Journal of Geriatric Physical Therapy最新文献

Background and purpose: Frailty, a multidimensional syndrome, is linked with heightened risk of adverse outcomes. Targeted physical therapy interventions for individuals with frailty have proven beneficial, underscoring the value of routine frailty assessment in both clinical and research settings. This study aimed to: (1) describe development of a simple self-report cumulative deficits frailty scale (Sr-CDFS); (2) establish the criterion validity of Sr-CDFS against the commonly used Fried's frailty scale and Study of Osteoporotic Fracture criteria (SOF); and (3) assess other concurrent validity and internal consistency of the new Sr-CDFS.

Methods: The study included 230 older adults ( M age = 79.27 ± 7.42 years), with 76.5% being women. Outcome measures were: (1) validated frailty scales, including Fried's frailty phenotype, SOF, and Sr-CDFS; and (2) a battery of tests for impairment, activity limitations, and health status. Data analysis involved calculating frailty prevalence using the validated frailty scales. The clinimetric properties of the Sr-CDFS were assessed against validated frailty scales. Convergent and discriminative validity of the Sr-CDFS were examined. Internal consistency and structure were evaluated using Cronbach's alpha and exploratory factor analysis.

Results and discussion: No differences ( P = .80) in frailty prevalence were found between Fried (26.1%) and SOF (25.2%) methods. The Sr-CDFS exhibited excellent internal consistency (Cronbach's alpha = .92), with reliability of questionnaire components (health, falls, physical, cognitive, socioemotional function) ranging from .73 (falls) to .90 (physical ability). Additionally, the Sr-CDFS demonstrated convergent and discriminative validity, with its total score and various parts correlating significantly with most outcomes ( r = .25-.59, P < .05). Using K1-criterion and a scree plot, we identified a 5-factor solution that had a common variance of 63.9%.

Conclusion: The newly developed Sr-CDFS exhibits robust clinimetric properties with good-to-excellent reliability and validity. The newly developed Sr-CDFS has the potential to increase the feasibility of assessing frailty in clinical settings or large-scale epidemiological studies.

Background: In skilled nursing facilities (SNFs), i-STRONGER is a novel, high-intensity resistance training approach that incorporates progressive resistance training to promote greater improvements in patient function compared to usual care. To inform large-scale expansion of i-STRONGER as standard-of-care in SNFs, this mixed-methods study assessed rehabilitation providers' perceptions of i-STRONGER and purported needs for its adoption.

Methods: Forty-three rehabilitation providers participated in an 18-week, interactive i-STRONGER training program. Post-training, the validated Perceived Characteristics of Intervention Scale was used to evaluate i-STRONGER relative advantage, compatibility with practice, complexity, potential for reinvention (ie, adaptability), trialability, and risk. Providers reported the top 3 needs for successful i-STRONGER adoption and described i-STRONGER perceptions in training modules and focus groups. A convergent mixed-methods design was used to evaluate and describe clinician perceptions of i-STRONGER.

Results: i-STRONGER program conceptually aligned with providers' practice. The patterns and was endorsed as feasible and adaptable as part of patient care; however, initial hesitancies surrounding patients' physical abilities and motivation were noted as barriers and appeared to reflect negative age-related beliefs and attitudes within SNF cultures. Providers feared patients would be unwilling or unable to engage with i-STRONGER activities due to their age, deconditioning, medical complexity, or expectation that rehabilitation should feel "easier." As providers began implementing i-STRONGER in real-time, concerns surrounding i-STRONGER's potential risks lessened as providers observed improvements in patient function and motivation, and patients were described as "embracing" i-STRONGER principles. Patient acceptance and satisfaction, equipment, time, and clear communication among providers were cited as critical needs for i-STRONGER adoption.

Conclusions: With i-STRONGER, a safe and effective approach for delivering resistance training to older adults in SNF settings, "seeing is believing." Real-time implementation of i-STRONGER facilitated an evolution of perspective among providers, fueled by observable, positive changes in patient function and affect as well as unexpected patient participation. Findings support i-STRONGER use in SNF settings, provided that specific training strategies showcase older adults with medical complexity participating in progressive resistance training.

Background and purpose: Difficulty performing concurrent tasks while walking, or dual-task walking, may have negative consequences for safe and independent functional mobility among older adults. Older adults with amnestic mild cognitive impairment (aMCI) may demonstrate slower gait and worse cognitive task speed or accuracy during dual-task conditions. However, prior research has not consistently quantified cognitive performance during dual-task walking, and it is unclear whether changes in dual-task performance are consistent across different task combinations. The purpose of this study was to compare cognitive and gait performance during dual-task conditions in older adults with aMCI and those with normal cognition (NC).

Methods: An observational cross-sectional study was conducted with 40 community-dwelling older adults, aged 70-95 years with aMCI (n = 18) and NC (n = 22). Gait (self-paced, fast-paced) and cognitive task performance (serial 3, serial 7 subtraction) were quantified during single-task and dual-task conditions. Linear mixed-effects models with a random effect for participants were used to quantify differences between groups (aMCI vs NC) and task conditions (single-task vs dual-task). Further analysis was performed to quantify cognitive performance and gait changes during more challenging dual-task combinations.

Results: Across task combinations, gait performance declined for both groups during dual-task conditions. Gait speed was slower during dual-task conditions than single-task conditions in both the NC and aMCI groups for all task combinations. Older adults with aMCI performed worse on cognitive tasks than those with NC during both single-task and dual-task conditions. Correct response rate was slower for people with aMCI than NC during both single-task and dual-task conditions.

