Aims: The aging population in the Netherlands is increasing, with 4.7 million people aged 65+ expected by 2040. Many older people experience difficulties maintaining Functional Independence (FI), which is essential for aging in place. This study examined the feasibility of a decision support tool to promote FI through integrated assessment and personalized advice. Methods: A mixed-methods feasibility study focused on demand, acceptability, and implementation. Quantitative data were collected from physical therapists and older persons using the Acceptability of Intervention Measure, Intervention Appropriateness Measure, Motivation and Intention to Use Measure, and the Client Satisfaction Questionnaire, and analyzed descriptively. Semi-structured interviews were thematically analyzed. Results: Fifteen physical therapists and fourteen older persons participated. Both groups valued the tool. Physical therapists reported concerns regarding time, workflow integration, and interpretation. Older people reported increased awareness and supported shared decision-making. Conclusion: The DST-FI tool shows potential but requires refinement for implementation in physical therapist practice.
Objectives The purpose of this study was to investigate the effects of gradual speed robot-assisted gait training on lower extremity strength and balance in stroke patients. Methods All subjects were randomly divided into three groups based on the speed of robotic application: Gradual speed increase Robot-assisted gait training Group (GRG, n = 27), Comfortable speed Robot-assisted gait training Group (CRG, n = 26), and control group (n = 28). Participants received 30-minutes robot-assisted gait training thrice weekly for 8 weeks, with pre- and post-assessments of strength and balance. Results The study results showed that all subjects showed significant differences in all measurements post-intervention (p < 0.05). Additionally, GRG was found to significantly improve in Medical Research Council (MRC), Berg Balance Scale (BBS) and Activities-specific Balance Confidence (ABC) compared to CRG (p < 0.05). Conclusions Progressive speed robot-assisted gait training is more effective than constant speed or conventional therapy for improving strength and balance in chronic stroke method (KCT0002552).
AimsTremor Dominant (TD) and Postural Instability/Gait Difficulty (PIGD) are clinical subtypes of Parkinson disease (PD). The purpose of this study was to determine if the instrumented Timed-Up-and-Go (iTUG) and Timed-Up-and-Go Cognitive (iTUGc) differed between TD and PIGD subtypes.MethodsTurn velocity, sit to and from stand duration, sit to and from stand lean angles, trunk rotation, turning duration, and total duration were captured during the iTUG and iTUGc. Independent t-tests, Cohen's d, Mann-Whitney U and effect size r were used.ResultsPIGD group (n = 19) had significantly slower turning velocity (p = 0.048, d = 0.52) during iTUGc compared to TD group (n = 24). Moderate effect sizes were found between groups for trunk rotation during iTUG (p = 0.271, r = 0.17) and iTUGc (p = 0.092, r = 0.26).ConclusionsAssessing turning during the iTUGc may be useful in detecting important movement difficulties in people living with PD classified in the PIGD subtype.
BackgroundFalls are a major problem in long-term care health facilities (LTCHFs). This study investigated fall incidence and risk factors during the first three months of admission.MethodsThis retrospective study at a Japanese LTCHF included 69 residents (mean age 85.7 +/- 6.3 years). Admission data on demographics, physical and cognitive function, and Activities of Daily Living (ADL) were collected. Falls were tracked for three months using the facility's incident reporting system.ResultsWithin three months, 31.9% of residents fell at least once (n = 22). GEE analysis identified toileting dependence as significantly associated with falls (p = 0.026). Logistic regression adjusted for sex confirmed it as an independent predictor (OR = 8.850, 95% CI: 1.067-73.370, p = 0.043), with a sensitivity of 95.5% (AUC = 0.680).ConclusionToileting dependence at admission is a key predictor of falls among new LTCHF residents. These findings highlight the importance of ADL assessment, particularly toileting ability, to enable early, targeted fall prevention.
