Monica Rodrigues Perracini

Virtual reality using games for improving physical functioning in older adults: a systematic review.

The use of virtual reality through exergames or active video game, i.e. a new form of interactive gaming, as a complementary tool in rehabilitation has been a frequent focus in research and clinical practice in the last few years. However, evidence of their effectiveness is scarce in the older population. This review aim to provide a summary of the effects of exergames in improving physical functioning in older adults. A search for randomized controlled trials was performed in the databases EMBASE, MEDLINE, PsyInfo, Cochrane data base, PEDro and ISI Web of Knowledge. Results from the included studies were analyzed through a critical review and methodological quality by the PEDro scale. Thirteen studies were included in the review. The most common apparatus for exergames intervention was the Nintendo Wii gaming console (8 studies), followed by computers games, Dance video game with pad (two studies each) and only one study with the Balance Rehabilitation Unit. The Timed Up and Go was the most frequently used instrument to assess physical functioning (7 studies). According to the PEDro scale, most of the studies presented methodological problems, with a high proportion of scores below 5 points (8 studies). The exergames protocols and their duration varied widely, and the benefits for physical function in older people remain inconclusive. However, a consensus between studies is the positive motivational aspect that the use of exergames provides. Further studies are needed in order to achieve better methodological quality, external validity and provide stronger scientific evidence.

What are the Main Physical Functioning Factors Associated With Falls Among Older People With Different Perceived Fall Risk

BACKGROUND AND PURPOSE Fall risk perceptions may influence the judgement over physical and functional competencies to avoid falls. However, few studies have explored the physical functioning characteristics associated with falls among older people with low perceived fall risk. This study aimed to identify the prevalence of falls and physical functioning factors associated with falling among community-dwelling older adults with low and high perceived fall risk. METHODS We conducted a cross-sectional population based study with 773 community-dwelling elders. Perceived fall risk was investigated using Falls Efficacy Scale International. We considered fallers those who reported at least one fall in the previous 12 months. Physical functioning measures used were grip strength, usual gait speed, sit-to-stand test, five step test, timed up and go test, one-legged stance test, anterior and lateral functional reach test. RESULTS At least one fall was reported by 103 (30%) participants with low perceived fall risk and by 196 (46%) participants with high perceived fall risk. The odds of falling were lower among those with greater grip strength and with a greater stance time in one-legged test, and the odds of falling among elders with high perceived fall risk were higher among those who took more time in performing the five step test. DISCUSSION We believe that our results highlight the need of not neglecting the risk of falls among active older adults with low perceived fall risk, particularly in those elders that show reduced stability in a small base of support and a lower leg strength. In addition, we suggest that elders with high perceived fall risk should be assessed using anticipatory postural adjustment tests. Particularly, our results may help physiotherapists to identify eligible elders with different perceptions of fall risk for tailored interventions aimed at reducing falls. Copyright

Comparison of Two Methods for Estimating Adjustable One-Point Cane Length in Community-Dwelling Older Adults

Background and Purpose. Our aim is to estimate inter‐observer reliability, test–retest reliability, anthropometric and biomechanical adequacy and minimal detectable change when measuring the length of single‐point adjustable canes in community‐dwelling older adults. Methods. There are 112 participants in the study. They are men and women, aged 60 years and over, who were attending an outpatient community health centre. An exploratory study design was used. Participants underwent two assessments within the same day by two independent observers and by the same observer at an interval of 15–45 days. Two measures were used to establish the length of a single‐point adjustable cane: the distance from the distal wrist crease to the floor (WF) and the distance from the top of the greater trochanter of the femur to the floor (TF). Each individual was fitted according to these two measures, and elbow flexion angle was measured. Results and Discussion. Inter‐observer reliability and the test–retest reliability were high in both TF (ICC3.1 = 0.918 and ICC2.1 = 0.935) and WF measures (ICC3.1 = 0.967 and ICC2.1 = 0.960). Only 1% of the individuals kept an elbow flexion angle within the standard recommendation of 30° ± 10° when the cane length was determined by the TF measure, and 30% of the participants when the cane was determined by the WF measure. The minimal detectable cane length change was 2.2 cm. Conclusion. Our results suggest that, even though both measures are reliable, cane length determined by WF distance is more appropriate to keep the elbow flexion angle within the standard recommendation. The minimal detectable change corresponds to approximately a hole in the cane adjustment.

