Validation of a fall rate prediction model for community-dwelling older adults: a combined analysis of three cohorts with 1850 participants.

BACKGROUND: Fragility fractures in older adults are often caused by fall events. The estimation of an expected fall rate might improve the identification of individuals at risk of fragility fractures and improve fracture prediction. METHODS: A combined analysis of three previously developed fall rate models using individual participant data (n = 1850) was conducted using the methodology of a two-stage meta-analysis to derive an overall model. These previously developed models included the fall history as a predictor recorded as the number of experienced falls within 12 months, treated as a factor variable with the levels 0, 1, 2, 3, 4 and ≥ 5 falls. In the first stage, negative binomial regression models for every cohort were fit. In the second stage, the coefficients were compared and used to derive overall coefficients with a random effect meta-analysis. Additionally, external validation was performed by applying the three data sets to the models derived in the first stage. RESULTS: The coefficient estimates for the prior number of falls were consistent among the three studies. Higgin's I2 as heterogeneity measure ranged from 0 to 55.39%. The overall coefficient estimates indicated that the expected fall rate increases with an increasing number of previous falls. External model validation revealed that the prediction errors for the data sets were independent of the model to which they were applied. CONCLUSION: This analysis suggests that the fall history treated as a factor variable is a robust predictor of estimating future falls among different cohorts.

Evaluation of the psychometric properties of the Swiss French version of the Older People's Quality of Life questionnaire (OPQOL-35-SF).

BACKGROUND: The proportion of the world population aged over 65 years is increasing in the world population. Quality of life is an important factor in the biopsychosocial management of older patients. The Older People's Quality of Life-35 (OPQOL-35) questionnaire was developed specifically for assessment of the quality of life of older people. The aim of this study is to evaluate the psychometric properties of a Swiss French version of the OPQOL-35 questionnaire (OPQOL-35-SF). METHODS: Forward-backward procedure was used to translate the original questionnaire from English into Swiss French. A sample of older people then completed the questionnaire. Construct validity of the OPQOL-35-SF was evaluated by comparing the results with those from three other questionnaires [World Health Organisation Quality of Life in older people questionnaire (WHOQOL-OLD), Control, Autonomy, Self-realization, Pleasure in 12 questions (CASP-12), and EuroQol-5-dimensions-5-levels (EQ-5D-5L)] and two visual analogue scales (health and quality of life). The structure of the OPQOL-35-SF questionnaire was assessed using exploratory and confirmatory factor analysis. To evaluate the reliability the OPQOL-35-SF questionnaire was completed a second time after 7-23 days. RESULTS: A total of 264 older people completed all the questionnaires at the first session, and 262 completed the OPQOL-35-SF again at the second session. Mean age of participants was 76.8 (standard deviation (SD) = 7.1) years. The majority of participants were women (73.9%). The Kaiser-Meyer-Olkin Measure of Sampling Adequacy (KMO) was 0.86 and Bartlett's test of sphericity was significant (p < 0.001). The result of Exploratory Factor Analysis (EFA) revealed 8 factors with eigenvalues greater than one, which explained 58% of the observed variance. All items had an acceptable loading (< 0.30) in at least one factor. The convergent validity presented low to moderate correlations (rho: 0.384-0.663). Internal consistency was good (Cronbach's alpha 0.875 for test and 0.902 for retest). Test-retest reliability presented an intra-class correlation coefficient, two-way random effects, absolute agreement, single rater (ICC2.1) of 0.83 [95% confidence interval (CI) 0.78-0.87]. CONCLUSIONS: The Swiss French version of the OPQOL-35 questionnaire shows good psychometric properties, which permit its use in clinical practice or research. A supplementary sample would be necessary for a better distribution of the items in the different factors.

Effects of three home-based exercise programmes regarding falls, quality of life and exercise-adherence in older adults at risk of falling: protocol for a randomized controlled trial.

BACKGROUND: Fall prevention interventions with home-based exercise programmes are effective to reduce the number and the rate of falls, by reducing risk factors. They improve balance, strength, function, physical activity, but it is known that older adults' exercise adherence declines over time. However, it is unclear which delivery-modalities of the home-based exercise programmes show the best adherence and the largest effect. We created a new home-based exercise programme, the Test-and-Exercise (T&E) programme, based on the concepts of self-efficacy and empowerment. Patients learn to build their own exercise programme with a mobile application, a brochure and cards, as well as with eight coaching sessions by physiotherapists. The main objective of this study is to compare the T&E programme with the Otago Exercise Programme and the recommendation-booklet and exercise-cards of Helsana regarding incidence of falls. Other outcomes are severity of falls, functional capacities, quality of life and exercise-adherence. METHODS: The design of this study is a Swiss multicentre assessor blind randomized controlled trial. A block-randomization, stratified in groups for age and risk of fall categories, will be used to allocate the participants to three groups. The targeted study sample consists of 405 older adults, ≥ 65 years of age, living in the community and evaluated as at "risk of falling". Experimental group will receive the T&E programme (N = 162). Second group will receive the Otago programme (N = 162) and the third group will receive the Helsana programme (N = 81). All interventions last six months. Blinded assessors will assess participants three times: at baseline before the start of the intervention, after six months of intervention and a final assessment after twelve months (six months of follow up). DISCUSSION: Although home-based exercises programmes show positive effects in fall prevention in elderly persons, existing programmes do often not include patients in the decision-making process about exercise selection. In our programme the physiotherapist and the older adult work together to select the exercises; this collaboration helps to increase health literacy, pleasure of exercising, and empowers patients to be more autonomy. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02926105 , First Posted: October 6, 2016, Last Update: November 11, 2016: Enrolment of the first participant.

