Journal of Geriatric Physical Therapy最新文献

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.

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.

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: Multisensory exercises target visual, vestibular, and somatosensory systems to improve balance and mobility, thus reducing fall risk in older adults. Unlike traditional exercise interventions focusing on physical strength or motor skills, multisensory exercises challenge sensory inputs to enhance adaptability and stability. Despite their potential benefits, the role of sensory training in balance improvement and fall prevention has not been extensively explored. This scoping review aimed to examine and summarize multisensory exercise interventions' content, delivery, and outcomes in older adults without specific health diagnoses.

Methods: A scoping review was conducted following Arksey and O'Malley's framework, encompassing stages such as identifying the research question, identifying relevant studies, study selection, charting the data, and synthesizing, summarizing, and reporting the results. Cochrane Library, Medline, PEDro, EMBASE, ProQuest, and Google Scholar were systematically searched using key terms such as "older adults," "multisensory," "balance," "exercise," and "fall." Studies were included if they evaluated the impact of multisensory exercises on balance and fall incidence in older adults without specific health diagnoses. The TIDieR checklist guided data extraction to ensure comprehensive reporting and analysis of intervention protocols.

Results and discussion: A total of 21 articles met the inclusion criteria, including 15 randomized controlled trials and 6 pre-post design studies without control groups. The total number of enrolled older adults was 1,018, 65% of whom were women. The review identified 4 principal categories of sensory interventions targeting visual, vestibular, proprioceptive modalities, and their combinations. Walking with sensory stimulation was the most common exercise intervention, featured in almost 60% of the studies. The Berg Balance Scale was the most frequently employed outcome measure, used in 42% of studies. However, the studies demonstrated considerable diversity in objectives, reporting, and intervention designs, including variations in exercise duration, frequency, intensity, and the specific sensory challenges applied. Additionally, inconsistencies were observed in the selection of outcome measures, with limited standardization across studies, making comparisons challenging.

Conclusion: Although multisensory interventions are widely used to improve balance, empirical evidence is limited by inconsistencies in study design, intervention delivery, and reporting. Greater theoretical clarity, operational definitions, intervention mapping, and codesign techniques are necessary to enhance the quality and impact of future research in clinical practice.