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1.
Alexander T. Peebles Adam P. Bruetsch Sharon G. Lynch Jessie M. Huisinga 《Archives of physical medicine and rehabilitation》2018,99(10):2030-2037
Objectives
To compare physiological impairments between persons with multiple sclerosis (MS) with a history of falls and persons with MS without a history of falls, and to investigate the association between physiological impairments and dynamic balance.Design
Cross-sectional study.Setting
University motion analysis laboratory.Participants
Persons with MS (N=55; 27 recurrent fallers and 28 nonfallers). Participants were classified as fallers if they self-reported ≥2 falls in the previous 6 months.Interventions
None.Main Outcome Measures
Physiological impairment was assessed with sensorimotor delays, spasticity, plantar cutaneous sensation, and the sensory, cerebellar, and pyramidal subscales of the Expanded Disability Status Scale (EDSS). Dynamic balance was assessed using the average and variability of margin of stability and variability of trunk accelerations.Results
Compared with nonfallers, fallers had lower plantar sensation, longer sensorimotor delays, more spasticity, and more impairment in the pyramidal and cerebellar subscales of the EDSS. Additionally, these impairments were all moderately to strongly correlated with worse dynamic balance.Conclusions
This study highlights the multifactorial nature of instability in persons with MS. A better understanding of the physiological mechanisms of dynamic instability in persons with MS can be used to improve methods of monitoring disease progression, identifying which impairments to target through interventions, and appropriately evaluating intervention efficacy. 相似文献2.
Aqeel M. Alenazi Mohammed M. Alshehri Shaima Alothman Jason Rucker Kari Dunning Linda J. D’Silva Patricia M. Kluding 《PM & R》2018,10(8):806-816
Background
Falls are a common adverse event among people with stroke. Previous studies investigating risk of falls after stroke have relied primarily on retrospective fall history ranging from 6-12 months recall, with inconsistent findings.Objectives
To identify factors and balance assessment tools that are associated with number of falls in individuals with chronic stroke.Design
Secondary analysis of a randomized clinical trial.Setting
Multisite academic and clinical institutions.Participants
Data from 181 participants with stroke (age 60.67 ± 11.77 years, post stroke 4.51 ± 4.78 years) were included.Methods
Study participants completed baseline testing and were prospectively asked about falls. A multivariate negative binomial regression was used to identify baseline predictive factors predicting falls: age, endurance (6 minute walk test), number of medications, motor control (Fugl-Meyer lower extremity score), depression (Patient Health Questionnaire-9), physical activity (number of steps per week), and cognition (Mini Mental Status Exam score). A second negative binomial regression analysis was used to identify baseline balance assessment scores predicting falls: gait velocity (comfortable 10 Meter Walk), Berg Balance Scale (BBS), Timed Up and Go (TUG), and Functional Reach Test (FRT). Receiver operating characteristic (ROC) and area under the curve (AUC) were used to determine the cutoff scores for significant predictors of recurrent falls.Main Outcome Measurement
The number of falls during the 42-week follow-up period.Results
Baseline measures that significantly predicted the number of falls included increased number of medications, higher depression scores, and decreased FRT. Cutoff scores for the number of medications were 8.5 with an AUC of 0.68. Depression scores differentiated recurrent fallers at a threshold of 2.5 scores with an AUC of 0.62. FRT differentiated recurrent fallers at a threshold of 18.15 cm with an AUC of 0.66.Conclusions
Number of medications, depression scores, and decreased FRT distance at baseline were associated with increased number of falls. Increased medications might indicate multiple comorbidities or polypharmacy effect; increased depression scores may indicate psychological status; and decreased functional reach distance could indicate dynamic balance impairments.Level of Evidence
II 相似文献3.
