Validity of temporo-spatial characteristics of gait as an index for fall risk screening in community-dwelling older people.

[Purpose] This study aimed to identify kinematic gait indicators for a fall risk screening test through quantitative comparisons of gait characteristics measured using mobile inertial sensors between faller and non-faller groups in a population of community-dwelling older people. [Participants and Methods] We enrolled 50 people aged ≥65 years who used long-term care prevention services, interviewed them to determine their fall history during the past year, and divided them into faller and non-faller groups. Gait parameters (velocity, cadence, stride length, foot height, heel strike angle, ankle joint angle, knee joint angle, and hip joint angle) were assessed using the mobile inertial sensors. [Results] Gait velocity and left and right heel strike angles were significantly lower and smaller, respectively, in the faller versus non-faller group. Receiver operating characteristic curve analysis revealed areas under the curve of 0.686, 0.722, and 0.691 for gait velocity, left heel strike angle, and right heel strike angle, respectively. [Conclusion] Gait velocity and heel strike angle during gait assessed using mobile inertial sensors may be important kinematic indicators in a fall risk screening test to estimate the likelihood of falls among community-dwelling older people.

Effect of non-surgical interventions on pain relief and symptom improvement in farmers with diseases of the musculoskeletal system or connective tissue: an exploratory systematic review based on randomized controlled trials.

Objective: There are many observational and clinical studies on pain treatment in farmers; however, little is known about the effects of interventions based only on randomized controlled trials (RCTs) on diseases of the musculoskeletal system or connective tissue (D-MSCT). This review aimed to summarize evidence on the effects of non-surgical interventions for pain relief and symptom improvement in farmers with D-MSCT. Materials and Methods: We searched seven databases, including MEDLINE, and three clinical trial registries, including the International Clinical Trials Registry Platform, from inception up to February 15, 2021, to identify studies that included at least one treatment group wherein nonsurgical interventions were applied. We focused on 1) pain relief and symptom improvement and 2) quality of life and improvement in physical fitness. Results: Four studies (three on low back pain and one on knee osteoarthritis) met all the inclusion criteria. Overall, the risk of bias was high, and meta-analysis could not be performed due to heterogeneity. However, a participatory ergonomic approach, exercise centered on strength training with a transtheoretical model, and/or a combination of both could be included in effective educational programs, at least in the short term, to prevent and/or reduce exacerbation of D-MSCT in farmers. Based on internal and external validity, we could postulate a future research agenda and a conceptual education model to prevent D-MSCT in farmers. Conclusion: Participatory ergonomic intervention, exercise centered on strength training, and/or a combination of both could be included for effective educational programs to prevent and reduce exacerbation of D-MSCT in farmers. High-quality RCTs with a less risk of bias will be implemented for many agricultural work types in various parts worldwide (especially developing countries and regions) during the COVID-19 pandemic.

Effectiveness of intervention for low back pain in female caregivers in nursing homes: a pilot trial based on multicenter randomization.

OBJECTIVES: Although the importance of stretching exercise for pain-relieving and patient education is well documented for chronic lumbago patients, it is uncertain how effective on-the-job training (OJT) is for female caregivers in nursing homes. In the present pilot trial based on multicenter randomization, we evaluated the intervention effect of a lecture and stretching exercise on caregivers in nursing homes. METHODS: Eighty-eight female caregivers (four nursing homes) volunteered to participate in this study, and they were separated into two groups randomly. For the intervention group, guidance by an orthopedist and an exercise instructor were provided as one OJT, and stretching exercises for only 6 min every day were recommended for low back pain prevention to the caregivers. Low back pain visual analogue scale (VAS), physical fitness, and mental and physical health were compared at baseline and immediately after the intervention. RESULTS: A total of 29 (33%) participants withdrew by 12 weeks. Regarding the reasons for withdrawal, 28 participants resigned, and one took a leave of absence due to exacerbation of lumbago. Adherence to the stretching exercises was 2.3 ± 1.3 (mean ± SD) times per week. No significant differences were seen for any outcome measurements. The high adherence group (≧3 times per week) did not show a change in the VAS, but the low adherence group (<3 times per week) and control group showed a tendency towards an increased score (p = 0.068). CONCLUSIONS: Even with the conduct of one OJT, and exercises of only 6 min every day, the adherence of caregivers was low, and there appeared to be few effects of the OJT.

