Association Between Falls Experience and Physical Performance Measures in Community-Living Older Adults

Abstract

Aims: To determine if various physical performance tests are able to adequately discriminate older adults based on their experience with falls and assess the concurrent validity of the “Barthel index” against these tests.

Methods: Fifty-four older adults above 60?years of age were divided into three groups: those who suffered a fall, have fear of fall (FoF), or were part of an age-matched control group. Performance measures that quantified balance impairments, the strength of the trunk, and respiratory muscles along with the Barthel index were evaluated.

Results: Older people who have experienced falls have lower scores in all the variables measured compared to the other two groups. Though certain measures were able to discriminate the scores between the three groups, not all of these measures were related to Barthel index scores.

Conclusion: The Berg Balance Scale (BBS) seems to be more appropriate for discriminating balance impairment and performance among elders.     

Frailty assessment of older adults,first-time applicants of public home care service in Norway

ObjectiveEarly detection of frailty is essential to prevent or delay disability. The most appropriate screening tool for frailty among home-dwelling older adults is under debate. The present study estimates the prevalence of frailty among older adults, first-time applicants of public home care service in Norway, and investigates the appropriateness of gait speed and Short Physical Performance Battery as screening-tools for frailty.Design and settingWe conducted a cross-sectional study of 116 older adults >65 years applying for public home care service for the first time. Frailty was assessed by an adapted version of the Fried Frailty Phenotype. The test accuracies of gait speed and Short Physical Performance Battery to detect frailty were calculated for a general population >70 years in Norway.Results62.1% of the participants were frail, 29.3% were prefrail, and 8.6% were robust. Mean gait speed and Short Physical Performance Battery-scores were significantly lower in frail compared to prefrail individuals, and significantly lower in prefrail compared to robust individuals. The sensitivity and specificity of gait speed at a cut point of 0.8 m/s to detect physical frailty phenotype was 99% and 68%, respectively.Conclusions The high prevalence of frailty in the present study indicates that screening for frailty should be considered at an earlier time point than when older adults apply for public home care service for the first time. Gait speed may be an appropriate screening tool for frailty in a general population >70 years in Norway.

KEY POINTS

• The prevalence of frailty among older adults, first-time applicants of public home care services in Norway is major.
• Screening for frailty should be considered before older adults apply for public home care service for the first time.
• Gait speed at a cut point at 0.8 m/s may be an appropriate screening tool for frailty in a general population >70 years in Norway.

     

水中运动治疗对脑卒中患者下肢运动功能及日常生活活动能力效果的Meta分析

目的 系统评价水中运动治疗对脑卒中患者下肢运动功能及日常生活活动能力的干预效果。 方法 检索Cochrane Library、PEDro、PubMed、EMBASE、Web of Knowledge、Web of Science、OVID、EBSCO、CMCI、CNKI、Wanfang和VIP数据库,筛选脑卒中患者水中运动治疗的随机对照试验(RCTs),进行方法学质量评价,提取相关数据,采用RevMan 5.3软件进行Meta分析。 结果 最终纳入23项RCTs,共861例患者。与对照组相比,水中运动治疗可改善患者Berg平衡量表评分(WMD = 4.61, 95%CI 3.79~5.43, P < 0.001)、计时起立-行走测试成绩(WMD = -1.56, 95%CI -3.07~-0.05, P < 0.05)、功能性前伸测试成绩(WMD = 2.69, 95%CI 1.21~4.16, P < 0.001)、压力中心移动速度(左右) (WMD = -1.38, 95%CI -2.72~-0.05, P < 0.05)、压力中心移动速度(前后) (WMD = -1.64, 95%CI -3.10~ -0.18, P < 0.05)、步速(SMD = 0.33, 95%CI 0.07~0.58, P < 0.05)、2分钟步行测试成绩(WMD = 12.75, 95%CI 4.17~21.34, P < 0.01)、功能性步行量表分级(WMD = 0.94, 95%CI 0.67~1.20, P < 0.001)、膝关节伸肌肌力(WMD = 4.30, 95%CI 1.53~7.07, P < 0.01)、膝关节屈肌肌力(WMD = 4.80, 95%CI 0.29~9.32, P < 0.05)和功能独立性测试评分(WMD = 6.12, 95%CI 3.98~8.27, P < 0.001),但对改良Barthel指数评分无明显改善作用(WMD = 2.92, 95%CI -6.74~12.58, P = 0.55)。 结论 水中运动治疗能够改善脑卒中患者的平衡功能、步行能力和下肢肌力,但对日常生活活动能力的效果不明显。     

