Diagnostic accuracy of the five times stand-to-sit test for the screening of global muscle weakness in community-dwelling older women.

BACKGROUND: Although the 5 times stand-to-sit test (5TSST) is indicated for screening for muscle weakness in older adults, its validity is based only on the correlation with quadriceps muscle strength or with the muscle strength of a few muscle groups of the lower limbs. Thus, the objective of the present study was to verify whether in independent older women, the 5TSST can really estimate global muscle strength, considering the sum of muscle strength of the trunk, hip, knee and ankle, which are important for functional activities. METHODS: 119 independent older women participated in this cross-sectional study, undergoing the 5TSST and an isometric muscle strength assessment of the trunk, hip, knee and ankle, using an isokinetic dynamometer. The accuracy of the 5TSST for the discrimination of older women with reduced global muscle strength was evaluated by the ROC curve. RESULTS: The ROC curve showed that the 5TSST may discriminate older women with reduced global muscle strength with moderate accuracy (AUC = 0.783; 95 % CI = 0.681-0.886; p < 0.001). The 5TSST score with the best accuracy (sensitivity: 80.0 % and specificity: 61.8 %) to evaluate global muscle strength was 11.64 s. CONCLUSION: 5TSST can be used to identify reduced global muscle strength in independent older women, standing out as an accessible tool for the screening of muscle weakness.

Brief Lower Body Functional Performance Questionnaire (Brief-LBFPQ) for independent older adults / Breve Questionário de Desempenho Funcional dos Membros Inferiores (Brief-LBFPQ) para idosos independentes

Abstract Introduction The literature still lacks evidence about patient-reported outcome measures to fast screen the reduced physical performance of the lower body in older adults to be applied in any clinical setting as primary health care or without specific instruments in prevention campaigns, or even easy to be applied by phone. Objective: To develop a brief questionnaire to screen the lower body functional performance in community-dwelling older adults and to validate this new questionnaire with objective clinical tests. Methods A convenience sampling of 221 community-dwelling older adults was included in this cross-sectional study. The validity between Brief-LBFPQ and objective tests such as gait speed, Timed-Up and Go test (TUG), 5-Time Stand-to-Sit test (5TSST), and step test were assessed by multinominal logistic regression. Internal consistency was determined using Cronbach's alpha and Test-retest reliability was determined using intraclass correlation coefficient (ICC) for numeral scale and Cohen's Kappa for ordinal scale. Results Brief-LBFPQ was significantly associated with objective tests. All eight items from Brief-LBFPQ presented an absolute agreement with ICCs values above 0.7. Kappa values of Brief-LBFPQ items ranged from 0.6 to 0.83, showing substantial agreement and perfect agreement. Conclusion Brief-LBFPQ could be very useful in general clinic settings as it provides earlier screening of functional impairment in independent older adults, and consequently may allow an earlier intervention approach.

Resumo Introdução A literatura ainda carece de evidências acerca de instrumentos de autorrelato para o rastreio rápido do prejuízo no desempenho físico dos membros inferiores em idosos, que possam ser aplicados em qualquer ambiente clínico, como na Atenção Básica à Saúde, e que não requeiram nenhum ins-trumento específico para campanhas de prevenção, ou mesmo de fácil aplicação por contato telefônico. Objetivo Desenvolver um breve questionário para triagem do desempenho funcional dos membros inferiores em idosos da comunidade e validar este novo questionário com testes clínicos objetivos. Métodos Uma amostra de conveniência de 221 idosos da comunidade foi incluída neste estudo transversal. A validade entre o Brief-LBFPQ e os testes objetivos como velocidade da marcha, Timed-Up and Go (TUG), teste de levantar e sentar 5 vezes (TLS5x) e teste do degrau foi avaliada pela regressão logística multinominal. A consistência interna foi determinada pelo alfa de Cronbach e a confiabilidade teste-reteste foi determinada pelo coeficiente de correlação intraclasse (CCI) para a escala numérica e o Kappa de Cohen para a escala ordinal. Resultados O Brief-LBFPQ foi significativamente associado aos testes objetivos. Todos os oito itens do Brief-LBFPQ apresentaram concordância absoluta com valores de CCI acima de 0,7. Os valores de Kappa dos itens do Brief-LBFPQ variaram de 0,6 a 0,83, mostrando concordância substancial e concordância perfeita. Conclusão O Brief-LBFPQ pode ser muito útil em diferentes ambientes clínicos, pois permite uma triagem precoce do comprometimento funcional em idosos independentes e, consequentemente, pode permitir uma abordagem de intervenção mais precoce.

