Skinfold thickness affects the isometric knee extension torque evoked by Neuromuscular Electrical Stimulation

BACKGROUND:

Subcutaneous adipose tissue may influence the transmission of electrical stimuli through to the skin, thus affecting both evoked torque and comfort perception associated with neuromuscular electrical stimulation (NMES). This could seriously affect the effectiveness of NMES for either rehabilitation or sports purposes.

OBJECTIVE:

To investigate the effects of skinfold thickness (SFT) on maximal NMES current intensity, NMES-evoked torque, and NMES-induced discomfort.

METHOD:

First, we compared NMES current intensity, NMES-induced discomfort, and NMES-evoked torque between two subgroups of subjects with thicker (n=10; 20.7 mm) vs. thinner (n=10; 29.4 mm) SFT. Second, we correlated SFT to NMES current intensity, NMES-induced discomfort, and NMES-evoked knee extension torque in 20 healthy women. The NMES-evoked torque was normalized to the maximal voluntary contraction (MVC) torque. The discomfort induced by NMES was assessed with a visual analog scale (VAS).

RESULTS:

NMES-evoked torque was 27.5% lower in subjects with thicker SFT (p=0.01) while maximal current intensity was 24.2% lower in subjects with thinner SFT (p=0.01). A positive correlation was found between current intensity and SFT (r=0.540, p=0.017). A negative correlation was found between NMES-evoked torque and SFT (r=-0.563, p=0.012). No significant correlation was observed between discomfort scores and SFT (r_s=0.15, p=0.53).

CONCLUSION:

These results suggest that the amount of subcutaneous adipose tissue (as reflected by skinfold thickness) affected NMES current intensity and NMES-evoked torque, but had no effect on discomfort perception. Our findings may help physical therapists to better understand the impact of SFT on NMES and to design more rational stimulation strategies.     

The Relationship Between Wheelchair Mobility Patterns and Community Participation Among Individuals With Spinal Cord Injury

Participation is considered the most meaningful outcome of rehabilitation. The purpose of this study was to investigate whether there were correlations between wheelchair activity recorded with a data logger and community participation as measured by the Participation Survey/Mobility. Data from 16 participants were included in this study. Data collected during a two week period using a data logging device were analyzed to determine the mobility characteristics of participants. Among manual wheelchair users, significant positive correlations were found between average speed traveled and the community participation content areas of transportation (r_s = .837, p = .019) and socialization (r_s = .772, p = .042). In addition, for manual wheelchair users there was a trend toward a significant correlation between average speed traveled and total community participation score (r_s = .714, p = .071). Among power wheelchair users, there was a trend toward a significant negative correlation between average speed traveled and the community participation content area of leisure activity (r_s =??.635, p = .066). Understanding the relationship between wheelchair speed and community participation can be useful information to enable clinicians to recommend the most appropriate mobility devices designed to enhance community participation.     

Reliability and validity of the Falls Efficacy Scale-International after hip fracture in patients aged ≥65 years

Abstract

Purpose: To assess the measurement properties of the Falls Efficacy Scale-International (FES-I) in patients after a hip fracture aged ≥ 65 years. Methods: In a sample of 100 patients, we examined the structural validity, internal consistency and construct validity. For the structural validity a confirmatory factor analysis was carried out. For construct validity predetermined hypotheses were tested. In a second sample of 21 older patients the inter-rater reliability was evaluated. Results: The factor analysis yielded strong evidence that the FES-I is uni-dimensional in patients with a hip fracture; the Cronbach’s alpha was 0.94. When testing the reliability, the intra-class correlation coefficient was 0.72, while the Standard Error of Measurement was 6.4 and the Smallest Detectable Change was 17.7 (on a scale from 16 to 64). The Spearman correlation of the FES-I with the one-item fear of falling instrument was high (r?=?0.68). The correlation was moderate with instruments measuring functional performance constructs and low with instruments measuring psychological constructs. Conclusions: Reliability and structural validity of the FES-I in patients after a hip fracture are good. The construct validity appears more closely related to functional performance constructs than to psychological constructs, suggesting that the concept measured by the FES-I may not capture all aspects of fear of falling.

