Screening for Osteoporosis Risk Among Community-Dwelling Older Adults: A Scoping Review.

BACKGROUND AND PURPOSE: Due to potential health-related consequences of osteoporosis (OP), health care providers who do not order imaging, such as physical therapists, should be aware of OP screening tools that identify individuals who need medical and rehabilitation care. However, current knowledge and guidance on screening tools is limited. Therefore, we explored OP screening tools that are appropriate and feasible for physical therapy practice, and evaluated tools' effectiveness by examining their clinimetric properties. METHODS: A systematic search of the following databases was performed: PubMed, PEDro, PsycINFO, CINAHL, and Web of Science. Articles were included if the study population was 50 years and older, had a diagnosis of OP, if the screening tool was within the scope of physical therapy practice, and was compared to either a known diagnosis of OP or bone densitometry scan results. Included articles underwent multiple reviews for inclusion and exclusion, with each review round having a different randomly selected pair of reviewers. Data were extracted from included articles for participant demographics, outcome measures, cut-off values, and clinimetric properties. Results were categorized with positive and negative likelihood ratios (+LR/-LR) based on the magnitude of change in the probability of having or not having OP. RESULTS: +LRs ranged from 0.15 to 20.21, with the Fracture Risk Assessment Tool (FRAX) and Study of Osteoporotic Fractures (SOF) having a large shift in posttest probability. -LRs ranged from 0.03 to 1.00, with the FRAX, Male Osteoporosis Risk Estimation Scores, Osteoporosis Self-Assessment Tool (OST), and Simple Calculated Osteoporosis Risk Estimation having a large shift in posttest probability. CONCLUSION: Tools with moderate-large shift for both +LR and -LR recommended for use are: (1) OST; (2) FRAX; and (3) SOF. The variability in cut-off scores and clinimetric properties based on gender, age, and race/ethnicities made it impossible to provide one specific recommendation for an OP screening tool. Future research should focus on OP risk prediction among males and racial and ethnic groups.

Reliability, responsiveness, and validity of slow walking speed in community dwelling older adults.

BACKGROUND: Independent ambulation requires adaptability. Self-selected and maximum walking speeds are often both assessed to demonstrate the ability to adapt speed to different tasks and environments. However, purposefully walking at a slow speed (slowWS) could also be an appropriate adaptation in certain situations but has rarely been investigated. RESEARCH QUESTION: The purpose of this study was to assess the reliability, responsiveness, and concurrent validity of slowWS in community-dwelling older adults. METHODS: This was an observational, cross-sectional study of 110 community-dwelling older adults. Test-retest and inter-rater reliabilities of slowWS were assessed with intra-class correlation coefficients. Standard error of measurement (SEM) and minimal detectable change (MDC95) were calculated to determine responsiveness. Concurrent validity was assessed with Spearman rank-order correlations between slowWS and a battery of tests previously shown to be related to walking speed. RESULTS: Walking speed measurement for slowWS was shown to have excellent test-retest and interrater reliability (ICCs values of 0.971-0.997). Standard error of measurement value was small (0.015 m/sec) and MDC95 was 0.04 m/sec. SlowWS was not found to significantly correlate to any other study variable. SIGNIFICANCE: Walking speed, whether self-selected, maximum, or slow, can be measured reliably with a stopwatch and specific verbal commands. While slowWS could be beneficial for certain tasks or environments, walking slowly was not associated with age, sex, comorbidity, or measures of cognition, depression, strength, balance, disability, or life-space in this sample.

Examining physical activity participation barriers among adults 50 years and older: a scoping review.

