Journal of Geriatric Physical Therapy最新文献

Background and purpose: Standardized screening tests that detect early mobility decline, regardless of etiology, are needed for healthy aging. The locomotive syndrome (LS) tests are designed to identify stages of mobility decline and inform appropriate levels of intervention. The long-term goal of this research is to develop standardized mobility screening tests that can be used across health care settings and throughout a patient's lifespan to guide appropriate medical care. As the first step in this process, this study examines the concurrent validity between the reference and the LS tests.

Methods: This cross-sectional study examined correlations between the LS functional tests and a set of reference tests and the ability to differentiate the 3 stages of mobility decline. The reference tests included the stair-climbing test, the 30-second chair rise test, the 6-minute walk test, the Global Physical Health (GPH) portion of the PROMIS, and the Lower Extremity Functional Scale (LEFS). The LS tests included the Stand-Up Test, the 2-Step Test, and the 25-question Geriatric Locomotive Function Scale (25-GLFS). A total of 115 community dwellers of 61.2 years old on average (±10.0 years), with n = 71 (61%) older than 60 years, voluntary participated in this prospective study. Nonparametric analyses of variance and correlations were used to examine the concurrent validity.

Results and discussion: Performance-based tests were significantly correlated (| r | = 0.38-0.61, P < .001) with LS tests. The LEFS was correlated with all LS tests, but the GPH was only correlated with the 25-GLFS. Also, significant differences were found in reference test scores between the 3 LS stages ( P < .05).

Conclusions: The LS tests and reference tests demonstrated significant correlations, and participants performed significantly worse on reference tests as LS severity increased. Given these results, it is possible that the LS standardized tests may play an important role in mobility screening. Future research should investigate feasibility, sensitivity, and specificity of these tests.

Background and purpose: Dementia prevalence is expected to increase dramatically with population aging. As a nonpharmacological therapy, physical activity is an appealing alternative to tackling aging and dementia. However, contradictions were found in previous studies. The aim of this systematic review is to gather the latest evidence of the effects of physical activity interventions on cognition and noncognitive functions of older people with dementia.

Methods: PubMed, Cochrane, and Web of Science databases were searched to identify relevant studies. We followed the PRISMA guidelines to identify randomized controlled trials that reported original findings of physical activity interventions on older people with dementia (≥65 years of age). These studies were published in English between January 1, 2009 and November 9, 2019.

Results: In total, 16 trials with 2085 participants were included in the review. Compared to baseline, cognitive function improved significantly in 2 studies, deteriorated in 3 studies, and remained stable in 11 studies. In the exercise relative to the control group, 5 studies showed no significant differences, 2 studies showed significantly greater deterioration in cognition, and 9 studies showed significantly greater improvement in cognition. However, most studies (n = 13.81%) had notable limitations (eg, with a high risk of bias, limited follow-up time, or unexplained high heterogeneity in their findings). Fourteen studies reported a positive impact on one or more areas of physical function, mobility, activities of daily living, depression levels, and behavioral/psychological symptoms of dementia.

Conclusions: Physical activity interventions have a positive impact on physical function, mobility, and activities of daily living. However, the available evidence is insufficient to support the conclusion that physical activity improves cognitive function of older people with dementia.

Background: Health care providers, including physical therapists, need to identify the reasons for insufficient physical activity (PA) to assist the 56% to 73% of community-dwelling adults 50 years of age and older who are not performing the recommended 150 minutes of moderate to vigorous PA. Currently, there is no feasible, multifactorial tool to assess PA barriers among this population. Without a tool, health care providers must either rely on self-generated questions or collate results from multiple assessments to identify PA barriers related to personal, social, and environmental factors, which can be time-consuming and incomplete.

Purpose: To develop the Inventory of Physical Activity Barriers (IPAB), an assessment tool that examines personal, social, and environmental PA barriers.

