoskeleton-assisted training regarding overall mobility capacity (SMD 0.37, 95% CI 0.04; 0.69). At the end of follow-up, exoskeleton-assisted training was superior to conventional gait training in overall mobility (SMD 0.45, 95% CI 0.07; 0.84) and endurance (MD 46.23 m, 95% CI 9.90; 82.56). CONCLUSIONS Exoskeleton-assisted training was superior to dose-matched conventional gait training in several gait-related outcomes at the end of the intervention and follow-up in this systematic review and meta-analysis, which may support the use of exoskeleton-assisted training in the rehabilitation setting. Whether wearing versus not wearing a wearable exoskeleton is beneficial during walking remains unknown.
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Affiliation(s)
- Ting-Hsuan Hsu
- Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chi-Lin Tsai
- Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Ju-Yang Chi
- Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Chih-Yang Hsu
- Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Yen-Nung Lin
- Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan.
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Chang FH, Lin YN, Liou TH, Ni PS. Predicting trends of community participation after hospital discharge for younger adults after stroke. Ann Phys Rehabil Med 2023; 66:101644. [PMID: 35150932 DOI: 10.1016/j.rehab.2022.101644] [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: 06/18/2021] [Revised: 01/04/2022] [Accepted: 01/15/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND Community participation is an indicator of recovery for younger adults after stroke who generally have a greater need to return to society than do older adults. However, little is known about the trends of participation and their determinants in this population. OBJECTIVE To explore the trends of community participation by younger (<65 years) adults with stroke in Taiwan after their hospital discharge and to identify predictors of these trends. METHODS This longitudinal, multicenter, prospective cohort study enrolled 570 relatively young adults (aged 20-65 years) with stroke. Participants were assessed at hospital discharge and at 3-, 6-, and 12-month follow-up. The primary outcome measure was the Participation Measure-3 Domains, 4 Dimensions (PM-3D4D). Sociodemographic and stroke-related variables were derived by using standardized instruments and questionnaires. Mixed models were used to derive the trends of each participation domain and to identify predictors. RESULTS PM-3D4D score changes showed a positive trend from discharge to 1-year follow-up (particularly in social and community subscales); however, the improvement was mild and mainly occurred in the first 3 months. Sociodemographic factors, such as income and education levels, and stroke-related variables, such as stroke severity, comorbidity, and physical function, significantly predicted changes in PM-3D4D scores over time. Physical function demonstrated the strongest prediction ability for all participation domains and dimensions. CONCLUSION Multiple sociodemographic and stroke-related variables, particularly physical function, predicted improvement in community participation by younger adults after stroke. These findings may help clinicians identify younger adults at risk of unfavorable long-term participation outcomes after stroke.
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Affiliation(s)
- Feng-Hang Chang
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, 250 Wu-Hsing Street, Taipei 110, Taiwan; Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
| | - Yen-Nung Lin
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, 250 Wu-Hsing Street, Taipei 110, Taiwan; Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Tsan-Hon Liou
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Peng-Sheng Ni
- Health Law, Policy, and Management Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA
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Ji Y, Feng Y, Wu S, Wu Y, Wang J, Zhao X, Liu Y. Longitudinal trajectories of depressive symptoms: the role of multimorbidity, mobility and subjective memory. BMC Geriatr 2023; 23:22. [PMID: 36635652 PMCID: PMC9837987 DOI: 10.1186/s12877-023-03733-4] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 01/06/2023] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The high prevalence of depression among older people in China places a heavy burden on the health system. Multimorbidity, mobility limitation and subjective memory impairment are found to be risk indicators for depression. However, most studies on this topic focused on depression at a single point in time, ignoring the dynamic changes in depressive symptoms and the relationship between the trajectories and these three conditions. Therefore, we aimed to identify distinct trajectories of depressive symptoms in older people and investigate their associations with multimorbidity, mobility limitation and subjective memory impairment. METHODS Data was drawn from China Health and Retirement Longitudinal Study conducted during 2011-2018. A total of 5196 participants who completed 4 visits, conducted every 2-3 years were included in this study. Group-based trajectory modeling was conducted to identify distinct trajectories of depressive symptoms z-scores. Multinomial logistic regression was used to investigate the relationships. RESULTS Four distinct trajectories of depressive symptoms z-scores were identified, labeled as persistently low symptoms (68.69%, n = 3569), increasing symptoms (12.14%, n = 631), decreasing symptoms (14.05%, n = 730) and persistently high symptoms (5.12%, n = 266). Participants with multimorbidity had unfavorable trajectories of depressive symptoms compared with those without multimorbidity, with adjusted odds ratios (95% CIs) of 1.40 (1.15, 1.70), 1.59 (1.33, 1.90) and 2.19 (1.65, 2.90) for the increasing symptoms, decreasing symptoms and persistently high symptoms, respectively. We also observed a similar trend among participants with mobility limitations. Compared with participants who had poor subjective memory, participants with excellent/very good/good subjective memory had a lower risk of developing unfavorable trajectories of depressive symptoms. The adjusted odds ratios (95% CIs) of the increasing symptoms, decreasing symptoms and persistently high symptoms were 0.54 (0.40, 0.72), 0.50 (0.38, 0.65) and 0.48 (0.31, 0.73), respectively. CONCLUSIONS Multimorbidity, mobility limitation and subjective memory impairment were found to be potential risk factors for unfavorable depression trajectories.
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Affiliation(s)
- Yiman Ji
- grid.27255.370000 0004 1761 1174Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012 Shandong China ,grid.27255.370000 0004 1761 1174Institute for Medical Dataology, Cheeloo College of Medicine, Shandong University, Jinan, 250000 Shandong China
| | - Yiping Feng
- grid.27255.370000 0004 1761 1174Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012 Shandong China ,grid.27255.370000 0004 1761 1174Institute for Medical Dataology, Cheeloo College of Medicine, Shandong University, Jinan, 250000 Shandong China
| | - Sijia Wu
- grid.27255.370000 0004 1761 1174Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012 Shandong China ,grid.27255.370000 0004 1761 1174Institute for Medical Dataology, Cheeloo College of Medicine, Shandong University, Jinan, 250000 Shandong China
| | - Yutong Wu
- grid.27255.370000 0004 1761 1174Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012 Shandong China ,grid.27255.370000 0004 1761 1174Institute for Medical Dataology, Cheeloo College of Medicine, Shandong University, Jinan, 250000 Shandong China
| | - Jiongjiong Wang
- grid.27255.370000 0004 1761 1174Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012 Shandong China ,grid.27255.370000 0004 1761 1174Institute for Medical Dataology, Cheeloo College of Medicine, Shandong University, Jinan, 250000 Shandong China
| | - Xiangjuan Zhao
- Department of gynecology, Maternal and Child Health Care Hospital of Shandong Province, Jinan, 250014 Shandong China
| | - Yunxia Liu
- grid.27255.370000 0004 1761 1174Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012 Shandong China ,grid.27255.370000 0004 1761 1174Institute for Medical Dataology, Cheeloo College of Medicine, Shandong University, Jinan, 250000 Shandong China
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Carvalho PDAF, Regis TS, Faiçal AVB, Lago RMRDS, Terse-Ramos R, Acosta AX. Functional status of individuals with osteogenesis imperfecta: data from a reference center. J Pediatr (Rio J) 2023; 99:94-98. [PMID: 35940209 PMCID: PMC9875273 DOI: 10.1016/j.jped.2022.07.002] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 07/09/2022] [Accepted: 07/11/2022] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE To evaluate the functional status of individuals with Osteogenesis Imperfecta (OI) followed up at a reference center in the state of Bahia. MATERIALS AND METHODS This is an observational, cross-sectional, descriptive study, which evaluated individuals with OI, based on a non-probabilistic sampling. To assess motor function, the Motor Function Measure (MFM) score was used, in addition to the measurement of muscle strength using the Medical Research Council (MRC) score. Functional performance was measured using the Pediatric Assessment of Disability Inventory, Computerized Adaptive Testing (PEDI-CAT). RESULTS Thirty-one individuals aged between two and 18 years old were evaluated. The overall score of MFM was 74.2%, and the lowest score was found in participants with type III OI (56.3%). The median of the MRC index was 80. The mobility domain was the most affected in the PEDI-CAT evaluation, with a mean T score of 23.9, (14.2 in type III OI). CONCLUSIONS Among the evaluated individuals, functional alterations were identified, reduced global gross motor functionality and muscle strength, impacting the mobility domain, with the most relevant findings in individuals with type III OI.
