Prevalence and associated factors of locomotive syndrome in young Japanese adults: a cross-sectional study.

BACKGROUND: The onset of locomotive syndrome (LS) precedes that of frailty. Therefore, the first step in extending healthy life expectancy is to implement measures against LS in young adults. The aim of this study was to investigate the prevalence of LS and its associated factors in young adults for early detection and prevention of LS. METHODS: The participants of this study comprised 413 university students specializing in health sciences (192 males and 221 females) with an average age of 19.1 ± 1.2 years. All participants voluntarily participated in the study and reported no serious health problems. The presence or absence of LS was evaluated using the stand-up test, two-step test, and the 25-question Geriatric Locomotive Function Scale. Additionally, musculoskeletal assessment (one-leg standing, squatting, shoulder elevation, and standing forward bend), body composition analysis (weight, body mass index, body fat mass, body fat percentage, skeletal muscle mass index (SMI), and phase angle), handgrip strength test, physical activity assessment, and nutritional assessment were conducted. Sex-stratified analyses were performed, comparing groups with and without LS. Factors associated with LS were explored using binomial logistic regression. RESULTS: Of the 413 young adults studied, 86 individuals (20.8%) were found to have LS. When stratified by sex, LS was observed to have a considerably higher prevalence in females (55, 24.9%) than in males (31, 16.1%). In males, the notable differences between the groups with and without LS were observed in one-leg standing and phase angle, whereas in females, differences were identified in body fat mass, body fat percentage, SMI, musculoskeletal pain, and handgrip strength. Two types of binomial logistic regression analysis revealed that the inability to perform one-leg standing was associated with LS in males, while the presence of musculoskeletal pain and a high body fat percentage were identified as factors associated with LS in females. CONCLUSIONS: One in five young adults were found to have LS in this study, underscoring the necessity for early intervention and LS health education. Furthermore, effective management of musculoskeletal pain is also crucial.

Safety and feasibility of in-hospital autonomous transportation using a driverless mobility for patients with musculoskeletal disorders: preliminary clinical study to achieve mobility as a service in medical care.

BACKGROUND: Recent advancements in and the proliferation of autonomous mobility technology, such as intelligent wheelchairs, have made it possible to provide mobility services for patients with reduced mobility due to musculoskeletal disorders. In the present study, we conducted a preliminary clinical study to assess the safety and feasibility of in-hospital autonomous transportation using a driverless mobility (wheelchair) for patients with musculoskeletal disorders. METHODS: From January to February 2022, 51 patients with musculoskeletal disorders exhibiting gait disturbance who presented to our institution were included in the present study. Driverless mobility rides were conducted over a straight-line distance of 100 m from the orthopaedic outpatient reception to the payment counter after the outpatient consultation. We assessed the quality of life using an EQ-5D-5 L index and pain using a VAS score before riding the mobility to investigate the patient's condition. After the ride, a questionnaire survey was conducted to assess patient satisfaction on a 5-point scale. In addition, adverse events during the mobility ride were investigated. RESULTS: Overall satisfaction levels showed that 44 out of 51 (86%) patients rated the level as 3 or higher. There were no significant differences in the level of satisfaction based on the cause of disorders or EQ-5D-5 L Index. Among 19 patients who rated the level of satisfaction as 2-3, the ratio of postoperative patients and those with pain tended to be higher (p < 0.05). While 26 of 51 (51%) patients reported moments of feeling unsafe during the mobility ride, no actual adverse events, such as collisions, were observed. CONCLUSIONS: An in-hospital autonomous transportation service using a driverless mobility for patients with musculoskeletal disorders demonstrated high satisfaction levels and was safe with no severe adverse events observed. The expansion of autonomous mobility deployment is expected to achieve mobility as a service in medical care.

A hub and spoke model to supply the Sicilian neurorehabilitation demand: effects on hospitalization rates and patient mobility.