AimsTo ascertain whether hip flexor explosive strength, agility, and functional mobility tests can discriminate between multiple-step (MS) and single-step (SS) fall avoidance strategies.MethodsThirty-six community-dwelling older women (79.6 +/- 5.9 years) were evaluated using a tether-release method to induce forward balance recovery and were classified into MS (n = 17) and SS (n = 19) groups. Hip flexor isometric maximum strength, peak normalized rate of force development (NRFD), time-to-peak RFD, five-times sit-to-stand (FSST), two-square agility test, ten-step test (TST), 20-s open-close stepping, and walking speed were assessed. Discriminant analysis was performed to identify the factors differentiating the MS and SS groups.ResultsThe MS group showed lower NRFD, slower time-to-peak RFD, and worse performance in the FSST and TST. A model combining NRFD and TST achieved a 91.6% discrimination rate.ConclusionHip flexor explosive strength and agility, particularly rapid alternate foot placement, may help distinguish fall avoidance strategies in older women.
AimsTo assess the impact of telerehabilitation (TR) on health-related quality of life (HRQOL) in older adults with chronic pain or numbness following lumbar spine surgery.MethodsA randomized trial (UMIN: R000051202) included individuals aged 65 and older experiencing pain/numbness three months post-surgery for lumbar spinal stenosis. Participants were assigned to a 12-week TR group (remote pain education and activity guidance) or a home exercise (HE) group (unsupervised exercises). Outcomes included SF-12, pain intensity (NRS), and kinesiophobia (TSK), analyzed via ANCOVA.ResultsTwenty-nine TR and 27 HE participants completed assessments. Significant group effects were found for role physical (eta 2=0.137) and bodily pain (eta 2=0.100) on the SF-12, and TSK (eta 2=0.100). The TR group demonstrated significantly superior outcomes in these measures compared to the HE group.ConclusionsTR interventions combining exercise and education may effectively enhance HRQOL and reduce kinesiophobia in this postoperative population, offering a viable alternative to standard care.
Aim This study aims to compare the effects of Xbox Kinect-based adapted sports program and traditional exercise on neuromuscular and functional outcomes in older adults. Methods Sixty participants (aged 60-79 years) were randomized into experimental and control groups. Both underwent thrice-weekly sessions for six weeks. Assessments included H-reflex (Hmax, Mmax, H/M ratio), Mini-Balance Evaluation Systems Test (Mini-BESTest), Timed Up and Go (TUG) test, One-Leg Stance (OLST), proprioception, and muscle strength. Results The experimental group demonstrated significant improvements in all neuromuscular measures (p < 0.001) and greater gains in postural stability (Mini-BESTest, d = 1.78) compared with controls. Significant between-group differences were also observed for H/M ratio, Hmax, Mmax, right-sided proprioception, and left OLST (p < 0.001). Both groups improved in strength and proprioception; however, TUG scores showed no significant change. Conclusion The Xbox-adapted sports program showed improvements in selected neuromuscular and proprioceptive outcomes compared to traditional exercise. These findings support their use in fall prevention and elderly rehabilitation.
Objective This study examined the direct and indirect effects of physical function and age-related diseases on activity limitation using path analysis. Methods A cross-sectional study was conducted using data from the fifth Indonesian Family Life Survey. A total of 2,017 individuals aged >= 60 years were included in the analysis. Path analysis within a structural equation modeling framework was applied to examine the proposed relationships. Model fit was evaluated using the p-value, root mean square error of approximation (RMSEA), standardized root mean square residual (SRMR), comparative fit index (CFI), Tucker-Lewis index (TLI), and coefficient of determination (CD). Results The path model showed that arthritis acted as a mediator between higher body mass index and an increased risk of falls among older adults. Handgrip strength emerged as a key determinant, directly reducing activity limitation (beta = -0.20; 95% CI = -0.24 to -0.15; p < 0.001) and improving lung volume capacity and balance. Conclusion Physical function decline in older adults is influenced by both physiological capacity and fall-related factors.
