Physical fitness in older women with osteoporosis and vertebral fracture after a resistance and balance exercise programme: 3-month post-intervention follow-up of a randomised controlled trial.

BACKGROUND: Exercise is recommended for individuals with vertebral fractures, but few studies have investigated the effect of exercise on outcomes of importance for this population. Post-intervention effects of exercise are even less studied. The objective of this study was to evaluate habitual walking speed and other health-related outcomes after cessation of a 3-month exercise intervention. METHODS: This follow-up study was conducted 3 months post-intervention of a randomised controlled trial. A total of 149 community-dwelling Norwegian women aged 65 years or older, diagnosed with osteoporosis and vertebral fracture were randomised into either exercise or control group. Primary outcome was habitual walking speed at 3 months. Secondary outcomes were other measures of physical fitness - including the Four Square Step Test (FSST), functional reach, grip strength and Senior Fitness Test - measures of health-related quality of life and fear of falling. Herein we report secondary data analysis of all outcomes at 6 months (3 months post-intervention). Data were analysed according to the intention-to-treat principle, linear mixed regression models were employed. RESULTS: For the primary outcome, habitual walking speed, there was no statistically significant difference between groups (0.03 m/s, 95%CI - 0.02 to 0.08, p = 0.271) at the 3-month post-intervention follow-up. For secondary outcomes of physical fitness, statistically significant differences in favour of the intervention group were found for balance using the FSST (- 0.68 s, 95%CI - 1.24 to - 0.11, p = 0.019), arm curl (1.3, 95%CI 0.25 to 2.29, p = 0.015), leg strength using the 30-s sit to stand (1.56, 95%CI 0.68 to 2.44, p = 0.001) and mobility using the 2.45-m up and go (- 0.38 s, 95%CI - 0.74 to - 0.02, p = 0.039). There was a statistically significant difference between the groups regarding fear of falling in favour of the intervention group (- 1.7, 95%CI - 2.97 to - 0.38, p = 0.011). No differences between groups were observed for health-related quality of life. CONCLUSION: The results show the improved effects of a multicomponent exercise programme on outcomes like muscle strength, balance and mobility as well as fear of falling in a group of older women with osteoporosis and vertebral fracture 3 months post-intervention. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02781974 . Registered 25.05.16. Retrospectively registered.

Associations between health-related quality of life, physical function and pain in older women with osteoporosis and vertebral fracture.

BACKGROUND: Osteoporosis and vertebral fractures represent a major health burden worldwide, and the prevalence of osteoporosis is expected to increase as the world's population ages. Suffering from vertebral fracture has a substantial impact on the individual's health-related quality of life (HRQoL), physical function and pain. Complex health challenges experienced by older people with osteoporosis and vertebral fractures call for identification of factors that may influence HRQoL, as some of these factors may be modifiable. The objective is to examine the independent associations between HRQoL, physical function and pain in older women with osteoporosis and vertebral fracture. METHODS: This study has a cross-sectional design, using data from 149 home-dwelling Norwegian women with osteoporosis and vertebral fracture, aged 65+. Data on HRQoL (Short Form 36 (SF-36), Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO-41)), physical function (walking speed, balance and strength), pain, as well as sociodemographic information were collected. Simple linear regression analyses were conducted and multivariable regression models were fitted to investigate the associations. RESULTS: Lower levels of HRQoL were significantly associated with lower levels of physical function, measured by walking speed, and higher levels of pain. Pain was significantly associated with all of the subscales in SF-36, with the exception of Mental Health and Mental Component Score, and all the subscales of QUALEFFO-41. Walking speed was significantly associated with 5 of 8 subscales of SF-36 (except Bodily Pain, Vitality, Mental Health and Mental Component Score), and with 4 of 6 subscales of QUALEFFO-41 (except Score Pain and Mood). CONCLUSION: This study shows that pain and walking speed were, independently of one another, associated with HRQoL in older women with osteoporosis and vertebral fracture. These findings can inform clinicians and health managers about the importance of pain management and exercise interventions in health care for this group. Future research should address interventions targeting both physical function and pain with HRQoL as an outcome. REGISTRATION: ClincialTrials.gov Identifier: NCT02781974. Registered 18.05.16. Retrospectively registered.