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Affiliation(s)
- Patricia de Abreu Farias Carvalho
- Programa de Pós-graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, BA, Brasil; Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, BA, Brasil.
| | - Taiane Sousa Regis
- Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, BA, Brasil
| | | | - Renata Maria Rabello da Silva Lago
- Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, BA, Brasil; Universidade Federal do Recôncavo da Bahia, BA, Brasil
| | - Regina Terse-Ramos
- Programa de Pós-graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, BA, Brasil; Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, BA, Brasil; Departamento de Pediatria da Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, BA, Brasil
| | - Angelina Xavier Acosta
- Programa de Pós-graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, BA, Brasil; Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, BA, Brasil; Departamento de Pediatria da Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, BA, Brasil
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Tsunoda K, Nagata K, Jindo T, Fujii Y, Soma Y, Kitano N, Okura T. Acceptable walking and cycling distances and functional disability and mortality in older Japanese adults: An 8-year follow-up study. Health Place 2023; 79:102952. [PMID: 36535074 DOI: 10.1016/j.healthplace.2022.102952] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 11/26/2022] [Accepted: 11/29/2022] [Indexed: 12/23/2022]
Abstract
We prospectively investigated the association between acceptable travel distances (i.e., walking and cycling) and the incidence of functional disability and mortality among older Japanese adults. A baseline survey was conducted in 2013 among 7618 individuals aged ≥65 years in Kasama City, Japan, and they were tracked through the city's database until 2021. Acceptable travel distances were assessed using a questionnaire. Outcomes (i.e., functional disability and mortality) were gathered as binary (incident or not) with survival time. A multivariable-adjusted Cox proportional-hazards model indicated that shorter acceptable walking and cycling distances were markedly linked with higher risks of functional disability and mortality. In conclusion, acceptable distances of ≤500 m for walking and ≤1 km for cycling were associated with higher risks of functional disability and mortality among older adults.
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Affiliation(s)
- Kenji Tsunoda
- Faculty of Social Welfare, Yamaguchi Prefectural University, 6-2-1 Sakurabatake, Yamaguchi, Yamaguchi, 753-0021, Japan.
| | - Koki Nagata
- Doctoral Program in Public Health, Degree Programs in Comprehensive Human Sciences, Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki, 305-8574, Japan
| | - Takashi Jindo
- Faculty of Health and Sport Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8574, Japan
| | - Yuya Fujii
- Physical Fitness Research Institute, Meiji Yasuda Life Foundation of Health and Welfare, 150 Tobuki, Hachioji, Tokyo, 192-0001, Japan
| | - Yuki Soma
- Faculty of Education, Hirosaki University, 1 Bunkyo-cho, Hirosaki, Aomori, 036-8560, Japan
| | - Naruki Kitano
- Physical Fitness Research Institute, Meiji Yasuda Life Foundation of Health and Welfare, 150 Tobuki, Hachioji, Tokyo, 192-0001, Japan
| | - Tomohiro Okura
- Faculty of Health and Sport Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8574, Japan
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Thrush A, Steenbergen E. Clinical Properties of the 6-Clicks and Functional Status Score for the ICU in a Hospital in the United Arab Emirates. Arch Phys Med Rehabil 2022; 103:2404-2409. [PMID: 35613651 DOI: 10.1016/j.apmr.2022.04.008] [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: 10/13/2021] [Revised: 03/14/2022] [Accepted: 04/02/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To determine measurement properties of the Activity Measure for Post-Acute Care Inpatient Mobility Short Form (6-clicks) and Functional Status Score for the Intensive Care Unit (FSS-ICU). DESIGN Retrospective analysis of scores from a cohort of patients over 24 months. Outcome measures were administered to patients referred to physical therapy on admission and discharge. SETTING Tertiary care hospital in the United Arab Emirates. PARTICIPANTS 2793 adults referred to physical therapy; 62% were male, with a median age of 58 (interquartile range=44-70) and the median length of stay was 14 days (interquartile range=8-28). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE Instruments' clinical measurement properties: (1) responsiveness as per mean change and effect size; (2) floor and ceiling effects; and (3) minimal important difference. Results were analyzed for the whole group as well as 3 subgroups: patients with stroke as primary diagnosis (n = 644), discharged from heart and vascular floors (n = 642), and discharged from medical floors (n = 554). RESULTS The mean change and effect size (Cohen's d) for the 6-clicks were +8.3 (±8.6) and 0.97, and for the FSS-ICU they were +6.8 (±7.8) and 0.87, respectively. 6-Clicks had a floor effect on admission among patients with stroke (16.9%) and patients discharged from medical floors (19.3%), as well as a ceiling effect on discharge (25.5% in the whole group). The FSS-ICU had a ceiling effect on discharge (23.2% in whole group). The estimated minimal important difference for the 6-clicks was 4.3, and for the FSS-ICU it was 3.9. CONCLUSION Both instruments demonstrate good responsiveness in adults hospitalized in the United Arab Emirates. The FSS-ICU exhibited several advantages in performance that suggest greater clinical utility than the 6-clicks. Minimal important differences were generated, which has not been previously reported for the 6-clicks.
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Affiliation(s)
- Aaron Thrush
- Cleveland Clinic Abu Dhabi, Department of Inpatient Therapies and Rehabilitation, Abu Dhabi, United Arab Emirates.
| | - Emma Steenbergen
- Cleveland Clinic Abu Dhabi, Department of Inpatient Therapies and Rehabilitation, Abu Dhabi, United Arab Emirates
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Prayogo M, Tinduh D, Poerwandari D, Dharmanta RS, Wulan SMM, Mikami Y, Melaniani S. Improving Capacity of Older Adults with Locomotive Syndrome Stage 1 Living in Nursing Home: A Pilot Clinical Trial. Ann Geriatr Med Res 2022; 26:323-329. [PMID: 36195555 PMCID: PMC9830069 DOI: 10.4235/agmr.22.0073] [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: 07/07/2022] [Accepted: 09/27/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Aging causes locomotive syndrome (LS), which is characterized by difficulty in walking. The present study determined the effects of locomotion training and regular aerobic exercise programs on the aerobic capacity of older nursing home residents with LS stage 1. METHODS This randomized controlled trial included 24 participants aged 60-80 years with LS stage 1 residing in a single nursing home in Surabaya, Indonesia. The participants were randomly assigned to either the locomotion training group (LTG) or the control group (CG). Both the groups performed 30 minutes of a daily group-based aerobic exercise program for 8 weeks. The LTG performed additional locomotion training three times weekly, with three sets per session, gradually increasing to five sets per session according to the participant's tolerance. Two-minute walking test (2MWT) values before and after the 8-week intervention were determined in both the groups and converted to maximum oxygen consumption (VO2max) values. RESULTS After 8 weeks of intervention, a significant increase in VO2max was observed in both the groups (both p<0.05). The LTG showed a more significant improvement in VO2max (p<0.05) compared to the CG. CONCLUSION The study results demonstrated the positive effect of 8 weeks of locomotion training and regular aerobic exercise programs in improving the aerobic capacity of older adult nursing home residents with LS stage 1.