Relationship Between Lower Limb Muscle Strength and Future Falls Among Community-Dwelling Older Adults With No History of Falls: A Prospective 1-Year Study.

Objective: To investigate whether lower limb muscle strength could be a risk factor for the first fall among nonfaller community-dwelling older adults. Method: Hip, knee, and ankle peak torque (PT) was measured with an isokinetic dynamometer in 101 older adults with no history of falls in the previous year. Next, the authors followed up the participants on a monthly basis by telephone contact to determine the occurrence of fall episodes over a period of 1 year. Multivariate logistic regression adjusted for confounding variables was applied to assess the relationship between falls and lower limb PT. Results: there was no association between lower limb PT and future falls (p > .05). Conclusion: Based on these results, it is important to identify other factors that predispose older adults with no history of falls to falling for the first time, so that early and effective preventive strategies may be elaborated.

Diagnostic Accuracy of Clinical Tests for the Indirect Assessment of Hip Abductor Muscle Strength in Community-Dwelling Older Women.

OBJECTIVE: The objective of this study was to determine the accuracy of 3 clinical tests (lateral step [LS], tandem gait [TG], and single-leg stance [SS]) in identifying older women with reduced hip abductor muscle strength and to determine the post-test probability of each test and of their combination in changing the certainty of diagnosis. METHODS: In this cross-sectional study, a total of 123 older women received clinical testing to obtain the variables LS height, time for TG execution, percentage of errors in TG, and time of permanence on SS and were tested for isometric hip abductor peak torque using an isokinetic dynamometer. Only the dominant lower limb was evaluated. Multiple linear regression analysis with adjustment was performed to determine the association among variables, followed by the receiver operating characteristic curve to identify clinical variables that can discriminate older women with reduced abductor muscle strength. Post-test probability was then calculated based on the receiver operating characteristic curve data. RESULTS: Although the 4 clinical variables showed correlation with abductor peak torque, only LS and TG time were able to discriminate reduced abductor muscle strength with low accuracy (area under the curve was between 0.5 and 0.7). However, the combination of LS and TG time increased post-test probability from 47% (prevalence of weakness in the population) to 76% when both tests were positive and reduced it from 47% to 18% when both tests were negative. CONCLUSION: The combination of the LS test and TG time is useful for the indirect assessment of hip abductor strength in community-dwelling older women. IMPACT: Hip abductor muscle strength is extremely important for function in older women. This study presents clinicians with simple, fast, and inexpensive methods for assessing hip abductor muscle strength.

Association between the trunk muscle function performance and the presence of vertebral fracture in older women with low bone mass.

BACKGROUND: Despite the clinical importance, it has remained unclear which changes in the trunk muscle function parameters are more associated with the presence of vertebral fracture (VF). AIMS: The aim of this study was to verify the association between the trunk muscle function performance and the presence of VF in older women with low bone mass. The secondary aim was to evaluate the correlation between trunk muscle function and both fall history and muscle mass. METHODS: This cross-sectional study was composed by 94 women over 60 years within value of T-Score lumbar spine BMD <- 1.0 DP. Multidimensional evaluations were performed: appendicular skeletal muscle mass index (ASMI) was determined by the total body DEXA; the radiographic evaluations measured the degree of thoracic kyphosis and classification of VF. The trunk muscle function parameters, such as peak torque (PT), rate of torque development (RTD) and torque steadiness (TS) were evaluated by isokinetic dynamometer. The trunk muscle endurance was evaluated by the timed loaded standing test. The adjusted multivariate logistic regression model and multivariate linear regression were performed to verify the association between the variables studied. RESULTS: The results showed that the trunk muscle function parameter with greater association with the presence of VF is TS extensors (OR = 1.70; p < 0.001). The other two significant muscle parameters were: RTD30 flexors (OR = 0.31; p = 0.033) and PT extensors (OR = 0.13; p = 0.009). No statistical association was found between the presence of VF and the ASMI and trunk muscle endurance. No correlation between trunk muscle function and fall history was observed. There was a weak correlation between ASMI and extensor PT (R2 = 0.21; p = 0.027) and extensor RTD30 (R2 = 0.21; p = 0.026). CONCLUSIONS: This study demonstrated that deficit in trunk muscle function has shown a strong association with the presence of VF, highlighting issues heretofore unexplored regarding the association between VF with muscle power and motor control.