AimsThis study aimed to examine how participation in a combined information and communication technology (ICT) and exercise-based preventive care program affects the daily lives and health-related behaviors of community-dwelling older adults.MethodsThis qualitative descriptive study was conducted in 12 older adults (age: >= 65 years) who participated in an 8-month preventive care program in Tokyo. The program consisted of a 4-month ICT training phase, followed by a 4-month physical activity phase. After the program, two focus-group discussions were conducted. Data were transcribed and thematically analyzed by multiple researchers to ensure analytical reliability.ResultsFive themes were identified: (1) behavioral changes and health practices through ICT utilization; (2) development of daily routines and habits; (3) psychological and cognitive changes and improvements; (4) improvements in ICT literacy and social connectedness; and (5) physical activity, fatigue, and refreshment. These five descriptive themes were further integrated into two overarching patterns: (a) ICT-supported self-management of health and daily life, and (b) psychophysical activation through the combined ICT and exercise program. ICT use supported self-monitoring and helped ensure the continuity of exercise routines.ConclusionThe sequential ICT and exercise-based preventive care program facilitated multidimensional changes in lifestyle and health behaviors in older adults. The two overarching themes illustrate how ICT contributes to self-management while exercise promotes psychophysical activation, highlighting the synergistic impact of integrated interventions. The study findings highlight the potential of integrated interventions to support sustained behavioral changes and inform the future development of preventive care programs.
Aim: Despite the availability of physical activity questionnaires in Portuguese, there is a lack of instruments specifically adapted to the Brazilian cultural context that adequately capture physical activity patterns in older adults. Therefore, this study aimed to translate and cross-culturally adapt the Physical Activity Scale for the Elderly (PASE) into Brazilian Portuguese and to assess its internal consistency and reliability. Methods: The cross-cultural adaptation involved translators, back-translators, and experts who prepared the PASE-Br version. Intraclass correlation coefficient was used to assess its reliability in 48 older adults. The final PASE-Br version was approved by consensus, with no need for pretesting changes. Result: Intra- and inter-rater assessments classified PASE-Br reliability as low to very high/excellent and moderate to very high/excellent, respectively. Internal consistency was considered acceptable (Cronbach's alpha 0.81). Conclusion: The PASE-Br demonstrates preliminary evidence of reliability and internal consistency for estimating physical activity levels in the Brazilian older population.
Aims: Referral to the Convalescence Unit predicts a rehabilitation time up to 30 days. It is important to understand whether the functionality level at admission may predicts functional gains and whether an appropriate functional level can be identified for this type of Units.Methods: This retrospective observational study examined a sample of 290 individuals mainly elderly. Collected Barthel Index (BI) and Functional Independence Measure (FIM) values at admission and discharge from the Unit between 2020 and 2022. We applied ROC curves to calculate the BI and FIM cutoff at admission based on the discharge destination.Results: We identified a cutoff point of >= 55 for BI and >= 83 for FIM, indicating a high probability of returning home at the end of CU stay. Patients with functional levels below these cutoff points have a high probability of requiring other responses.Conclusions: Evaluating functionality at the time of referral increase predictability and enables more effective resource management.
Aims: This cross-sectional study compared physical activity, physical performance, and posture in middle-aged and elderly women. Methods: Forty middle-aged women (mean age 51.37 +/- 5.03) and forty elderly women (mean age 66.57 +/- 3.68) participated. Physical activity was measured using the International Physical Activity Questionnaire-Short Form, physical performance with the Timed-Up-and-Go Test, and posture with the New York Posture Analysis. Statistical comparisons were made using the independent t-test and Mann-Whitney U test. Results: Physical performance scores were 8.42 (6.95/10.15) and 8.95 (8.30/10.97) for the middle-aged and elderly groups, respectively, showing significant differences favoring the middle-aged group (p = 0.01). However, physical activity (2185.22 +/- 1410.49 vs. 1728.36 +/- 1476.58) and posture (59.40 +/- 6.60 vs. 56.37 +/- 8.72) were similar between the groups (p > 0.05). Conclusion: Physical performance decreases with age, while physical activity and posture remain comparable. We believe that improving physical performance, which declines with age, is important for healthy aging.