Introduction: Cerebrovascular diseases in Sicily have led to high mortality and healthcare challenges, with a notable gap between healthcare demand and supply. The mobility of patients seeking care, both within and outside Sicily, has economic and organizational impacts on the healthcare system. The Hub and Spoke model implemented by the IRCCS Centro Neurolesi "Bonino-Pulejo" of Messina aims to distribute advanced neurorehabilitation services throughout Sicily, potentially reducing health mobility and improving service accessibility. Methods: The evaluation was based on calculating hospitalization rates, examining patient mobility across Sicilian provinces, and assessing the financial implications of neurorehabilitation admissions. Data from 2016 to 2018, covering the period before and after the implementation of the Hub and Spoke network, were analyzed to understand the changes brought about by this model. Results: The analysis revealed a significant increase in hospitalization rates for neurorehabilitation in the Sicilian provinces where spokes were established. This increase coincided with a marked decrease in interregional health mobility, indicating that patients were able to receive high-quality care closer to their residences. Furthermore, there was a decrease in both intra-regional and inter-regional escape rates in provinces within the Hub and Spoke network, demonstrating the network's efficacy in improving accessibility and quality of healthcare services. Discussion: The implementation of the Hub and Spoke network substantially improved neurorehabilitation healthcare in Sicily, enhancing both accessibility and quality of care for patients. The network's establishment led to a more efficient utilization of healthcare resources and balanced distribution of services. These advancements are vital steps toward equitable and effective healthcare delivery in Sicily.

[How has life expectancy without functional limitations developed in Germany? An analysis with data from the German Ageing Survey (DEAS)]. / Wie hat sich die Lebenserwartung ohne funktionelle Einschränkungen in Deutschland entwickelt? Eine Analyse mit Daten des Deutschen Alterssurveys (DEAS).

INTRODUCTION: The long-term increase in life expectancy raises the question of whether the increased life expectancy is accompanied by an extension of years without health limitations. The study analyzes how life expectancy without functional and mobility limitations from the ages of 46 and 65 and their proportions of remaining life expectancy have changed since 2008. METHODS: We analyze data from the German Ageing Survey of the 2008, 2014, and 2020/21 waves. Life expectancy without functional limitations (disability-free life expectancy-DFLE) was calculated using the Sullivan method. Severe functional limitations (using the Global Activity Limitation Indicator-GALI) and mobility limitations (climbing stairs, walking more than 1 km) were examined. RESULTS: Compression of morbidity in the GALI has been observed in 46- and 65-year-old men since 2014, but not in women of the same age. In terms of mobility, 46- and 65-year-old men show trends towards compression when climbing stairs and 46-year-old men when walking more than 1 km since 2014. The values for women have stagnated for the first two indicators mentioned, but not for 46-year-old women since 2014 when walking more than 1 km. DISCUSSION: Our analyses show different trends in DFLE depending on the indicator, age, and gender and do not allow a clear answer to the question of morbidity compression or expansion. We tend to see morbidity compression in men, whereas trends of stagnation or expansion tend to be seen in women. These results signal challenges in maintaining functional health, especially in women, and point to the need for targeted interventions to improve quality of life and healthy life expectancy.

Impairments and related social inequalities among adults: a population-based study in São Paulo city, Brazil.

The study of the association of social variables with the prevalence of impairments can provide subsidies for more adequate care and health policies for the most needy people by incorporating social aspects. This article aims to estimate the prevalence of diverse types of impairments, the degree of difficulty, limitations, and the need for help they cause and attest whether this prevalence differ by educational attainment in individuals aged 20 years or older. This is a populational cross-sectional study (2015 Health Survey of São Paulo-ISA Capital). Data from 3184 individuals were analyzed via educational attainment as exposure variable and outcome variables related to visual, hearing, intellectual, and mobility impairments. 19.9% of participants had visual, 7.8%, hearing, 2.7%, intellectual, and 7.4%, mobility impairments. Mobility and intellectual impairments limited participants' daily activities the most, 70.3% and 63.3%, respectively; who, thus, needed the most help: 48.9% and 48.5%, respectively. Lower schooling was associated with a higher prevalence of impairments, greater need for help due to visual and intellectual impairments, and greater limitations due to hearing and visual impairments.