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Affiliation(s)
- Michael Prayogo
- Department of Physical Medicine and Rehabilitation, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia,Faculty of Medicine, Airlangga University, Surabaya, Indonesia
| | - Damayanti Tinduh
- Department of Physical Medicine and Rehabilitation, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia,Faculty of Medicine, Airlangga University, Surabaya, Indonesia,Corresponding Author: Damayanti Tinduh, MD, PhD Department of Physical Medicine and Rehabilitation, Dr Soetomo General Academic Hospital, Faculty of Medicine, Airlangga University, Jalan Mayjen. Prof. Dr. Moestopo No. 6-8, Surabaya, Jawa Timur 60286, Indonesia E-mail:
| | - Dewi Poerwandari
- Department of Physical Medicine and Rehabilitation, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia,Faculty of Medicine, Airlangga University, Surabaya, Indonesia
| | - Rwahita Satyawati Dharmanta
- Department of Physical Medicine and Rehabilitation, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia,Faculty of Medicine, Airlangga University, Surabaya, Indonesia
| | - Sri Mardjiati Mei Wulan
- Department of Physical Medicine and Rehabilitation, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia,Faculty of Medicine, Airlangga University, Surabaya, Indonesia
| | - Yukio Mikami
- Department of Rehabilitation Medicine, Hiroshima University Hospital, Hiroshima, Japan
| | - Soenarnatalina Melaniani
- Department of Epidemiology, Biostatistics, Population Studies, and Health Promotion, Faculty of Public Health, Airlangga University, Surabaya, Indonesia
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Williams G, Hassett L, Clark R, Bryant AL, Morris ME, Olver J, Ada L. Ballistic resistance training has a similar or better effect on mobility than non-ballistic exercise rehabilitation in people with a traumatic brain injury: a randomised trial. J Physiother 2022; 68:262-268. [PMID: 36253280 DOI: 10.1016/j.jphys.2022.09.004] [Citation(s) in RCA: 3] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/01/2022] [Accepted: 09/22/2022] [Indexed: 11/06/2022] Open
Abstract
QUESTIONS In people recovering from traumatic brain injury, is a 3-month ballistic resistance training program targeting three lower limb muscle groups more effective than non-ballistic exercise rehabilitation for improving mobility, strength and balance? Does improved mobility translate to better health-related quality of life? DESIGN A prospective, multicentre, randomised trial with concealed allocation, intention-to-treat analysis and blinded measurement. PARTICIPANTS A total of 144 people with a neurological movement disorder affecting mobility as a result of traumatic brain injury. INTERVENTION For 3 months, the experimental group had three 60-minute sessions of non-ballistic exercise rehabilitation per week replaced by ballistic resistance training. The control group had non-ballistic exercise rehabilitation of equivalent time. The non-ballistic exercise rehabilitation consisted of balance exercises, lower limb stretching, conventional strengthening exercises, cardiovascular fitness training and gait training. OUTCOME MEASURES The primary outcome was mobility measured using the High-Level Mobility Assessment Tool (HiMAT). Secondary outcomes were walking speed, strength, balance and quality of life. They were measured at baseline (0 months), after completion of the 3-month intervention (3 months) and 3 months after cessation of intervention (6 months). RESULTS After 3 months of ballistic resistance training, the experimental group scored 3 points (95% CI 0 to 6) higher on the 54-point HiMAT than the control group and remained 3 points (95% CI -1 to 6) higher at 6 months. Although there was a transient decrement in balance at 3 months in the experimental group, the interventions had similar effects on all secondary outcomes by 6 months. Participants with a baseline HiMAT < 27 gained greater benefit from ballistic training: 6 points (1 to 10) on the HiMAT. CONCLUSION This randomised trial shows that ballistic resistance training has a similar or better effect on mobility than non-ballistic training in people with traumatic brain injury. It may be better targeted towards those with more severe mobility limitations. TRIAL REGISTRATION ACTRN12611001098921.
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Affiliation(s)
- Gavin Williams
- Physiotherapy Department, Epworth Healthcare, Melbourne, Australia; School of Physiotherapy, Faulty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia.
| | - Leanne Hassett
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Institute for Musculoskeletal Health, The University of Sydney, Sydney Local Health District, Sydney, Australia
| | - Ross Clark
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Sippy Downs, Australia
| | - Adam L Bryant
- School of Physiotherapy, Faulty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Meg E Morris
- The Victorian Rehabilitation Centre Healthscope & Academic and Research Collaborative in Health (ARCH), La Trobe University, Melbourne, Australia
| | - John Olver
- Rehabilitation Medicine, Epworth Healthcare, Melbourne, Australia
| | - Louise Ada
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Hinrichs T, Portegijs E, Rantanen T, Infanger D, Schmidt-Trucksäss A, Karavirta L. Association between arterial stiffness and walking capacity in older adults. Exp Gerontol 2022; 167:111925. [PMID: 35963452 DOI: 10.1016/j.exger.2022.111925] [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: 06/23/2022] [Revised: 07/08/2022] [Accepted: 08/08/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIM Arterial stiffening - a process that is largely due to intimal thickening, collagen disposition or elastin fragmentation - significantly contributes to cardiovascular events and mortality. There is also some evidence that it may negatively affect physical function. This study aimed to evaluate whether arterial stiffness was associated with measures of walking capacity in a large, population-based sample of highly aged older adults. METHODS A population-based sample of 910 community-dwelling adults (aged 75, 80, or 85 years) were investigated in a cross-sectional observational study. Pulse wave velocity (PWV), a surrogate marker of arterial stiffness, was estimated based on the oscillometric recording of pulse waves at the brachial artery site. Walking capacity was assessed by 10-meter habitual walking speed, 10-meter maximum walking speed, and six-minute walk distance. We used multiple linear regression models to examine possible associations between PWV and parameters of walking capacity, and we adjusted the models for sex, age, socioeconomic status, anthropometry, physician-diagnosed diseases, prescription medication, smoking history, physical activity, and mean arterial pressure. Continuous variables were modelled using restricted cubic splines to account for potential nonlinear associations. RESULTS Mean (standard deviation) 10-meter habitual walking speed, 10-meter maximum walking speed, and six-minute walk distance were 1.3 (0.2) m/s, 1.7 (0.4) m/s, and 413 (85) m, respectively. The fully adjusted regression models revealed no evidence for associations between PWV and parameters of walking capacity (all p-values >0.05). CONCLUSION Our results did not confirm previous findings suggesting a potential negative association between arterial stiffness and walking capacity in old age. Longitudinal studies, potentially taking additional confounders into account, are needed to disentangle the complex relationship between the two factors.
