A Danish version of the life-space assessment (LSA-DK) - translation, content validity and cultural adaptation using cognitive interviewing in older mobility limited adults.

BACKGROUND: Identification and prevention of mobility limitations in older adults is important to reduce adverse health outcomes. The Life-Space Assessment (LSA) provides a single measure of mobility including environmental and social resources of the older adult. Availability of the LSA for non-English speaking countries is still sparse. Therefore, we translated the LSA into Danish and performed a content validity analysis of the translation in older adults with mobility limitations. METHODS: After translation into Danish, the Danish version (LSA-DK) was content validated using cognitive interviewing in older mobility limited adults (+ 65) from an outpatient rehabilitation center (n = 12), medical wards at a university hospital (n = 11), and an assisted living facility (n = 7). The interviews were transcribed and analyzed according to the four stages of the Information Processing Model. Based on the analyses, recommendations for changes to the LSA-DK and to the manual were made and presented to the developers of the LSA. RESULTS: Consensus was reached on the LSA-DK. Thirty cognitive interviews were carried out. A wide range of sources of error primarily related to the comprehension, memory and decision process were identified. The frequency and type of error sources were most prevalent among assisted living facility informants and included difficulties in defining the geographical extension of neighborhood, town and outside town. The results led to adaptations to the questionnaire and manual to support implementation of the LSA-DK in clinical practice. CONCLUSIONS: The Life-Space Assessment was translated into Danish and content validated based on cognitive interviews. Adaptations were made to support that the Danish version can be implemented in clinical practice and used in the assessment of mobility in older Danish adults.

Stroke rehabilitation at home before and after discharge reduced disability and improved quality of life: a randomised controlled trial.

OBJECTIVE: To evaluate if home-based rehabilitation of inpatients improved outcome compared to standard care. DESIGN: Interventional, randomised, safety/efficacy open-label trial. SETTING: University hospital stroke unit in collaboration with three municipalities. SUBJECTS: Seventy-one eligible stroke patients (41 women) with focal neurological deficits hospitalised in a stroke unit for more than three days and in need of rehabilitation. INTERVENTIONS: Thirty-eight patients were randomised to home-based rehabilitation during hospitalization and for up to four weeks after discharge to replace part of usual treatment and rehabilitation services. Thirty-three control patients received treatment and rehabilitation following usual guidelines for the treatment of stroke patients. MAIN MEASURES: Ninety days post-stroke the modified Rankin Scale score was the primary endpoint. Other outcome measures were the modified Barthel-100 Index, Motor Assessment Scale, CT-50 Cognitive Test, EuroQol-5D, Body Mass Index and treatment-associated economy. RESULTS: Thirty-one intervention and 30 control patients completed the study. Patients in the intervention group achieved better modified Rankin Scale score (Intervention median = 2, IQR = 2-3; Control median = 3, IQR = 2-4; P=0.04). EuroQol-5D quality of life median scores were improved in intervention patients (Intervention median = 0.77, IQR = 0.66-0.79; Control median = 0.66, IQR = 0.56 - 0.72; P=0.03). The total amount of home-based training in minutes highly correlated with mRS, Barthel, Motor Assessment Scale and EuroQol-5D™ scores (P-values ranging from P<0.00001 to P=0.01). Economical estimations of intervention costs were lower than total costs of standard treatment. CONCLUSION: Early home-based rehabilitation reduced disability and increased quality of life. Compared to standard care, home-based stroke rehabilitation was more cost-effective.

Peak Power Output in Loaded Jump Squat Exercise is Affected by Set Structure.

A priority in strength and power exercise might be to train with as high quality as possible for the shortest possible duration. In this context, peak power output could reflect quality. Designing an exercise session as a cluster set structure, as compared to a traditional set structure, may be a way to obtain higher peak power output in the session. But it is unknown whether that is obtainable for non-elite individuals performing loaded jump squat exercise. The aim of the present study was therefore to test the hypothesis that peak power output would be highest in a jump squat exercise session, which was structured with cluster sets, as compared to traditional sets. Ten individuals (2 women, 8 men; 26.5 ± 4.8 years, 1.81 ± 0.08 m, 90.9 ± 13.2 kg) performed two loaded jump squat exercise sessions structured with cluster sets and traditional sets, respectively. The sessions were performed on two separate days, in counterbalanced order. The position of the barbell was used to calculate derived values including peak power output. Values calculated as averages across the entire exercise sessions showed peak power output to be 178 ± 181 W, corresponding to 4.1% ± 4.9%, higher in the session with cluster set structure, as compared to the session with traditional set structure (p = 0.005). It was concluded that for non-elite individuals, peak power output was approximately 4% higher in a loaded jump squat exercise session structured with cluster sets as compared to an exercise session structured with traditional sets.

Repeated Bout Rate Enhancement Is Elicited by Various Forms of Finger Tapping.

Voluntary rhythmic movements, such as, for example, locomotion and other cyclic tasks, are fundamental during everyday life. Patients with impaired neural or motor function often take part in rehabilitation programs, which include rhythmic movements. Therefore, it is imperative to have the best possible understanding of control and behaviour of human voluntary rhythmic movements. A behavioural phenomenon termed repeated bout rate enhancement has been established as an increase of the freely chosen index finger tapping frequency during the second of two consecutive tapping bouts. The present study investigated whether the phenomenon would be elicited when the first bout consisted of imposed passive finger tapping or air tapping. These two forms of tapping were applied since they can be performed without descending drive (passive tapping) and without afferent feedback related to impact (air tapping) - as compared to tapping on a surface. Healthy individuals (n = 33) performed 3-min tapping bouts separated by 10 min rest. Surface electromyographic, kinetic, and kinematic data were recorded. Supportive experiments were made to measure, for example, the cortical sensory evoked potential (SEP) response during the three different forms of tapping. Results showed that tapping frequencies in the second of two consecutive bouts increased by 12.9 ± 14.8% (p < 0.001), 9.9 ± 6.0% (p = 0.001), and 16.8 ± 13.6% (p = 0.005) when the first bout had consisted of tapping, passive tapping, and air tapping, respectively. Rate enhancement occurred without increase in muscle activation. Besides, the rate enhancements occurred despite that tapping, as compared with passive tapping and air tapping, resulted in different cortical SEP responses. Based on the present findings, it can be suggested that sensory feedback in an initial bout increases the excitability of the spinal central pattern generators involved in finger tapping. This can eventually explain the phenomenon of repeated bout rate enhancement seen after a consecutive bout of finger tapping.