Prediction of walking speed one year following hip fracture based on pre-fracture assessments of mobility and physical activity.

BACKGROUND: Older people with hip fracture are often medically frail, and many do not regain their walking ability and level of physical activity. The aim of this study was to examine the relationship between pre-fracture recalled mobility, fear of falling, physical activity, walking habits and walking speed one year after hip fracture. METHODS: The study had a longitudinal design. Measurements were performed 3-5 days postoperatively (baseline) and at one year after the hip fracture. The measurements at baseline were all subjective outcome measures recalled from pre-fracture: The New Mobility Scale (NMS), the 'Walking Habits' questionnaire, The University of California, Los Angeles (UCLA) Activity Scale, Fear of Falling International (FES-I) and demographic variables. At one year 4-meter walking speed, which was a part of the Short Physical Performance Battery (SPPB) was assessed. RESULTS: At baseline 207 participants were included and 151 were assessed after one year. Their age was mean (SD) 82.7 (8.3) years (range 65-99 years). Those with the fastest walking speed at one year had a pre-fracture habit of regular walks with a duration of ≥ 30 min and/or a frequency of regular walks of 5-7 days a week. Age (p =.020), number of comorbidities (p <.001), recalled NMS (p <.001), and recalled UCLA Activity Scale (p =.007) were identified as predictors of walking speed at one year. The total model explained 54% of the variance in walking speed. CONCLUSIONS: Duration and frequency of regular walks before the hip fracture play a role in walking speed recovery one year following the fracture. Subjective outcome measures of mobility and physical activity, recalled from pre-fracture can predict walking speed at one year. They are gentle on the old and medically frail patients in the acute phase after hip fracture, as well as clinically less time consuming.

Fatigue, fear of being mobilized and residual limb pain limit independent basic mobility and physiotherapy for patients early after major dysvascular lower extremity amputation: A prospective cohort study.

AIM: Early mobilization of patients with a major lower extremity amputation (LEA) is often a challenge because of lack of compliance. Therefore, we investigated factors limiting independent mobility and physiotherapy on the first day with physiotherapy (PTDay1) and the following 2 days after LEA. METHODS: A total of 60 consecutive patients, mean age 73.7 years (SD 12.1 years), undergoing LEA were included over a period of 7 months. The Basic Amputee Mobility Score was used to assess basic mobility. Predefined limitations for not achieving independent mobility or not completing physiotherapy were residual limb pain, pain elsewhere, fear of being mobilized, fatigue, nausea/vomiting, acute cognitive dysfunction or "other" factors reported on PTDay1 and the following 2 days after LEA. RESULTS: Fatigue and fear of being mobilized were the most frequent limitations for not achieving independent mobility on PTDay1 and the following 2 days after LEA. Patients (n = 55) who were not independent in the Basic Amputee Mobility Score activity transferring from bed to chair on PTDay1 were limited by fatigue (44%) and fear of being mobilized (33%). A total of 21 patients did not complete planned physiotherapy on PTDay1, and were limited by fatigue (38%), residual limb pain (24%) and "other" factors (24%). CONCLUSION: Fatigue and fear of being mobilized were the most frequent factors that limited independent mobility early after LEA. Fatigue, residual limb pain and "other" factors limited completion of physiotherapy. Geriatr Gerontol Int 2024; 24: 470-476.

Longitudinal changes in life-space mobility and autonomy in participation outdoors among Finnish community-dwelling older adults from pre-COVID-19 to through the pandemic.

