Normative data for tests of neuromuscular performance and DXA-derived lean body mass and fat mass in pre-pubertal children.

AIM: To present gender-specific normative data on estimates of neuromuscular performance, such as muscle strength, vertical jump and standing unilateral balance, in pre-pubertal children. METHODS: Lean body mass (kg) and fat mass (%) were estimated by dual-energy X-ray absorptiometry in 246 boys and 190 girls aged 6-12 years in Tanner stages 1 and 2. Isokinetic concentric peak torque at 60 and 180°/sec of the right knee extensors, and flexors were evaluated by a computerized dynamometer. Vertical jump height (VJH) was evaluated with an electronic mat and postural control with a one-leg stand test and a blindfolded one-leg stand test. RESULTS: Anthropometry, muscle strength and VJH in both genders showed improved performance with advancing ages (all p < 0.01 for trend) but there were no constant gender differences across the age groups (all ns.). In boys and girls, the ratio muscle strength/muscle mass showed significantly higher ratios with higher ages (both p < 0.01, respectively), but with no constant gender discrepancy. The postural control tests also showed significantly better performance with higher ages in both boys and girls (both p < 0.01). CONCLUSION: This report, which provides normative gender-specific data on muscle strength, muscle and fat mass and VJH, shows that in Swedish children aged 6-12 years, there seems to be a linear increase with age and no structural gender differences.

The physiotherapy clinical outcome variables scale predicts length of hospital stay, discharge destination and future home facility in the acute comprehensive stroke unit.

OBJECTIVE: The aims of this study were: to follow the course of recovery of motor function following acute stroke, as assessed by the Physiotherapy Clinical Outcome Variables Scale (COVS), and; to investigate the ability of this instrument to predict length of hospital stay, discharge destination and future home facility. METHODS: In this prospective longitudinal study, COVS was registered at admission and discharge from an acute stroke unit and at 3 months post-stroke onset. SUBJECTS: Sixty subjects were recruited consecutively from a sample of patients after first-ever acute stroke, and of these, 50 received follow-up assessment. OUTCOME VARIABLES: Length of hospital stay, discharge destination and home facility 3 months post-stroke. RESULTS: The overall COVS scores increased significantly during the 3-month follow-up. The admission COVS score correlated negatively with length of stay. A cut-off at 50 points and 41 points could predict discharge destination and future home facility, respectively. CONCLUSION: COVS measures improvements and can predict length of hospital stay, discharge destination and future home facility. Thus, it could be used in early prediction for effective planning of the acute stroke unit services and efficient discharge planning.

Falls among dizzy patients in primary healthcare: an intervention study with control group.

The objective of this study is to investigate whether vestibular rehabilitation can improve balance, reduce self-perceived handicap because of dizziness and, if possible, reduce falls among dizzy patients in primary healthcare. The study also finds out which of the balance measures and measure of self-perceived handicap, if any, predicted the risk of falls. The design of this study is an intervention study with control group. Fifty-eight patients, 65 years and older, with multisensory dizziness were taken as participants. The intervention group trained vestibular rehabilitation twice a week for 9 weeks. All patients were assessed at baseline and after 3 months, with four different balance measures and the Dizziness Handicap Inventory. After 6, 9 and 12 months, a follow-up by telephone was performed and, at 12 months, the patients also filled out a Dizziness Handicap Inventory questionnaire. Statistically significant differences were found between the groups between baseline and 3 months in one static balance measure and in one dynamic measure (P=0.038 and 0.044). In total, 40 falls were reported, 31 were classified as intrinsic falls, 26 of them caused by vertigo and nine falls were classified as extrinsic. No difference was found between the two groups in proportions of patients who fell. Poor ability to stand in tandem stance doubled the risk for falls. Vestibular rehabilitation can improve balance in elderly patients with multisensory dizziness. Vertigo is a common cause of falls in this group of patients and vestibular rehabilitation is a feasible treatment.

Dizziness among patients with whiplash-associated disorder: a randomized controlled trial.

OBJECTIVE: To investigate whether vestibular rehabilitation for patients with whiplash-associated disorder and dizziness had any effect on balance measures and self-perceived handicap. DESIGN: Randomized, controlled trial. SUBJECTS: Twenty-nine patients, 20 women and 9 men, age range 22-76 years. METHODS: The patients were randomized to an intervention group or a control group. The intervention comprised vestibular rehabilitation. All patients were assessed at baseline, after 6 weeks and after 3 months with 4 different balance measures and the Dizziness Handicap Inventory. RESULTS: After 6 weeks, the intervention group showed statistically significant improvements compared with the control group in the following measures: standing on one leg eyes open (p=0.02), blindfolded tandem stance (p=0.045), Dizziness Handicap Inventory total score (p=0.047), Dizziness Handicap Inventory functional score (p=0.005) and in Dizziness Handicap Inventory physical score (p=0.033). After 3 months, the intervention group showed statistically significant improvements compared with the control group in the following measures: standing on one leg eyes open (p=0.000), tandem stance (p=0.033) and Dizziness Handicap Inventory physical score (p=0.04). CONCLUSION: Vestibular rehabilitation for patients with whiplash-associated disorder can decrease self-perceived handicap and increase postural control.