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Affiliation(s)
- Timo Hinrichs
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland.
| | - Erja Portegijs
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, the Netherlands
| | - Taina Rantanen
- Faculty of Sport and Health Sciences and Gerontology Research Center, University of Jyvaskyla, Jyväskylä, Finland
| | - Denis Infanger
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Arno Schmidt-Trucksäss
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Laura Karavirta
- Faculty of Sport and Health Sciences and Gerontology Research Center, University of Jyvaskyla, Jyväskylä, Finland
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da Silva MMM, Travensolo CDF, Probst VS, Felcar JM. Quantification of changes in functional capacity and muscle strength in patients: a burn intensive care unit cohort study. Burns 2022; 48:833-840. [PMID: 35221156 DOI: 10.1016/j.burns.2022.01.010] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 01/08/2022] [Accepted: 01/16/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Regular functional status and muscle strength assessments should be performed with burn victims. OBJECTIVE To evaluate the functionality and peripheral muscle strength of burn patients admitted to the hospital. METHODS A longitudinal and prospective study was conducted from March to November 2019, including adult burn victims who were admitted to the ICU and discharged from the hospital. Patients were assessed on admission, every 10 days, at discharge from the ICU and from the hospital. Functionality was assessed using the Chelsea Critical Care Physical Assessment (CPAx) and the Functional Independence Measure (FIM). Muscle strength was assessed using the Medical Research Council (MRC) scale and handgrip dynamometry. RESULTS 41 patients were included, 27 men and 14 women, with a median age of 41 (IQR [28-56]) years, mean TBSA of 19 (SD ± 12) percent, mean Abbreviated Burn Severity Index (ABSI) of 6 (SD ± 2) and the mean ICU time was 29 (SD ± 9) days. The CPAx, FIM and MRC evaluations improved (P < 0.0001) when compared to admission to the ICU and at hospital discharge, while the dynamometry showed no statistical difference. The ABSI only showed an association with the length of stay. CONCLUSION The CPAX scale was sensitive to changes in functionality throughout the hospital stay in severely burned patients, in the present study. The assessment of global muscle strength was more sensitive than handgrip strength and the ABSI was associated with length of stay in this population.
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Affiliation(s)
| | | | - Vanessa Suziane Probst
- Postgraduation Program in Rehabilitation Sciences UEL-UNOPAR, State University of Londrina (UEL), Londrina, PR, Brazil.
| | - Josiane Marques Felcar
- Postgraduation Program in Rehabilitation Sciences UEL-UNOPAR, State University of Londrina (UEL), Londrina, PR, Brazil.
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Prevett C, Moncion K, Phillips S, Richardson J, Tang A. The role of resistance training in mitigating risk for mobility disability in community-dwelling older adults: a systematic review and meta-analysis. Arch Phys Med Rehabil 2022; 103:2023-2035. [PMID: 35504310 DOI: 10.1016/j.apmr.2022.04.002] [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: 12/01/2021] [Revised: 02/15/2022] [Accepted: 04/06/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine the effects of community-based resistance training (RT) on physical function for older adults with mobility disability. DATA SOURCES Four databases (PEDro, MedLine, Ovid, CINAHL and Web of Science) were searched from inception to February 2, 2021. STUDY SELECTION Randomized controlled trials that examined community-based RT for improving physical function in community-dwelling older adults were included. DATA EXTRACTION Two reviewers independently conducted title and abstract screening, full-text evaluation, data extraction, and risk of bias quality assessment. DATA SYNTHESIS Twenty-four studies (3,656 participants, age range 63-83 years) were included. RT programs ranged from 10 weeks to 18 months in duration. RT was more effective than control in improving 6MWT distance (n=638; mean difference (MD) 16.1 meters; 95% CI 12.27-19.94, p<0.0001), lower extremity strength (n=785; standard MD 2.01; 95% CI 1.27-2.75, p<0.0001) and usual gait speed (n= 2,106; MD 0.05 meters/second, 95% CI 0.03-0.07, p<0.001). In sensitivity analyses, benefits were maintained when studies with a high risk of bias were excluded. There was no effect of RT on fast gait speed or Short Physical Performance Battery score compared to control. CONCLUSIONS RT improves walking distance, lower extremity strength, and usual gait speed in older adults with mobility disability. Improvements in physical function could increase independence in activities of daily living for this at-risk population.
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Affiliation(s)
- Christina Prevett
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada, L8S 1C7
| | - Kevin Moncion
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada, L8S 1C7
| | - Stuart Phillips
- Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada, L8S 1C7
| | - Julie Richardson
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada, L8S 1C7
| | - Ada Tang
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada, L8S 1C7.
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Moeyersons M, De Vliegher K, Huyghe B, De Groof S, Milisen K, de Casterlé BD. 'Living in a shrinking world'-The experience of loneliness among community-dwelling older people with reduced mobility: a qualitative grounded theory approach. BMC Geriatr 2022; 22:285. [PMID: 35387595 PMCID: PMC8984073 DOI: 10.1186/s12877-022-02998-5] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 03/31/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Loneliness is associated with severe consequences for both the physical and mental health of older people. Research has shown that mobility limitations are an important risk factor for the emergence and maintenance of feelings of loneliness. The aim of this study was to explore the experiences of loneliness among community-dwelling older people with reduced mobility and its underlying dynamics. METHODS This study employed a qualitative, descriptive design, inspired by a grounded theory approach. Participants were purposively recruited in collaboration with home health care providers. The main inclusion criteria were as follows: aged 75 years or older, being mobile impaired, experiencing feelings of loneliness, and living at home and being cognitively able to be interviewed. Data analysis of 15 semi-structured, in-depth interviews was conducted based on the Qualitative Analysis Guide of Leuven (QUAGOL). RESULTS Loneliness was expressed through all the stories, but it appeared as an elusive, intangible phenomenon. Both indicating the presence of loneliness and describing what this phenomenon means were difficult to express for most participants. Loneliness was experienced as an inherent part of the ageing process characterised by losses, limitations and meaninglessness. Participants described how they have experienced losing grip on the world in which they live and feel isolated in a literally and figuratively shrinking world. Loneliness is described as the feeling that one is unable to address the situation that results in deep sadness and the feeling of no longer being of value to their environment. CONCLUSIONS This study shows that loneliness among community-dwelling older persons with reduced mobility is embedded in experiences of loss related to ageing, among which reduced mobility plays a significant role. The results suggest the existence of a more profound experience of loneliness than might appear at first glance. How to recognise experiences of loneliness and how to support a meaningful existence for community-dwelling older persons should be given priority in health care. The findings of this study can increase professional caregivers' sensitivity to implicit signals of loneliness. Further research is necessary to refine the outcomes and to further explore the role of reduced mobility in the experience of loneliness.
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Affiliation(s)
- Marika Moeyersons
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Kapucijnenvoer 35 blok d bus, 7001, 3000, Leuven, Belgium
| | - Kristel De Vliegher
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Kapucijnenvoer 35 blok d bus, 7001, 3000, Leuven, Belgium.,Nursing Departement, Wit-Gele Kruis van Vlaanderen, Frontispiesstraat 8 bus 1.2 1000, Brussels, Belgium
| | - Brooke Huyghe
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Kapucijnenvoer 35 blok d bus, 7001, 3000, Leuven, Belgium
| | - Sacha De Groof
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Kapucijnenvoer 35 blok d bus, 7001, 3000, Leuven, Belgium
| | - Koen Milisen
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Kapucijnenvoer 35 blok d bus, 7001, 3000, Leuven, Belgium.,Department of Geriatric Medicine, University Hospital Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Bernadette Dierckx de Casterlé
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Kapucijnenvoer 35 blok d bus, 7001, 3000, Leuven, Belgium.