Identifying fallers and nonfallers with the maximal base of support width (BSW): a one-year prospective study.

The purpose of this prospective cohort study was to determine whether the maximal width of the base of support (BSW) measure is able to predict the risk of multiple falls in community-dwelling women. Thirty-eight community-dwelling women (mean age of 72 ± 8 years old) participated. Falls were prospectively recorded during the following year. Overall, 29 falls were recorded; six (16%) women were multiple fallers and 32 (84%) were nonfallers. There was a significant difference in the BSW between the fallers and nonfallers (F[1, 37] = 5.134 [p = .030]). A logistic regression analysis indicated a significant contribution of the BSW test to the model (odds ratio = 0.637; 95% CI [0.407, 0.993]; p = .046 per 1 cm).The cut-off score was determined to be 27.8 cm (67% sensitivity and 84% specificity). These results indicate that women with a smaller BSW at baseline had a significantly higher risk of sustaining a fall.

Adapted Home-Based Exercises in Dementia: An Exploratory Pre-post Pilot and Feasibility Study.

The goals of this exploratory pre-post pilot and feasibility study (NCT04916964) were to assess the feasibility and effectiveness of an adapted Test-and-Exercise home-based exercise program on basic functional mobility and executive functions in persons with prodromal or mild Alzheimer's disease. Participants followed an 8 week exercise program at home, once per week with a physiotherapist and twice per week with their usual caregiver or independently. Functional mobility and executive functions were assessed before and after the intervention. Feasibility criteria were recruitment opportunity, participation agreement rate, cost adequacy, and drop-out rate. Twelve participants aged 80.83 ± 4.65 years took part in the study. All the basic functional mobility measures showed small effect sizes. Concerning executive functions, 5 measures showed small to moderate effect sizes. The 4 feasibility criteria were met. A larger scale study would, however, need adaptations and prior research on the ability of this population to use touch-screen technology.

Corrigendum: History of falls and fear of falling are predictive of future falls: Outcome of a fall rate model applied to the Swiss CHEF trial cohort.

[This corrects the article DOI: 10.3389/fragi.2022.1056779.].

History of falls and fear of falling are predictive of future falls: Outcome of a fall rate model applied to the Swiss CHEF Trial cohort.

Background: A third of adults aged 65 years and older fall every year, and falls are a common cause of unintentional injuries. Accurate identification of people at risk of falling is an important step in the implementation of preventive strategies. Objective: Our aim was to investigate the association of fall risk factors with number of reported falls in terms of incidence rate ratios and to develop a fall rate prediction model. Methods: In the randomized controlled trial Swiss CHEF, multiple fall risk variables were assessed in community-dwelling older adults at baseline examination, including age, sex, body mass index, fear of falling, number of falls during the prior 12 months, scores on several physical performance tests, comorbidities, and quality of life. Over the following 6 months, interventions were administered in the form of three home-based exercise programs. Participants were subsequently followed up for another 6 months. Falls were reported prospectively using monthly calendars. Incidence rate ratios were derived via negative binomial regression models. Variable selection for the prediction model was conducted using backward elimination and the least absolute shrinkage and selection operator method; the model with the smallest prediction error was then identified. Results: Associations with the number of reported falls were found for number of prior falls, fear of falling, balance and gait deficits, and quality of life. The final model was derived via backward elimination, and the predictors included were prior number of falls and a measure of fear of falling. Outcome: Number of prior falls and fear of falling can be used as predictors in a personalized fall rate estimate for community-dwelling older adults. Recurrent fallers having experienced four or more falls are especially at risk of falling again.

Current practices of physiotherapists in Switzerland regarding fall risk-assessment for community-dwelling older adults: A national cross-sectional survey.