Clinical history and biologic age predicted falls better than objective functional tests.

OBJECTIVE: Fall risk assessment is important because the consequences, such as a fracture, may be devastating. The objective of this study was to find the test or tests that best predicted falls in a population-based sample of elderly women. STUDY DESIGN AND SETTING: The fall-predictive ability of a questionnaire, a subjective estimate of biologic age and objective functional tests (gait, balance [Romberg and sway test], thigh muscle strength, and visual acuity) were compared in 984 randomly selected women, all 75 years of age. RESULTS: A recalled fall was the most important predictor for future falls. Only recalled falls and intake of psycho-active drugs independently predicted future falls. Women with at least five of the most important fall predictors (previous falls, conditions affecting the balance, tendency to fall, intake of psychoactive medication, inability to stand on one leg, high biologic age) had an odds ratio of 11.27 (95% confidence interval 4.61-27.60) for a fall (sensitivity 70%, specificity 79%). CONCLUSION: The more time-consuming objective functional tests were of limited importance for fall prediction. A simple clinical history, the inability to stand on one leg, and a subjective estimate of biologic age were more important as part of the fall risk assessment.

The relation between previous fractures and physical performance in elderly women.

OBJECTIVE: To examine the association between previous fracture and different aspects of physical performance. DESIGN: Population-based retrospective study. SETTING: Orthopaedic research department. PARTICIPANTS: Randomly selected women (N = 1044), all 75 years old and participants of the Malmö Osteoporosis Prospective Risk Assessment study. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Type of and time since any previous fracture event were compared with results of tests on physical performance function (Romberg test, computerized sway test, gait speed, questionnaire) at the age of 75. RESULTS: Women with no previous fractures (n = 505) had a better median Romberg balance of 94 seconds (interquartile range [IQR], 75-118s) than women with 1, 2, or 3 or more fractures, who had a median balance of 88 seconds (IQR, 71-111s), 85 seconds (IQR, 68-107s), and 81 seconds (IQR, 65-109s), respectively (Kruskal-Wallis analysis of variance, P = .002). Balance was inferior in women who had sustained a previous fracture between the ages of 65 and 75 years compared with women with no previous fractures or fractures before the age of 65 years. Gait speed and questions on tendency to fall followed the same pattern. The computerized sway test could not differ between women with and without previous fractures. CONCLUSIONS: Poor physical performance is associated with previous fractures. Inferior physical performance may exist up to 10 years after a fracture.

Bone mass cannot be predicted by estimations of frailty in elderly ambulatory women.

BACKGROUND/METHODS: High biological age, or frailty, a possible risk factor for fragility fracture, and its relation to known risk factors for fracture (low bone mineral density (BMD), low muscle strength, poor gait performance and poor balance, previous falls, previous fractures and future risk of falls) were investigated in 993 randomly selected 75-year-old women. Frailty, which has no accepted definition, was here defined as a subjective immediate impression of an individual's general health appearance and was transferred into an arbitrary scale. 993 individuals were scored by at least one of four observers. RESULTS: The frailty score and BMD were not correlated. A high frailty score was significantly correlated to poor gait (r = 0.53-0.59, p < 0.0001), poor balance (r = -0.49, p < 0.0001), low muscle strength (r = -0.25 to -0.41, p < 0.0001), low activity level (r = -0.43, p < 0.0001) and a high risk of falling (r = 0.24, p < 0.0001). The group of women who had experienced at least one fall the previous year had a higher frailty score (p < 0.0001) compared to those who had not. Women who had sustained a hip or femoral fracture after the age of 70 had a higher frailty score than women with no earlier fracture at all. CONCLUSIONS: Bone mass cannot be predicted by our subjective frailty score in elderly, ambulant women. Since a high frailty score correlates with factors that affect or are likely to affect fall propensity, this could indicate that a high frailty score is a risk factor for fracture, independent of bone mass. Frailty may be regarded as a complex risk factor, including several assessments that can be objectively measured. Whether estimation of frailty is a method to improve the assessment of the patient at risk for a fragility fracture is yet to be proven and can only be shown in a prospective study of fracture occurrence.