Background: Addressing physical activity (PA) barriers is essential for increasing PA levels in middle-aged and older adults. However, there are no recommendations on selecting PA barrier assessment tools. Objectives: Thus, we aimed to identify and provide clinimetric properties on PA barrier assessment tools that healthcare providers, exercise experts, and public health officials can use to examine potential barriers faced by community-dwelling adults 50 years and older. Methods: We performed a systematic search of the following databases: PubMed, PsycINFO, CINAHL, and Web of Science. Articles were included if they presented clinimetric data on a PA participation barrier assessment tool for community-dwelling participants with a mean age of 50 years and older. The 561 identified articles underwent multiple rounds of blinded reviews. Included articles underwent data extraction for participant characteristics, scoring, constructs, reference tests, and clinimetric properties. Results: The 35 included articles reported on 33 different PA participation barrier assessment tools. Eighteen articles reported on participants with cardiovascular, musculoskeletal, or neurological diagnoses, diabetes, hemodialysis, history of cancer, or mobility limitations. Tools with two or more supporting publications included the Exercise Benefits/Barrier Scale (EBBS), Episode-Specific Interpretations of Exercise Inventory (ESIE), and Inventory of Physical Activity and Barriers (IPAB). Due to differences in methodologies, across-tool comparison was not possible. Conclusion: The EBBS, ESIE, and IPAB are promising tools for community-dwelling adults 50 years and older. However, additional research is warranted to identify the best PA barrier assessment tool among adults 50 years and older.

Effects of constraint-induced movement therapy on activity and participation after a stroke: Systematic review and meta-analysis.

Introduction: Hemiparesis is the main sensorimotor deficit after stroke. It can result in limitations in Activities of Daily Living (ADL) and social participation. Hemiparesis can be treated with behavioral techniques of intensive use of the affected arm, such as constraint-induced movement therapy (CIMT), however, it remains unclear whether motor improvement can lead to increases in the domains of activity and participation. Objective: Identify whether CIMT is superior to usual techniques to enhance activity and participation outcomes in stroke survivors. Methods: A systematic review with meta-analysis was conducted, based on the PRISMA guidelines. Search databases were: PubMed, LILACS, Embase, SciELO, Cochrane Library, Scopus, Medline, and Web of Science, with no language restriction. Meta-analysis was performed with Review Manager (version 5.3), significance level p ≤ 0.05. Results: A total of 21 articles were included for analysis. Superior effects were observed on motor function and performance in activities of daily living of individuals treated with CIMT. The outcomes measures utilized were: Fugl-Meyer Assessment (p = 0.00001); Wolf motor function test (p = 0.01); Modified Barthel Index (p = 0.00001); Motor Activity log (MAL) Amount of use (AOU) (p = 0.01); MAL Quality of movement (QOM) (p = 0.00001); Action Research Arm Test-ARAT (p = 0.00001); and FIM (p = 0.0007). Conclusion: Our results show that CIMT results in more significant gains in the functional use of the upper limb in ADL and functional independence, demonstrating superior activity and participation results in stroke survivors when compared to conventional therapies.

Examining physical activity participation barriers among adults 50 years and older: a scoping review protocol.

Background: Despite the benefits of physical activity (PA), 61% of adults 50 years and older do not meet the recommended levels of PA. One method of increasing PA participation is assessing and addressing PA participation barriers. Currently, no guidance on methodologies for assessing PA participation barriers exist. Objective: The primary objective of this scoping review is to map the methodologies used to examine potential PA participation barriers faced by community-dwelling adults 50 years and older. A secondary objective is to evaluate the clinimetric properties of these methodologies. Methods: This scoping review protocol is registered with Open Science Framework (https://osf.io/wd2hx). A systematic search of the following databases will be performed: PubMed, PsycINFO, CINAHL, Web of Science, and PEDro. Included studies will 1) present either a) data on development or clinimetric properties of PA participation barrier tool (s); or b) relative risk or odds ratios of PA participation barrier(s); 2) compare PA participation barriers or PA participation barrier tool(s) to either subjective or objective measures of PA; and 3) comprise of community-dwelling participants with a mean age of 50 years and older. A two-phase blinded independent screening process will be conducted to select the included publications. Data will be extracted using a standardized form and cross-checked by the first author. A narrative summary will accompany the results presented in tables and figures. Conclusion: This scoping review will provide a comprehensive understanding of current literature and gaps related to PA participation barrier methodologies used with adults 50 years and older.