Effectiveness of aquatic exercise and balneotherapy: a summary of systematic reviews based on randomized controlled trials of water immersion therapies.

BACKGROUND: The objective of this review was to summarize findings on aquatic exercise and balneotherapy and to assess the quality of systematic reviews based on randomized controlled trials. METHODS: Studies were eligible if they were systematic reviews based on randomized clinical trials (with or without a meta-analysis) that included at least 1 treatment group that received aquatic exercise or balneotherapy. We searched the following databases: Cochrane Database Systematic Review, MEDLINE, CINAHL, Web of Science, JDream II, and Ichushi-Web for articles published from the year 1990 to August 17, 2008. RESULTS: We found evidence that aquatic exercise had small but statistically significant effects on pain relief and related outcome measures of locomotor diseases (eg, arthritis, rheumatoid diseases, and low back pain). However, long-term effectiveness was unclear. Because evidence was lacking due to the poor methodological quality of balneotherapy studies, we were unable to make any conclusions on the effects of intervention. There were frequent flaws regarding the description of excluded RCTs and the assessment of publication bias in several trials. Two of the present authors independently assessed the quality of articles using the AMSTAR checklist. CONCLUSIONS: Aquatic exercise had a small but statistically significant short-term effect on locomotor diseases. However, the effectiveness of balneotherapy in curing disease or improving health remains unclear.

[Muscle and bone health as a risk factor of fall among the elderly. Biomechanics of falling and fall-related fracture].

Simulation of fall can predict the fall direction, impact load and location. This is effective measure for preventing falls in the elderly. Also, the 3D-finite element analysis used in measuring by micro CT, allows one to estimate bone strength and quality without numerous and expensive fracture testing of real human bones.

Change in Calcaneal Bone Strength in Long-Term Care Residents Treated With Low-Intensity Pulsed Ultrasound.

OBJECTIVE: We examined the effect of low-intensity pulsed ultrasound (LIPUS) on bone strength in osteoporotic elderly residents. MATERIALS AND METHODS: This was a randomized controlled trial. Elderly residents with osteoporosis in a long-term care facility were treated with LIPUS (oscillation frequency 100 KHz) that involved treatment of the heel bone for 2 minutes a day. The selection of the treated heel was decided randomly with a personal computer. The heel bone mineral density before and after treatment was measured by calcaneal quantitative ultrasound (GE-1000 Express). RESULTS: The study included 23 residents but 3 patients developed fractures and 1 withdrew from the study. Nineteen elder residents (average age 86.9 years) completed the study with ultrasonic quantitation before and after treatment. The average speed of sound (following SOS) of the treated and non-treated side was 1438.3 and 1437.4 m/s, respectively at baseline. After 3 months, the SOS was increased to 1450.8 and 1450.5 m/s, respectively, and after 8 months it increased to, 1452.8 and 1451.6 m/s. There were no significant changes between the treated and the non-treated side of the heel bone. DISCUSSION: LIPUS had no effect on increasing bone density in the elderly residents when treatment duration was 2 minutes per day. We suggest that therapy for osteoporosis with LIPUS for the elderly should be studied in the future to reduce the number of prescribed oral agents.

[Effect of vitamin D on bone mineral density; bone strength and fracture prevention].

Although vitamin D improves bone mineral density 0.66% per year at spine site and 1.23% per year at femoral neck site, respectively, vitamin D is useful for preventing osteoporotic fractures, especially hip fractures in the elderly. Vitamin D affects microstructure and bone turnover for osteoporotic bone to become strong bone. And vitamin D improves muscle function to prevent falls in the elderly. Moreover the appropriate amount and treatment target of vitamin D must be considered for the elderly with many different diseases.

