TITLE: How Effective Is a Matter of Balance When Conducted By Dpt Students As Lay Leaders?
CURRENT SECTION: Geriatrics
AUTHORS: Erika Barger, Alexander Keith Beyer, Christopher Birotte, Amanda Lynn Imyak, Adam Garrhain Peng, Michele Lynn Tremblay, Ann W.B. Coventry
Purpose/Hypothesis: A Matter of Balance is a program for the aging adult population designed to reduce the fear of falling, increase activity level, and improve balance. Every year approximately 30% of community dwelling older adults fall. The fear of falling is a major risk factor for falls, approximately one-third to one-half of older adults acknowledge having this fear. One previous Matter of Balance program showed improvements of individuals physical performance and fall-related attitude. The purpose of this study was to investigate the effects that the A Matter of Balance program has on balance and fear of falling among community dwelling aging adults in Manchester, NH.
Number of Subjects: Twenty participants began with 14 completing, the average age was 81 years, age range 65-95, with 12 females and 2 males.
Materials and Methods: Participants were recruited via the senior center newsletter. Twenty participants started the program, with 14 participants completing the program attending 5 of 8 sessions. Participants were involved in predetermined exercises, discussion, and other group activities that addressed fears of falling, providing education that deflated myths about falls and aging, problem solving, and home modifying strategies. Outcomes were measured using the Modified Functional Reach Test (MFRT) and 30-second Chair Sit to Stand Test (CSST). Attitudes about falling were assessed with a Fall-Related Attitude survey pre and post interventions.
Results: The results of this study showed statistical significance in the group's MFRT mean score (32.25cm pre-test, 37.46cm post-test, p=0.004, MCID=6.35cm) and 30CSTS mean score (9.07 pre-test, 11.07 post-test, p=<0.001, MCID=2.6) after intervention. Among the group, 3 participants met the MCID in both 30CSTS and MFRT, 5 participants met the MCID in 30CSTS only, and 6 participants met the MCID in MFRT only. Participants showed no significant improvement in their scores in their Fall-Related Attitude survey at final visit with regards to (1) fearfulness of falling (p=0.174) and (2) self-perceptions of health status (p=0.102). However, participants did show an improvement in their survey scores with confidence in performing physical activities (9.14 pre-test, 13.43 post-test, p=0.0003) at their final visit.
Conclusions: The increased scores indicate that the intervention of the A Matter of Balance Program resulted in meaningful improvements in balance among participants, thus decreasing their risk of falls. Participants showed improved confidence and decreased fear of falling, evident through discussion and survey. The study was limited in the following ways: the use of the Functional Reach Test may have been a better indicator of balance than the Modified Functional Reach Test. Six of the 20 participants did not complete the program.
Clinical Relevance: A Matter of Balance is a program that leads to improved balance, decreased fall risk, and demonstrates positive implications on fear of falling among aging adults. As more aging adults visit PT clinics, it is important for Physical Therapists to reference programs in the community that aging adults can access without utilizing skilled PT to manage falls.
TITLE: Sleep Quality and Walking Performance and Motor Skill
CURRENT SECTION: Geriatrics
AUTHORS: Jessie M. VanSwearingen, Subashan Perera, Leslie Coffman, Valerie Shuman, David Wert, Jennifer Sokol Brach
Purpose/Hypothesis: Motor learning and motor skill performance is enhanced by sleep, particularly for fine motor skills. Motor learning of gross motor skills seems less impacted by sleep; however, in young athletes, sustained gross motor skill sport performance level was facilitated by the quantity of nighttime sleep. Among older adults and for well-learned motor skills such as walking, this relation of sleep and sustained motor skill level has not been explored. In older adults, we examined the relation of sleep quality and walking performance and motor skill.
Number of Subjects: Participants were older adults (n=249; mean age, 77.4±6.6 years; 65.5% female; 88% white; 80% college educated) who walked independently with or without a cane, had slow gait speed (<1.2m/s) and completed baseline testing for a randomized controlled trial of interventions to improve walking.
Materials and Methods: Sleep quality was assessed using the self-reported or interview administered Pittsburgh Sleep Quality Index (PSQI); score range, 0-21. Higher PSQI scores represent poorer sleep quality, with scores > 5 sensitive and specific for disordered sleep. Walking performance and motor skill of walking was assessed using physiological (energy cost of walking, ml/kg-m, six minute walk test), biomechanical (gait speed, m/s; step length, m; stride width, m; step time, s; variability by SD of step length, m; stride width, m; and step time, s) and neuromotor control (Figure of 8 Walk time, s and # steps; walk ratio, m/min/step) measures. Subjects self-reported demographics and the Comorbidity Index of health domains (0-8). We used linear regression models to examine association between disordered sleep (PSQI>5) and walking adjusted for age, gender, and comorbidities.
Results: The older adults studied had moderate deficits in physiological walking performance (efficiency, .24±.07ml/kg-m, six minute walk, 122.9±26.4m) mild deficits in biomechanics (gait speed, 1.07±.16; step length, .58±.07, stride width, .077±.03; step time, .55±.05; and variability, length, width, and time .03±.01m, 03±.01m, 0±.01s, respectively) and moderate deficits in neuromotor control (Figure of 8 walk time, 10.0±2.1 and steps, 17.2±2.9; walk ratio, .0054±.0007); n=109 (44%) reported poor sleep quality. Those with poor compared to good sleep quality had 6.8m shorter six minute walk distance (p=0.0363), 0.05m/s slower gait speed (p=0.0241), .018m shorter step length (p=0.0377), 0.003m marginally significantly greater step length SD (p=0.0624) and 0.004m greater stride width SD (p=0.0210), independent of age, gender, and comorbidities.
Conclusions: Among older adults with walking difficulty, disordered sleep was associated with poorer walking performance and motor skill of walking independent of age, gender, and comorbidities.
Clinical Relevance: In efforts to sustain and prevent decline and enhance recovery of walking performance and motor skill, physical therapists may attend to sleep health. For older adults with disordered sleep, referral and collaboration with clinical sleep experts may be important in the maintenance and possibly the recovery of the motor skill of walking.
TITLE: Walking the Plank to Improve Dynamic Mediolateral Stability in Older Adults
CURRENT SECTION: Geriatrics
AUTHORS: Ben Sidaway, Dylan Bryce, Ryan Blaney, Mary Kate Frey, Marley Harmon, Kathryn Olson, Katelyn Ryan
Purpose/Hypothesis: Loss of mediolateral stability during gait leads to an increased risk of falls in older adults. Numerous programs have been developed to reduce the fall risk in this population but few are specifically targeted at dynamic mediolateral stability. Recent research has shown that beam-walking can be used to assess mediolateral stability and so the current experiment examines whether beam-walking training might also be able to reduce gait variability and improve dynamic balance in older adults.
Number of Subjects: 13 community dwelling older adults (65 – 90 years old).
Materials and Methods: During the pretest falls history was first collected then participants completed the Activities-specific Balance Confidence (ABC) scale and the Dynamic Gait Index (DGI). Participants then walked 4 times over a 6 m long computerized gait mat in an unrestricted manner. The gait mat was used to record; gait velocity, cadence, step length, step length variability, step time, and step timing variability. Participants then attempted to walk 3 times along a series of 6 m long wooden beams of decreasing widths (21, 18, 15, 12, 9, 6 cm). Following the pretest participants practiced the beam walking task in the same manner as in the pretest for 20 minutes twice a week for 4 weeks. On the final day of practice participants' gait was again assessed on the computerized mat. One week following completion of the training a post-test was conducted that consisted of all pre-test measures.
Results: By the end of training participants were able to walk on a plank on average 3 beam widths narrower than their narrowest pretest width. 54% of participants progressed to the narrowest beam (6 cm). As a result of the beam training significant improvements were found in gait velocity, step length, step length variability and stride width variability. Improvements were also found in cadence, step time variability and DGI scores but these changes did not reach statistical significance. No changes were found in fear of falling or ABC data.
Conclusions: One month of beam training resulted in clear increases in beam walking ability that in turn led to significant improvements in important gait parameters indicative of improved dynamic mediolateral stability. A 6-month follow-up on fall frequency is currently being conducted.
Clinical Relevance: Simple beam walking training may be a clinically efficacious method to increase dynamic mediolateral stability and reduce falls risk in older adults.
TITLE: Motor Learning Exercises Improves Fall Risk With Patient With High-Functioning Gait Speed
CURRENT SECTION: Geriatrics
AUTHORS: Melissa Dreger
Background and Purpose: The use of a multimodal physical therapy program incorporating both impairment-based therapeutic exercise and task-oriented motor sequence learning has been studied in many neurological disorders, revealing improvements in the efficiency of gait and improved gait speed. Recent evidence has also utilized this approach in individuals with subclinical walking difficulty, revealing improved gait speed and motor skill including improved smoothness of walking. The purpose of this case study is to demonstrate the clinical utility of motor learning exercises in combination with an impairment-based physical therapy program in a patient with high-functioning gait speed and subclinical walking difficulty as noted by the Modified Gait Abnormality Rating Scale (GARS-M).
Case Description: Patient with primary complaint of left knee pain and difficulty straightening both knees of insidious onset beginning 3 years ago. Past medical history of right knee menisectomy 15 years ago.
Initial evaluation findings include no limitations in knee range of motion, hip extension range of motion, nor effusion bilaterally, but noted deficits in quadriceps strength as measured by MMT bilaterally which was later evaluated by HHD, deficits in hip abduction strength, limited hamstring length as evaluated by straight leg raise, and concordant knee pain with palpation of the distal hamstring tendons of the left knee. Patient's gait speed was 1.1 m/s, the Lower Extremity Functional Scale (LEFS) was 63 points out of 80, with highest difficulty ratings in squatting activities, and the GARS-M was 12 points, with observations of high guardedness/hesitancy, foot flat at heel strike, shoulder extension, and little to no temporal coherence of arm and leg.
Treatment occurred over a period of 6 visits over 4 weeks including hamstring stretching, glute and quadriceps strengthening, functional training, and motor learning exercises. The motor learning exercises were stepping and walking patterns progressively increased over time in speed, amplitude, accuracy, and in walking pattern complexity.
Outcomes: Patient improved LEFS score of 63 points to 73 points meeting both the MDC and MCID. The GARS-M improved from 12 points to 2 points, indicating reduced risk of falls. Gait speed improved from 1.1m/s to 1.5m/s meeting both MDC and MCID. Observation of gait speed demonstrating bilateral arm swing and increased step length. Lastly, patient reporting complete resolve of knee pain at end of plan of care.
Discussion: The use of motor learning exercises in combination with a multimodal physical therapy program addressing musculoskeletal impairments yielded positive outcomes for a patient with subclinical gait dysfunction as evidenced by reduced risk of falls based on GARS-M and gait speed, as well as improved overall function based on patient self-reported outcomes.
TITLE: Cognitive Status Affects Degree of Improvement in Driving Reaction Time Following High-Intensity Aerobic Exercise
CURRENT SECTION: Geriatrics
AUTHORS: Robert Edwin Mills, Zach C. Carr, Michael Bryan Ethington, Evan Smith, Nathan Forrest Johnson
Purpose/Hypothesis: Mobility refers to any form of movement that permits a physical change in body position or destination. Driving is often overlooked as a form of mobility and is the preferred choice reported by older adults. Mobility and global measures of cognition are associated biomarkers of independence in older adults. Attention and the ability to rapidly respond to environmental changes are reflective of general cognition, are requisites of safe driving and are representative biomarkers that decline with age. Moderate-intensity aerobic exercise attenuates age-related cognitive decline, but less is known about the effects of high-intensity aerobic exercise on cognition. Further, it is unclear if the benefits of aerobic exercise differentially affect high and low cognitive performers. The aim of this study was to determine if a high-intensity aerobic exercise program differentially boosts driving-related reaction time (RT) on a divided-attention task in older adults with low and high baseline levels of general cognition. We hypothesized that older adults with lower levels of general cognition would demonstrate greater decreases in RT following high-intensity aerobic training when compared to older adults with higher levels of general cognition.
Number of Subjects: 43
Materials and Methods: Participants completed baseline and follow-up assessments of cardiorespiratory fitness, global cognition and divided attention RT during a simulated drive. Cardiorespiratory fitness was assessed using a bicycle ergometer. Global cognition was assessed using the Mini-Mental State Exam (MMSE), and a median split was performed to stratify the subjects into low- and high-normal groups. Divided attention was assessed during an 8-minute simulated drive. Specifically, participants were required to maintain lane position and speed while attending and responding to changing shapes on the computer screen. RT and accuracy were recorded for 48 total trials. Follow-up measures of each outcome variable were collected at the conclusion of a 3-month high-intensity aerobic training intervention.
Results: Independent samples t-test were used to determine if a high-intensity aerobic exercise differentially improves driving-related RT on a divided-attention task in older adults with low- and high-normal global cognition. The study found that subjects with low-normal MMSE scores showed greater improvement in driving-related RT (M = −0.178, SD = 0.269) following high-intensity aerobic exercise than subjects with high-normal MMSE scores (M = 0.009, SD = 0.263), t(34) = −2.102 p=0.043.
Conclusions: Findings suggest that high-intensity aerobic exercise has a greater impact on a driving-related divided attention task in individuals with low-normal global cognition.
Clinical Relevance: Operating a motor vehicle is a form of mobility many clinicians fail to consider. Age-related declines in divided attention limit the mobility of older adults. Physical therapists are in a unique position to help attenuate aged-related declines in cognition by promoting modifiable lifestyle variables that contribute to driving performance.
TITLE: Impact of Boxing Training on Turning, Gait Speed, and Balance in Individuals With Parkinson Disease
CURRENT SECTION: Geriatrics
AUTHORS: Cathy Lee Stucker, Lincoln Bois, Myra Gene Ann Degre, Kari Fletcher, Saker Ghanayem, Sarabeth Plotkin, Mary St. Cyr
Purpose/Hypothesis: Physical activity has been established as a means for counteracting the degenerative nature of Parkinson Disease (PD) on motor planning and functional mobility. A measure of gait stability that is not frequently addressed with exercise programs is control and fluidity with directional changes. This effort and time to turn has been identified as an important measure of self-confidence with functional mobility in persons with PD. This study examined the effect of a student-run boxing program for people with PD on gait speed, turn time, and balance parameters of gait.
Number of Subjects: 12
Materials and Methods: Twelve participants with PD, 7 males and 5 females, mean age 70 (±6.6 SD), participated in a 12-week boxing program with one group session per week. The participants were divided into two groups for statistical analysis based on their functional score on the Modified Hoehn & Yahr Scale (H&Y). The cutoff score was 2.5 resulting in a high function (HF) group and a low function group (LF) (HF=7 < 2.5, LF=5 >2.5). The boxing sessions incorporated boxing training drills for directional training, stepping, and rotation. Gait speed, Timed Up and Go (TUG), 180° turning time (TT), and 30 Second Sit to Stand (30STS) were assessed at baseline and at the end of the 12 weeks. No falls or injuries were reported during the boxing sessions.
Results: Prior to stratifying into H&Y groups, improvements were noted for both groups from baseline to post-test for gait speed (p=0.02), TUG (p=0.04), and turn time (p=0.01). There was no significant change noted with 30STS (p=0.97). No significant difference was found between the groups for gait speed (p=0.08) or 30STS (p=0.16). Although TT (p=0.01) and TUG (p=0.01) were found to be significant between groups, there was no significant interaction found between the variables (TT, p=1.0 and TUG, p=0.65). The minimal detectable change (MDC) for gait speed is 0.18 m/s. Three participants in LF and 4 in HF demonstrated the MDC for gait speed. The MDC for 30STS and TUG was not met for participants in either group from baseline to post-test. Turning time does not have an established MDC.
Conclusions: This study demonstrated that a boxing program is a safe and effective way to improve functional gait and balance for individuals with PD. Although turn time is a relatively new measure with no established norms for PD, it has been shown to reflect self-confidence with functional mobility. The boxing training program significantly improved turn time in the HF and LF groups. Considering the progressive nature of PD, any improvements over time reflect a potential positive impact on function.
Clinical Relevance: Improving self-confidence with walking leads to increased willingness to remain functionally engaged. Boxing training was shown to improve gait speed, TUG, and turn time significantly in participants with PD regardless of functional status of the disease. Recommending a boxing training program for people with PD is a viable option for improving their functional mobility.
TITLE: My Wings Have Been Clipped. the Impact of Shelter in Place on the Older Adult
CURRENT SECTION: Geriatrics
AUTHORS: Christine Mary Childers, Salina Jivan
Purpose/Hypothesis: During the 2020 COVID 19 pandemic there was mandated social distancing and shelter in place. Older adults in the community could only leave their home for essential business and the mandates included closing senior centers, silver sneaker programs, and the general closing of religious programs, restaurants, movie theaters and other community locations. This research was initiated 3 weeks into the mandates. The purpose of this study was to explore the lived experiences and feelings of the community dwelling older adult during these times.
Number of Subjects: Forty-two subjects were interviewed during May 2020. The sample included 11 males, 31 females, aged from 64- 93; mean age of 74. 30 of the individuals lived with a significant other the rest lived alone.
Materials and Methods: Recruitment was through colleagues and peers of the researchers. Permission was obtained and the researchers used contact information to schedule telephone interviews. The interview included informed consent and the 6-item cognitive impairment test was used to eliminate participants with cognitive impairment. Data was collected for age, gender, and living situation. The interviews were open ended questions with requests for examples where appropriate. Interviews ranged from 15 to 30 minutes and were transcribed by the researchers for analysis for codes and themes.
Results: Participants initially expressed that being retired meant there was no significant impact, but with probing many issues emerged. One participant explained “I don't feel cooped up, I don't feel isolated, I just feel like my wings have been clipped”. Reasons for this were the losses which included travel plans, community classes, seeing family and friends and activities from their daily life, eating out, getting their hair done, or sitting in the donut shop. Positive and negative emotions emerged. Positives included getting things done around the house that they had been avoiding, walking more, enjoying cooking and baking again and experiencing a trial run of retirement. Negatively there was frustration and anger, being sucked into the news, finding technology unsatisfactory and video exercise unappealing and feeling robbed of what time they had left. Encasing all these emotions was an overwhelming concern for others, those that lost jobs, were struggling financially or trying to raise young families. Finally, there was universal consensus that they were going to be very cautious with community re-entry.
Conclusions: Community dwelling older adults demonstrated acceptance and while their feelings of being “clipped” caused positive issues of getting more done, negative issues of lost time and anger emerged. Many participants expressed concern for others, but all indicated anxiety and cautiousness for community re-entry.
Clinical Relevance: Clinicians must understand the experiences and concerns of the older adult re-entering the community. As older adults return to clinics, senior centers and the community, their concerns and anxiety must be addressed to make them feel confident and safe.
TITLE: Curriculum Integration/Implementation of Student-Led Community Outreach Program for Aging Adults: Case Study Report
CURRENT SECTION: Geriatrics
AUTHORS: Jill Elaine Heitzman, Joni Goldwasser Barry, Olaide Oluwole-Sangoseni, Rachel Anne Rose
Background and Purpose: Recognizing underserved areas of Metropolitan St Louis and the surrounding regions along with a University's mission regarding valuing service to underserved populations, the physical therapy program developed a Community Outreach Program as an alternative to an onsite clinic. Many of these people from underserved areas have significant factors related to social determinants of health resulting in being ill-equipped to accommodate traveling to an onsite clinic.
Case Description: This four-year-old community wellness program is a bi-weekly pro bono outreach program with a local senior independent living community partner. Designed to meet the needs of promoting health and wellness in these often-overlooked populations. Students were provided with opportunities to interact with the aging population. The process for how to establish and sustain partnerships for reaching diverse communities as well as integrating the program within the physical therapy curriculum were included. By providing students with an invaluable opportunity to experience application of didactic material into real-life communities while learning to implement health and wellness screenings, assessment of change, opportunities to practice motivational interviewing and develop/prescribe/implement appropriate intervention programs, outcomes for student learning were assessed with positive results both quantitatively via survey feedback as well as quantitatively in reference to future course feedback.
Outcomes: Students, participants and staff at the senior center all reported positive outcomes via surveys and comments. 100% of the participants reported improvement in functional abilities in the home, increased social interaction and enjoyment of the program. Students reported improved knowledge of aging adults, health promotion and wellness as well as patient interactions. Staff of the centers reported satisfaction with how the program was integrated into their schedule and requested more interprofessional activities. Quantifiable results indicate stronger performance in future courses, clinical experiences and the 1st time pass rate on the NPTE is improved to 100%.
Discussion: This model presents potential challenges and opportunities for hands-on learning, future expansion, inter-professional engagement, and implementation for PT program within their own communities. These outreach programs are an alternative model to an onsite clinic that helps both the students and the community. The report elucidates ways to incorporate faculty engagement, curriculum integration and sustainability of such pro bono outreach programs. Successes and challenges of starting up this outreach program regarding application to their specific communities have been identified and justification for these community outreach programs in benefitting the local community and inter-professional education have proven outcomes. Future plans include adding other health professions to the program and integrating this with the residency programs the university partners with.
TITLE: Effects of a Short Tai Chi for Pre-Frail Elderly People in Senior Living Communities
CURRENT SECTION: Geriatrics
AUTHORS: Sonali Aggarwal, Yasser Salem, Hao Liu, Yu-Jie Ge, Qing-Wen Wu
Purpose/Hypothesis: To investigate the effects of a short 8-form Tai Chi exercise program on physical function, fear of falling, and depression in pre-frail elderly people living in senior communities.
Number of Subjects: 65
Materials and Methods: This 8-week randomized controlled trial was conducted in senior living communities with qualified pre-frail elderly subjects into a Tai Chi group (TCG, n=32) and a control group (CG, n=33). The TCG received TC intervention: 3/week, 60 minutes each. The CG did usual care only. Four assessments of the 30-second chair rise test (CRT), 4.5-meter walking speed (WS), fear of falling (FOF), and Geriatric Depression Scale (GDS) were all applied at baseline, end of 4th week, and 8th week.
Results: Between-group comparison at the 4th week showed significantly better outcomes in CRT and WS in the TCG than those in the CG (all P =.001), but not in FOF (P =.228) and GDS (P =.285). However, at the 8th week, such significant differences were found in all 4 assessments (all P = .001). For within-group comparison of the TCG, significant improvements (P <.05) were identified in CRT, WS, and FOF (but not in GDS) at the 4th week, and also in CRT, WS, FOF, and GDS at the 8th week. On the other hand, there were no significant differences in the CG for pre-and post- comparison (P>.05).
Conclusions: This short form TC exercise could improve physical function (the lower limbs' strength and gait speed), fear of falling and depression. Results were more significantly obvious after an 8-week intervention of this 8-form short Tai Chi.
Clinical Relevance: Frailty is becoming more recognized as an issue with elderly individuals & effective interventions must be made readily available. Short form TC is a novel, accessible exercise which has significant impacts on physical & psychologic well-being that may be used to address & prevent frailty.
TITLE: Effects of Group Dance on Balance and Wellness of Healthy Older Adults: A Systematic Review
CURRENT SECTION: Geriatrics
AUTHORS: Gabrielle Flaherty, James Stoll, Meagan Lee Kuniega, Lukas Smillie
Purpose/Hypothesis: The purpose of this study is to review the current scientific literature to investigate physical and emotional influences of groups dance classes on healthy, community-dwelling older adults over the age of 60.
Number of Subjects: The inclusion criteria for participants included: over the age of 60, a community dweller, no disabling co-morbidities, no cognitive deficits and can ambulate independently.
Materials and Methods: A systematic search of Ovid MEDLINE, Cochrane library, CINAHL, ScienceDirect using the terms “aged”, “community dwelling”, “balance”, “postural balance”, “quality of life”, “dance therapy” and “group dance”. The eligibility criteria included: written in the English language, published later than January 2011, randomized controlled trials (RCT), studies that analyzed the effects of group dance on healthy older adults over the age 65 and included the following variables: balance, dynamic mobility, postural stability, and quality of life.
Results: 118 articles were found during the literature search. After removing duplicates and screening the abstracts, 14 articles were included in this qualitative study. The selected articles showed clinically and meaningfully significant improvements (p<0.05) in balance, sway, health perspective, and depressive symptoms. However, there were some aspects of the studies, such as diversity in dance techniques, lack of homogeneity in outcome measures, differing types of study design, and small sample size of male participants, that limited the ability to determine the generalizability of these results based on scientific data.
Conclusions: Group dance classes have been shown to improve balance and general well-being in healthy, community-dwelling older adults. It has the benefits of exercise while maintaining adherence through enjoyable, social interaction.
Clinical Relevance: This systematic review identified aspects of group dance that are of clinical relevance for working with healthy, community dwelling older adults. These results indicate group dance exercise can be implemented in local community centers to increase the general well-being of older adults, while decreasing the risk of balance-related injuries. Also, physical therapists can utilize rhythmic movement into group therapy to improve balance and maintain motivation to participate. This information should be used by physical therapists during clinical decision-making to provide the best practice when addressing wellness and balance interventions for this population.
