The impact of the COVID-19 pandemic on community prescription of opioid and antineuropathic analgesics for cancer patients in Wales, UK.

PURPOSE: Public health measures instituted at the onset of the COVID-19 pandemic in the UK in 2020 had profound effects on the cancer patient pathway. We hypothesise that this may have affected analgesic prescriptions for cancer patients in primary care. METHODS: A whole-nation retrospective, observational study of opioid and antineuropathic analgesics prescribed in primary care for two cohorts of cancer patients in Wales, using linked anonymised data to evaluate the impact of the pandemic and variation between different demographic backgrounds. RESULTS: We found a significant increase in strong opioid prescriptions during the pandemic for patients within their first 12 months of diagnosis with a common cancer (incidence rate ratio (IRR) 1.15, 95% CI: 1.12-1.18, p < 0.001 for strong opioids) and significant increases in strong opioid and antineuropathic prescriptions for patients in the last 3 months prior to a cancer-related death (IRR = 1.06, 95% CI: 1.04-1.07, p < 0.001 for strong opioids; IRR = 1.11, 95% CI: 1.08-1.14, p < 0.001 for antineuropathics). A spike in opioid prescriptions for patients diagnosed in Q2 2020 and those who died in Q2 2020 was observed and interpreted as stockpiling. More analgesics were prescribed in more deprived quintiles. This differential was less pronounced in patients towards the end of life, which we attribute to closer professional supervision. CONCLUSIONS: We demonstrate significant changes to community analgesic prescriptions for cancer patients related to the UK pandemic and illustrate prescription patterns linked to patients' demographic background.

Age differences in upper extremity joint moments and strength during a laboratory-based tether-release forward fall arrest in older women.

Age-related declines in upper extremity muscle strength may affect an older adult's ability to land and control a simulated forward fall impact. The role of individual upper extremity joints during a forward fall impact has not been examined. The purpose was to evaluate the age differences in upper extremity joint moment contributions during a simulated forward fall and upper extremity muscle strength in older women. A convenience sample of 68 older women (70 (8) yrs) performed three trials of a simulated forward fall. Percentage joint moments of the upper extremity were recorded. Upper extremity muscle strength was collected via handgrip, hand-held dynamometry of the shoulder and elbow and a custom multi-joint concentric and eccentric strength isokinetic dynamometer protocol. Percentage joint moment contributions differed between women in their sixties and seventies with significantly greater relative shoulder joint involvement (P =.008), coupled with lower elbow joint contributions (P =.004) in comparison to 80 year olds. An increase in each year of age was associated with a 4% increase in elbow contribution (Beta = -0.421, r2 = 17.9, P = 0.0001) and a 3.7% decrease in shoulder contribution (Beta = 0.373, r2 = 14.6, P = 0.002). Older women exhibit different landing strategies as they age. Fall injury prevention research should consider interventions focused on these differences taking into account the contributions of upper extremity strength.

Does functional performance and upper body strength predict upper extremity reaction and movement time in older women?

BACKGROUND: Reaction time to initiate upper limb movement and movement time to place hands on the landing surface may be important factors in forward fall landing and impact, contributing to injury reduction. The aim was to investigate the relationship of physical function and upper body strength to upper limb reaction and movement time in older female participants. METHODS: 75 female participants (72 ± 8 yrs) performed 5 arm response trials. Reaction time (signal to initiation of movement), and movement time (initial movement to contact), were collected using 3D motion capture. Additional variables were: handgrip; sit-to-stand; shoulder flexion and elbow extension strength measured by hand-held dynamometry; one-legged balance; fall risk; and physical activity scores. Prediction variables for reaction and movement time were determined in separate backward selection multiple regression analyses. Significance was set at P < 0.05. FINDINGS: Significant regression equations for RT (r2 = 0.08, P = 0.013) found a relationship between stronger handgrip (Beta = -0.002) and faster reaction time, accounting for 8% variance. For movement time (r2 = 0.06, P = 0.036) greater shoulder flexion strength (Beta = -0.04) was related to faster movement time, explaining 6% variance. Stronger SF strength was related to a decrease in MT by 4%. DISCUSSION: A relationship between arm strength measures and faster upper body reaction and movement time was shown, with 10-20% higher strength associated with a 5% faster response time. Even though this was a relatively weak relationship, given that strength is a modifiable component this provides a potential avenue for future intervention efforts. This in turn could have an impact on forward fall landing and potential reduction of injury risk.

