Anne Tiedemann

Reliability of the GAITRite® walkway system for the quantification of temporo-spatial parameters of gait in young and older people

The purpose of this study was to evaluate the test-retest reliability of an instrumented walkway system (the GAITRite mat) for the measurement of temporal and spatial parameters of gait in young and older people. Thirty young subjects (12 males, 18 females) aged between 22 and 40 years (mean 28.5, S.D. 4.8) and 31 older subjects (13 males, 18 females) aged between 76 and 87 years (mean 80.8, S.D. 3.1) walked at a self-selected comfortable walking speed across the pressure-sensor mat three times and repeated the process approximately 2 weeks later. Intra-class correlation coefficients (ICC), coefficients of variation (CV) and 95% limits of agreement were then determined. For both groups of subjects, the reliability of walking speed, cadence and step length was excellent (ICCs between 0.82 and 0.92 and CVs between 1.4 and 3.5%). Base of support and toe in/out angles, although exhibiting high ICCs, were associated with higher CVs (8.3-17.7% in young subjects and 14.3-33.0% in older subjects). It is concluded that the GAITRite mat exhibits excellent reliability for most temporo-spatial gait parameters in both young and older subjects, however, base of support and toe in/out angles need to viewed with some caution, particularly in older people.

Exercise to prevent falls in older adults: an updated meta-analysis and best practice recommendations

This systematic review update includes 54 randomised controlled trials and confirms that exercise as a single intervention can prevent falls (pooled rate ratio 0.84, 95% CI 0.77-0.91). Meta-regression revealed programs that included balance training, contained a higher dose of exercise and did not include walking training to have the greatest effect on reducing falls. We therefore recommend that exercise for falls prevention should provide a moderate or high challenge to balance and be undertaken for at least 2 hours per week on an ongoing basis. Additionally, we recommend that: falls prevention exercise should target both the general community and those at high risk for falls; exercise may be undertaken in a group or home-based setting; strength and walking training may be included in addition to balance training but high risk individuals should not be prescribed brisk walking programs; and other health-related risk factors should also be addressed.

Physical activity interventions for people with mental illness: a systematic review and meta-analysis

OBJECTIVE To determine effects of physical activity on depressive symptoms (primary objective), symptoms of schizophrenia, anthropometric measures, aerobic capacity, and quality of life (secondary objectives) in people with mental illness and explore between-study heterogeneity. DATA SOURCES MEDLINE, Cochrane Controlled Trials Register, PsycINFO, CINAHL, Embase, and the Physiotherapy Evidence Database (PEDro) were searched from earliest record to 2013. STUDY SELECTION Randomized controlled trials of adults with a DSM-IV-TR, ICD-10, or clinician-confirmed diagnosis of a mental illness other than dysthymia or eating disorders were selected. Interventions included exercise programs, exercise counseling, lifestyle interventions, tai chi, or physical yoga. Study methodological quality and intervention compliance with American College of Sports Medicine (ACSM) guidelines were also assessed. DATA EXTRACTION AND ANALYSIS Two investigators extracted data. Data were pooled using random-effects meta-analysis. Meta-regression was used to examine sources of between-study heterogeneity. RESULTS Thirty-nine eligible trials were identified. The primary meta-analysis found a large effect of physical activity on depressive symptoms (n = 20; standardized mean difference (SMD) = 0.80). The effect size in trial interventions that met ACSM guidelines for aerobic exercise did not differ significantly from those that did not meet these guidelines. The effect for trials with higher methodological quality was smaller than that observed for trials with lower methodological quality (SMD = 0.39 vs 1.35); however, the difference was not statistically significant. A large effect was found for schizophrenia symptoms (SMD = 1.0), a small effect was found for anthropometry (SMD = 0.24), and moderate effects were found for aerobic capacity (SMD = 0.63) and quality of life (SMD = 0.64). CONCLUSIONS Physical activity reduced depressive symptoms in people with mental illness. Larger effects were seen in studies of poorer methodological quality. Physical activity reduced symptoms of schizophrenia and improved anthropometric measures, aerobic capacity, and quality of life among people with mental illness. TRIAL REGISTRATION PROSPERO registration #CRD42012002012.