TITLE: Relationship Between Gait Parameters and Progression of Disease From Mild Cognitive Impairment to Alzheimer's Disease
CURRENT SECTION: Geriatrics
AUTHORS: Kim Bader, Joe Nocera
Purpose/Hypothesis: Patients with Alzheimer's Disease (AD) and Mild Cognitive Impairment (MCI) have impairments in multiple gait parameters compared to healthy individuals. However, much less is known about the longitudinal progression of gait impairment within these populations. As such, the purpose of this study is to evaluate the trajectory of gait changes in patients with MCI, early onset AD, and late onset AD as well as those that transition from MCI to AD.
Number of Subjects: The cross-sectional sample included 457 individuals with late-onset AD, 127 early-onset AD, and 424 MCI. The longitudinal sample included 70 late-onset AD, 19 early-onset AD, 24 who transitioned from MCI at visit 1 to AD at visit 2 (MCI-AD), and 61 who remained MCI at visit 2 (MCI-MCI). To be included in the longitudinal analysis, subjects had to have two gait evaluations separated by at least 6 months.
Materials and Methods: Individuals were assessed using the PKMAS Gait system with the following gait parameters linked to patients' medical charts: gait velocity, step length mean and standard deviation within trials, and total double limb support time mean.
Results: This study found that at visit 1, velocity and step length mean were significantly different between MCI, early onset AD, and late onset AD (p<0.05). For the longitudinal analysis, the late and early onset AD groups demonstrated a significant decrease in step length and velocity from visit 1 to 2. Similarly, the MCI-AD transition group demonstrated a significant decreased step length and velocity and an increase in step length variability from visit 1 to 2. Interestingly, the MCI-MCI group did not have a statistically significant difference in velocity or step variability between visits but did demonstrate significant decrease in step length.
Conclusions: This study aligns with previous findings that people with AD, both early onset and late onset, have decreased gait velocity and step length mean when compared to MCI. This study also shows that people with late onset AD and early onset AD demonstrate significant decline in gait outcomes overtime. Similarly, those with MCI who transition to AD also show a significant change over time in gait function, while patients with MCI who remain MCI at visit 2 have a gait pattern that remains more stable. These findings are important as they indicate an increasingly pathological gait profile among this population. While further research is needed, an aggressive decrease in gait function may provide insight into those at risk for progressing from MCI to AD.
Clinical Relevance: Gait impairment is an established marker of overall physical decline and increased fall risk in multiple patient populations. Gait impairment coupled with the changes in cognitive functioning in this population, put individuals at heightened risk of falls. Implementing physical therapy intervention during and early in disease progression is important to allow for maintenance of functional tasks and safe mobility. Lastly, given the multi domain diagnostic criterion for AD diagnosis and/or transitioning from MCI to AD, gait outcomes may serve as an additional tool in the diagnostic process.
TITLE: Can Dual Activity-Specific Balance Confidence Scales Identify Falls Prevention Focus Areas for Persons With Dementia?
CURRENT SECTION: Geriatrics
AUTHORS: Veronica Ann Smith, Victoria Panzer, Dorothy Wakefield, Richard H. Fortinsky
The rate of falls in persons with dementia (PwD) is higher than that of other community dwelling older adults1. Our studies involving family caregivers (CG) of PwD identified physical function as a prevalent concern2. We have also shown that CG's self-efficacy often did not consider the PwD's confidence3.
Theory/Body: In addition to the falls history and functional evaluation, a physical therapist may benefit from understanding the PwD's confidence, as well as their CG's. We hypothesized that a dual approach using the Activity-Specific Balance Confidence Scale4 (ABC) with both members of the dyad could help to identify focus areas for falls prevention (FP) interventions. Thirty dyads participated in an ‘ABC-Dyad’ (ABC-D) approach, the CGs were 91% female, PwD were 76% male, the PwD's average Mini-Mental Status Exam5 (MMSE) score was 22.3, reflecting predominantly mild to moderate dementia. On two separate visits, CGs self-administered a 16 item ABC scale, rating their confidence from 0-10 (No confidence to completely confident) in preventing a fall or loss of balance (FLOB) for the PwD. At the same time, an interviewer asked the PwD to respond Yes, I can prevent a FLOB=1, or No, I can't prevent a FLOB=0 to the 16 ABC items. Our previous research examined ‘Congruence’, a term which we used to describe the match between the individual's ABC confidence and their personal fall risk6. For dyads, we were interested in the match between CG's and PwD's confidence. The CG's ABC rating was categorized as Low (0-3), Neutral (4-6) or High (7-10) confidence. High CG confidence and PwD response of Yes, or Low CG confidence and PwD response of No were considered ‘Agreement’. High CG confidence and PwD response of No, or Low CG confidence and PwD response of Yes were considered ‘Disagreement’.
The ABC situations showing the most Agreement between CG and PwD initially were Icy sidewalk (12), Getting in or out of a car (11) and Walking up a driveway (10). Strengthened Agreement may result from increased OR decreased confidence in one or more specific ABC situations. For example, for gait on an icy sidewalk 12 agreed at both visits, while 5 dyads initially agreed, but then disagreed and 2 dyads initially disagreed, but agreed later. For transfers in or out of a car 11 agreed at both visits, 1 dyad initially agreed, but then disagreed and 1 dyad initially disagreed, but agreed later. For the PT, this approach can identify focus areas for person-centered functional rehabilitation and provide insight for a therapist monitored home safety or exercise program supported by the CG. The ABC-D can reflect strengthened Agreement within the dyad, which may result from increased OR decreased confidence in one or more specific ABC situations. Such shifts between visits represent meaningful change in FP issues for the individual dyad. The rehabilitation goal is to improve communication between the CG and PwD to understand and manage fall risks. ABC-D can provide a new tool to support the therapist's falls prevention interventions by elucidating key focus areas for a holistic rehabilitation plan of care.
TITLE: Variability in Rate of Bone Mineral Density Loss Between Bones in the Diabetic Foot
CURRENT SECTION: Geriatrics
AUTHORS: Nicholas James Youmans, Mary Kent Hastings, Michael Jeffrey Mueller, Paul K Commean, Jennifer Ann Zellers
Purpose/Hypothesis: Low foot bone mineral density (BMD) in those with diabetes mellitus (DM) and peripheral neuropathy (PN) is a risk factor for developing severe foot deformity.1 The calcaneus of people with type II diabetes mellitus (T2DM) has been observed to have higher BMD but more rapid bone loss than that of healthy, age-matched controls.2,3 Little is known about the bone-specific rates of BMD loss of the remaining tarsals and metatarsals.3 Therefore, the purpose of this study is to identify the rate of BMD change in the tarsal/metatarsal bones of individuals with DM and PN.
Number of Subjects: 19 individuals (8 male, mean(SD) age: 67(5.8) years) with T2DM (average time since diagnosis(SD): 16.5(10.1) years) and PN.
Materials and Methods: Volumetric Quantitative Computed Tomography (VQCT) was performed4,5 on the tarsals and metatarsals of each participant at baseline and three years later. All tarsal and metatarsal bones in one foot were segmented and BMD was calculated as Hounsfield Units (HU). Percent rate of change was calculated. Descriptive statistics are reported for BMD of each bone. Paired t-tests were used to determine the presence of a significant difference in BMD (of all tarsals and metatarsals averaged within subject) between baseline and three years, and to identify if there was a significant difference in the rate of BMD loss between the bones with the highest and lowest rates of BMD loss.
Results: Mean BMD for all tarsals and metatarsals significantly decreased over 3 years (mean(SD) pre: 426(70.8) HU, post: 419(72.3) HU, p=0.007). Mean(SD) percent change in BMD over 3 years was as follows: calcaneus= −3.97(4.1)%, first cuneiform= −2.81(6.1)%, talus= −2.56(3.3)%, fifth metatarsal= −2.40(4.1)%, cuboid= −2.31(3.8)%, fourth metatarsal= −1.88(3.9)%, first metatarsal= −1.63(3.3)%, third metatarsal= −1.55(2.9)%, navicular= −1.41(2.7)%, second cuneiform= −1.38(3.5)%, third cuneiform= −1.32(3.2)%, second metatarsal= −0.47(2.7)%. The calcaneus had a significantly greater rate of BMD loss per year compared to the second metatarsal (p=0.004).
Conclusions: This study is the first to report selective BMD loss in the tarsals and metatarsals in people with T2DM and PN. This study identified that tarsals and metatarsals in this population lose BMD at a wide range of rates with the calcaneus having the most rapid BMD loss. Yearly calcaneal bone loss of people with DM and PN as measured by CT (1.32%/year) was similar to values acquired with single-photon absorptiometry in healthy women (1.4%/year) and women with DM (1.6%/year).3 Primary limitations for this study include a small sample size and a lack of a control group.
Clinical Relevance: The rate of bone loss within the tarsals and metatarsals of people with DM and PN varies by bone. This may be due, in part, to altered force distribution in the foot during gait.6 Further research on the relationship between physical activity and walking mechanics with BMD changes in healthy and diabetic patients may help guide physical therapy intervention to mitigate BMD changes, particularly in people with diabetes.
TITLE: Scoliosis Specific Exercises, Quality of Life, and Exercise Adherence in Adults with Scoliosis
CURRENT SECTION: Geriatrics
AUTHORS: Frank Thomas Tudini, Amy Lynn Sbihli, Kevin K. Chui
Purpose/Hypothesis: There is a paucity of research focusing on adults with scoliosis, despite the high prevalence of pain and disability associated with this condition. Traditional physical therapy (PT) uses stretching and strengthening exercises to decrease pain and improve function, but has not been found to be overly successful. Conversely, scoliosis specific exercises (SSE) incorporates three-dimensional curve-specific exercises to decrease the risk of curve progression, improve postural awareness, reduce pain, increase strength, and improve breathing and body mechanics with an overall goal of improving quality of life (QoL). Exercise adherence is critical to the success of the intervention. The purpose of this study was to perform a retrospective analysis of how adults with scoliosis perceive that PT, utilizing SSE, has impacted their QoL and what factors correlated with home exercise program (HEP) adherence.
Number of Subjects: 57
Materials and Methods: All methods were approved by a university internal review board. A clinic that specializes in the treatment of scoliosis provided a list of all adult patients with scoliosis ≥ 18 years of age, who had received SSE treatment over the last 7 years and had been discharged. Each adult was sent an email that included a link to a 10-question survey on a secure Qualtrics server. The returned surveys were de-identified and given to the primary researcher for data analysis.
Results: Fifty-seven adults (88.9% female) responded to the survey (55% response rate) with 67.2% ≥ 55 years of age. The majority (61.9%) felt that PT had moderately or significantly positively impacted their QoL. The most common number of PT visits ranged from 5 – 10, after which 71.9% of participants were either somewhat or very confident in their ability to perform their SSE program independently at home. The most common frequency of HEP performance was 1-2 times per week (46.0%) for a duration of 5 – 40 minutes. Quantitative analysis of exercise adherence using a Spearman's rho (rs) revealed a positive association between the frequency of performing the HEP with the confidence that the exercises were being performed correctly (rs = .30, p = .024). Confidence was also correlated with the perceived positive impact of the exercises (rs = .45, p = .000) and greater time performing the HEP (rs = .33, p = .004). Neither the number of PT sessions (rs = .25, p = .06) nor age (rs = .14, p = .31) were significantly correlated with HEP performance.
Conclusions: This retrospective analysis showed that 61.9% of adults felt that PT utilizing SSE had moderately or significantly positively impacted their QoL. While adherence to a HEP is critical to the success of the program; of the questions surveyed, only confidence that the exercises were being performed correctly was correlated to HEP frequency. The sample was limited to adults from one clinic that specializes in scoliosis and may not be generalizable to other clinics.
Clinical Relevance: Adults with scoliosis can benefit from PT incorporating SSE. It is important that patients are confident in their ability to perform their exercise program to foster greater adherence to the HEP and improve outcomes.
TITLE: Movement Reaction Time in Individuals With Mild Dementia VS. Healthy Individuals
CURRENT SECTION: Geriatrics
AUTHORS: Beth Horton Schaeffer, Robert Daniel Austin, Diana Torres, Brian Stanton
Purpose/Hypothesis: (1) To compare the lower extremity (LE) and upper extremity (UE) Movement-Reaction Time (MRT) with mild to moderate dementia scores to those with normal scores. Subjects: 60+ year old, healthy seniors were evaluated from various senior centers, skilled nursing facilities, an Alzheimer's support group, and local clinics.
Number of Subjects: 35 subjects
Materials and Methods: Subjects completed consent form and a health history questionnaire, including past traumatic brain injury/stroke history. Manual muscle testing was performed on the dominant UE and right LE. Those who passed the inclusion criteria proceeded to answer The Mini-Mental State Examination (MMSE) to identified subjects who scored in a classification range of mild/moderate dementia. The control group (CG) were subjects who scored 27-30 where the dementia group (DG) scored 10-26 on the MMSE. After completing the MMSE, UE reaction time was tested through the iPad application “Reaction Speed” composed of 5 trials and required tapping on the screen when a change in color from red to green was noted. LE reaction time was collected through a Multi-Choice Reaction Timer by recording 5 trials requiring subjects to press a pedal with the right foot when a change of color from red to a green light was noted. The mean of 5 successive trials for both LE and UE was used for data analysis. An independent samples t-test was used to compare the two groups. Data analysis was performed using SPSS (version 26) (p<0.05).
Results: Thirty-five subjects completed the test with 18 (M=4, F=14) in the CG and 17 (M=7, F=10) in the DG with a mean age of 75.95 years. The MRT-CG was 0.382 (±0.085) seconds(s) for the UE and 0.536s (±0.090) for the LE whereas the MRT-DG measured 0.605s (±.293) in the UE and 0.804 s (±.364) for the LE. Independent-samples t-tests comparing the mean reaction time scores of the DG and CG found a significant difference between both group scores with UE (t(33)=-3.085; p=0.005) and LE (t(33)=-3.040; p=0.004) scores.
Conclusions: The CG was 38% faster than the DG for UE MRT and 33% faster for the LE. Therefore, the CG that scored between a 27-30 on the MMSE were significantly faster than those in the DG who scored a 10-26.
Clinical Relevance: A lower score on the MMSE corresponded with a significantly lower MRT. Further research evaluating the relationship between cognitive decline and reaction time is needed to provide a foundation of normative evidence for medical professionals when evaluating and determining the safety of elderly drivers. Such information may also be valuable in assessing other functional tasks which require speed of processing for safety such as responding after touching hot water or a hot stove, avoiding obstacles while walking in the community, and preventing falls.
TITLE: A Pilot Study to Examine Altered Strategies During Sit-to-Stand in People in Age-Related Mobility Decline
CURRENT SECTION: Geriatrics
AUTHORS: Paige Affleck Goodwin, Yuri Yoshida
Purpose/Hypothesis: Even at middle-aged, ager-related musculoskeletal system altered movement patterns before they need rehabilitative care to manage pain or functional mobility declines. The Stand-up Test (SUT) is the first of a series of diagnostic tests used to detect subtle, age-related mobility deficits in independent community dwellers, termed Locomotive Syndrome (LS).1 Patients categorized as LS 0 are considered to have no functional limitations and those as LS 1 demonstrate early functional limitations.1 Our previous study showed no difference in center of gravity (COG) control during the sit-to-stand (STS) in the forward and upward movement; however, the COG control in the side-to-side direction was significantly different between LS groups.2 We hypothesize that the LS 1 group used movement-compensation strategies during the (STS) associated with age-related impairments proven by quadriceps weakness and mobility declines.3,4 Therefore, the purpose of this study is to reassess each LS group's joint strategies and kinetic forces during the SUT.
Number of Subjects: 14 middle-aged volunteers (Average age: 56 years old) participated in the 3D motion analysis.
Materials and Methods: With consideration of mechanical inequality, each comparison limb was assigned a painful or less painful side based on the numeric pain scales (i.e. 0-10) at their hips and knees. Maximum vertical Ground Reaction Forces (vGRF) and supported joint moments5,6 of the lower limbs were analyzed during STS. Due to the limited sample size, effect sizes between groups for each variable were calculated for comparative analysis.
Results: Average pain between LS groups was not clinically different (LS0:1.17±1.33, LS1: 1.25±1.28). A large effect size (d=-1.31) of inter-limb asymmetry in vGRF was found in LS 1 compared to LS 0 (d=-0.07). Subjects in LS 0 demonstrated asymmetrical joint strategies, especially at the hips and knees (Hip:d=-1.47, Knee:d=1.44), compared to LS 1 (Hip: d=0.26, Knee: d= −0.38). For the group comparison, reduced vGRF (d=0.60), increased hip support moment (d=0.88), decreased knee support moment (d=1.00), and negative ankle support moment in the painful limb were found in LS 1.
Conclusions: More than 1/3 of subjects with LS performed the STS with their COG posterior to the ankle joint at peak vGRF, increasing the mechanical load at the knees but decreasing it at the hips. Middle-aged adults without LS utilize altered and asymmetrical joint strategies to produce symmetrical limb forces during the STS, overcoming any age-related musculoskeletal changes. Conversely, those with LS are unable to utilize these same joint strategies and demonstrate joint movement symmetry by reducing lower extremity force generation during the STS. Clinically, this decreased force generation is observed though significant quadriceps weakness and poorer performance in the 30-sec Chair Test and 6MW test.
Clinical Relevance: Although this is a pilot study, our findings provide clinical insight into the transition of middle-aged adults' movement patterns into clinically observable functional declines that accompany early age-associated musculoskeletal impairments.
TITLE: Do Concussive Symptoms Differ in Adolescents and Older Adults?
CURRENT SECTION: Geriatrics
AUTHORS: Rebecca Suzann Chisholm, Madeline Upham, David Brock Phillips, Charity Johansson, Crystal Renee Ramsey
Purpose/Hypothesis: This study examines the incidence of concussive symptoms in older adults in acute care who have not been diagnosed with a traumatic brain injury (TBI) following a trauma, and compares the nature and severity of concussive symptoms to those of adolescent athletes diagnosed with concussion.
Number of Subjects: 42 adults ≥ 60 years old who experienced trauma within 30 days of their initial hospitalization and were prescribed physical therapy in the acute-care setting. Individuals diagnosed with a concussion or brain injury were excluded.
Materials and Methods: Older adults completed a 20-question survey derived from the Post-Concussion Symptom Scale (PCSS). Participants were asked to rate the severity of 20 symptoms on a 6-point Likert scale. From the collected surveys, incidence and severity of each symptom were determined. These values were then compared to values obtained in a young athletic population (12-24 years-old) using a one-sample t-test. Significance was indicated by p < 0.05.
Results: Of the 42 individuals completing the PCSS after experiencing a physical trauma, all reported at least one concussive symptom. Older adults showed significantly higher severity on post-concussive symptoms than young athletes in 9 reported PCSS categories. There was a clinically significant difference between older adults and adolescent athletes in the following symptoms: vomiting, balance problems, feeling slowed down, difficulty remembering, trouble falling asleep, fatigue or low energy, feeling more emotional, sadness, and nervousness. There was not a significant difference in noise sensitivity.
Conclusions: Older adults should be screened for concussion following trauma due to the high incidence of previously unreported symptoms in acute care. Significant differences between symptoms of older adults and adolescent athletes following trauma attests to the need for an age-appropriate concussion screening tool in the acute-care setting. Screenings to determine concussion incidence can serve as the foundation for more extensive research addressing accurate diagnosis, effective interventions, and associated outcomes such as physiological and neurological effects, quality of life, hospital length of stay, and financial implications.
Clinical Relevance: Those over 75 years old have the highest incidence of TBI with the majority of TBIs occurring secondary to falls. However, concussion research in the older adult population is conspicuously absent, with current concussion literature focusing largely on sports-related injuries in adolescents and younger adults. While the topic of physical therapy management for concussion has grown with the recent publication of a clinical practice guideline, the evaluation and treatment of concussion and mild-TBI trauma was formulated without evidence on concussion in older adults. In addition to an increased fall risk with age, neurophysiological changes common with aging (e.g. loss of white matter) may also make older adults more vulnerable to concussive effects. Early concussion identification following trauma (e.g. fall, motor vehicle accident, assault) in the older adult population is essential to guiding optimal intervention.
TITLE: Using Treatment Fidelity Measures to Understand Walking Recovery: Secondary Analysis From the Community Ambulation Project
CURRENT SECTION: Geriatrics
AUTHORS: Kathleen Kline Mangione, Michael Posner, Rebecca Lynn Craik, Edward Wolff, Barbara Resnick
Purpose/Hypothesis: Physical therapy intervention studies can be deemed ineffective when, in fact, they may have not been implemented as intended. The goal of this study was to describe TF of an intervention (PUSH), a multicomponent exercise program for participants who competed usual care post hip fracture and its association with walking outcome by determining the baseline factors and components of TF that were associated with change in six minute walk distance (6MWD).
Number of Subjects: Of 105 participants randomized, 89 had measured 6MWD and were included in the analyses.
Materials and Methods: PUSH was a 16-week home-based intervention of lower extremity strengthening and endurance training. TF was defined as attendance rate, progression in training load, exercise position (exercise on floor), heart rate reserve during exercise, and duration of endurance training. The outcome was change in 6MWD. Independent variables include demographic and clinical measures. Descriptive statistics were calculated and linear and logistic regressions were performed.
Results: We found that those who exercised on the floor improved by 62 meters more than those who did not get on the floor, and each 50 meter increment walked at baseline was associated with a 0.35 meter reduction in change in 6MWD (p<0.05), those with reported pulmonary (-53 meters, p<0.01) or back (-29 meters, p<0.05) diseases improved less than those without those conditions. Baseline body mass index and 6MWD were significantly associated with the five components of TF.
Conclusions: Measures of treatment fidelity help inform understanding of treatment outcome. In our sample of patients post hip fracture, exercising on the floor was the strongest predictor of improvement in 6MWD, but the presence of pulmonary and back disease remained negatively associated with change in 6MWD.
Clinical Relevance: In this careful review of treatment fidelity (assurance that the intervention was implemented and received as intended), participants who could perform all components of this intensive exercise intervention achieved greater walking distances. Physical therapists should evaluate patients' ability to maximally participate in exercise interventions to optimize outcomes among those post hip fracture.
TITLE: Comparative Case Study of Two Covid 19 Neurologic Patients in Skilled Nursing Facility
CURRENT SECTION: Geriatrics
AUTHORS: Carmina Lagarejos Rafael
Background and Purpose: Covid-19 has severely impacted the geriatric population. Current data states 8 in 10 Covid deaths are 65 years and older1. The virulence of this disease caused a haywire of at least 34% mortality among SNF residents2. Currently, 3.88% of Florida SNF residents have Covid-19 increasing the burden of care to health providers3. Physical therapy (PT) provision of care in skilled nursing facilities (SNF) has significantly changed. This study is a case comparison of two SNF residents who contracted Covid-19 and recovered, both with a history of stroke. The purpose of this study is to present observations of geriatric post-Covid symptoms, PT interventions, patient responses, conclusions, recommendations, and encourage further discussion or input from the audience upon presentation.
Case Description: FG is a 78 y/o male, contracted Covid-19 on 04/30/2020 was hospitalized on 05/06/2020 when he developed pneumonia, fever, altered mental status, loss of consciousness, and acute metabolic encephalopathy. PT started on 05/18/2020. LA is a 66 y/o female diagnosed with Covid on 04/19/2020, and PT initiated on 05/20/2020. Both were provided 3 months of PT 4 to 6 times per week4. Both patients have a history of CVA. FG has right hemiparesis with very slight deficits. LA has left hemiplegia with her upper extremity more involved. For prior level of function (PLOF), FG was modified independent (MI) with wheelchair mobility (w/c mob), standby assistance (SBA) transfers, gait with rolling walker (RW) for 200 feet and MI bed mobility. Elderly mobility scale (EMS) at PLOF were FG 11 points, and LA 9 points, respectively5. LA was MI for w/c mob, minimal assistance (min A) gait with hallway railing support for 15 feet, contact guard (CGA) bed mobility and min A transfers. Upon evaluation, both FG and LA were maximum assistance (max A) for bed mobility, transfers and unable to functionally ambulate.
Outcomes: Both cases had functional progress. FG's EMS score was 3 points, went up to 7, and LA's EMS was 3, increased to 10 points. FG is now CGA bed mobility, min A transfers and min A gait with RW for 150 feet. LA is now SBA for bed mobility, CGA for transfers and gait with wide quad cane for 25 feet. At discharge, FG did not return to PLOF and even needed assistance with w/c mob, while LA surpassed her PLOF and returned to MI with w/c mob.
Discussion: LA surpassed her PLOF which may be associated with weight loss during her illness.6 EMS scores indicated that both cases needed mobility assistance, FG appropriate for long-term care, LA is borderline for home with proper caregiver. Functional improvements contributed to decreased burden of care for the staff and increased quality of life for the patients attributed to increased physical activities.7 Current studies are demonstrating neurologic involvements in Covid-19 patients.8,9 Both cases were provided PT after they tested Covid negative for infection control. There are indications that early PT intervention, during Covid infection, may prove more beneficial to this patient population for early mobilization.10
TITLE: The Association Between Mobility Determinants and Life Space Among Older Adults
CURRENT SECTION: Geriatrics
AUTHORS: Pamela Marie Dunlap, Andrea L Rosso, Xiaonan Zhu, Brooke Nicole Klatt, Jennifer Sokol Brach
Purpose/Hypothesis: Mobility is essential for the maintenance of independence and an active lifestyle among older adults. Declines and limitations in life space mobility are related to disability, poorer quality of life, fall risk, and mortality. It is important to understand the factors associated with life space mobility so that they can be addressed by targeted prevention and/or treatment strategies. The purpose of this analysis was to identify the association between cognitive, psychosocial, and physical determinants of mobility and life space among older adults.
