Alexandra Halvarsson

Balance training with multi-task exercises improves fall-related self-efficacy, gait, balance performance and physical function in older adults with osteoporosis: a randomized controlled trial

Objective: To evaluate the effects of a balance training program including dual- and multi-task exercises on fall-related self-efficacy, fear of falling, gait and balance performance, and physical function in older adults with osteoporosis with an increased risk of falling and to evaluate whether additional physical activity would further improve the effects. Design: Randomized controlled trial, including three groups: two intervention groups (Training, or Training+Physical activity) and one Control group, with a 12-week follow-up. Setting: Stockholm County, Sweden. Participants: Ninety-six older adults, aged 66-87, with verified osteoporosis. Interventions: A specific and progressive balance training program including dual- and multi-task three times/week for 12 weeks, and physical activity for 30 minutes, three times/week. Main measures: Fall-related self-efficacy (Falls Efficacy Scale-International), fear of falling (single-item question – ‘In general, are you afraid of falling?’), gait speed with and without a cognitive dual-task at preferred pace and fast walking (GAITRite®), balance performance tests (one-leg stance, and modified figure of eight), and physical function (Late-Life Function and Disability Instrument). Results: Both intervention groups significantly improved their fall-related self-efficacy as compared to the controls (p ≤ 0.034, 4 points) and improved their balance performance. Significant differences over time and between groups in favour of the intervention groups were found for walking speed with a dual-task (p=0.003), at fast walking speed (p=0.008), and for advanced lower extremity physical function (p=0.034). Conclusions: This balance training program, including dual- and multi-task, improves fall-related self-efficacy, gait speed, balance performance, and physical function in older adults with osteoporosis.

Long-term effects of new progressive group balance training for elderly people with increased risk of falling – a randomized controlled trial:

Objective: To evaluate the long-term effects of a progressive and specific balance group-based program in healthy elderly individuals with increased risk of falling. Design: Follow-up of a randomized controlled trial at nine and 15 months on a population that has previously been described at three months. Setting: The study was conducted in Stockholm, Sweden. Subjects: 59 community-dwelling elderly (age 67–93 years), recruited by advertisement, were randomly allocated to training or to serve as controls. Intervention: Group balance training three times per week during 12 weeks with a 15 month follow-up time. Main measures: Participants were assessed at baseline, three, nine, and 15 months thereafter for gait function (preferred and fast walking), rapid step execution (single and dual task), fear of falling, and likelihood of depression. Results: Fast gait speed (p = 0.004), dual task step execution (p = 0.006) and fear of falling (p = 0.001) were still improved in the training group at nine months follow-up. Only self-perceived fear of falling remained significantly improved (p = 0.012) at 15 months follow-up. Although fast gait speed had decreased to baseline level in the training group (1.49 m/s) it remained significantly higher than in the control group (1.37 m/s) at the end of the study, a difference between the groups that was not seen at baseline. Conclusion: This training program provided important positive short and long-term benefits to gait, balance function, and fear of falling.

Assessing the relative and absolute reliability of the Falls Efficacy Scale-International questionnaire in elderly individuals with increased fall risk and the questionnaire’s convergent validity in elderly women with osteoporosis

SummaryThe Falls Efficacy Scale-International (FES-I) is a highly reliable questionnaire for assessing fear of falling in elderly individuals with increased fall risk and has low or no convergent validity with balance performance tests and health-related quality of life (HRQL) among elderly women with osteoporosis, which indicates that both measurements should be included as they are measuring different components.IntroductionFear of falling is increased in elderly individuals with osteoporosis and FES-I is a widely used questionnaire to assess fear of falling. There is limited evidence of the reliability and convergent validity in elderly with increased risk of falling and osteoporosis.MethodsReliability and validity study of the FES-I. Community-dwelling elderly with increased fall risk, 59 subjects, were recruited to the reliability assessment, and 81 women with osteoporosis, in the validity assessment. For the reliability assessment, two postal surveys were used. For the validity assessment, we used baseline data from an on-going study in women with osteoporosis. The FES-I was correlated to a single-item question regarding fear of falling, self-reported history of falls, balance performance tests and health-related quality of life.ResultsThe FES-I had very good relative reliability (intra-class correlation 0.88) and internal consistency reliability (Cronbach’s alpha 0.94). The value for absolute reliability was a standard error of measure 2.9 (10.6xa0%), smallest real difference 7.9 (29xa0%). There was “little if any” to “low” correlation between the FES-I and the single-item question regarding fear of falling and self-reported history of falls, HRQL and balance performance tests.ConclusionThe FES-I seems to be a highly reliable questionnaire for assessing fear of falling in elderly with increased fall risk but has low relation to/convergent validity with balance performance and HRQL among elderly women with osteoporosis.