BACKGROUND: Among older people, community mobility was reduced at the beginning of the COVID-19 pandemic, but the longer-term changes are unclear. AIMS: To study lower extremity performance and car driving as predictors of changes in older adults' life-space mobility, autonomy in participation outdoors, and the risk of developing restricted life-space mobility from 2017 to 2022. METHODS: Life-space mobility (scoring range 0-120) and autonomy in participation outdoors (scoring range 0-20) were assessed in community-dwelling individuals (n = 657) in 2017-2018 (baseline age 75, 80, or 85 years), during the first wave of COVID-19 in 2020, and in 2021-2022. Lower extremity performance was assessed using the Short Physical Performance Battery, and car driving was self-reported at baseline. Data were analysed using generalized estimating equations and Cox regression. RESULTS: During the first wave of COVID-19 in 2020, life-space mobility decreased on average by 10.3 (SD 21.6) points and partially recovered in 2021-2022 (+ 2.7, SD 21.8). The same pattern was observed for autonomy in participation outdoors. Non-drivers and those with impaired lower extremity performance had a 2.4-to-3.6-fold adjusted risk of developing restricted life-space mobility over the follow-up period compared to drivers with intact lower extremity performance. CONCLUSIONS: For older people, the recovery of community mobility was incomplete after the restrictions stemming from the pandemic were lifted. Older adults with impaired lower extremity performance and who did not drive were particularly vulnerable to developing restricted life-space mobility, a situation that could lead to social isolation and reduced well-being.

Functional abilities, respiratory and cardiac function in a large cohort of adults with Duchenne muscular dystrophy treated with glucocorticoids.

BACKGROUND AND PURPOSE: The transition to adult services, and subsequent glucocorticoid management, is critical in adults with Duchenne muscular dystrophy. This study aims (1) to describe treatment, functional abilities, respiratory and cardiac status during transition to adulthood and adult stages; and (2) to explore the association between glucocorticoid treatment after loss of ambulation (LOA) and late-stage clinical outcomes. METHODS: This was a retrospective single-centre study on individuals with Duchenne muscular dystrophy (≥16 years old) between 1986 and 2022. Logistic regression, Cox proportional hazards models and survival analyses were conducted utilizing data from clinical records. RESULTS: In all, 112 individuals were included. Mean age was 23.4 ± 5.2 years and mean follow-up was 18.5 ± 5.5 years. At last assessment, 47.2% were on glucocorticoids; the mean dose of prednisone was 0.38 ± 0.13 mg/kg/day and of deflazacort 0.43 ± 0.16 mg/kg/day. At age 16 years, motor function limitations included using a manual wheelchair (89.7%), standing (87.9%), transferring from a wheelchair (86.2%) and turning in bed (53.4%); 77.5% had a peak cough flow <270 L/min, 53.3% a forced vital capacity percentage of predicted <50% and 40.3% a left ventricular ejection fraction <50%. Glucocorticoids after LOA reduced the risk and delayed the time to difficulties balancing in the wheelchair, loss of hand to mouth function, forced vital capacity percentage of predicted <30% and forced vital capacity <1 L and were associated with lower frequency of left ventricular ejection fraction <50%, without differences between prednisone and deflazacort. Glucocorticoid dose did not differ by functional, respiratory or cardiac status. CONCLUSION: Glucocorticoids after LOA preserve late-stage functional abilities, respiratory and cardiac function. It is suggested using functional abilities, respiratory and cardiac status at transition stages for adult services planning.

Early-Life Exposure to War and Later-Life Physical Functional Health.

OBJECTIVES: A growing body of research shows that early-life exposure to war has adverse effects on later-life health. Research has emphasized the importance of exposure timing implicating domain-specific developmental processes and associated critical/sensitive periods. This study looks at the impacts of early childhood war exposure and the repercussions for later-life physical and functional health, with a focus on time of exposure as a source of variability. METHODS: We use residential histories from the Survey of Health Ageing, and Retirement in Europe linked to external data on the location and timing of hostilities to examine the impact of early-life exposure to World War II on later-life physical and functional health. RESULTS: Exposure to war increases the risk of objective (grip strength, chair rise, and peak expiratory flow) and self-reported (mobility limitations and activities of daily living) measures of functional health. Effects are especially pronounced for those born during the war and for those with more prolonged exposures. There is little evidence that the impact of war is mediated by war-related hardships, socioeconomic conditions, health behaviors, or adult chronic disease. DISCUSSION: Our results suggest early-life exposure to war has a lasting impact on physical functional health. Exposure appears to largely operate via direct effects, indicative of altered initial development of physical capacity in early life. Because exposure was so pervasive among some cohorts of older individuals, understanding the health of present older European populations requires wrestling with the residual consequences of wartime exposure at the start of their lives.