Number of Subjects: 254 community-dwelling older adults.
Materials and Methods: This cross-sectional analysis used baseline data from a randomized single-blind intervention trial comparing the effects of a standard physical therapy program to a standard plus timing and coordination program in community dwelling older adults. Participants were included if they were ≥65 years, had a walking speed of 0.6-1.2 m/s, ambulated without an assistive device, and had physician clearance to participate. The Life Space Assessment (LSA), measures of physical function, psychosocial factors, and cognition were completed at baseline and the bivariate correlations between measures were assessed using Spearman's correlation coefficients. A multivariate linear regression model using backward elimination was conducted to determine factors associated with the LSA.
Results: The mean age of the sample was 77 (±6.5) years and 65% were female. The mean LSA total score was 75 (±18; range: 32-120) and differed among gender and education level (p<0.05). The LSA had significant correlations with personal factors [age (ρ=-0.24), comorbidity index (ρ=-0.13)], cognitive [Trail Making Test Parts A and B (ρ=-0.22, −0.17)], psychosocial [Modified Gait Efficacy Scale (ρ=0.22), Late Life Function and Disability Instrument (LLFDI) social, personal, and instrumental role domain scores (ρ=0.31, 0.16, 0.15)], and physical domain variables [lower extremity (LE) power (ρ=0.36), gait speed (ρ=0.26), Six Minute Walk Test (ρ=0.33), Figure-of-8 Walk Test (ρ=-0.28), energy cost of walking (ρ=-0.28), and LLFDI upper extremity, basic LE, and advanced LE function scale scores (ρ=0.17, 0.23, 0.32)] (all p<0.05). After removal of non-significant variables, the multivariate linear regression model indicated that 28% of the variation in LSA score was accounted for by gender (β=8.6), age (β=-0.62), energy cost of walking (β =-63.8), and LLFDI social role score (β =0.74) (all p<0.001).
Conclusions: Younger age, male gender, lower energy cost of walking, and higher LLFDI social role scores were associated with greater life space mobility indicating that personal factors, physical, and psychosocial domains within the mobility framework were related to life space.
Clinical Relevance: Clinicians treating individuals with limited mobility should consider personal and psychosocial factors in addition to physical function when assessing for barriers to life space mobility.
TITLE: Effects and Duration of Different Dosages of an Otago-Based Exercise Program for Older Active Adults
CURRENT SECTION: Geriatrics
AUTHORS: James L. Karnes, Victoria Bates, Ashley Chafin, Sarah Fisher, Kelcie Gilmore, Kelsey Pack, Roger Fiedler
Purpose/Hypothesis: Falls are common among older adults. One in four older adults fall each year resulting in an estimated $50 billion in medical costs. The Otago Exercise Program (OEP) is an evidence-based, at home exercise program that focuses on improving strength and balance. Previous research showed OEP is also effective when performed in groups. However, exercise dosage for effective group-based OEP exercise is unknown. Therefore, the purpose of this study was to investigate the effectiveness of different dosages of an OEP-based falls prevention program on falls risk variables and fear of falling in older adults, and the duration of the influence of the intervention.
Number of Subjects: Forty-seven subjects met inclusion criteria and were assigned to control (Con), once-weekly (Grp 1) or twice-weekly (Grp 2) intervention groups based on their attendance in the OEP-based program. Fifteen subjects (13 females, 2 males; mean age 72 years ± 3.6) completed the exercise program.
Materials and Methods: Subjects were recruited from two senior centers. Prior to, immediately after, and 3 months after the 12-week OEP-based exercise program, data were collected for all dependent variables: 4-Stage-Balance-Test, 30-Second Chair Stand, Timed Up and Go (TUG), Geriatric Depression Scale (GDS), and Fall Efficacy Scale-International (FES-I). One-way and repeated measures ANOVA (p≤.05) were used to assess changes in dependent variables among all time frames.
Results: Data analyses indicated no statistically significant changes in within- and between-subject data over all three time points. However, repeated measures analyses showed significant improvements from pre to post in TUG times (p<.05) and 30-second chair rise (p<.01), with subjects receiving intervention twice weekly showing greatest improvement in TUG times and greater magnitude of improvement in chair rise over 30-seconds in those receiving intervention twice weekly compared to once weekly. Moreover, there were improved FES-I scores in those receiving intervention once a week compared to twice weekly.
Conclusions: A 12-week OEP-based exercise program produced few statistically significant changes on various falls-related variables perhaps due in part to the small sample sizes. However, positive trends for selected variables suggest this program may be a beneficial falls prevention program. Greater participation of subjects would strengthen results.
Clinical Relevance: While twelve weeks of an OEP-based exercise program to increase muscle strength and improve balance did not significantly effect various falls risks variables, encouraging trends suggest this program may have positive effects on reducing falls in community-dwelling older adults.
TITLE: Effects of Animal Assisted Intervention for Individuals With Dementia
CURRENT SECTION: Geriatrics
AUTHORS: Kaitlyn Hollingshead, Annika Bustos, Yasser Salem, Howe Liu
Purpose/Hypothesis: Animal Assisted Intervention (AAI) is a treatment in which an animal is used therapeutically to improve quality of life, behavior and function. The purpose of this systematic review was to examine the evidence regarding the effects of AAI on individuals with dementia.
Number of Subjects: A total of 20 studies with 480 participants were analyzed.
Materials and Methods: Articles were compiled using the databases PubMed, CINAHL, Scopus, and PEDro. Two authors reviewed relevant literature and compiled a list of articles that were then sorted based on the predefined inclusion and exclusion criteria. Studies were included if they included adult patients with a diagnosis of any type of dementia and used AAI with dogs as the intervention. Articles were excluded if they were not available in English, used robots or stuffed animals, or utilized other types of animals for the intervention. Study characteristics, such as the amount and duration of interventions, and specific methodological criteria were analyzed.
Results: The initial search resulted in 306 articles. After screening for duplicates, 116 articles were identified. Following a review of titles, 83 articles were identified. 23 articles resulted after screening abstracts. These articles were further reviewed to ensure that the methods coincided with established inclusion criteria and resulted in 20 articles. Of the 20 articles, two were randomized control trials, five were quasi experimental, eight were pre-test/post-test, two were a cross-sectional studies, one was a retrospective design, one was a matched case control trial, and one was a case report. Participants age ranged from 63-99 years old. The sample size ranged from 1-80 participants. Duration of treatment was from three weeks to nine months, with a frequency of 5 times a week to every other week, and length of each session ranged from 15 minutes to 1 hour. A variety of animal assisted activities were used with a focus on improving quality of life, mood, behavior, cognitive state, and functional activities. Various outcome measures were used, both specific and non-specific to patients with dementia, to assess quality of life, mood, behavior, cognitive status and functional activities.
Conclusions: The evidence suggests that AAI may have a positive effect on quality of life, agitation and depression, social interaction and physical activity. Studies report that animal assisted therapy is a safe and enjoyable activity for patients with dementia, as long as candidates are screened for allergies and fear of animals. There was significant variability between studies regarding prescription of intervention, sample size and outcome measures.
Clinical Relevance: Currently available literature on AAI for patients with dementia suggest that there may be some benefit on quality of life, agitation, depression, social interaction, and physical activity. The lack of adverse outcomes and potential for improved well-being further supports AAI as a valid intervention for clinical practice. Additional research should include higher quality study designs and larger sample sizes.
TITLE: Application of the Otago Exercise/Fall Prevention Program in the Long Term Care Setting
CURRENT SECTION: Geriatrics
AUTHORS: Andrea Emese Ecsedy, Akshay Nitish Hudlikar, Christie B. Depner
Background and Purpose: The Otago Exercise Program (OEP) is endorsed by the Centers for Disease Control and Prevention (CDC) and is well established in the literature as reducing falls by at least 40 % in the community dwelling elderly.(1-7) To date, there is no literature describing the effects of the OEP applied in the Long Term Care (LTC) setting.
The purpose of this pilot was to apply the OEP in the LTCS for 6-12 months and assess its effect on fall frequency in participant's pre and post OEP implementation.
Case Description: Data from 11 LTC facilities was collected over a 12 month period. Participants were LTC residents who had sustained a fall and were selected for the pilot based on the OEP criteria and a patient's ability to participate in group activity.
Participants initially received individual Physical Therapy (PT) sessions and were moved into an OEP group when appropriate for group exercise. Groups were led by a Physical Therapist (PT) or Physical Therapy Assistant (PTA) who monitored patient progress and modified exercises as needed. Patients were reassessed every 30 days by the PT.
Maintaining fidelity and the prescriptive nature of the OEP was a priority. Progression of the program was based on a participant's performance on OEP's defined outcome measures. Mild modifications to the delivery of the OEP were made to meet the needs of the LTC population. Modifications included: delivery of exercise in a group format with the direction of a licensed PTA and the walking portion of the program to occur with assistance if needed.
Additional outcome measures monitored on the participants included: number of falls, 30 second Sit to Stand (30STS), gait velocity (GV), and 2 or 6 minute walk test (2MWT, 6MWT). Not all measures were monitored on all participants due to data collection preferences of some therapists. Falls experienced 6 months prior to starting OEP were compared to falls 6 months post initiation of OEP. A second 6 month period was also analyzed for participants who remained on program for 52 weeks.
Outcomes: Total participants N=63; Fall reduction rates comparing 6 months pre-OEP to 6 months post-OEP showed a 46% reduction at P=.04. 28% of participants completed the full 52 weeks in the program, N=18, this group showed a 76% reduction in falls at P=.02. Other measures analyzed included: TUG: N=61, 54% met a Minimum Detectable Change (MDC) for this measure. 30 STS: N=59, 47% improved, no MDC available for this measure. Gait velocity: N=35; 33% met MDC. 2 or 6 MWT: N=29, 66% met MDC for the measures.
Discussion: It was encouraging to observe that the reduction in falls in this population closely approximated those reported by OEP seen in community dwelling elderly. Weaknesses of this case study include: possible reporting error secondary to data collected from multiple sites and by several therapists, there was no formal control group. Each patient served as their own control utilizing fall rates for each individual pre and post OEP implementation.
TITLE: Mobility Matters: Health Promotion Outcomes With Diverse Fall Risk Elders After Health Literacy Randomized Intervention
CURRENT SECTION: Geriatrics
AUTHORS: Mary K Milidonis, Jane Groeneweg Keehan, Rebecca Deuley, Sara B. Formoso, Katie Montgomery, Karen Kopera- Frye
Purpose/Hypothesis: Older adults may have gaps in their health literacy due to communication barriers, cultural barriers and or limited health knowledge/experience. Mobility activities and education are important to live safely and independently for older adults. The purpose of this project is to evaluate the benefit of health literacy tools with a health promotion program for diverse older adults with mobility problems.
Number of Subjects: 16
Materials and Methods: Older adults with moderate fall risk and physician approval were recruited from community centers for a 3-month program where participants were paired with physical therapy students for pre- and post-intervention assessments. Sixteen participants (mean age =76, 69% African American, 94% female) were randomly assigned to a health literacy (HL) intervention group (n=9) and received teach back and ask me 3 tools, twice a month for three months. The control group (n=7) did not receive HL tools. Both the intervention and control group received the same health promotion that included MyMobility Plan, Otago balance exercises and walking program. The health promotion included individual health education with standardized materials in simple language and short sentences.
Results: Groups were not significantly different on age, gender, and REALM scores. Assessment measures included: timed up and go, 30 second chair rise, 4 stage balance test, 6-minute walk test and activity balance confidence scale (ABC). Paired t-test analysis revealed mean significant differences on the measures of four stage balance test (p=.008), 6-minute walk test (p=.026) and approached significance on ABC (p=.054).
Conclusions: No significant differences in outcome measures were found for the no health literacy tool group. The results suggest that health literacy tools may improve balance and endurance outcomes for diverse older adults.
Clinical Relevance: Health literacy tools and plain language materials are needed in physical therapy health promotion interventions with older adults. Health literacy gaps are known to be prevalent in older adults with chronic conditions. Use of teach back and ask me 3 tools may improve health outcomes in physical therapy.
TITLE: Impact of Resistance Training of Quality of Life in Individuals With Dementia: A Systematic Review
CURRENT SECTION: Geriatrics
AUTHORS: Mary Jansen, James Cameron McDermott, Mitchell Sharkey, Sangeetha Madhavan
Purpose/Hypothesis: Given the extensive literature on the benefits of resistance training (RT) in older adults, a systematic review was undertaken to explore whether participating in RT can lead to significant improvements in quality of life (QOL) and functional strength in patients with dementia. RT is defined as exercise targeting muscular strength, including weight training and the use of resistance bands.
Number of Subjects: 449 across six studies
Materials and Methods: Six randomized control trials (RCT) reviewing dementia in the context of RT were identified. Outcome measures in each RCT included QOL and muscular strength. QOL was defined in each article and measured using standard assessment tools, and strength was recorded as the change from baseline of the targeted muscle groups. Interventions ranged from progressive weight training to resistance band exercises performed 2 to 4 times a week for 2 to 12 months. The PEDro scale was used for quality assessment of each article.
Results: QOL was considered the primary outcome measure and muscular strength the secondary. All six studies analyzed reported similar results: significant differences were found in both QOL and muscular strength as a result of RT in patients with dementia. The specific QOL improvements included increased cadence and functional performance, as well as the improved ability to complete basic activities of daily living (ADLs). Also, three of the studies reported a slowed degradation of cognition and increased scores on the Mini-Mental State Examination (MMSE). Strength gains were seen only in large muscle groups in the upper and lower extremities.
Conclusions: RT is an effective method to improve the QOL of individuals with dementia. RT can also effectively increase muscular strength in this population. Also, the fact that a wide variety of RT protocols all yielded similar results indicates that any form of RT can be beneficial for individuals with dementia. It should also be noted that the inferences drawn in this review are not in complete agreement with previously published studies of the same subject matter. One review reported that RT is only beneficial when combined with other interventions, while another concluded that RT was an effective stand-alone intervention to improve QOL.
Clinical Relevance: Our systematic review demonstrates RT interventions can lead to QOL improvements for individuals with dementia. The implantation of RT into PT interventions will likely lead to improvements in cadence and mobility, functional capacity, and the ability to perform ADLs. These markers of QOL will be supplemented by strength gains and possibly even cognitive improvements. The manner in which RT is implemented is entirely dependent upon the current level of function and goals of each individual patient. A patient who is fairly independent in their ADLs would benefit from a progressive weight training program targeting the upper and lower extremities. However, a low intensity resistance band program would be more appropriate for a patient who relies on a caregiver.
TITLE: The Impact of Prescribed Walking on Dizziness in Seniors With Vestibular Hypofunction: Preliminary Findings
CURRENT SECTION: Geriatrics
AUTHORS: Amie Marie Flores Jasper, Mary Tischio Blackinton, Joann Gallichio, Anne K. Galgon
Purpose/Hypothesis: Dizziness, a common complaint among older adults, is associated with multiple falls, loss of function and independence, and reduced balance confidence. The Clinical Practice Guideline for Peripheral Vestibular Hypofunction5 recommends walking for endurance as a component of vestibular rehabilitation (VR), however, studies on VR in the older adults do not include walking in the intervention. The main purpose of this pilot study was to assess the feasibility of conducting a vestibular research in the outpatient rehabilitation setting; specifically, to determine recruitment, retention, and adherence rates of older adults with peripheral vestibular hypofunction to a prescribed walking program. Other purposes were to evaluate the impact of walking as an exercise component of VR on vestibular outcomes; and to determine whether pedometers increase the adherence of older adults with vestibular issues to a walking program.
Number of Subjects: 17
Materials and Methods: This pilot study utilized a pragmatic randomized experimental design. Seventeen patients who met the inclusion criteria were randomly assigned into Vestibular Rehabilitation with Walking with Pedometer (VRWP), Vestibular Rehabilitation with Walking without Pedometer (VRW) and Vestibular Rehabilitation (VR). All patients received one-hour VR sessions once or twice a week in the outpatient center and home instructions according to the patient's group assignment. Pre-post intervention measures were taken on the Dizziness Handicap Inventory (DHI), Dynamic Gait Index (DGI), Timed Up and Go (TUG) test, and Modified Clinical Test of Sensory Integration of Balance (mCTSIB). The International Physical Activity Questionnaire (IPAQ) was completed at pre-post intervention and four-weeks follow-up.
Results: The recruitment (59%), retention (79%), and adherence (moderate to high compliance in step recording and meeting step goals) met our feasibility criteria. Four patients dropped out. The DHI mean difference (20.60 points) for the walking group (effect size g=0.9) exceeded the Minimal Clinical Difference (MCD) (18 points). VRWP group showed an overall upward trend in the level of physical activity as represented by change in IPAQ scores from baseline to four-weeks follow-up.
Conclusions: In this pilot study, a prescribed walking program is feasible in the outpatient rehabilitation setting. To our knowledge, this is the first study that applied the interventions stated in the Clinical Guidelines for Peripheral Vestibular Hypofunction. Our preliminary findings showed that VR with a prescribed walking program had potential in creating clinically meaningful changes in the DHI compared to VR only. This study should be replicated as a multi-site main trial with an extended duration, and lowered age of eligibility.
Clinical Relevance: Physical therapists may consider using vestibular rehabilitation in combination with a prescribed walking program to achieve an optimal DHI outcome.
TITLE: Older Adult'S Preferences for a Physical Therapy Mobility Checkup
CURRENT SECTION: Geriatrics
AUTHORS: Dalerie J. Lieberz, Alexandra L. Borstad, Lindsey Michelle Ewings, Abby M. Schultz, Korina Klaysmat, Rachel Sowers
Purpose/Hypothesis: We conducted a Discrete Choice Experiment (DCE) to determine the preferences of older adults for a new, preventative model of care called a mobility checkup. A mobility checkup includes a series of common, valid and reliable measures of mobility including functional transitions, fall risk, walking speed and endurance. Age related norms enable individualized education related to mobility disability.
Number of Subjects: 31 adults ranging in age from 55 to 93 years (M = 73.2 years, SD = 12.1) participated in this study. All participants were able to walk with or without an assistive device. A sample of convenience from multiple sites within one community was used. 83% were female, 74% lived alone, and 45% had a 2 year college degree or higher.
Materials and Methods: Qualtrics was used to collect demographic information and responses for a DCE during a face to face interview with participants. All participants attended a 30-45 minute face to face session. Participants received education describing a mobility checkup and its purpose in the form of a 2 minute video. For the DCE they chose between 2 options for 12 hypothetical choice pairs, each having different levels of four attributes of interest: cost, visit duration, education content, and education visual format. Participants chose the most desirable profile in each set. Parameter estimates, which represent consumer satisfaction, were calculated based on Firth bias-corrected maximum likelihood estimators. Statistical significance was based on False Discovery Rate p-value for each model effect which controls for multiple tests. Alpha was set at p < 0.05. Analyses were conducted in JMP 13.2.0.
Results: 96% indicated that they would participate in a mobility checkup if available. The cost of a mobility checkup was the most important attribute, participants preferred no out of pocket cost (Parameter estimate = 1.38, SD = 0.15, p < 0.001). Participants preferred a 30 minute session with education concerning their fall risk over other areas. Participants also preferred their results in the form of a colored bar graph.
Conclusions: DCEs are a practical method to identify consumer preferences for physical therapy care. The concept of a mobility checkup was well received and participants preferred $0 out of pocket cost. All attributes significantly contributed to the model, but a larger sample size is needed to understand how meaningful the difference is between the levels of the other attributes.
Clinical Relevance: An opportunity exists for physical therapists to educate older adults on the importance of mobility for overall health and provide individualized care which should improve health and quality of life for older adults.
TITLE: Development of a Reference Chart for Monitoring Quadriceps Strength Recovery After Knee Arthroplasty
CURRENT SECTION: Geriatrics
AUTHORS: Jeremy Graber, Andrew John Kittelson, Michael John Bade, Elizabeth Juarez-Colunga, Charles Alden Thigpen, Dawn Ann Waugh, Jennifer Elaine Stevens-Lapsley
Purpose/Hypothesis: Quadriceps weakness is among the most pronounced and debilitating impairments that occurs following total knee arthroplasty (TKA).1-5 Handheld dynamometry (HHD) is a reliable and feasible method for measuring quadriceps strength in TKA rehabilitation.6,7 However, there are no established benchmarks to guide clinical monitoring of quadriceps strength using HHD, thus impeding clinicians' ability to determine whether a patient's strength is recovering as expected. The purpose of this study was to create a reference chart for normative quadriceps strength recovery following TKA, to serve as a tool for monitoring progress during postoperative rehabilitation.
Number of Subjects: This analysis used a combination of research and clinical data, collected between January 2014 and October 2018. A total of 670 patient records (59% female, mean age = 66 years) with 1358 strength observations were available for chart development.
Materials and Methods: Quadriceps strength (in pounds) was assessed regularly over the first six postoperative months using a reliable HHD technique.7 Reference charts were developed separately for males and females using Generalized Additive Models for Location Scale and Shape (R statistical computing).8 Population centiles were calculated at each postoperative timepoint from one week to six months after surgery. Since the dataset included multiple observations per patient, we performed a sensitivity analysis by comparing these results to reference charts developed with a reduced dataset (one observation per patient).
Results: Both males and females demonstrated rapid improvements in quadriceps strength following surgery. The median prediction for female strength increased from 9.2 to 38.2 pounds over the first six postoperative months. The 10th percentile improved from 3.0 to 22.7 pounds and the 90th percentile from 18.3 to 55.6 pounds. The median prediction for males increased from 11.2 to 56.0 pounds. The 10th percentile improved from 3.0 pounds to 37.1 pounds and the 90th percentile from 23.4 to 80.3 pounds. Our sensitivity analysis suggested the reference charts were robust to the inclusion of repeated measures; the mean difference between the full and reduced models was 1.1 pounds for females and 0.8 pounds for males.
Conclusions: These reference charts describe quadriceps strength recovery for males and females for the first six months after TKA surgery.
Clinical Relevance: The reference charts developed in this analysis may be used as tools to augment clinical monitoring of quadriceps strength after TKA surgery. Patients demonstrating suboptimal quadriceps strength recovery may be more quickly identified, providing clinicians with the opportunity to adjust treatment strategies accordingly. Additionally, these charts may increase the value of HHD for goal setting and plan of care decision making throughout TKA rehabilitation.
TITLE: Relationship Between Rate of Change in Cognition and Fall-Risk Following Group Exercise in Older Adults
CURRENT SECTION: Geriatrics
AUTHORS: Stephen John Carp, Paige M. Brooks, Andrew Stephen Check, Kayla Victoria Rush, Kaelyn Marie Storr, Jakob Todd Stoudt
Purpose/Hypothesis: The aim of this study is to elucidate the relationship between rate of change in cognition and rate of change in fall risk in persons identified as fall risk who are participating in an evidence-based fall risk remediation group exercise program.
Number of Subjects: A quasi-experimental design study was conducted at three facilities: an independent living retirement home for religious, an independent living retirement home and skilled nursing facility for retired religious, and a large adult activity center. This study included 50 exercise participants and 20 control participants.
Materials and Methods: Participants identified as fall risk received a 10-week evidence-based fall risk remediation group exercise program. Pre- and post-intervention data were collected for the following: Timed Up and Go (TUG), gait speed, Montreal Cognitive Assessment (MoCA), and Activities-Specific Based Confidence Scale (ABC). Statistical analysis determined the change between pre- and post-intervention measures, and further analyses determined if there was a predictable relationship between the rate of change of the variables.
Results: Dependent t-tests were used to determine significance of change in cognition as measured by the MoCA (t=-12.164, p<0.001) and fall risk as measured by gait speed (t=-13.429, p<0.001), TUG (t=8.794, p<0.001), and ABC (t=-31.106, p<0.001) over the span of the 10-week exercise intervention. Pearson product moment correlations were used to determine the relationships between change in MoCA and each of the following: change in gait speed (r=-0.169, p=0.178), change in TUG (r=-0.253, p=0.042), and change in ABC (r=-0.008, p=0.953). A simple linear regression equation was found significant (F(1,63) = 4.324, p= 0.042) with an R2 of 0.064. Participants' improvement was able to be predicted as follows: TUG score = −0.747 + −0.132 * (MoCA score).
Conclusions: The TUG was the only fall risk variable found to significantly correlate with the MoCA. Participants' change in TUG score improved 0.132 seconds for every point of improvement on the MoCA.
Clinical Relevance: This evidence shows that there is a predictable relationship between change in fall risk and change in cognition associated with a 10-week evidence-based fall risk remediation exercise program in persons identified as fall risk. Though the relationship is weak between change in TUG score and change in MoCA, there is evidence that such a relationship exists and is grounds for further research.