Use of the BESTest and the Mini-BESTest for Fall Risk Prediction in Community-Dwelling Older Adults Between 60 and 102 Years of Age.

BACKGROUND AND PURPOSE: Reference values for the Balance Evaluation Systems Test (BESTest) and the Mini-Balance Evaluation Systems Test (Mini-BESTest) need to be established to predict falls in older adults during every stage of aging. The purpose of this study was to determine the cutoff scores for the BESTest and the Mini-BESTest for community-dwelling older adults in order to predict fall risk. METHODS: A total of 264 older adults, of both sexes, between the ages of 60 and 102 years, were divided into 4 groups according to age range. After evaluation, participants received telephone follow-up for 6 months to record the number of fall episodes. To define the reference values of the tests in relation to fall risk prediction, a receiver operating characteristic curve was drawn to identify the area under the curve and the sensitivity and specificity of the tests. Statistical analyses were done using SPSS (Version 16.0-SPSS Inc) with a significance level of 5% (P ≤ .05). RESULTS: The cutoff scores to identify older adults with fall risk according to the BESTest and the Mini-BESTest in the different age groups were 99 and 25 points, respectively, for people 60 to 69 years of age, 92 and 23 points for the age group of 70 to 79 years, 85 and 22 points for people 80 to 89 years of age, and 74 and 17 points for people 90 years of age or older. CONCLUSION: The BESTest and the Mini-BESTest are good tools for predicting fall risk in the 6 months following an initial evaluation in community-dwelling Brazilian older adults. The study also determined that cutoff values vary for different age groups.

Recomendações para prescrição de dispositivos auxiliares da marcha em idosos / Recommendations for prescribing walking aids in older adults

O uso de um dispositivo auxiliar da marcha (DAM), como bengala ou andador, pode auxiliar os idosos na realização de suas atividades diárias, mantendo-os funcionalmente independentes e relativamente ativos. Porém, a utilização inadequada, o mau estado e as dimensões incorretas do dispositivo, assim como erros na prescrição do tipo de dispositivo podem aumentar o risco de quedas nos idosos usuários de DAM. Diante da falta de recomendações quanto à sua prescrição, o objetivo desse artigo é discorrer sobre os pré-requisitos para a prescrição de cada dispositivo (bengala e andador), de acordo com a nossa experiência adquirida na Área de Fisioterapia em Gerontologia, no Centro de Reabilitação (CER) do Hospital das Clínicas de Ribeirão Preto, considerando as evidências científicas disponíveis até o momento. Assim, com a difusão das informações contidas nesse artigo para os profissionais da saúde que prestam assistência a idosos, espera-se aprimorar a prática de prescrição do DAM e de educação do idoso, de seus familiares e cuidadores, a fim de que sejam alcançados os benefícios do uso de um DAM e prevenidos os possíveis eventos adversos, como as quedas.

The use of a walking aid device (WAD), such as a cane or walker, can assist older adults in performing their daily activities, keeping them functionally independent and relatively active. However, improper use, poor condition and incorrect dimensions of the device, as well as errors in prescribing the type of device may increase the risk of falls in older people who use a WAD. Given the lack of recommendations on its prescription, the purpose of this article is to discuss the requirements for the prescription of each device (cane and walker), according to our experience obtained in the area of ​​Gerontology Physiotherapy in the Rehabilitation Center (CER) of the Hospital das Clínicas de Ribeirão Preto, considering the scientific evidence available at the moment. Thus, by disseminating the information contained in this article to health professionals who provide care to older people, it is expected to improve the practice of prescribing WAD and educating the older adults, their families and caregivers, in order to achieve the benefits of use a WAD and prevent possible adverse events such as falls.