Ettore Beghi Elisa Gervasoni Elisabetta Pupillo Elisa Bianchi Angelo Montesano Irene Aprile Michela Agostini Marco Rovaris Davide Cattaneo 《Archives of physical medicine and rehabilitation》2018,99(4):641-651
Objective
To compare the risk of falls and fall predictors in patients with Parkinson disease (PD), multiple sclerosis (MS), and stroke using the same study design.Design
Multicenter prospective cohort study.Setting
Institutions for physical therapy and rehabilitation.Participants
Patients (N=299) with PD (n=94), MS (n=111), and stroke (n=94) seen for rehabilitation.Interventions
Not applicable.Main Outcome Measures
Functional scales were applied to investigate balance, disability, daily performance, self-confidence with balance, and social integration. Patients were followed for 6 months. Telephone interviews were organized at 2, 4, and 6 months to record falls and fall-related injuries. Incidence ratios, Kaplan-Meier survival curves, and Cox proportional hazards models were used.Results
Of the 299 patients enrolled, 259 had complete follow-up. One hundred and twenty-two patients (47.1%) fell at least once; 82 (31.7%) were recurrent fallers and 44 (17.0%) suffered injuries; and 16%, 32%, and 40% fell at 2, 4, and 6 months. Risk of falls was associated with disease type (PD, MS, and stroke in decreasing order) and confidence with balance (Activities-specific Balance Confidence [ABC] scale). Recurrent fallers were 7%, 15%, and 24% at 2, 4, and 6 months. The risk of recurrent falls was associated with disease type, high educational level, and ABC score. Injured fallers were 3%, 8%, and 12% at 2, 4, and 6 months. The only predictor of falls with injuries was disease type (PD).Conclusions
PD, MS, and stroke carry a high risk of falls. Other predictors include perceived balance confidence and high educational level. 相似文献4.
Roberta de Matos Brunelli Braghin Elisa Cavalheiro Libardi Carina Junqueira Marcello Henrique Nogueira – Barbosa Daniela Cristina Carvalho de Abreu 《Journal of bodywork and movement therapies》2018,22(1):76-82
Objectives
To assess balance and function of symptomatic and asymptomatic subjects with knee osteoarthritis (OA) and investigate the influence of physical exercise.Design
Subjects were divided into three groups: Group 1 (n = 15), symptomatic knee OA; Group 2 (n = 11), asymptomatic knee OA; and Group 3 (n = 16), knee OA and no intervention. History of falls, the WOMAC questionnaire, balance and functionality were assessed.Results
After intervention, there was a significant difference in the total WOMAC score and in the pain and function domains only in Group 1. After intervention, Group 2 showed significant differences in decreased time on the Step Up/Over test and postural sway increased.Conclusion
After the intervention, the symptomatic group reported improvement in pain and function on the WOMAC, while the asymptomatic group showed improvement in performance in the Step Up/Over test. There were no new episodes of falls in groups 1 and 2. 相似文献5.
Cleveland T. Barnett Natalie Vanicek David F. Rusaw 《Archives of physical medicine and rehabilitation》2018,99(11):2271-2278
Objective
To assess whether variables from a postural control test relate to and predict falls efficacy in prosthesis users.Design
Twelve-month within- and between-participants repeated measures design. Participants performed the limits of stability (LOS) test protocol at study baseline and at 6-month follow-up. Participants also completed the Falls Efficacy Scale-International (FES-I) questionnaire, reflecting the fear of falling, and reported the number of falls monthly between study baseline and 6-month follow-up, and additionally at 9- and 12-month follow-ups.Setting
University biomechanics laboratories.Participants
Participants (N=24) included a group of active unilateral transtibial prosthesis users of primarily traumatic etiology (n=12) with at least 1 year of prosthetic experience and age- and sex-matched control participants (n=12).Interventions
Not applicable.Main Outcome Measures
Postural control variables derived from center of pressure data obtained during the LOS test, which was performed on and reported by the Neurocom Pro Balance Master, namely reaction time, movement velocity (MVL), endpoint excursion (EPE), maximum excursion (MXE), and directional control (DCL). Number of falls and total FES-I scores.Results
During the study period, the prosthesis users group had higher FES-I scores (U=33.5, P=.02), but experienced a similar number of falls, compared to the control group. Increased FES-I scores were associated with decreased EPE (r= ?0.73, P=.02), MXE (r= ?0.83, P<.01) and MVL (r= ?0.7, P=.03) in the prosthesis users group, and DCL (r= ?0.82, P<.01) in the control group, all in the backward direction.Conclusions
Study baseline measures of postural control, in the backward direction only, are related to and potentially predictive of subsequent 6-month FES-I scores in relatively mobile and experienced prosthesis users. 相似文献6.