Taking balance training for older adults one step further: the rationale for and a description of a proven balance training programme:

Objective: To give the rationale and evidence for and a detailed description of a rehabilitation programme of proven effectiveness in improving balance in older adults. Background theory and evidence: Based on the knowledge that balance loss usually occurs in situations when attention is divided, especially when being older, and that balance control relies on the interaction of several physiological systems, we have developed a specific and progressive balance training programme with dual- and multi-task exercises for older adults. Practical application: Balance demanding exercises, specific to the various components of balance control and to situations in daily life, were performed in sitting, standing and walking at three different levels of progression (basic, moderate and advanced) of increasing difficulty and complexity. The training was performed in 45-minutes group sessions, with 6–10 participants in each group, three times per week during 12 weeks, with two or three physiotherapists present. Conclusions: This balance training programme strengthens self-efficacy in balance control leading to improved fall-related self-efficacy, reduced fear of falling, increased walking speed, and improved physical function. Participants found the programme motivating, valuable, fun, and enjoyable, which was reflected in a high attendance rate.

Long-term effects of a progressive and specific balance-training programme with multi-task exercises for older adults with osteoporosis: a randomized controlled study

Objective: To evaluate long-term effects of balance-training on concerns about falling, gait, balance performance, and physical function in older adults with osteoporosis and increased risk of falling. Design: Randomized controlled trial, including three groups (training, training+physical activity, and control group), with follow-ups at three, nine, and 15u2009months. Short-term, three-month follow-up, benefits for those who fulfilled the first follow-up (nu2009=u200969) have previously been reported. Setting: Stockholm, Sweden. Participants: A total of 96 elderly, age 66–87, with verified osteoporosis. Interventions: Balance-training programme including dual- and multitasks, with or without supplementary physical activity, three times/week over 12u2009weeks. Measurements: Concerns about falling Falls Efficacy Scale -International (FES-I), walking at preferred speed with and without a cognitive dual-task and at fast speed, balance tests (one-leg stance and modified figure-of-eight), and physical function Late-Life Function and Disability Instrument (LLFDI). Results: Participants in the training group maintained positive effects throughout the study period for concerns about falling (baseline vs. 15u2009months, median 27.5 vs. 23 points, pu2009<u20090.001) and walking performance (baseline vs. 15u2009months, pu2009⩽u20090.05 with an improvement of 0.9–1.4u2009m/s). The Training+physical activity group declined to baseline values at the nine-month follow-up, and were even lower at the 15-month follow-up for concerns about falling (median 26 vs. 26 points), walking performance (changes of −0.02 to 0.04u2009m/s), and physical function (mean 44.0 vs. 42.9u2009points). The control group remained unchanged throughout the study period. Conclusions: This balance-training programme reduced concerns about falling, and also improved gait in older adults with osteoporosis and increased risk of falling in a long-term perspective – important issues for fall prevention.

Task-specific balance training improves self-assessed function in community-dwelling older adults with balance deficits and fear of falling: a randomized controlled trial

Objective: To evaluate the effects of a 12-week balance training programme on self-assessed function and disability in healthy community-dwelling older adults with self-perceived balance deficits and fear of falling. Design: A prospective, randomized controlled trial. Setting: Stockholm County, Sweden. Participants: A total of 59 community-dwelling older adults (42 women and 17 men) aged 67–93 were randomized to either an intervention group (n = 38) or to serve as controls (n = 21) after baseline testing. Intervention: The intervention was a 12-week, three times per week, progressive, specific and individually adjusted group balance-training programme. Main measures: Self-perceived function and disability measured with Late Life Function and Disability Instrument. Results: The intervention group reported improvement in overall function (p = 0.016), as well as in basic (p = 0.044) and advanced lower extremity function (p = 0.025) compared with the control group. The study showed no improvement in overall disability or upper extremity function. Conclusion: This group balance training programme improves self-assessed function in community-dwelling older adults with balance deficits and fear of falling.

Relative and absolute reliability of the new "Step-Ex" step-execution test in elderly people with and without balance problems

Purpose: To evaluate the relative and absolute test–re-test reliability of a new step-execution test, “Step-Ex”, for clinical use in elderly with and without balance problems. Method: Test–re-test design to assess intrarater reliability. Thirty-four healthy community-dwelling elderly (65–87 years), 16 with balance problems, were tested twice two weeks apart. Step-Ex consists of two portable force platforms that register vertical ground reaction forces connected to a computer for easy detection of temporal events and phases (reaction-, preparation-, stepping- and step execution phase). Standing with one foot on each platform, the subjects were given a tactile stimulus on the heel to initiate rapid steps forward. Results: Test–re-test agreement was good to very good: ICC2.6 0.83–0.87 (without balance problems) and 0.71–0.83 (with balance problems) with no apparent systematic differences between the tests. The SEM, i.e. the smallest detectable change that may indicate a real clinical improvement for a group of individuals was small, 4.6–8.6%. The smallest real difference, representing the smallest change that reveals clinical improvement for a single individual, was 13–24%. Conclusion: Step-Ex is a highly reliable instrument and can be recommended as an outcome measure evaluating the effects of balance training in elderly people with and without balance deficits. Implications for Rehabilitation Balance deficits are common in the elderly population. To evaluate the effects of treatment or changes over time it is of great importance to have reliable instruments. Step-Ex is a highly reliable instrument and can be recommended as an outcome measure evaluating the effects of treatment or changes over time in elderly people with and without balance deficits.