Frailty in Older Age: Concepts and Relevance for Occupational and Physical Therapy

Frailty refers to a state of vulnerability in older persons for adverse outcomes. The recent assumption that frailty, disability, and comorbidity are distinct concepts creates possibilities for interventions that focus on delaying the onset of disabilities. However, disagreement exists on the definition of frailty and the factors contributing to it. This article presents an overview of the discussion about the concept of frailty, of intervention research, and instruments to identify frail elderly, and discusses the implications for the fields of occupational and physical therapy.     

Predictors of Engagement in Home Activities Among Community-Dwelling Older Adults

Aims: This analysis aims to identify what older adults self-report about engagement in home activities (EHA), if there is a difference between perceived and observed activity performance in the home, and what predicts EHA. Methods: Baseline data were analyzed from a randomized controlled trial of an occupational therapy fall prevention intervention with older adults age 65 and older with a fall within 6 months. A multiple linear regression model was used to compare perceived and observed activity performance. Results: Ninety-two participants (mean age 77.7 ± 7.4) were included. EHA can be predicted (F(6, 85) = 13.86, p < 0.001, R = 0.70, R² = 0.50) by perceived activity performance (p = 0.02), fear of falling (FOF) (p < 0.001), and depression (p = 0.05). Conclusions: Perceived activity performance predicts EHA but observed activity performance does not, indicating clinicians should consider older adults' perceptions. Self-efficacy and awareness may be reasons for differences between perceived and observed activity performance in the home. FOF and depression are also predictors of EHA.     

老年女性肌少症与平衡功能的相关性

目的 探讨老年女性肌少症与平衡功能之间的相关性。方法 2017年9月至11月,招募60~70岁老年女性224例,根据肌容量、握力和6米步速分为正常组(n = 198)和肌少症组(n = 26)。比较两组闭眼单足站立时间和5次坐立试验时间;闭眼单足站立时间和5次坐立试验时间分别与肌容量、握力和6米步速行Pearson相关分析。结果 老年女性肌容量、握力、6米步速单个指标异常率分别为20.5%、14.3%和2.2%,肌少症发生率11.6%。肌少症组闭眼单足站立时间显著短于正常组(t = 4.072, P < 0.001),5次坐立试验时间显著长于正常组( t = -5.461, P < 0.001);正常组闭眼单足站立时间与6米步速明显正相关( r = 0.675, P < 0.01);肌少症组闭眼单足站立时间与6米步速( r = 0.492)和握力(r = 0.286)均显著正相关(P < 0.001);两组5次坐立时间均与握力( r = 0.351, r = 0.462)、肌容量(r = 0.258, r = 0.321)、6米步速(r = 0.337, r = 0.396)显著正相关(P < 0.001)。 结论 相对肌肉质量和力量而言,老年女性增龄过程中肌肉功能保持相对较好。患肌少症的老年女性动静态平衡功能均下降。静态平衡主要与肌肉功能关系较大,动态平衡与肌肉质量、力量和功能均有关联。     

Impact of middle ear effusion on balance performance in children

Middle ear effusion (MEE) is a common childhood disease characterized by accumulation of fluid in the middle ear. MEE treatment focuses on the resultant conductive hearing loss. Recently, researchers have investigated the potential effects of MEE on balance.

Purpose:?The purpose of this study was to compare balance of children with MEE to that of healthy children and to examine whether a relation exists between balance skills and the degree of muscle strength.

Methods:?Twenty children with MEE and twenty healthy children aged 4.5?–?7.5 years underwent balance and strength sub-tests of Bruininks?–?Oseretsky Test of Motor Performance (BOTMP) and electronystagmography recordings (ENG). Parents completed a questionnaire designed to elicit their perceptions of their child's balance abilities in daily living activities.

Results:?MEE children performed significantly worse than did the control group on BOTMP balance sub-test. BOTMP strength subtest indicated that children with MEE had poorer muscle strength than the control group, although the difference was not significant. ENG results showed no pathologic recordings in both study group and control group. Finally, a significant correlation was found between parents' responses on the questionnaire and their child's performance on BOTMP balance subtest.