Objective: The aim of this study was to systematically review physical therapists' and physical therapist students' attitudes toward working with older adults. Methods: CINAHL, EMBASE, ERIC, MEDLINE, Scopus, PsycINFO, and SocIndex databases were searched in duplicate (from inception to March 2023). Studies that assessed knowledge on aging, intention to work with older adults or attitudes toward older adults for physical therapist students and/or clinicians, and that were written in English, Finnish, Spanish, or Swedish were included. Grey literature, qualitative studies, or articles of people with a specific diagnosis (eg, dementia) were excluded. All articles were reviewed by 2 authors independently, and consensus was required for inclusion. Data extraction was completed using a standardized data extraction sheet. Results: Of 2755 articles screened, 34 met the inclusion criteria. Twenty-five studies recruited only physical therapist students, 6 recruited only physical therapist clinicians, and 3 involved mixed samples of both. Ten intervention studies were included, all of which recruited physical therapist students. Overall, physical therapist students were observed to have predominantly positive attitudes toward older adults, while clinicians had neutral to weak positive attitudes toward older adults. Both physical therapist students and clinicians were observed to have low knowledge on aging and low intentions to work with older adults. Results from intervention studies suggest that education combined with clinical experience with older adults improves attitudes toward older adults. Conclusion: A discrepancy is observed in physical therapists in that although attitudes toward older adults are positive, a lack of knowledge on aging and a disinterest in working with older adults exists. Intervention studies suggest that clinical experience may improve attitudes toward older adults in physical therapist students. Impact: Predominantly positive attitudes toward older adults are reported by physical therapist students, while for clinicians mixed results are observed. Education coupled with clinical experiences appears to be effective interventions to improve attitudes toward older adults, but such research has only been explored in student samples.
Introduction Sarcopenia is largely underdiagnosed in Geriatric rehabilitation (GR). Diagnosing sarcopenia and muscle mass in particular requires scarce equipment like a CT scan or bioelectrical impedance analysis (BIA), which are generally not available. We explore whether muscle mass can be successfully predicted using routine care data. Methods In this cross-sectional study, the appendicular skeletal muscle mass (ASM) of GR patients was measured using BIA. Routine care data from electronic patient files were explored to construct a prediction model for determining muscle mass using linear regression backward modeling. Results Out of 150 included patients, 56 were identified with low ASM. This could significantly (p < 0.001) be predicted by gender, BMI, handgrip strength, and the Ten Meter Walk test, with 70.5% of the variance explained. Conclusion Muscle mass and, thereby, sarcopenia can be successfully predicted in GR patients using routine-care data. Further research on the external validity of our model is necessary.
Introduction: Muscle function, including strength and power, is vital for post-stroke functional performance such as gait speed. However, how neurologic deficits affect muscle function in acute stroke is unclear. In this study, we investigated muscle function in acute stroke. Methods: The mean age of the participants was 74.4 years, and 36% were women. We measured maximal knee extensor angular velocity (KAV) and maximal isometric knee extensor strength (KES) on both the paretic and nonparetic sides within 72 h of stroke onset. We used multiple regression analysis to determine whether KAV (degrees) and KES (Nm/kg) on the paretic side are associated with maximal gait speed. Results: Multiple regression analysis results showed that paretic side contraction velocity (standardized beta = -0.347; p < 0.01) was associated with gait speed, with a coefficient of determination = 0.258 (p < 0.01). Conclusions: Paretic-side KAV is a key determinant of gait speed in acute stroke.
AimThis study aimed to examine the relationship between cognitive function and physical performance parameters, including grip strength, walking speed, mobility, and frailty, in geriatric individuals.MethodsA cross-sectional study was conducted among 50 geriatric individuals aged 65 years and older. Cognitive functions were assessed using the Standardized Mini-Mental Test. Physical performance was measured with the Short Physical Performance Battery, grip strength with a hand dynamometer, walking speed with the six-meter walk test, mobility with the Timed Up and Go test, and frailty with the FRAIL Scale.ResultsA significant relationship was found between cognitive function and walking speed (r = 0.448, 95% CI: 0.19-0.65, p = 0.001) and between cognitive function and frailty (rho = -0.345, 95% CI: -0.57 to -0.07, p = 0.016). No significant associations were observed between cognitive function and physical performance, grip strength, or mobility.ConclusionsHigher walking speed was related to better cognitive function, whereas increased frailty was associated with poorer cognitive function. These findings suggest that mobility, frailty status, and cognitive health are closely interconnected in geriatric individuals.
