Journal of Geriatric Physical Therapy最新文献

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.

Background purpose: Cognitive deficits associated with mild cognitive impairment (MCI) likely impact balance control, especially during dynamic tasks. The Four Square Step Test (FSST) presents concurrent obstacle step-over and multi-directional stepping tasks to clinically interrogate dynamic balance. The primary FSST outcome, completion time , delivers a coarse measure of dynamic balance control, but cannot reveal underlying kinematic strategies that may further characterize MCI-related balance deficits. The objective of this study was to use an augmented FSST to characterize aging and MCI effects on both dynamic balance performance and lower-extremity kinematic execution strategies.

Methods: Younger adults (YA, mean age = 23.7y; n = 7), older adults (OA, mean age = 67.4y; n = 20), and individuals with MCI (MCI, mean age = 71.7y; n = 17) performed the FSST in an observational study. We compared overall group effects, then performed 2-way, post-hoc comparisons to identify age (YA vs OA) and cognitive (OA vs MCI) differences in: (1) FSST completion times indicating dynamic balance performance , and (2) lower-extremity peak joint angles during leading and trailing steps in anterior-posterior and lateral directions, indicating kinematic execution strategies .

Results discussion: The FSST completion time was impaired in OA compared to YA (31% slower; p < .001) and in MCI compared to OA (18% slower, p = .008). Both YA and OA exhibited similar kinematics throughout. Individuals with MCI exhibited reduced knee flexion across steps compared to OA ( p ≤ .002). Reduced knee flexion was associated with degraded FSST performance (Pearson's r < -0.44) and is generally less amenable to the obstacle step-over sub-task. While longer FSST completion times revealed aging-and MCI-related impacts on dynamic balance performance, kinematic analyses further revealed altered dynamic balance strategies only in individuals with MCI.

Conclusions: Deficits associated with MCI impair FSST performance. Altered lower-extremity kinematics suggest that individuals with MCI may be especially challenged by the complexity of concurrent multi-directional stepping and obstacle step-over FSST sub-tasks. Clinicians should consider both impaired overall performance and underlying kinematic strategies when characterizing altered dynamic balance control during complex tasks (eg, FSST) in individuals with MCI.

Background and purpose: Exercise is recommended for individuals with idiopathic normal pressure hydrocephalus (iNPH), but its effects on gait and functional performance remain underexplored. This scoping review aimed to search (1) effects of exercise or physical therapy on gait and functional outcomes in individuals with iNPH, along with its underlying physiological and biomechanical mechanisms; (2) challenges to exercise implementation; and (3) replication potential of interventions.

Methods: Five databases (PubMed, Embase, Latin American and Caribbean Health Sciences Literature, Cumulative Index to Nursing and Allied Health Literature, and SpringerLink) were searched for full-text, peer-reviewed articles (2010-2023) on exercise or physical therapy for individuals with iNPH, with all types of study design. Two reviewers independently screened, extracted, and tabulated the search results. Research quality was assessed using the Joanna Briggs Institute critical appraisal checklist. The Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews and the Template for Intervention Description and Replication checklists were used as reporting guidelines.

Results: Six articles met the criteria, covering exercise interventions such as the Lee Silverman Voice Treatment-BIG exercise program, Dynamic Equilibrium Gait Training, High-Intensity Functional Exercise, Action Observation, and home-based physical exercise program (stretching exercises for back, gluteal, and trunk; strengthening exercise for shoulder, arm, and leg; and balance training). These exercises indicated positive effects on gait, sit-to-stand, mobility, balance, balance confidence, and disability, but did not significantly improve quality of life. All six articles provided sufficient details for replication; however, two were based on the same study project, leaving five unique studies included.

Conclusion: Exercise interventions, when carefully prescribed by physical therapists, represent a promising approach for improving gait and balance in individuals with iNPH. However, the current paucity of well-powered randomized controlled trials highlights the urgent need for further research to identify the most effective exercise protocol. Future studies should focus on specific exercise modalities and their long-term impact to improve management and rehabilitation of individuals with iNPH.

Physical therapy for older adults must evolve to address the increasingly complex needs of older adults, who are living longer and managing multiple chronic conditions within challenging psychosocial and environmental contexts. Foundational models, such as the International Classification of Functioning, Disability and Health and the Patient/Client Management model provide structural guidance but fail to fully integrate critical components necessary for comprehensive geriatric care. These models often emphasize immediate medical concerns rather than considering the broader, multifaceted influences on function and overall well-being. The prevailing focus remains on restorative approaches rather than proactive prevention and individualized management strategies, limiting their effectiveness in optimizing movement, function, and quality of life. The Movement Framework for Older Adults (MFOA) offers a paradigm shift in geriatric physical therapy by bridging these gaps and prioritizing a holistic, movement-centered approach. Rooted in the Geriatric 5Ms-Mind, Mobility, Medication, Multicomplexity, and what Matters Most-the MFOA provides a structured yet adaptable model by integrating movement with the physiological, cognitive, psychosocial, and pharmacological factors influencing mobility and function. This approach compels clinicians to assess and address the unique needs of each older adult, moving beyond impairment-based care toward a more comprehensive, person-centered strategy. Developed by the APTA Academy of Geriatrics' Geriatric Movement System Task Force, the MFOA builds upon existing frameworks by explicitly incorporating movement and the Geriatric 5Ms into the assessment and intervention process. It aligns with hypothesis-driven clinical reasoning, equipping physical therapists with a systematic method to analyze movement impairments and functional limitations. This paper introduces the MFOA as a critical advancement in geriatric physical therapy, strengthening the foundation of current practice and enhancing its relevance to the evolving landscape of aging and health care. By emphasizing movement as a fundamental determinant of function and well-being, the MFOA empowers physical therapists to deliver targeted, effective, and person-centered care that aligns with what Matters Most to older adults.