Effect of a resistance and balance exercise programme for women with osteoporosis and vertebral fracture: study protocol for a randomized controlled trial.

BACKGROUND: Osteoporotic vertebral fractures are common, and are associated with reduced functioning and health related quality of life. The primary aims of this randomized controlled trial are to examine the immediate and long-term effects of a 12-weeks supervised group exercise programme on habitual walking speed in older women with osteoporosis and a history of vertebral fracture. The secondary aims are to examine the immediate and long-term effects of the exercise program on physical fitness, fear of falling and quality of life. METHODS: The study is a single-blinded randomized controlled trial. Women aged 65 years or older with osteoporosis and a history of vertebral fracture are included. The intervention group receives a 12-week multicomponent exercise programme, including resistance training combined with balance training. The control group receives usual care. Adherence to the programme will be of importance for the internal validity of the study. Participants in the exercise group who don't attend will be followed up with motivational phone calls. The primary outcome is habitual walking speed over 10 m. Secondary outcomes are health related quality of life (Qualeffo-41, SF-36), physical activity (I-PAQ), Patient Specific Functional Scale, Fear of falling (FES-1) and physical fitness (Senior Fitness test, Functional reach test, 4 square step test, grip strength). Sample size, based on the primary outcome, is 150 participants randomized into the two arms on a 1:1 allocation, including an estimated 20% drop out. Descriptive data will be reported as mean (standard deviation), median (range) or count (percent) as appropriate. The data will be analysed following the intention-to-treat principle. Between group differences in primary and secondary outcomes at 3 months follow-up will be assessed using linear regression models with respective outcome at baseline as covariate and the randomised group as factor. DISCUSSION: This trial will generate new knowledge on the effects of a multicomponent exercise programme among women over 65 years with osteoporosis and a history of vertebral fracture, knowledge that is of importance for clinicians, health managers and policy makers. TRIAL REGISTRATION: ClincialTrials.gov Identifier: NCT02781974 . Registered 18.05.16. Retrospectively registered.

The effect of occupational therapy in patients with chronic obstructive pulmonary disease: A randomized controlled trial.

Aim The main aim of this study was to evaluate the effect of individualized occupational therapy in patients with chronic obstructive pulmonary disease (COPD). Additionally, the authors wanted to explore the occupational problems experienced in daily life by individuals with COPD. Methods A total of 52 patients were randomly assigned to the intervention group (occupational therapy) or control group (treatment as usual). The primary outcome was assessed using the Canadian Occupational Performance Measure (COPM), and participants were assessed at baseline and after four and 12 months. Results There were no treatment effects on occupational performance or satisfaction with performance, as measured by the COPM. However, we found a significant effect in favour of the intervention group at exertion when performing an individually chosen activity, and in the activity dimension of St George's Respiratory Questionnaire. A total of 595 occupational problems were reported, most frequently within mobility, active recreation, and household management. Conclusions The results show that, compared with the usual care, individualized occupational therapy did not improve occupational performance or satisfaction with performance. Small but significant changes in activity performance in favour of the intervention group were found in some of the secondary outcomes.

Physical Fitness in Older People with Mild Cognitive Impairment and Dementia.

Maintenance of physical activity and good physical fitness is important for functional independence. This study had two aims: examine the physical fitness level in older persons with mild cognitive impairment (MCI) or dementia, and examine the relationship between the components of physical fitness and cognitive domains in this group. The cross-sectional study included community-living older people ≥ 65 years of age with MCI or dementia. Physical fitness and cognition were assessed using the Senior Fitness Test and five cognitive tests. Most of the participants scored below the criteria for maintaining physical independence in later years. There were significant associations between the components of physical fitness and cognition, except flexibility. Declines in executive function were most related to declines in physical fitness. These factors should receive more attention in people with MCI and dementia because they risk losing independence.

Reliability of the senior fitness test in community-dwelling older people with cognitive impairment.