• Implications for Rehabilitation

• The Falls Efficacy Scale-International (FES-I), which is commonly used to measure fear of falling in community-dwelling older persons, can also be used to assess fear of falling in patients after a hip fracture.

• The reliability and the structural validity of the FES-I for these hip patients are good, whereas the construct validity of the FES-I is not optimal.

• The FES-I may not capture all aspects of fear of falling and may be more closely related to functional performance than to psychological concepts such as anxiety.

     

The risk of being fearful or fearless of falls in older people: An empirical validation

Purpose.?To investigate the risk of being fearful or fearless of falls in older people.

Methods.?Using a force plate, postural control in different sensory and rhythmic conditions was measured in 263 community-dwelling older people. Other assessments included fear of falling, and handgrip strength. Fall incidence was assessed at baseline and during a one-year follow-up period.

Results.?Logistic regression analysis revealed that increased lateral sway in near-tandem stance with eyes open (OR = 5.33; p < 0.01) and a worse performance on anteroposterior rhythmic weight shifts (OR = 0.65; p < 0.05) were related to falls. Univariate analyses revealed that older people with inappropriate high fear of falling according to their fall incidence had worse balance capacities on the rhythmic weight shifts (p < 0.05) but had similar static balance and physical capacities. Older people with inappropriate low fear of falling had a better hand grip (p < 0.05) but equally worse balance capacities than the comparison group.

Conclusions.?The results indicate the importance of lateral stability in relation to falls. They also suggest a substantial impact of inappropriate fear of falling on physical performance. Inappropriate high fear of falling may result in worse performance during dynamic balance tests, whereas older people with inappropriate low fear seem to overrate their capacities because of higher strength.     

Aspects of reliability and validity of the Swedish version of the Self-Efficacy for Exercise Scale for older people

Abstract

The aim was to test aspects of reliability and validity of a Swedish version of the Self-Efficacy for Exercise Scale (SEE-SV) for older people. Floor and ceiling effects, item-total correlation, internal consistency, test--retest reliability, content and construct validity were tested on 39 older people, mean age 72 years (SD 3.3). Content validity was also tested on five physical therapists. The results showed no floor and ceiling effects. The ICC for the total score was 0.79 (95% CI 0.61–0.89). The median weighted kappa coefficients square for the individual items was 0.63. Item-to-total correlation varied between 0.64 and 0.86 and Cronbach’s Alpha for all items was >0.92. The correlations between SEE-SV and the SF-36 Mental Health and Bodily Pain subscales were r_s?=?0.50 and r_s?=?0.30 (ns), respectively. The correlation between SEE-SV and self-assessed physical activity was r_s?=?0.13 (ns). Eighty-nine percent responded that the items were relevant and 92% that no item should be excluded. All physical therapists considered the items relevant, but the written instructions could be improved. In conclusion, SEE-SV has good item-to-total correlation, satisfactory internal consistence and substantial test--retest reliability. Our results show satisfactory content validity; however, studies are needed to further evaluate construct validity and to evaluate other aspects such as predicitve validity and responsiveness.     

Correlation Among Pain Intensity,Catastrophizing, and Falls in Older Individuals With Unilateral Knee Osteoarthritis: A Cross-Sectional Study

ObjectiveThe purpose of this study was to investigate whether pain intensity and catastrophizing are associated with fear of falls and the number of falls in older persons with knee osteoarthritis (OA).MethodsA cross-sectional study was conducted involving 100 volunteers (male and female participants), 60 to 80 years old, with a diagnosis of knee OA. Patients were recruited from a physical therapy clinic in the city of São Paulo, Brazil, from March 2019 to November 2019. The following measures were used for the evaluations: Numerical Rating Pain Scale (NRPS), Pain-Related Self-Statement Scale (PRSS), and Falls Efficacy Scale. In statistical analysis, histograms were created to determine the distribution of data. Spearman's correlation coefficients (r_s) were then calculated to determine the strength of the associations among the variables. The receiver operating characteristic curve was used to identify the accuracy of PRSS and NRPS in differentiating participants with a history of falls from those without.ResultsNo significant correlation was found among the pain intensity, pain catastrophizing, fear of falling, and number of falls (r_s value ranging from –0.033 to –0.167; P value ranging from .096-.743). The accuracy of PRSS and NRPS in differentiating participants with falls from those without was insufficient, with area under the curve values of 0.46 and 0.42, respectively.ConclusionPain catastrophizing and intensity were not significantly associated with fear of falling and numbers of falls in older individuals with unilateral knee OA.     