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Kang J, Yun S, Hong J. Health-related quality of life measured with the EQ-5D-5L in critical care survivors: A cross-sectional study. Intensive Crit Care Nurs 2022; 72:103252. [PMID: 35396103 DOI: 10.1016/j.iccn.2022.103252] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 01/09/2022] [Revised: 03/23/2022] [Accepted: 03/24/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The aim of this study was to investigate health-related quality of life (HRQOL) and related factors in intensive care unit survivors one-12 months after discharge. RESEARCH METHODOLOGY/DESIGN This cross-sectional survey included survivors who had been admitted to an intensive care unit for ≥48 hours. MAIN OUTCOME MEASURES HRQOL was measured using the EQ-5D-5L profile, which evaluates five dimensions of health (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression) on five levels (no, slight, moderate, severe, and extreme problems), EQ-VAS (score range 0-100, 100 indicating best health) and EQ values (score range -0.066-1, 1 indicating best health). The factors influencing HRQOL were analyzed by Tobit regression. SETTING Survivors treated in an intensive care unit at six institutions in Korea. RESULTS Only 7.9% of the 534 participants had self-reported profiles of no health problems in all five dimensions. The proportion of participants with slight problems was highest in pain/discomfort with 85.0%. The proportion with severe problems was highest in usual activities with 21.7%, followed by mobility with 21.0%. The median and interquartile range of the EQ-VAS and EQ values were 60.00 (45.00 to 75.00) and 0.72 (0.52 to 0.80), respectively. Negative impact factors on HRQOL included older age, women, residing in a long term care facility, unemployment, emergency intensive care admission, and intensive care stay ≥ 7 days. CONCLUSION HRQOL among Korean intensive care survivors is low. The level of problems in physical dimensions is more severe than that in mental health dimensions. Early rehabilitation in the intensive care unit should be provided to facilitate long-term recovery.
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Affiliation(s)
- Jiyeon Kang
- College of Nursing, Dong-A University, Busan, Republic of Korea.
| | - Seonyoung Yun
- Department of Nursing, Youngsan University, Yangsan, Kyungnam, Republic of Korea.
| | - Jiwon Hong
- College of Nursing, Dong-A University, Busan, Republic of Korea.
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Schaun GZ, Bamman MM, Andrade LS, David GB, Krüger VL, Marins EF, Nunes GN, Häfele MS, Mendes GF, Gomes MLB, Campelo PC, Pinto SS, Alberton CL. High-velocity resistance training mitigates physiological and functional impairments in middle-aged and older adults with and without mobility-limitation. GeroScience 2022. [PMID: 35084687 DOI: 10.1007/s11357-022-00520-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 01/17/2022] [Indexed: 01/14/2023] Open
Abstract
The aim of the present study was to compare the neuromuscular, morphological, and functional responses to a high-velocity resistance training (HVRT) program between three cohorts: middle-aged adults (40–55 years, n = 18), healthy older adults (> 60 years, n = 18), and mobility-limited older adults (n = 8). Participants were tested before and after a 4-week control period and then assigned to a 12-week HVRT intervention. Investigated outcomes included ultrasound-derived muscle thickness and quality, maximal dynamic strength (1RM), maximal voluntary isometric contraction (MVIC), and muscle activation (sEMG), as well as muscle power and functional performance. After the intervention, quadriceps muscle thickness, 1RM, and sEMG improved in all three groups (all p < 0.05), whereas muscle quality improved only in middle-aged and older participants (p ≤ 0.001), and MVIC only in middle-aged and mobility-limited older adults (p < 0.05). With a few exceptions, peak power improved in all groups from 30–90% 1RM (p < 0.05) both when tested relative to pre-training or post-training 1RM workloads (all p < 0.05). Both mobility-limited older adults and older adults improved their short physical performance battery score (p < 0.05). Chair stand, stair climb, maximal gait speed, and timed up-and-go performance, on the other hand, improved in all three groups (p < 0.05), but no change was observed for habitual gait speed and 6-min walk test performance. Overall, our results demonstrate that a HVRT intervention can build a stronger foundation in middle-aged individuals so that they can better deal with age-related impairments at the same time that it can mitigate already present physiological and functional impairments in older adults with and without mobility-limitation.
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Ullrich P, Werner C, Abel B, Hummel M, Bauer JM, Hauer K. Assessing life-space mobility : A systematic review of questionnaires and their psychometric properties. Z Gerontol Geriatr 2022; 55:660-6. [PMID: 35244765 DOI: 10.1007/s00391-022-02035-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 01/27/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Life-space mobility (LSM), as the extent of mobility within one's environment, is a key for successful aging and has become a relevant concept in gerontology and geriatric research. Adequate assessment instruments are needed to identify older persons with LSM restrictions, and to initiate, adapt or evaluate intervention strategies. OBJECTIVE To systematically identify, describe and analyze the psychometric properties of LSM questionnaires, with a special focus on their availability in the German language. METHODS A systematic literature search was conducted in PubMed, PsycINFO, Cochrane Library, CINAHL, and Web of Science. Studies that examined at least one psychometric property of LSM questionnaires published up to August 2021 were included and evaluated based on the consensus-based standards for the selection of health measurement instruments (COSMIN) guidelines. RESULTS This study included 37 validation studies describing 13 different LSM questionnaires. Methodological quality and comprehensiveness of validations were heterogeneous. Based on comprehensive and high-quality results, four LSM questionnaires stood out: the University of Alabama at Birmingham life-space assessment (UAB-LSA), life-space assessment in persons with cognitive impairment (LSA-CI), interview-based and proxy-based versions of the life-space assessment in institutionalized settings (LSA-IS), all of them available in the German language. CONCLUSION This systematic review provides a concise overview of available LSM questionnaires and their psychometric properties to facilitate the selection for use in clinical practice and research. The UAB-LSA and LSA-CI for community settings and the interview-based or proxy-based LSA-IS for institutional settings were found to be the most appropriate LSM questionnaires.
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Karavirta L, Leppä H, Rantalainen T, Eronen J, Portegijs E, Rantanen T. Physical activity scaled to preferred walking speed as a predictor of walking difficulty in older adults: a 2-year follow-up. J Gerontol A Biol Sci Med Sci 2021; 77:597-604. [PMID: 34590115 PMCID: PMC8893185 DOI: 10.1093/gerona/glab277] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Indexed: 11/13/2022] Open
Abstract
Background The usual accelerometry-based measures of physical activity (PA) are dependent on physical performance. We investigated the associations between PA relative to walking performance and the prevalence and incidence of early and advanced walking difficulties compared to generally used measures of PA. Methods Perceived walking difficulty was evaluated in 994 community-dwelling participants at baseline (age 75, 80, or 85 years) and 2 years later over 2 km (early difficulty) and 500 m (advanced difficulty). We used a thigh-mounted accelerometer to assess moderate-to-vigorous PA, daily mean acceleration, and relative PA as movement beyond the intensity of preferred walking speed in a 6-minute walking test (PArel). Self-reported PA was assessed using questionnaires. Results The prevalence and incidence were 36.2% and 18.9% for early and 22.4% and 14.9% for advanced walking difficulty, respectively. PArel was lower in participants with prevalent (mean 42 [SD 45] vs 69 [91] min/week, p < .001) but not incident early walking difficulty (53 [75] vs 72 [96] min/week, p = .15) compared to those without difficulty. The associations between absolute measures of PA and incident walking difficulty were attenuated when adjusted for preferred walking speed. Conclusions The variation in habitual PA may not explain the differences in the development of new walking difficulty. Differences in physical performance explain a meaningful part of the association of PA with incident walking difficulty. Scaling of accelerometry to preferred walking speed demonstrated independence on physical performance and warrants future study as a promising indicator of PA in observational studies among older adults.