Association Rule Mining to Examine Predictors for the Outcome of Gait Rehabilitation Programs in Stroke Survivors.

ABSTRACT: This study presents a novel application of association rule data mining to determine the predictors of the response to locomotor training and home exercise for improving gait after stroke. The study was a secondary data analysis on the Locomotor Experience Applied Post Stroke Trial dataset. The association rule analysis was applied to analyze three interventions: (1) early locomotor training, (2) late locomotor training, and (3) home exercise program. The outcome variable was whether participants poststroke had greater than median improvement in the self-selected comfortable gait speed. Three types of predictors were investigated: (1) demographics, (2) behavioral and medical history, and (3) clinical assessments at baseline. Association rules were generated when they meet two criteria determined based on the data: 10% of support and 70% of confidence. The identified rules showed that the predictors of the response were different across the three interventions, which was inconsistent with the previous report based on traditional logistic regression. However, the rules were identified with high confidence but low support, indicating that they were reliable but did not appear often in the Locomotor Experience Applied Post Stroke Trial dataset. Further investigation of these rules with a larger sample size is warranted before applying them to clinical settings.

An examination of muscle force control in individuals with a functionally unstable ankle.

Previous studies suggest that functional ankle instability (FAI) may be associated with deficits in the ability to sense muscle forces. We tested individuals with FAI to determine if they have reduced ability to control ankle muscle forces, which is a function of force sense. Our test was performed isometrically to minimize the involvement of joint position sense and kinesthesia. A FAI group and a control group were recruited to perform an ankle force control task using a platform-based ankle robot. They were asked to move a cursor to hit 24 targets as accurately and as fast as possible in a virtual maze. The cursor movement was based on the direction and magnitude of the forces applied to the robot. Participants underwent three conditions: pre-test (baseline), practice (skill acquisition), and post-test (post skill acquisition). The force control ability was quantified based on the accuracy performance during the task. The accuracy performance was negatively associated with the collision count of the cursor with the maze wall. The FAI group showed reduced ability to control ankle muscle forces compared to the control group in the pre-test condition, but the difference became non-significant in the post-test condition after practice. The change in performance before and after practice may be due to different degrees of reliance on force sense.

Pre-season concussion assessment utilizing the King-Devick Test.

This study's objectives were to assess the test-retest reliability and concurrent validity of the King-Devick Test (KDT) during concussion screening and to analyze potential sport-specific differences in test performance across two sports. Two hundred and sixty-six high school male American football and soccer players recruited from four area high schools participated prior to the fall sports season. Main outcome measures included the KDT and Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT). KDT performance demonstrated significant correlations with the ImPACT visual motor speed composite scores, reaction time, Cognitive Efficiency Index and age. Significant baseline differences were noted on the KDT between football and soccer players. The KDT demonstrates concurrent validity with three neurocognitive domains on the ImPACT. Significant differences in baseline King-Devick Test scores were found between football and soccer players and may be related to the neurocognitive demands of the sport.

Effects of kinesiotaping and athletic taping on ankle kinematics during walking in individuals with chronic ankle instability: A pilot study.

BACKGROUND: Individuals with chronic ankle instability (CAI) tend to walk with an overly inverted foot, which increases the risk of ankle sprains during stance phase. Clinicians could perform ankle taping using kinesiotape (KT) or athletic tape (AT) to address this issue. Because KT is elastic while AT is not, the techniques and underlying mechanisms for applying these tapes are different, which may lead to different outcomes. RESEARCH QUESTION: To compare the effects of KT and AT interventions on foot motion in the frontal plane and tibial motion in the transverse plane during stance phase of walking. METHODS: Twenty subjects with CAI were assigned to either KT or AT group, and walked on a treadmill in no tape and taped conditions. Their foot and tibial motions were captured by 3D motion analysis system. The main component of KT application was two pieces of tape applied from the medial aspect of the hindfoot to the lateral to generate a pulling tension towards eversion. AT was applied to the ankle using the closed basket weave approach. AT was not stretchable and not able to generate the same pulling tension as KT. RESULTS: KT increased foot eversion during early stance, but showed no effect during late stance. AT increased tibial internal rotation during late stance, but showed no effect during early stance. SIGNIFICANCE: Compared to AT, KT better provides a flexible pulling force that facilitates foot eversion during early stance, while not restricting normal inversion in late stance during walking. KT may be a useful clinical tool in correcting aberrant motion while not limiting natural movement in sports.

