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.     

Contribution of subjective balance confidence on functional mobility in subjects with chronic stroke

Purpose.?To examine the contribution of subjective balance confidence, balance ability, motor impairments and muscle strength to the timed ‘Up & Go’ (TUG) scores of 78 subjects with chronic stroke using cross-sectional design.

Methods.?Functional mobility was measured in terms of TUG scores. Balance ability and subjective balance confidence were assessed with the Berg Balance Scale (BBS) and the activities-specific balance confidence (ABC) scale, respectively. Stroke-specific motor impairment and muscle strength of lower extremity were measured using the Fugl-Meyer Motor Assessment lower extremity (FMA-LE) scores and hand-held dynamometer.

Results.?We found that the TUG scores had the highest negative correlation with subjective balance confidence. After controlling for use of walking aids, significant partial correlations were identified between the TUG scores and subjective balance confidence and balance ability. Applying linear regression model, the TUG scores showed association with subjective balance confidence and balance ability, independently. The motor impairments and muscle strength, however, were not significant predictors of TUG scores. The whole model could explain 63.0%% of the variance in the TUG scores.

Conclusions.?Our results support that improving both subjective balance confidence, in addition to functional balance training could be crucial in promoting functional mobility of community-dwelling stroke survivors.     

Psychometric properties of the Activities-Specific Balance Confidence Scale in persons 0–14 days and 3 months post stroke

Purpose: To test the internal consistency and validity of a Swedish translation of the Activities-specific Balance Confidence Scale (ABC) 0–14 days and 3 months post stroke. Method: 37 persons were tested at 0–14 days (median 5 days) post stroke and 31 were retested 3 months later (median 87 days). In addition to the ABC, the Functional Ambulation Categories, modified Rivermead Mobility Index, timed up and go test, 10-meter timed walk, SF-36 and the 12-item Walking Scale were used. Results: The internal consistency was high at α?=?0.94 to 0.97. Kendall correlation-τ coefficients were moderate and varied somewhat depending on time poststroke. At 0–14 days post stroke the highest correlation was found between the ABC and the 12-item Walking Scale (?0.55, p?<?0.01). At 3 months poststroke, the correlations with the Functional Ambulation Categories was 0.49 (p?<?0.01), timed up and go test ?0.43 (p?<?0.01), 10-meter timed walk ?0.41 (p?<?0.01), and modified Rivermead Mobility Index 0.46 (p?<?0.01). Divergent validity was established by the non-significant correlation (0.12) between the ABC and SF-36 mental component summary. Conclusions: The Swedish version of ABC has high internal consistency and is valid for measuring balance confidence in the acute and sub acute phases of stroke.

Implications for Rehabilitation

• The ABC is a valid measure of balance confidence in persons in the acute and sub acute phases after stroke.

• A moderate convergent validity was found between the ABC and measures of physical function.

     

Validity,reliability and minimal detectable change of the balance evaluation systems test (BESTest), mini-BESTest and brief-BESTest in patients with end-stage renal disease

Abstract

Purpose: This study determined the validity, test–retest reliability and minimal detectable change of the balance evaluation systems test (BESTest), mini-balance evaluation systems test (Mini-BESTest) and brief-balance evaluation systems test (Brief-BESTest) in patients with end-stage renal disease.

Methods: A cross-sectional study with 74 patients with end-stage renal disease (male 66.2%; 63.9?±?15.1?years old) was conducted. Participants were asked to report the number of falls during the previous 12?months and to complete the activity-specific balance confidence (ABC) scale. The BESTest was administered, and the Mini-BESTest and Brief-BESTest scores were computed based on the BESTest performance. Validity was assessed by correlating balance tests with each other and with the ABC scale. Test–retest relative reliability and agreement were explored with the intraclass correlation coefficient (ICC) equation (2,1) and the Bland and Altman method. Minimal detectable changes at the 95% confidence level were established.

Results: Balance test scores were significantly correlated with each other (spearman’s correlation?=?0.89–0.92) and with the ABC scale (spearman’s correlation?=?0.49–0.59). Balance tests presented high test–retest reliability (ICC?=?0.84–0.94), with no evidence of bias. Minimal detectable change values were 10.8 (expressed as a percentage 13.5%), 5.3 (23.7%) and 5.6 (34%) points for the BESTest, Mini-BESTest and Brief-BESTest, respectively.