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Affiliation(s)
- Laura Karavirta
- Faculty of Sport and Health Sciences and Gerontology Research Center, University of Jyväskylä, Jyväskylä, Finland
| | - Heidi Leppä
- Faculty of Sport and Health Sciences and Gerontology Research Center, University of Jyväskylä, Jyväskylä, Finland
| | - Timo Rantalainen
- Faculty of Sport and Health Sciences and Gerontology Research Center, University of Jyväskylä, Jyväskylä, Finland
| | - Johanna Eronen
- Faculty of Sport and Health Sciences and Gerontology Research Center, University of Jyväskylä, Jyväskylä, Finland
| | - Erja Portegijs
- Faculty of Sport and Health Sciences and Gerontology Research Center, University of Jyväskylä, Jyväskylä, Finland
| | - Taina Rantanen
- Faculty of Sport and Health Sciences and Gerontology Research Center, University of Jyväskylä, Jyväskylä, Finland
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Portegijs E, Saajanaho M, Leppä H, Koivunen K, Eronen J, Rantanen T. Impact of mobility restrictions on active aging; cross-sectional associations and longitudinal changes parallel to COVID-19 restrictions. Arch Gerontol Geriatr 2021; 98:104522. [PMID: 34638047 DOI: 10.1016/j.archger.2021.104522] [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: 06/29/2021] [Revised: 09/06/2021] [Accepted: 09/08/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND Meaningful activities can be done in or around home, but opportunities for participation and active aging decrease when moving in smaller areas. Active aging refers to having an active approach to life in line with one's goals, ability and opportunities. In adults over 75 years with different baseline neighborhood mobility levels, we studied active aging scores two years prior to and amid COVID-19, when governments restricted mobility of residents to slow the COVID-19 outbreak. METHODS AGNES cohort data were collected in 2017-2018 and spring 2020. Individuals were queried about their will, ability, and opportunity, and extent of doing 17 activities, and subsequently, item, composite and sub-scores of active aging were computed. Neighborhood mobility was assessed as frequency of moving in or beyond own neighborhood (limited, regular, daily=reference). Associations were studied using Generalized Linear Models (cross-sectionally, n = 1007) and General Estimating Equations (prospectively, n = 774). RESULTS Participants with limited baseline neighborhood mobility had lower active aging scores than those with daily mobility, but the decline over time was similar. Some item scores on opportunity to act and extent of doing, e.g. for making one's day more interesting and advancing matters of faith or worldview, were better retained amid COVID-19 by those with limited mobility, attenuating group differences. CONCLUSIONS Active aging scores were somewhat compromised in individuals with limited neighborhood mobility, but opportunities for and engagement in several activities seemed to be better retained amid COVID-19 than for those with daily mobility. Thus, active aging may be possible despite mobility restriction.
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Affiliation(s)
- Erja Portegijs
- Faculty of Sport and Health Sciences and Gerontology Research Center, University of Jyvaskyla, Jyväskylä, Finland.
| | - Milla Saajanaho
- Faculty of Sport and Health Sciences and Gerontology Research Center, University of Jyvaskyla, Jyväskylä, Finland
| | - Heidi Leppä
- Faculty of Sport and Health Sciences and Gerontology Research Center, University of Jyvaskyla, Jyväskylä, Finland
| | - Kaisa Koivunen
- Faculty of Sport and Health Sciences and Gerontology Research Center, University of Jyvaskyla, Jyväskylä, Finland
| | - Johanna Eronen
- Faculty of Sport and Health Sciences and Gerontology Research Center, University of Jyvaskyla, Jyväskylä, Finland
| | - Taina Rantanen
- Faculty of Sport and Health Sciences and Gerontology Research Center, University of Jyvaskyla, Jyväskylä, Finland
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Braun T, Marks D, Thiel C, Grüneberg C. A generic outcome assessment of mobility capacity in neurorehabilitation: measurement properties of the de Morton Mobility Index. BMC Neurol 2021; 21:298. [PMID: 34320926 PMCID: PMC8317343 DOI: 10.1186/s12883-021-02327-0] [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: 04/22/2021] [Accepted: 07/14/2021] [Indexed: 11/25/2022] Open
Abstract
Background Mobility capacity is a key outcome domain in neurorehabilitation. The de Morton Mobility Index (DEMMI), an established and generic outcome assessment of mobility capacity in older patients, is promising for use in neurorehabilitation. The aim of this study was to examine the measurement properties of the DEMMI in rehabilitation inpatients with neurological conditions. Methods Cross-sectional study including a mixed sample of adult inpatients in a neurorehabilitation hospital. Structural validity, unidimensionality and measurement invariance (Rasch analysis), construct validity, internal consistency reliability, and inter-rater reliability of the DEMMI (scale range: 0–100 points) were established. The minimal detectable change, the 95% limits of agreement, and possible floor and ceiling effects were calculated to indicate interpretability. Results We analyzed validity (n = 348) and reliability (n = 133) in two samples. In both samples, the majority of participants had a sub-acute stroke or Parkinson’s disease. Rasch analysis indicated unidimensionality with an overall fit to the model (chi-square = 59.4, P = 0.074). There was no relevant measurement invariance by disease group. Hypotheses-based correlation analyses (DEMMI and other functional outcome assessments) showed sufficient construct validity. Internal consistency reliability (Cronbach’s alpha = 0.94) and inter-rater reliability (intraclass correlation coefficient = 0.94; 95% confidence interval: 0.91–0.95) were sufficient. The minimal detectable change with 90% confidence was 15.0 points and the limits of agreement were 39%. No floor or ceiling effects were observed. Conclusions Results indicate sufficient measurement properties of the DEMMI in rehabilitation inpatients with neurological conditions. The DEMMI can be used as a generic outcome assessment of mobility capacity in neurorehabilitation. Trial registration German Clinical Trials Register (DRKS00004681). Registered May 6, 2013. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-021-02327-0.
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Affiliation(s)
- Tobias Braun
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801, Bochum, Germany. .,IB University of Health and Social Sciences, Study Center Cologne, Cologne, Germany.