Female Age-Related Differences in Biomechanics and Muscle Activity During Descents on the Outstretched Arms.

The purposes of this study were to examine female age differences in: (1) upper extremity (UE) and trunk muscle activity, elbow joint moment, loading force, and UE energy absorption during a controlled forward body descent; and (2) UE muscle strength. Twenty young (mean 24.8 ± 3.4 years) and 20 older (68.4 ± 5.7 years) women were assessed via dynamometry for isometric, concentric, and eccentric UE strength and performed forward descents on force plates at three body lean angles (60°, 45°, and 30° from horizontal). Significant differences (p < .05) were found for muscle strength, biomechanics, and muscle activity. Concentric UE strength averaged 15% lower in older women. At 30° body lean, older women absorbed less energy. Older women had greater biceps brachii activation and less external oblique activation at all body lean angles. Age differences in muscle strength, activation, and energy absorption may contribute to fall-related injury risk.

Does Fall Arrest Strategy Training Added to a Fall Prevention Programme Improve Balance, Strength, and Agility in Older Women? A Pilot Study.

Purpose: The purpose of this study was to determine the effect of a unique exercise programme (Fall Arrest Strategy Training, or FAST) on upper body strength, range of motion (ROM), and fall risk in older women. FAST was designed to improve upper body capacity to prevent injury when a fall cannot be avoided. Method: A quasi-randomized site design included 71 older women (aged 67-95 y, mean age 83 years), who participated either in a standard fall prevention programme (Staying on Your Feet, or SOYF; n=29) or in SOYF combined with FAST (n=42). The women were measured three times-at baseline, after the 12-week intervention, and again 12 weeks later-for upper body strength, ROM, and fall risk factors (fall risk questionnaire, balance, mobility, and leg strength). Results: No significant differences were found in age, physical activity, or cognitive or functional status between the SOYF-standard and the SOYF-FAST groups. Both groups improved their fall risk status after the intervention, with no significant differences between them; however, the SOYF-FAST group showed greater improvements in upper extremity strength and ROM (p=0.007). Conclusion: FAST can feasibly be integrated into fall prevention programming, with additional gains in upper body strength and ROM in older women.

Objectif : déterminer l'effet d'un programme d'exercices unique (Fall Arrest Strategy Training, ou formation sur la stratégie d'arrêt des chutes, FAST) sur la force du haut du corps, l'amplitude de mouvements (AdM) et le risque de chute chez les femmes âgées. Le programme FAST vise à améliorer la capacité du haut du corps à prévenir les blessures lorsqu'il est impossible d'éviter une chute. Méthodologie : l'étude quasi aléatoire dans le milieu incluait 71 femmes âgées (de 67 à 95 ans, âge moyen de 83 ans), qui ont participé soit à un programme de prévention des chutes standard (Staying on Your Feet, ou rester sur ses pieds, SOYF), soit aux programmes SOYF et FAST combinés (n=29 et n=42, respectivement). Les femmes ont été mesurées trois fois (au début, après l'intervention de 12 semaines, puis de nouveau 12 semaines plus tard), afin d'évaluer la force du haut de leur corps, leur AdM et les facteurs de risque de chute (questionnaire sur le risque de chute, équilibre, mobilité et force des jambes). Résultats : il n'y avait pas de différence significative en matière d'âge, d'activité physique ou d'état cognitif ou fonctionnel entre le groupe SOYF standard et le groupe SOYF­FAST. Les deux groupes avaient réduit leur risque de chute après l'intervention, sans différence significative entre les deux. Cependant, le groupe SOYF­FAST avait amélioré davantage la force du haut du corps et l'AdM (p=0,007). Conclusion : le programme FAST peut être intégré à un programme de prévention des chutes et être également bénéfique pour la force du haut du corps et l'AdM chez les femmes âgées.

Upper limb and trunk muscle activation during an unexpected descent on the outstretched hands in young and older women.

