Journal of Geriatric Physical Therapy最新文献

Background and purpose: Falls are common in older adults and can seriously impact physical and emotional health. By screening for fall risk, health care professionals can provide interventions to those with the greatest need. The purpose of this work is to identify which common outcome measures are most useful for screening for recurrent fall history in community-dwelling older adults (CDOAs).

Methods: This is a secondary analysis of a data set retrieved from physionet.org. The set includes data from 77 CDOAs, classified as participant with falls (PF) (at least 2 falls) or participant without falls (PNF) (1 or no falls) based on patient report in the prior year. Group differences based on prior recurrent fall status were identified with independent t tests. Relationship with prior recurrent fall status was determined using Pearson's point biserial correlation (rpb). Binary logistic regression modeling and receiver operating characteristic curves identified cut points and likelihood ratios for prior recurrent fall status. Eight measures were included based on prior association with fall risk. Two were patient-reported: 36-item Short-Form Health Questionnaire (SF-36) and Activities-specific Balance Confidence (ABC) scale. Six were functional measures: Timed Up and Go (TUG), Four Square Step Test, Self-Selected Walking Speed, Dual-Task Walking Speed, Berg Balance Scale, and the Dynamic Gait Index. Population prevalence was used to estimate the pretest probability of falls (27.5%).

Results and discussion: The median age was 78.5 years (interquartile range = 6.01) with 50 females (64.9%); 33 recurrent PF and 44 PNF. The SF-36, ABC, and TUG demonstrated the greatest utility for predicting prior recurrent fall status. Scores of 64.5 (range 0-100) or higher on SF-36 indicate less than a 10% chance of being a PF. Completing the TUG more slowly than 12.5 seconds results in a posttest probability of 70% for being a PF. Scoring over 81% on the ABC results in only a 13.7% likelihood of being a PF.

Conclusions: Self-reported health, including general overall health and balance confidence, as assessed by the SF-36 and ABC, respectively, may provide valuable insight into an older adult's risk of recurrent falls. Future longitudinal studies are needed to determine the value of these tests in prospectively predicting falls.

Background and purpose: Fatigue is among the most disabling symptoms of Parkinson's disease (PD), and physical exercise is a promising intervention. This study aimed to evaluate the effects of physical exercise on PD-related fatigue and provide clinical and research recommendations.

Methods: This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Two independent investigators conducted searches using the "Patient, Intervention, Comparison, Outcome" strategy in PubMed, Cochrane Library, Scopus, Web of Science, Embase, and Physiotherapy Evidence Database (PEDro) until August 2024. Randomized clinical trials examining physical exercise and fatigue in PD were included. The standardized mean difference (SMD) was used for effect estimation, and a random-effects model was applied for meta-analysis. Methodological quality was assessed using the PEDro scale, and confidence in cumulative evidence was evaluated with the Grading of Recommendations, Assessment, Development, and Evaluation framework.

Results: Twenty-two studies were included. Meta-analysis comparing exercise with nonexercise (usual care) interventions showed a large effect favoring exercise (SMD = -0.92, 95% CI: -1.57 to -0.28; 7 studies), with interventions including multimodal training, walking, strengthening, and dance. An overview of all the studies with available data (19 studies) suggested that interventions with greater specificity, intensity, or active engagement had larger effects. However, certain control interventions, such as sleep hygiene, relaxation/education, and stretching, may play a role comparable to some active exercises. Fatigue was primarily measured using the Parkinson's Fatigue Scale and the Fatigue Severity Scale.

Conclusions: Moderate-certainty evidence supports that physical exercise, particularly active, continuous modalities such as walking, aerobic, resistance, and multimodal training at moderate intensity (at least twice weekly for 20-60 minutes), can reduce PD-related fatigue. Future research should distinguish between central and peripheral fatigue, compare high-intensity exercise interventions, and explore combinations of exercise with other promising interventions.

Background and purpose: Chronic kidney disease (CKD) affects approximately 37 million Americans and is a leading cause of mortality. Chronic kidney disease is a systemic, progressive disease that impacts multiple bodily systems, including bone, skeletal muscle, heart, and vasculature, leading to conditions such as osteoporosis, sarcopenia, frailty, and heart failure. Despite these impairments, physical therapists (PTs) are not commonly integrated into the interdisciplinary care team. This simulated case study aims to provide PTs with plan of care recommendations for patients with CKD and to facilitate interdisciplinary collaborations between primary care physicians, nephrologists, and PTs.

Methods: Multiple clinical practice guidelines (CPGs) related to pathophysiological changes in CKD were identified and synthesized to direct PT-guided care and inform nephrologists of key indicators warranting physical therapy referral. Recommendations include exercise prescription, screening, assessment, and promotion of interdisciplinary care. The study emphasizes the importance of early intervention and episodic care to manage musculoskeletal health and improve quality of life for patients with CKD.