Hip-ankle coordination during gait in individuals with chronic ankle instability.

Individuals with chronic ankle instability (CAI) may have sensorimotor impairments that affect control at the hip in addition to the ankle. The purpose of this study was to compare hip-ankle coordination and coordination variability between individuals with CAI and healthy individuals during walking. Ten healthy subjects and 10 subjects with CAI were recruited to walk on a treadmill. Hip-ankle coordination was quantified using vector coding, and coordination variability was quantified using coefficient of correspondence. We found significant between-group differences in hip-ankle coordination in the frontal plane around loading response (Control: 165.9±18.4°; CAI: 127.6±48.6°, p=0.04) and in the sagittal plane around the first half of mid stance (Control: 307.2±9.8°; CAI: 291.8±11.4°, p<0.01), terminal stance (Control: 301.1±13°; CAI: 313.4±10.9°, p=0.04), and pre-swing (Control: 243.9±35.2°; CAI: 329.9±57.8°, p<0.01). We also found significant between-group differences in hip-ankle coordination variability in the frontal plane around the second half of mid stance (Control: 0.54±0.06; CAI: 0.45±0.07, P<0.01). CAI is associated with alteration of hip-ankle coordination and coordination variability in stance phase during walking. Gait training is important in CAI rehabilitation, and the training should address altered hip-ankle coordination to reduce the risk of recurrent injuries.

Determining Risk of Falls in Community Dwelling Older Adults: A Systematic Review and Meta-analysis Using Posttest Probability.

BACKGROUND: Falls and their consequences are significant concerns for older adults, caregivers, and health care providers. Identification of fall risk is crucial for appropriate referral to preventive interventions. Falls are multifactorial; no single measure is an accurate diagnostic tool. There is limited information on which history question, self-report measure, or performance-based measure, or combination of measures, best predicts future falls. PURPOSE: First, to evaluate the predictive ability of history questions, self-report measures, and performance-based measures for assessing fall risk of community-dwelling older adults by calculating and comparing posttest probability (PoTP) values for individual test/measures. Second, to evaluate usefulness of cumulative PoTP for measures in combination. DATA SOURCES: To be included, a study must have used fall status as an outcome or classification variable, have a sample size of at least 30 ambulatory community-living older adults (≥65 years), and track falls occurrence for a minimum of 6 months. Studies in acute or long-term care settings, as well as those including participants with significant cognitive or neuromuscular conditions related to increased fall risk, were excluded. Searches of Medline/PubMED and Cumulative Index of Nursing and Allied Health (CINAHL) from January 1990 through September 2013 identified 2294 abstracts concerned with fall risk assessment in community-dwelling older adults. STUDY SELECTION: Because the number of prospective studies of fall risk assessment was limited, retrospective studies that classified participants (faller/nonfallers) were also included. Ninety-five full-text articles met inclusion criteria; 59 contained necessary data for calculation of PoTP. The Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS) was used to assess each study's methodological quality. DATA EXTRACTION: Study design and QUADAS score determined the level of evidence. Data for calculation of sensitivity (Sn), specificity (Sp), likelihood ratios (LR), and PoTP values were available for 21 of 46 measures used as search terms. An additional 73 history questions, self-report measures, and performance-based measures were used in included articles; PoTP values could be calculated for 35. DATA SYNTHESIS: Evidence tables including PoTP values were constructed for 15 history questions, 15 self-report measures, and 26 performance-based measures. Recommendations for clinical practice were based on consensus. LIMITATIONS: Variations in study quality, procedures, and statistical analyses challenged data extraction, interpretation, and synthesis. There was insufficient data for calculation of PoTP values for 63 of 119 tests. CONCLUSIONS: No single test/measure demonstrated strong PoTP values. Five history questions, 2 self-report measures, and 5 performance-based measures may have clinical usefulness in assessing risk of falling on the basis of cumulative PoTP. Berg Balance Scale score (≤50 points), Timed Up and Go times (≥12 seconds), and 5 times sit-to-stand times (≥12) seconds are currently the most evidence-supported functional measures to determine individual risk of future falls. Shortfalls identified during review will direct researchers to address knowledge gaps.

