Journal of Geriatric Physical Therapy最新文献

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.

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 η2 = 0.069) but no time effect or interaction. A significant time × group interaction was found for IKES (P = .036, partial η2 = 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: Global estimates forecast an increase in the number of people living with dementia (PLWD) or mild cognitive impairment (MCI). Physiotherapists play an important role in the delivery of care to PLWD or MCI; however, physiotherapists report less confidence when working with PLWD or MCI, citing limited educational opportunities. Our scoping review sought to quantify and assess the type of research published in physiotherapy journals related to these groups of people.

Methods: Fifteen journals were selected based on global physiotherapy representation, indexing, and online accessibility of archives. Extraction of all articles published within a decade (2011-2021) for the selected journals was completed. Inclusion criteria: (1) research reports, reviews, case studies, or expert opinion pieces related to PLWD or MCI and (2) published in English. Each article was categorized by type of article, clinical setting, type of dementia, physiotherapy focus, and Sackett's system of hierarchy of evidence. An analysis of trends over time and a bibliometric assessment of research impact were performed.

Results and discussion: Of 11 091 articles identified, 67 were included. The most common country of origin was the United States (38.8%). Articles were mainly research reports (70.1%), from a community-dwelling setting (50.8%), with a combined physiotherapy focus (28.4%), and a level IV (37.3%) of hierarchy of evidence. Close to half of studies did not identify the underlying dementia type (43.3%, n = 29), followed by people living with Alzheimer's dementia (28.4%, n = 19), combined groups of PLWD or MCI (20.9%, n = 14), and individuals with only MCI (7.5%, n = 5). Six articles on average related to PLWD or MCI were published annually (32.7 citation per article), and no growing trend was observed.

Conclusions: Few articles published in prominent physiotherapy journals over the last decade were related to PLWD or MCI. Publication trends remained unchanged, and publication origins were from the Americas which impacts generalizability. Physiotherapists should obtain complementary information on care for PLWD or MCI through more general rehabilitation journals. Physiotherapy journals should seek to promote research related to PLWD or MCI through different avenues (eg, special issues) as increased information is needed for clinicians to feel confident in providing informed care.