Conclusions: All tests are valid and reliable to assess balance in patients with end-stage renal disease. Nevertheless, based on the minimal detectable changes found, BESTest and Mini-BESTest may be the most recommended tests for this specific population.

• Implications for Rehabilitation

• Balance evaluation systems test (BESTest), mini-balance evaluation systems test (Mini-BESTest) and brief-balance evaluation systems test (Brief-BESTest) are reliable and valid in patients with end stage renal disease (ESRD).

• The minimal detectable changes of 10.8 for the BESTest, 5.3 for the Mini-BESTest and 5.6 for the Brief-BESTest can be used by clinicians to identify a true change in balance over time or in response to interventions.

• Based on the minimal detectable changes found, BESTest and Mini-BESTest may be the most recommended; and the selection of one of them may be based on time and equipment availability.

     

Influence of fear of falling on gait and balance in Parkinson’s disease

Abstract

Purpose: To study the relationship of fear of falling (FoF) with gait characteristics and balance in individuals with Parkinson's disease (PD). Method: Seventy-nine non-demented individuals (62 males) with PD were studied. Their mean age was 69.22?±?8.93 years. The average time since diagnosis was 8.27?±?5.31 years. FoF was assessed by the Activities-specific Balance Confidence (ABC) Scale in which high scores indicate less FoF. Gait was measured using a computerized walkway. Balance was measured by timed tests including the 5-step test, 360 degree turn, timed sideways walk, and timed up and go test. Participants were divided into two groups based on their ABC score (high FoF, ABC score <69; low FoF, ABC score ≥69). Gait characteristics and balance measures of the two groups were compared. Results: Gait speed and stride length for forward walking (p?<?0.0005 for both) and backward walking (p?=?0.001 and 0.002, respectively) were lower for those with a high level of FoF compared to those with a low level of FoF. The time to take five steps (p?=?0.025), time to turn (p?<?0.0005), time to walk sideways (p?=?0.001), and time to complete the up and go test (p?=?0.003) were longer in those with a high level of FoF than in those with a low level of FoF. Number of steps to complete the turn (p?=?0.001) and steps to walk sideways (p?=?0.002) were greater in those with a high level of FoF than in those with a low level FoF. Conclusions: Gait and balance of individuals with PD with a high level of FoF were poorer than those with a low level of FoF, regardless of previous fall history.

• Implications for Rehabilitation

• The results demonstrates that fear of falling (FoF) is related to gait and balance in individuals with PD.

• Clinicians should be aware that FoF has a negative impact on gait and balance in individuals with PD.

     

Balance confidence among people with lower-limb amputations

BACKGROUND AND PURPOSE: Confidence in a person's balance has been shown to be an important predictor of social activity among people with lower-limb amputations. The purposes of this study were to describe confidence in balance among people with transtibial or transfemoral lower-limb amputations and to compare people whose amputations were due to vascular and nonvascular causes. SUBJECTS AND METHODS: A survey of a sample of 435 community-dwelling individuals from 2 regional clinics was conducted. The sample consisted of people with unilateral transfemoral (26.7%) and transtibial (73.3%) amputations who lost their limb for vascular (53%) and nonvascular (47%) reasons. The mean age of the primarily male (71%) sample was 62.0 years (SD=15.7). RESULTS: Mean scores, using the Activities-specific Balance Confidence (ABC) Scale, were 63.8 for the total sample, 54.1 for the subjects with amputations due to vascular reasons, and 74.7 for the subjects with amputations due to nonvascular reasons. Given a maximum possible ABC Scale score of 100, the results suggest that confidence was low. A difference between the subjects with amputations due to vascular reasons and those with amputations due to nonvascular reasons was observed over each item of the ABC Scale. Variables that were statistically related to balance confidence included age, sex, etiology, mobility device use, the need to concentrate while walking, limitations in activities of daily living, depression, and fear of falling. DISCUSSION AND CONCLUSION: Balance confidence scores among the study sample were low when compared with values previously reported by other researchers. Confidence was particularly low among individuals who had their amputation for vascular reasons. Balance confidence might be an important area of clinical concern.     

