Jaap Swanenburg

Falls prediction in elderly people: A 1-year prospective study

The aim of the present study was to determine whether force plate variables in single- and dual-task situations are able to predict the risk of multiple falls in a community-dwelling elderly population. Two hundred and seventy elderly persons (225 females, 45 males; age, 73+/-7 years) performed balance assessment with and without vision. Seven force plate variables were assessed to predict the risk of multiple falls; maximum displacement in the anteroposterior and medial-lateral directions (Max-AP, Max-ML), mean displacement in the medial-lateral direction (MML), the root mean square amplitude in anteroposterior and medial-lateral directions (RMS-AP, RMS-ML), the average speed of displacement (V), and the area of the 95th percentile ellipse (AoE). Falls were prospectively recorded during the following year. A total of 437 registered falls occurred during monitoring period. The force plate variable RMS-ML in the single-task condition (odds ratio, 21.8) predicted multiple falls together with the following covariables: history of multiple falls (odds ratio, 5.6), use of medications (fall-risk medications or multiple medicine use; odds ratio, 2.3), and gender (odds ratio, 0.34). Multiple fallers had a narrower stance width than non-fallers.

Entwicklung und Evaluation einer deutschen Version der Tegner Aktivitätsskala zur Erfassung der Funktion nach einer Verletzung des vorderen Kreuzbands

BACKGROUND The aim of this study is to provide a valid and reliable German version of the Tegner activity scale (Tegner-G). The Tegner activity scale assesses on 11 levels the activity in sports (competitive and recreational) and work of patients with anterior cruciate ligament injuries. The English original version was elaborated in Sweden and contains sports that are unknown in German-speaking countries. METHODS The translation and adaptation was conducted in several steps according to the guidelines in the literature. The validity (discriminative validity and content validity) and (absolute and relative) reliability were determined in 46 patients after reconstruction of the anterior cruciate ligament and in 20 healthy subjects. The patients were divided into an acute group (< 3 months after operation; 11 men; 30.9 ± 8.3 years) and a chronic group (3 - 12 months after operation; 18 men; 31.3 ± 11.6 years). All subjects filled in the scale two times within 3 - 7 days. For the additional determination of the relation between activity and function, they also filled in the German version of the Lysholm score (Lysholm-G). RESULTS The three groups differed significantly from each other (Kruskal-Wallis test: χ2 = 27.95, p < 0.001; post hoc Mann-Whitney U tests: acute-chronic p < 0.001; acute-control p < 0.001; chronic-control p = 0.003). There was a floor effect in the acute patient group. The intraclass correlation coefficients indicated a high relative reliability (ICC2,1 > 0.9). The minimal detectable change was 1.4 points. The relation between activity (Tegner-G) and function (Lysholm-G) was stronger in the acute than in the chronic patient group (ρ = 0.77 and ρ = 0.60, respectively). CONCLUSION The psychometric properties of the Tegner-G are comparable to those of the English original version. The Tegner-G is thus valid and reliable for the German-speaking part of Switzerland. The application in other German-speaking countries probably requires adaptations for some of the sports included. The relation between activity and function changes depending on time since operation. This confirms that a comprehensive assessment of the outcome after an anterior cruciate ligament injury requires the separate assessment of both parameters.

Reliability and validity of the extended timed-get-up-and-go test in patients with bilateral vestibular loss

BACKGROUND The aim of his study was to evaluate the reliability and validity of the Expanded Timed Get-up-and-Go (ETGUG) test in patients with bilateral vestibular loss (BVL). METHODS 21 BVL patients (58 ± 14 years) were recruited and measured twice by two raters. After a one hour break ETGUG was repeated by the first rater. 21 age matched controls (CON; 58 ± 14 years) were measured once by the first rater. All time scores of the ETGUG for the separate tasks and gait speed calculated from tasks 3 and 5 were analysed to determine relative and absolute reliability, smallest detectable change (SDC) and discriminatory capabilities. RESULTS The ETGUG scores showed good to excellent inter-rater (ICC2,1 = 0.85-0.97) and test-retest reliability (ICC3,1 = 0.86-0.98) following log-transformation for tasks 2-6. Task1 scored fair r = 0.46-0.68. The SDCs were small (SDC = 0.05-0.21 seconds). Bland-Altman plots demonstrated good agreement between the measurements. There were significant differences between BVL and CON in ETGUG scores for tasks 1, 3, 4, 5, 6 & overall time. Task 2 showed no difference between the groups. BVL patients walked slower compared to the age-matched controls. DISCUSSION Good reliability of the ETGUG in BVL and an indication for the discriminatory capabilities for the separate tasks suggest that the ETGUG could facilitate the study of functional deficits in BVL patients. Good reliability, small measurement error and values of SDC warrant the further utilisation of the ETGUG for the evaluation of physical functioning in BVL patients.