Conclusions:?MEE may negatively impact children's balance, while muscle strength is less affected. Furthermore, the BOTMP appears to be a sensitive assessment of balance disturbances in children with MEE.     

Impact of Pain and Psychosocial Factors on Frailty Among Older Adults With Physical Functional Limitations: A Cross-Sectional Study

AimsThe objective of this study was to determine the prevalence of frailty and pain among older adults with physical functional limitations in China. We also assessed the impact of pain and psychosocial determinants on frailty among this vulnerable population.DesignThis study was a cross-sectional study.Setting and participantsTotally, 2,323 Chinese elders with physical functional limitation were enrolled.MethodsPhysical functioning was assessed by the Barthel Index, participants who reported “often troubled with pain” were further asked about the intensity of their pain using a 1-10 numeric rating scale, and frailty was assessed by the Assessment of frailty FRAIL scale. The impact of pain and psychosocial factors on frailty was assessed by multivariable binary logistic regression.ResultsThe prevalence of frailty and pain were 30.9% and 46.1%, respectively. Compared with subjects who reported no pain, those who reported mild (odds ratio [OR] = 1.70, 95% confidence interval [CI] = 1.21-2.31), moderate (OR = 2.10, 95% CI = 1.53-2.82), or severe pain (OR = 2.31, 95% CI = 1.56-3.40) tended to be more vulnerable to frailty. Furthermore, compared with participants with positive psychosocial determinants, those with negative psychosocial determinants seemed more likely to be frail.ConclusionsThese findings suggest that the incidence of pain, negative psychosocial status, and frailty were prevalent, and the presence of pain and negative psychosocial factors increased the risk of frailty among older adults with physical functional limitation.     

Stability of Kyphosis, Strength, and Physical Performance Gains 1 Year After a Group Exercise Program in Community-Dwelling Hyperkyphotic Older Women

Pawlowsky SB, Hamel KA, Katzman WB. Stability of kyphosis, strength, and physical performance gains 1 year after a group exercise program in community-dwelling hyperkyphotic older women.

Objective

To determine if subjects maintained improvements in kyphosis, spinal extensor strength, and physical performance 1 year after a 12-week multidimensional group exercise program.

Design

Follow-up data compared with posttest outcome measures.

Setting

Outpatient academic medical center.

Participants

Nineteen of the initial 21 women, ages 65 to 80, with thoracic kyphosis of 50° or greater at the onset of the study completed follow-up testing.

Interventions

Initial intervention included multidimensional group exercise performed 2 times a week for 12 weeks, consisting of spinal extensor strengthening, flexibility exercises, and integrated spinal proprioception training. Subjects exercised independently during the following year.

Main Outcome Measures

Primary measures at the 1-year follow-up were usual and best kyphosis. Secondary measures included spinal extensor strength, modified Physical Performance Test (PPT), and the Jug Test.

Results

Subjects maintained gains at the 1-year follow-up (P>.05). Best kyphosis improved by 3° during the follow-up year (P=.022). There were no significant declines in usual kyphosis (P=.302), spinal extensor strength (P=.999), PPT (P=.087), and the Jug Test (P=.999) at follow-up.

Conclusions

Hyperkyphotic women maintained gains in usual kyphosis, spinal extensor strength, and physical performance 1 year after a group exercise program. Improvement in best kyphosis in the year after the intervention was also observed. Detraining effects may be minimized by multidimensional exercises.     

Effects of Upper-Extremity Progressive Resistance Strength Training in Older Adults: The Missing Picture

ABSTRACT

Age-related decline in muscle strength affects both upper and lower extremities. This decline is associated with late-life onset of physical disability. Although progressive resistance strength training (PRT) has shown promising results in lower-extremity-related physical function, such as walking speed, little is known about the effect on upper-extremity-related physical function. This study reviewed 28 randomized controlled trials published before 2008. Outcomes of upper-extremity muscle strength, hand-grip strength, eye–hand coordination, and physical function were appraised. It is hard to conclude whether or not upper-extremity PRT is beneficial for upper-extremity-related physical function in older adults because the specific effect of upper extremities was often unmeasured, poorly measured with timed tests, or buried in mixed results of upper and lower extremities. Additional research that focuses on examining the effect of upper-extremity PRT is recommended to support the need for a comprehensive muscle strength training program.     