TITLE: Strategies to Reduce Hip Force of Impact From Falls in Older Adults: A Scoping Review
CURRENT SECTION: Geriatrics
AUTHORS: Stacey Lynn Zeigler, Stephanie Noelle McMikle, Marissa Dawn DeAngelo
Purpose/Hypothesis: Falls from a standing height are the most common mechanisms of injury for the older adult population with hip fracture from fall being a leading cause of morbidity and mortality. Efforts to reduce the incidence of hip fracture in this population has evolved to focus on three prevention areas including falls, fragility, and force of impact. While fall and bone fragility prevention strategies have demonstrated success, studies have failed to show actual fracture reduction in elderly who do take a fall. Reducing the force of impact when a fall does occur has been suggested as the most significant strategy to combat fracture but has the least amount of practical and evidence-based strategies to date. The purpose of this scoping review was to determine the most effective strategies in impact reduction to prevent hip fracture from falls in older adults toward evidence-based decisions for clinical recommendations.
Number of Subjects: Not applicable
Materials and Methods: A scoping review was chosen to address the exploratory research question to map key concepts and determine types of evidence available. The Arksey and O'Malley framework with Levac enhancement was utilized for methodological guidance in the process. Key concepts and available evidence were discovered using Google Scholar, PubMed, and Web of Science databases. Three researchers collaborated to determine inclusion and exclusion criteria for the ultimate analysis and synthesis of data.
Results: Four strategies for decreasing the force of impact to prevent fracture emerged quickly via Google Scholar search of ‘fracture prevention, impact force, hi’ (3,671 entries) including wearable hip protectors, teaching fall techniques to reduce injury, energy damping floor mats, and air bag devices. Force attenuation capacity of hip protectors varies widely (2.4-89.4%) by available products and by experimental testing approach. Individuals can be taught to fall in ways that reduce hip impact force by 8-28% however the study methods are safety restricted to measuring planned falls from a kneeling position on padded surfaces, much unlike actual fall presentation. Limited studies of energy damping floor mat effectiveness reveal reduction in hip force of impact between 18.4-47.2%. Impact reduction capacity of airbag devices in falling has not been sufficiently studied.
Conclusions: This scoping review reveals four primary strategies for reduction of force of impact to the hip from a fall. Of these strategies, hip protectors have the greatest amount of evidence and demonstrated effectiveness with the most promising ongoing product development to enhance usability. This information is vital for physical therapists to consider when making recommendations to reduce the potential of hip fracture from an older adult fall.
Clinical Relevance: Physical therapists (PT) are well-versed to initiate and direct successful programs for fall and bone fragility prevention strategies with the new opportunity to put force of impact reduction strategies in practice. Results of this scoping review inform the PT of the available evidence to select and implement effective hip impact reducing strategies for older adults.
TITLE: Falling Behind in Fall Prevention: Using Virtual Fall Risk Screenings to Reach Homebound Older Adults
CURRENT SECTION: Geriatrics
AUTHORS: Sara James Migliarese, Alison Page Hartman, LaVerene Marie Garner, Nancy Schneider Smith, Christina May Criminger, Cynthia Bell, Megan Edwards-Collins
Purpose/Hypothesis: With older adults compelled to stay indoors and practice social isolation during the Covid-19 pandemic, their ability to access evidence-based fall risk screening and fall prevention programming has essentially disappeared. Social distancing and closure of much needed community resources have left older adults at risk for decreased mobility, loss of social interaction, increased frailty, and a potential increase in risk for falls. One potential and timely solution to this problem involves bringing virtual fall risk screenings to older adults as they shelter at home. The purpose of this study was to pilot the provision of multi-disciplinary virtual evidence-based fall screening for older adults sheltering at home.
Number of Subjects: 76 community dwelling adults responded to recruitment through word of mouth and online flyers. 43 completed screenings (43.4% attrition).
Materials and Methods: Participants who signed up to participate in the virtual screenings received an email with specific instructions and videos of what to expect the day of the screens. Zoom (HIPAA compliant version) was used as the platform for participants to be screened in individual video-breakout rooms. Licensed OT and PT faculty and doctor of physical therapy students (SDPT) performed the screens and followed a specific script and algorithm to maximize safety for each participant in their home environment. The algorithm consisted of four yes or no questions followed by either proceeding to physical testing, including the 30 second sit-to-stand (STS) and Timed-Up-and-Go (TUG), or patient education based on the participants' needs. Those that were considered too high-risk to perform physical tests based on either the four subjective fall risk questions, their current environment, or lack of ability to connect through zoom technology were only provided patient education specific to their level of function. Each participant received a follow up email within 3 days for more specific information and links to virtual community programs most appropriate for them.
Results: 43 participants (avg age 70.61 yrs, 39.5 % with recent fall history) were screened over 3, hour-long sessions, without safety incident. 25 were assessed as appropriate for a virtual Otago fall prevention class and 12 agreed to participate. Nine were considered too frail to attempt virtual exercise, while 9 performed at a high physical level and were instructed to continue their level of physical activity.
Conclusions: Virtual fall risk screening is safe and effective for determining fall prevention interventions. The utilization of evidence-based assessments in an algorithm is crucial for maintaining a safe testing environment and appropriate referrals.
Clinical Relevance: Older adults responded positively to participation in online fall screens. Participants managed technology requirements and safely performed evidenced-based assessments in their home without hands-on supervision. Fall risk screening could be encouraged as a component of telehealth for older adults and may have the potential to decrease falls.
TITLE: Functional and Disability Differences of Patients With T2DM and Knee OA per ICF Core Sets
CURRENT SECTION: Geriatrics
AUTHORS: Anna Maria Ng, Chelsea R Vasquez, Elaine Gattenby, Melanie Hummert, Annalisa Na, Steven Ross Fisher, Mary Kent Hastings
Purpose/Hypothesis: Approximately 52% of adults with type 2 diabetes mellitus (T2DM) experience osteoarthritis (OA). Together, T2DM and OA can have interacting pathophysiology that exacerbate functional disabilities. For example, advanced glycation end products from T2DM can accelerate joint degeneration, while OA pain can preclude the physical activity necessary for glucose control. Recognizing the functional consequences of these conditions, the World Health Organization developed individual International Classification of Functioning, Disability and Health (ICF) core sets for OA and for T2DM. Both conditions share underlying ICF constructs and overlapping comorbidities. To date, ICF core set have only been applied to individual diseases and not comorbidities. Identifying shared constructs across core sets for T2DM and knee OA could be helpful for highlighting key functional factors unique to this common patient presentation. The purpose of this study was to use the ICF T2DM and knee OA core sets to identify constructs that are meaningful to those with knee OA and T2DM versus knee OA alone.
Number of Subjects: N=19 (T2DM=11, mean age=70.7 years; no T2DM=8, mean age=61.1, Female=57.9%). Criteria included 1) aged 50-80; 2) English speaking; 3) lived in the community; 4)knee OA, 5) with or without T2DM.
Materials and Methods: Sociodemographic data and self-reported measures were mapped to shared constructs of pre-established ICF domains. Body functions and structure included the Short Form Health Survey (SF-36), Knee Osteoarthritis Outcomes Survey (KOOS) Pain and Other, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain and Stiffness, and the Pittsburgh Sleep Quality Index (PSQI). Activities included Patient Specific Functional Scale (PSFS), SF-36 Function; KOOS Activities of Daily Living and sports and WOMAC function. The Participation domain included the SF-36 social and KOOS quality of life. The SF-36 Physical health and emotional problems were considered as mixed. Group differences were examined with Student's t-test or nonparametric equivalent.
Results: The SF-36 Emotional subscale (p=0.03) was significantly worse for T2DM than the non-T2DM group, while sleep as assessed on the PSQI sleep quality subscale (p=0.03) was significantly worse for non-T2DM. All other Body Functions and Structures, Activity, Participation, and Environmental/Personal ICF outcomes were not significant.
Conclusions: Emotional functions, energy and drive functions are shared constructs for the body function domain and appeared to be worse for those with T2DM and OA versus OA alone. Unexpectedly, the non-T2DM group self-reported worse sleep quality than the T2DM group. While sleep is a shared construct for the comorbidities, sleep was worse for those without DM than with DM, which warrants future studies to confirm and explore.
Clinical Relevance: Although psychosocial factors are not often prioritized in physical therapy, clinicians should consider them when designing treatment plans for those with OA and T2DM. This may lessen the risk of other health problems, improve motivation, and strengthen coping skills for successful recovery and better physical health.
TITLE: Perspectives on Physical Activity and Identity From Black Older Adults
CURRENT SECTION: Geriatrics
AUTHORS: Talina S. M. Corvus
Background and Purpose: Physical inactivity is a significant contributor to loss of function, disability, and premature death in older adults. As PTs engage in initiatives to promote physical activity (PA), working towards our vision of transforming society, there is value in recognizing that our society is more diverse than the models we have to understand it. Current theoretical frameworks for PA motivation and maintenance, such as Identity Theory or Social Determination Theory, were founded in the perspectives of primarily younger White study populations but many of the groups targeted for PA promotion are older and/or racial and ethnic minorities. The purpose of this qualitative study was to explore the ways in which Black older adults conceptualize PA and orient their identities in relationship to these activities with the goal of improving the cultural relevance of PA promotion in African American communities.
Case Description: This exploratory qualitative case study used semi-structured interviews to examine the perspectives of six active Black older adults. Participants in this study represent a subset from a larger study examining physical activity identity (PAI) and physical PA engagement among BOAs. This case study group included individuals who demonstrated both high levels of moderate to vigorous PA and high strength of PAI, as assessed using the modified Exercise Identity Scale. Participants were aged 60 and over, community dwelling, self-identified as Black or African American, and lacked cognitive, physiological, or musculoskeletal conditions that limit PA participation. Individuals participated in a 30-60min interview exploring their personal identities as they relate to being active, their history of PA, their beliefs about the value of PA, and their perspectives on the role of race in their PA participation, as well as PA promotion, broadly. Data from interviews, along with journal entries completed in the previous study, were taken through a thematic content analysis by two separate reviewers. Outcomes were then reconciled for common concepts and themes.
Outcomes: Findings from this study addressed three distinct areas of PA engagement as it relates to how BOAs in this case conceptualized their internalized relationship to PA and exercise. Emergent themes fed into describing how individuals began being active (in childhood), how they conceptualize PA (as more than just exercise), and what has kept them active throughout their lifetimes (community and identity congruence). Three themes wove through all areas: freedom, connectivity, and resiliency. While many of these themes are present in current models, they were conceptualized differently by this BOA sample.
Discussion: As physical therapists strive to be more effective agents for PA promotion, it is important that we have an understanding of the ways in which the communities we serve perceive and relate to PA. This research serves to enrich our conceptual understanding of how older adults build relationships with healthy physical activities in ways that are intrinsic, relevant, and sustainable.
TITLE: Traditional Versus Functional Strength Training in Community-Dwelling Older Adults: A Systematic Review
CURRENT SECTION: Geriatrics
AUTHORS: Sherry Teer Colson, Savanna Smith, Joshua Eargle, Kyle Graham, Matthew Scott Lawalin
Purpose/Hypothesis: Normal physiological changes with aging lead to a decline in muscle strength. Prior research has shown resistive exercise improves muscle strength in the elderly. Traditional exercise training uses high intensity/low velocity exercise such as weights and machines. Functional training uses multiplane resistive tasks that simulate activities of daily living. There is currently a lack of literature comparing functional strength training versus traditional strength training and their effects on strength outcomes in community-dwelling older adults. The purpose of the review was to determine whether functional training or traditional training in community dwelling older adults produces greater strength gains.
Number of Subjects: 523 total participants from five studies aged greater than 60.
Materials and Methods: Two online databases, PubMed and Embase, were searched on November 11, 2019. Inclusion criteria applied: 1) experimental studies of any type; 2) participants who were community dwelling men or women, aged 60+ years; 3) studies compared traditional strength training to functional training; and 4) studies measured strength outcomes. 130 articles were identified through initial search. Title screen, abstract screen, and full text review was conducted resulting in 5 studies selected. Risk of bias was assessed using the PEDro scale and ranged from 5 to 7 indicating moderate to high quality studies.
Results: Five out of five studies showed no statistical significance between functional and traditional training (p-values ranging from 0.05-1.00) using the majority of the strength outcome measures. Common outcome measures utilized between the studies include chest press, leg press, bench press, manual muscle testing, and hand grip strength. It should be noted that isolated outcome measures may favor traditional over functional exercises or functional over traditional but there were no consistent differences. However, both functional and traditional strength training groups showed significant improvements in strength compared to the control groups alone.
Conclusions: Functional training and traditional training are equally effective in improving strength outcomes in community-dwelling older adults.
Clinical Relevance: The findings are clinically important in deciding the approach used for therapeutic strengthening for the geriatric population. Both traditional strengthening and functional strengthening are effective in producing strength gains. Therefore, physical therapists can create a plan specific to patient preference when determining and selecting effective interventions. Limitations of this review include some comparable data were not reported and/or could not be calculated.
TITLE: Effects of Seated Vibration Training on Dynamic Postural Control and Power in Healthy Young Adults
CURRENT SECTION: Geriatrics
AUTHORS: Kanikkai Steni Balan Sackiriyas, Ashley Hope Butalla, Carly Volp, Trace Alexander Von Bruenchenhein, Matthew Weinhold, Kirstin Teresa Klemp
Purpose/Hypothesis: Training that involves the application of mechanical vibration to the lower extremities has been shown to improve postural control and lower extremity power in both healthy individuals and those with movement-related disorders. However, previous training protocols have typically required participants to stand while vibration is administered, which is not possible for some individuals. Seated vibration training may be a feasible alternative in some instances; however, the effects of seated vibration training on dynamic postural control and lower extremity power has not been examined. Therefore, the purpose of this study was to examine the effects of seated vibration training on dynamic postural control and lower extremity power in a group of relatively young, healthy individuals, with no known movement-related disorders. We hypothesized that dynamic postural control and lower extremity power would improve following the completion of a 4-week seated vibration training protocol.
Number of Subjects: 16 (10 females, 6 males), 21 to 34 years of age.
Materials and Methods: Participants performed a seated leg press protocol while receiving vibration to their bare feet for 10 minutes, twice a week, for 4 weeks (8 total sessions). Average sway velocity and maximum sway excursion were measured in the forward, backward, right, and left directions at baseline (pre) and after the 4-week training period (post), using a computerized dynamic posturography system, to assess dynamic postural control. Faster sway velocity and greater sway excursion are believed to reflect better dynamic postural control. In addition, peak lower extremity power during a maximal vertical jump was measured pre- and post-training using a force platform. Two-way ANOVA with within-factors of direction (forward, backward, right, left) and time (pre, post) were conducted to analyze sway velocity and sway excursion. A paired t-test was used to compare lower extremity power (post vs. pre). Alpha was set to .05.
Results: There were no direction-by-time interaction effects for sway velocity or sway excursion (p≥.361); however, there were main effects of time for the sway velocity (p=.049) and sway excursion (p=.016) measures. Sway velocity increased by 45.6% in the forward direction, 26.9% in the backward direction, 10.0% in the right direction, and 3.2% in the left direction following the training period. Sway excursion increased by 3.2% in the forward direction, 0.9% in the backward direction, 8.1% in the right direction, and 10.4% in the left direction following training. In addition, peak lower extremity power also increased by 2.3% following training (p=.011).
Conclusions: Four weeks of seated vibration training appeared to promote improved dynamic postural control (faster sway velocities and greater sway excursion) in all directions and greater lower extremity power during jumping in a cohort of healthy participants.
Clinical Relevance: Our study provides preliminary evidence to suggest that seated mechanical vibration training may be a viable alternative to standing mechanical vibration training, for promoting improvements in dynamic postural control and lower extremity power.
TITLE: Altering Somatosensory Input Via Different Footwear to Improve Walking in People With Chronic Post-Stroke Hemiparesis
CURRENT SECTION: Geriatrics
AUTHORS: Jing Nong Liang, Kai-Yu Ho, Jynelle Marie Arches, Megan Leigh Keohane, Wee Jin Jed Lee, Aaron Abraham Simon
Purpose/Hypothesis: Stroke is a leading cause of disability that results in various neurological deficits. One deficit impaired somatosensory input, which results in decreased balance and gait speed, ultimately increasing fall risks. Therapies targeting increased somatosensory input have been shown to be beneficial in stroke as well as other neurological populations. However, few studies have systematically investigated effects of varying somatosensory input via different footwear to improve walking in people post-stroke. The purpose of this study was to investigate the effects of altering somatosensory input via different types of footwear (i.e., barefoot, self-selected shoes, and soft shoes) on gait kinetics and ankle kinematics during gait in individuals with chronic post-stroke hemiparesis. We hypothesized that increased somatosensory input via barefoot walking would improve paretic propulsive force and improve paretic ankle kinematics.
Number of Subjects: 9 individuals post-stroke (62.9±11.2 years old; 5.9±4.4 years post-stroke) and 5 non-neurologically impaired (53.4±17.0 years old) individuals.
Materials and Methods: Reflective markers were placed over lower extremities landmarks, and surface electromyography sensors over ankle muscles. Participants then walked over a dual belt instrumented treadmill for 5 minutes, under self-selected walking speed, wearing self-selected shoes. Consequently, trials were conducted in barefoot and soft-sole shoes conditions, with the order randomly assigned. Peak propulsive force, peak braking force, peak plantarflexion angle at push-off, and peak dorsiflexion angle during swing phase were assessed using a 3 (Limbs: paretic, non-paretic, and non-impaired) × 3 (Shoes: self-selected footwear, soft-sole shoes, and barefoot) mixed factorial ANOVA. A priori significance was set at p<0.05.
Results: Statistically significant main effect of Shoes was observed for ankle angle at toe off (p<0.01), suggesting that regardless of limb, wearing self-selected shoes presented with greater plantarflexion at toe off, whereas wearing soft-sole shoes presented with increased dorsiflexion at toe off. Statistically significant main effect of Shoes was observed for peak dorsiflexion during swing (p<0.01), indicating regardless of limb, wearing soft-sole shoes exhibited more dorsiflexion during swing than self-selected shoes. Additionally, statistically significant interaction was observed for Shoes × Limb for peak propulsive force (p=0.04). Simple effects revealed that in non-impaired legs, greater propulsive forces were generated when wearing self-selected shoes compared to soft-sole or barefoot.
Conclusions: Our results suggest soft-sole shoes can encourage paretic ankle dorsiflexion during swing phase of gait, which can potentially be used to address foot-drop in post-stroke gait training. If the goal of gait training was to target propulsive force to increase walking speed, then soft sole shoes or barefoot is not recommended.
Clinical Relevance: Findings can help inform clinicians on appropriate footwear recommendations to ensure safety for community ambulation, and may be incorporated into gait training paradigms in rehabilitation.
TITLE: Post-Operative Total Knee Arthroplasty Rehabilitation Following Preoperative Cryothermal Analgesia for Improved Pain Control
CURRENT SECTION: Geriatrics
AUTHORS: Julia Patterson, Jennifer Cruse, Robert Scott Van Zant
Background and Purpose: Post-operative pain can be a significant limitation to patient recovery and function following total knee arthroplasty (TKA). This can lead to excessive reliance on opiate pain medication both acutely and chronically following surgery. Cryothermal analgesia involves cryoneurolysis of the sensory nerves of the knee joint in the weeks prior to TKA, and offers a possible solution for improving post-operative pain control while reducing post-surgical use of opioids. The purpose of this retrospective case report was to describe the recovery of a patient who underwent pre-operative cryothermal analgesia prior to TKA.
Case Description: The patient was a 73-year-old female patient who had significant end stage osteoarthritis of the left (L) knee that had failed conservative management. One month prior to surgery she underwent outpatient cryothermal analgesia targeting the L anterior femoral cutaneous nerve and the infrapatellar branch of the saphenous nerve. The patient was discharged to her home within 24 hours post-TKA, reporting minimal (3/10) post-operative pain. Subsequent outpatient physical therapy examination results included: L active ROM 10-100°, L knee strength grossly 4/5, knee outcome survey (KOS) 53/80. She underwent 13 outpatient treatment sessions over 6.5 weeks with a focus on pain and edema management while increasing ROM, strength, and lower extremity function.
Outcomes: Under cyrothermal analgesia protocol the patient met hospital discharge goals for gait and safe return to home environment in < 24 hours with pain levels rated at <3/10. She progressed well in outpatient treatment with excellent pain control throughout. By two weeks of outpatient treatment she consistently reported her pain as 0/10, and never higher than 2/10. She was able to discontinue all use of opioid pain medications by her third week post-operative, managing any pain with periodic use of over the counter ibuprofen. At discharge, L knee active ROM was 8 to 122°, L knee strength was grossly 5/5, and KOS was 65/80. The patient's 6- minute walk distance was 394 meters (97% of age norm). She reported little or no pain and was able to complete all activities of daily living without issue.
Discussion: The results of this case report demonstrate successful functional rehabilitation following TKA with pre-operative cryothermal analgesia. The patient met all treatment goals with effective pain control (rated <2/10) without use of opioid medications from her third week post-surgery. The case supports evidence that cryothermal analgesia can be effective for managing post-operative pain throughout the rehabilitation process and may lead to shortened hospital stays and improved patient tolerance to rehabilitation.
TITLE: Lifestyle Habits and Comorbidities As Predictors of Falls in Community-Dwelling Older Adults
CURRENT SECTION: Geriatrics
AUTHORS: Evan V. Papa, Jacob Gibson, Sophia Marie Garrett
Purpose/Hypothesis: Falls among older adults have far reaching effects, including personal injury and loss of independence. In 2014, over one third of older adults who fell within the previous 12 months experienced a decrease in physical function.1 According to the Centers for Disease Control and Prevention (CDC), the number of falls and deaths due to falls in older adults has been increasing in recent years.2 Over half of older adults who are hospitalized due to a fall are subsequently placed in a nursing facility.3 Estimated medical costs due to falls totaled $50 billion in 2015.4 Identifying risk factors leading to falls in older adults will allow healthcare providers to provide appropriate interventions, which will mitigate the physical, emotional, and economic burdens associated with falls. The purpose of this study was to determine which sociodemographic, behavioral, and physiologic conditions can be used to predict falls in community-dwelling older adults.
Number of Subjects: 153,236
Materials and Methods: Data were collected from individuals aged 65 years or older in the United States who responded to the 2016 Behavioral Risk Factor Surveillance System (BRFSS) survey. The BRFSS is a cross-sectional telephone survey conducted by the Center for Health Statistics with technical and methodological assistance provided by the CDC.
Results: A multiple regression was run to predict fall incidence from various sociodemographic factors including sex, race, ethnicity, state of residence, marital status, income, education, BMI, as well as behavioral and physiological conditions including physical activity, heart attack, stroke, COPD, and diabetes. The multiple regression model statistically significantly predicted falls F(16, 153219) = 203.126, p < .000, adj. R2 = 0.021. Thirteen variables added statistically significantly to the prediction, p < .05. Married females with an income greater than $75,000/yr and a high school education were less likely to experience at least one fall. Individuals with serious difficulty walking or climbing stairs were 1.11 times more likely to fall. Previous or current medical conditions resulted in 35-83% increased likelihood of falling.
Conclusions: Sex, marital status, income, education, physical activity are independent fall predictors in community-dwelling older adults. Consistent with prior studies, previous or current medical conditions such as coronary artery disease, stroke, and diabetes are also predictive of falls.5 Falls however, are multifactorial; no single measure is an accurate diagnostic tool. Further research is needed to determine causal factors of falls in these areas.
Clinical Relevance: Physical therapists play a vital role in the education and treatment of persons at risk for injuries due to falls. Most of the variables examined in this study were positively correlated with increased risk of experiencing a fall. As such, it is imperative that physical therapists increase their awareness of these risk factors and learn strategies to intervene on modifiable risk factors to appropriately manage and prevent falls.
TITLE: Identity and Function: Correlates Between Concept of Self and Gait Speed in Black Older Adults
CURRENT SECTION: Geriatrics
AUTHORS: Talina S. M. Corvus
Purpose/Hypothesis: Identity plays a significant role in shaping physical activity motivation and behavior in older adults. Research shows that individuals with identities strongly linked to exercise and physical activity participate in higher volumes and intensity of activity. Similarly, individuals who increase their engagement in physical activity have been shown to demonstrate an increase in their strength of exercise identity. Whether that activity participation, or sense of self, also yields improved physical function, however, has not been tested. Likewise, there is little research regarding correlates to physical function that focus on African Americans. The purpose of this study was to examine the relationship between identity and physical function in a Black older adult sample.
Number of Subjects: Thirty community-dwelling older adults were included in this study. All participants were age 60 and over, self-identified as Black or African American, and resided in the Pacific Northwest.
Materials and Methods: This study utilized the modified Exercise Identity Scale (mEIS) as a measure of Physical Activity Identity, and three physical function tests; gait speed, grip strength, and the Five Times Sit to Stand Test (5xSTS). All function tests have validated norms for age and are used to determine functional capacity, independence, and frailty risk.
Results: Outcomes of independent T-tests showed a significant correlation (p=.001) between mEIS scores and meeting age and sex matched norms for gait speed (t=3.652) but not grip strength or 5×STS. The correlation between mEIS score and gait speed performance was present in the absence of a correlation between performance and physical activity volume (t=1.80, p=.081).