Medo de quedas e força muscular do quadril em idosos independentes da comunidade / Miedo a caerse y fuerza muscular de cadera en ancianos independientes de la comunidad / Fear of falling and hip muscular strength in independent older adults of the community

RESUMO O medo de quedas pode fazer com que o idoso desenvolva estratégias que alteram o equilíbrio semiestático e dinâmico, predispondo-o a um risco aumentado de cair. A função muscular dos abdutores e adutores de quadril tem importante papel na manutenção da estabilidade postural. Entretanto, não se sabe se idosos com medo de cair apresentam maior comprometimento na função muscular do quadril. Assim, o objetivo foi comparar o pico de torque (PT) isométrico dos músculos abdutores e adutores de quadril entre idosos com e sem medo de quedas. Os participantes foram divididos em dois grupos: com (n=81) e sem (n=81) medo de quedas. O PT dos abdutores e adutores de quadril foi obtido com dinamômetro isocinético (System 4 Pro, Biodex, Nova York, EUA). A comparação do PT dos grupos foi realizada por meio de modelo linear geral univariado, ajustado pelas covariáveis idade, sexo, índice de massa corporal, nível de atividade física e histórico de quedas, utilizando o software SPSS 17.0, com nível de significância de 5%. Não houve diferença do PT abdutor e adutor do quadril entre os grupos após análise univariada com ajustamento. Observou-se que idosos com medo de quedas não apresentam prejuízos na função muscular dos estabilizadores de quadril quando comparados a idosos sem medo de quedas.

RESUMEN El miedo a caerse puede hacer que los ancianos desarrollen estrategias de alteración del equilibrio semiestático y dinámico, predisponiéndolos a un mayor riesgo de caídas. La función muscular de los abductores y de los aductores de cadera juega un papel importante en el mantenimiento de la estabilidad postural. Sin embargo, no se sabe si los ancianos con miedo a caerse tienen un mayor deterioro en la función muscular de la cadera. Por lo tanto, el objetivo fue comparar el torque máximo (TM) isométrico de los músculos abductores y aductores de cadera entre los ancianos con miedo y sin miedo a caerse. Los participantes se dividieron en dos grupos: con miedo a caerse (n=81) y sin (n=81) miedo a caerse. El TM de los abductores y aductores de cadera se obtuvo mediante la utilización del dinamómetro isocinético (System 4 Pro, Biodex, Nueva York, EE.UU.). La comparación del TM de los grupos se realizó mediante un modelo lineal general univariado, ajustado por covariables edad, género, índice de masa corporal, nivel de actividad física e historial de caídas, utilizando el software SPSS 17.0, con nivel de significancia del 5%. No hubo diferencias entre el TM del abductor y del aductor de cadera entre los grupos tras el análisis univariado con ajuste. Se observó que los ancianos con miedo a caerse no presentaron daños en la función muscular de los estabilizadores de la cadera en comparación con los ancianos sin miedo a caerse.

ABSTRACT The fear of falling can cause older adults to develop strategies that alter the semi-static and dynamic balance, predisposing them to increased risk of falling. The muscular function of abductors and adductors plays an important role in maintaining postural stability. However, it is unknown whether older people with fear of falling have greater impairment in hip muscular function. Thus, the objective was to compare the isometric peak torque (PT) of hip abductor and adductor muscles among older adults with and without fear of falling. Participants were divided into two groups: with (n=81) and without (n=81) fear of falling. The PT of hip abductors and adductors was obtained with isokinetic dynamometer (System 4 Pro, Biodex, New York, USA). The PT groups were compared using general linear model univariate, adjusted for covariates age, sex, body mass index, physical activity level and history of falls, using the SPSS 17.0 software, with a significance level of 5%. No difference was found between the PT of hip abductor and adductor and the groups after univariate analysis with adjustment. We observed that older people with fear of falling have no muscle function loss of the hip stabilizers when compared with subjects without fear of falling.

Contribution of hip abductor-adductor muscles on static and dynamic balance of community-dwelling older adults.

BACKGROUND: The previous studies have investigated causes of and risk factors for falls and impairment of functional capability in older adults. However, the biomechanical factors involved in functional performance and postural control, and the contribution of hip muscles, are still unknown. AIMS: The aim of the present study was to verify the association between the muscle function of hip abductors and adductors and static and dynamic balance, in a narrow base of support, in community-dwelling older adults. METHODS: Eighty-one older adults, including both women and men, were evaluated. Tandem gait and single-leg stance were used to assess static and dynamic balance, and an isokinetic dynamometer was used to analyze muscle function (peak torque and rate of torque development according to body weight). Data were analyzed by a multivariate linear regression test without adjustment and with adjustment using two models: adjustment I (sex) and adjustment II (age). RESULTS: There was a statistically significant association between peak torque of abductor in single-leg stance and tandem gait speed. The PT of hip adductors contributed to static balance performance, in a narrow base of support from the unadjusted data and from the adjusted data by sex. CONCLUSION: The findings of the present study are relevant, because if deficits in balance and functionality in older adults can be linked to a decline in maximum muscle strength of hip abductors, this parameter can be treated to maintain independence in older adults for as long as possible.