Falling on the outstretched hands (FOOSH), a protective mechanism to arrest the body and avoid injury, requires upper limb and trunk motor control for effective body descent. The purpose of this study was to investigate muscle activity during three phases of an unexpected FOOSH in healthy older and younger women. Twenty young (mean age 22.9yrs, SD±3.7) and 20 older females (mean age 68.1yrs, SD±5.0) performed five trials of unexpected FOOSHs. Surface electromyography (EMG) determined muscle activations for left shoulder girdle, elbow and abdominal muscles during an unexpected FOOSH. Root mean squared EMG data were calculated during three phases: (1) baseline (BL; 500msprior to release), (2) the preparatory phase (PRE; time between release and impact) (mean 257±37ms) and post-impact (POST; 200msafter impact). A mixed MANOVA determined differences between phases and age groups. There was a significant multivariate interaction effect of age and time phase on muscle activity (p=0.001). Younger women had significantly higher internal oblique/transversus abdominus activity during PRE (p=0.006) as well as variations in muscle activity of shoulder girdle and elbow muscles. The age differences observed may lead to poorer preliminary trunk activation and greater arm bracing in older women, potentially increasing risk of fallrelated injury.

The effect of adding core stability training to a standard balance exercise program on sit to stand performance in older adults: a pilot study.

This study compared sit to stand (STS) performance between older adults in a nine-week training program focusing on core stability exercises to enhance balance and postural control (EB) versus standard balance (SB) exercises. Repetitions in 30 s (STSreps) and kinematic performance (vertical and horizontal momentum, and margin of stability) were measured pre and postintervention in 23 older adults with at least one fall risk factor. Although both groups combined improved STSreps (P = .001) and vertical momentum (.008), a significant between-group difference was observed for completers only (MANCOVA of posttest group differences, with pretest scores as covariates; P = .04). EB demonstrated a greater but nonsignificant improvement in vertical momentum (P = .095). In conclusion, core stability training added to SB did not result in STS reps improvement. Compliance may modify these results and future larger sample studies should evaluate the impact of core stability training on STS biomechanics.

Cross-education for improving strength and mobility after distal radius fractures: a randomized controlled trial.

OBJECTIVE: To evaluate the effects of cross-education (contralateral effect of unilateral strength training) during recovery from unilateral distal radius fractures on muscle strength, range of motion (ROM), and function. DESIGN: Randomized controlled trial (26-wk follow-up). SETTING: Hospital, orthopedic fracture clinic. PARTICIPANTS: Women older than 50 years with a unilateral distal radius fracture. Fifty-one participants were randomized and 39 participants were included in the final data analysis. INTERVENTIONS: Participants were randomized to standard rehabilitation (Control) or standard rehabilitation plus strength training (Train). Standard rehabilitation included forearm casting for 40.4±6.2 days and hand exercises for the fractured extremity. Nonfractured hand strength training for the training group began immediately postfracture and was conducted at home 3 times/week for 26 weeks. MAIN OUTCOME MEASURES: The primary outcome measure was peak force (handgrip dynamometer). Secondary outcomes were ROM (flexion/extension; supination/pronation) via goniometer and the Patient Rated Wrist Evaluation questionnaire score for the fractured arm. RESULTS: For the fractured hand, the training group (17.3±7.4kg) was significantly stronger than the control group (11.8±5.8kg) at 12 weeks postfracture (P<.017). There were no significant strength differences between the training and control groups at 9 (12.5±8.2kg; 11.3±6.9kg) or 26 weeks (23.0±7.6kg; 19.6±5.5kg) postfracture, respectively. Fractured hand ROM showed that the training group had significantly improved wrist flexion/extension (100.5°±19.2°) than the control group (80.2°±18.7°) at 12 weeks postfracture (P<.017). There were no significant differences between the training and control groups for flexion/extension ROM at 9 (78.0°±20.7°; 81.7°±25.7°) or 26 weeks (104.4°±15.5°; 106.0°±26.5°) or supination/pronation ROM at 9 (153.9°±23.9°; 151.8°±33.0°), 12 (170.9°±9.3°; 156.7°±20.8°) or 26 weeks (169.4°±11.9°; 162.8°±18.1°), respectively. There were no significant differences in Patient Rated Wrist Evaluation questionnaire scores between the training and control groups at 9 (54.2±39.0; 65.2±28.9), 12 (36.4±37.2; 46.2±35.3), or 26 weeks (23.6±25.6; 19.4±16.5), respectively. CONCLUSIONS: Strength training for the nonfractured limb after a distal radius fracture was associated with improved strength and ROM in the fractured limb at 12 weeks postfracture. These results have important implications for rehabilitation strategies after unilateral injuries.

