Activities-specific performance frequency can accurately detect fallers in elderly populations: an alternative method for quantifying activity restrictions.

BACKGROUND: The high prevalence of falling among older adults constitutes a major public and clinical health concern. Many elderly persons may develop activities-specific restriction due to the risk of falling. This highlights the need for relevant evaluative tools. METHODS: This cross-sectional study used activities-specific performance frequency indicators to quantify activity restrictions in elderly participants, with all measures based on items from the Activities-Specific Balance Confidence (ABC) scale. Specifically, we tested for correlations between activities-specific performance frequency and balance confidence, functional balance/mobility, and fall history. There were 88 elderly participants, including 28 with stroke, 30 with Parkinson's disease, and 30 with no neurological diseases. In addition to their activities-specific performance frequency measures, we collected a series of demographic and health-related characteristics from each participant. We analyzed between-group differences in activities-specific performance frequency and other demographic and health-related characteristics via the one-way analysis of variance and Kruskal-Wallis test. Next, we used the Spearman's rank correlation test and binary logistic regression to investigate the correlations between activities-specific performance frequency and demographic/other health-related characteristics. RESULTS: There were significant group differences in performance frequency for all ABC activity items except for walking around the house, average ABC scores, and functional balance/mobility among normal older adults, participants with strokes and those with Parkinson's disease. Activities-specific performance frequency showed stronger correlations with activities-relevant functional mobility (r=0.250-0.713 for 15 items with significant correlations, 13 activity items with r≧0.4) than with balance confidence (r=0.279-0.668 for 13 items with significant correlations, 10 activity items with r≧0.4). The performance frequency of walking in crowds/bumped was the most sensitive measure for predicting fallers (odd ratio=3.310, p<0.05). CONCLUSIONS: This study proposed and validated the usage of activities-specific performance frequency as an alternative method for quantifying activity restrictions among older adults.

Establishing content validity for a composite activities-specific risk of falls scale:linkage between fear of falling and physical activity.

BACKGROUND: Fear of falling (FoF) and physical activity (PA) are important psychological and behavioral factors associated with falls. No instrument quantifies the link between these two factors to evaluate the risk of falls. We aimed to design a scale linking FoF with PA (Composite Activities-specific Risk of Falls Scale, CARFS) for people with various disability levels. METHODS: First, we designed a questionnaire comprising 40 balance-related activities from the International Classification of Functioning, Disability, and Health (ICF) for a pilot survey. Second, participants were interviewed about their activities-specific FoF degree and PA frequency. The participants comprised 30 community-dwelling older adults, hospitalized patients with strokes, and those with spinal cord injuries, each with different disability levels. Third, the content validity of the items was evaluated twice by 12 experienced rehabilitation professionals: one based on experience and the other on the survey responses. Items with a higher than moderate relevance in both evaluations were included in the CARFS. The panel of professionals discussed and voted on the contribution of FoF and PA on the CARF score. Finally, the scale sensitivity in distinguishing disability levels was analyzed to evaluate the population suitability to the CARFS. RESULTS: The CARFS included 14 activities. A five-point Likert scale was used to quantify degree of FoF (A) and frequency of PA (B). The CARF score (C), which was determined using the eq. C = A+(4-B) + A × B/2, reflected sensitivity to disability levels in most items. CONCLUSIONS: The CARFS has strong content validity for measuring risk of falls in relation to the FoF and PA of people with various disability levels. It has a potential to provide a guide for designing individualized exercise- and behavior-focused fall prevention programs and enable the precise trtrun 0acking of program effectiveness as a multidimensional outcome measure.

Reliability and Validity of the Composite Activity-Related Fall Risk Scale.

Introduction: The newly developed Composite Activity-related Risk of Falls Scale (CARFS) is designed to measure composite activity-related risk of falls (CARF) in relation to the activity-specific fear of falling and physical behavior. This study tested the reliability and validity of the CARFS in older people with various health statuses and persons with stroke or spinal cord injury. Methods: Participants included 70 older adults, 38 persons with stroke, and 18 with spinal cord injury. They were first surveyed using a combined questionnaire including the CARFS and activity-specific balance confidence (ABC) scale in addition to items asking for personal and disease-related information, fall history, walking independence levels for examining internal consistency, ceiling and floor effects, and convergent validity in each participant group. One week after the initial survey, 33 older participants were reexamined using the CARFS to analyze test-retest reliability, where a minimal detectable change was found. Significance was set at α = 0.05 for all analyses. Results: The CARFS showed excellent test-retest reliability in the dimensions of fear of falling, physical behavior, and CARF [ICC (3,1) = 0.972, 0.994, and 0.994, respectively for their overall score], with a minimal detectable change of 3.944 in the older population. The internal consistency of CARFS items was excellent in the older participants, good in participants with stroke or spinal cord injury (Cronbach's alpha = 0.945, 0.843, 0.831 in each participant group, respectively). No ceiling and floor effects were demonstrated in the wide range of people. For the convergent validity, overall CARF score was significantly correlated with the average ABC score in each participant group (rho = -0.824, -0.761, and -0.601, respectively; p < 0.01), and was significantly correlated with walking independence levels in each participant group (rho = -0.636, -0.423, and -0.522, respectively; p < 0.01). It showed weak correlation with the number of previous falls only in participants with stroke (rho = 0.291, p = 0.076). Conclusion: The CARFS is a reliable and valid tool for measuring fall risk in older people and persons with stroke or spinal cord injury.

The influence of electro-acupuncture on neural plasticity in acute cerebral infarction.

OBJECTIVE: To observe the effect of electro-acupuncture (EA) on dendritic spine and ephrin-A5 and to investigate the action of EA on neural plasticity after acute cerebral ischemic infarction. METHODS: Focal acute cerebral ischemia model was established by middle cerebral artery occlusion (MCAO) with electrocoagulation contralateral method. Ninety male Sprague-Dawley rats were randomly divided into sham operation (SO) group, MCAO group and EA treatment (ET) group. Golgi dying, double immunofluorescence method and RT-PCR were used to detect dendritic spine density, expression patterns of ephrin-A5 and the effect of EA on them at the end of the first, second and fourth week after ischemia. RESULTS: The dendritic spine density in MCAO group significantly decreased after ischemia (p<0.01). The dendritic spine density was raised in ET group in the corresponding time period (p<0.01) and among the ET groups. It was higher at the end of the fourth week than before (p<0.05). The signal of ephrin-A5 was detected mainly in neuron cytoplasm, and the mRNA expression in MCAO group and ET group increased compared to that in SO group (p<0.01). The mRNA expression in ET group at the first week was much higher than that in MCAO group (p<0.01). In ET groups, the mRNA expression of ephrin-A5 was down-regulated along with the time going (p<0.01). CONCLUSION: It is possibly the regulation of the ephrin-A5 expression by which EA treatment improves the neural plasticity at the peri-infarct cerebral cortex in acute cerebral ischemia rat. There may be a time window in EA treatment for acute cerebral ischemia.