Journal of Geriatric Physical Therapy最新文献

Background and purpose: Approximately, 30% to 60% of older adults experience functional decline following hospitalization, which has implications for their ability to meet social needs after discharge. Exploring the unmet social needs of older adults following discharge is warranted to rethink the elements of hospital discharge in low-resource countries. This study explored the unmet social needs of older adults with mobility limitations following discharge from an inpatient rehabilitation unit in a state hospital in Northern Nigeria.

Methods: This narrative qualitative study is based on the social constructivism paradigm guided by the 3-Dimensional Narrative Inquiry Space (3-D NIS) methodology. We purposively selected and conducted telephone interviews with 12 older adults, aged 55 years and older, with mobility limitations and discharged from inpatient rehabilitation units. The 3-D NIS guided the thematic analysis of the data. Two author coders independently conducted a thematic analysis of the transcripts. Reflexivity was maintained throughout the research process.

Results and discussions: Two related themes [6 sub-themes] emerged: "limitations in social functioning" [leisure activity, religious engagement, and instrumental activities of daily living modifications]; and "accepting the status quo" [Care/support from relatives, friends, and strangers, regrets and aspirations, and adaptation to psychological needs]. Seven tensions from the participants' transcripts were embedded in emotions, focused on belief, well-being, and spirituality, COVID-19 pandemic impact, desire to be "normal," limited finance, non-age-friendly homes and community settings, and undetailed rehabilitation discharge planning.

Conclusion: This study highlights the substantial unmet social needs of older adults with mobility limitations following discharge from inpatient rehabilitation units in Northern Nigeria, underscoring the importance of a holistic approach to hospital discharge planning. Future research in low-resource countries should delve deeper into developing comprehensive discharge strategies that integrate social workers and rehabilitation professionals to effectively address these multifaceted social needs.

Background and purpose: The COVID-19 pandemic has raised concerns about nursing home (NH) residents' well-being, with recent studies indicating a significant increase in functional decline rate during this critical period. However, a comprehensive exploration of functional capacity trajectories in NH residents during the pandemic remains unexplored. This study aims to address this research gap by conducting an in-depth analysis of the impact of the COVID-19 pandemic on NH residents' functional capacity.

Methods: A 24-month multicenter prospective study involving 123 NH residents from Spain, with data collected at 6-month intervals over 5 waves, starting just before the pandemic's onset. Functional capacity was assessed using the Modified Barthel Index, and data were analyzed employing the actuarial method, log-rank test, and Cox's regression.

Results and discussion: The likelihood of maintaining functional capacity was unfavorable, with only a 19.3% chance of preservation for a 1-point decline (FD-1) in Barthel scores and a 50.5% probability for a 10-point decline (FD-10). Personal hygiene, eating, and toilet use were identified as the most affected activities of daily living. Urinary continence decline emerged as a risk factor for FD-1, while fecal continence decline was associated with FD-10. The probability of maintaining functional capacity in the initial 6 months of a pandemic was comparable to a 2-year non-pandemic follow-up. Pandemic-induced isolation strategies significantly impacted toileting and personal hygiene. Urinary decline was associated with minor functional decline (FD-1), while fecal decline correlated with major functional decline (FD-10). Notably, the number of days spent in room confinement did not significantly contribute to the observed decline.

Conclusions: A substantial increase in the risk of FD among NH residents during the COVID-19 pandemic compared to the pre-pandemic period was found. It is crucial to implement urgent, targeted interventions that prioritize promoting physical activity and the implementation of mobility and toileting programs. These measures are pivotal for mitigating functional decline and enhancing the overall health and well-being of NH residents in a pandemic context.

Background and purpose: Motoric cognitive risk syndrome (MCR) is a predementia syndrome and is a strong predictor of Alzheimer's disease (AD). Functional mobility, such as balance, sit-stand transitions, and turning, has not been clearly investigated in this population. This study aimed to compare functional mobility among older adults with normal cognition (NC), MCR, and mild AD. Cognitive-motor interactions were also investigated in all the groups.