Methods: We developed and psychometrically evaluated the IPAB using a 3-phase process. For phase 1, we used a deductive method to develop the initial scale. During phase 2, we refined the scale and explored its psychometric properties by collecting cross-sectional pilot data on community-dwelling adults 50 years of age and older. We used descriptive statistics, item-scale correlations, construct validity via Mann-Whitney U test, and internal consistency via Cronbach α to analyze the data from phase 2. After identifying the scale's potential for being valid and reliable, we implemented phase 3, a modified Delphi technique.

Results: Using item-scale correlations, descriptive statistics, and consensus among PA experts, we refined the initial scale from 172 items to 40 items. The 40-item IPAB demonstrated good construct validity (determined by the scale's ability to differentiate between individuals who did and did not meet 150 min/wk of moderate to vigorous PA; P = .01) and internal consistency (Cronbach α of 0.97).

Conclusion: Our preliminary results suggest that the IPAB is valid and reliable. Using the IPAB, health care providers will be able to identify patients' PA barriers and thus develop individualized PA prescriptions, an evidence-based method of increasing PA.

It is a steep challenge to fully implement the wide range of evidence that supports rehabilitation interventions for the prevention of chronic disease. Proactive physical activity (PA) promotion can lead to increased PA levels to improve and maintain physical function. Higher levels of PA throughout the lifespan lead to better overall population health, wellness, aging, disease prevention, and chronic condition management. This article introduces the Wellness Aging Model related to Inactivity, Illness, and Injury (WAMI-3) as a simple visual tool to educate patients on the importance of PA and exercise for primary, secondary, and tertiary prevention. As a clinical construct, the WAMI-3 can be applied to all body systems affected by aging, inactivity, illness, and/or injury and exemplifies the concept of Exercise is Medicine®. The WAMI-3 framework is intended for easy integration into clinical practice; a clinician-friendly resource, based on health promotion, is provided to serve as a catalyst for enhancing the patient interview and education on the importance of PA and exercise. Video Abstract available: For more insight from the authors, see Supplemental Digital Content 1 (available at: http://links.lww.com/JGPT/A115).

Background and purpose: Exercise interventions can improve physical recovery and reduce falls in older adults following hospitalization. The aim of the study was to identify factors associated with exercise engagement after hospital discharge.

Methods: This study was a secondary analysis of data collected as part of a randomized controlled trial. Participants were 60 years and older, discharged from 3 rehabilitation hospitals in Australia, and followed for 6 months after discharge. The primary outcome was level of engagement in exercise after discharge, measured using setting, type, frequency, and time. A secondary outcome was self-efficacy for exercise at 6-month follow-up. Data were gathered at baseline in hospital and at 6 months after discharge by telephone using structured surveys. Associations between exercise and participant characteristics were evaluated using logistic regression models.

Results and discussion: Participants' (n = 292) mean age was 78 (SD 8) years and 63% were female. There were 146 (50%) who exercised after hospitalization for a median (interquartile range) time of 60 (60-75) minutes per week. Characteristics that were significantly associated with post-discharge engagement in exercise were having higher levels of functional ability at discharge (adjusted odds ratio [AOR] 1.2, 95% CI 1.0, 1.4), living with a partner (AOR 2.9, 95% CI 1.7, 4.9), and engagement in exercise prior to hospital admission (AOR 1.7, 95% CI 1.0, 2.8). The mean self-efficacy for exercise score at 6 months post-discharge was 58.5/90 (SD 24.5). Characteristics that were significantly predictive of a higher mean self-efficacy score at 6 months after hospitalization were having a college or university education (adjusted β-coefficient [Adj β] 11.5, 95% CI 3.8, 19.0), exercise prior to hospital admission (Adj β 12.3, 95% CI 5.1, 19.5), living with a partner at discharge (Adj β 14.5, 95% CI 7.1, 21.9), and higher functional ability at discharge (Adj β 4.0, 95% CI 1.9, 6.1).

Conclusion: Older adults have low levels of engagement in exercise that might impact their recovery after hospitalization. During exercise prescription, clinicians should prioritize older adults who live alone, who have lower functional ability, and no previous habit of exercising.