Effectiveness of Senior Dance on risk factors for falls in older adults (DanSE): a study protocol for a randomised controlled trial

Introduction Strong evidence shows that exercise is effective to improve fall risk factors among older people. However, older peoples participation and adherence to exercise programmes is suboptimal. Type of exercise and apathy are reported to be barriers to exercise participation, suggesting that new effective interventions are needed. The primary aim of this randomised controlled trial is to investigate the effect of Senior Dance plus brief education for falls prevention on balance among people aged 60 years or over, compared with a control group receiving only brief education. Methods and analysis This single-blind randomised controlled trial will involve 82 community-dwelling older people aged 60 years or over who are cognitively intact. Participants allocated to the intervention group will attend a single educational class on strategies to prevent falls, and will participate in a 12-week, twice-weekly group-based programme of Senior Dance. The Senior Dance consists of different choreographies, which include rhythmic and simple movements with rhythmic folk songs. Participants allocated to the control group will attend the same educational class that intervention group participants will receive, and will be instructed not to take part in any regular exercise programme. The primary outcome will be single-leg stance with eyes closed. Secondary outcomes include: Short Physical Performance Battery, Falls Efficacy Scale, Trail Making Test and the Montreal Cognitive Assessment. Continuous outcomes will be reported using mean (SD) or median (IQR), depending on the distribution of the data. The linear regression approach to analysis of covariance will be used to compare the mean effect between groups. All patients will be included in the analyses following an intention-to-treat approach. Ethics and dissemination Ethics approval has been granted by the Human Ethics Committee of the São Paulo State University (CAAE 48665215.9.0000.5402). Outcomes will be disseminated through publication in peer-reviewed journals and presentations at conferences. Trial registration number NCT02603523, Pre-results.

The Berg Balance Scale as a clinical screening tool to predict fall risk in older adults: a systematic review

BACKGROUND The Berg Balance Scale (BBS) is often used in clinical practice to predict falls in the older adults. However, there is no consensus in research regarding its ability to predict falls. OBJECTIVE To verify whether the BBS can predict falls risk in older adults. DATA SOURCE Manual and electronic searches (Medline, EMBASE, CINAHL, Ageline, Lilacs, Web of Science, Cochrane Library and PEDro) were conducted using blocks of words (older adults, falls, BBS, study design) and their synonyms, with no language restrictions and published since 1989. STUDY SELECTION CRITERIA Prognostic studies or clinical trials were used to assess the BBS and falls history. DATA EXTRACTION AND DATA SYNTHESIS In this narrative synthesis, two independent assessors extracted data from articles and a third reviewer provided consensus, in case of disagreement. The methodological quality was assessed using the Quality In Prognosis Studies tool. RESULTS 1047 studies were found and 8 studies were included in this review. The mean BBS score was high, regardless of the history of falls. Three studies presented cut-off scores for BBS, ranging from 45 to 51 points. Two studies reported a difference in the BBS score between fallers and non-fallers. Studies presented low to moderate risk of bias. LIMITATIONS Unfeasible to conduct a meta-analysis due the heterogeneity of included studies. CONCLUSION The evidence to support the use of BBS to predict falls is insufficient, and should not be used alone to determine the risk of falling in older adults. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42016032309.

Promotion of Physical Activity for Older People with Neurological Conditions

Physical activity (PA) has benefits in optimising function and decreasing the impact of secondary chronic conditions due to deconditioning in older people with neurological conditions. However, PA is poorly recommended, prescribed, and delivered in this population despite the growing body of existing evidence-based research. This chapter reviews the major determinants of physical inactivity and sedentary behaviour for key neurological conditions that affect older people including stroke, Parkinson’s disease, and neuromuscular diseases and summarises the evidence on the implementation of PA programmes.

