What instruments have been used to assess the mobility of community-dwelling older adults?

Abstract

Background: The primary aim of this review was to identify existing instruments that have been used to assess the mobility status of community-dwelling older adults. The secondary aims were to identify instruments that have face validity for measuring across the full mobility spectrum and to summarise and compare their clinimetric properties.

Methods: MEDLINE, CINAHL, PEDro, and EMBASE were searched until April 2007. The first stage included searching for papers that reported mobility outcome measures that had been applied to healthy community-dwelling older adults. The second stage identified these outcome measures and the third stage compared clinimetric properties of the instruments that had face validity for measuring across the full mobility spectrum (from bed-bound to high levels of independent mobility). Two independent reviewers extracted data from the included studies.

Results: From the 128 included papers, 14 outcome measures were identified, two of which, the Lower Extremity Functional Scale (LEFS) and the Elderly Mobility Scale (EMS), measured across the full spectrum of mobility. No clinimetric evidence was found for the LEFS amongst a community-dwelling older population and only evidence of known groups validity was identified for the EMS.

Discussion: An outcome measure that has face validity for measuring across the full mobility spectrum and has sufficient clinimetric evidence in a community dwelling population was not identified.

Conclusion: This review supports the need for the development of such an instrument.     

Reliability of Manual Mobility Testing of the Upper Cervical Spine in Subjects with Cervicogenic Headache

Abstract

The identification of a cervicogenic headache is determined by criteria as stated by the International Headache Society (IHS). One of the criteria involves a finding of abnormal tenderness or resistance to movement in the neck region. The purpose of this study was to examine the inter-examiner and intra-examiner reliability of manual mobility testing of the upper cervical spine in the diagnosis of cervicogenic headaches in symptomatic subjects. Two groups of 20 subjects were required to meet initial criteria for a cervicogenic headache as adapted from the IHS. Subjects were not currently receiving medical treatment for headaches. To determine inter-examiner reliability, two examiners independently examined the 20 subjects (ages 22-48; 5 males and 15 females). Each examiner performed 15 mobility tests in random order on each subject. To establish intra-examiner reliability, a separate group of 20 subjects (ages 21-48; 3 males and 17 females) was evaluated by one examiner on two consecutive days. The Spearman's rho correlation was applied to the total number of abnormal findings recorded across each group of subjects. The Kappa correlation coefficient and percent agreement were used to compare the findings of each of the 15 mobility tests. They were also used to compare the identification of at least one abnormal finding for every subject. For this study, Kappa values ≥0.400 were considered acceptable. The Spearman's rho value for inter-examiner reliability was 0.943. Acceptable inter-examiner reliability was found on 11 out of 15 mobility tests, with Kappa values ranging from –0.053 to 1.000 and percent agreement values ranging from 70 to 100%. There was 100% agreement between examiners on whether the subject met the IHS criteria, resulting in a Kappa value of 1.000. The Spearman's rho value for intra-examiner reliability was also 0.943. Kappa values for intra-examiner reliability were acceptable for 11 out 15 tests and ranged from 0.208 to 1.000. The percent agreement values ranged from 60 to 100%. There was 100% agreement on consecutive days on whether the subject met the IHS criteria, yielding a Kappa value of 1.000. This study found that mobility testing, which includes palpation of the cervical spine, is a reliable tool, specifically in the identification of a cervicogenic headache in symptomatic subjects.     

Particle Loss in a Scanning Mobility Particle Analyzer Sampling Extension Tube

Abstract

Deposition of particles in sampling lines may occur due to various physical forces. Particles in the nanoscale are not highly susceptible to inertial or sedimentary deposition, and electrical losses are reportedly controlled by using conductive tubing. Particle losses from diffusion affect size distribution and number concentration. Selectively removing the smallest particles has the effect of increasing the statistical measure of particle size—the geometric mean—while decreasing number concentration and geometric standard deviation. Quantification of losses is necessary to interpret or correct the data. Sample loss from a rigid graphitic or flexible Tygon tube attached to a scanning mobility particle sizer inlet was investigated during sampling at the Center for Nanophase Materials Sciences. Mean concentrations and particle size parameters determined from samples collected with and without sample inlet extensions were compared. Number concentration decreased and mean particle size increased for both tubing types at lengths of ～0.7m.     

Preliminary study of potential for rapid prototype and surface scanned radiotherapy facemask production technique

Preliminary investigations into the potential of an elegant technique to create a rudimentary facemask for patient immobilization during radiotherapy treatment are presented. This method combines modern technology to cause the patient far less discomfort compared with current plaster of Paris (POP) face mould procedures. Near instantaneous patient face scanning is accomplished with charge-coupled devices for imaging in an optical surface scanning system. The surface generated data is input to a rapid prototype (RP) system that creates a life-size model of the patient's face topology. As proof of principle a basic prototype facemask was successfully constructed using this technique and some qualitative comparison measurements for position and surface dose were made. These initial results confirm the validity of this technique and justify the need for further quantitative studies to fully investigate the potential of RP facemasks over POP based methods for mask production.     