Could poor glycaemic control be a predictor of walking speed decline in older adults? Evidence from the English Longitudinal Study of Ageing.

AIM: Although diabetes is a risk factor for walking speed decline in older adults, it remains unclear how glycaemic control [assessed by glycated haemoglobin (HbA1c)] might affect the long-term trajectories of walking speed. We investigated whether the glycaemic control status accelerates the walking speed decline and whether this decline differs depending on previous mobility conditions. MATERIALS AND METHODS: In total, 3202 individuals aged ≥60 years from the English Longitudinal Study of Ageing (ELSA) were classified at baseline and after 4 and 8 years of follow-up according to glycaemic control status as 'without diabetes' (no self-reported diabetes and HbA1c <6.5%), 'good glycaemic control' (self-reported diabetes and HbA1c ≥6.5% and <7.0%) and 'poor glycaemic control' (PGC) (self-reported diabetes and HbA1c ≥7.0%). The generalized linear mixed models verified the walking speed trajectories in m/s. A second analysis was performed, including only participants without slowness at baseline (>0.8 m/s). RESULTS: Compared with the status 'without diabetes', the annual walking speed decline was -0.015 m/s for PGC and -0.011 m/s for good glycaemic control, totalling -0.160 and -0.130 m/s, respectively, over 8 years. Among those without slowness at baseline, only PGC had a significant walking speed decline, corresponding to -0.014 m/s per year and -0.222 m/s over 8 years. CONCLUSIONS: Poor glycaemic control is a discriminator of walking speed decline in older adults, regardless of previous mobility conditions. It may serve as an early screening tool for those at risk of decreased functional performance later in life.

[Chinese expert consensus on multidisciplinary decision-making model for mobility limitation in older adults (2024 edition)].

Mobility limitation is an age-related geriatric syndrome that is affected by multiple factors such as aging, multimorbidity, nutritional status, chronic pain, psychological and social factors, which increases the risk of adverse events such as pressure ulcers, venous thrombosis, constipation, frailty, disability, falls and death in older adults. Early identification of mobility limitation and individualized comprehensive management are of great significance to maintain the functional status and quality of life of older adults. However, the understanding of the importance of mobility limitation prevention and treatment in older adults is insufficient, and there is a lack of standardized diagnosis and treatment standards for mobility limitation. Based on evidence-based medicine, this consensus expert group integrated the latest research progress, guidelines and consensus recommendations on mobility limitation and proposed 20 recommendations containing screening, assessment, intervention and comprehensive management, emphasizing the multidisciplinary decision-making model of "screening-comprehensive assessment-multiple interventions-joint management". We aimed to provide guidance and suggestions for the standardized management of mobility limitation in older adults.

Measurement properties of the backward walk test in people with balance and mobility deficits: A systematic review.

BACKGROUND: Backward walking is an indispensable component of activities of daily living. The backward walk test has been used to assess balance, mobility, and fall risk in different populations. This systematic review aimed to identify and synthesize measurement properties of the backward walk test in people with balance and mobility deficits. METHODS: Three bibliographic databases, PubMed, Embase, and Scopus, were searched on June 18th, 2023. Cross-sectional or cohort studies assessing the measurement properties (reliability, validity, responsiveness) of the backward walk test were included. The COSMIN risk of bias checklist was used for methodological quality assessment. Study selection, data extraction, and quality assessment were completed by two reviewers independently and in duplicate. RESULTS: A total of 786 records were identified from three databases. Fourteen studies published from 2019 to 2023 with a total of 853 participants were included. Two studies were rated inadequate in quality assessment, all other studies demonstrated adequate to very good quality. The participants population included patients with cerebral palsy, stroke, multiple sclerosis, Parkinson's disease, fibromyalgia, hip and knee arthroplasty, dementia, and community-dwelling older adults. Good interrater and intrarater reliability, and moderate to good concurrent validity of the backward walk test were demonstrated. SIGNIFICANCE: The review demonstrates that the backward walk test appears to be a valid and reliable tool in different patient populations. The 3-meter backward walk time and 3-meter backward walk speed can be used as outcome measures in clinical practice to assess balance and mobility and track progress throughout the course of physical rehabilitation. Future studies with a prospective cohort design are required to provide information regarding the predictive validity of the backward walk test for fall risk assessment.