Marcos Eduardo Scheicher Ligia Cristiane Santos Fonseca Tiago Buso Bortolloto Isabela Feitosa de Carvalho 《Journal of bodywork and movement therapies》2018,22(2):482-486
Background
The deterioration in the somatosensory and motor systems observed with increasing age can cause balance problems. Studies have shown that the use of infrapatellar bandages can enhance proprioception and improve postural balance.Aims
To evaluate the effect of an infrapatellar bandage on static balance and mobility in elderly female fallers and non-fallers.Methods
Forty older women (20 fallers and 20 non-fallers) were evaluated. Mobility (Timed Up and Go test) and balance (force platform) were measured in the presence and absence of additional sensory information (elastic infrapatellar bandage).Results
Mobility differed in fallers (p = 0.0001), but not in non-fallers (p = 0.27), when the patellar bandage was applied. Additional sensory information did not improve static balance in either group (p > 0.05), but a trend towards improvement was observed in fallers.Conclusion
Additional sensory input from an infrapatellar bandage improves mobility but not bipedal stance in elderly fallers. 相似文献7.
Sharon Hetherington Tim Henwood Paul Swinton Justin Keogh Paul Gardiner Anthony Tuckett Kevin Rouse 《Archives of physical medicine and rehabilitation》2018,99(8):1525-1532
Objective
To investigate the associations of balance confidence with physical and cognitive markers of well-being in older adults receiving government-funded aged care services and whether progressive resistance plus balance training could positively influence change.Design
Intervention study.Setting
Community-based older adult–specific exercise clinic.Participants
Older adults (N=245) with complex care needs who were receiving government-funded aged care support.Interventions
Twenty-four weeks of twice weekly progressive resistance plus balance training carried out under the supervision of accredited exercise physiologists.Main Outcome Measures
The primary measure was the Activity-specific Balance Confidence Scale. Secondary measures included the Short Physical Performance Battery; fall history gathered as part of the health history questionnaire; hierarchical timed balance tests; Geriatric Anxiety Index; Geriatric Depression Scale; Fatigue, Resistance, Ambulation, Illness, Loss of Weight scale; and EuroQoL-5 dimension 3 level.Results
At baseline, better physical performance (r=.54; P<.01) and quality of life (r=.52; P<.01) predicted better balance confidence. In contrast, at baseline, higher levels of frailty predicted worse balance confidence (r=?.55; P<.01). Change in balance confidence after the exercise intervention was accompanied by improved physical performance (+12%) and reduced frailty (?11%). Baseline balance confidence was identified as the most consistent negative predictor of change scores across the intervention.Conclusions
This study shows that reduced physical performance and quality of life and increased frailty are predictive of worse balance confidence in older adults with aged care needs. However, when a targeted intervention of resistance and balance exercise is implemented that reduces frailty and improves physical performance, balance confidence will also improve. Given the influence of balance confidence on a raft of well-being determinants, including the capacity for positive physical and cognitive change, this study offers important insight to those looking to reduce falls in older adults. 相似文献8.