A pilot study of long-term monitoring of human movements in the home using accelerometry

We assessed the feasibility of using a waist-mounted, wireless triaxial accelerometer (TA) to monitor human movements in an unsupervised home setting to detect changes in functional status. A pilot study was carried out with six healthy subjects aged 80–86 years. The subjects wore a TA unit every day for two to three months. Each morning they carried out a short routine of directed movements that included standing, sitting, lying and walking. Important movement variables were measured. During the rest of the day, subjects were monitored for falls, and variables such as metabolic energy expenditure were measured. All subjects remained healthy; there was no overall change in functional status and there were only slight fluctuations in health status. No longitudinal changes were detected in any of the variables measured during the directed routine. There was a moderate correlation between weekly self-reported health status and energy expenditure: subjects reported a lower health status for weeks in which they expended less energy. The TA system was found to be practical for long-term, unsupervised home monitoring. All subjects found the system simple to use and the TA unit unobtrusive and comfortable to wear. High compliance rates were achieved: the TA units were worn on 88% of the days in the study, for an average of 11.2 hours per day.

The Effect of an Individualized Fall Prevention Program on Fall Risk and Falls in Older People: A Randomized, Controlled Trial

Objectives: To determine whether an individualized falls prevention program comprising exercise, visual, and counseling interventions can reduce physiological falls risk and falls in older people.

Physiological and Psychological Predictors of Walking Speed in Older Community-Dwelling People

Background: Six-metre walking speed (SMWS) is a commonly used test for measuring functional performance in older people. However, apart from lower limb strength, few studies have examined the range of physiological and psychological factors that influence performance in this test. Objective: To investigate the relative contributions of a range of sensorimotor, balance and psychological factors to SMWS in a large sample of older people. Methods: 668 community-dwelling people aged 75–98 years (mean age 80.1, SD = 4.4) underwent the SMWS test as well as quantitative tests of vision, peripheral sensation, strength, reaction time, balance, fear of falling, pain and vitality. Results: Many physiological and psychological factors were significantly associated with SMWS in univariate analyses. Stepwise multiple regression analyses revealed that a composite lower limb strength measure (sum of knee extension, knee flexion and ankle dorsiflexion muscle strength scores), postural sway, leaning balance as assessed with the coordinated stability test, reaction time, edge contrast sensitivity, SF12 body pain and vitality scores and age were significant and independent predictors of SMWS. Of these measures, the combined lower limb strength measure had the highest beta weight indicating it was the most important variable in explaining the variance in SMWS. However, the other sensorimotor, balance and psychological measures each provided important independent information. The combined set of variables explained 40% of the variance in SMWS (multiple r = 0.63). Conclusions: The findings indicate that in community-dwelling older people, self-selected walking speed is influenced not only by lower limb strength but also by balance, reaction time, vision, pain and emotional well-being.

Age and gender differences in seven tests of functional mobility

BackgroundThe objective of this study was to examine age and gender differences in seven tests of functional mobility.MethodsThe study included 50 young participants aged 20 to 39 years, and 684 older participants aged 75 to 98 years. Functional mobility measures included the coordinated stability test, the near tandem balance test, the six metre walk test, the sit to stand test with five repetitions, the alternate step test and the stair ascent and descent tests.ResultsOlder participants performed significantly worse than the younger participants in all of the functional mobility tests (p < 0.001), with the older women performing worse than the older men in all of the tests (p < 0.05). Significant correlations were found within the older group among all the functional mobility tests scores (r = 0.24–0.87, p < 0.001), and between functional mobility performance and age (r = 0.14–0.35, p < 0.001). People with arthritis and stroke performed worse than people without these conditions in these tests.ConclusionThis study provides a normative database for performance of young and older community-dwelling people in a battery of validated and reliable functional mobility tests. The results confirm age-related differences in functional mobility between young and older adults.

