Journal of Geriatric Physical Therapy最新文献

Background and purpose: Fear of falling (FOF) is a common concern among older adults that can affect balance control. The Falls Efficacy Scale-International (FES-I) and the Activities-specific Balance (ABC) scale, while commonly used for assessing FOF, were originally validated for measuring concern about falling and balance confidence during imagined activities. This study aimed to validate the use of FES-I and ABC as measures of fall-related state anxiety during unpredictable balance challenges by examining their relationship with skin conductance levels (SCLs) as a measure of psychophysiological state anxiety. Additionally, we aimed to compare state anxiety responses during sudden balance perturbations between older adults with high versus low concern about falls.

Methods: Sixteen community-dwelling and ambulatory older adults (mean age, 70.29 ± 5.31 years) were exposed to 3 unpredictable trip perturbations. Outcomes included FES-I and ABC, Subjective Units of Distress Scale (SUDS, measuring state anxiety), and SCL. The Wilcoxon signed rank test compared SCL before and after perturbations. Spearman's correlations analyzed relationships between SCL change and FES-I and ABC scores. The Mann-Whitney U test compared SUDS between participants with low (FES-I <23) and high (FES-I ≥23) concern about falls.

Results: SCL significantly increased from pre- to post-trip perturbation (P = .03), indicating perturbation-induced state anxiety. This increase correlated positively with both FES-I (rho = 0.62, P = .01) and ABC (rho = -0.59, P = .02) scores. Subjective Units of Distress Scale scores differed significantly (P = .01) between older adults with high vs low concern for falls.

Conclusions: Results suggest that FES-I and ABC scores are related to perturbation-induced state anxiety in older adults during balance challenges. Additionally, older adults with high concern about falls report higher levels of subjective state anxiety during these challenges. These findings provide initial evidence for the criterion validity of these clinical scales in relation to fall-related state anxiety. Further investigations with larger cohorts encompassing a wider range of falls efficacy and balance confidence levels are warranted.

Background and purpose: Physical activity is a key determinant of health in older adults. Despite the World Health Organization (WHO) recommendations, many older adults remain insufficiently active. The clinical measurement of physical activity levels remains a challenge, as the gold standard for this measurement is costly and requires multiple days of assessment. The aim of this study was to explore the correlation between subjective and objective physical activity levels and identify whether moderate-to-vigorous physical activity (MVPA) levels correlate with functional tests in community-dwelling older adults, establishing a cutoff point.

Methods: This cross-sectional study evaluated 90 older adults regarding their physical activity level [MVPA, metabolic equivalent, and sedentary behavior] using both subjective [International Physical Activity Questionnaire, Brazilian version (IPAQ-Br)] and objective (activity monitor) measurements. Functional performance was assessed by the 6-Minute Walk Test (6MWT), Timed Up and Go test, and Berg Balance Scale. Spearman's correlation test, Student t-test, and receiver operating characteristic curves were used for statistical analyses.

Results and discussion: Most participants were female (85.5%) with a mean (SD) age of 69 (6) years, and 87.8% were between 60 and 74 years old. The correlation between objective and subjective measures of sedentary behavior (P = .06), MVPA (P = .34), and metabolic equivalents (P = .10) was not significant. The objective measurement of MVPA recorded lower levels compared to subjective measurement (95% CI = 38.2-351.5). The correlation between objective MVPA measurement and 6MWT was moderate (r = 0.43; P < .0001). The correlation between MVPA and Timed Up and Go (P = .065) and Berg Balance Scale (P = .137) was not significant. The 6MWT cutoff point was 362.50 m (walking speed of 1 m/s) to identify active individuals according to WHO guidelines (area under the curve = 0.83).

Conclusion: Objective and subjective physical activity levels were not correlated in older adults in this study, who were predominantly female and had good physical capacity. They may overestimate their physical activity levels, with self-reported activity levels higher than objective ones. Clinical testing can add value to assessing physical activity levels, with the objective measures being correlated with 6MWT. Based on cut score, maintaining an average gait speed of 1 m/s during the 6MWT may be useful in identifying older adults who meet WHO physical activity MVPA recommendations.

Background and purpose: Older adults in the US often do not meet the recommended amount of physical activity. Coach2Move has demonstrated effectiveness in improving physical activity, yet its comparisons with usual physical therapy from the patients' perspectives are limited. This study examined patients' perceptions and experiences of Coach2Move compared to usual care.