The Activities-specific Balance Confidence scale: reliability and validity in Spanish patients with vestibular disorders

Purpose: To examine the reliability and validity of the Spanish version of the Activities-specific Balance Confidence scale (ABC-S), and its ability to discriminate between patients with and without a history of falls among a Spanish population with vestibular disorders. Method: A total of 84 participants completed the ABC-S. Internal consistency, test–retest reliability and construct validity (exploratory factor analysis) were analysed. Concurrent validity was evaluated using the 12-item Short Form Health Survey (SF-12) and the Dizziness Handicap Inventory (DHI). To determine the accuracy of the ABC total score in discriminating patients with and without a history of falls, a receiver operating characteristic (ROC) curve analysis was performed. Results: The ABC-S showed excellent internal consistency (Cronbach’s α?=?0.916) and substantial test–retest reliability (ICC?=?0.86, 95% CI: 0.74–0.93), with standard error and minimal detectable change values of 8.64 and 16.94, respectively. Factor analyses suggested a three-factor structure (explained variance was 62.24%). The ABC total score significantly correlated with the physical component summary score of the SF-12 and with the DHI-P, DHI-E, DHI-F and DHI total scores (p?p?Conclusions: The ABC-S is a valid and reliable instrument, suitable to assess balance confidence in Spanish patients with vestibular disorders.

• Implications for Rehabilitation

• The Spanish version of the ABC scale is a valid and reliable measure of balance confidence in patients with vestibular disorders.

• In persons with vestibular disorders, the Spanish version of the ABC scale has shown the ability to discriminate between patients with and without a history of falls in the last year.

     

Usefulness of perceived level of exertion in patients with chronic low back pain attending a physical training programme

Purpose.?Firstly, to examine whether heart rate (HR) can be predicted based on the Borg-scale for perceived exertion in patients with chronic low back pain (CLBP) and secondly, to assess changes in HR, Borg-scores and workload to study the relevance of a stepwise increase of workload based on the Borg-score and HR.

Methods.?Ninety-nine patients with CLBP and a mean disability-score (Roland Morris Disability Questionnaire) of 13.8 (SD?=?3.7) participated in a 10-week aerobic training programme (20?min, 3 times/week). HR, ratings of perceived exertion (RPE), and workload were monitored. Prior to treatment, patients completed questionnaires on pain, disability, and several psychological factors (catastrophizing, kinesiophobia, and depression).

Results.?The original Borg-equation (i.e. ‘HR?=?Borg?×?10’) appears accurate in predicting HR on a group-level. Pain-related and psychological factors were not significantly related to the accuracy of the Borg equation. Whereas mean workload increased significantly (from 93.8 (SD?=?29.9) to 129.5?W (SD?=?39.7), p?<?0.001) throughout the training programme, HR increased only slightly (from 130.2 (SD?=?13.5) to 139.2 (SD?=?13.9) bpm; p?<?0.001) and Borg-scores remained stable (from 13.2 (SD?=?1.9) to 13.3 (SD?=?1.8); p?=?0.48).

Conclusions.?The capability of the Borg-scale to accurately predict HR appears moderate. However combined with measuring HR, it results in a relevant and efficient method for training CLBP patients in clinical practice.     

Validity of six balance disorders scales in persons with multiple sclerosis

Purpose.?The aim of this study was to test concurrent and discriminant validity of several tests of static and dynamic balance in a sample of subjects suffering from MS.

Method.?A group of 51 patients were enrolled in the study. The following tests were administered: Berg Balance Scale (BBS), Timed Up and Go Test (TUG), Dynamic Gait Index (DGI), Hauser Deambulation Index (DI), Dizziness Handicap Inventory (DHI), and Activities-specific Balance Confidence (ABC). The scales used in this study were initially translated into Italian.

Results.?The sample of subjects reported a mean of 0.98 (1.8 SD) falls in the month prior to evaluation. The tests demonstrated good concurrent validity: Higher correlation coefficients among tests tapping the same aspect and lower correlation coefficients among tests tapping slightly different aspects. ABC and DHI tests discriminated better than the others between fallers and non-fallers and appeared the best predictors of fall status. BBS and DGI were not as efficient in discriminating between groups. Conversely all tests showed good difference validity in the prediction of patients who used an assistive device.

Conclusion.?BBS, TUG, DI, DGI, ABC, DHI have acceptable concurrent validity. The scales have poor performance in discriminating between faller and non-faller.     

Effects of a Community-Based Tai Chi Program on Balance,Functional Outcomes,and Sensorimotor Function in Older Adults

Abstract

Aims: Examine effects of a community Tai Chi program on measures of balance and sensorimotor function.