Exercise to prevent falls in older adults: an updated systematic review and meta-analysis

Objective Previous meta-analyses have found that exercise prevents falls in older people. This study aimed to test whether this effect is still present when new trials are added, and it explores whether characteristics of the trial design, sample or intervention are associated with greater fall prevention effects. Design Update of a systematic review with random effects meta-analysis and meta-regression. Data sources Cochrane Library, CINAHL, MEDLINE, EMBASE, PubMed, PEDro and SafetyLit were searched from January 2010 to January 2016. Study eligibility criteria We included randomised controlled trials that compared fall rates in older people randomised to receive exercise as a single intervention with fall rates in those randomised to a control group. Results 99 comparisons from 88 trials with 19 478 participants were available for meta-analysis. Overall, exercise reduced the rate of falls in community-dwelling older people by 21% (pooled rate ratio 0.79, 95% CI 0.73 to 0.85, p<0.001, I2 47%, 69 comparisons) with greater effects seen from exercise programmes that challenged balance and involved more than 3 hours/week of exercise. These variables explained 76% of the between-trial heterogeneity and in combination led to a 39% reduction in falls (incident rate ratio 0.61, 95% CI 0.53 to 0.72, p<0.001). Exercise also had a fall prevention effect in community-dwelling people with Parkinsons disease (pooled rate ratio 0.47, 95% CI 0.30 to 0.73, p=0.001, I2 65%, 6 comparisons) or cognitive impairment (pooled rate ratio 0.55, 95% CI 0.37 to 0.83, p=0.004, I2 21%, 3 comparisons). There was no evidence of a fall prevention effect of exercise in residential care settings or among stroke survivors or people recently discharged from hospital. Summary/conclusions Exercise as a single intervention can prevent falls in community-dwelling older people. Exercise programmes that challenge balance and are of a higher dose have larger effects. The impact of exercise as a single intervention in clinical groups and aged care facility residents requires further investigation, but promising results are evident for people with Parkinsons disease and cognitive impairment.

Reliability of clinical tests of foot and ankle characteristics in older people.

Lower-extremity problems are common in older people; however, the reliability of clinical tools used to assess foot and ankle characteristics has not been rigorously evaluated. This study evaluated the test-retest reliability of a battery of simple clinical tests of foot and ankle characteristics (tactile sensitivity of the first metatarsophalangeal joint, navicular height, foot length and width, hallux valgus severity, an overall foot problem score, ankle flexibility, ankle dorsiflexion strength, and foot pain) in 31 individuals (13 men and 18 women) aged 76 to 87 years recruited from the community. Three examiners performed the tests on two occasions approximately 2 weeks apart. Intraclass correlation coefficients and coefficients of variation were calculated for continuously scored tests, and the kappa statistic (kappa) was used to determine the reliability of hallux valgus severity grading. All of the continuously scored tests had acceptable reliability (intraclass correlation coefficients of 0.64 to 0.98; coefficients of variation of 0.6% to 15.0%), as did hallux valgus severity grading (kappa = 0.77; absolute percentage agreement, 84%). These simple clinical tests can now be used with confidence in clinical and research settings to provide reliable and functionally important information regarding foot and ankle characteristics in older people.

The Development and Validation of a Brief Performance-Based Fall Risk Assessment Tool for Use in Primary Care

BACKGROUND To report the development, external validity, reliability, and feasibility of a falls risk assessment tool for use in primary care. METHODS Two prospective cohort studies, a test-retest reliability study, and a feasibility study were included. Seven hundred and sixty four older community-living people (mean age = 75.3 years, SD = 5.8) participated in the tool development study, 362 people (mean age = 80.25 years, SD = 4.5) participated in the external validation study, 30 older people took part in the test-retest reliability study, and 32 clinicians participated in the feasibility study. RESULTS The fall risk assessment score (number of risk factors) displayed a good ability to discriminate between multiple fallers (those who experienced two or more falls) and non-multiple fallers in the external validation study (area under the receiver operating characteristic curve = 0.72, 95% confidence interval = 0.66-0.79). Each of the performance items; low contrast visual acuity, tactile sensitivity, sit to stand, alternate step, and near tandem stand ability; and measures of previous falls and medications could discriminate between prospectively categorized multiple fallers and non-multiple fallers with relative risk values ranging from 1.4 to 2.4 in the development study. The probability of future multiple falls increased from 7% with the identification of zero or one risk factor up to a probability of 49% with the identification of six or more risk factors. The assessment items exhibited moderate to excellent test-retest reliability and a high degree of acceptance by health professionals. CONCLUSION The assessment tool is an externally validated, reliable, and feasible falls risk assessment that can accurately predict multiple falls and assist with guiding interventions in community living older people.