Conclusions: This study demonstrates that identity may play a meaningful role in physical function performance among community dwelling older adults.
Clinical Relevance: New insights into the role of identity in function introduces novel utility for leveraging identity models in motivating and supporting older adults through exercise prescriptions designed to improve functional outcomes. This study also demonstrates how identity can be positioned within the International Classification of Functioning, Disability, and Health model, linking personal and environmental factors to activity and participation. This work shows that identity can be a meaningful tool for physical therapists promoting physical activity for the purpose of increasing functional independence among a globally aging population.
TITLE: Step Test Evaluation of Performance on Stairs (STEPS): Assessing Stair Safety in Older Adults
CURRENT SECTION: Geriatrics
AUTHORS: Deb A. Kegelmeyer
Purpose/Hypothesis: Older adults exhibit progressive deficits in strength, motor control, cognition, perception, and sensation. These deficits lead to difficulty negotiating stairs, with resultant falls. Currently, clinicians lack a tool to identify underlying impairments to guide their treatment plans to improve stair negotiation and safety. The Step Test Evaluation of Performance on Stairs (STEPS) is a quick and easily administered stair assessment that has been validated in the Huntington's disease population. This study investigated the psychometric properties of the STEPS tool to determine its usefulness in older adults.
Study aims were to determine the intrarater reliability of the STEPS tool and its concurrent content validity to clinical functional and mobility measures in older adults.
Number of Subjects: Fifty-one older adults >65 years participated (mean [SD]: 84.7 [7.2] years) and were mostly female (66%).
Materials and Methods: Participants were rated on their performance on the STEPS tool by a licensed physical therapist on two separate days to determine intrarater reliability. Participants performed the Five Times Sit to Stand (5xSTS) and Timed Up and Go (TUG) tests on their initial visit to determine concurrent content validity across measures.
Results: The STEPS tool demonstrated excellent intrarater reliability (ICC=0.90; 95% CI= 0.83, 0.95). Better STEPS scores correlated with better performance on the 5×STS (rs =-0.57; 95%CI= −0.73, −0.34; p<.001) and TUG (rs −0.59; 95%CI= −0.74,-0.37; p<.001). Common items which participants demonstrated deficits were foot placement (21.6%), and use of handrails on ascent (51%), and descent (53%).
Conclusions: The STEPS tool is an efficient and simple tool that can be administered in under 5 minutes. In older adults, it shows excellent intrarater reliability and good concurrent validity with measures of functional lower extremity strength (5xSTS) and functional mobility (TUG). Future studies are needed with larger sample sizes to determine whether STEPS scores can predict falls on stairs in older adults.
Clinical Relevance: The STEPS tool may assist clinicians in determining targeted interventions to improve stair performance.
TITLE: High Intensity Walking Reduces Frailty Among Older Adults Living With HIV
CURRENT SECTION: Geriatrics
AUTHORS: Margaret K. Danilovich, Andrea Dean, Erin Hardiman, Erin Gentile, Brandon St. Peters, Prisco Sawal Sinfuego, Daniel Montie Corcos
Purpose/Hypothesis: Due to the improvements in anti-retroviral drugs, HIV has become a geriatric chronic condition. There is limited evidence on interventions for this population, but physical activity has consistent positive outcomes. Data in other populations suggests a dose-response relationship whereby higher intensity interventions lead to better health outcomes. However, there is little research on this relationship for older adults living with HIV. The purpose of this study was to determine the feasibility and preliminary efficacy of high intensity walking for older adults living with HIV.
Number of Subjects: n=12
Materials and Methods: We recruited participants from infectious disease physicians for a single group pretest/posttest study. Included participants were over 50 years old, pre-frail/frail on SHARE-FI or a SPPB of less than 10, and no other exercise contraindications. Participants completed 16 sessions consisting of 5 minute walking interval tasks: (warm-up, stair climbing, fast, weighted, balance, weight, step-ups, cool-down) at 70-80% heart rate max. During each interval, we measured heart rate, rating of perceived exertion, and affect using The Feeling Scale. At the beginning and end of the intervention, we assessed the SHARE-FI (Frailty), Short Physical Performance Battery (SPPB), Timed Up and Go (TUG), gait speed, PROMIS-global health and fatigue, 6 Minute Walk Test (6MWT).
Results: All participants achieved the target heart rate zone with no adverse events in or out of sessions. We saw positive trends toward improvements in physical performance: SHARE-FI scores decreased by an average of 1.98 indicating improved frailty levels after intervention, mean SPPB total scores increased by 2.2 points which is more than the MCID of 1.0 and were statistically significant. Differences in baseline and follow up 6MWT (456.4 ft) were substantially higher than the MCID of 164 feet. TUG times improved by a mean of 3.4 seconds. Self-reported fatigue on the PROMIS fatigue decreased by an average of 8.2 points, more than double the MCID values of 2.5-4.5. We also found a statistically significant negative relationship between affect and RPE and RPE and affect*session (an interaction term to account for the session) showing that as RPE increases, affect becomes more negative and the relationship became even more negative with more completed sessions.
Conclusions: It is feasible for older adults living with HIV to engage in high intensity walking activity with no adverse events and significant improvements in frailty levels, physical function, and fatigue. Given the statistically significant negative relationship between RPE and affect, high intensity training may have low adherence. Future research needs to explore long term effects of this intervention, as well as explore treatment effects and compare high versus moderate intensity to determine optimal exercise prescription.
Clinical Relevance: Physical therapists should consider exercise prescription and aerobic intensity when prescribing therapeutic interventions for older adults living with HIV.
TITLE: Identify Fall-Specific Somatosensory Thresholds (FaSST) for Improving Steadi Fall Risk Screening Algorithm: Preliminary Data Analysis
CURRENT SECTION: Geriatrics
AUTHORS: Ashley Skutka, Riley Jay Horn, Summer Alexis Kenny, Emma Marie Blount, Stacey A. Meardon, Kevin O'Brien, Chia-Cheng Lin
Purpose/Hypothesis: The Stopping Elderly Accidents, Deaths & Injuries (STEADI) has been promoted by the CDC to prevent falls in older adults. Somatosensory input from the foot plays a critical role in postural control and is commonly screened by primary care providers. However, the STEADI fall risk screening algorithm does not include sensory screening. The purpose of this study was to identify specific sensory cutoff values for pressure sensation (PST) and vibration perception threshold (VPT) associated with abnormal static and dynamic balance performance to complement STEADI screening.
Number of Subjects: One hundred and twelve participants.
Materials and Methods: A set of monofilaments and hand-held bio-thesiometer were used to measure PST and VPT, respectively. PST and VPT were measured at 6 sites bilaterally (big toe, 1st metatarsal, 5th metatarsal, medial arch, and calcaneus) and averaged for each foot and across both feet. The dynamic gait index (DGI) and Sensory Organization Test (SOT) were used to assess dynamic and static balance performance. A DGI score < 19 and SOT composite score less than age-matched controls were considered abnormal findings. Receiver Operating Characteristic (ROC) curves were used to identify cutoff values for PST and VPT associated with abnormal dynamic and static balance as well as the associated sensitivity (sn), specificity (sp), and the area under the curve (ROCA) (α < 0.05).
Results: Results indicated that 5 subjects displayed abnormal DGI scores and 37 subjects displayed abnormal SOT results. ROC analysis suggested that PST cutoff values to predict abnormal DGI scores were ∼0.4g for right foot (sn=100%, sp=74%, ROCA=0.94, p<0.01), ∼0.6g for left foot (sn=100%, sp=88%, ROCA=0.95, p<0.01), and ∼0.5g for the averaged PST (sn=100%, sp=80%, ROCA=0.95, p<0.01). The VPT cutoff values for abnormal DGI were 11.53 volts (v) for right foot (sn=100%, sp=85%, ROCA=0.92, p < 0.01), 11.10 v for left foot (sn=100%, sp=84%, ROCA=0.92, p<0.01), and 11.53 v for the averaged PST (100% sensitivity, 84% specificity, ROCA = 0.93, p<0.01). The PST cutoff values to predict abnormal SOT values were ∼0.3g for right foot (sn=62%, sp=64%, ROCA=0.65, p<0.05), ∼0.3g for left foot (sn=65%, sp=55%, ROCA=0.64, p<0.05), and ∼0.3g for the averaged PST (sn=65%, sp=59%, ROCA=0.65, p<0.01). The VPT cutoff values for abnormal SOT values were 6.42 v for right foot (sn=62%, sp=63%, ROCA=0.63, p<0.05), 6.21 volts for left foot (sn=62%, sp=63%, ROCA=0.63, p<0.05), and 6.42 v for the averaged VPT (sn=60%, sp=63%, ROCA=0.63, p<0.05).
Conclusions: These results suggest that diminished plantar pressure and vibration sensation were associated with both impaired dynamic and static balance. PST and VPT cutoff values differentiating those with and without abnormal postural control approximated the 0.4g and 6.2-11.5 v.
Clinical Relevance: The STEADI fall risk screening algorithm has been promoted in the primary care setting. Incorporating screening for diminished sensation along with the STEADI screening fall risk algorithm may improve early identification of elderly with potential fall risk and prompt referral to physical therapy.
TITLE: Meta-Analysis of Randomized Controlled Trials Investigating Cognitive-Motor Dual-Task Training Effects for Community-Dwelling Older Adults
CURRENT SECTION: Geriatrics
AUTHORS: Shatha Aldraiwiesh, Neva Jillaine Kirk-Sanchez
Purpose/Hypothesis: Dual-task related deficits in older adults have been linked to fall risk. Cognitive-motor dual-task (CMDT) training, in which cognitive and motor tasks are performed concurrently, has emerged as an approach to improve mobility and dual-task capacity. Meta-analysis of randomized controlled trials (RCTs) examining CMDT training for older adults would be useful to evaluate the efficacy of these interventions. The purpose of this meta-analysis was to synthesize RCTs to assess the effects of CMDT training compared to usual single-task (ST-Motor) or no training on ST gait speed, DT gait speed and Timed Up and Go (TUG) in healthy community-dwelling older adults.
Number of Subjects: Fifteen studies including 260 subjects in the CMDT group, 156 in the ST-Motor group, and 102 in passive control.
Materials and Methods: Systematic search for published RCTs in English was performed, adhering to PRISMA guidelines, from inception until May 2020, using the electronic databases: MEDLINE, CINAHLplus, PsycINFO, PubMed, Embase, CENTRAL, and Web of Science. Keywords included: ((older adults) OR (elderly)) AND ((training) OR (Exercise)) AND ((dual task) OR (simultaneous) OR (secondary)) AND ((motor) OR (walking) OR (physical)) AND (Cognitive). To be included, studies had to compare a concurrent physical and cognitive exercise intervention protocol to either ST-Motor or passive control on mobility, balance, cognition, or dual-task performance pre- and post-training. The search retrieved 691 articles after removal of duplicates, 120 were left after abstract review, and full text review identified 28 studies that met the inclusion criteria. RCTs were critically appraised using Cochrane's risk of bias tool and data was extracted using a standardized tool from Covidence™. Of the 28 RCTS that met the criteria, 15 were pooled for random effects meta-analysis via RevMan 5.4™.
Results: Comparison of CMDT to ST-Motor showed that DT gait speed significantly favored CMDT (5 studies, n=181, mean difference= 0.10m/s, 95%CI: 0.06, 0.15, P<0.01), but mean difference was not significant in ST gait speed (7 studies, n=227, mean difference=0.05m/s, 95%CI: −0.02, 0.13, P=0.16), or TUG (7 studies, n=220, mean difference=0.18 s, 95%CI: −0.17, 0.5, P=0.32). When CMDT compared to passive control, mean difference was not significant for TUG (6 studies, n=242, mean difference= −0.63 s, 95%CI:-1.35, 0.08, P=0.08), but ST gait speed significantly favored CMDT (3 studies, n=103, mean difference= 0.15m/s, 95%CI: 0.08, 0.23, P<0.01). Only one study examined DT gait speed between CMDT and passive control.
Conclusions: CMDT training can improve usual gait speed and dual-task gait speed in older adults. CMDT does not appear to have an effect on TUG scores when compared to either passive control or ST-Motor training.
Clinical Relevance: This review supports the use of CMDT training to improve mobility in older adults. With such training, elderly might learn to better integrate two distinct tasks simultaneously, minimizing dual-task related deficits and risk for falls.
TITLE: Bone Health in Aging Cyclists
CURRENT SECTION: Geriatrics
AUTHORS: Becca D. Jordre, Micah Eldon Hettinger, Chesney Nagel, Ember Jeanne Newman, Ashley Renae Wilson, William E Schweinle, Adam L. Ladwig
Purpose/Hypothesis: Long-term participation in cycling has been proposed to contribute to low bone density in aging men. However there have been no recent investigations of bone health in aging male or female cyclists. The purpose of this study was to (1) identify the prevalence of osteoporosis and osteopenia in competitive senior athlete cyclists and compare that prevalence to senior athletes who participate in other sports as well as the general population (2) determine any relationship between exercise volume or frequency and the prevalence of osteoporosis or osteopenia in these cyclists and (3) compare grip strength values of cyclists with osteoporosis or osteopenia to cyclists without these diagnoses and to senior athletes engaged in other sports.
Number of Subjects: 2,998 (74 cyclists, 2,924 senior athletes)
Materials and Methods: Participants completed a health and sport history interview and grip strength dynamometry as part of a larger study. Inclusion criteria were 1) age 50 or older and 2) registration to compete in the National Senior Games between 2011 and 2019. Athletes were designated as cyclists if they were registered for only cycling events. All other athletes were designated as non-cyclists. Chi Square analyses and independent samples t-tests were used to compare between-group differences. Prevalence of low bone health in senior athletes and senior athlete cyclists were compared to the general population with binomial approximation to the normal.
Results: Of these senior athletes, 74 (38 males and 36 females) competed exclusively in cycling events. Osteoporosis and osteopenia prevalence in these cyclists were significantly lower than the general population for both genders (ps<.001). When comparing cyclists to non-cyclists (N=2,924), the only significant difference found in reported bone health diagnoses was a greater prevalence of osteoporosis in female cyclists (p=.03). Both male and female cyclist groups were found to spend more time engaging in cardiovascular exercise than non-cyclists (p<.001) but reported no significant differences in strength training volume (ps>.05). Male cyclists with osteoporosis or osteopenia reported less strength training volume than those without these conditions (p<.001). No other differences in exercise habits or grip strength were seen between cyclists with or without a bone health diagnosis.
Conclusions: These findings suggest a relationship between exclusive engagement in cycling and a diagnosis of osteoporosis for aging female, but not male, athletes. These findings are observational in nature and cannot be considered to be causative. When compared to the general population, senior athlete cyclists enjoy an overall lower prevalence of osteoporosis and osteopenia. Despite this benefit, female senior athletes who cycle exclusively may demonstrate relatively more risk for poor bone density than non-cyclists.
Clinical Relevance: Further investigation is needed to determine the risk that extensive cycling may have on the bone density of competitive senior athletes. Further investigation with a larger sample is indicated.
TITLE: Assessing Gait Speed Vs. Repeated Chair Rise Task to Identify Pre-Clinical Disability in Older Adults
CURRENT SECTION: Geriatrics
AUTHORS: Christopher Glenn Neville, Moshe Marko
Purpose/Hypothesis: Observed daily task modification is an early, independent symptom of declining mobility among apparently healthy older adults.1 30%-40% of task modifiers report no mobility disability.2 Objective, sensitive to change, and easily directed outcome measures associated with task modifications, would offer impartially quantifiable diagnostic targets promoting early detection of declining mobility among this unique group of older adults.3 Well researched outcome measures commonly used in physical therapy are gait speed4 and timed repeated chair rise.5 This study compares the strength of the association between the timed 4-meters gait speed (4mGS) VS. timed five chair (43 inches sit pan height) rises (5tCR), and task modification.
Number of Subjects: 53 Older adults (76.4 years, SD=5.2) living independently in the community participated in this study.
Materials and Methods: Using a previously validated tool (MOD)1 to identify older adults who modify tasks of daily living, twenty-six of the participants were classified as task modifiers (TM), and 27 participants were classified as non-task modifiers (NTM).
Results: On average, gait speed in both groups were well above the gait speed threshold corresponding to declining mobility or health6,7 with the NTM and TM groups walking at 1.7 (SD: ±0.2) and 1.3 (SD: ±0.2) meters/seconds, respectively (P=.<.001). 5tCR was also different between groups (P=.<.001), with the NTM and TM completing the task within 8.7 (SD = ±1.7) and 12.7 (SD = ±4.2) seconds, respectively. Seeking for the most parsimonious clinical model of task modification, i.e., a clinical decision model with the minimum number of covariates needed to optimally predict task modifications, two separate multivariate logistic regression analyses with either the 4mGS or the 5tCR as the independent variable, and task modification groups as the dependent variable were conducted controlling for age and isometric strength (ISOstr) in the lower extremities (i.e. combined isometric strength of hip and knee extensors, and ankle dorsiflexors). The results showed that the 5tCR predicted being in the TM group (OR=2.287, 95% CI=1.182–4.424, P=0.014) independent of age (OR=1.138, 95% CI=0.911–1.422) and/or lower extremities combined isometric muscle strength (OR=2.165, 95% CI=0.207 − 1.034), neither of which predicted being in the TM group. Gait speed was not an independent predictor of belonging in the TM group (OR=0.691, 95% CI=0.470–1.017).
Conclusions: Even when controlling for covariates, a 1-second increase in time to complete 5tCR was associated with a 2.3-fold increased likelihood of being in the TM group. The strength of the association between gait speed and task modification depends on other covariates e.g., age and/or muscle strength. Compared to 4mGS, 5tCR was a stronger predictor of group assignment.
Clinical Relevance: Citing barriers like practicality, time, perceived clinical relevance, or lack of familiarity with the process, only few clinicians routinely assess outcome measures during office visits. Compared to the 4mGS which requires walking space and math calculations, the 5tCR requires only a standard chair which can be found in any clinic.
TITLE: State Senior Games Participants: Analyses of Usual and Fast Gait Speed Results
CURRENT SECTION: Geriatrics
AUTHORS: Kristin Thomanschefsky, Emily Margaret Matlack, Samantha Lee Nofsinger, Bradley Tavernier, Chloe Victoria Tuma, John S. Schmitt, Becca D. Jordre
Purpose/Hypothesis: Senior Games promote physical activity and sports participation among older adults. Gait speed is a widely accepted valid and reliable measure of functional and physiological health. In community-dwelling older adults, usual (self-selected) gait speed is indicative of overall functional status and is predictive of several health outcomes. Fast gait speed is reflective of one's abilities with community navigation. Gait speed reserve, the difference between the two, is one's ability to adjust speed to varying conditions in the community.
The purpose of this study was to 1) explore differences in gait speed measures between community-dwelling older adults and athletes participating in state-level Senior Games, and 2) establish normative values of gait speed for this active subgroup of older adults, including usual and fast gait speed and gait speed reserve.
Number of Subjects: 591
Materials and Methods: De-identified usual and fast gait speed data were used from state-level senior athletes who participated in the Senior Athlete Fitness Exam (SAFE). Gait speed reserve was calculated as the difference between usual and fast speed. Athletes were compared to age and sex-stratified norms for community-dwelling seniors using independent samples t-tests.
Results: Data were analyzed from 591 records of senior athletes aged 50-79. Mean age was 64.8 (sd=7.6) years and the sample was 50% female. Both male and female senior athletes had significantly higher values than community-dwelling older adults for usual gait speed (UGS) at all age levels (p<0.005). Male senior athletes' UGS ranged from 1.60+/-0.27 m/s for ages 50-59 to 1.49+/-0.32 for ages 70-79 compared to 1.39+/-0.23 to 1.33+/-0.20 respectively for community-dwelling males. Female senior athletes' UGS ranged from 1.61+/-0.29 m/s for ages 50-59 to 1.49+/-0.30 for ages 70-79 compared to 1.40+/-0.15 to 1.27+/-0.21 respectively for community-dwelling females. Similarly, fast gait speed (FGS) was significantly greater for both male and female senior athletes at all age levels (p<0.001). Male athletes' FGS ranged from 2.65+/-0.51 m/s for ages 50-59 to 2.43+/-0.73 for ages 70-79 compared to 2.07+/-0.45 to 2.08+/-0.36 respectively for community-dwelling males. Female senior athletes' FGS ranged from 2.45+/-0.50 m/s for ages 50-59 to 2.15+/-0.53 for ages 70-79 compared to 2.01+/-0.26 to 1.75+/-0.28 respectively for community-dwelling females. Gait speed reserve for senior athletes ranged from 0.91-1.05 m/s for males and 0.66-0.84 m/s for females compared to 0.57-0.75 for male and 0.47-0.61 for female community-dwelling older persons.
Conclusions: Senior athletes demonstrated significantly better scores for UGS and FGS compared to age and sex-matched community dwelling older adults, as well as significantly greater gait speed reserve.
Clinical Relevance: Senior athletes' level of performance on all gait speed measures indicate lower risk of functional decline. Physical therapists can encourage older adult clients to participate in sports to gain health benefits and maintain quality of life.
TITLE: PT Management in a Student Run Clinic for Patient With Balance Impairments Following a Fall
CURRENT SECTION: Geriatrics
AUTHORS: Brendan J. Keane, Gabrielle Flaherty, Juliann Cosetta
Background and Purpose: The Balance Movement and Wellness Center (BMW) is a physical therapy student-run pro bono program directly supervised by licensed physical therapy faculty members within a Doctorate of Physical Therapy Program. The center provides non-skilled therapy interventions to those in the community who have completed skilled PT, but could benefit from a continued exercise program, or are at risk for falls. Purpose of this case report is to investigate the effectiveness of treatment in a student led clinical setting on a participant who continued to have balance impairments following discharge of skilled PT for total hip arthroplasty and femur fracture.
Case Description: Participant is an 81 y/o male, 1 year s/p ORIF due to left femur fracture in 2019. Past medical history includes bilateral THA in 2007 and 2013. Prior to BMW, the participant underwent skilled PT and was discharged and cleared by his physician to continue his care within the pro-bono clinic. During initial evaluation decreased flexion, abduction, and internal rotation range of motion of the left hip was noted as well as decreased left hip extension, adduction, and internal rotation strength. Chief complaints included fear of falls, decreased step length during ambulation, and neck pain that made it difficult to turn his head when driving.
Outcomes: Initial and end of episode of care outcome measures utilized included: Timed Up and Go (TUG), Activity Balance Confidence Scale (ABC), Berg Balance Scale (BBS), 6 Minute Walk Test (MWT), 10-Meter Walk Speed Test and Neck Disability Index (NDI). These were selected to document progress toward achieving participant's goals of increasing balance and mobility when walking, as well as tracking the progression of his neck pain. Initial evaluation demonstrated a BBS score of 45/56 and TUG of 15.11 seconds classified him as a fall risk. After four weeks of treatment the BBS and TUG were reassessed: BBS increased to 50/56 and TUG improved to 12.16 seconds. Participant also met 3 of 4 short term goals relating to neck pain, hip ROM and balance. Additional outcome measures as well as long term goals were unable to be assessed due to closing of BMW secondary to the COVID-19 pandemic.
Discussion: Closing of BMW during COVID-19 resulted in lack of data for most outcome measurements due to the originally planned 10 weeks becoming incomplete. Quality of life improvement is an important outcome measure, using the MOS SF-20, that we were unfortunately unable to reassess. However, improvements were seen in the TUG and the BBS, indicating an overall decreased risk for falls. Primary limitation of this study was closure of BMW, which limited participation in the established program. Additionally, some of the goals may not have been achievable due to prosthetics in the L hip and femur. Although treatment was not carried out in its entirety, this case report shows the potential benefits an exercise program can have on balance, mobility, and fall risk even in a brief time period. Further research should be done to standardize programs to improve balance deficits of THA patients to protect them from falls and possible fractures.
TITLE: Impact of Initiating PT in the Emergency Department for Older Adult Fallers: A Systematic Review
CURRENT SECTION: Geriatrics
AUTHORS: Dana Rose Maida, Erin Lowry Hultberg, Rachel Erin Kosty, Lauren N. Wyant, Vanessa Marie Zimmerman
Purpose/Hypothesis: The purpose of this systematic review was to determine the impact of providing physical therapy (PT) initiated in the emergency department (ED) for older adults presenting post-fall on the incidence of recurrent falls.
Number of Subjects: N/A
Materials and Methods: A literature search of Cochrane, CINAHL, ProQuest, and PubMed was conducted using search terms:(geriatric OR older adults OR seniors OR elderly) AND (physical therapy OR physical therapist OR balance assessment OR balance screen OR balance) AND (fall OR “fall related injury” OR fallers) AND (“emergency room” OR “emergency department” OR emergency). Search limits: English and peer-reviewed. Selection criteria: adults 65+ years admitted to ED post fall, interventions including PT services and/or balance assessment (BA), and outcomes including recurrent falls. Two reviewers independently assessed each study for methodological quality based on OCEBM Levels of Evidence(2009).