Background and purpose: In light of the fear avoidance model, kinesiophobia and fear avoidance (FA) can lead to physical inactivity and disability. Previous studies regarding kinesiophobia and FA in older adults have reported conflicting results. The purpose of this review was to identify the reported constructs and assessment instruments used in published studies on kinesiophobia and FA in older adults and to verify the alignment between the instruments used and the constructs under study.

Methods: Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 statement (PRISMA-2020), 4 databases were searched from January 2005 to March 2020. All study types, except qualitative, were eligible for inclusion. The participants were 65 years and older. Studies were excluded in the absence of sufficient data on participant age. Study characteristics, constructs related to kinesiophobia, fear and/or avoidance, and instruments used were extracted independently by 2 reviewers.

Results: Fourteen articles were selected for inclusion in the study, in which 7 constructs were identified. The most reported constructs were "fear avoidance beliefs" (FAB) (50%; n = 7), "kinesiophobia" (35.7%; n = 5), and "fear of falling" (14.3%; n = 2). The remaining constructs were only approached, each in 7.1% (n = 1) of the included studies. Seven instruments were used to assess the constructs. The Fear Avoidance Beliefs Questionnaire (FABQ) was the most used instrument (n = 3) to evaluate "FAB," and the Tampa Scale for Kinesiophobia-11 (TSK-11) was the most reported (n = 3) to assess "kinesiophobia."

Conclusion: This review identified a large diversity in the constructs and instruments used to study kinesiophobia and FA among older adults. Some constructs are used interchangeably although they do not share the same conceptual definition. There is poor standardization in the use of assessment tools in accordance with the construct under study. Clinical evaluation and study results can be biased owing to this ambiguity.

Background and purpose: Low back pain (LBP) has a high prevalence in older adults and is associated with elevated health care costs. This systematic review and meta-analysis examines the effects of progressive resistance training (PRT) interventions on physical function (PF) and pain control in community-dwelling older adults with chronic LBP.

Methods: A meta-analysis applying the quality effect method was performed by calculating the effect sizes (ESs) using the Cohen d with a 95% CI. A subgroup analysis was performed according to the participant and intervention characteristics. The statistical significance of differences between subgroups was calculated using a Z -test. Study bias was estimated using the version 2 of the Cochrane risk of bias tool for randomized trials (RoB 2.0) and quality of evidence (Qi) index. Small study effect/publication bias was estimated using the Doi plot and Luis Furuya-Kanamori (LFK) index. The systematic search was conducted in major databases for clinical trials published between January 1, 1990, and January 9, 2021. The inclusion criteria were articles that (1) were peer-reviewed; (2) had participants' mean age of more than 60 years; (3) studied PRT interventions; (4) had participants with LBP; (5) measured LBP or PF outcomes; (6) measured PF in terms of functionality; (7) were randomized controlled trials; (8) and non-randomized controlled trials. The exclusion criteria were (1) articles not written in English, (2) nonexperimental studies, and (3) repeated publications.

Results and discussion: Twenty-one studies were included (n = 1661). Clear improvements were found in PF (ES = 0.32 [95% CI, 0.05-0.58]; I2 = 75.1%; P < .001), but results on LBP decrease were inconclusive (ES = 0.24 [95% CI, -0.05 to 1.10]; I2 = 75.7%; P < .001). The overall evidence of this aggregated data meta-analysis of clinical trials is level C+. Main limitations are the use of aggregated data and the large heterogeneity between studies.

Conclusions: The Qi of this meta-analysis is level I (C+). We concluded that PRT interventions are useful for PF improvement in older adults with generalized LBP, LBP not arising from lumbar spinal stenosis, and having body mass index less than 27. In older adults with LBP not arising from lumbar spine stenosis, PRT interventions also decrease LBP. Interventions should have a frequency of at least 3 sessions per week. In addition, at a lower level of evidence IV (C+), we recommend that interventions with a duration of more than 12 weeks should be considered, whenever possible.