Heidi Prather Abby Cheng Karen Steger-May Vaibhav Maheshwari Linda VanDillen 《PM & R》2018,10(1):11-18
Background
Relationships between low back pain (LBP) and the hip in patient cohorts have been described primarily in patients with moderate to severe hip osteoarthritis (OA). Less is known about the links of LBP with hip radiographic findings of hip deformity and minimal OA.Objective
To describe the incidence of radiographic hip deformity or hip OA; to describe and compare spine- and hip-related pain and function in the subset of patients who were found to have radiographic hip deformity or hip OA; and to compare patients with evidence of radiographic hip deformity or hip OA to patients without hip radiographic findings.Design
Prospective cohort study with cross-sectional design.Setting
Tertiary university.Patients
A total of 63 patients (40 women, 23 men) with a mean age of 48.5 ± 14 years with LBP and a minimum of one positive provocative hip test.Methods
Hip radiographs were assessed by an independent examiner for hip OA and deformity.Main Outcome Measurements
Comparisons of hip and lumbar spine pain and function were completed for patients with radiographic findings of hip OA or deformity.Results
Moderate to severe hip OA was found in 12 of 60 patients (20.0%). At least one measurement of femoroacetabular impingement (FAI) was found in 14 of 60 patients (23.3%) to 33 of 45 patients (73.3%). At least one measurement of developmental hip dysplasia (DDH) was found in 7 of 60 patients (11.6%) to 11 of 63 patients (17.4%). Greater pain and reduced hip and lumbar spine function were found in the patients with moderate to severe hip OA. Patients with LBP and FAI were found to have significantly greater extremes of pain and reduced lumbar spine function.Conclusion
Links between the hip and the spine affecting pain and function may be found in patients with LBP and hip deformity and before the onset of radiographic hip OA, and may be associated with hip deformity. Further investigation is needed to better understand these links and their potential impact on prognosis and treatment of LBP.Level of Evidence
II 相似文献9.
Tianma Xu Lindy Clemson Kate OLoughlin Natasha A. Lannin Catherine Dean Gerald Koh 《Archives of physical medicine and rehabilitation》2018,99(3):563-573.e5
Objective
To identify the risk factors for falls in community stroke survivors.Data Sources
A comprehensive search for articles indexed in MEDLINE, Embase, CINAHL, PsycINFO, Cochrane Library, and Web of Science databases was conducted.Study Selection
Prospective studies investigating fall risk factors in community stroke survivors were included. Reviewers in pair independently screened the articles and determined inclusion through consensus. Studies meeting acceptable quality rating using the Q-Coh tool were included in the meta-analysis.Data Extraction
Data extraction was done in duplicate by 4 reviewers using a standardized data extraction sheet and confirmed by another independent reviewer for completeness and accuracy.Data Synthesis
Twenty-one articles met the minimum criteria for inclusion; risk factors investigated by ≥3 studies (n=16) were included in the meta-analysis. The following risk factors had a strong association with all fallers: impaired mobility (odds ratio [OR], 4.36; 95% confidence interval [CI], 2.68–7.10); reduced balance (OR, 3.87; 95% CI, 2.39–6.26); use of sedative or psychotropic medications (OR, 3.19; 95% CI, 1.36–7.48); disability in self-care (OR, 2.30; 95% CI, 1.51–3.49); depression (OR, 2.11; 95% CI, 1.18–3.75); cognitive impairment (OR, 1.75; 95% CI, 1.02–2.99); and history of fall (OR, 1.67; 95% CI, 1.03–2.72). A history of fall (OR, 4.19; 95% CI, 2.05–7.01) had a stronger association with recurrent fallers.Conclusions
This study confirms that balance and mobility problems, assisted self-care, taking sedative or psychotropic medications, cognitive impairment, depression, and history of falling are associated with falls in community stroke survivors. We recommend that any future research into fall prevention programs should consider addressing these modifiable risk factors. Because the risk factors for falls in community stroke survivors are multifactorial, interventions should be multidimensional. 相似文献10.