Spatial and temporal gait characteristics in pre-frail community-dwelling older adults.

AIM: A number of studies have explored possible relationships, behavior, and meanings of spatial and temporal gait variables in frail and pre-frail older adults, particularly the gait speed variable. However, it is necessary to know the relationship of other spatial and temporal gait variables of pre-frail older adults. Thus, the objective of the present study was to evaluate and compare gait standards between pre-frail and non-frail older people. METHODS: A total of 69 older adults aged 60 year and older, divided into two groups, non-frail (n = 42) and pre-frail (n = 27), were evaluated. Gait parameters were analyzed using the GAITRite® Platinum 26' Portable Walkway System. RESULTS: Pre-frail older people had smaller step lengths (P = 0.041), larger base of support (P = 0.040), lower speed (P = 0.019), lower single support percentage (P = 0.033) and higher double support percentage (P = 0.036), compared with non-frail older people. A history of falls was correlated to lower gait speed and step length in pre-frail older adults. CONCLUSIONS: Identifying pre-frail older people could have significant clinical consequences, as frailty is a dynamic process, and such individuals can therefore progress into a state of frailty or revert to a non-frail state. Therefore, the identification of gait variables in pre-frail older people can be an important tool to recognize gait deficits and to initiate the appropriate treatment. Geriatr Gerontol Int 2016; 16: 1102-1108.

Strengthening exercises to improve hand strength and functionality in rheumatoid arthritis with hand deformities: a randomized, controlled trial.

Rheumatoid arthritis (RA) is a systemic inflammatory and chronic disease of joints, which may result in irreversible deformities. To evaluate the effects of an exercise programme aimed at improving the hand strength in individuals with hand deformities resulting from RA and to analyse the impact these exercises have on functionality. Twenty women with RA hand deformities participated in the study. They were randomly divided into two groups as follows: Group 1 (n = 13) had women participating in the exercise programme aimed at improving handgrip (HS) and pinch strengths (PS) as well as the motor coordination of the hand; Group 2 (n = 7) had women with RA who received no treatment for their hands (control). The treatment programme for hands consisted of 20 sessions, twice a week and at-home exercises. Both groups were submitted to Health Assessment Questionnaire (HAQ) and evaluation of HS and PS by means of dynamometry. Re-evaluations were performed after 10 and 20 sessions in Group 1 and after 2 months in Group 2. After 20 sessions of physiotherapy, Group 1 had a significant gain in HS and PS (p < 0.05) in addition to the improvement of functionality as assessed by HAQ (p = 0.016). For Group 2, no difference was found between the variables analysed (p > 0.05). The strengthening exercises for individuals with RA hand deformity are beneficial to improve handgrip and pinch strengths as well as functionality.

Avaliação funcional de pacientes vítimas de queimaduras com acometimento em mãos: revisão da literatura

A mão representa menos que 5% da superfície corporal total, porém seu acometimento por queimaduras está associado à considerável morbidade devido ao desenvolvimento de sequelas estéticas e funcionais, afetando a qualidade de vida da vítima. O objetivo deste estudo foi realizar uma breve revisão das medidas utilizadas para avaliar a função de pacientes vítimas de queimaduras com acometimento em mãos. Foi realizada uma pesquisa nas bases de dados MEDLINE, PubMed e SciELO, em que foram encontrados 97 artigos, sendo que 43 adequavam-se ao tema. Os métodos de avaliação encontrados foram divididos em três categorias: métodos tradicionais, métodos de desempenho e métodos de percepção do paciente. Cada método de avaliação apresentava suas vantagens, desvantagens, limitações e objetivos específicos. Aplicado de maneira isolada nenhum método representa a função da mão de maneira real. A aplicabilidade, confiabilidade, validade e responsividade das medidas de função de mão já existentes na literatura, principalmente para os pacientes com queimaduras devem ser melhor examinadas. Nesta revisão não foram encontrados métodos específicos para a avaliação da mão queimada. Torna-se claro que a sua elaboração é necessária devido a grande complexidade de dados a serem investigados em casos de queimaduras com acometimento de mão, a fim de servir como orientação para prática clínica e para a pesquisa.