Results: 604 articles were screened for eligibility, yielding 10 studies after detailed appraisal (5 RCTs, 2 prospective cohort, 1 case report, 1 case control, and 1 retrospective cohort). Sample size ranged from 1-560,277 subjects (n=563,050) with mean age range 66-82.4 years. CEBM levels of evidence ranged 1B-4. Subjects received one of the following post fall: PT in the ED (2 studies), PT after discharge from ED (4 studies), or post-discharge BA by a healthcare provider and therapeutic PT intervention (4 studies). Assessment and intervention methods varied with follow-up ranging 30 days-1 year. No adverse events were reported. The primary outcome measure was recurrent falls and secondary outcomes were ED revisit rates and recurrent injurious falls. For articles reporting recurrent falls, 1 reported statistically significant improvement, 5 reported improvement without statistical significance, and 4 did not report statistical analysis. No significant difference in recurrent falls was reported for PT in the ED and the case report patient did not fall or report to the ED at 3 mo. follow-up. All articles with PT after discharge from the ED reported recurrent fall reduction; 1 specifically noted statistical significance. No articles with post-discharge BA found statistically significant results, however, 1 reported recurrent fall reduction. For secondary outcomes, 1 article reported statistically significant improvements in ED revisit rates within 30 and 60 days and 1 found statistically significant reductions in recurrent injurious falls.
Conclusions: Primarily moderate levels of evidence exist to support providing PT to older adult fallers during or after an ED visit to decrease recurrent falls. PTs were key members of the interdisciplinary team and some intervention was more effective than none. Limitations included 5 study designs, varied assessment methods, and control group contamination. Future research with standardized assessments is needed to determine optimal use of PT services.
Clinical Relevance: Older adults should receive PT services in the ED post-fall; however, if resources are unavailable, ED providers should consider referring patients to PT to facilitate appropriate intervention to decrease recurrent falls.
TITLE: Comparison of Physiologic Responses Between Three Outcome Measures of Endurance
CURRENT SECTION: Geriatrics
AUTHORS: Colleen Griffin Hergott, Aaron J. Dowling, Kennedy Ezzell, Corley Graves, William Clate Peed, Lori Bolgla
Purpose/Hypothesis: Aerobic fitness tests are important for older adult populations to establish baseline cardiovascular fitness and determine appropriate aerobic exercise intensity. While the six-minute walk test (6MWT) is a commonly used field test, the time and space requirements may impede clinical practice use. The two-minute step test (2MST) is an alternative test that requires less time and space to administer. The timed-up-and-go (TUG) is a simple measure of functional mobility that could be modified to include multiple repetitions. Therefore, the time needed to complete the TUG ten times (TUG-10) may assess aerobic endurance in older adults. The purpose of this study is to compare physiologic responses between the 6MWT, 2MST and TUG-10. We hypothesize the following for all tests: 1) similar changes in heart rate (HR); diastolic and systolic blood pressure (DBP and SBP); and rate of perceived exertion (RPE); 2) similar %HRmax; and 3) strong correlations in performance.
Number of Subjects: 14
Materials and Methods: Subjects randomly performed the 6MWT, 2MST, and TUG-10. A lower TUG-10 time and higher 6MWT and 2MST scores represented greater endurance. HR, DBP, SBP, and RPE were measured before and after each test. Separate 2 (time) X 3 (test) analyses of variance (ANOVA) with repeated measures compared changes in HR, DBP, and SBP between each test. A 1-way ANOVA with repeated measures compared %HRmax. The Wilcoxon rank-sum test compared changes in RPE. Pearson correlations determined associations between test results. Level of significance was at the 0.05 level.
Results: HR increased more during the 2MST (P=.02) than the TUG-10; HR change was similar between the TUG-10 and 6MWT (P=.10). DBP increased similarly (P=.01) for all tests. SBP increased significantly during all tests, with a higher and similar increase during the 2MST and TUG-10 than the 6MWT (P<.01). A higher RPE occurred during the 2MST (P<.01). %HRmax was higher during the 2MST than the TUG-10 (P=.02) and 6MWT (P=.04); it was similar between the TUG-10 and 6MWT (P=.10). A strong inverse correlation existed between the TUG-10 and 6MWT (r=-.85; P=.001) and 2MST (r =-.77; P=.01). A strong positive correlation existed between the 6MWT and 2MST (r=.69, P=.007).
Conclusions: Findings indicated that the 2MST was more challenging based on a greater change in HR and RPE and higher %HRmax. Except for SBP, similar physiologic responses existed between the 6MWT and TUG-10. Strong correlations between test scores provided evidence that all tests measured aerobic endurance.
Clinical Relevance: Our results suggest that the 2MST is more challenging than the 6MWT or TUG-10. The TUG-10 elicits a similar RPE and physiologic response as the 6MWT, with time and space requirements similar to the 2MST. Selection of aerobic tests for clinical use should include consideration of physiologic response and perceived challenge in addition to patient functional level, equipment, space, and time available.
TITLE: Mobility Limitations and Frequency of Physical Activity in Older Adults With Cognitive Impairment No Dementia
CURRENT SECTION: Geriatrics
AUTHORS: Matthew Joseph Miller, Irena Cenzer, Kenneth Covinsky, Deborah Barnes
Purpose/Hypothesis: Older adults with cognitive impairment no dementia (CIND) are at increased risk of developing dementia. Physical activity could potentially reduce their risk of progression to dementia; however, mobility limitations may make it challenging for them to engage in physical activity. The purpose of this study was to estimate the population prevalence of self-reported mobility limitations and frequency of physical activity for older adults with CIND.
Number of Subjects: 3089 community-dwelling older adults with CIND (age [mean±SD]: 69±12 years old, male: 44%, non-Hispanic White: 40%) from the 2016 wave of the Health and Retirement Study (HRS), a nationally representative study of older adults in the United States.
Materials and Methods: CIND was identified based on cognitive test performance using a validated method. Walking limitation was identified by asking participants whether they had difficulty walking several blocks, one block, and across the room. Stair climbing limitation was identified by asking participants whether they had difficulty climbing several flights and one flight. Participants were asked how often they engaged in vigorous (e.g., jogging, swimming), moderate (e.g., gardening, walking, dancing), or light (e.g., vacuuming, laundry) intensity physical activities. Frequency of each intensity was classified as regular (≥2x/week), weekly (1x/week), rare (1-3x/month), and never. Population prevalence estimates were calculated using HRS survey weights.
Results: Fifty-six percent of participants reported no difficulty walking several blocks, while 17% had difficulty walking several blocks, 14% one block, and 13% across the room. Forty-three percent of participants reported no difficulty climbing several flights, while 26% reported difficulty climbing several flights and 31% climbing one flight. Light intensity physical activity was reported as regular by 41%, weekly by 30%, rare by 11%, and never by 18% of participants. Moderate intensity physical activity was reported as regular by 37%, weekly by 19%, rare by 13%, and never by 31% of participants. Vigorous intensity physical activity was reported as regular by 20%, weekly by 11%, rare by 8%, and never by 62% of participants.
Conclusions: The prevalence of mobility limitations in older adults with CIND is high, but the majority have sufficient mobility to engage in physical activity. Frequency of physical activity is highest for light intensity and lowest for vigorous intensity. Engaging in any light or moderate intensity physical activity (i.e., more than never) is common. These findings suggest there is potential to increase light and/or moderate intensity physical activity frequency among older adults with CIND.
Clinical Relevance: Physical therapists are uniquely positioned to use physically-focused and/or behavior-based interventions targeting mobility limitations and physical activity. These targets may be high yield targets for preventing cognitive decline in older adults with CIND.
TITLE: Effect of High Intensity Interval Training on Cognitive Tasks in a Person With Parkinson's Disease
CURRENT SECTION: Geriatrics
AUTHORS: Caitlin E. Osborn, Brittani Elizabeth Sullivan, Nicole Turcotte, Crystal Renee Ramsey
Background and Purpose: The clinical presentation of Parkinson's disease (PD) is typically defined by gait abnormalities, postural instability, exertional intolerance, and declining cognitive performance secondary to basal ganglia degradation, which is exacerbated in dual-task (DT) activities. Aerobic exercise has been shown to slow disease progression in those with PD, and high intensity interval training (HIIT) has been proposed as superior to moderate intensity exercise for its effect on neuroplasticity, cardiovascular health, and exercise adherence. Research has suggested benefits of HIIT for PD on substantia nigra and frontal lobe activity, however, more research is needed to explore HIIT and DT in people with PD. The purpose of this study is to evaluate the use of a HIIT protocol supervised via telehealth to improve cognitive DT in a patient with PD.
Case Description: The patient is a 66 year-old male with a primary diagnosis of PD. Patient was diagnosed with PD in 2013 (self-reported Hoehn and Yahr Stage II). He was seen via telehealth for six sessions. The patient has remained active since diagnosis. The patient's primary complaints are freezing of gait, festination, and difficulty with ADLs. Each intervention session included a warm up, HIIT circuit, and gait training with cognitive DT. The warm up focused on large amplitude movements coupled with deep breathing and stretching exercises. The patient performed two to three rounds of HIIT consisting of six exercises that addressed patient specific impairments. An active recovery period consisting of gait training followed each round of the circuit integrating a cognitive component in the latter half of training. RPE and HR were monitored throughout sessions. The patient was instructed to perform the HIIT circuit two additional times per week.
Outcomes: On initial evaluation, the patient completed the Timed up and Go (TUG) and the TUG with a cognitive task (TUG Cog) in 11.98 seconds and 13.27 seconds respectively which indicates a dual-task cost (DTC) of 10.8%. Gait speed was assessed with the 10MWT to be 0.75 m/s. The patient performed a two-minute step test (2MST) completing 100 steps total. During reassessment at discharge, the patient completed the TUG and TUG Cog in 10.86 seconds and 13.71 seconds respectively indicating a DTC of 26.2%. The patient's gait speed improved to 0.86 m/s and 2MST to 120 total steps.
Discussion: The results of this study support a further need of research in HIIT for improved cognitive dual-tasking in patients with PD. The results suggest that HIIT may improve gait speed and 2MST. There is conflicting evidence as to whether or not HIIT improves DTC due to regression in TUG Cog and improvement in 2MST.
TITLE: Balance and Fall Risk Outcome Measures Utilization for Older Adults in Outpatient Physical Therapy Settings
CURRENT SECTION: Geriatrics
AUTHORS: Debra Rone McDowell, Denise Gobert, Rachel Raulerson, Taylor Koudela, Katelynn Anne McGrath, Leigha Tate Jarzombek
Purpose/Hypothesis: Occurrence of falls in older adults contributes to increased morbidity and mortality, exponential healthcare costs, and reduced quality of life. Utilization of outcome measures for screening and assessing fall risk in older patients for implementation of plan of care contributes to reduced fall-related injuries, deaths, and healthcare costs, while promoting improved mobility, function, and health status. These outcome measures are described and recommended by the American Geriatric Society, American Physical Therapy Association, Academy of Neurologic Physical Therapy, and Academy of Geriatric Physical Therapy. The first purpose of this study was to explore the utilization of outcome measures that assess balance and fall risk in patients who are adults 65 years and older within the outpatient physical therapy setting. Secondary purposes included determining the most frequently used outcome measures and examining associations between demographic variables and clinicians' screening habits.
Number of Subjects: A convenience sample of 205 licensed physical therapists (PTs) (n=185) and physical therapist assistants (PTAs) (n=20) who practice in an outpatient physical therapy setting and treat older adults in Texas.
Materials and Methods: This study consisted of a confidential short online survey distributed from November 2019 to April 2020 using Qualtrics Survey Software. Participants, identified through a Texas Physical Therapy Association database of licensed PTs and PTAs, completed the survey with questions regarding demographic data, physical therapy practice, and utilization of outcome measures for balance and fall risk. Frequency distributions were generated to describe demographic trends and Chi square analysis (p=0.05) was used to explore associations between demographic variables and utilization of the outcome measures.
Results: Most respondents (66.83%) reported screening all older adults 65 years and older for balance and fall risk, regardless of diagnosis or condition. Chi square analysis (p= .05) revealed no significant relationships existed between demographic variables and whether clinicians screened balance and fall risk for older adults. The outcome measures most frequently utilized were the Timed Up and Go (55%), Berg Balance Scale (55%), and 5 Time Sit to Stand (55%).
Conclusions: This study indicates that nearly 1/3 (33.17%) of practicing PTs and PTAs in the outpatient physical therapy setting are not assessing adults 65 years and over for balance dysfunction and fall risk despite current recommendations, thus potentially neglecting to identify at-risk patients.
Clinical Relevance: Results may assist practicing PTs and PTAs with recognizing that it is essential that utilization of balance and fall risk outcome measures are incorporated into clinicians' practice to improve the standard of care when treating adults 65 years and older. Furthermore, this study may guide PTs and PTAs with the selection of continuing education that addresses the appropriate outcome measures that are recommended for evidenced-based practice.
TITLE: Gait Speed: Understanding It Better to Target Interventions
CURRENT SECTION: Geriatrics
AUTHORS: Alexander Peller, Lara Suarez, Ashleigh Dyanne Trapuzzano, Matt S. Stock, Nicole Therese Dawson
Purpose/Hypothesis: Gait speed has been used as a measure that has been shown to be valid and reliable for predicting health status in the older adult population. While gait speed is a great predictor of health status, improvements in gait speed also reduce morbidity and mortality. Being able to target and improve gait speed can improve quality of life, decrease fall risk, and increase participation in the community. Clinicians should understand the variables that make up both fast and comfortable gait speed for better targeted intervention.
Number of Subjects: 90 community dwelling older adults (33 males 57 females) all ≥ 60 years old (SD 74 ± 6).
Materials and Methods: An observational study using a convenient sample of 90 older adults to participate in a one-day assessment to provide demographic, cognitive, and functional performance data. Bivariate correlation analyses were used to determine the level of association between variables. The results of the correlation were used to create nested hierarchical linear regression models to examine the association of comfortable and fast gait speeds.
Results: Comfortable gait speed was significantly correlated with demographic data of age, height, weight, self-reported health, performance measures of balance (Biodex m-CTSIB) and 30-Second Chair Stand test, and the Digit Symbol Substitution for cognitive measures (r =± 0.223-0.427; p <0.05). Fast gait speed significantly correlated with age, self-reported health, all physical performance measures, and cognitive measures that include Digit Symbol Substitution test, Reaction time, and Flanker test (r= ±.203-.491; p <0.05). Unique predictors remaining after hierarchical linear regression for comfortable gait speed included 30 SCS (B = 1.13, β = 0.233, P< .05), Comorbid health (B = −2.95, β = −0.22, P < 0.05), and gender(B = −8.28, β = −0.19, P < .05) and fast gait speed included 30 SCS (B = 1.96, β = 0.26, P < .05), FR (B = 2.45, β = 0.20, P < .05), Biodex Balance mCTSIB (B = −25.29, β =–0.22, P < .05).
Conclusions: This research continues to add to the body of knowledge to understand the unique properties of both comfortable and fast gait speeds. This study revealed that comfortable gait speed was influenced by physical performance on the 30 Second Chair Stand test, Gender, and premorbid conditions while fast gait speed was influenced by physical performance on the 30 Second Chair Stand Test, and Balance measures. Physical performance on the 30- Second Chair Stand test continues to be a strong predictor of both comfortable and fast gait speeds. While cognitive measure has demonstrated little utility in defining gait speed in this study.
Clinical Relevance: Functional physical performance measures have been shown to share much of the variance for both comfortable and fast gait speeds. Interventions should be focused towards functional strength and performance to maximize gait speed. Preventive lifestyle factors also demonstrate importance as it relates to comorbid health conditions that affect an individual's gait speed.
TITLE: Identifying Factors Associated With Outpatient Physical Therapy Utilization for Older Adults With Osteoarthritis Using EHR
CURRENT SECTION: Geriatrics
AUTHORS: Catherine T. Schmidt, Shweta Gore, Wallace Leo Frigon
Purpose/Hypothesis: Over 60% of adults in the United States live with osteoarthritis (OA) making it one of the largest contributors of disability and economic burden. Despite physical therapy (PT) demonstrating improvement in functional outcomes for adults with OA post-surgery, outpatient PT utilization for older adults with OA who have not undergone surgery is not yet known. This study proposes to determine patient level factors associated with the receipt of PT for community-dwelling older adults with OA. We hypothesize that PT utilization will be associated with advanced age, more comorbidities, and incident diagnosis from a physical medicine and rehabilitation provider.
Number of Subjects: 27,962 community-dwelling older adults, aged > 60 years with an incident diagnosis of OA from January 1, 2017-December 31, 2018.
Materials and Methods: This retrospective cohort study used Partners Healthcare electronic health record (EHR) data within the Research Patient Data Registry to identify older adults with an incident diagnosis of OA. An incident diagnosis was defined as the first occurrence of the disorder identified within the EHR during 2017. International Classification of Diseases 10th revision (ICD-10) codes were used to identify the presence of OA. The sample included higher prevalence conditions of OA at the spine, hip, and knee. Diagnosis of OA was identified from a clinical encounter in the outpatient setting.
A multilevel logistic regression model was used to determine factors associated with receipt of outpatient PT adjusting for various health and demographic factors: age, sex, race, marital status, body mass index, insurance coverage, medication use, comorbidities and prior PT.
Results: Preliminary findings show that N=1,252 (4.48%) older adults received outpatient PT services within 30 days of the incident diagnosis. Of those receiving PT, 604 had a diagnosis of Spine OA, 301 hip OA, 540 knee OA, and 181 had OA in more than one body region. When all other variables were held constant, older adults who are white (OR=1.306, 95% CI 1.139, 1.497), divorced (OR=2.277, 95% CI 1.313, 3.948) and received PT prior to the incident diagnosis of OA (OR=0.204, 95% CI = 0.172, 0.241) had greater odds of receiving PT than not receiving PT following an incident diagnosis of OA.
Conclusions: Despite extensive research showing the benefits of PT for those with OA, only a small percentage of those with spine, hip, and knee OA received PT after an incident diagnosis. White, older adults who were divorced and had previous PT had greater odds of receiving PT services following incident diagnosis of OA.
Clinical Relevance: This research provides a summary of outpatient PT utilization among a sample of older adults with OA. Findings from this research can be used to inform referring providers and current providers of PT care about characteristics of older adults who receive PT following a diagnosis of OA. This research represents the first step toward exploring barriers and facilitators to accessing PT care.
TITLE: Test-Retest Reliability and Minimal Detectable Change of the TUG in Seniors With Dizziness
CURRENT SECTION: Geriatrics
AUTHORS: Amie Marie Flores Jasper, Mary Tischio Blackinton, Joann Gallichio, Anne K. Galgon
Purpose/Hypothesis: The Timed Up and Go (TUG) test is a commonly used outcome measure recommended by Vestibular Evidence Database to Guide Effectiveness (VEDGE) for assessing individuals with vestibular disorders.1 Although the test-retest reliability studies of TUG performed on older adults showed excellent reliability, there are no studies on the test-retest reliability and MDC of TUG in older adults with peripheral vestibular hypofunction. Previous TUG test-retest reliability and MDC studies were on older adults with medical conditions substantially different from peripheral vestibular hypofunction such as dementia,2 hip fracture,3 Parkinson's disease,4 advanced organ failure,5 and Alzheimer's disease.6 Dizziness was an exclusion criterion for TUG test-retest study on community-dwelling older adults.7 The purpose of this study is to establish test-retest reliability and MDC of the TUG test on older adults with peripheral vestibular hypofunction.
Number of Subjects: 16
Materials and Methods: A descriptive design was used on the data collected on the 16 patients. Four physical therapists at two clinical sites measured the patients during the study. After the patients gave informed consent and met the inclusion criteria, the patients performed one practice trial followed by two final performances of the TUG that were included in the data analysis.
Results: The ICC of TUG was calculated using 16 patients, 52.9% were male and 47.1% were female, with a mean age of 72 years old (age range 66-94 years old). Based on the Dizziness Handicap Inventory scores, 75% of the patients had mild disability from dizziness while 25% had moderate to severe disability. The TUG showed excellent reliability (ICC 0.990), and small SEM (0.33) and 95% MDC (0.916 seconds). These values were less than values of older adults with dementia (SEM 2.12, MDC 5.88),2 Alzheimer (SEM 2.48, MDC 4.09),6 organ failure (SEM 0.79, MDC 2.19),5 and Parkinson's Disease (3.5 to 11 seconds).4,8,9 Generalization of results of TUG test-retest is limited among the older adults with peripheral vestibular hypofunction. To improve the validity of the study, stratification sampling based on the DHI severity score may be a better methodology.
Conclusions: To our knowledge, this is the first study that explored on the test-retest reliability and MDC of TUG in older adults with dizziness. The test-retest reliability of the TUG for older adults with dizziness is equivalent to that of older adults without dizziness.
Clinical Relevance: Physical therapists that treat older adults with vestibular issues can feel confident that their TUG findings are consistent within a patient. Two trials of TUG are sufficient, and a third trial is unnecessary for older adults with dizziness. The MDC of TUG can be used as a reference for goal setting and clinical interpretations of results.
TITLE: Effect of Secondary Cognitive Task on Age-Related Dual-Task Gait
CURRENT SECTION: Geriatrics
AUTHORS: Kylee Guthrie, Hannah Christine Schake, Miranda Inoue Pearce, Emily Lauren Olguin, Asha Vas, Hui-Ting Goh
Purpose/Hypothesis: Older adults (age > 65 years) often demonstrate impaired dual-task gait performance compared to young adults. Impaired dual-task gait has been associated with increased fall risk. Previous studies have shown that the magnitude of dual-task interference is mediated by the type and difficulty of the secondary cognitive tasks. Little is known about how age-related dual-task gait is modulated by the nature of the secondary tasks. The purpose of this study was to determine the effects of different secondary tasks on dual-task gait performance in young and older adults. The second purpose of this study was to explore the relationship between cognitive function and dual-task gait performance.
Number of Subjects: 40
Materials and Methods: 20 young adults (mean age = 26 years) and 20 older adults (mean age = 72 years) participated in this single-session repeated-measure study. Participants ambulated under single- and dual-task conditions for 30 seconds while gait performance was captured with an instrumented walkway. There were 4 different types of secondary tasks and each consisted of 2 difficulty levels, yielding a total of 8 different dual-task conditions. The dual-task conditions included 1) walking and counting backward by 3s and by 7s; 2) walking and remembering a 5-item and 7-item lists; 3) walking and responding to a simple and choice reaction time tasks; and 4) walking and generating words from single and alternated categories. Gait speed measured under single- and dual-task conditions was used to compute dual-task cost (in %) with a greater dual-task cost indicating a worse dual-task gait. In addition, participants' cognitive function was assessed using Montreal Cognitive Assessment, Trail Making Test, and Digit Span Forward and Backward test.
Results: Repeated-measure ANOVA revealed a significant interaction in dual-task cost between age, task type and difficulty (p = .04). Increased difficulty in the reaction time task significantly increased dual-task cost for older adults (p = .01) but not for young adults (p = .90). In contrast, increased difficulty level in the counting backward task significantly increased dual-task cost for young adults (p = .03) but not for older adults (p = .85). Increased task difficulty in the other 2 tasks led to a similar effect for both groups. Digit Span Forward test was significantly correlated with the dual-task cost for the older adults (r = - 0.50, p = .02).
Conclusions: Compared to young adults, older adults demonstrated a different response to dual-task challenge during walking. The findings suggest that aging might have a different effect on various cognitive domains and result in different patterns of dual-task gait interference.
Clinical Relevance: Therapists should consider the impact of secondary cognitive task when evaluating dual-task gait in older adults. The type and level of difficulty of the secondary cognitive tasks should be considered when designing targeted dual-task gait interventions to reduce fall risks.
TITLE: Relationships Between the Promis Physical Function Questionnaire and Objective Measures of Function in Aging Veterans
CURRENT SECTION: Geriatrics
AUTHORS: Michael Harris-Love, Stephan G Bodkin, Brian Hoover, Katie Boncella, Erin Leasure, Valerie McIntosh, Marc R Blackman
Purpose/Hypothesis: Long-term health care for older persons poses large societal financial burdens. Additional burdens are associated with the diagnosis of age-related illnesses in complex patient populations. Patient-reported outcome measures are reliable tools to both assess a patient's progression and their response to treatments. The purpose of this study was to examine the associations between the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function questionnaire and clinical measures used to diagnose sarcopenia in aging veterans. We hypothesize that patient-reported outcome measures will exhibit strong relationships with objective measures used in the diagnosis of sarcopenia, thus providing clinical utility the treatment and management of aging patient populations.
Number of Subjects: Thirty-one community-dwelling African American male veterans (mean age: 68.8 ±3.5 years; body mass index, BMI: 29.5 ±5.6) participated in this study.
Materials and Methods: The PROMIS Physical Function ((PROMIS–29 Profile v1.0) questionnaire was administered to quantify subjective patient function. Dual-energy x-ray absorptiometry was used to quantify total body fat (BF%) and lean body mass (LBM). Muscle performance measures consisted of peak grip force and peak isometric knee extensor torque. Functional assessments included the sit-to-stand test (timed for 5 repetitions) and 6-meter walk gait speed.