Results and discussion: The case simulation presents a 58-year-old woman with stage 4 CKD who was referred to PT. The tests, measures, and interventions utilized were guided by the synthesized recommendations from multiple CPGs. The case highlights the need for principles of geriatric physical therapy regardless of age, proactive episodic care, and a tailored exercise program to mitigate musculoskeletal deterioration. The case underscores the necessity of integrating PTs into the CKD care team to address the multisystem effects of the disease and improve patient outcomes.

Conclusion: There is a greater need for better communication and involvement across the medical specialties that manage those with CKD. Patients with CKD experience a multitude of changes in their bodily systems that impact their mobility and quality of life. This simulated case study provided direction on the management of musculoskeletal health where one does not currently exist by synthesizing recommendations across multiple CPGs. Although these guidelines were not originally developed with this population in mind, they provide direction for clinicians to treat these patients.

Background and purpose: Physical performance reference values play an important role in older adult care, yet data are extremely limited in individuals 90 years and older, the "oldest old." The Five Times Sit to Stand Test (5XSST) is a frequently used method of quantifying functional lower extremity strength. To improve the classification and interpretation of 5XSST scores, we aim to develop 5XSST reference values in individuals 90+ years.

Methods: Participants are members of The 90+ Study, a longitudinal oldest-old cohort study. The current study is cross-sectional, using data from the first visit on which each participant completed the 5XSST. Participants performed the 5XSST with arms folded (traditional test) or using their arms to push from the chair (modified test). We calculated means, standard deviations, and percentiles (5 th , 10 th , 25 th , 50 th , 75 th , 90 th , 95 th ) by test type and age category. We used linear regression to compare mean scores by sex (men, women), age category (90-91, 92-94, 95+), test type (traditional, modified), living situation (home alone, home with another person, nursing home/assisted living), and falls in the past year (0, 1+).

Results and discussion: The 972 participants had a mean age of 93.0 years (range = 90.0-103.1, SD = 2.5). Of these, 64.8% performed the traditional test and 36.2% the modified test. Mean time for the traditional test was 16.2 seconds (SD = 6.3) and, for the modified test, 22.6 seconds (SD = 9.9). Scores were significantly slower in participants in the oldest age category, who performed the modified test, lived in a facility, or fell in the past year. No significant differences were found according to sex. We present 5XSST reference values in men and women by test type and age category. Previous studies in younger groups have reported faster 5XSST times than those from our 90+ cohort, which suggests using reference values established in younger groups to categorize the performance of oldest-old individuals is not optimal for accurate categorization of scores.

Conclusions: The reference values we present will allow providers to correctly classify and interpret 5XSST scores in the rapidly growing group of individuals 90 years and older.

Introduction: Sarcopenia can be more significant and severe in the presence of cardiovascular diseases. In hospitalized older adults with acute cardiac disease, assessing strength parameters, muscle mass, and physical performance is difficult largely because of bed rest restrictions. In this context, a simple questionnaire to rapidly diagnose sarcopenia (SARC-F) emerges as a feasible screening tool to identify sarcopenia in an emergency room setting.

Objectives: Assess the association between SARC-F, length of stay, mechanical ventilation, and in-hospital mortality in older adults with cardiovascular diseases admitted to the ER.

Methodology: An observational longitudinal study with 160 Brazilian older adults with cardiovascular diseases admitted to the hospital following an ER visit. The risk of sarcopenia was assessed by the SARC-F tool (independent variable). Length of stay, use of mechanical ventilation, and in-hospital mortality were the dependent variables, collected via an electronic medical chart. Data were analyzed by simple and multiple linear and logistic regression.

Results: SARC-F explained 62% of length of stay, adjusted for the confounding variables age, male sex, and use of continuous medication, mechanical ventilation, and corticosteroids. Risk of sarcopenia was also associated with mechanical ventilation during hospitalization (odds ratio = 1.398; 95% CI, 1.018-1.919). SARC-F was not related to mortality.

Conclusion: Older adults with cardiovascular diseases hospitalized at greater risk of sarcopenia were more likely to need invasive mechanical ventilation and more prone to prolonged hospital stays.

Background and purpose: The Falls Efficacy Scale-International (FES-I) is widely used in clinical practice, but it is unclear how each item can discriminate different levels of fall concern. This study applied item response theory (IRT) to evaluate the psychometric properties of each item in the original English version of FES-I among older adults, and compared those properties across genders and with translations in French, Portuguese, and Spanish.

Methods: This cross-sectional study used data from the International Mobility in Aging Study, which recruited community-dwelling older adults. Modified graded IRT was used to assess the psychometric properties of the FES-I items, specifically estimating difficulty and discrimination (ie, ability to differentiate levels of fall concern) parameters. Item reliability across the different levels of fall concern was estimated and differential item functioning (DIF) was tested for each item to assess if participants perceived the items similarly regardless of gender and language.