Fibrinogen adsorption by PS latex particles coated with various amounts of a PEO/PPO/PEO triblock copolymer

Polystyrene (PS) latex particles of different sizes were adsorption coated with the polymeric surfactant Pluronic F108 (PEO₁₂₉-PPO₅₆-PEO₁₂₉). The commercial surfactant was found to have a bimodal molecular weight distribution. However, the maximum surface concentrations resulting from adsorption of either the purified high molecular weight component or the composite were identical. An increase in the copolymer surface concentration on 252-nm particles was found to decrease their fibrinogen uptake exponentially. At maximum copolymer surface concentration, the fibrinogen uptake was two orders of magnitude lower than that of bare particles (down from 3.3 mg/m² to 0.03 mg/m²). This surface protection was equally effective whether the adsorption involved the bimodal polymer surfactant or the purified high molecular weight fraction. The PEO tail mobility was investigated with electron paramagnetic resonance (EPR), and found to increase with an increase in polymer surface concentration. The comparatively slow motion of the PEO chains at low surface concentration indicated that not only the PPO block, but also the PEO blocks interacted hydrophobically with the PS surface. When the copolymer surface concentration was increased, the PEO tails were gradually being released, acquiring higher mobility as the surface became covered by the more strongly binding PPO blocks. Results obtained with F108 coated particles of different sizes showed that particle size had a significant effect on the fibrinogen uptake, with larger particles showing larger fibrinogen uptakes.     

Therapeutic interventions in the treatment of people with multiple sclerosis with mobility problems: a literature review

Abstract

Objectives: Multiple sclerosis (MS) is a demyelinating, degenerative disease of the central nervous system. It is a progressive disease that can lead to severe disability, functional limitations and a poor quality of life (QoL). People with multiple sclerosis (PwMS) may live for many years with severe mobility problems and may require regular therapeutic intervention. The objective of this review is to assess current published literature evaluating all types of interventions for PwMS with an expanded disability status scale (EDSS) score ≥6.

Methods: A search of eight databases was conducted using relevant search terms. Articles were included if a therapeutic intervention was evaluated in PwMS with an EDSS score of ≥6 or if some or all of the participants used a walking aid.

Results: Twelve studies fulfilled the criteria for this review. The interventions evaluated in these studies included a range of physiotherapy treatments, for example, balance rehabilitation, resistance exercise, aerobic exercise and others.

Discussion: The evidence from this review suggests that all of the interventions described can potentially be beneficial for PwMS. As studies have not taken mobility levels into account the optimal type of intervention and its frequency and duration for this population is unknown and further research is needed to develop treatment recommendations for clinicians treating PwMS with moderate to severe mobility problems.     

A review of factors affecting the performances of latex agglutination tests

The present review describes the different strategies followed to improve the performance of latex agglutination tests. The analysis is mainly focused on the diverse parameters that affect the final colloidal stability of the immunoprotein-latex system. These parameters include: the surface properties of polymer carriers; the different kind of antibodies usually employed; the use of BSA as stabilizer; the co-adsorption of various macromolecules (BSA, surfactants and lipids) and antibodies; recent approaches to colloidal stability at high ionic strengths due to hydration forces; and the covalent coupling of antibodies on functionalized latex particles. Special emphasis is given to the relation between electrophoretic mobility and the colloidal stability of the sensitized particles and how this knowledge can be utilized for a better understanding of the immunoagglutination kinetic.     

Effects of three‐monthly oral 150,000 IU cholecalciferol supplementation on falls,mobility, and muscle strength in older postmenopausal women: A randomized controlled trial

Daily vitamin D in addition to calcium supplementation reduces falls and fractures in older women. However, poor adherence to therapy is a common clinical problem. To examine the effects of supervised oral 3‐monthly vitamin D therapy on falls, muscle strength, and mobility, we conducted a 9‐month randomized, double‐blind, placebo‐controlled trial in 686 community‐dwelling ambulant women aged over 70 years. Participants received either oral cholecalciferol 150,000 IU every 3 months (n = 353) or an identical placebo (n = 333). All participants were advised to increase dietary calcium intake. Falls data were collected 3‐monthly. At baseline, 3, 6, and 9 months, muscle strength was measured by a handheld dynamometer and mobility by the Timed Up and Go (TUG) test. Serum 25 hydroxyvitamin D (25OHD) was measured in a subgroup of 40 subjects. Mean age at baseline was 76.7 ± 4.1 years. The average serum 25OHD value at baseline was 65.8 ± 22.7 nmol/L. By 3, 6, and 9 months after supplementation, 25OHD levels of the vitamin D group were approximately 15 nmol/L higher than the placebo group. Calcium intake did not change significantly between baseline (864 ± 412 mg/day) and 9 months (855 ± 357 mg/day). Faller rates in the two groups did not differ: vitamin D group, 102 of 353 (29%); placebo group, 89 of 333 (27%). At 9 months, compared to placebo or baseline, muscle strength, and TUG were not altered by vitamin D. In conclusion, oral cholecalciferol 150,000 IU therapy administered 3‐monthly had neither beneficial nor adverse effects on falls or physical function. These data together with previous findings confirm that intermittent large doses of vitamin D are ineffective or have a deleterious effect on falls. Thus despite adherence issues with daily vitamin D replacement, an intermittent, high‐dose vitamin D regimen cannot be supported as a strategy to reduce falls and fractures. © 2012 American Society for Bone and Mineral Research