Compensated hepatitis C: unenhanced MR imaging correlated with pathologic grading and staging

Abstract Background We prospectively examined unenhanced MR imaging findings in relation to pathologic fibrosis, inflammation and steatosis in patients with compensated chronic hepatitis C viral infection (HCV). Methods Unenhanced MRI at 1.5 T was obtained within one month of core liver biopsy in 64 consecutive candidates for antiviral therapy for compensated HCV. Two pathologists independently graded inflammatory activity index (HAI) and steatosis, and staged fibrosis (grades 0–6). Morphologic MRI findings of cirrhosis, periportal lymph nodes, and MR fat signal ratio from dual gradient echo images were assessed independently by two radiologists blinded to clinical data. MRI and laboratory liver function results were correlated with pathologic results, using Spearman correlation coefficient and stepwise multiple regression. Results MR fat signal ratio correlation coefficient with pathologic steatosis was 0.71 (p < 0.0001). Coefficients with fibrosis stage were highest for surface nodularity (r _s = 47, p < 0.0001) and expanded gallbladder fossa (r _s = 0.42, p = 0.0006). Coefficients with HAI were highest for lymph node size (r _s = 0.355, p = 0.0040), surface nodularity (r = 0.47, p < 0.0001), expanded gallbladder fossa (r = 0.332, p = 0.0073), and caudate/right lobe ratio (r = 0.326, p = 0.0110). Combined lab and MRI variables provided the best prediction of fibrosis stage (r ² = 0.656) and HAI (r ² = 0.597). Conclusions A combination of MRI and laboratory findings was most predictive of fibrosis and inflammation.     

Adipose tissue distribution in relation to insulin sensitivity and inflammation in Pakistani and Norwegian subjects with type 2 diabetes

Abstract

Immigrants from South Asia to Western countries have a high prevalence of type 2 diabetes mellitus (T2DM) associated with obesity. We investigated the relationship between diabetes and adipose tissue distribution in a group of younger T2DM subjects from Norway and Pakistan. Eighteen immigrant Pakistani and 21 Norwegian T2DM subjects (age 29–45, 49% men) were included. They underwent anthropometrical measurements including bioelectrical impedance analysis, CT scans measuring fatty infiltration in liver and adipose and muscle tissue compartments in mid-abdomen and thigh, a euglycemic clamp, and blood samples for serum insulin and plasma glucose, adipokines and inflammation markers. Adipose tissue distribution was similar in Norwegians and Pakistanis. Pakistanis, but not Norwegians, showed a negative correlation between insulin sensitivity and visceral adipose tissue (VAT, r_s = ? 0.704, p = 0.003). Subcutaneous adipose tissue (SAT) correlated to leptin in both Pakistanis and Norwegians (r_s = 0.88, p < 0.001 and 0.67, p = 0.001). SAT also correlated to C-reactive protein (CRP) in the Pakistanis only (r_s = 0.55, p = 0.03), and superficial SAT to Interleukin-1 receptor antagonist (IL-1RA) in Norwegians only (r_s = 0.47, p = 0.04). In conclusion, despite similar adipose tissue distribution in the two groups Pakistanis were more insulin resistant, with a negative correlation of VAT to insulin sensitivity, not present in Norwegians. The correlation of adipose tissue to Leptin, CRP and IL-1RA showed ethnic differences.     