| | - Detlef Marks
- Physiotherapy Department, Rehaklinik Zihlschlacht, Hauptstr. 2, 8588, Zihlschlacht, Switzerland
| | - Christian Thiel
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801, Bochum, Germany.,Faculty of Sports Science, Training and Exercise Science, Ruhr-University Bochum, Bochum, Germany
| | - Christian Grüneberg
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801, Bochum, Germany
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Traxler K, Schinabeck F, Baum E, Klotz E, Seebacher B. Feasibility of a specific task-oriented training versus its combination with manual therapy on balance and mobility in people post stroke at the chronic stage: study protocol for a pilot randomised controlled trial. Pilot Feasibility Stud 2021; 7:146. [PMID: 34311772 PMCID: PMC8313417 DOI: 10.1186/s40814-021-00886-0] [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: 12/17/2020] [Accepted: 07/09/2021] [Indexed: 11/28/2022] Open
Abstract
Background Large studies have shown that stroke is among the most relevant causes of acquired adult disability. Walking and balance impairment in stroke survivors often contribute to a restriction in daily activities and social participation. Task-oriented training (TOT) is an effective treatment strategy and manual therapy (MT) is used successfully to enhance ankle joint flexibility in this population. No study, however, has compared TOT against its combination with MT in a randomised controlled trial. Aims of this pilot study are therefore to explore the feasibility of a full-scale RCT using predefined feasibility criteria. Secondary aims are to explore the preliminary effects of specific TOT with a combined specific TOT-MT versus a control group in people post stroke. Methods This is a protocol of a 4-week prospective randomised controlled parallel pilot trial in people post stroke at the chronic stage with limited upper ankle joint mobility and an impairment in balance and mobility. At a German outpatient therapy centre using 1:1:1 allocation, 36 patients will be randomised into one of three groups: 15-min talocrural joint MT plus 30-min specific TOT (group A), 45-min specific TOT (group B), and controls (group C). Training will be goal-oriented including tasks that are based on daily activities and increased in difficulty utilising predefined progression criteria based on patients’ skill levels. Interventions will be provided face-to-face 2 times per week, for 4 weeks, in addition to 20-min concurrent x4 weekly home-based training sessions. Data will be collected by blinded assessors at baseline, post-intervention and 4-week follow-up. The primary outcome will be feasibility assessed by recruitment, retention and adherence rates, compliance, adverse events, falls and the acceptability of the intervention. Secondary outcomes will be walking speed, single and dual tasking functional mobility, ankle range of motion, disability and health-related quality of life. Discussion Feasibility provided, results from this study will be used to calculate the sample size of a larger randomised controlled trial to investigate the effects of specific TOT and specific TOT-MT compared to a post stroke control group. Trial registration German Clinical Trials Register, DRKS00023068. Registered on 21.09.2020, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00023068. Supplementary Information The online version contains supplementary material available at 10.1186/s40814-021-00886-0.
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Affiliation(s)
- Kristina Traxler
- Therapiezentrum "Kinema", Neukirchen b. hl. Blut, Germany.,Department for Health Sciences, Medicine and Research, Faculty of Health and Medicine, Danube University Krems, Krems an der Donau, Austria
| | - Franz Schinabeck
- Überörtliche Gemeinschaftspraxis Hohenwarth/ Lam, Hohenwarth, Germany
| | - Eva Baum
- Therapiezentrum "Kinema", Neukirchen b. hl. Blut, Germany
| | - Edith Klotz
- Praxis Mittelpunkt Mensch, Furth im Wald, Germany
| | - Barbara Seebacher
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria. .,VASCAGE GmbH, Research Centre on Vascular Ageing and Stroke, Innsbruck, Austria.
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Odden MC, Sims KD, Thorpe RJ, Sims M, Dhamoon M, Min YI, Correa A. Recovery From Mobility Limitation in Middle-Aged African Americans: The Jackson Heart Study. J Gerontol A Biol Sci Med Sci 2021; 76:937-943. [PMID: 33075819 DOI: 10.1093/gerona/glaa272] [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: 04/17/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Despite evidence that African Americans shoulder a high burden of mobility limitation, little is known about factors associated with recovery. METHOD Participants from the Jackson Heart Study underwent 3 in-person exams from 2000 to 2013. Mobility limitations were assessed over this period by self-reported limitations in walking half a mile or climbing stairs during annual phone calls. The outcome of interest, recovery from mobility limitation, was defined as no mobility limitation the year following an incident event. Candidate predictor variables were assessed in logistic regression models, including sociodemographic, psychosocial, and health measures. Inverse probability weights were used to address missing data in the outcome. RESULTS Among 4526 participants (mean [SD] age = 54.5 (12.8) years) without a mobility limitation at baseline, 1445 (32%) had an incident mobility limitation over 12 years of follow-up, and 709 (49%) reported recovery from mobility limitation by 1 year later. Low income and daily discrimination were associated with a lower likelihood of recovery even after adjustment for covariates. In adjusted models, greater comorbidity was associated with a lower likelihood of recovering (p-value for trend = .05). History of heart failure and cancer were associated with a lower likelihood of recovering from mobility limitation (OR: 0.52, 95% CI: 0.29, 0.94 and OR: 0.74, 95% CI: 0.55, 1.00). Adiposity, smoking status, and physical activity were not associated with recovery from mobility limitation. CONCLUSION Half of incident mobility limitations in this population of middle-aged African Americans were transient. Adverse sociodemographic factors and comorbidities were associated with lower likelihood of recovery.
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Affiliation(s)
- Michelle C Odden
- Department of Epidemiology and Population Health, Stanford University School of Medicine, California
| | - Kendra D Sims
- School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis
| | - Roland J Thorpe
- Hopkins Center for Health Disparities Solutions, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson
| | - Mandip Dhamoon
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Yuan-I Min
- Department of Medicine, University of Mississippi Medical Center, Jackson
| | - Adolfo Correa
- Department of Medicine, University of Mississippi Medical Center, Jackson
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Lindh-Rengifo M, Jonasson SB, Ullén S, Mattsson-Carlgren N, Nilsson MH. Perceived walking difficulties in Parkinson's disease - predictors and changes over time. BMC Geriatr 2021; 21:221. [PMID: 33794786 PMCID: PMC8015068 DOI: 10.1186/s12877-021-02113-0] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 02/24/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND People with Parkinson's disease (PD) have described their walking difficulties as linked to activity avoidance, social isolation, reduced independence and quality of life. There is a knowledge gap regarding predictive factors of perceived walking difficulties in people with PD. Such knowledge could be useful when designing intervention studies. This study aimed to investigate how perceived walking difficulties evolve over a 3-year period in people with PD. A specific aim was to identify predictive factors of perceived walking difficulties. METHODS One hundred forty-eight people with PD (mean age 67.9 years) completed the Generic Walk-12 (Walk-12G) questionnaire (which assesses perceived walking difficulties) at both baseline and the 3-year follow-up. Paired samples t-test was used for comparing baseline and follow-up mean scores. Multivariable linear regression analyses were used to identify predictive factors of perceived walking difficulties. RESULTS Perceived walking difficulties increased after 3 years: mean Walk-12G score 14.8 versus 18.7, p < 0.001. Concerns about falling was the strongest predictor (β = 0.445) of perceived walking difficulties, followed by perceived balance problems while dual tasking (β = 0.268) and pain (β = 0.153). Perceived balance problems while dual tasking was the strongest predictor (β = 0.180) of a change in perceived walking difficulties, followed by global cognitive functioning (β = - 0.107). CONCLUSIONS Perceived walking difficulties increase over time in people with PD. Both personal factors (i.e. concerns about falling) and motor aspects (i.e. balance problems while dual tasking) seem to have a predictive role. Importantly, our study indicates that also non-motor symptoms (e.g. pain and cognitive functioning) seem to be of importance for future perceived walking difficulties. Future intervention studies that address these factors need to confirm their preventative effect on perceived walking difficulties.