Risk of sarcopenia and mobility of older adults during the COVID-19 pandemic: the longitudinal data from the REMOBILIZE study.

BACKGROUND: We assessed whether clinical, functional and behavioral factors were associated with the decrease in mobility trajectories reported in older people at risk of sarcopenia (RS) and without risk of sarcopenia (NRS) during COVID-19 pandemic. METHODS: We prospectively analyzed mobility trajectories reported in older adults with RS and NRS over 16-month follow-up (Remobilize study). The self-perceived risk of sarcopenia and mobility were assessed using the SARC-F and the Life-Space Assessment (LSA) tools, respectively. Gender, age, comorbidities, pain, functional limitation, physical activity (time spent in walking; min/week), and sitting time (ST; hours/day) were assessed. We used a multilevel model to determine changes in mobility between groups and over time. RESULTS: Mobility was lower in RS than in NRS. Older people at RS, who were women, aged 70-79 years and 80 years or older, inactive, and with moderate to severe functional limitation experienced reduced mobility trajectories reported over the pandemic. For older people at NRS, trajectories with reduce mobility reported were experienced by women with comorbidities, for those with insufficient walking time and aged 70-79 years; aged 70-79 years and with ST between 5 and 7 hours/day; for those with insufficient walking time and increased ST; and for those with pain and increased ST. CONCLUSION: Mobility trajectories reported in older people at risk of sarcopenia were negatively influenced by insufficient level of physical inactivity and pre-existing moderate to severe functional limitation. Health and social interventions should be target to avoid mobility limitation during and after the COVID-19 pandemic.

Evaluations of virtual exercise programmes for adults with mobility limitations: a scoping review protocol incorporating an equity lens to inform the development of strategies to optimise participation of under-represented groups.

INTRODUCTION: For individuals with mobility limitations, virtual exercise programmes can address the challenges of in-person participation in community exercise programmes. A synthesis of studies of virtual exercise programmes targeting mobility limitations provided outside of conventional rehabilitation services and strategies used to optimise equitable access and inclusivity in these programmes is lacking. We aim to characterise evaluations of virtual exercise programmes for adults with mobility limitations, and the nature of and extent to which equity, diversity and inclusion considerations are integrated in the research process. METHODS AND ANALYSIS: A scoping review following a six-stage methodological framework, including a consultation exercise, is proposed. A comprehensive strategy will be used to search Medline, Embase, PEDro, CINAHL and Scopus to identify peer-reviewed studies evaluating virtual exercise programmes for adults with mobility limitations living in the community. Three trained reviewers will select studies independently. Data (eg, study methodology, programme structure and content, participant characteristics) will be extracted using a standardised form, and collated and summarised using quantitative and qualitative methods. The PROGRESS-Plus and International Classification of Functioning, Disability and Health frameworks will be used to classify participant characteristics and study outcomes, respectively. During the consultation exercise, key knowledge users, including exercise participants, programme providers and coordinators, and members of community organisations for persons living with disabilities and under-represented groups, will be asked to provide insights regarding the applicability of review findings. A directed content analysis of data from the consultation exercise will be performed. ETHICS AND DISSEMINATION: The research ethics board at the University of Toronto approved the consultation exercise. Findings will be disseminated through peer-reviewed publications and conference presentations. Findings will enhance understanding of current research evaluating virtual exercise programmes and inform future research and strategies for promoting equitable access and outcomes for individuals with mobility limitations. REGISTRATION DETAILS: https://doi.org/10.17605/OSF.IO/X5JMA.