Effectiveness of Pilates exercise: A quality evaluation and summary of systematic reviews based on randomized controlled trials.

OBJECTIVE: The objective of this review were to summarize evidence for the effectiveness of Pilates exercise (PE) and to assess the quality of systematic review (SRs) based on randomized controlled trials (RCTs). STUDY DESIGN: A systematic review of SRs based on RCTs. METHODS: Studies were eligible if they were RCTs. Studies included those with one treatment group in which PE was applied. We searched the following databases from 1995 up to August 20, 2014: MEDLINE via PubMed, CINAHL, Web of Science, Global Health Library, and Ichushi-Web. We also searched All Cochrane Database and Campbell Systematic Reviews up to August 20, 2014. Based on the International Classification of Diseases-10 (ICD-10), we identified a disease targeted for each article. RESULTS: Nine studies met all inclusion criteria. As a whole, the quality of the articles was good. Seven studies were about "Musculoskeletal system and connective tissue (M5456)". There were two studies in "Factors influencing health status and contact with health services (Z723)". The traits of participants were for females and the comparatively young- and middle-aged. Five SRs for chronic low back pain (CLBP) concluded that there was pain-relief and functional improvement of the intervention in the short term, but two SRs were inconclusive about the effectiveness of PE. There were no adverse events described in any of the studies. CONCLUSION: Although no SR reported any adverse effect or harm by PE, there was pain-relief and functional improvement attributed to PE in the short term in participants with CLBP. There was also evidence of improved flexibility and dynamic balance, and of enhanced muscular endurance in healthy people in the short term. In addition, there may have been an effect on body composition in the short term.

[Osteoporosis and physical exercise activity].

Since mechanical stress affects bone mineral density, exercise, especially weight-bearing exercise, is effective for preventing osteoporosis. Exercise activity is useful for preventing falls and fractures in the elderly. However, the appropriate amount and type of exercise must be considered for the elderly with many different diseases.

[Practices and strategies for the prevention of falls in the osteoporotic elderly].

Among seniors with osteoporosis, falls can cause devastating injuries such as hip fractures even with only weak impacts. We have begun a combined medical examination and educational program for exercise to prevent injurious falls. To make fall prevention practices more widespread, we hold one-day simplified fall prevention program and instruction courses for practitioners.

Effectiveness of horticultural therapy: a systematic review of randomized controlled trials.

AIM: To summarize the evidence from randomized controlled trials (RCTs) on the effects of horticultural therapy (HT). METHODS: Studies were eligible if they were RCTs. Studies included one treatment group in which HT was applied. We searched the following databases from 1990 up to August 20, 2013: MEDLINE via PubMed, CINAHL, Web of Science, Ichushi-Web, GHL, WPRIM, and PsyclNFO. We also searched all Cochrane Database and Campbell Systematic Reviews up to September 20, 2013. RESULTS: Four studies met all inclusion criteria. The language of all eligible publications was English and Korean. Target diseases and/or symptoms were dementia, severe mental illness such as schizophrenia, bipolar disorder, and major depression, frail elderly in nursing home, and hemiplegic patients after stroke. These studies showed significant effectiveness in one or more outcomes for mental health and behavior. However, our review especially detected omissions of the following descriptions: method used to generate randomization, concealment, blinding, and intention-to-treat analysis. In addition, the results of this study suggested that the RCTs conducted have been of relatively low quality. CONCLUSION: Although there was insufficient evidence in the studies of HT due to poor methodological and reporting quality and heterogeneity, HT may be an effective treatment for mental and behavioral disorders such as dementia, schizophrenia, depression, and terminal-care for cancer.

Effectiveness of animal-assisted therapy: A systematic review of randomized controlled trials.