Background: Falls can strongly impact older people's quality of life, health, and lifestyle. Multifactorial assessment can determine an individual's risk of falling as the first step for fall prevention intervention. Physiotherapists have an essential role to play in assessing fall risk by older adults living in the community. In the absence of published data on this topic in Switzerland, this study investigated the current practices of physiotherapists to determine whether those are in line with recommendations. Methods: An anonymous cross-sectional survey was undertaken among physiotherapists practising in Switzerland between the 21st of November and the 31st of December 2020. A priori and exploratory hypotheses were tested. Responses to open-ended questions were grouped into themes for analysis. Results: A total of 938 questionnaires from all three language regions of Switzerland was analysed. Participants worked in different settings, with a higher representation of private practice self-employees (56%). Standardised fall risk assessments or instruments were used by 580 (62%) participants, while 235 (25%) preferred subjective assessment of fall risk only. Differences in fall risk assessment were observed according to the workplace setting (adjusted OR 1.93, 95% CI 1.37 to 2.7) and education level (trend test, p<0.001). The standardised assessments most frequently employed were the Berg Balance Scale (58%), the Timed-Up-and-Go (57%) and the Tinetti Balance Assessment tool (47%). Risk factors for falls were frequently queried, particularly history of falls (88%), home hazards (84%), and functional ability (81%). Technical resources (40%), knowledge (30%), and time (22%) were common barriers to implement a systematic fall risk assessment. Conclusions: This study provides an overview of the current practices of physiotherapists in Switzerland in fall risk assessment. There is still room to optimise the standardisation and systematisation of this assessment to implement a best practice strategy and prevent avoidable falls.

Gaze, behavioral, and clinical data for phantom limbs after hand amputation from 15 amputees and 29 controls.

Despite recent advances in prosthetics, many upper limb amputees still use prostheses with some reluctance. They often do not feel able to incorporate the artificial hand into their bodily self. Furthermore, prosthesis fitting is not usually tailored to accommodate the characteristics of an individual's phantom limb sensations. These are experienced by almost all persons with an acquired amputation and comprise the motor and postural properties of the lost limb. This article presents and validates a multimodal dataset including an extensive qualitative and quantitative assessment of phantom limb sensations in 15 transradial amputees, surface electromyography and accelerometry data of the forearm, and measurements of gaze behavior during exercises requiring pointing or repositioning of the forearm and the phantom hand. The data also include acquisitions from 29 able-bodied participants, matched for gender and age. Special emphasis was given to tracking the visuo-motor coupling between eye-hand/eye-phantom during these exercises.

Effect of indoor wheelchair curling training on trunk control of person with chronic spinal cord injury: a randomised controlled trial.

STUDY DESIGN: Randomised, controlled, single-blind crossover design study. OBJECTIVE: Effect of indoor wheelchair curling training on trunk control of a person with chronic spinal cord injury (SCI). SETTING: SCI Centre of Balgrist University Hospital in Zurich, Switzerland. METHODS: The trunk control of 13 subjects was assessed by the modified functional reach test (MFRT) and nonlinear dynamic systems analysis (NDSA) before and after eight indoor curling training sessions and compared to everyday life over 4 weeks. RESULTS: The attendance rate was 95% during the training sessions. There were no adverse events. Neither the MRFT nor the NDSA showed any significant differences in the sitting stability. The subjects subjectively reported improved physical feeling, an increase in their trunk control and strength; 39% of the participants wanted to continue the training. CONCLUSIONS: With subjective improvements and no adverse events, indoor wheelchair curling training is a safe physical activity for people with SCI. Wheelchair curling offers a suitable alternative to sports already used in rehabilitation and in recreational activities of a person with SCI. In order to be able to draw more unambiguous conclusions from the training method for trunk control and to answer the question of the study unambiguously, the number of subjects would have to be greater and the test methods should provide more exact and specific measurements.

The maximal width of the base of support (BSW): clinical applicability and reliability of a preferred-standing test for measuring the risk of falling.

The aim of this study was to test the reliability and validity of a preferred-standing test for measuring the risk of falling. The preferred-standing position of elderly fallers and non-fallers and healthy young adults was measured. The maximal BSW was measured. The absolute and relative reliability and discriminant validity were assessed. The expanded timed get-up-and-go test (ETGUG), one-leg stance test (OS), tandem stance (TS), and falls efficacy scale international version (FES-I) were used to determine criterion validity. In total, 146 persons (102 females, 44 males; mean age 55±22 years, range 20-94) were recruited. Forty elderly community dwellers (8 fallers) and 26 young adults were tested twice to determine the test-retest reliability. The BSW showed acceptable test-retest reliability (Intraclass correlation coefficient, ICC2,1=0.77-0.83) and inter-rater reliability (ICC3,1=0.77-0.95) for all groups. The standard error of measurement (SEM) was between 0.77 and 1.87, and the smallest detectable change (SDC) was between 2.14cm and 5.19cm. The Bland-Altman plot revealed no systematic errors. There was significant difference between elderly fallers and non-fallers (F(1/75)=11.951; p=0.001. Spearman's rho coefficient values showed no correlation between the BSW and the ETGUG (-0.17, p=0.47), OLS (-0.04, p=0.65), TS (-0.11, p=0.21), and FES-I (-0.10; p=0.27). Only the BSW was a significant predictor for falling (odds ratio=0.736, p=0.007). The reliability and validity of the BSW protocol were acceptable overall. Prospective studies are warranted to evaluate the predictive value of the BSW for determining the risk of falling.