Validation of the Saskatoon Falls Prevention Consortium's Falls Screening and Referral Algorithm.

PURPOSE: To investigate the concurrent validity of the Saskatoon Falls Prevention Consortium's Falls Screening and Referral Algorithm (FSRA). METHOD: A total of 29 older adults (mean age 77.7 [SD 4.0] y) residing in an independent-living senior's complex who met inclusion criteria completed a demographic questionnaire and the components of the FSRA and Berg Balance Scale (BBS). The FSRA consists of the Elderly Fall Screening Test (EFST) and the Multi-factor Falls Questionnaire (MFQ); it is designed to categorize individuals into low, moderate, or high fall-risk categories to determine appropriate management pathways. A predictive model for probability of fall risk, based on previous research, was used to determine concurrent validity of the FSRI. RESULTS: The FSRA placed 79% of participants into the low-risk category, whereas the predictive model found the probability of fall risk to range from 0.04 to 0.74, with a mean of 0.35 (SD 0.25). No statistically significant correlation was found between the FSRA and the predictive model for probability of fall risk (Spearman's ρ=0.35, p=0.06). CONCLUSION: The FSRA lacks concurrent validity relative to to a previously established model of fall risk and appears to over-categorize individuals into the low-risk group. Further research on the FSRA as an adequate tool to screen community-dwelling older adults for fall risk is recommended.

Objectif : Étudier la validité concurrente de l'algorithme de dépistage des risques de chute et de renvoi en consultation (Falls Screening and Referral Algorithm, FSRA) du Saskatoon Falls Prevention Consortium. Méthode : Vingt-neuf personnes âgées (moyenne d'âge [ET] de 77,7 ans [4,0]) vivant dans une résidence pour personnes âgées autonomes satisfaisaient les critères d'inclusion; elles ont rempli un questionnaire démographique et ont été soumises à certaines composantes du FSRA et du test d'équilibre de l'échelle de Berg (EEB). Le FSRA comprend un test de dépistage des risques de chute (Elderly Fall Screening Test, EFST) et le questionnaire multifactoriel en matière de chutes (Multi-Factor Falls Questionnaire, MFQ). Il est conçu pour classer les individus dans trois catégories ­ risque de chute élevé, modéré ou faible ­ afin d'établir les approches de gestion appropriées. Un modèle prédictif de probabilité des risques de chute basé sur une étude antérieure a été utilisé pour établir la validité concurrente du FRSA. Résultats : Au total, 79 % des participants ont été classés dans la catégorie à faible risque du FSRA, puisque le modèle prédictif a permis d'établir la probabilité des risques de chute dans leur cas entre 0,04 et 0,74, avec une moyenne de 0,35 (ET=0,25). On n'a pu établir aucune corrélation significative sur le plan statistique entre le FSRA et le modèle prédictif de la probabilité des risques de chute (ρ de Spearman=0,35, p=0,06). Conclusion : Le FSRA manque de validité concurrente si on le compare à un modèle de risques de chute préalablement établi et semble « surclasser ¼ les individus dans le segment à faible risque. D'autres études sur le FSRA en tant qu'outil approprié de dépistage chez les aînés résidant dans la communauté sont recommandées.

The Relationship of Knee-Extensor Strength and Rate of Torque Development to Sit-to-Stand Performance in Older Adults.