Francisco Rodriguez-Fontan Nicolas S. Piuzzi Matthew J. Kraeutler Cecilia Pascual-Garrido 《PM & R》2018,10(12):1353-1359
Background
Bone marrow aspirate concentrate (BMC) is one of the few cell-based therapies available as a possible biological treatment for early osteoarthritis (OA). Its efficacy, safety, and benefit compared with other treatments are still to be determined.Objective
To assess the clinical outcomes of patients undergoing intra-articular injection of BMC for the treatment of early knee and hip OA.Design
Prospective, cohort study.Setting
Single institution, quaternary level of care.Patients
Nineteen patients (16 female and 3 male), totaling 25 joints (10 knees, 15 hips), treated with intra-articular BMC for early OA between 2014 and 2016. The mean age at time of the procedure was 58 ± 12.7 years (range, 30-80 years). The mean follow-up was 13.2 ± 6.3 months (range, 6-24 months). Inclusion criteria included ≥18 years; knee OA, Kellgren–Lawrence grade I-II; hip OA, Tönnis grade I-II; first-time intra-articular BMC therapy, after unsuccessful symptomatic and conservative treatments (ie, physical therapy, analgesics and anti-inflammatory drugs) for 6 months. Exclusion criteria included pregnancy; malignancy; rheumatologic diseases; infection; Kellgren–Lawrence grade III-IV; Tönnis grade III; and previous intra-articular injections or surgery.Interventions
All patients had autologous bone marrow aspirate harvested from the iliac crest and centrifuged to achieve BMC, for intra-articular injection.Main Outcome Measurements
The hypothesis was formulated before the study. Patient-reported outcomes measures were assessed preoperatively and at last follow-up using the Western Ontario and McMaster Universities Arthritis Index.Results
Western Ontario and McMaster Universities Arthritis Index improved from a baseline of 40.8 ± 18.3% to 20.6 ± 17% (P < .001) at final follow-up. The satisfaction rate was 63.2%. The minimal clinically important difference threshold of 9.15 points was reached by 64% of the patients. Two patients were converted to total hip arthroplasty at 8 months after BMC injection.Conclusions
Intra-articular injections of BMC for the treatment of early knee or hip OA were safe and demonstrated satisfactory results in 63.2% of patients. Future studies are necessary to determine the efficacy of this technique and its safety profile.Level of Evidence
II 相似文献11.
Ana Clara Bonini-Rocha Anderson Lúcio Souza de Andrade André Marques Moraes Liana Barbaresco Gomide Matheus Leonardo Rios Diniz Wagner Rodrigues Martins 《PM & R》2018,10(4):398-409
Background
Several interventions have been proposed to rehabilitate patients with neurologic dysfunctions due to stroke. However, the effectiveness of circuit-based exercises according to its actual definition, ie, an overall program to improve strength, stamina, balance or functioning, was not provided.Objective
To examine the effectiveness of circuit-based exercise in the treatment of people affected by stroke.Methods
A search through PubMed, Embase, Cochrane Library, and Physiotherapy Evidence Database databases was performed to identify controlled clinical trials without language or date restriction. The overall mean difference with 95% confidence interval was calculated for all outcomes. Two independent reviewers assessed the risk of bias.Results
Eleven studies met the inclusion criteria, and 8 presented suitable data to perform a meta-analysis. Quantitative analysis showed that circuit-based exercise was more effective than conventional intervention on gait speed (mean difference of 0.11 m/s) and circuit-based exercise was not significantly more effective than conventional intervention on balance and functional mobility.Conclusion
Our results demonstrated that circuit-based exercise presents better effects on gait when compared with conventional intervention and that its effects on balance and functional mobility were not better than conventional interventions.Level of Evidence
I 相似文献12.