The objectives of this review were to summarize the evidence from randomized controlled trials (RCTs) on the effects of animal-assisted therapy (AAT). Studies were eligible if they were RCTs. Studies included one treatment group in which AAT was applied. We searched the following databases from 1990 up to October 31, 2012: MEDLINE via PubMed, CINAHL, Web of Science, Ichushi Web, GHL, WPRIM, and PsycINFO. We also searched all Cochrane Database up to October 31, 2012. Eleven RCTs were identified, and seven studies were about "Mental and behavioral disorders". Types of animal intervention were dog, cat, dolphin, bird, cow, rabbit, ferret, and guinea pig. The RCTs conducted have been of relatively low quality. We could not perform meta-analysis because of heterogeneity. In a study environment limited to the people who like animals, AAT may be an effective treatment for mental and behavioral disorders such as depression, schizophrenia, and alcohol/drug addictions, and is based on a holistic approach through interaction with animals in nature. To most effectively assess the potential benefits for AAT, it will be important for further research to utilize and describe (1) RCT methodology when appropriate, (2) reasons for non-participation, (3) intervention dose, (4) adverse effects and withdrawals, and (5) cost.

Effectiveness of music therapy: a summary of systematic reviews based on randomized controlled trials of music interventions.

OBJECTIVE: The objective of this review was to summarize evidence for the effectiveness of music therapy (MT) and to assess the quality of systematic reviews (SRs) based on randomized controlled trials (RCTs). STUDY DESIGN: An SR of SRs based on RCTs. METHODS: Studies were eligible if they were RCTs. Studies included were those with at least one treatment group in which MT was applied. We searched the following databases from 1995 to October 1, 2012: MEDLINE via PubMed, CINAHL (Cumulative Index of Nursing and Allied Health Literature), Web of Science, Global Health Library, and Ichushi-Web. We also searched all Cochrane Database and Campbell Systematic Reviews up to October 1, 2012. Based on the International Classification of Diseases, 10th revision, we identified a disease targeted for each article. RESULTS: Twenty-one studies met all inclusion criteria. This study included 16 Cochrane reviews. As a whole, the quality of the articles was very good. Eight studies were about "Mental and behavioural disorders (F00-99)"; there were two studies on "Diseases of the nervous system (G00-99)" and "Diseases of the respiratory system (J00-99)"; and there was one study each for "Endocrine, nutritional and metabolic diseases (E00-90)", "Diseases of the circulatory system (I00-99)", and "Pregnancy, childbirth and the puerperium (O60)". MT treatment improved the following: global and social functioning in schizophrenia and/or serious mental disorders, gait and related activities in Parkinson's disease, depressive symptoms, and sleep quality. CONCLUSION: THIS COMPREHENSIVE SUMMARY OF SRS DEMONSTRATED THAT MT TREATMENT IMPROVED THE FOLLOWING: global and social functioning in schizophrenia and/or serious mental disorders, gait and related activities in Parkinson's disease, depressive symptoms, and sleep quality. MT may have the potential for improving other diseases, but there is not enough evidence at present. Most importantly, no specific adverse effect or harmful phenomenon occurred in any of the studies, and MT was well tolerated by almost all patients.

Vitamin D deficiency in elderly women in nursing homes: investigation with consideration of decreased activation function from the kidneys.