PURPOSE: To investigate the association of knee-extensor strength and power to performance in the 30-second sit-to-stand test (30sSTS) in healthy older adults. METHOD: In a cross-sectional study of 29 healthy older adults aged 60-82 years (12 male, 17 female), hierarchical regression was used to determine the relationship of knee-extensor concentric and eccentric strength, peak rate of torque development (peak RTD) using isokinetic dynamometry, and momentum variables with the number of sit-to-stand repetitions completed in 30 seconds (30sSTSreps). RESULTS: Concentric (180°/s) and eccentric (90°/s) knee-extensor strength were significant independent predictors of 30sSTSreps after controlling for physical activity level, height and weight (adjusted R (2)=0.425, p=0.004; adjusted R (2)=0.427, p=0.004 respectively), as was concentric (90°/s) knee-extensor peak RTD (adjusted R (2)=0.424, p=0.004). Peak linear vertical momentum (PLVM) (adjusted R (2)=0.615, p<0.001) accounted for 36% of the variance. CONCLUSIONS: Generation of PLVM is an important predictor of 30sSTSreps; knee-extensor concentric and eccentric strength and power are associated with improved performance in this common functional task. Focusing on these parameters in exercise interventions may improve functional performance and give insight into specific factors related to success on the test.

Objectif : Étudier le lien entre la force et la puissance de l'extenseur du genou et le rendement au cours d'un test assis-debout de 30 secondes (TAD30s) chez des adultes âgés en bonne santé. Méthode : Au cours d'une étude transversale portant sur 29 adultes en bonne santé âgés de 60 à 82 ans (12 hommes, 17 femmes), on a utilisé une régression hiérarchique pour déterminer le lien entre la force concentrique et excentrique de l'extenseur du genou, le taux maximal de production du moment de force (RTD maximal) au moyen de la dynamométrie isokinétique, et les variables de la quantité de mouvement en fonction du nombre de répétitions assis-debout complétées en 30 secondes (répTAD30s). Résultats : La force concentrique (180°/s) et excentrique (90°/s) de l'extenseur du genou constituait un prédicteur indépendant significatif de repTAD30s compte tenu du niveau d'activité physique, de la taille et du poids (R2 rajusté=0,425, p=0,004; R2 rajusté=0,427, p=0,004 respectivement), tout comme l'était le RTD de pointe concentrique (90°/s) de l'extenseur du genou (R2 rajusté=0,424, p=0,004). La quantité de mouvement vertical linéaire de pointe (MVLP) (R2 rajusté=0,615, p<0,001) a représenté 36 % de la variation. Conclusions : La production du MVLP constitue un prédicteur important des répTAD30s. On établit un lien entre la force et la puissance concentriques et excentriques de l'extenseur du genou et une amélioration du rendement dans cette tâche fonctionnelle courante. La concentration de l'attention sur ces paramètres au cours d'intervention basées sur l'exercice peut améliorer le rendement fonctionnel et donner une idée de facteurs particuliers liés à la réussite au test.

Former premenarcheal gymnasts exhibit site-specific skeletal benefits in adulthood after long-term retirement.

Young female gymnasts have greater bone strength compared to controls; although possibly due to selection into gymnastics, it is thought that their loading activity during growth increases their bone mass, influencing both bone geometry and architecture. If such bone mass and geometric adaptations are maintained, this may potentially decrease the risk of osteoporosis and risk of fracture later in life. However, there is limited evidence of the persisting benefit of gymnastic exercise during growth on adult bone geometric parameters. Therefore, the purpose of this study was to determine whether adult bone geometry, volumetric density, and estimated strength were greater in retired gymnasts compared to controls, 10 years after retirement from the sport. Bone geometric and densitometric parameters, measured by peripheral quantitative computed tomography (pQCT) at the radius and tibia, were compared between 25 retired female gymnasts and 22 controls, age range 22 to 30 years, by multivariate analysis of covariance (covariates: age, height, and muscle cross-sectional area). Retired gymnasts had significantly greater adjusted total and trabecular area (16%), total and trabecular bone mineral content (BMC) (18% and 22%, respectively), and estimated strength (21%) at the distal radius (p < 0.05) than controls. Adjusted total and cortical area and BMC, medullary area, and estimated strength were also significantly greater (13% to 46%) in retired gymnasts at the 30% and 65% radial shaft sites (p < 0.05). At the distal tibia, retired gymnasts had 12% to 13% greater total and trabecular BMC and volumetric bone mineral density as well as 21% greater estimated strength; total and cortical BMC and estimated strength were also greater at the tibial shaft (8%, 11%, and 10%, respectively) (p < 0.05). Former female gymnasts have significantly better geometric and densitometric properties, as well as estimated strength, at the radius and tibia 10 years after retirement from gymnastics compared to females who did not participate in gymnastics in childhood and adolescence.