Self-reported function and disability in late life – cross-cultural adaptation and validation of the Swedish version of the late-life function and disability instrument

Abstract

Purpose: To translate and perform a cross-cultural adaptation of the Late-Life Function and Disability Instrument (LLFDI) to Swedish, to investigate absolute and relative reliability, concurrent validity, and floor and ceiling effects within a Swedish-speaking sample of community-dwelling older adults with self-reported balance deficits and fear of falling. Method: Translation, reliability and validation study of the LLFDI. Sixty-two community-dwelling, healthy older adults (54 women and 8 men) aged 68–88 years with balance deficits and fear of falling performed the LLFDI twice with an interval of 2 weeks. Results: Test–retest agreement, intra-class correlation coefficient was very good, 0.87–0.91 in the LLFDI function component and 0.82–0.91 in the LLFDI disability component. The standard error of measure was small, 5–9%, and the smallest real difference was 14–24%. Internal consistency (Cronbach’s alpha) was high (0.90–0.96). Correlation with the SF-36 PCS and PF-10 was moderate in both LLFDI function, r?=?0.39–0.68 and r?=?0.35–0.52, and LLFDI disability, r?=?0.40–0.63 and 0.34–0.57, respectively. There was no floor or ceiling effects. Conclusion: The Swedish version of the LLFDI is a highly reliable and valid instrument for assessing function and disability in community-dwelling older women with self-reported balance deficits and fear of falling.

• Implications for Rehabilitation

• The Swedish LLFDI is a highly reliable and valid instrument for assessing function and disability in older women with self-reported balance deficits and fear of falling.

• The instrument may be used both in clinical settings and in research.

• The instrument is sensitive to change and a reasonably small improvement is enough to detect changes in a group or a single individual.

     

Development and Validation of the Comprehensive Falls Risk Screening Instrument

ABSTRACT

Annually, one in three older adults experiences a fall. Falls can lead to death, disability, and/or decreased health-related quality of life (HRQL). Objectives: To validate the Comprehensive Falls Risk Screening Instrument (CFRSI). Methods: Data were collected on 286 older adults (M age in years = 74.2 ± 10.0). The CFRSI total falls risk score was compared to subscale scores, the Physical Activity Scale for the Elderly (PASE), the Functional Status Index (FSI), and HRQL (SF-36, PCS, and Mental Component Summary (MCS)) scores. Results: The total CFRSI falls risk score was associated with all subscales (r = 0.25, p < 0.01 to r = 0.69, p < 0.01), PASE (r = ?0.30, p < 0.01), FSI (r = 0.30, p < 0.01), and SF-36 PCS and MCS scores (r = ?0.44, p < 0.01 to r = ?0.24, p = 0.03, respectively). Fallers (n = 90) had a higher total falls risk score (M = 41.03 ± 9.38) than nonfallers (n = 188, M = 34.06 ± 10.05, t [276] = 5.53, p < 0.001). The most important predictor of falling status was only the history risk score (r = 0.96). Strong association of variables supports the construct validation of the CFRSI. The CFRSI is a valid comprehensive measure of falls risk that allows for identification of older adults who are at risk for falls and the specific areas that should be targeted for falls prevention.     

Leisure Time Physical Activity Instrument and Physical Activity at Home and Work Instrument. Development,face validity,construct validity and test-retest reliability for subjects with fibromyalgia

Purpose.?A new instrument measuring leisure time physical activity (LTPAI) in populations predominately engaging in low intensity activities and a new instrument measuring the Physical Activity at Home and Work (PAHWI) were designed.

Methods.?Patients with long-lasting pain and expert physiotherapists participated in the development of the two instruments. Test-retest reliability was evaluated for the LTPAI and the PAHWI. Construct validity was evaluated for the LTPAI by comparing it with an instrument measuring physical activities for older people, six-minute walk test and aerobic capacity.

Population.?37 women with FM, with the mean age of 46 years (SD 8.4) and mean symptom duration of 11 years (SD 5.9) were recruited to the study.