The Effects of Loaded Versus Unloaded Activities on Foot Volumetrics in Older Healthy Adults

Background

Health care practitioners, including sports physical therapists, commonly prescribe and recommend aerobic exercise for those patients seeking to improve their cardiovascular fitness across all ages. Current literature demonstrates that weight bearing activities such as walking or running may lead to foot and ankle edema.

Objectives

The purpose of this study is to determine if a significant difference exists between foot volumes (edema) in pre versus post-exercise measurements during a loaded activity (treadmill walking) or an unloaded activity (upright exercise bike) in 31 healthy subjects 50 years of age and older.

Methods

After a rest period, a pre-exercise volumetric measurement of the right leg was obtained by the use of a foot volumeter. The first condition (walking or cycling) was randomly chosen. Each subject completed two 10-minute exercise sessions. Immediately following both exercise sessions, a post-exercise volumetric measurement was completed.

Results

A statistically significant difference in foot volume was found between pre (mean = 742.39ml, 95% CI: 685.23 – 799.55) and post (mean = 753.03ml, 95% CI: 697.51ml – 808.55ml) measurements for the treadmill (weight bearing) protocol. When considering each sex separately, males produced significant increases in foot volume following tread-mill walking (pre mean = 871.00ml, 95% CI: 793.95ml – 948.05ml; post mean = 886.20ml, 95% CI: 811.28ml – 961.13ml), while females displayed no significant changes.

Discussion and Conclusion

This study demonstrated a 1.4% increase in foot volume after 10 minutes of treadmill walking. Based on these results, it may be advisable to prescribe non-weight bearing exercise to active older individuals with pre-existing conditions for edema.     

Effects of line dancing on physical function and perceived limitation in older adults with self-reported mobility limitations

Introduction: Older adults with mobility limitations are at greater risk for aging-related declines in physical function. Line dancing is a popular form of exercise that can be modified, and is thus feasible for older adults with mobility limitations.

Purpose: The purpose of this study was to assess the effects of 8 weeks of line dancing on balance, muscle strength, lower extremity function, endurance, gait speed, and perceived mobility limitations.

Methods: An experimental design randomly assigned older adults to either an 8-week line dancing or usual care group. The convenience sample consisted of 23 participants with mobility limitations (age range: 65–93?years). The intervention used simple routines from novice line dance classes. At baseline and at 8 weeks, balance, knee muscle strength, lower extremity function, endurance, gait speed, and mobility limitations were measured. ANCOVA tests were conducted on each dependent variable to assess the effects of the intervention over time.

Results: Results found significant positive differences for the intervention group in lower extremity function (p?p?p?p?Conclusions: Eight weeks of line dancing significantly improved physical function and reduced self-reported mobility limitations in these individuals. Line dancing could be recommended by clinicians as a potential adjunct therapy that addresses mobility limitations.

• Implications for Rehabilitation

• Line dancing may be an alternative exercise for older adults who need modifications due to mobility limitations.

• Line dancing incorporates cognitive and motor control.

• Line dancing can be performed alone or in a group setting.

• Dancing improves balance which can reduce risk of falls.

     

Effects of Chronic Ethanol Abuse on Structure and Enzyme Activities of Skeletal Muscle in Man

Biopsies from vastus lateralis muscle of male patients suffering from chronic ethanol abuse were studied with regard to histochemical reactions of ATP-ase and NADH-diaphorase; enzymatic activities of triosephosphate dehydrogenase (TPD), lactate dehydrogenase (LD), and cytochrome c oxidase (cytox); content of ATP, creatine phosphate, and glycogen; and volume fractions of fat, mitochondria, and fibrillar and extrafibrillar space. The results were compared with those from controls without known abuse of ethanol. The relative numbers of fibers were the same in the two groups, but the size of the fast-twitch-glycolytic (white) fibers was diminished in the alcoholic group. The activities of TPD and LD were diminished in skeletal muscle of the alcoholics. This is most probably caused by the reduced amount of fast-twitch-glycolytic tissue, as there was a good correlation between this amount and the activity of the two enzymes. The activity of cytox was slightly lower in muscle of the alcoholics than in that of the controls. The volume fraction of mitochondria was lower in the alcoholic group than in the control group. Volume fractions of fat and fibrillar and extrafibrillar space were equal in the two groups. No significant differences were found in the amount of glycogen and ATP in the muscle of the two groups. However, the content of creatine phosphate is higher in the alcoholic group than in the control group.     