Physiotherapy following fragility fractures

Physiotherapy can play a vital role in the pathway of care of people after fragility fracture and includes interventions of early mobilisation and prescription of structured exercise programmes for maximising functional recovery and reducing the risk of falls and further fractures. Although the optimal nature of physiotherapist interventions after hip and vertebral fracture requires further investigation in large-scale trials, evidence supports the prescription of high-intensity and extended exercise interventions. This article will overview interventions in the acute and chronic phases after hip fractures, interventions after vertebral fracture and the role of physiotherapy in the prevention of further fractures.

Microwave diathermy and transcutaneous electrical nerve stimulation effects in primary dysmenorrhea: clinical trial protocol.

The aim of this study will be to analyze the effects of microwave diathermy (MWD) and transcutaneous electrical nerve stimulation (TENS) on primary dysmenorrhea. Eighty eight women, age range 18-44 years, with no previous pregnancy, no practice physical activities, a BMI of ≤29.9 kg/m2, a regular menstrual cycle and a diagnosis of primary dysmenorrhea, with menstrual pain ranging from mild to severe, will be selected. The participants will be randomized into four groups: MWD and TENS, MWD and placebo TENS, placebo MWD and TENS, and placebo MWD and placebo TENS. Pain will be measured using the visual numeric scale and the McGill Pain Questionnaire; the pressure pain threshold using a digital algometer and conditioned pain modulation using the cold pressor test. Brazilian Clinical Trials Registry (RBR-5QKCK4. Registered on 16 March 2016).

Physical activity in older people – Case studies of how to make change happen

Enhancing physical activity (PA) is recognized as a powerful intervention for the prevention and treatment of chronic diseases and disability in older people. Furthermore, there is an agreement that increased PA in daily life is a key determinant of active and healthy ageing and should be recommended for frail and sedentary older people. Unfortunately, relatively few older people engage in regular PA or stay active in the long term. This article summarizes and discusses PA recommendations for older adults without focussing on specific diseases, presents the main barriers and facilitators for increasing PA levels, and considers the implementation of these recommendations on the basis of the existing evidence. Finally, we provide case studies of PA programmes for older people that were successfully implemented and highlight the current lessons learned.

What are the sociodemographic and health determinants for older adults continue to participate in work

OBJECTIVE This study aimed to determine the sociodemographic and health factors that influence older adults who continue to participate in the workforce. METHODS Data were collected and evaluated for 1762 older adults aged 65 years and older who were living in the community and were enrolled in a population-based study (FIBRA Network Study). Older adults who participated in the workforce were compared with those who did not in terms of sociodemographic characteristics, physical and mental health, and physical functioning and performance in advanced and instrumental activities characteristic of daily living. A multivariate hierarchical logistic regression analysis was performed. RESULTS Factors associated with not participating in the workforce were aged (OR: 1.71, [95% CI: 1.26-2.30], p<0.001), female gender (OR: 1.70, [95% CI: 1.22-2.37], p=0.002), poor visual perception (OR: 1.31, [95% CI: 1.00-1.72], p=0.046), using 4 or more medications regularly (OR: 1.41, [95% CI: 1.489-2.247], p=0.034), having 3 or more comorbidities (OR: 1.44, [95% CI: 1.01-2.04], p=0.040), and a handgrip strength below 24.6kg/f (18.1-24.6kg/f (2nd tertile): OR: 1.52, [95% CI: 1.06-2.18], p=0.022; 0-18kg/f (1st tertile): OR: 1.60, [95% CI: 1.08-2.38], p=0.019). The probability estimates of the final model explained 67.9% of the events related to not participating in the workforce, as observed by the area under the ROC curve. CONCLUSION Our results highlight that work in later life is influenced by sociodemographic characteristics, intrinsic capacity, and multimorbidity. We suggest that strategies for optimizing healthy and active aging may help older people to continue participating in the workforce and contributing toward their communities.