Methods: This qualitative study employed semi-structured interviews using reflexive thematic analysis. Participants included 15 community-dwelling older adults (≥65 years) with musculoskeletal pain, balance deficits, or general health decline recruited from an assisted living facility and surrounding suburban communities in the Pacific Northwest. Each participant received two 60-minute physical therapy evaluations in random order: 1 using Coach2Move and 1 using usual physical therapy. Physical therapists trained in both approaches followed structured guides, and interviews occurred within 3 days of the second session.

Results: Four themes were generated reflecting participants' perceptions of evaluation style, therapist characteristics, person centeredness, and behavior change. Both approaches were viewed positively, though participants often favored Coach2Move for its greater challenge, person-centered focus, and support for behavior change.

Conclusion: Findings highlight positive perceptions of Coach2Move and suggest that its emphasis on collaboration and tailored activity may promote behavior change and physical activity among older adults.

Clinical relevance: These findings provide insight into potential strategies important to older adults when promoting physical activity and behavior change.

Background and purpose: Lumbar spinal stenosis (LSS) is a common spine disease in older adults leading to mobility limitations and decreased quality of life. Physical therapy (PT) is effective at improving pain and function for patients with LSS. However, PT utilization remains low contributing to higher surgical rates. Compared to PT, surgery is associated with greater medical risk and health care costs. The purpose of this scoping review is to identify facilitators and barriers to PT engagement among older adults with LSS with the aim of understanding PT underutilization and reducing unnecessary surgical interventions.

Methods: Two independent reviewers searched 3 databases, PubMed, CINAHL (EBSCO), and PEDro. Inclusion criteria were the following: observational (prospective or retrospective), experimental (randomized and nonrandomized controlled trials, prospective clinical trials, and cohort studies) and qualitative studies published in English; adults ages 60 years and older with LSS; evidence of PT utilization; and outcomes of facilitators and/or barriers. Thematic analysis was used to categorize facilitators and barriers extracted from included studies.

Results and discussion: Of 332 studies, 8 remained following screening of titles, abstracts, and full texts. A total of 392 patients were included across studies. Six themes were identified for both, facilitators and barriers. Facilitators included flexible clinic scheduling and accessibility, personalized patient education, and positive social support. Barriers included unreliable transportation, high cost, symptoms from a medical condition(s), and excessive travel and time. Patient-centered factors, patient-provider relationship, and delivery of care were categorized as both facilitators and barriers. Facilitators and barriers identified for patients with LSS align with those previously identified for other musculoskeletal conditions.

Conclusion: This scoping review is the first to identify facilitators and barriers influencing PT engagement for patients with LSS. It is imperative that clinicians consider facilitators and barriers in addition to patient-specific needs to optimize engagement in PT and maximize mobility and health for patients with LSS. Future research should focus on other potential factors impacting PT engagement such as health care practitioner referrals to PT.

Background: Mobile apps (MA) may help to identify and measure fall risk factors to develop fall prevention interventions. However, the perception of health care professionals on using MA needs further investigation. Understanding the needs, context, and opinions of users is essential for developing high-quality tools.

Objective: This study aimed to investigate the perception of physical therapists about using MA for fall risk assessment in older adults.

Methods: Physical therapists caring for older adults (>60 years) in Brazil were invited to respond a web-based survey consisting of an online questionnaire about fall prevention in clinical practice. The likelihood of using MA for fall risk assessment was measured on a scale from 0 (not likely) to 10 (very likely). Sociodemographic, educational, and professional data were also collected. Barriers to MA use were investigated quantitatively and qualitatively. Descriptive statistics summarized the data, and the Chi-square test identified associations between perceived barriers and participant data. Qualitative data were summarized and analyzed using the Theoretical Domains Framework (TDF).

Results: The survey received responses from 454 physical therapists. Most participants were women (age between 22 and 73 years) who worked independently and had six or more years of professional experience. The mean likelihood of using MA for fall risk assessment was 8.5 out of 10 (± 2.3). The main barriers were paying for the MA (n = 288; 63.4%) and need for internet connection (n = 103; 22.7%). Qualitative barriers were mostly related to the TDF domains of "environmental context and resources" and "goals". Younger age and practice in geriatric physical therapy were associated with a high likelihood of using MA for fall risk assessment.

Conclusion: Optimal design of MA for fall risk assessment should address potential barriers for its use, such as cost and internet connectivity. Additionally, these tools should account for user acceptability and environmental factors to ensure their successful implementation.

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.

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: 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.