Methods: In a pretest and post-test design, balance was measured in older adults (N?=?344; 73.4?±?7.4?years) with 30-s chair stand, timed-up-and-go, and 4-stage balance test following a 12-week community-based Tai Chi intervention. Balance and sensorimotor measures, including hip abductor electromechanical delay and hip proprioception, were measured in a smaller sample of older adults (n?=?11; 67.3?±?3.7?years).

Results: Balance improved (p?<?0.0001) following intervention compared to pretest. Similarly, participants in the smaller sample showed improvements at post-test (p?<?0.05) in electromechanical delay and lower extremity proprioception, but no bone density or muscle mass changes.

Conclusions: These preliminary results suggest that a community-based Tai Chi program improves balance in older adults. In a smaller sample, Tai Chi resulted in additional sensorimotor changes, specifically faster hip abductor muscle contraction speed and improved hip proprioception.     

Perceived sexual satisfaction among women with drug-dependent husbands in Iran

Abstract

Background: Sexual satisfaction is known as one of the most important components of relationship satisfaction and quality of life. The present study aimed to evaluate the associated parameters of sexual satisfaction among female spouses of male drug dependents as one of the hidden populations in Iran.

Method: A total of 138 women with drug-dependent husbands were included in this cross-sectional study. Sociodemographic characteristics, anxiety and depression scores, sexual function and emotional parameters were entered into a stepwise linear regression model to find the possible predictors.

Findings: Mean age, marital length and spousal drug use length were 35?±?8, 14?±?10 and 12?±?8 years, respectively. Perceived lack of security [p?<?0.001, B?=?0.630, 95%?confidence interval (CI)?=?0.364–0.897], history of physical abuse by husband (p?<?0.001, B?=?0.297, 95%?CI?=?1.912–5.771) and marital length (p?=?0.003, B?=?0.142, 95%?CI?=?0.048–0.236) were found to be significantly associated with sexual satisfaction among female spouses of male drug dependents in Iran.

Conclusion: Results of the current study highlight the need for more attention to environmental and sociocultural parameters as the associated parameters of sexual satisfaction among female spouses of male drug dependents. Further research is needed with respect to a multidimensional evaluation of sexual satisfaction among this vulnerable hidden population in Iran, especially to find causative relations.     

Development and feasibility of the Help to Overcome Problems Effectively (HOPE) self-management intervention for people living with multiple sclerosis

Purpose: To describe the development and feasibility of a self-management intervention called the Help to Overcome Problems Effectively (HOPE: MS), aimed at improving the physical and psychological wellbeing of people living with Multiple Sclerosis (MS).

Method: HOPE: MS is an innovative, 6-week group-based, manualised self-management intervention combining positive psychology theory and practice, and cognitive behavioural therapy (CBT). Participants (N?=?21) recruited via a local East Midlands branch of the MS Society attended one of three HOPE: MS interventions and completed self-reported outcome measures in week 1 and week 6. The following outcome measures were used: The Multiple Sclerosis Impact Scale; Multiple Sclerosis Fatigue Severity Scale; The Multiple Sclerosis Self-Efficacy Scale; The Adult State Hope Scale; The Hospital Anxiety and Depression Scale; The Positive and Negative Affect Scale.

Results: Post-intervention (6 weeks) mean scores decreased in the physical impact (baseline M?=?65.6, SD?=?17.4; 6 weeks M?=?55.1, SD?=?17.9, 95% CI [?4.39, ?16.47] and the psychological impact of MS (baseline M?=?24.0, SD?=?7.3; 6 weeks M?=?18.9; SD?=?6.3, 95% CI [?2.54, ?7.66]). There was also a decrease mean fatigue severity scores (baseline 49.4, SD?=?13.3, 6 weeks M?=?41.1, SD?=?14.4, 95% CI [?2.65, ?13.44]). There was a mean decrease in depression scores (baseline M?=?6.9, SD?=?3.5; 6 weeks M?=?4.2, SD?=?2.8, 95% CI [?1.43, ?4.00]). There were smaller mean decreases in anxiety (baseline M?=?7.6, SD?=?3.4; 6 weeks M?=?6.7 (4.0), 95% CI [0.69, ?2.50]) and negative affect (baseline M?=?22.9, SD?=?6.8; 6 weeks M?=?20.8 (8.1), 95% CI [0.69, ?2.50]) refer Table 3). Mean MS self-efficacy scores (baseline 21.7, SD?=?4.2; 6 weeks M?=?24.1, SD?=?4.7, 95% CI [0.23, 4.53]), mean total hope scores (baseline M?=?23.3, SD?=?10.7; 6 weeks M?=?32.2 (10.6), 95% CI [4.91, 12.9]), hope agency scores (baseline M?=?10.5, SD?=?5.7; 6 weeks M?=?15.7 (6.2), 95% CI [2.37, 8.01]), hope pathways (baseline M?=?12.9, SD?=?6.0; 6 weeks M?=?16.6 (4.9), 95% CI [2.00, 5.43]) and positive affect scores increased (baseline M?=?27.3, SD?=?7.1; 6 months M?=?32.2, SD?=?8.4, 95% CI [0.42, 9.39]). Participants positively rated the intervention quality and delivery.