Risk Adjustment for Lumbar Dysfunction: Comparison of Linear Mixed Models With and Without Inclusion of Between-Clinic Variation as a Random Effect.

BACKGROUND: Valid comparison of patient outcomes of physical therapy care requires risk adjustment for patient characteristics using statistical models. Because patients are clustered within clinics, results of risk adjustment models are likely to be biased by random, unobserved between-clinic differences. Such bias could lead to inaccurate prediction and interpretation of outcomes. PURPOSE: The purpose of this study was to determine if including between-clinic variation as a random effect would improve the performance of a risk adjustment model for patient outcomes following physical therapy for low back dysfunction. DESIGN: This was a secondary analysis of data from a longitudinal cohort of 147,623 patients with lumbar dysfunction receiving physical therapy in 1,470 clinics in 48 states of the United States. METHODS: Three linear mixed models predicting patients' functional status (FS) at discharge, controlling for FS at intake, age, sex, number of comorbidities, surgical history, and health care payer, were developed. Models were: (1) a fixed-effect model, (2) a random-intercept model that allowed clinics to have different intercepts, and (3) a random-slope model that allowed different intercepts and slopes for each clinic. Goodness of fit, residual error, and coefficient estimates were compared across the models. RESULTS: The random-effect model fit the data better and explained an additional 11% to 12% of the between-patient differences compared with the fixed-effect model. Effects of payer, acuity, and number of comorbidities were confounded by random clinic effects. LIMITATIONS: Models may not have included some variables associated with FS at discharge. The clinics studied may not be representative of all US physical therapy clinics. CONCLUSIONS: Risk adjustment models for functional outcome of patients with lumbar dysfunction that control for between-clinic variation performed better than a model that does not.

Spatial and temporal parameters of self-selected and fast walking speeds in healthy community-living adults aged 72-98 years.

PURPOSE: There is limited data about typical performance for spatial and temporal measures of self-selected walking speed (SSWS) and fast walking speeds (FWS) for healthy adults older than 75 years. This study reports both velocity and spatial and temporal characteristics of walking by age group and gender for 118 community-living adults between the ages of 72 and 98 years, mean age 84.8 (5.3) years, participating in a functional assessment clinic held at their continuing care retirement community. METHODS: Three trials of SSWS and 3 trials of FWS were captured using the GAITRite system (CIR Systems, Inc., Havertown, Pennsylvania). Velocity, normalized velocity, and other spatial and temporal parameters were calculated by GAITRite software. Independent ttests were used to evaluate differences by age and gender in demographic and anthropometric characteristics, and vital signs. Mean of 3 trials was used to develop performance values by age group and gender. Analysis of variance with appropriate post hoc testing was used to identify differences in gait characteristics by age and gender. RESULTS: There were no differences in anthropomorphic or vital signs by age group; men where taller and heavier as would be expected. There was a consistent age effect for both SSWS and FWS; gait velocity decreased as age increased, with significant differences between all decades of age. There was a significant gender effect, with men walking faster than women at SSWS and FWS. Even after normalizing SSWS and FWS to leg length, men walked faster than females. CONCLUSION: Data reported in this study of generally healthy older adults can be used by rehabilitation professionals to develop goals for functional walking speed and determine readiness for discharge for patients intending to return to community-living settings following their rehabilitation.