Introduction
Gait speed is recognized as an important predictor of adverse outcomes in older people. However, it is unknown whether other more complex mobility tasks are better predictors of such outcomes.Objective
To examine a range of clinic-based mobility tests and determine which were most strongly associated with measures of community performance and risk (CP&R).Design
Cross-sectional study.Setting
Central Control Mobility and Aging Study, Westchester County, New York.Participants
Aged ≥65 years (n = 424).Methods
Clinic-based mobility measures included gait speed measured during normal and dual-task conditions, the Floor Maze Immediate and Delay tasks, and stair ascending and descending. CP&R measures were self-reported by the use of standardized questionnaires and classified into measures of performance (distance walked, travel outside one’s home [life space], activities of daily living, and participation in cognitive leisure activities) or risk (balance confidence, fear of falling, and past falls). Linear and logistic regression were used to examine associations between the clinic-based mobility measures and CP&R measures adjusting for covariates.Results
The mean age of the sample was 77.8 (SD 6.4) years, and 55.2% (n = 234) were female. In final models, faster normal walking speed was most strongly associated with 5 of the 7 community measures (greater distance walked, greater life space, better activities of daily living function, higher balance confidence, and less fear of falling; all P < .05). More complex tasks (walking while talking and maze immediate) were associated with cognitive leisure activity (P < .05), and ascending stairs was the only measure associated with a history of falls (P < .05).Conclusion
Normal walking speed is a simple and inexpensive clinic-based mobility test that is associated with a wide range of CP&R measures. In addition, poorer performance ascending stairs may assist in identifying those at risk of falls. Poorer performance in more complex mobility tasks (walking while talking and maze immediate) may suggest inability to participate in cognitive leisure activities.Level of Evidence
III 相似文献13.
Hsin-Yu Chiang Wen-Shian Lu Wan-Hui Yu I-Ping Hsueh Ching-Lin Hsieh 《Archives of physical medicine and rehabilitation》2018,99(8):1499-1506
Objective
To examine the interrater and intrarater reliability of the Balance Computerized Adaptive Test (Balance CAT) in patients with chronic stroke having a wide range of balance functions.Design
Repeated assessments design (1wk apart).Setting
Seven teaching hospitals.Participants
A pooled sample (N=102) including 2 independent groups of outpatients (n=50 for the interrater reliability study; n=52 for the intrarater reliability study) with chronic stroke.Interventions
Not applicable.Main Outcome Measures
Balance CAT.Results
For the interrater reliability study, the values of intraclass correlation coefficient, minimal detectable change (MDC), and percentage of MDC (MDC%) for the Balance CAT were .84, 1.90, and 31.0%, respectively. For the intrarater reliability study, the values of intraclass correlation coefficient, MDC, and MDC% ranged from .89 to .91, from 1.14 to 1.26, and from 17.1% to 18.6%, respectively.Conclusions
The Balance CAT showed sufficient intrarater reliability in patients with chronic stroke having balance functions ranging from sitting with support to independent walking. Although the Balance CAT may have good interrater reliability, we found substantial random measurement error between different raters. Accordingly, if the Balance CAT is used as an outcome measure in clinical or research settings, same raters are suggested over different time points to ensure reliable assessments. 相似文献14.
Hui-Fen Mao Hsing-Po Huang Tung-Wu Lu Ting-Ming Wang Cheng-Hua Wu Jwu-Sheng Hu 《Archives of physical medicine and rehabilitation》2018,99(10):1982-1990
Objective
To quantify the effects of initial hip angle and angular hip velocity settings of a lower-limb wearable robotic exoskeleton (WRE) on the balance control and mechanical energy requirements in patients with paraplegic spinal cord injuries (SCIs) during WRE-assisted sit-to-stand (STS).Design
Observational, cross-sectional study.Setting
A university hospital gait laboratory with an 8-camera motion analysis system, 3 forceplates, a pair of instrumented crutches, and a WRE.Participants
Patients (N=12) with paraplegic SCI.Interventions
Not applicable.Main Outcome Measures
The inclination angle (IA) of the body’s center of mass (COM) relative to the center of pressure (COP), and the rate of change of IA (RCIA) for balance control, and the mechanical energy and forward COM momentum before and after seat-off for energetics during WRE-assisted STS were compared between conditions with 2 initial hip angles (105° and 115°) and 3 initial hip angular velocities (800, 1000, 1200 rpm).Results
No interactions between the main factors (ie, initial hip angle vs angular velocity) were found for any of the calculated variables. Greater initial hip angle helped the patients with SCI move the body forward with increased COM momentum but reduced RCIA (P<.05). With increasing initial angular hip velocity, the IA and RCIA after seat-off (P<.05) increased linearly while total mechanical energy reduced linearly (P<.05).Conclusions
The current results suggest that a greater initial hip angle with smaller initial angular velocity may provide a favorable compromise between momentum transfer and balance of the body for people with SCI during WRE-assisted STS. The current data will be helpful for improving the design and clinical use of the WRE. 相似文献15.