IntroductionParkinson's disease (PD) involves autonomic dysfunction, and heart rate variability (HRV) analysis can reveal related alterations. This study investigated whether two aquatic exercise programs produce distinct acute and chronic adaptations in cardiac autonomic control.MethodsIn a non-randomized, single-blind clinical trial, 24 individuals with PD completed either a high-intensity interval aquatic exercise (HIIAE) or a multicomponent aquatic training (MAT) for 12 wk, twice weekly. HRV was assessed before, immediately after a single session (acute), and after program completion (chronic).ResultsBoth interventions increased parasympathetic modulation and reduced sympathetic activity at rest as chronic effects. MAT produced a greater chronic increase in vagal indices, while the HIIAE elicited stronger acute sympathetic responses. Men showed higher HRV indices than women.DiscussionThese findings suggest that different aquatic exercise modalities can beneficially modulate autonomic balance in individuals with PD, supporting aquatic therapy as an effective adjunct in rehabilitation.Registration number on the Brazilian Clinical Trials Registry platform - RBR-3hp5yvhDiscussionThese findings suggest that different aquatic exercise modalities can beneficially modulate autonomic balance in individuals with PD, supporting aquatic therapy as an effective adjunct in rehabilitation.Registration number on the Brazilian Clinical Trials Registry platform - RBR-3hp5yvh
Background: Postural disorders like camptocormia are prevalent in late Parkinson's Disease (PD), causing disabilities. However, the impact of anterior trunk flexion (lumbar fulcrum) (ATF-lf) on functionality of patients without camptocormia remains unclear. Aim: We investigated the association between ATF-lf and functional impairment in older adults with mild to moderate PD without camptocormia. Methods: Older adults in stages 2, 2.5, or 3 on the modified Hoehn and Yahr Scale, without lower camptocormia, were included. ATF-lf was defined as total trunk flexion angle >15 degrees and <= 30 degrees. Functional impairment, postural balance, walking ability, and quality of life were evaluated. Results: Among 68 participants, 24 (35.3%) exhibited ATF-lf. Those with ATF-lf showed less distance on the walking test and lower scores on balance and perceived mobility. Conclusion: Older adults with mild to moderate PD and ATF-lf show worsened walking ability, balance, and perceived mobility, underlining the need for targeted interventions to address ATF-lf-related impairments.
Objectives. We investigated how age (younger [YA] vs. older adults [OA]) and hole dimensions (60 cm vs. critical point) affect frontal plane adaptations-margin of stability (MoS), thorax-pelvis coordination, and joint angles-when stepping into a hole while walking. Methods. Fifteen YA and fifteen OA walked under three conditions: no hole, 60-cm hole, and critical point hole (1.3 times foot length). Results. MoS did not differ by age but decreased with holes, especially the critical point hole. OA increased in-phase and thorax phase coordination compared to YA across all surface conditions. When the foot was inside the hole, OA showed greater in-phase coordination than YA in the critical point condition. OA moved the pelvis downward more than YA when stepping into the hole. Conclusions. These findings indicate that older adults maintained their stability, albeit with changes in pelvis-thorax coordination and a more pronounced downward motion of the pelvis when stepping into the hole.
AimImbalances in the elderly can increase the fall risk. This study compared two independent pre-post intervention groups involving Semi-Immersive Virtual Reality (VR) training and Functional Electrical Stimulation (FES), each combined with static cycling, in older adults.MethodsA total of 232 participants (aged 55-75 years) were allocated to Group 1 (VR, n = 118) or Group 2 (FES, n = 114), receiving 20-minute sessions, five times a week, for four weeks. Outcomes were assessed using the Timed Up and Go (TUG) test, Falls Efficacy Scale (FE_Scale), and Lower Quarter Y Balance Test (LQYBT).ResultWithin-group analysis showed significant improvements in all measures (p = 0.001). However, no statistically significant differences were observed between the groups (TUG, p = 0.13; FE_Scale, p = 0.66; LQYBT-LT, p = 0.98; LQYBT-RT, p = 0.70).ConclusionWhile the FES group showed greater numerical improvements, the differences between the groups were not statistically significant. Both interventions appear beneficial in improving dynamic balance in older adults.Clinical trial registrationCTRI/2023/06/053399.