BACKGROUND AND PURPOSE: In older people with cognitive impairment, we require reliable and valid measures to assess physical fitness and to measure change, for example, as a result of an exercise intervention. The purpose of our study was to determine the relative and absolute test-retest reliability of the Senior Fitness Test (SFT) in older people with cognitive impairment. METHODS: A test-retest reliability study was conducted for the Senior Fitness Test in older people with cognitive impairment. Participants were tested at two time points with a time interval of 24 hours to 1 week between tests. The Intraclass Correlation Coefficient model 3.1 (ICC, 3.1) with 95% confidence intervals (CIs) was used as a measure of relative reliability. The standard error of measurement and minimal detectable change (MDC) were used to measure absolute reliability. RESULTS: The ICC reflected very high reliability (0.93-0.98) in all SFT items, indicating that there was no systematic error in the measurements. MDC values at the 90% CIs were calculated: chair stand test = 2.0 repetitions, armcurl test = 2.3 repetitions, chair sit and reach test = 6.0 cm, back scratch test = 4.6 cm, 2.45-m up-and-go test = 1.4 seconds and 6-minute walk test = 37.1 metres. DISCUSSION: The SFT battery showed high to very high test-retest reliability and thus may be suitable for detecting changes in physical fitness and evaluating physical fitness in older people with cognitive impairment, both in research and for clinical purposes.

Disability in instrumental activities of daily living in elderly patients with mild cognitive impairment and Alzheimer's disease.

BACKGROUND/AIMS: The aim is to examine disability in instrumental activities of daily living (IADL) in elderly persons with mild cognitive impairment (MCI) and Alzheimer's disease (AD), further to identify items of IADL which separate the two conditions and to explore potential gender differences. METHODS: A cross-sectional study of 729 patients aged ≥65 years recruited from outpatient memory clinics. Multiple logistic regression analysis was used in the main analysis to explore the association between IADL and diagnosis. RESULTS AND CONCLUSIONS: We found an association between IADL and diagnosis, and a difference in the proportion of disability in IADL in patients with MCI and AD, i.e. 66 and 88%, respectively. Six of the 8 items revealed differences in the proportions of patients with IADL disability among MCI and AD. No substantial gender differences were found, except for laundry.

Diagnostic accuracy of three types of fall risk methods for predicting falls in nursing homes.

AIMS: To determine the diagnostic accuracy of three different methods for identifying individuals at high risk of falling. The St- Thomas Risk Assessment tool (STRATIFY- modified for nursing homes), staff judgment of fall risk, and previous falls remembered by the staff were evaluated. We also examined whether a combination of two of the methods would increase accuracy. MATERIALS AND METHODS: A prospective observational cohort study was carried out for 18 months. One thousand one hundred and forty-eight participants were included and assessed for fall risk. Falls among these residents were recorded from the date of inclusion to the date of death, transfer, or end of observation time. Diagnostic accuracy was evaluated in terms of sensitivity, specificity, predictive values and likelihood ratios, as well as Kaplan-Meier estimates and the Cox proportional hazard model, with time to the first fall as the dependent variable. Sensitivity, specificity, predictive value and likelihood ratios were calculated for falls within 30, 90 and 180 days of assessment for fall risk. RESULTS: Five hundred and seventy (49.6%) of the 1148 residents had one or more falls during the observation period. One thousand one hundred had more than 30 days of observation, 987 more than 90 days, and 867 more than 180 days. For falls within 30 days of assessment for fall risk, sensitivity varied from 65% to 72%, specificity from 69% to 75%, positive predictive value from 31% to 35% and negative predictive value from 91% to 92%. Sensitivity and negative predictive value decreased for falls within 90 days and decreased further for falls within 180 days, whereas specificity and positive predictive value increased for all three assessment methods. Staff judgment of fall risk was the single method having the highest sensitivity but the lowest specificity. A combination of either two of them increased sensitivity to more than 80%, but decreased specificity. The positive Likelihood ratio varied from 2.24 to 2.70 and the negative Likelihood ratio from 0.41 to 0.49 for falls within 30 days. The relative risk of sustaining a fall was 2.4, 2.9 and 3.0 times higher for those assessed to be at high risk of falls compared with those assessed to be at low risk, according to STRATIFY, staff judgment of fall risk and previous falls remembered by the staff, respectively. CONCLUSIONS: The diagnostic accuracy of the three methods did not differ markedly. However, staff judgment had the highest sensitivity and the lowest specificity after 30, 90 and 180 days. A combination of either two of the methods showed the highest sensitivity but the lowest specificity.