Methods: This cross-sectional study included 91 older adults, including 36 with NC, 32 with MCR, and 23 with mild AD. A battery of neuropsychology tests encompassing several domains, including general cognition, executive function, attention, episodic memory, visuospatial performance, and language, was administered, and functional mobility tasks, including the Short Physical Performance Battery (SPPB) and the Timed Up and Go Test (TUG), were also carried out. Differences between groups were analyzed with MANCOVAs (post hoc Bonferroni correction). Partial correlation analysis adjusted for age and education levels was used to examine correlations between functional mobility and cognitive function in each group. Canonical correlation analyses were used to determine the extent of the relationship between a set of cognitive variables (executive function, attention, and visuospatial performance) and a set of functional mobility variables (the SPPB and TUG) in the NC, MCR, and mild AD groups.

Results and discussion: The SPPB and TUG performance of the MCR and mild AD groups was significantly worse than that of the NC group. Visuospatial performance and depression were significantly correlated with functional mobility in the MCR group, while depression was the only specific cognitive aspect associated with functional mobility in the mild AD group. Canonical analysis demonstrated a significant relationship between cognition and mobility, explaining approximately 28.4% of the variance, in the NC group. However, the other two groups showed no significant correlation between cognition and mobility.

Conclusions: In addition to slow gait, deficits in sit-stand transitions and turning were also observed in the MCR and mild AD groups. We also found that motor-cognitive interactions may differ according to the level of cognitive impairment. Future studies should comprehensively assess functional mobility for different cognitive impairment populations.

Background and purpose: Nearly 2 decades have elapsed since the last national survey examining entry-level PT geriatric content. Furthermore, no survey has been completed investigating the extent to which the "Essential Competencies in the Care of Older Adults at the Completion of Entry-level Physical Therapist Professional Program of Study" were incorporated into DPT programs. The purpose of this study is to identify the extent to which DPT programs include geriatric topics and the Essential Competencies within curricula and determine geriatric content requiring proficiency for entry-level practice.

Methods: A survey was developed in Qualtrics™ and distributed via email 4 times over 2 months in 2023 to DPT program chairs and APTA social media platforms. The survey contained sections on geriatric curriculum models, environment of content coverage, incorporation of Essential Competencies, and skills requiring entry-level proficiency. Data analysis was completed using descriptive statistics.

Results and discussion: Responses were received from 134/276 programs. Seventy-nine and nine tenths percent of responding programs have a dedicated geriatric course, 93.4% of which require 1 geriatric course, with a mean of 2.6 credits (SD 1.02). In programs without dedicated geriatric courses, a mean of 2.7 credit hours (SD 2.88) of geriatric content was reported. Eighty-nine percent of programs cover age-related changes to major body systems and balance and fall screening, with <60% addressing interventions for cognition and social isolation. Of the surveyed Essential Competencies, 80.4% were incorporated into >70% of programs. A total of 31.6% of the tests and measures were taught, 15.8% were practiced, and 10.5% were identified by >70% of programs as requiring proficiency for entry-level practice.

Conclusions: There is variation in geriatric content incorporated into entry-level DPT programs and moderately robust uptake of Essential Competencies. Entry-level education may not meet APTA-Geriatrics Best Practice guidelines with relatively few tests, measures, and interventions recommended with consensus to be proficient prior to entry-level practice. Improved knowledge translation and curricular guidance may help reduce practice variation and enhance entry-level education in geriatric physical therapy.

Background and purpose: Muscle strength, power, and mass decline with aging, leading to functional loss highly correlated with balance and falls in older adults. Lower limb muscle function is critical for fall prevention in older adults, and hip abductor force and rapid force development have been shown to be important during stepping tasks. However, it remains unclear whether hip abductor muscle function changes with aging. Therefore, the primary aim of this study was to compare maximum torque, submaximal power, and submaximal velocity of hip abductor muscles, as well as hip abductor strength and power clinical assessments, between young and older adults. The secondary aim was to investigate whether there is a relationship between the clinical assessments and hip abduction maximum torque, submaximal power, and submaximal velocity in young and older adults.