Long-term effects of self-reported physical function and disability after participation in an individually adjusted and specific progressive balance training programme for older adults with fear of falling and tendency to fall

Abstract Purpose: To evaluate the long-term effects from a 12-week balance-training programme on self-rated physical function and disability in healthy older adults with a tendency to fall and fear of falling. Method: RCT, 59 participants, 67–93 years (42 women). The participants were randomised to an exercise group (nu2009=u200938) and a control group (nu2009=u200921). The intervention consisted of a specific and progressive balance-training programme three times/week for 12 weeks and was evaluated using the Late-Life Function and Disability Instrument (LLFDI) before training, directly after the training period and 6 and 12 months thereafter training. Data were analysed using a mixed model. Results: Significant effects were found regarding physical function: ‘Functioning total’, ‘Basic lower extremity’ and ‘Advanced lower extremity’ in favour for the Exercises group. The exercise group improved significantly from baseline to directly after the training. At the 6 months follow-up, the effects had decreased to values similar to before the training, and remained unchanged until the 12 months follow-up. No significant effects regarding disability were found. The control group remained unchanged over time. Conclusion: No long-term effects were found for physical function or disability assessed with the LLFDI after participation in a specific and progressive balance-training programme for healthy older adults.

Self-reported musculoskeletal complaints and injuries and exposure of physical workload in Swedish soldiers serving in Afghanistan

Background Musculoskeletal complaints and injuries (MSCI) are common in military populations. However, only a limited number of studies have followed soldiers during international deployments and investigated the prevalence of MSCI during and at the end of their deployment. The aim was to describe the prevalence of MSCI in different military occupational specialties and categorise their most common tasks in terms of exposures to physical workloads during a six-month long international deployment in Afghanistan. Methods Cross-sectional survey, including 325 soldiers (300 men), aged 20–62 participating in an international deployment in Afghanistan during the spring of 2012. Soldiers were clustered into different military occupational specialties: Infantry, Administration, Logistics, Logistics/Camp, Medical and Other. Data were collected through the use of the Musculoskeletal Screening Protocol at the end of the international mission. Results Forty-seven percent reported MSCI during deployment, with 28% at the end. The most common locations of MSCI during the mission were lower back, knee, shoulders, upper back, neck and foot, while the knee and lower back prevailed at the end of the mission. Almost half of the soldiers who had MSCI reported affected work ability. The most common duties during the mission were vehicle patrolling, staff duties, guard/security duties, foot patrols and transportation. Soldiers reported that vehicle patrolling, staff duties and transportation were demanding with respect to endurance strength, guard/security duties challenged both maximum and endurance strength while foot patrolling challenged maximum and endurance strength, aerobic and anaerobic endurance and speed. Conclusions MSCI during international deployment are common among Swedish soldiers. The results indicate the need to further develop strategies focusing on matching the soldiers’ capacity to the job requirements, with relevant and fair physical selection-tests during the recruitment process and proactive interventions targeting MSCI before and during deployment, in order to enhance soldiers’ readiness and promote operational readiness.

Psychometric properties of the Swedish version of the Falls Efficacy Scale-International for older adults with osteoporosis, self-reported balance deficits and fear of falling

Abstract Purpose: Investigate the psychometric properties of the Swedish version of the Falls Efficacy Scale-International (FES-I). Method: Cross-sectional study. Community-dwelling older adults with self-reported balance deficits and fear of falling were recruited from an ongoing randomised controlled study to evaluate the psychometric properties of the FES-I using Rasch model analysis. Results: The Rasch model analysis revealed good category function, the questionnaire measured one dimension with an explained variance of 68.6% and item goodness-of-fit with mean square values (MnSq) 0.7–1.44. The item map showed that all items are spread over the scale, which indicates different difficulties in the items. Non-satisfactory person goodness-of-fit was shown with seven persons and showed person misfit according to both the MnSq-value and the z-value, 38 persons (40%) showed a person misfit when only following the threshold for MnSq. Conclusions: The Swedish version of FES-I shows good psychometric properties with unidimensionality and item goodness-of-fit. Lower person goodness-of-fit was shown probably because of confounding factors that may influence the answers. The transformed values of the FES-I make it possible to use parametric statistics preferable for this population in future research. Implications for rehabilitation The Falls Efficacy Scale-International (FES-I) shows good psychometric properties with unidimensionality, item goodness-of-fit and good item reliability, which means that FES-I is a valuable tool when measuring concerns about falling in an older population with osteoporosis and could be useful in clinical settings. Confounding factors such as pain, high number of falls, low fall self-efficacy, experience of previous falls, and vertigo may influence the answers and result in low person goodness-of-fit.