OBJECTIVES: To determine the approximate percentage of women in nursing homes who have vitamin D deficiency and to investigate whether, in assessing vitamin D status in elderly women, there are problems with measuring only 25 hydroxy-vitamin D(3) (25(OH)D(3) ) and whether decreased vitamin D activation as a result of poor renal function needs to be considered. DESIGN: Cross-sectional study. SETTING: Forty-eight nursing homes in Japan. PARTICIPANTS: Four hundred three women with a mean age of 86.5 living in nursing homes who had participated in a clinical trial for hip protectors and were not bedridden. MEASUREMENTS: At the start of the trial, in addition to general biochemical data, 25(OH)D(3) , 1,25-dihydroxy-vitamin D(3) (1,25(OH)(2) D(3) ), intact parathyroid hormone (intact PTH), calcium (Ca), phosphorus (P), bone alkaline phosphate (BAP), cross-linked N-telopeptide of type I collagen (NTx), and osteocalcin were measured in participants' blood, and statistical analysis was performed. RESULTS: 25(OH)D(3) , which is thought to reflect vitamin D status in the body, was surveyed and found to have a mean value of 16.7 ng/mL. 25(OH)D(3) was less than 16 ng/mL in 49.1% of all participants. Creatinine clearance (CCr) was less than 30 mL/min in 20.1% of participants. Participants with serum 25(OH)D(3) less than 16 ng/mL and CCr less than 30 mL/min had significantly higher levels of intact PTH and serum NTx. Participants with a CCr less than 30 mL/min had significantly lower levels of 1,25(OH)(2) D(3) . CONCLUSION: Frail elderly adults living in nursing homes with poor renal function had lower 1,25(OH)(2) D(3) and higher intact PTH levels and were thus thought to have poorer vitamin D activating capacity. Supplementation with cholecalciferol may be insufficient in people who have poor renal function.

A systematic review of randomized controlled trials on curative and health enhancement effects of forest therapy.

OBJECTIVE: To summarize the evidence for curative and health enhancement effects through forest therapy and to assess the quality of studies based on a review of randomized controlled trials (RCTs). STUDY DESIGN: A systematic review based on RCTs. METHODS: Studies were eligible if they were RCTs. Studies included one treatment group in which forest therapy was applied. The following databases - from 1990 to November 9, 2010 - were searched: MEDLINE via PubMed, CINAHL, Web of Science, and Ichushi- Web. All Cochrane databases and Campbell Systematic Reviews were also searched up to November 9, 2010. RESULTS: Two trials met all inclusion criteria. No specific diseases were evaluated, and both studies reported significant effectiveness in one or more outcomes for health enhancement. However, the results of evaluations with the CONSORT (Consolidated Standards of Reporting Trials) 2010 and CLEAR NPT (A Checklist to Evaluate a Report of a Nonpharmacological Trial) checklists generally showed a remarkable lack of description in the studies. Furthermore, there was a problem of heterogeneity, thus a meta-analysis was unable to be performed. CONCLUSION: Because there was insufficient evidence on forest therapy due to poor methodological and reporting quality and heterogeneity of RCTs, it was not possible to offer any conclusions about the effects of this intervention. However, it was possible to identify problems with current RCTs of forest therapy, and to propose a strategy for strengthening study quality and stressing the importance of study feasibility and original check items based on characteristics of forest therapy as a future research agenda.

Clinical factors as predictors of the risk of falls and subsequent bone fractures due to osteoporosis in postmenopausal women.

In Japan, the "bedridden state" is one of the most serious problems the aged face, and it is becoming a social problem. The main causes of the bedridden state are cerebrovascular disorders and bone fractures following falls. The purpose of this study was to predict risk factors for falls and resultant bone fracture due to osteoporosis. We explored mobility parameters for possible fall prevention. In order to examine the correlation between the risk of falling and resultant bone fracture due to osteoporosis, logistic regression analysis was performed between bone mass (independent variable) and various factors dependent variables: body mass index [BMI], body fat percentage, atherogenic index, presence of transformation-related osteoarthritis of knee, presence of transformation-related osteoarthritis of spine, maximum step length, single-leg stance with open eyes, and hip-joint flexion motion angle); predictive factors were then examined. Predictive factors were determined by the stepwise method. Subjects who could not perform the "single-leg stance with open eyes" test had a risk of falling and bone fracture 2.49 times as large as that of subjects who could. The "single-leg stance with open eyes" test may be considered a useful method for the early detection of the risk of falling and bone fracture associated with osteoporosis. As a first step to identify factors predicting the occurrence of falls and bone fractures due to osteoporosis, we intended to discover an indicator that would help to detect incipient osteoporosis.