Hybrid maneuver for benign paroxysmal positional vertigo in individuals with limited neck mobility: Case series.

INTRODUCTION: Mobility limitation of the cervical spine compromises the adequate execution of the canalith repositioning maneuver (CRM) in cases of posterior semicircular canal benign paroxysmal positional vertigo (PSC-BPPV-GEO). Thus, novel therapeutic options are required for such individuals. OBJECTIVES: This study describes the effects of a change in the biomechanical position for the execution of the CRM on symptoms of dizziness and mobility limitation regarding flexion-extension of the cervical spine in older people with unilateral PSC-BPPV-GEO. METHODS: A quasi-experimental viability study was conducted with 15 older adults (11 women; mean age: 72.2 ± 8.1 years). Treatment consisted of a hybrid CRM. The participants were evaluated before and after the intervention using the modified Dix & Hallpike test, Dizziness Handicap Inventory (DHI) and a visual analog scale (VAS) for vertigo. RESULTS: The modified Dix & Hallpike test was negative in all cases after the execution of the hybrid CRM. A significant reduction was found for dizziness measured using the DHI (mean difference: -39.3 ± 9.4, p < 0.001) and VAS (mean difference: -2.9 ± 0.8, p = 0.04) after the intervention. CONCLUSION: The hybrid CRM proved executable and satisfactory for resolving symptoms of dizziness in older adults with PSC-BPPV. The present findings are promising and randomized controlled clinical trials should be conducted to evaluate the effectiveness of the hybrid CRM in this population.

Life-Space Mobility, Transportation, and the Companionship Network of Members of a Hispanic Senior Center.

OBJECTIVES: Companions (i.e., friends who spend time together) are important for the well-being of older adults. Senior centers in the United States are places for older adults to participate in group activities and form and maintain companionships. However, differences in mobility and transportation may affect the ability of older adults to leverage senior center activities into actual companionships. METHODS: This social network analysis was conducted to characterize the companionship network among members of a senior center in relation to their life-space mobility and transportation resources. An exponential random graph model was estimated to identify mobility- and transportation-related correlates of the likelihood of a companionship tie among senior center members (N = 42). RESULTS: Members had an average of 2 companionships with one another (M = 2.2, SD = 2.7). Companionships were more likely for members with greater life-space mobility (p = .009), who attended the senior center more frequently (p = .004), with automobile ownership in their households (p = .034), and who were not transportation cost-burdened (i.e., spent less than 15% of their income on transportation, p = .005). Demographic characteristics, limitations on instrumental activities of daily living, and being at risk for depression were not significantly associated with the likelihood of companionships. DISCUSSION: These findings extend previous knowledge of the role of life-space mobility and transportation in supporting general social participation for older adults to include the importance of transportation and mobility for having companions within a senior center.

Comparison of patient-reported outcomes of physical activity and accelerometry in people with multiple sclerosis and ambulatory impairment: A cross-sectional study.