Conclusions: This feasibility study showed that the HOPE: MS was acceptable and useful to people living with MS. Further robust evaluations using a randomised controlled trial design with longer follow ups are needed to confirm early promising results of the HOPE: MS.

• Implications for rehabilitation

• Living with MS requires constant adjustments to cope with unpredictable symptoms.

• Self-management interventions have the potential to help people living with MS to improve their quality of life.

• A feasibility study of the HOPE: MS self-management group-based intervention showed that it was acceptable and useful to people living with MS.

     

Psychosocial predictors of long-term adjustment to lower-limb amputation and phantom limb pain

Purpose:?To evaluate the utility of a biopsychosocial model to predict long-term adjustment to lower-limb amputation and phantom limb pain (PLP).

Method:?One month after lower-limb amputation, 70 participants completed measures of PLP intensity, cognitions (catastrophizing, perceived control over pain), coping (pain-contingent rest), social environment (social support, solicitous responding), and functioning (pain interference, depressive symptoms). The measures of functioning were administered again at 1- and 2-years post-amputation. Multiple regression analyses were used to examine the ability of the psychosocial variables at 1-month post-amputation to predict changes in the functioning measures over time.

Results:?The psychosocial variables at 1-month post-amputation, controlling for initial PLP intensity, accounted for 21% of the variance in change in depressive symptoms at 1-year (p?<?0.05), and 27% and 22% (p's <?0.01 and 0.05, respectively) of the variance in change in pain interference and depressive symptoms, respectively, at 2-years post-amputation. Catastrophizing and social support were associated with decreases (improvement) in both criterion measures, while solicitous responding was associated with increases (worsening) in both measures.

Discussion:?The findings support a biopsychosocial model of long-term adjustment to amputation and PLP. In addition, results suggest that some psychosocial variables are more important than others for predicting adjustment, providing important implications for early interventions after amputation.     

The ABC Scale and Fall Risk: A Systematic Review

ABSTRACT

Objective: The aim of this systematic review was to assess the ability of the Activities-specific Balance Confidence (ABC) scale to predict the fall risk in older community-living adults. Methods: A systematic literature review was conducted from February 1, 2010, to October 8, 2010, through Pubmed, CINAHL and MEDLINE. Appraisal of full-text English articles, which were published from January 1996 to October 2010, provided the framework for this analysis. Results: On the basis of our inclusion/exclusion criteria, three studies qualified for inclusion in this review. Two of the three selected studies indicated a significant association between ABC scores and falls. The third study concluded that the ABC scale was unable to distinguish fallers from nonfallers. Conclusion: Despite the abundance of studies, which include the ABC scale, there is insufficient research that specifically examines the relationship between balance confidence scores with actual falls in community-dwelling older adults. In this population of adults, who live in the community and are aged at least 60 years, there is limited support for the hypothesis that the ABC scale can predict the fall risk.     

“Strong and steady”: a community-based strength and balance exercise group for children with cerebral palsy

Abstract

Purpose: This study investigated the effect of an eight-week community-based strength and balance exercise group for children with cerebral palsy (CP). Method: Ten children with CP participated in the study (8–15 years; six male; GMFCS I?=?6, II?=?4; five diplegia; five hemiplegia). Muscle strength was assessed using dynamometry and functional strength tests (seated throw, distance jump, vertical jump). Balance was assessed using the Bruninks–Oseretsky Test of Motor Proficiency, the Movement Assessment Battery for Children (MABC), lateral and forward reach tests and the Timed-up and Go. Results: Muscle strength improved in dominant side elbow flexors, hip abductors, ankle dorsiflexors and ankle plantarflexors (p?=?0.018–0.042). Functional strength improved in seated throw (t?=?2.7; p?=?0.024), distance jump (t?= ?2.8; p?=?0.025) and lateral step-up (p?<?0.05). Balance improved on the MABC (t?=?2.4; p?=?0.040), lateral (p?<?0.05) and forward reach (p?<?0.05). Conclusion: This feasibility study translated research into sustainable practice, showing that a community-based, low dose, group exercise program can improve the balance and strength of children with CP within current funding capacity.