David R. Howell Louis R. Osternig Li-Shan Chou 《Archives of physical medicine and rehabilitation》2018,99(7):1318-1324
Objective
To examine the acute (within 72h of injury) and long-term (2mo postinjury) independent associations between objective dual-task gait balance and neurocognitive measurements among adolescents and young adults with a concussion and matched controls.Design
Longitudinal case-control.Setting
Motion analysis laboratory.Participants
A total of 95 participants completed the study: 51 who sustained a concussion (mean age, 17.5±3.3y; 71% men) and 44 controls (mean age, 17.7±2.9y; 72% men). Participants who sustained a concussion underwent a dual-task gait analysis and computerized neurocognitive testing within 72 hours of injury and again 2 months later. Uninjured controls also completed the same test protocol in similar time increments.Interventions
Not applicable.Main Outcome Measures
We compared dual-task gait balance control and computerized neurocognitive test performance between groups using independent samples t tests. Multivariable binary logistic regression models were then constructed for each testing time to determine the association between group membership (concussion vs control), dual-task gait balance control, and neurocognitive function.Results
Medial-lateral center-of-mass displacement during dual-task gait was independently associated with group membership at the initial test (adjusted odds ratio [aOR], 2.432; 95% confidence interval [CI], 1.269–4.661) and 2-month follow-up test (aOR, 1.817; 95% CI, 1.014–3.256) tests. Visual memory composite scores were significantly associated with group membership at the initial hour postinjury time point (aOR, .953; 95% CI, .833–.998). However, the combination of computerized neurocognitive test variables did not predict dual-task gait balance control for participants with concussion, and no single neurocognitive variable was associated with dual-task gait balance control at either testing time.Conclusions
Dual-task assessments concurrently evaluating gait and cognitive performance may allow for the detection of persistent deficits beyond those detected by computerized neurocognitive deficits alone. 相似文献16.
Daniel L. Riddle Gregory J. Golladay 《Archives of physical medicine and rehabilitation》2018,99(5):967-972
Objective
To identify preoperative risk factors associated with posthospitalization falls over an approximate 2-year postoperative period in patients undergoing both hip and knee arthroplasty.Design
A longitudinal cohort design.Setting
Communities surrounding 4 urban university–based medical centers.Participants
Adults (N = 596) with hip or knee arthroplasty over a 9-year period and followed yearly.Interventions
Not applicable.Main Outcome Measures
The primary outcome measure was a self-reported history of falls over the 2-year postoperative period. A fall was recorded when the participant reported landing on the floor or ground. Preoperative predictors of falls derived from previous evidence included preoperative fall history, depressive symptom severity, narcotic use, age, activity level, and comorbidity. Multinomial regression analysis was performed to determine factors that predicted either a single fall or multiple falls during a 2-year postoperative period.Results
Preoperative predictors of multiple postoperative falls were a preoperative history of falls, depressive symptoms, and hip vs knee arthroplasty. Patients with hip arthroplasty were more than twice as likely (odds ratio, 2.26; 95% confidence interval, 1.21–4.20) as patients with knee arthroplasty to have multiple self-reported falls in the first 2 postoperative years. No predictors were found for persons who reported falling only once postoperatively. Findings were generally supported in a sensitivity analysis.Conclusions
Clinicians involved in the pre- and postoperative care of persons undergoing hip or knee arthroplasty can use these findings to inform fall risk screening and intervention delivery to reduce fall risk in patients who are at risk for multiple falls after hip or knee arthroplasty. 相似文献17.