成年残疾人参与体育活动状况及其影响因素的Logistic回归模型研究

目的 研究残疾人体育活动参与状况及其影响因素。方法 以2019年2 302 833名残疾人参与体育活动数据为样本,应用多重响应交叉列联表分析残疾人体育活动的参与状况,应用Logistic回归模型分析残疾人参与体育活动的影响因素。结果 残疾人体育活动参与率非常低(7.0%),其中,男性(7.3%)高于女性;18~59岁(7.6%)高于其他年龄段;农业户口(7.1%)高于非农业户口;言语残疾(7.7%)高于其他类型;四级残疾(8.6%)高于其他等级。在残疾人未经常参与体育活动的原因方面,农业户口残疾人报告没有适合自己的活动项目(14.4%)和没有适合的场所及设施(12.3%),高于非农业户口残疾人。Logistic回归模型显示,不同性别(B = 0.048,P< 0.001)、年龄(B = 0.178,P< 0.001)、户口性质(B = 0.078,P < 0.001)、残疾类别(B _视力= 0.055, P < 0.01; B _听力= 0.133, P < 0.001; B _言语= 0.282, P< 0.001; B_智力= -0.159, P < 0.001; B _精神= -0.062, P < 0.01)的残疾人体育活动参与状况的差异较小;残疾等级对残疾人体育活动的参与状况有显著影响( P < 0.001),一级残疾人是四级残疾人的0.571倍(B = -0.561, OR = 0.571),二级残疾人是四级残疾人的0.659倍(B = -0.417, OR = 0.659)。 结论 成年残疾人体育活动参与率较低,残疾人功能特点直接影响到其体育活动的参与状况。应根据ICF理论与方法,设计适应性体育项目,建设无障碍体育设施,培训具备专业知识的指导人员,以促进残疾人参与体育活动。     

运动想象对脑卒中患者偏瘫步态和步行能力的影响

目的:探讨运动想象对脑卒中患者步态的时间与空间参数和步行能力的影响。方法:选择34例慢性偏瘫患者分为治疗组(n=18)和对照组(n=16),采用运动解析系统评测运动想象前后及12周随访时的最大步行速度、步态时相和时间-空间参数。结果:运动想象治疗前后及第12周随访时,最大步行速度、步态时间-空间参数、时相参数和步态不对称指数差异均有显著性意义(P0.01),治疗6周后与对照组比较差异也有显著性意义(P0.05)。PostHoc检验,治疗前与12周随访时比较,步频、步幅、健侧步长和不对称指数差异有显著性意义(P0.05);与治疗第3周比较,所有评价指标差异有显著性意义(P0.05);与第6周比较,除双腿支撑期外,其他参数差异均有显著性意义(P0.05);治疗第6周和12周随访时比较,只有不对称指数差异有显著性意义(P0.01)。结论:运动想象可以改善偏瘫步态时间-空间和时相参数,矫正步态不对称,提高步行能力。     

C6—T6脊髓损伤患者应用往复式步行矫形器的疗效分析

目的：观察往复式步行矫形器对T6以上脊髓损伤患者心肺功能和ADL能力及步行能力的影响。方法：将40例C6—T6以上脊髓损伤患者分为观察组18例（装配往复式步行矫形器者）和对照组22例（未装配者）。对照组进行系统综合康复治疗（包括有氧训练、肌力训练、站立训练、平衡、转移训练、被动关节活动度训练、心肺功能训练、ADL训练、膀胱功能等其他综合康复训练），观察组进行系统综合康复治疗外还进行装配步行矫形器前训练、矫形器装配后训练及步态步行训练。结果：经过12周的训练后两组患者的心肺功能和日常生活活动能力明显改善，观察组明显优于对照组（P<0.05）。观察组18例患者装配矫形器及训练后患者10m步行时间平均87.27±39.57s， 6min步行距离为46.35±26.24m ，在装配往复式步行矫形器后7例可达到室内治疗性步行，11例可达到实用性步行，对照组无一例能步行。结论：往复式步行矫形器对改善T6以上脊髓损伤患者心肺功能、ADL能力及步行能力有重要意义。     

Physical Activity and the Effect of Multimorbidity on All-Cause Mortality in Older Adults

Objective

To examine the stratified and joint associations of physical activity (PA) and the number of chronic conditions on long-term all-cause mortality.