Results and discussion: The study included 1608 community-dwelling older adults, of which 395 had completed the English version of the FES-I. Generally, the IRT results showed that the English version was a reliable tool, especially for older adults with high fall concerns, but did not distinguish between low and moderate levels of concern. Factor analysis supported the construct validity of the FES-I. In the DIF analysis, 2 items were perceived differently by gender in the English version, and 9 items were perceived differently between the English and the translated versions (French, Spanish, and Portuguese). The presence of DIF indicates that the psychometric properties of these items are different across genders and languages, and they might relate to cultural factors, the surrounding environment, the wording, the biological differences between men and women, and the item's task itself.

Conclusions: The FES-I is a reliable and valid scale for identifying older adults with high fall concern, but it should include more difficult items. Additionally, differing perceptions of items across genders and languages necessitate caution in comparing results among diverse populations.

Background and purpose: Older adults with chronic diabetes have been shown to exhibit reduced balance function and increased fear of falling; however, the contextual inter-relationships between diabetes and its psychological consequences on physical functioning are not fully understood. This study examined the relationships between diabetes disease status, balance confidence, fear of falling avoidance behavior, and changes in performance and confidence after massed practice of a balance task in participants with and without diabetes (PWD and PWOD).

Methods: Older adult PWD and PWOD were recruited for the pre-post control group study (n = 27 PWD, n = 26 PWOD). Participants underwent practice of a novel stabilometer-based balance task over a 2-day period (40 practice trials in 8 blocks). Changes in balance task performance and balance confidence were assessed pre- and post-training. Balance confidence and activity avoidance behavior associated with fear of falling were assessed using the Activities-Specific Balance Confidence Scale and Fear of Falling Avoidance Behavior Questionnaire, respectively. Repeated measures analysis of variance and mediation analyses were conducted to examine the effects of diabetes and training on balance performance and confidence, as well as how baseline balance confidence affects the training outcomes.

Results and discussion: Fifty-three participants (27 with type II diabetes, 29 men, 23 women, and 1 gender nonconforming, mean age = 63.8, range 50-89 years) were enrolled in the study. Of them, 48 (90.6%) successfully completed the balance training with significant balance task performance improvement of approximately 30% in both groups (PWD: 3.04 [95% confidence interval, 1.77-4.31], P < .001; PWOD: 4.39 [95% confidence interval, 3.04-5.74], P < .001). Activities-Specific Balance Confidence Scale score significantly mediated the effect of diabetes on balance confidence after training and fear of falling avoidance behavior.

Conclusions: Despite the physical and psychological deficits associated with diabetes, individuals with chronic diabetes are capable of improving balance confidence and performance through targeted training. Balance confidence was identified as an important mediating factor, explaining the relationship between diabetes disease status and activity-related psycho-physical outcomes. Future research should focus on the potentially self-reinforcing effects of psycho-physical gains induced by exercise training.

Background and purpose: The objective was to examine the adjuvant effect of active pulsed electromagnetic field (PEMF) versus microwave (MW) therapy, as well as sham PEMF, in addressing pain and improving functionality for treating knee osteoarthritis (KOA).

Methods: This was a double-blind, placebo-controlled, randomized clinical trial. Individuals diagnosed with KOA were assigned to an intervention combining an exercise program (EX) with active PEMF, MW, or sham PEMF. The main outcomes were pain, reported on a visual analogue scale (VAS), and functionality, assessed using the Western Ontario and McMaster Universities Arthritis (WOMAC) questionnaire, and the Timed Up and Go test (TUG). The outcomes were measured preintervention, immediately postintervention, and at 1 and 4 months of follow-up (FU).

Results: Sixty individuals (n = 83 knees) were evaluated. Significant between-group differences were found in WOMAC stiffness (rmMANOVA (F(2,77) = 4.33, P = .017, partial η 2  = 0.10)). A notable interaction effect between group and time was found for the WOMAC pain score (rmMANOVA (F(2, 77) = 3.14, P = .049, partial η 2  = 0.07)). After 4 months, the PEMF + EX group demonstrated superior pain relief compared to the sham PEMF + EX (WOMAC pain "mean difference ± standard error between-groups": -3.2 ± 1.2, P = .028) and MW + EX (VAS pain: -2.1 ± 0.9, P = .042) groups. PEMF + EX perceived less stiffness than did the sham PEMF + EX in both the pre-FU (WOMAC stiffness: -1.6 ± 0.6, P = .047), 1-month FU (-1.7 ± 0.6, P = .015) and 4-month FU (-1.4 ± 0.6, P = .038), with no changes in the MW + EX group. WOMAC function score showed greater improvement in the PEMF + EX group compared to the MW + EX group at 4-month of FU (-9.0 ± 3.6, P = .039). Only PEMF + EX showed a positive effect on the TUG score at 1-month FU (-1.7 ± 0.5, P = <.001) and 4-month of FU (1.9 ± 0.5, P = .020).

Conclusions: The application of PEMF could be a useful adjuvant treatment to exercise programs to further decrease pain and improve knee stiffness and function in individuals with KOA in the medium term compared to MW and sham PEMF.