Mehdi Kargarfard Ardalan Shariat Lee Ingle Joshua A. Cleland Mina Kargarfard 《Archives of physical medicine and rehabilitation》2018,99(2):234-241
Objective
To assess the effects of an 8-week aquatic exercise training program on functional capacity, balance, and perceptions of fatigue in women with multiple sclerosis (MS).Design
Randomized controlled design.Setting
Referral center of an MS society.Participants
Women (N=32; mean age ± SD, 36.4±8.2y) with diagnosed relapsing-remitting MS. After undergoing baseline testing by a neurologist, participants were allocated to either an intervention (aquatic training program, n=17) or a control group (n=15).Interventions
The intervention consisted of an 8-week aquatic training program (3 supervised training sessions per week; session duration, 45–60min; 50%–75% estimated maximum heart rate).Main Outcome Measures
Six-minute walk test (6-MWT), balance (Berg Balance Scale [BBS]), and perceptions of fatigue (Modified Fatigue Impact Scale; [MFIS]) at baseline and after the 8-week intervention. Differences over time between the experimental and control groups were assessed by a 2×2 (group by time) repeated-measures analysis of variance.Results
Thirty-two women completed the 8-week aquatic training intervention (experimental group, n=17; control group, n=15). All outcome measures improved in the experimental group: 6-MWT performance (pretest mean ± SD, 451±58m; posttest mean ± SD, 503±57m; P<.001); BBS (pretest mean ± SD, 53.59±1.70; posttest mean ± SD, 55.18±1.18; P<.001), and MFIS (pretest mean ± SD, 43.1±14.6; posttest mean ± SD, 32.8±5.9; P<.01). A significant group-by-time interaction was evident between the experimental and control groups for 6-MWT (P<.001, partial eta2 [ηp2]=.551), BBS (P<.001, ηp2=.423), and MFIS (P<.001, ηp2=.679).Conclusions
Aquatic exercise training improved functional capacity, balance, and perceptions of fatigue in women with MS. 相似文献18.
19.
Nam G. Lee Joshua H. You Chung H. Yi Hye S. Jeon Bong S. Choi Dong R. Lee Jae M. Park Tae H. Lee In T. Ryu Hyun S. Yoon 《Archives of physical medicine and rehabilitation》2018,99(11):2168-2174
Objectives
To compare the effects of conventional core stabilization and dynamic neuromuscular stabilization (DNS) on anticipatory postural adjustment (APA) time, balance performance, and fear of falls in chronic hemiparetic stroke.Design
Two-group randomized controlled trial with pretest-posttest design.Setting
Hospital rehabilitation center.Participants
Adults with chronic hemiparetic stroke (N=28).Interventions
Participants were randomly divided into either conventional core stabilization (n=14) or DNS (n=14) groups. Both groups received a total of 20 sessions of conventional core stabilization or DNS training for 30 minutes per session 5 times a week during the 4-week period.Main Outcome Measures
Electromyography was used to measure the APA time for bilateral external oblique (EO), transverse abdominis (TrA)/internal oblique (IO), and erector spinae (ES) activation during rapid shoulder flexion. Trunk Impairment Scale (TIS), Berg Balance Scale (BBS), and Falls Efficacy Scale (FES) were used to measure trunk movement control, balance performance, and fear of falling.Results
Baseline APA times were delayed and fear of falling was moderately high in both the conventional core stabilization and DNS groups. After the interventions, the APA times for EO, TrA/IO, and ES were shorter in the DNS group than in the conventional core stabilization group (P<.008). The BBS and TIS scores (P<.008) and the FES score (P<.003) were improved compared with baseline in both groups, but FES remained stable through the 2-year follow-up period only in the DNS group (P<.003).Conclusions
This is the first clinical evidence highlighting the importance of core stabilization exercises for improving APA control, balance, and fear of falls in individuals with hemiparetic stroke. 相似文献20.
Alejandro Gómez-Bruton Alejandro González-Agüero Angel Matute-Llorente Cristina Julián Gabriel Lozano-Berges Alba Gómez-Cabello Nuria Garatachea Jose A. Casajús German Vicente-Rodríguez 《PM & R》2018,10(9):889-897