Risk factors for falls in older adults with lower extremity arthritis: a conceptual framework of current knowledge and future directions.

PURPOSE: As the numbers of Canadians aged 65 years and over increases over the next 20 years, the prevalence of chronic conditions, including arthritis, will rise as will the number of falls. Although known fall-risk factors are associated with hip and knee osteoarthritis (OA), minimal research has evaluated fall and fracture risk and/or rates in this population. Thus, the purpose was to summarize research on fall and fracture risk in older adults with hip or knee OA and to develop a conceptual framework of fall-risk screening and assessment. METHOD: The International Classification of Functioning, Disability and Health, clinical practice guidelines for fall-risk screening, and a selected literature review were used. RESULTS: Gaps exist in our knowledge of fall and fracture risk for this population. Muscle performance, balance, and mobility impairments have been identified, but little is known about whether personal and environmental contextual factors impact fall and fracture risk. Physical activity may help to prevent falls, but non-adherence is a problem. CONCLUSION: A need exists to assess fall risk in older adults with hip and knee OA. Promoting regular physical activity by focusing on disease- and activity-specific personal contextual factors may help direct treatment planning.

Objectif : Le nombre de Canadiens de 65 ans et plus augmentera au cours des 20 prochaines années et la prévalence des maladies chroniques, dont l'arthrite, sera en hausse, tout comme le nombre de chutes. Bien que des facteurs de risques de chute connus soient associés à l'arthrose du genou ou de la hanche, une somme minimale de recherches a évalué les risques ou les taux de chutes et de fractures chez ce segment de la population. En conséquence, l'objectif de cette étude était de dresser un résumé des recherches réalisées sur les risques de chute ou de fracture chez les adultes plus âgés aux prises avec de l'arthrose au genou ou à la hanche, et d'élaborer un cadre conceptuel pour le dépistage et l'évaluation des risques de chute. Méthode : La Classification internationale du fonctionnement, du handicap et de la santé (CIF), qui forme les directives cliniques pour le dépistage des risques de chute, et une revue documentaire sélective ont été utilisées. Résultats : Il existe des lacunes dans nos connaissances relatives aux risques de chute et de fracture au sein de ce segment de la population. La dégradation de la performance musculaire, de l'équilibre et de la mobilité a été établie, mais on sait peu de choses en ce qui a trait aux répercussions possibles de facteurs contextuels personnels ou environnementaux sur les risques de chute ou de fracture. L'activité physique peut aider à prévenir les chutes, mais la non-adhésion des patients à un programme d'activité physique pose problème. Conclusion : Une évaluation des risques de chute chez les adultes plus âgés souffrant d'arthrose du genou ou de la hanche est nécessaire. La promotion de l'activité physique régulière, en se concentrant sur les facteurs contextuels personnels propres à la maladie ou à l'activité, pourrait aider directement la planification du traitement.

Higher premenarcheal bone mass in elite gymnasts is maintained into young adulthood after long-term retirement from sport: a 14-year follow-up.

Sports that impact-load the skeleton during childhood and adolescence increase determinants of bone strength such as bone mineral content and density; however, it is unclear if this benefit is maintained after retirement from the sport. The purpose of this study was to assess whether the previously reported higher bone mass in a group of premenarcheal gymnasts was still apparent 10 years after the cessation of participation and withdrawal of the gymnastics loading stimulus. In 1995, 30 gymnasts 8 to 15 years of age were measured and compared with 30 age-matched nongymnasts. Twenty-five former gymnasts and 22 nongymnasts were measured again 14 years later (2009 to 2010). Gymnasts had been retired from gymnastics training and competition for an average of 10 years. Total body (TB), lumbar spine (LS), and femoral neck (FN) bone mineral content (BMC) was assessed at both measurement occasions by dual-energy X-ray absorptiometry (DXA). Multivariate analysis of covariance (MANCOVA) was used to compare former gymnasts' and nongymnasts' BMC while controlling for differences in body size and maturation (covariates: age, height, weight, and years from menarche [1995] or age at menarche [2009 to 2010]). Premenarcheal gymnasts (measured in 1995) had significantly greater size-adjusted TB, LS, and FN BMC (p < 0.05) (15%, 17%, and 12%, respectively) than nongymnasts. Ten years after retirement, gymnasts had maintained similar size-adjusted TB, LS, and FN BMC differences (p < 0.05) (13%, 19%, and 13%, respectively) when compared with nongymnasts. Bone mass benefits in premenarcheal gymnasts were still apparent even after long-term (10 years) removal of the gymnastics loading stimulus.