Results.?The mean time that the study population spent in physical activities during leisure time was 5.2?hours (SD 4.0) a week. Satisfactory test-retest reliability was found for the total score of LTPAI (ICC 0.86, CI 0.79?–?0.93) and for the PAHWI (ICC 0.91, CI 0.82?–?9.96). A significant association between the LTPAI and the six-minute walk test (r_s 0.40, p?=?0.02) and another physical activity instrument (r_s 0.39, p?=?0.02) was found. As expected, LTPAI did not have any association with aerobic capacity.

Conclusions.?Face validity of the instruments was ensured during the development process. Satisfactory test-retest reliability was found for the LTPAI and the PAHWI. Significant but low associations were found between the LTPAI and the six-minute walk test and an instrument designed for older people, respectively, while no association was found between the LTPAI and aerobic capacity.     

Translation and validation of the Swedish version of the mini-BESTest in subjects with Parkinson's disease or stroke: A pilot study

Recently, a comprehensive clinical balance test, the balance evaluation systems test (BESTest), was developed to identify the postural control systems causing balance impairments. A short version, the mini-BESTest, was thereafter developed by eliminating redundant and insensitive items. This study aimed to translate the mini-BESTest to Swedish, adapt it and investigate its validity in subjects with Parkinson's disease (PD) or stroke. The Mini-BESTest was translated and back-translated in accordance with Guillemin's guidelines. Discrepancies were discussed and solved by a panel and the test was culturally adapted. Concurrent validity of the final version was explored by correlating well-known clinical tests – the Berg Balance Scale (BBS), the Timed Up and Go (TUG) test and the Falls Efficacy Scale (FES(s)) – with the new mini-BESTest in nine subjects with mild-to-moderate PD (60 years, range 46–85) and nine with chronic stroke (78 years, range 66–90). A high-to-very-high correlation was shown between the mini-BESTest and the BBS (PD: r_s?=?0.94, stroke: r_s?=?0.86). The mini-BESTest correlated highly with the TUG (PD: r_s?=??0.81, stroke: r_s?=??0.89). In the PD group, a low correlation (r_s?=?0.26) was seen between the mini-BESTest and the FES(s). The mini-BESTest has high concurrent validity and is a comprehensive assessment of balance. However, its psychometric properties should be evaluated further.     

Validity,reliability and sensitivity of the NORLA-6: Naming and oral reading for language in aphasia 6-point scale

Purpose: Evaluation of the Naming and Oral Reading for Language in Aphasia 6-point scale (NORLA-6), a scoring system of oral reading and naming performance in aphasia.

Method: Data were drawn from 91 participants with non-fluent aphasia secondary to left-hemisphere stroke across four treatment studies. To assess validity, Spearman’s correlations were calculated between the NORLA-6 and the Gray Oral Reading Test-Fourth Edition (GORT-4) Accuracy score, GORT-4 Rate score and the Boston Naming Test (BNT). Inter-rater and test–retest reliability were evaluated using correlations. Sensitivity to change following oral reading intervention was analysed using Wilcoxon Signed Rank tests between pre- and post-treatment NORLA-6 scores.

Result: NORLA-6 performance was significantly correlated (p?r_s=0.84; GORT-4 Rate, r_s= 0.61; and BNT, r_s= 0.92). Inter-rater (ICC ≥0.90) and test–retest (r?>?0.92) reliability were both excellent. Sensitivity following oral reading intervention was demonstrated in both oral reading accuracy and rate (p?Conclusion: The NORLA-6 is a valid and reliable measure of oral reading and naming performance. It also demonstrates sensitivity to change in treatment-targeted behaviours. Therefore, the NORLA-6 scale may enhance outcome measurement in both clinical practice and aphasia research.     