Results: The PROMIS Physical Function questionnaire was negatively associated to the patient's age (r=-.38, p=.038) and BMI (r=-.40, p=.027). Higher LBM% (r=.55, p=.001) and lower BF% (r=-.37, p=.039) values were related to higher PROMIS physical function scores. The PROMIS Physical Function questionnaire was moderately related to peak grip force (r=.52, p=.003), peak isometric knee extensor torque (r=.45, p=.011), sit-to-stand performance time (r=.-41, p=.021), and gait speed (r=.67, p<.001).
Conclusions: Validated, subjective measures of patient function were related to objective measures of body composition, strength, and functional performance within our sample of older African American veteran men. Administering subjective measures of patient function can aid clinicians in determining the functional status among aging patients typically seen for ambulatory care in VA health care facilities.
Clinical Relevance: The PROMIS is a publicly available questionnaire information system that covers a wide range of patient care domains. Our data suggest that the PROMS Physical Function questionnaire is worthy of increased utilization within the VA health care system. The PROMIS Physical Function questionnaire may be used as a clinical proxy to assess functional status in the older adult and document the response to selected rehabilitation interventions.
TITLE: Unicompartmental Knee Arthroplasty Rehabilitation on Function and Patient Satisfaction: A Systematic Review
CURRENT SECTION: Geriatrics
AUTHORS: Kent Edward Irwin, Patrycja Ilona Krupa, Kimberly Rae Stanczak, Alyssa Williams
Purpose/Hypothesis: Unicompartmental knee arthroplasty (UKA) is a growing alternative to total knee arthroplasty especially with medial compartment osteoarthritis. Systematic reviews (SRs) report on surgical complications and return to sports/physical activity following UKA; however, none have specifically described or evaluated postoperative rehabilitation. The purpose of this SR was to evaluate the effectiveness of postoperative rehabilitation on pain, function, and quality of life (QoL) in patients following UKA.
Number of Subjects: 18 studies (865 subjects)
Materials and Methods: PRISMA guidelines were followed for this SR (registered, international database of SRs). PubMed, PEDro, CINAHL, SPORTDiscus, and Cochrane Library were searched with key words to identify relevant articles up through October 2019. Potential articles described rehabilitation/exercises for patients following UKA and measured pain, function, and/or QoL. Review of titles/abstracts and full-text articles as well as quality assessments were independently performed by two evaluators. A third evaluator helped resolve discrepancies throughout the review process.
Results: Of the 1249 records generated by the literature review, 68 full-text articles were examined. Eighteen articles met the inclusion criteria and had moderate to strong quality assessment indicated by an average Modified Downs and Black Checklist score of 19.33 ± 3.29 (range: 14/28-23/28). The studies were categorized into the following Levels of Evidence: 1 (n=3), 2 (n=6), 3 (n=8), and 4 (n=1). A total of 865 patients with UKA were reported in the studies (range of average ages: 49.2 to 76 years). Common outcome measures for pain, function, and QoL were the Visual Analog Scale (VAS), Oxford Knee Score (OKS), Knee Injury in Osteoarthritis Outcome Score (KOOS), Knee Society Score (KSS), and the Western Ontario and McMaster Universities Arthritis Index (WOMAC).
A majority of the studies (15/18 = 83.3%) described acute care rehabilitation and discharge to either home; home with a home exercise program (HEP); outpatient PT; or outpatient PT with an HEP. The remaining studies (3/18 = 16.7%) examined only outpatient PT with or without an HEP. The course of UKA rehabilitation was described in vague terms (7/18 = 38.8%), general exercise/mobility categories (8/18 = 44.4%), or with specific intervention parameters (3/18 = 16.7%). Significant variation existed between the timeframe of sessions (day of surgery up to 16 weeks), type of interventions (stretching, strengthening, ROM, gait, etc.), and intervention parameters.
Conclusions: Specific rehabilitation programs following UKA are underexamined. Patients who underwent a UKA and had some form of rehabilitation demonstrated improvements in VAS, OKS, KOOS, KSS, and WOMAC scores. Due to a lack of specific intervention descriptions, these improvements cannot be attributed to rehabilitation activities alone.
Clinical Relevance: Patients with UKA who receive immediate rehabilitation and/or HEP instructions generally have positive changes in pain, function, and QoL. What is unknown; however, is the most effective parameters of specific rehabilitation interventions following UKA.
TITLE: Physiomap: A Data Visualization App to Display Functional Mobility Performance Levels in Older Adults
CURRENT SECTION: Geriatrics
AUTHORS: Marcus Alan Johnson, Michael Fernandes, Ellen L. McGough
Purpose: To develop a progressive web app for physical therapists to visually display performance across domains of functional mobility, prescribe targeted interventions, and educate older adult patients and caregivers.
Description: Physical therapists today are empowered to capture and display functional mobility data of older adults through emerging methods such as body worn sensors. A challenge arises in using the data to move beyond simple diagnosis to using it as a tool to communicate change in performance and risk of reinjury in order to aid a patient's recovery process. The App developers, a DPT student, faculty and an information technology software engineer, collaborated to design a progressive web app to generate a graphic data visualization of four domains of functional mobility. Stages of development involved: (1) Systematic literature review of normative values on standardized performance-based measures commonly used in geriatric physical therapy practice. These measures included 4m walk, Five Time Sit to Stand, the Short Physical Performance Battery, and the Timed Up and Go. (2) Inertial sensor data (APDM Mobility Lab, Portland, OR) analysis to determine normative ranges and cut-points indicating function in older adults populations. Measures included postural sway (eyes open and eyes closed), turns duration, turn peak velocity, and steps in turn. (3) Software engineering enabled the app to convert raw data into a dynamic visual display crossing 6 levels of function (0 = unable to perform, 5 = highest level of performance). Data analysis and decision-making processes were employed to define and fit the data to the 0-5 levels. (4) A radar chart displays 4 quadrants of function (gait, turns, balance, multi-component mobility), across 6 levels of performance. The radar chart displays both standard performance-based levels and/or inertial sensor performance levels.
Summary of Use: This data visualization tool is designed to help physical therapists prescribe targeted interventions and empower older adult patients and caregivers to focus on functional mobility improvement. Physical therapists using this tool gain useful information for education and goal setting. The visual display is able to show performance at a single point in time and show pre-to-post changes across 4 domains of functional mobility including gait, balance, turns and LE function. Future development goals of this platform include (1) downloadable displays for electronic medical record (EMR) compatibility and patient education materials, and (2) adaptation for utilization across other physical therapy patient populations.
Importance to Members: This progressive web app offers a comprehensive visualization of a patient's functional mobility performance. This user-friendly clinical app can be applied to intervention planning, patient/caregiver education and outcome tracking. Physiomap provides patient-centered information to support PT decision-making that targets key impairments and motivates action by the patient/caregiver through a display of baseline and outcome performance.
TITLE: Does the Type of Dual Cognitive Task Impact Gait Variability in Community-Dwelling Adults?
CURRENT SECTION: Geriatrics
AUTHORS: Laurie G. Hiatt, Mary Tischio Blackinton, Joann Gallichio, Mirtha Whaley
Purpose/Hypothesis: Divided attention, tested in dual task activities like the TUG-C, have been shown to identify fall risk in some older adults.1,2 Previous research has studied the cost of dual-task conditions on functional mobility and confidence,3,4 it is unclear if the different type of secondary cognitive task impacts a response in gait parameters. fMRI research has identified that distinct neural pathways are activated during cognitive functions such as math, reading, auditory response naming and visual confrontation naming.5-10 The purpose of this study was to determine how different cognitive dual-tasks impact gait variability in community-dwelling adults using the Quantitative Timed Up and Go (QTUG).
Number of Subjects: Forty-four participants (30 females, 14 males) with mean age 73.11 years.
Materials and Methods: Inclusion criteria: ability to ambulate without assistive devices, independent community living, adequate or corrected vision and hearing to enable participants to read and follow directions. Demographics included BMI, gender, fall history, medications, education, and age. QTUG body-worn sensors were applied on participant's shins and recorded temporal and spatial gait parameters. Sensors streamed data to a handheld tablet. Participants performed ten TUG tests, two standard TUG tests were used as a control. The dual-cognitive tasks of serial subtraction (Subtract), reading (Read), auditory response naming (Audible) i.e. answering a question, and visual confrontation naming (Visual) i.e. naming pictures were randomized and recorded twice.
Results: The dual-task costs of Subtract was significantly different (p <.0001) from standard TUG. Read condition was also significantly different from standard TUG (p <.006) for total TUG recording time. There were notable changes in gait in the Audible condition including increased steps/min, shorter stance times, decreased stride velocity variability and decreased pre-turn time compared to the TUG control for non-fallers. Mean stance time for participants with a history of falls was greatest during the Read condition, but for non-fallers the longest mean stance time was under the Subtract condition. Significant gait parameter differences were found between fallers and non-fallers in all conditions for mean pre-turn time.
Conclusions: Of the four dual-task conditions, the cognitive task of Subtract significantly impacts dual task costs for many TUG gait parameters. The four cognitive conditions (serial subtraction, reading, answering a question, and identifying pictures by name) impact gait differently as measured by the QTUG. The QTUG distinguished fallers from non-fallers under all cognitive conditions for TUG pre-turn time but not for the Control. Mean pre-turn time for the Audible condition resulted in dual-task facilitation vs. a dual-task cost for non-fallers under other conditions.
Clinical Relevance: Physical therapists need to understand how attentional resources for various real-world cognitive dual-tasks influence gait. Future studies may be able to determine if the unique findings in this study can help identify those at increased fall risk.
TITLE: Physical Therapy Students' Attitudes Toward the Older Adults: The Impact of a Senior Partner Program
CURRENT SECTION: Geriatrics
AUTHORS: Cynthia Jean Watson, Martha Rammel Hinman
Purpose/Hypothesis: The number of Americans over the age of 65 is projected to nearly double from 52 million in 2018 to 95 million by 2060.1 Further, nearly half of the individuals who utilize physical therapy (PT) services are over the age of 65.2 Engaging curriculum strategies that incorporate interactions with real seniors who are independently living, are needed.3 Many Doctor of Physical Therapy (DPT) students feel unprepared or less willing to provide services to older adults after graduation.4 Educators must recognize that as the United States supply of PTs is projected to decline5 we must prepare a higher percentage of our graduates to meet the needs of older patients.6 The purpose of this study is to determine the impact of a senior partner program on PT students' attitudes toward working with the elderly.
Number of Subjects: 28
Materials and Methods: 28 students completed the Carolina Opinions on Care of Older Adults (COCOA) instrument prior to starting a DPT program and following completion of the first year. The COCOA is a valid and reliable instrument that was developed to examine health professional students' attitudes toward working with the elderly and to assess the compatibility of a career choice in geriatrics.7 Twenty eight older adult volunteers were recruited from senior centers in the greater-Greenville area of South Carolina. Volunteers were screened and underwent background checks prior to participation. After orientation, each senior partner was paired with a student. Senior partners participated in lab activities including: taking a medical history, obtaining vital signs, performing balance testing, completing home safety evaluations, etc. In addition, senior partners participated as simulated patients during selected practical exams and met for social events such as having a meal with their student.
Results: We used a repeated measures, multivariate analysis of variance (RM-MANOVA) to test our hypothesis that student ratings on the COCOA would become increasingly positive following the students' first year of interaction with their senior partners. We analyzed data at the 0.05 alpha level using SPSS statistical software. We analyzed changes in the student ratings on each of five subscales. Our RM-MANOVAs revealed significantly more positive ratings on the subscales associated with value of older adults, experience in caring for older adults, and perceptions of helplessness.
Conclusions: This study confirms that incorporating experiential learning with community-dwelling seniors improves student attitudes toward older adults. This is a small sample and long term studies are needed to examine the effect of senior partners mentoring DPT students throughout the curriculum.
Clinical Relevance: As the population in America ages, educational programs must look for ways to prepare graduates to effectively and willingly meet the needs of older adults. Involving community-dwelling older adult volunteers as senior partners throughout the DPT curriculum may be an effective way to encourage more students to provide services to older adults after graduation.
TITLE: Interdisciplinary Management for an Aging Adult With Dizziness and Vertigo in the Skilled Nursing Facility
CURRENT SECTION: Geriatrics
AUTHORS: Timothy Nguyen
Background and Purpose: Vestibular dysfunction can result in postural instability, visual blurring with head movement, and subjective complaints of imbalance.3,4 Vestibular dysfunction can also escalate with increasing age such that nearly 85% of people aged 80 years and more have vestibular dysfunction.1 Without proper attention, persistent vestibular dysfunction can delay recovery, increase risk for long term care placement, and lead to possible re-hospitalization due to increased fall risk and caregiver burden.6,7 The purpose of this case study is to highlight the interdisciplinary management of dizziness for an aging adult in short term rehabilitation to maximize the patient's ability to return back to the community independently.
Case Description: A 71-year-old female was seen in the skilled nursing facility with symptoms consistent with unilateral vestibular hypofunction after experiencing debilitating episodes of vertigo, nausea, and vomiting requiring an acute hospital stay. Due to an abnormal oculomotor exam, a referral to an occupational therapist specializing in low-vision revealed a convergency insufficiency that exacerbated her dizziness. After a 10-day plan of care the patient was discharged home independently with a referral to outpatient physical therapy and an optometrist.
Outcomes: Skilled interventions included alternating nasal occlusion, gaze stability, and habituation exercises that improved the overall symptoms of dizziness to trace or minimal by discharge. Post-treatment scores significantly improved for self-perceived dizziness and functional mobility for balance and vestibular disorders. Respectively, the Dizziness Handicap Inventory significantly improved from 76% to 16% and the modified Dynamic Gait Index from 8/12 to 10/12. Overall the patient was able to reach her prior level of function and felt more confident to return to the community with improved ambulation without an assistive device, ability to read without complaints, and minimal dizziness with positional changes.
Discussion: Aging adults with dizziness require a comprehensive evaluation for vestibular disorders including a detailed oculomotor exam. Furthermore, the interdisciplinary management in the skilled nursing setting can improve efficient symptom resolution, discharge planning, and community re-integration.
TITLE: Relationship Between Executive Function and Postural Control
CURRENT SECTION: Geriatrics
AUTHORS: Nicole Therese Dawson, Matt S. Stock, Lara Suarez
Purpose/Hypothesis: Past studies have revealed associations between physical and cognitive functions. While there is much evidence backing this relationship, more research is needed to further understand it. There are various physical function measures that may be used to observe this relationship. One that is particularly important due to its association with falls and other mobility issues among the elderly population is postural control. While it has been established that postural control is affected by executive function, research is lacking in identifying if specific executive function components are most responsible or if certain aspects of postural control are more affected than others (e.g., proprioception, vestibular, visual). The current study examined the role of inhibition, processing speed, and visuospatial ability in postural control under conditions affecting visual, proprioceptive, and vestibular sensory input in healthy older adults.
Number of Subjects: The sample consisted of 90 healthy, older adults with a mean age of 73.02 ± 6.09 years (63% female).
Materials and Methods: The study was an observational study consisting of a battery of cognitive testing and balance assessment. The cognitive battery consisted of the Flanker Inhibitory Control and Attention Test, Digit Symbol Substitution Test, Clock Drawing Test, Trail Making Test – Part B, and simple reaction time. NIH Toolbox Standing Balance was used to assess postural sway.
Results: Analyses revealed that overall balance (composite theta score) was significantly associated with simple reaction time (r = −0.31, p < .01) and the clock drawing test (r = −0.25, p < .05). Further analyses into the systems of balance revealed a significantly stronger relationship between pose #1 (eyes opened, firm) and average balance (r = −0.845, p < 0.1) when compared to pose #2 (eyes closed, firm), and pose #3 (eyes opened, foam) and average balance (r = −0.8015, p < 0.1) when compared to pose #4 (eyes closed, foam).
Conclusions: These findings are strongly indicative that visual input in both conditions #1 and #3 was associated with better postural control, which strengthens our knowledge that healthy older adults rely heavily on vision during postural control. Additionally, findings reveal reaction time and visuospatial abilities are associated with overall postural control in healthy older adults. Results suggest that reaction time should be more thoroughly researched to determine the extent of its influence on EF and physical function.
Clinical Relevance: Understanding the importance of reaction time and visuospatial abilities to postural control in older adults may allow clinicians to utilize measures of cognitive abilities to identify patients at risk of mobility issues such as slow gait and falls. Additionally, these findings can aid therapists in tailoring interventions unique to the needs of each patient.
TITLE: Got to Go Right Now?: Impact of Urinary Incontinence on Functional Balance and Dual Tasking
CURRENT SECTION: Geriatrics
AUTHORS: Derek Matthew Liuzzo, Olivia Dineen, Ashton MacFarlane, Rebecca Querfield
Purpose/Hypothesis: Urinary incontinence (UI) has been linked to an increase in fall risk for older adults. This may be for a variety of reasons including frequent trips to the restroom, nocturia, or sudden urges to void. While a link exists, little is understood about the impact of having UI has on the balance and dual tasking in older adults. This preliminary study aimed to determine if having UI influences a person's balance for functional tasks and cognitive dual tasking. Due to an increase cognitive load from controlling UI, older adults were expected to demonstrate worse functional balance and increased times for a cognitive dual task.
Number of Subjects: 16 participants (8 with UI[8 without], 14 women[2 men]) ranging in age from 61-82, community ambulators without assistive devices, no cognitive impairment (Montreal Cognitive Assessment [MoCA] ≥ 23/30)
Materials and Methods: The presence or absence of UI was self-reported. Participants were screened for cognitive deficits using the MoCA before testing. Baseline fall risk assessment was performed using the Mini-BESTest (MBT). Two trials of the Timed Up and Go (TUG) were used to establish a single task baseline, and two trials of the TUG Cognitive (TUGcog) with serial subtraction from 100 by 3 were performed to analyze dual task performance and cost.
Results: No significant differences existed between the medians(interquartile range) for cognitive screening for healthy individuals (26.5[3.0]) and those with UI (27.0[2.0]). Individuals with UI performed slightly worse and more varied on the MBT (23[5.3]) than their healthy counterparts (26[3.5]). These differences were not significant using non-parametric testing. This trend continued for the TUG dual task testing; individuals with UI had a 29.4%(4.5) increase in time to completion while healthy individuals had a 23.1%(3.0). Actual times were 7.6(2.3) seconds(s) and 10.1(4.1) s for TUG and TUGcog respectively for individuals with UI while TUG and TUGcog times were 5.8(2.3)s and 7.57(2.3)s respectively for healthy individuals. These differences were not significant with non-parametric testing.
Conclusions: In this preliminary study, individuals with UI tended to have an increase in balance difficulties on the MBT, increased time for completion for overall TUG testing, and increased dual task cost. While these results were not significant, this could be due to the limited number of participants. A larger study may reveal a continued trend for older adults with UI to have balance deficits for functional tasks and during dual tasking.
Clinical Relevance: UI is often mistaken for a normal aging process but can be considered abnormal at any age. Often UI can be managed with physical therapy. The presence of UI may indicate an increase in fall risk and the start of a decline in function. Clinicians may take into account the presence of UI when working with older adults to incorporate a complete treatment for their patients.
TITLE: A Systematic Review of the Measurement Properties of the Community Balance and Mobility Scale
CURRENT SECTION: Geriatrics
AUTHORS: Caitlyn Whitwer, Mohammed Khaled, Alexis D. Walls, Saurabh Mehta
Purpose/Hypothesis: Community Balance and Mobility Scale (CBM) was developed for assessing deficits in gait, balance, and overall function in high functioning individuals. It has been validated in healthier older adults,1 patients with neurological deficits,2,3 and osteoarthritis of knee. This systematic review searched, appraised, and synthesized the existing literature for the measurement properties of the CBM. In particular, this review summarized the evidence on reliability, construct validity, responsiveness, and clinically important changes for the CBM.
Number of Subjects: N/A
Materials and Methods: We searched four databases (PubMed, CINHAL, PEDro, and Google Scholar) using standardized keywords to locate the literature published on the measurement properties of the CBM. The studies published in English and assessed at least one measurement property of the CBM was included. Two reviewers independently examined the methodological quality of the studies included in the review using standardized appraisal form. The raw score of 0 on this appraisal form indicates the worst quality and 24 indicates the best quality article.5 The raw scores were normalized on 0-100% scale, where score between 40-70, 70-90, and >90% indicated moderate, good, and excellent quality. Agreement between the two reviewers in performing the appraisal was examined using weighted kappa with 0.61-0.80 as substantial and 0.81-1.00 as almost perfect agreement.6 The results concerning the test-retest reliability (Intraclass Correlation Coefficient (ICC)), concurrent validity (Pearson Correlation Coefficients (r)), responsiveness (Effect sizes (ES) or standardized response means (SRM)), and minimal detectable change (MDC) were summarized.
Results: The search yielded 14 studies that met the eligibility criteria. The agreement between the reviewers in appraising the methodological quality was substantial with the weighted kappa of 0.79. Eight studies had good (70-90%), four had excellent (>90%) and two had moderate (40-70%) quality. The intra- and interrater reliability of the CBM was excellent (ICC>0.90) in community dwelling older adults1 and traumatic brain injury,7 but moderate in stroke8 (ICC = 0.64). The CBM showed good convergent construct validity (r>0.60) with gait speed and Timed up and Go test.3,4,8 Responsiveness of the CBM was moderate (SRM<0.8) in patients with stroke.9
Conclusions: The results of our review suggest that published literature supports reliability and validity of the CBM, however there is limited evidence concerning its responsiveness. We could not locate any published literature that defined the MDC for the CBM.
Clinical Relevance: Since the literature concerning the responsiveness of CBM is still being developed and because of its challenging set of tasks, CBM may not be the most appropriate measure for assessing recovery following acute or subacute phase of recovery in neurological conditions. However, CBM can be used to reliably assess physical performance in community dwelling older adults.
TITLE: Adaptive Backward Walking for an Active Aging Adult With Limitations in Dual Task Performance
CURRENT SECTION: Geriatrics
AUTHORS: Logan Taulbee, Jacqueline Alicia Osborne
Background and Purpose: Backward walking is more challenging than forward walking due to decreased visual input and increased attentional demands. Therefore, adaptive backward walking (ABW) may increase attentional capacity and improve dual task performance. The purpose of this case report is to describe the implementation of ABW in an active older adult with limitations in dual-task performance and increased fall risk.
Case Description: An 82-year-old active aging older adult demonstrated deficits in balance confidence, dual-task performance, and muscle performance during a physical therapy assessment conducted in an outpatient setting. He performed 3 weeks of ABW, dual-task forward walking, strength training, and aerobic activity. Adaptive backward walking consisted of ascending and descending steps and a ramp in a backward direction. Upper extremity use and speed were manipulated in order to progress intensity.
Outcomes: The patient exhibited improvements in balance confidence on the Activities-specific Balance Confidence scale (60.62% to 81.56%). Backward compensatory stepping improved from requiring multiple steps to requiring 1 step to regain postural control. Dual task mobility improved on the Timed Up and Go-Cognitive (TUG-C) Test (13.22s to 11.90s; cut-off for fall risk = 10s). Backward walking speed improved on the 3 Meter Backward Walk Test (0.51m/s to 0.62m/s; proposed cut-off for fall risk = 0.60m/s).
Discussion: Adaptive backward walking is feasible to include in the plan of care for an aging adult with dual-task balance impairments and increased fall risk. Adaptive backward walking is a challenging task. The demand for high levels of attention and coordination may improve the overall attentional capacity for dual tasks. These factors may have also contributed to improvements in compensatory stepping and balance confidence. Research comparing ABW and other interventions designed to improve dual task performance would assist clinicians to select the most appropriate interventions to improve dual task performance in aging adults.
TITLE: Drums Alive Golden Beats Improves Functional Reach in Older Adults
CURRENT SECTION: Geriatrics
AUTHORS: Chelsea Noser, Peter Wright, Greg Walsh, Sarah Davey, Kiera Wilkinson, Carrie Ekins, Austin Robinson, Anne Graff, Mackenzie Hagan, Brittney Moshos, Kristen Marie Harrell, Nathan Forrest Johnson
Purpose/Hypothesis: Age-related declines in balance are pervasive. Impaired dynamic balance is one of the major predictors of falls. The Berg Balance Scale (BBS) is a frequently used clinical test to assess static and dynamic balance. Ceiling effects are often reported in healthy community-dwelling older adults. However, the functional reach component of the BBS can be used to test dynamic postural control by recording the maximal difference in distance between starting and ending position. Age-related declines in the vestibular, somatosensory, visual and musculoskeletal systems reduce the capacity to appropriately react to environment perturbations that shift the center of mass outside the base of support. Maintaining a physically active lifestyle can help attenuate age-related declines in dynamic postural control by systematically challenging these constituent systems. Drums Alive (DA) is a therapeutic exercise program that uses choreographed rhythmic movements to improve dynamic postural control. This study aimed to determine if a 10-week DA intervention, Golden Beats, could improve dynamic postural control in community dwelling older adults. We hypothesized that a 10-week Drums Alive intervention would improve functional reach in community-dwelling older adults.