BACKGROUND: Accelerometers and patient-reported outcomes (PRO) are used to assess physical activity (PA) in people with multiple sclerosis (pwMS). So far it is unknown, however, whether these assessments represent mobility limitations in pwMS with mild and moderate to severe disability alike. The primary aim of the study was to assess the correlation between accelerometry and International Physical Activity Questionnaire (IPAQ) scores in pwMS with different degrees of ambulatory impairment. Taken its frequent use into account, the Godin Leisure Time Exercise Questionnaire (GLTEQ) was investigated as additional PRO. METHODS: In a prospective cohort of pwMS, correlational analyses were performed between the number of daily steps, time spent in light, moderate to vigorous PA (MVPA) and time spent sitting as assessed using accelerometry (ActiGraph®-GT3X), and the respective IPAQ and GLTEQ scores. Additionally, associations of PA with disease-specific characteristics, aerobic capacity (VO2peak), walking assessments (Timed 25-Foot Walk, T25FW; 2-Minute Walk Test, 2MWT) and walking perception (Multiple Sclerosis Walking Scale-12; MSWS-12) were explored. Patient subgroups with mild (Expanded Disability Status Scale; EDSS score <4.0) and moderate to severe disability (EDSS ≥4.0) were analysed for the impact of ambulatory impairment on PA. Multiple linear regression was used to determine predictors of PA. RESULTS: A total of 56 pwMS completed the study, with a mean (standard deviation, SD) age of 48.4 (10.3) years, disease duration of 14.8 (9.6) years and median (interquartile range) EDSS score of 3.5 (2.0 - 4.4). Moderate to weak correlations were found between daily step count and IPAQ total metabolic equivalent (MET) minutes/week (p < 0.001; r = 0.506), MVPA MET-minutes/week (p < 0.01; r = 0.479) and walking MET-minutes/week (p < 0.05; r = 0.372) in the total cohort. Time spent sitting was inversely correlated with total MET-minutes/week and MVPA MET-minutes/week (p < 0.05; r = -0.358 and r = -0.365). Subgroup analysis revealed, that daily step count was significantly correlated with total MET-minutes/week, MVPA MET-minutes/week and walking MET-minutes/week (p < 0.01, r = 0.569; p < 0.01, r = 0.531 and p < 0.05, r = 0.480, respectively) in the "mild disability" subgroup only, whereas time spent sitting was inversely correlated with total MET-minutes/week (p < 0.05; r = -0.582) in the "moderate to severe disability" subgroup. There was no association between objectively assessed PA and GLTEQ scores in any group. In the total cohort, moderate to weak correlations were found between daily step count and walking assessments (T25FW: p < 0.01, ρ = -0.508; 2MWT: p < 0.01, ρ=0.463) and MSWS-12 (p < 0.001; ρ = -0.609). Moderate to weak correlations were also observed between VO2peak and walking assessments (T25FW: p < 0.01; ρ = -0.516; 2MWT: p < 0.01, ρ=0.480). Multiple linear regression analysis identified disability and VO2peak as predictors of PA (p = 0.045; ß=0.25 and p < 0.001; ß=0.49). CONCLUSION: Significant associations of objective PA measurements using accelerometry with IPAQ were found only in pwMS with "mild disability". In pwMS with "moderate to severe disability", IPAQ did not reflect the objectively assessed amount of PA. In our cohort, GLTEQ showed no association with objectively assessed PA. Thus, an MS-specific self-reported questionnaire for assessing PA is warranted.

Laboratory-assessed gait cycle entropy for classifying walking limitations among community-dwelling older adults.

Among older people, walking difficulty results from actual and perceived declines in physical capacities and environmental requirements for walking. We investigated whether the physiological complexity of the gait cycle covaries with experience of walking difficulty. Walking difficulty, gait speed, and gait cycle complexity were evaluated among 702 community-dwelling older people aged 75, 80, and 85 years who took part in the six-minute walking test in the research laboratory. Walking difficulty for 500 m was self-reported. Complexity was quantified as trunk acceleration multiscale entropy during the gait cycle. Complexity was then compared between those with no reported walking difficulty, walking with modifications but no difficulty, and those reporting walking difficulty. Higher entropy differentiated those reporting no difficulty walking from those reporting walking difficulties, while those reporting having modified their walking, but no difficulty formed an intermediate group that could not be clearly distinguished from the other categories. The higher complexity of the gait cycle is associated with slower gait speed and the presence of self-reported walking difficulty. Among older people, gait cycle complexity which primarily reflects the biomechanical dimensions of gait quality, could be a clinically meaningful measure reflecting specific features of the progression of walking decline. This encourages further investigation of the sensitivity of gait cycle complexity to detect early signs of gait deterioration and to support targeted interventions among older people.