Conclusion: Dual-task activities, combining gait and cognitive processes, are associated with fall risk and are therefore commonly evaluated in physical therapy care for older adults. Both aMCI and NC groups walked slower during dual-task conditions, but the aMCI group experienced changes with a lower cognitive load. This highlights the importance of quantifying both cognitive and gait performance during dual-task assessments. Changes in cognitive task and gait performance were consistent across different dual-task combinations, which could inform dual-task interventions.

Background and purpose: Identifying preclinical mobility limitation (PCML) and mobility disability are critical for a preventative model of physical therapy. Subjective fall risk and mobility screening questions are used to determine the need for objective testing. This study aimed to determine the diagnostic accuracy of subjective screening for mobility impairment.

Methods: Participants answered 8 evidence-based subjective fall risk and mobility screening questions followed by evaluation with the Short Physical Performance Battery (SPPB) and the grip strength test. Gait speed and the Five Times Sit to Stand Test time were calculated from the SPPB. Reference standards for the tests were used to binarize results as at/above or below standards. Relationships between binarized subjective screening and objective test results were analyzed with Phi (φ) correlation coefficients. Sensitivity and specificity were calculated for relationships with acceptable cutoff values ( P < .05, φ  > 0.3). Binomial regression was used to determine the sensitivity and specificity of asking multiple questions. Screening questions were considered useful predictors of the objective test result if combined sensitivity and specificity were ≥1.5.

Results and discussion: Ambulatory adults (N = 83) aged 65 to 92 years ( M = 70) participated. One question-"Do you have difficulty with balance?"-met the diagnostic accuracy threshold for predicting the SPPB outcome with a sensitivity of 0.632 and a specificity of 0.871.

Conclusions: Subjective screening does not adequately predict objective test results for identifying PCML. The findings indicate that improved screening tools or more referrals for objective testing are needed to detect early mobility loss with aging.

Background: Cardiovascular surgery causes muscle weakness associated with increased inflammatory cytokines. Diabetes mellitus (DM), through insulin resistance and diabetic polyneuropathy (DPN), promotes postoperative muscle weakness and is linked to elevated inflammatory cytokines. Identifying the effect of DM, particularly DPN, on postoperative muscle weakness could help target interventions to reduce physical disability.

Purpose: This study aimed to identify whether DPN predicts postoperative muscle weakness in older adults undergoing coronary artery bypass grafting.

Methods: Patients aged ≥65 years who underwent elective coronary artery bypass grafting were divided into 3 groups: those without DM (non-DM; n = 68), those with DM but without DPN (without-DPN; n = 28), and those with DPN (with-DPN; n = 24). Grip strength (GS) and isometric knee extensor strength (IKES) were measured pre- and postoperatively, and percent changes were calculated from baseline to discharge. The percent change in GS and IKES was compared among the 3 groups. In addition, a 2-way repeated-measures analysis of variance was conducted to compare muscle strength changes among groups, adjusting for potential confounders.

Results: The percent change in IKES was significantly greater in the DPN group, with values of -3.2% in the non-DM group, -6.3% in the without-DPN group, and -14.3% in the DPN group ( P = .018). No significant differences were observed in GS changes among the groups. A 2-way repeated-measures analysis of variance revealed a significant group effect for GS ( P = .018, partial η 2  = 0.069) but no time effect or interaction. A significant time × group interaction was found for IKES ( P = .036, partial η 2  = 0.057), indicating differing strength change patterns between groups.

Discussion: Patients with DPN had greater lower-extremity muscle weakness after surgery than those without DM and those with DM without DPN. These findings highlight the critical need for preventive strategies to mitigate physical disability in patients with DPN.

Conclusions: Older adults with DPN may have an increased risk of developing postoperative muscle weakness in the lower extremities.

Background and purpose: Physiotherapists in nursing homes perform a diversity of roles and tasks. But the delivery of physiotherapy services varies widely between organizations and between individual physiotherapists. This depends on both organizational and personal factors. This study aims to investigate to what extent physiotherapists in Dutch nursing homes agree on the scope and content of their professional roles and tasks.

Methods: We performed a cross-sectional survey study of a convenience sample of physiotherapists in nursing homes. The questions were divided into five themes: (1) care and functional problems (falls, incontinence, physical strain, decubitus, inactivity/immobility, pain, problems with lying and sitting, the use of physical restraints, malnutrition and sarcopenia, overweight, behavioral problems, oedema, joint contractures), (2) referrals and accessibility, (3) assessments and examinations, (4) interventions and actions, and (5) organizational matters. We asked the participants to answer the questions on a five-point Likert scale. We defined consensus when ≥75% of the participants rated the question with a Likert-score of 4 or 5 or with a Likert-score of 1 or 2.

Results and discussion: Sixty-five physiotherapists returned the survey. They agreed that physiotherapists play an essential role in the management of prevention of falls, mobility problems, transfer problems, ergonomic advice, physical strain, pain, problems with sitting and lying, sarcopenia, and joint contractures. There was a discrepancy in consensus regarding what a physiotherapist should do in the specific cases versus what they actually do.

Conclusion: Physiotherapists in nursing homes agreed they have an important role in a variety of care and functional problems. However, there was a difference between what needs to be done versus what is actually done by the physiotherapists. Future research should focus on the underlying reasons for this inconsistency.