The effect of aquatic exercise and education on lowering fall risk in older adults with hip osteoarthritis.

OBJECTIVE: To evaluate the effect of aquatic exercise and education on fall risk factors in older adults with hip osteoarthritis (OA). METHOD: Seventy-nine adults, 65 years of age or older with hip OA and at least 1 fall risk factor, were randomly assigned to 1 of 3 groups: aquatics and education (AE; aquatic exercise twice a wk with once-a-wk group education), aquatics only (A; 2 wk aquatic exercise) and control (C; usual activity). Balance, falls efficacy, dual-task function, functional performance (chair stands), and walking performance were measured pre- and postintervention or control period. RESULTS: There was a significant improvement in fall risk factors (full-factorial MANCOVA, baseline values as covariates; p = .038); AE improved in falls efficacy compared with C and in functional performance compared with A and C. CONCLUSION: The combination of aquatic exercise and education was effective in improving fall risk factors in older adults with arthritis.

The reliability and validity of handheld dynamometry for the measurement of lower-extremity muscle strength in older adults.

Lower-extremity muscle strength is important in predicting fall risk in older adults. Handheld dynamometry (HHD) is a tool used to measure isometric muscle strength in the older adult, but few studies have evaluated the utility of HHD for muscle groups beyond knee extension. The purpose of this study was to evaluate the reliability of HHD at the hip, knee, and ankle and to compare HHD strength values to other isometric dynamometry (ID) and to balance and recovery in older adults. This was a repeated measures study design of 18 men and women, age 65 to 92 years of age, who had HHD strength testing 3 to 7 days apart by the same examiner and repeat testing on the same day using 2 independent examiners. ID strength, balance, step length, and reaction time were measured once. HHD demonstrated good intrarater and interrater reliability for isometric strength at the hip and knee but was not a reliable measure for ankle strength. The HHD was a valid measure of isometric strength at the hip and knee, demonstrating moderate to high correlation values when compared to ID strength measures (r = 0.57-0.86; p < 0.05). Hip and knee strength was positively associated to step length and reaction time but not to balance (r = 0.40-0.71; p < 0.05). In conclusion, HHD is a reliable and valid assessment tool for measuring strength at the hip and knee in older adults, and greater strength in these muscles is associated with longer step length and decreased reaction time, which are important components of balance recovery in older adults. HHD can be used as an effective strength measurement tool for the older adult population.

The relationship of intrinsic fall risk factors to a recent history of falling in older women with osteoporosis.

STUDY DESIGN: Cross-sectional descriptive analysis investigating intrinsic fall risk factors in postmenopausal women with osteoporosis. OBJECTIVE: To examine the relationships between history of recent falls and balance, pain, quality of life, function, posture, strength, and mobility. BACKGROUND: Women with osteoporosis who fall are at a high risk of fracture due to decreased bone strength. Identifying fall risk factors for older women with osteoporosis is a crucial step in decreasing the incidence of falls and fracture. METHOD AND MEASURES: Seventy-three women over 60 years of age with established osteoporosis participated in comprehensive testing of fall history, physical function, and quality of life. RESULTS: Significant correlations were found between a recent history of falls and degree of kyphosis (r = 0.29), fear of falls/emotional status (r = -0.27), and balance (r = -0.27). Degree of kyphosis and fear of falls/emotional status explained 20% of the variance of recent fall history using binary logistic regression. Women with an increased kyphosis were more likely to have had a recent fall (odds ratio [OR], 1.17; 95% CI, 1.03-1.34) and those with better emotional status and less fear of falling were less likely to have had a recent fall (OR, 0.61; 95% CI, 0.38-0.97). CONCLUSION: Increased thoracic kyphosis and fear of falling are 2 intrinsic factors associated with recent falls in women with osteoporosis. To design more effective interventions to decrease fall risk in this population, future prospective, longitudinal studies should monitor kyphosis, fear of falling, balance reactions, and other potential risk factors not identified in this study.