• Implications for Rehabilitation

• It has been known that strength and balance training in the clinical research setting with specialized equipment is effective for children with CP, but this study demonstrates the translation of research into clinical practice in a low-cost, low-dose group program.

• Significant gains in both muscle strength and balance can be achieved in an eight-week community-based gym group using simple equipment.

     

Bladder function and falls in individuals with multiple sclerosis

Purpose: To examine the association between bladder function and falls while controlling for mobility in individuals with multiple sclerosis (MS).

Methods: A total of 92 ambulatory individuals with MS (mean age?±?SD?=?59.1?±?7.3 years, female n?=?69) were divided into two groups based on self-reported bladder function (none-mild n?=?43 versus moderate-severe n?=?49). The main outcome measure was a number of self-reported falls in the previous 3 months. Participants’ demographic information (age, type of MS, gender, use of the assistive device) was also collected. The balance was quantified with the Berg balance scale, and walking speed was indexed with the timed 25-foot walk test. Negative binomial regression analysis was used to examine the association between bladder function and falls in individuals with MS while controlling for balance and walking.

Results: The median number of self-reported falls in the previous 3 months was 2 (interquartile range, 0–4). The severe bladder dysfunction group was more likely (incidence rate ratio?=?1.84) to have a greater number of self-reported falls compared to mild bladder dysfunction group when balance and walking were taken into account.

Conclusion: Bladder dysfunction is related to falls history independently of mobility in individuals with MS. Future research examining whether bladder management programmes have an impact on fall incidence in MS is warranted.

• Implications for rehabilitation

• Bladder dysfunction and falls are common health concerns in individuals with multiple sclerosis.

• Bladder dysfunction was associated with the number of falls in individuals with MS, and this association was independent of mobility.

• Bladder management should be included in fall prevention strategies in individuals with MS.

     

Partner notification among HCV-positive couples who inject drugs

Background: This study examines predictors of partner notification (PN) confirmed by a test counselor among people who inject drugs (PWID) and their sexual partners in Kazakhstan.

Methods: We used baseline data from an HIV couple-based intervention study, restricting the sample to couples where both partners knew they were hepatitis C virus (HCV)-positive prior to participation in the study (N?=?136 individuals). Cross-tabulation and logistic regression were used to examine predictors of PN, including socio-demographic characteristics, sexual and drug risk behaviors, and access to health services.

Results: Of the sample, 68 (50%) participants notified their partners of their HCV status. PN was associated with participation in a needle/syringe exchange program and sexually transmitted infection counseling or education in the past 6 months. In the adjusted model, concurrent HIV infection (OR?=?2.4, p?<?0.05), having more than one sexual partner (OR?=?2.5, p?<?0.05), and participation in a needle exchange program (OR?=?4.3, p?<?0.01) were positively associated with notifying one's partner.

Conclusions: The findings from this study emphasize the importance of service access among PWID and point to the need for additional research on HCV counseling and notification strategies as a component of health services for injection drug users.     

Investigating the Effects of an Otago-Based Program among Individuals Living with Dementia

Abstract

Aim: To examine the impact of an Otago-based exercise program (OEP) on physical function in patients living with mild cognitive impairment (MCI) or dementia receiving home heath physical therapy.

Methods: 34 patients (mean age 88.3?years; 62% female; mean Mini-Cog 1.76) completed the following assessments: Four-Stage Balance test, Timed Up & Go, 30-Second Chair Stand test, and Tinetti Gait and Balance. Assessments were completed at baseline and an average of 4.79 (2.29) visits later, with a mean of 1.74 (0.79) months between assessments. The OEP-based exercises were individually tailored and progressed based on performance as recommended by the program protocol.

Results: A paired samples t-test revealed significant differences in scores for the Four-Stage Balance Test (p?<?0.001), the Timed Up & Go (p?=?0.002), and the Tinetti Gait and Balance (p?=?0.002).

Conclusion: The OEP can potentially be used for individuals living with cognitive impairments to improve performance outcomes such as balance and functional mobility.