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Affiliation(s)
- Magnus Lindh-Rengifo
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden.
| | | | - Susann Ullén
- Clinical Studies Sweden - Forum South, Skåne University Hospital, Lund, Sweden
| | - Niklas Mattsson-Carlgren
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
- Department of Neurology, Skåne University Hospital, Lund, Sweden
- Wallenberg Centre for Molecular Medicine, Lund University, Lund, Sweden
| | - Maria H Nilsson
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
- Memory Clinic, Skåne University Hospital, Malmö, Sweden
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
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Scheerman K, Schoenmakers AHC, Meskers CGM, Maier AB. Physical, motivational and environmental factors influencing physical activity promotion during hospitalization: Older patients' perspective. Geriatr Nurs 2021; 42:599-604. [PMID: 33714636 DOI: 10.1016/j.gerinurse.2021.02.013] [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: 12/10/2020] [Revised: 02/19/2021] [Accepted: 02/22/2021] [Indexed: 10/21/2022]
Abstract
Better understanding of older patients' perspective on physical, motivational and environmental barriers and enablers in physical activity promotion during hospitalization contributes to the development of strategies to increase in hospital physical activity. Using a mixed method approach, barriers and enablers from patients (in)dependent in physical activity (Functional Ambulation Categories ≥4 versus <4) were identified. Forty-nine patients (median age 77 years IQR:75-83, female: n = 25) were interviewed. Barriers reported as most important were feeling weak (n = 10), having lines/drains (n = 9) and pain (n = 7) and enablers reported as most important were feeling physically independent (n = 19), sense of importance of physical activity (n = 12), and maintaining physical strength (n = 10). Physically dependent patients were more frequently encouraged by professionals to be physically active compared to independent patients. Focus on physical barriers and motivational enablers for older patients may help to increase their physical activity during hospitalization and encouragement by health care professionals should also encompass physically independent patients.
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Affiliation(s)
- Kira Scheerman
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Internal Medicine, Section of Gerontology and Geriatrics, De Boelelaan 1117, 1081, HV Amsterdam, the Netherlands.; Amsterdam Movement Sciences, Van der Boechorststraat 9, 1081, BT Amsterdam, the Netherlands
| | - Amber Hendrica Cornelia Schoenmakers
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Internal Medicine, Section of Gerontology and Geriatrics, De Boelelaan 1117, 1081, HV Amsterdam, the Netherlands
| | - Carel Gerardus Maria Meskers
- Amsterdam Movement Sciences, Van der Boechorststraat 9, 1081, BT Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Rehabilitation Medicine, Amsterdam, the Netherlands, De Boelelaan 1117, 1081, HV Amsterdam, the Netherlands
| | - Andrea Britta Maier
- Department of Human Movement Sciences, @AgeAmsterdam, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Van der Boechorststraat 9, 1081, BT Amsterdam, the Netherlands; Department of Medicine and Aged Care, @AgeMelbourne, Royal Melbourne Hospital, University of Melbourne, Royal Parade, Parkville Victoria, 3010 Melbourne, Australia; Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Centre for Healthy Longevity, @AgeSingapore, National University Health System, Singapore.
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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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Boulton AJ, Kisala PA, Ni P, Tulsky DS. Linking the Spinal Cord Injury-Functional Index (SCI-FI) to the PROMIS Physical Functioning Item Bank. Arch Phys Med Rehabil 2021; 103:207-214. [PMID: 33684365 DOI: 10.1016/j.apmr.2021.02.011] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 01/11/2021] [Accepted: 02/08/2021] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To link 3 Spinal Cord Injury-Functional Index (SCI-FI) item banks (Basic Mobility, Fine Motor Function, Self-Care) to the Patient-Reported Outcome Measurement Information System (PROMIS) Physical Function (PF) metric. DESIGN Observational study SETTING: Six SCI Model Systems rehabilitation hospitals in the United States. PARTICIPANTS Adults with SCI (n=855) and healthy individuals (n=730) (N=1585). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Three SCI-FI item banks (Basic Mobility, Fine Motor Function, Self-Care), PROMIS PF v1.0 item bank. RESULTS SCI-FI item banks (including 30 items from the PROMIS PF item bank) were administered to 855 adults with SCI as part of the original SCI-FI development study. The data were used to attempt to link 3 SCI-FI banks to the PROMIS PF metric via 2 item-response theory methods: fixed-parameter calibration and separate calibration. Sixteen items common to SCI-FI and PROMIS and verified as free of differential item functioning were used as anchor items to implement the methods. Of the 3 banks, only SCI-FI Basic Mobility could be linked with sufficient precision to PROMIS PF. Comparisons of actual vs linked PROMIS PF scores and test characteristic curves suggested the fixed-parameter method provided slightly more precision than the separate calibration method. CONCLUSIONS The linkage between PROMIS PF and SCI-FI Basic Mobility was considered satisfactory for group-level usage. Score equivalents computed from SCI-FI Basic Mobility will be useful for researchers comparing functional levels in SCI to those observed in other clinical and nonclinical groups (eg, in comparative effectiveness research).
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Affiliation(s)
- Aaron J Boulton
- Center for Health Assessment Research and Translation, College of Health Sciences, University of Delaware, Newark, DE
| | - Pamela A Kisala
- Center for Health Assessment Research and Translation, College of Health Sciences, University of Delaware, Newark, DE
| | - Pengsheng Ni
- Department of Health Law, Policy, and Management, School of Public Health, Boston University, Boston, MA
| | - David S Tulsky
- Center for Health Assessment Research and Translation, College of Health Sciences, University of Delaware, Newark, DE; Departments of Physical Therapy and Psychological & Brain Sciences, University of Delaware, Newark, DE.
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Zhao J, Chau JPC, Lo SHS, Choi KC, Liang S. The effects of sitting Tai Chi on physical and psychosocial health outcomes among individuals with impaired physical mobility: A systematic review and meta-analysis. Int J Nurs Stud 2021; 118:103911. [PMID: 33751992 DOI: 10.1016/j.ijnurstu.2021.103911] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 02/18/2021] [Accepted: 02/21/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Impaired physical mobility refers to a limitation in independent and purposeful physical movement of the body or one or more extremities. Physical restrictions result in negative consequences on an individual's physical and psychosocial functions. Sitting Tai Chi, a derivative form of traditional Tai Chi, has been found to increase the flexibility of all joints involved and enhance the ability to perform physical activity. However, the evidence of sitting Tai Chi on physical and psychosocial health outcomes on individuals with impaired physical mobility is limited. OBJECTIVES To critically synthesize evidence that evaluates the effects of sitting Tai Chi on health outcomes among individuals with impaired physical mobility and to identify implementation strategies for the sitting Tai Chi intervention. METHODS Searches were performed across 11 English and two Chinese databases systematically from inception to January 2020. Randomised controlled trials and non-randomised controlled trials, written in English or Chinese were included. Two independent reviewers screened all eligible studies, appraised risk of bias, and extracted the data. Meta-analyses were conducted using Review Manager 5.4 and narrative syntheses were performed where meta-analysis was inappropriate. The certainty of evidence was assessed using Grades of Recommendation, Assessment, Development and Evaluation profiler Guideline Development Tool. This study was registered in PROSPERO. RESULTS A total of 1,446 records were generated and 11 studies were eligible for inclusion. Meta-analysis reported a statistically significant effect size favouring sitting Tai Chi on depressive symptoms (SMD: -1.53, 95% CI: -2.81 to -0.21, 2 studies; very low quality), heart rate (MD: -5.72, 95% CI: -11.16 to -0.29, 2 studies; low quality) and social domain of quality of life (MD: 1.42, 95% CI: 0.66 to 2.19, 3 studies; low quality). CONCLUSIONS Sitting Tai Chi was found to have favourable effects on depressive symptoms, heart rate, and social domain of quality of life of individuals with impaired physical mobility. Very low to low quality evidence does not support the effectiveness of sitting Tai Chi on dynamic sitting balance, handgrip strength, and the physical and psychological domains of quality of life. There was limited evidence to suggest the best implementation strategies for the sitting Tai Chi intervention. It is anticipated that more well-designed studies will continue developing high quality evidence in this field.
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