Predictors of uptake and adherence to the use of hip protectors among nursing-home residents.

The aim of the present study was to identify predictors for initial uptake and adherence with the use of hip protectors when offering hip protectors free of charge to nursing-home residents. An 18 months prospective follow up study was carried out in 18 Norwegian nursing homes. One thousand two hundred and thirty-six residents were included in the study of which 604 started to use a hip protector. A multivariate logistic regression model was used to identify predictors for the initial uptake. A Cox proportional hazard model was used to identify predictors for adherence. A stepwise backward strategy was used in both the logistic and in the Cox regression. The effect of nursing homes as clusters was adjusted for in the analysis. The uptake rate among all residents was 46% and the adherence was approximately 75% after 3 months, and approximately 60% after 18 months. Female gender [odds ratio (OR): 1.54, 95% CI: 1.06-2.24, P = 0.022], previous fractures (OR: 1.67, 95% CI: 1.02-2.75, P = 0.043), previous falls (OR: 2.08, 95% CI: 1.35-3.19, P < 0.001) and memory (not able to memorise: OR: 3.71, 95% CI: 2.09-6.59, P < 0.001, large problems with memorising: OR: 2.85, 95% CI: 1.81-4.49, P < 0.001, medium problems with memorising: OR: 2.45, 95% CI: 1.39-4.33, P = 0.002, some problems with memorising: OR: 1.99, 95% CI: 1.14-3.48, P = 0.016) seemed to be important predictors for uptake. Among those who took up the offer male gender (HR: 1.71, 95% CI: 1.00-2.91, P = 0.049), memory (not able to memorise: HR: 0.26, 95% CI: 0.14-0.50, P < 0.001, large problems with memorising: HR: 0.32, 95% CI: 0.22-0.45, P < 0.001, medium problems with memorising: HR: 0.46, 95% CI: 0.30-0.73, P < 0.001, some problems with memorising: HR: 0.49, 95% CI: 0.32-0.73, P = 0.001) and bowel incontinence (HR: 0.41, 95% CI: 0.25-0.66, P < 0.001) were predictors for a lower probability of ending hip protector use. Factors related to a high risk of falling were important predictors for both uptake and adherence. The fact that neither memory impairments nor incontinence (bowel) seemed to be barriers to hip protector use is important since these characteristics are common among nursing-home residents and tertiary prevention such as the use of hip protectors is probably the most feasible intervention to prevent hip fractures in this group.

[Pain, functional level and emotional problems of women with osteoporosis and vertebral fractures]. / Smerter, funksjonsnivå og emosjonelle forhold hos kvinner med osteoporose og vertebrale brudd.

We studied symptoms of pain, anxiety, and depression and physical function in postmenopausal women with low bone mass and vertebral fractures. One hundred patients attending an out-patient clinic for osteoporosis completed a visual analogue scale (VAS) for pain, the Hospital Anxiety Depression Scale (HADS) and Short Form (SF-12). Twenty patients also completed the osteoporosis specific form QUALEFFO, and were compared to a control group. Maximal pain (VAS) during the last week was 5.3 +/- 2.8. Based on HADS, the prevalence of anxiety disorder (29 %) was significantly higher among the patients than in the norm material; for depression, however, there was no difference. For SF-12, the standardized physical component summary (PCS) was significantly lower than norm data. No difference was found for the mental component summary (MCS). Using QUALEFFO, patients reported a worse score for all domains except the mental domain. We conclude that Norwegian women with vertebral fractures sustain a high level of pain probably leading to an increased level of anxiety, but not to increased level of depression compared to age-adjusted norm data.