Falls and fall risk among nursing home residents

Aim and objectives. The aim of this study was to identify risk factors for falls in older people living in nursing homes. Background. Impaired cognitive function and a poor sense of orientation could lead to an increase in falls among those with impaired freedom of movement. Many accidents occur while an older person is walking or being moved. Method. The study was carried out over four years (2000–2003) and 21 nursing home units in five municipal homes for older people in Stockholm, Sweden, participated. A questionnaire was sent to staff nurses, including questions on fall risk assessments, falls, fractures, medication and freedom‐restricting measures, such as wheelchairs with belts and bed rails. The data were aggregated and not patient‐bound. The study covered 2343 reported incidents. Results. There was a significant correlation between falls and fractures (r = 0·365, p = 0·004), fall risk and use of wheelchairs (r = 0·406, p = 0·001, safety belts (r = 0·403, p = 0·001 and bed rails (r = 0·446, p = 0·000) and between the occurrence of fractures and the use of sleeping pills with benzodiazepines (r = 0·352, p = 0·005). Associations were also found between fall risk and the use of anti‐depressants (r = 0·412, p = 0·001). Conclusion. In clinical practice, patient safety is very important. Preventative measures should focus on risk factors associated with individuals, including their environment. Wheelchairs with safety belts and bed rails did not eliminate falls but our results support the hypothesis that they might be protective when used selectively with less anti‐depressants and sleeping pills, especially benzodiazepines.     

Fear of Falling: A Qualitative Study Among Community-Dwelling Older Adults

The aim of this qualitative study was to uncover why older adults experience the fear of falling and discover the perceived consequences older adults fear. Seven participants between 61 and 88 (M = 75.4, SD = 9.1) years were interviewed. It was identified that participants developed the fear of falling after they had fallen or as they aged. Six themes related to the fear of falling were revealed, including Physical Injury, the Feeling Experienced when Falling, Becoming an Invalid or Burden, Losing Independence and Being Institutionalized, A Long Lie, and Being Confined to a Wheelchair or Unable to Walk. The results from this study indicated that older adults fear the consequences of falling. However, they fear not only physical injury as a result of the fall, but the injury's consequences that may precipitate the individual becoming more dependent on others and experiencing life altering events.     

A prospective study examining balance confidence among individuals with lower limb amputation

Purpose:?In this study we assessed whether balance confidence scores changed over a 2-year follow up period, and identified predictors of balance confidence and predictors of change in balance confidence among lower limb amputees.

Method:?A prospective follow-up survey of 245 community living adults with unilateral below and above knee lower limb amputation who used their prosthetic limb daily was conducted. Balance confidence, assessed using the 16-item Activity-specific Balance Confidence (ABC) Scale, socio-demographic, health and amputation related variables were collected at baseline and 2 years later.

Results:?ABC scores were similar at baseline (mean?= 67.6; SD?=?25.7) and follow up (mean?=?68.0; SD?=?25.8). Lower balance confidence scores at follow up were predicted by older age, being female, use of a mobility device, poor perceived health, increased symptoms of depression, having to concentrate while walking, and fear of falling (all p?<?0.05). Predictors of change in balance confidence included gender and perceived health (all p?<?0.05).

Conclusion:?Balance confidence appears to be a persistent problem in the amputee population. Health professionals are encouraged to consider balance confidence as a potentially important variable that may influence function in this clinically unique group of individuals. The identified predictor variables may be useful to clinicians in targeting individuals who require attention to improve balance confidence.     

A Timed Seated-Mobility Measure for Older Adults Using Manual Wheelchairs

Abstract

Aims: To assess reliability and validity of a two-minute wheeled mobility test (2MWMT) for older adults using manual wheelchairs living in long-term care communities. Methods: The distance wheeled on two days was compared. Three functional measures were completed on Day 1: Nursing Home Life Space Diameter (NHLSD), Physiotherapy Functional Mobility Profile (PFMP), and Nursing Home Physical Performance Test (NHPPT). Results: The 2MWMT showed excellent 1-week test-retest (ICC_2,2?=?0.92, CI?=?0.83???0.96), intra-rater (ICC_1,1?=?0.99, CI?=?0.98???1.0), and inter-rater (ICC_2,1?=?0.97, CI?=?0.94???0.99) reliability. The 2MWMT was moderately correlated with the NHLSD (r?=?0.55, p?<?0.01) and NHPPT (r?=?0.45, p?=?0.02), but poorly related to the PFMP (r?=?0.12, p?>?0.05). Conclusions: One 2MWMT measure is needed to provide a short, reliable test of seated mobility in older adults using manual wheelchairs.