Number of Subjects: 12
Materials and Methods: Twelve community dwelling volunteers (2 males) completed the DA intervention (mean age = 68.82 years, SD = 5.33). The intervention consisted of 20 one-hour sessions over the course of 10 weeks (2 sessions per week). Each session started with a 10-minute warm-up followed by 40 minutes of choreographed rhythmic movements and a 10-minute cool-down. The BBS was used to assess each participant's balance before and after the intervention. This 14-item scale is scored from 0 to 4, with a maximum possible score of 56 indicating no balance deficits. Functional reach, item #8, was evaluated by having each participant lift their arms to 90 degrees and reach forward as far as possible while maintaining a stable base of support. The difference in distance of the outstretched arms between standing erect and maximal forward reach was recorded.
Results: A paired-sample t-test was used to determine changes in functional reach. A p-value of <0.05 was utilized to analyze the data sets. There was a statistically significant difference in pre-intervention (M = 25.36, SD = 6.76) and post-intervention (M = 30.38, SD = 7.22) functional reach; t(11) = −5.67, p < 0.001, two-tailed. All participants scored well on the BBS as a whole; thus, no significant differences were observed for the total score.
Conclusions: Findings suggest that a choreographed rhythmic exercise intervention improves functional reach in community-dwelling older adults.
Clinical Relevance: Reducing age-related declines in balance is an essential part of preventing falls. Age-related declines in postural control limit the ability to maintain balance when the center of mass straddles the boundaries of the base of support. Physical therapists are in a unique position to promote novel intervention strategies aimed at improving postural control in older adults.
TITLE: Differences in Subjective Dietary Intake Patterns in Older Adults With and Without Self-Reported Functional Limitations
CURRENT SECTION: Geriatrics
AUTHORS: Megan Ingram, Brandi Brinkman, Claudia E. Diaz, Odessa Rene Addison, Gustavo J. Almeida, Monica Serra
Purpose/Hypothesis: Physical function commonly declines as we age. This decline may make consuming a healthy diet difficult, leading to greater reliance on readily available sources of dietary intake such as “ready-to-eat” or fast food meals. Lack of vital nutrients in these alternative food choices can have adverse effects on health and recovery from illness and injury. The purpose of this study is to explore whether dietary intake differed between those with and without functional limitations.
Number of Subjects: Older adults (>50 years) from the 2015-2016 National Health and Nutrition Examination Surveys (N=324).
Materials and Methods: Individuals reporting no limitations walking up 10 steps or walking a quarter mile were matched for age, gender, and BMI to those reporting limitations performing both tasks (N=162/group). Individuals were included if they had complete data regarding dietary intake from a 24-hr dietary recall and had answered questions regarding: 1) the frequency of consumption of ready-to-eat and fast food meals, 2) consumption of meals at community or senior centers, 3) difficulty using a fork, knife, or drinking cup, and 4) their perceived diet quality.
Results: Subjects were 41% male and, on average (mean±SEM), 67.6±0.5 years old and obese (BMI: 31.7±0.4 kg/m2). Dietary intake of protein (with limitations vs. without limitations: 0.81±0.03 vs. 0.92±0.04 g/kg/d), magnesium (0.15±0.01 vs. 0.19±0.01 mg/kcal/d), lycopene (2.34±0.30 vs. 3.31±0.44 mcg/kcal/d) and potassium (1.33±0.03 vs. 1.42±0.04 mg/kcal/d) differed between the groups (P's<0.05). Furthermore, those with limitations were more likely to consume ready-to-eat foods (2.11±0.48 vs. 1.09±0.20 foods/week) and fast food meals (1.93±0.24 vs. 0.91±0.14 meals/week), eat at community or senior centers (11% vs. 1%), have difficulty using a fork, knife, or drinking cup (10% vs. 3%) and less likely to report their diet as good or excellent (21% vs. 32%) (P's<0.05).
Conclusions: Our results suggest that older adults who report functional limitations consume lower levels of several key nutrients important to various aspects of rehabilitation, including rebuilding injured tissue, minimizing muscle atrophy, and supporting strength preservation. Protein intake for both groups was below the recommendation for older adults (>1.0 g/kg/d), indicating the need to educate this population on ways to incorporate greater protein intake into their diet. The identification of suboptimal dietary patterns may allow for early nutrition intervention to aid in the recovery and rehabilitation of older adults.
Clinical Relevance: Older adults with functional limitations may be at elevated risk for poor dietary intake, including several nutrients identified as important to aid rehabilitation. These data indicate that assessing dietary intake and providing appropriate guidance, counseling, and treatment may prevent rapid declines in functional outcomes and aid rehabilitation in older adults.
TITLE: The Effect of Frailty on Hip Fracture Ambulation Recovery
CURRENT SECTION: Geriatrics
AUTHORS: Kathleen Kline Mangione, Menki Chen, Molly Weingart, Anne Kenny, Arteid Memaj, Melissa F Miller, Rebecca Lynn Craik
Purpose/Hypothesis: The purposes of this study are to identify the prevalence of frailty, as measured by Fried's frailty phenotype, in older adults post hip fracture and to examine its effects on ambulation recovery. This a secondary analysis of a multicenter, randomized clinical trial that examined physical therapy interventions on recovery of community ambulation (CAP).
Number of Subjects: 210 community-dwelling participants aged 60 years or older and within 26 weeks post hospital admission for a hip fracture.
Materials and Methods: CAP compared the effects of a specific, multi-component physical therapy program to an active control of non-specific, multi-component physical therapy program on the participants' ability to ambulate 300 meters in the community 16 weeks after being randomized. The frailty phenotype was derived from the CAP databases. Weight loss was determined through the Mini-Nutritional Assessment; strength was measured a using the chair rise component of the Short Physical Performance Battery (SPPB); gait speed was obtained from the walk test of the SPPB, exhaustion was based off specific responses to the Center of Epidemiologic Depression Scale; inactivity was indicated by responses on the Yale Physical Activity Survey. Frailty was defined as having 3-5 of the traits, pre-frail as having 1-2, and non-frail having none. The outcomes were the total distance walked during the 6-Minute Walk Test (6MWT) and the ability to walk ≥ 300 meters during the 6MWT. ANCOVA test was used to determine correlation between frailty classification and total distance walked. Logistic regression models were used to estimate the probability of being able to walk 300 meters in 6 minutes.
Results: Nine percent of the sample were non-frail, 59% were pre-frail, and 32% were frail. Age and proportion of men increased with degree of frailty. Weakness, slowness, and weight loss were the most prevalent characteristics and expected after hip fracture, however, the majority of frail participants reported exhaustion as well. Walking distance at 16 weeks was highly dependent on frailty status at baseline (p< 0.01); non-frail participants walked 317±87; pre-frail walked 251±78; and frail walked 194±66 meters. 61% of the non-frail group, 22% of the pre-frail, and only 3% of the frail participants were able to walk ≥ 300 meters in the 6MWT. When controlling for treatment group and baseline walking distance, logistic regression models showed the odds of a non-frail patient walking ≥ 300 meters at week 16 were 17 [3.1-140.8] while the odds of a pre-frail patient at baseline were 5 [1.4-36.1] times the odds compared to a frail patient.
Conclusions: Frailty is common among those who sustain hip fractures. Patients who are frail are still able to increase walking distance, but frailty status impacts the change in walking distance as well the ability to achieve community ambulation.
Clinical Relevance: Physical therapists should measure frailty status since baseline frailty is important in making prognoses about recovery potential for ambulation in patients post hip fracture.
TITLE: Virtual Otago Program to Reach Older Adults at Home
CURRENT SECTION: Geriatrics
AUTHORS: LaVerene Marie Garner, Alison Hartman, Sara James Migliarese, Christina May Criminger, Nancy Schneider Smith, Cynthia Bell, Megan Edwards-Collins
Purpose/Hypothesis: Otago is an evidence based fall prevention program that has traditionally been administered 1:1 within the home environment or via in person group classes. Otago has historically been found to reduce falls in frail older adults who are at high risk for falling. Unfortunately, COVID-19 has negatively impacted the ability and/or willingness of older adults to participate in such programming. Social distancing and closure of community resources has left older adults at risk for decreased mobility, loss of social interaction, increased frailty, and a potential increase in risk for falls. One potential and timely solution to this problem for some elderly involves bringing Otago evidence based community engagement classes into their homes virtually. The purpose of this study was to pilot the virtual delivery of Otago for older adults.
Number of Subjects: 12 enrolled in the virtual Otago program.
Materials and Methods: 43 community dwelling older adults completed screening through virtual fall risk assessments conducted through the use of private breakout rooms in Zoom. Following the fall screens a total of 25 participants were referred to the virtual Otago program. A total of 12 participants chose to enroll in the virtual Otago program. The program began with pre-testing consisting of several standardized questions, completion of the Falls efficacy scale-International, and objective tests of physical function as per the Otago protocol. Participants then completed an eight-week group virtual Otago program. Zoom was used to administer the program. Each group intervention session lasted approximately 45 minutes, with one lead Otago instructor and at least 2 Otago trained “spotters”. Weekly check ins were completed with participants to monitor independent exercise completion and ensure proper progression of exercises based on Otago protocol.
Results: 25 participants were referred into the program, 12 chose to participate (8 female, 4 male; mean age: 72.71). At this time, 8 of the 12 participants are on track to attend 80% of the 8 total intervention sessions. Thus far, no adverse events related to performance of the Otago program virtually have occurred.
Conclusions: COVID-19 has led to social isolation and decreased access to fitness facilities. A virtual Otago program offers older adults the opportunity to participate in an evidence based fall prevention with minimal risk to the participant. A virtual platform offers clinicians the opportunity to provide care to individuals living in rural communities and those with less access to transportation.
Clinical Relevance: Virtual delivery of the Otago program through platforms such as Zoom is feasible and may increase access and adherence to evidence-based fall prevention programs while simultaneously increasing program availability for older adults negatively impacted by sheltering in place.
TITLE: Do Older Adults Need Skill in Addition to Speed to Function?
CURRENT SECTION: Geriatrics
AUTHORS: Madison K. Farren, Anthony Joseph McBroom, Kristin Ann Lowry, Jessie M. VanSwearingen
Purpose/Hypothesis: Slow straight path gait speed predicts physical and cognitive function decline, falls and mortality,1-4 but does good speed guarantee good function in daily life? The Figure-of-8 Walk Test (F8WT) of motor skill of walking requires curved and straight path walking, direction changes, navigation and planning.5-7 To understand if motor skill of walking is important to function in older adults with near normal gait speed, we examined differences in physical and cognitive function between those with good vs. poor F8WT performance.
Number of Subjects: Community-dwelling older adults, n=80
Materials and Methods: Secondary analyses of data previously collected in aging mobility studies were conducted. Measures included usual straight path walking over an instrumented walkway, the F8WT, the Late-Life Function & Disability Instrument (LLFDI),8 and executive function assessment (either Montreal Cognitive Assessment, MoCA, n=21; or Trails B, n=59). Variables derived were gait speed and means and standard deviations for step length, step time, and stride width during usual walking; F8WT time and steps; physical function, LLFDI Overall, Basic Lower Extremity (BLE) and Advanced Lower Extremity (ALE) function, higher scores better, and executive function, MoCA-EF subscale, max score 5, and Trails B time. Only data from participants with a usual gait speed of ≥1.1m/s included; classified into good motor skill (GMS) = F8WT<8sec, n=42, and poor motor skill (PMS)= F8WT≥8sec, n=38, of walking. Group differences in usual walking and executive function were determined using ANOVAs. Univariate analyses were conducted for each physical function measure as the dependent variable, motor skill of walking group as the independent variable and controlled for age, usual gait speed and step length.
Results: Those with PMS compared to GMS were older and had a slower usual gait speed and shorter step length (mean±SD: age 75.7±6.3 vs 72.0±7.0, gait speed 1.24m/s±0.11 vs 1.31m/s±0.13, step length 0.64m±0.05 vs 0.69m±.05; p<.015); no group differences in other straight path walking variables. Univariate analyses revealed that compared to GMS, those with PMS had reduced Overall (63.4±7.4 vs 70.7±8.3), BLE (74.3±10.3 vs 88.5±11.9) and ALE (56.3±10.7 vs 66.3±13.0) function, p<.019 for all. Compared to GMS, those with PMS had a lower MoCA EF subscale score (3.67±1.0 vs 4.53±0.74; p=.043) or a slower time to complete Trails B (108s ±42.8 vs 83.9s±26.4 p=.014).
Conclusions: In older adults walking with good usual straight path gait speed, those with poor motor skill of walking exhibited reduced physical and executive cognitive function. The motor skill embedded in the F8WT appears critical to daily life function, even if gait speed is near normal.
Clinical Relevance: Even with normal or near normal gait speed, for older adults who are slow to complete the F8WT, referral to a physical therapist for rehabilitation to restore motor skill of walking is important. Preventing loss in the motor skill of walking may ultimately maintain daily life physical function and reduce falls.
TITLE: Piloting a Post-Discharge, Home-Based Falls Prevention Program for Older Adults
CURRENT SECTION: Geriatrics
AUTHORS: Edgar Vieira, Destinee Elizabeth Bragwell, Catherine Frampton, Amber Rusher, Gabrielle Murphy, Amanda Wieder, Vida Alejandra Samcam, Keila Matos, Starlie Belnap, Amy Starosciak, Sergio Gonzalez-Arias
Purpose/Hypothesis: At least one-third of older adults fall each year. Falls can cause injuries leading to hospitalization and disability. Exercise can help reduce falls in older adults, but little is known about its effectiveness in preventing subsequent falls among those that have been hospitalized. The objectives of this study were to pilot test the feasibility of implementing a post-discharge exercise program for falls prevention in older patients and evaluate the effects on gait, strength, and balance.
Number of Subjects: Six subjects (3 in the control and 3 in the intervention group) completed this pilot study.
Materials and Methods: After signing an informed consent form, patients ≥60 years old being treated for fall-related injuries were randomly assigned into the intervention (exercise program) or control group. All participants were assessed at baseline, 3 and 6 months; the assessments included a health questionnaire, gait analysis during preferred and fast walking speeds using an instrumented mat and the timed up and go (TUG) test, the Tinetti balance assessment, and the 30s chair stands test.
Results: At 6 months, the preferred walking speed increased by 16% for the control group and 31% for the intervention group, while the fast walking speed increased by 7% and 16%, respectively. Stance time during preferred walking speed decreased by 8% for the control group and 13% for the intervention group, while during fast walking it decreased by 3% and 9%. Step length during preferred walking increased by 18% for both groups, while during fast walking it increased by 2% and 6% for the control and intervention groups. Stride width increased by 2% during preferred walking speed and by 8% during fast walking in the control group; on the other hand, for the intervention group, it decreased by 9% and 11%. Balance scores increased by 11% for both groups, and TUG times decreased by 9% for the control and 11% for the intervention group.
Conclusions: The findings demonstrate that it was feasible and helpful to implement a post-discharge, home-based falls prevention program. The intervention group had larger improvements in gait after six months than the control group, but improvements in balance were similar.
Clinical Relevance: Reducing subsequent falls after discharge is important to decrease the incidence of new injuries and re-hospitalizations. Home-based exercise programs can help improve physical function (gait, balance and strength) reducing the risk of falls.
TITLE: Effectiveness of Virtual Fall Prevention Education and Mobility Training for Patients Discharged From an Iru
CURRENT SECTION: Geriatrics
AUTHORS: Alicia Lynn Soto, John J. Kelly
Purpose: Telemedicine has been shown to be effective for multiple rehabilitation patient populations; however, no research has investigated the use of telemedicine or virtual education for fall prevention in patients discharged from an inpatient rehabilitation unit (IRU). This abstract describes the development of an IRU research project that will assess the efficacy of virtual education and training to prevent future falls and improve balance confidence in patients discharged from an IRU. The study will also aim to determine patient and/or caregiver satisfaction with the use of virtual education and training methods.
Description: Subjects will be recruited from a single IRU located within an urban academic medical center. Prior to discharge each patient and a family member/caregiver will receive standardized fall prevention education via a virtual platform. For patients who are unable to mobilize independently, family members and/or caregivers will also participate in mobility training in-person, via a video conference platform, or via both mechanisms. The following are the study's primary outcome measures: Self-reported or caregiver reported falls frequency at 1 and 3 months post discharge, self-reported or caregiver reported adherence to falls prevention education and therapy recommendations, self-reported or caregiver reported satisfaction with virtual fall prevention education, and change in patient balance confidence as measured by the Activities-Specific Balance Confidence Scale.
Summary of Use: Fall prevention education and mobility training are important IRU interventions, particularly on a unit with a predominately geriatric patient population. The expectation on an IRU is that all patients and families/caregivers will receive falls prevention education prior to a community-based discharge. A virtual link that is emailed to patients and caregivers is a low-cost intervention that reviews fall risk for an aging population and will also provide fall prevention strategies including medical and medication management, home adaptations, and mobility and equipment recommendations. The use of a virtual platform for family/caregiver education ensures that all caregivers receive mobility training even if the ability to train onsite is limited or restricted.
Importance to Members: The COVID-19 pandemic has changed the way that Physical Therapists deliver patient care. Therapists have had to adapt best practices to adhere to evolving hospital visitation guidelines while also treating more medically complex patients. As restrictions due to COVID-19 are expected to continue until a vaccine or effective treatment(s) are developed, a low-cost alternative process to deliver patient education is required. We view falls prevention education and mobility training as vital IRU PT interventions that promote successful return to the community with the goal to prevent injury and hospital readmission. This study is important because it will investigate both the effectiveness of virtual education and training methods as well as patient/caregiver satisfaction with these alternative modes of information delivery.
TITLE: The Effect of Cognitive Demands on the Four Square Step Test in Older Adults
CURRENT SECTION: Geriatrics
AUTHORS: Melissa Marie Taylor, Mike T. Studer, Sean Michael Cometto, Jordan Tesch, Tyler Chad Anderson, Gabriel William Goehring, Joel Douglas Spiehs
Purpose/Hypothesis: Daily functional activities for all individuals involve cognitive dual-tasking. These consist of a combination of activities such as walking, thinking, talking, reading, etc. Balance in older adults can be challenged when dual-tasking throughout the day and has been shown to increase the risk of falls. The Four-Square Step Test (FSST) is a valid and reliable dynamic balance assessment that helps to determine if a patient is at risk for falls. However, the FSST does not incorporate a cognitive dual task component. Adding a cognitive dual-task to the FSST may be a more valid assessment for overall mobility and balance in older adults. The purpose of this study was to obtain normative data for the FSST with the addition of a cognitive dual task (FSST-DT) in the community dwelling older adult population. The hypothesis was that there would be a significant increase in time for participants when comparing the standard FSST to the FSST-DT.
Number of Subjects: 36 participants (male and female) 65 years of age and older participated in the study. Participants were divided into two groups, fallers and non-fallers, based on if they had fallen in the last year. Eight participants were considered fallers and 28 participants were considered non-fallers.
Materials and Methods: Participants completed the FSST and FSST-DT to determine if cognitive dual-tasking would have an impact on the time to complete the assessment. The participants first performed 2 timed trials of the standard FSST and then 2 timed trials of the FSST-DT using a self-selected cognitive task. The fastest time for each assessment was recorded and the difference in time was calculated. The cognitive dual-task that was used during the FSST-DT was selected by each participant to improve autonomy (calculation, word generation, working memory recall, spelling backwards).
Results: A T-test was ran to measure the mean score of both groups. The statistically significant mean score (p-value <.0001) for all participants for the standard FSST was 11.87 sec and for the FSST-DT was 14.44 sec. The mean time difference between the 2 assessments was 2.57 sec. There was not a statistically significant difference between the standard FSST and the FSST-DT between the 2 separate groups of fallers and non-fallers.
Conclusions: The data shows that the addition of a dual-task component to FSST results in a significant increased amount of time (2.57 sec) to perform the assessment as hypothesized.
Clinical Relevance: The FSST-DT may be a valid test that can be used by healthcare professionals to identify if a patient is at an increased risk of falling. It is an easy assessment for PTs to perform in the clinical setting that better identifies functional balance impairments. It would be reasonable to expect that a patient could be considered at risk of falls if their time difference between the FSST-DT and the standard FSST was significantly more than the 2.57 sec threshold that was found in this study. Additional continuation studies are warranted to improve the validity of the FSST-DT, investigate the mode of distraction effect, develop normative data for different age groups, and to determine a fall risk cutoff score.
TITLE: State Senior Games Participants: Analyses of Senior Athlete Fitness Exam Results Related to Fall Risk
CURRENT SECTION: Geriatrics
AUTHORS: Kristin Thomanschefsky, Emily Margaret Matlack, Samantha Lee Nofsinger, Bradley Tavernier, Chloe Victoria Tuma, John S. Schmitt, Becca D. Jordre
Purpose/Hypothesis: Falls in older adults remain a significant area of concern, with 30% of adults over age 65 experiencing at least one fall annually. Physical performance measures of grip strength, lower extremity strength, ankle flexibility, balance, and gait speed have been found to be correlated with functional decline and falls in community-dwelling older adults. However, little is known about the fall risks associated with higher functioning seniors, including those involved in competitive sports.
Number of Subjects: 723
Materials and Methods: De-identified Senior Athlete Fitness Exam (SAFE) data from state-level Senior Games participants were analyzed. Participants that reported a history of falling in the past year were compared to non-fallers on age, sex, number of co-morbidities, and selected SAFE measures of physical health known to correlate with fall risk in community-dwelling older persons. Chi-square was used to test for association between categorical variables. Mann-Whitney U tests were used to examine between-group differences for continuous variables with non-normal distributions. Median values with interquartile range are reported for each comparison.
Results: Data from 723 senior athletes representing 12 states were analyzed. Mean age was 67.4 (sd=9.7) years and the sample was 49% female. There were a total of 93 subjects reporting one or more falls (12.6%) with 26 athletes (3.5%) reporting multiple falls. Fall prevalence for the subset of participants 65 and older increased to 14.3%. There was a significant association between fall history and sex with 59.6% of the fallers being female (p=.04). Fallers were older (68.5 (63-78) vs 67 (60-74) years; p=0.025), had more comorbidities (2 (1-3) vs. 1 (0-2); p<.001), weaker grip (29.5 (25.0-37.5) vs 36 (27.6-45.3) kg; p<.001), were slower on the five times sit to stand test (8.3 (6.5-10.4) vs. 7.3 (6.1-8.9) sec); p=.012), and stood for fewer seconds on the single leg stance (SLS) balance test with eyes closed on a firm surface (4.1 (2.2-7.8) vs. 5.2 (3.2-9.0) sec; p=.016) as well as with eyes open on a foam pad (9.3 (5.6-30) vs. 15 (3.9-18.4) sec; p=.004). SLS with eyes open was not analyzed as 72% of the athletes achieved the maximum score of 30 seconds. There were no significant differences between fallers and non-fallers for typical or fast gait speed, or with ankle dorsiflexion range of motion.
Conclusions: Senior athletes reported a lower rate of falls than community-dwelling older adults. Physical performance measures associated with a history of falls in senior athletes included grip strength, five times sit to stand, and SLS on a foam pad or with eyes closed. Other significant factors included older age, female gender, and a greater number of comorbidities. Gait speed was not significantly associated with a history of falls.
Clinical Relevance: Grip strength, five times sit to stand, and SLS on foam or with eyes closed were most predictive of falls in a senior athlete population.
TITLE: Fall Risk Identification Across Height Groups: Forward Functional Reach Comparison to Other Fall Risk Measures
CURRENT SECTION: Geriatrics
AUTHORS: Jill Elaine Heitzman, Jennifer Canbek, Shari Ann Rone-Adams, Steven Bryce Chesbro
Purpose/Hypothesis: The Forward Functional Reach (FFR) test assesses anterior/posterior movement to identify fall risk. Previous studies have used the same cut value to identify fall risk for all people of all height groups. The purpose of this study was to determine a correlation between FFR and other fall risk measures based on individual height.
Number of Subjects: 66
Materials and Methods: Participants age 60 plus were recruited from a senior activity center. Participants' height was measured using a stadiometer then each performed FRR test using the 1-arm reaching method per the protocol by Duncan et al (1990) followed by completing: Fall/medical history, Activities Based Confidence Scale, Timed up and Go, & grip strength. Analysis utilized descriptive statistics and a Pearson correlation between FFR and each outcome measure.
Results: Sixty-six participants were stratified into height groups: < 65”, 65” to 69”, >69”. Using 10” cut value for all groups, low correlations were found between FFR and each measure: Grip Strength: +0.45, ABC: +0.25, Fall history: +0.05 and TUG:-0.33. Only the medium height group was accurately identified as fall risk by the FFR when identified by at least one other measure. FFR only correctly identified 34% participants in the short height and 53% participants in the tallest height group as fall risk when compared to the other measures.
Conclusions: Using the current criterion of a single value (10”) as a cutoff for FFR is not supported by this study; with results of 66% false positives in the short height group and 47% false negative in the tall height group. Future studies should look at individual markers of fall risk for the FFR based on height of the individual.
Clinical Relevance: Falls are a major cost to the health care system as well as impacting quality of life of individuals. Early recognition if important to provide necessary interventions. The current Fall risk cut value does not accurately identify fall risk across all height groups resulting in many taller individuals being missed by this screening tool as well as increasing fear of falling in the false positives of the shorter height group resulting in decreased physical activity. Cut Scor Values need to be developed based on height to more accurately identify fall risk.