Methods: The volunteers young (n = 20, 26.5 ± 3.9) and older (n = 20, 71.9 ± 5.3) adults performed a hip abduction estimated 1-repetition maximum (e1RM) and submaximal tests (40%, 60%, and 70% of e1RM) and clinical assessments (stair climb power test and the 30-second chair stand test).

Results: Older adults exhibited a statistically significant decline in hip abduction torque, power, and velocity, accompanied by lower scores in clinical assessments in comparison to young adults. However, young adults did not exhibit any significant associations between clinical assessments and hip abduction maximum torque, power, and velocity, whereas older adults demonstrated strong correlations (r ≥ 0.52, P ≤ .02).

Discussion: Older adults have a significant reduction in their ability to produce hip abduction torque, power, and velocity, as well as poor performance in clinical assessments compared to young adults. The declines in hip abductor maximum torque, power, and velocity with aging may be related to functional performance, as shown by the significant correlations between these variables and clinical assessments in older adults.

Conclusion: Health care professionals should consider declines in the ability to generate muscle force rapidly, given its significance to lower limb function and overall physical capabilities.

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: Physical therapists play a vital role in preventing and managing falls in older adults. With advancements in digital health and technology, community fall prevention programs need to adopt valid and reliable telehealth-based assessments. The purpose of this study was to evaluate the validity and reliability of the telehealth-based timed up and go (TUG) test, 30-second chair stand test (30s-CST), and four-stage (4-stage) balance test as functional components of the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) fall risk assessment.

Methods: This cross-sectional study was conducted using a convenience sample of community-dwelling older adults. The TUG, 30s-CST, and 4-stage balance test were administered in random order in 1 session in the participant's own environment. Performance was scored concurrently by an in-person and synchronous telehealth rater. The video recordings of the performances were scored by an asynchronous telehealth rater on days 1 and 30 for inter- and intra-rater reliability. Additionally, participants performed the TUG test twice, using the distance measured by the participant and the distance measured by the in-person rater. To establish the validity of telehealth-based STEADI fall risk assessments, the Intraclass Correlation Coefficient (ICC), Pearson correlation coefficient, and 95% limits of agreement were derived. Inter- and intra-rater reliability were established by calculating ICC using a 2-way mixed model. Bland-Altman plots were created for nonsignificant proportional bias tests.

Results and discussion: Thirty community-dwelling older adults participated. Based on the STEADI algorithm, 13 participants were classified as having a moderate fall risk. A comparison of in-person and synchronous telehealth ratings showed excellent ICCs (0.97-0.99) and relationships (r = 0.94-0.98). Bland-Altman plots were created for all tests except for the 30s-CST (t = -2.168, P = .04). All tests had good to excellent inter-rater reliability (ICC = 0.84-1.00) and intra-rater reliability (0.77-1.00). No adverse events were reported.

Conclusion: This study suggests that telehealth-administered functional tests in the STEADI fall risk assessment are valid and reliable when technology, environment, camera view, and angle are optimally managed.

Background: Despite the promise wearable technology offers through detailed insight into mobility and fall risk, timely identification of high risk, assessment of risk severity, evaluation of clinical interventions, and potential to redefine the assessment of behaviours which influence health, they are not routinely used in clinical practice.

Objective: Establish consensus on how wearable technology can be applied to support clinical care for people aged 50 and over experiencing changes to mobility and/or who are at increased risk of falling.

Methods: A Delphi study was conducted among 17 hospital-based health professionals. Over three rounds, experts were asked about fall prevention, mobility assessment, the potential role of wearable sensors, and clinical considerations for implementing wearable technology into practice. Consensus was defined as 75% agreement. Data were analysed using qualitative and quantitative methods.

Results: Experts found that wearable technology has short and long-term clinical utility, data should be shared with general practitioners to improve long-term health outcomes, and devices would need to fit all individuals with a preference for wrist or pendant-worn locations. Technological literacy was not a perceived barrier. However, cost and data accuracy were important for successful implementation.

Conclusion: This study provides a group consensus statement and guidance on the clinical implementation of wearable technology to support care for people aged 50 and over experiencing changes to mobility and/or who are at increased risk of falling. Health professionals are receptive to using wearable technologies to advance fall risk and mobility assessment and believe wearable technology has a role in clinical practice.