Partially supervised exercise programmes for fall prevention improve physical performance of older people at risk of falling: a three-armed multi-centre randomised controlled trial.

BACKGROUND: Falls have a major impact on individual patients, their relatives, the healthcare system and related costs. Physical exercise programmes that include multiple categories of exercise effectively reduce the rate of falls and risk of falling among older adults. METHODS: This 12-month, assessor-blinded, three-armed multicentre randomised clinical trial was conducted in adults aged ≥ 65 years identified as at risk of falling. Four hundred and five participants were randomly allocated into 3 groups: experimental group (n = 166) with the Test&Exercise partially supervised programme based on empowerment delivered with a tablet, illustrated manual and cards, reference group (n = 158) with the Otago partially supervised programme prescribed by a physiotherapist delivered with an illustrated manual and control group (n = 81) with the Helsana self-administrated programme delivered with cards. Experimental and reference groups received partially supervised programmes with 8 home sessions over 6 months. Control group received a self-administered program with a unique home session. The 3 groups were requested to train independently 3 times a week for 12 months. Primary outcome was the incidence rate ratio of self-reported falls over 12 months. Secondary outcomes were fear of falling, basic functional mobility and balance, quality of life, and exercise adherence. RESULTS: A total of 141 falls occurred in the experimental group, 199 in the reference group, and 42 in the control group. Incidence rate ratios were 0.74 (95% CI 0.49 to 1.12) for the experimental group and 0.43 (95% CI 0.25 to 0.75) for the control group compared with the reference group. The Short Physical Performance Battery scores improved significantly in the experimental group (95% CI 0.05 to 0.86; P = 0.027) and in the reference group (95% CI 0.06 to 0.86; P = 0.024) compared with the control group. CONCLUSION: The self-administered home-based exercise programme showed the lowest fall incidence rate, but also the highest dropout rate of participants at high risk of falling. Both partially supervised programmes resulted in statistically significant improvements in physical performance compared with the self-administered programme. TRIAL REGISTRATION: NCT02926105. CLINICALTRIALS: gov. Date of registration: 06/10/2016.

Validation of a fall rate prediction model for community-dwelling older adults: a combined analysis of three cohorts with 1850 participants.

BACKGROUND: Fragility fractures in older adults are often caused by fall events. The estimation of an expected fall rate might improve the identification of individuals at risk of fragility fractures and improve fracture prediction. METHODS: A combined analysis of three previously developed fall rate models using individual participant data (n = 1850) was conducted using the methodology of a two-stage meta-analysis to derive an overall model. These previously developed models included the fall history as a predictor recorded as the number of experienced falls within 12 months, treated as a factor variable with the levels 0, 1, 2, 3, 4 and ≥ 5 falls. In the first stage, negative binomial regression models for every cohort were fit. In the second stage, the coefficients were compared and used to derive overall coefficients with a random effect meta-analysis. Additionally, external validation was performed by applying the three data sets to the models derived in the first stage. RESULTS: The coefficient estimates for the prior number of falls were consistent among the three studies. Higgin's I2 as heterogeneity measure ranged from 0 to 55.39%. The overall coefficient estimates indicated that the expected fall rate increases with an increasing number of previous falls. External model validation revealed that the prediction errors for the data sets were independent of the model to which they were applied. CONCLUSION: This analysis suggests that the fall history treated as a factor variable is a robust predictor of estimating future falls among different cohorts.

Neurorehabilitation including Virtual-Reality-Based Balance Therapy: Factors Associated with Training Response.

BACKGROUND: Virtual reality (VR) therapy is increasingly used and has shown encouraging effects. Yet, it is unknown which patients respond best to VR-based balance therapy as part of neurorehabilitation. METHODS: Data from 30 persons with stroke and 51 persons with multiple sclerosis who performed three to four weeks of VR-based balance therapy during in-patient rehabilitation were analysed. Participants were divided into responders and nonresponders based on achievement of the minimal clinically important difference in functional balance post intervention. Measures of balance, trunk function, mobility, gait, motivation, and exergame parameters were compared between groups. RESULTS: Post intervention, all clinical measurements significantly improved (p < 0.05; effect size: 0.45-0.59). Participants that achieved the minimal clinically important difference in functional balance (n = 49; 60%) had significantly lower preintervention functional and dynamic balance (median(IQR): 39(27-46) versus 45(37-50); p = 0.02 and 11(6-15) versus 16(11-18); p = 0.03). They spent less time on higher difficulty exercises (11(8-17) versus 14.5(10-12); p = 0.03) and demonstrated increased motivation over time compared with nonresponders (1(-1-5) versus -2(-7-3); p = 0.03). CONCLUSION: Lower baseline balance ability, spending more time on adequately challenging exercises, and increased motivation potentially influence response to therapy. These factors can support the personalisation of VR-based balance therapy.

Clinical practice and barriers among Swiss physiotherapists treating patients with anterior cruciate ligament reconstruction: A survey of pre-operative rehabilitation to return to sport.

OBJECTIVES: To investigate current clinical practice of Swiss physiotherapists treating patients with anterior cruciate ligament reconstruction (ACLR) from pre-operative rehabilitation until return to sport (RTS). We assessed optimisation strategies in daily practice and the perceived barriers to these optimisations, and evaluated whether there was a relevant difference in clinical practice for physiotherapists with post-graduate certification in sports physiotherapy or deep clinical experience and those without such experience. DESIGN: Cross-sectional survey. SETTING: Online survey platform. PARTICIPANTS: Swiss physiotherapists. MAIN OUTCOME MEASURES: The survey comprised six sections: participant information, pre-operative rehabilitation, post-operative rehabilitation, RTS, re-injury prevention, and optimisation strategies and barriers. RESULTS: A minority of physiotherapists treated ACLR patients pre-operatively. Overall, 91% included quadriceps open kinetic chain exercise in their treatment, 37% used patient-reported outcomes measures (PROMs) and 39% considered psychological criteria when making decisions about RTS. Most physiotherapists (67%) felt limited due to the time available, the number of prescriptions and the tariffication system. CONCLUSION: This study highlights areas within ACLR rehabilitation practice in Switzerland that could be improve. Improvements in understanding of the barriers to implementation of best evidence in practice and a redefinition of the clinical process around ACLR rehabilitation in Switzerland are necessary.

Assessment tools and incidence of hospital-associated disability in older adults: a rapid systematic review.

Background: During hospitalization older adults have a high risk of developing functional impairments unrelated to the reasons for their admission. This is termed hospital-associated disability (HAD). This systematic review aimed to assess the incidence of HAD in older adults admitted to acute care with two outcomes: firstly in at least one activity of daily living from a set of functional tasks (e.g., Katz Index) and secondly the incidence of functional decline in an individual functional task (e.g., bathing), and to identify any tools or functional tasks used to assess activities of daily living (ADL) in hospitalized older patients. Methods: A rapid systematic review was performed according to the recommendations of the Cochrane Rapid Reviews Methods Group and reported the data according the PRISMA statement. A literature search was performed in Medline (via Ovid), EMBASE, and Cochrane Central Register of Controlled Trials databases on 26 August 2021. Inclusion criteria: older adults (≥65 years), assessment of individual items of activities of daily living at baseline and discharge. Exclusion criterion: studies investigating a specific condition that could affect functional decline and studies that primarily examined a population with cognitive impairment. The protocol was registered on OSF registries (https://osf.io/9jez4/) identifier: DOI 10.17605/OSF.IO/9JEZ4. Results: Ten studies were included in the final review. Incidence of HAD (overall score) was 37% (95% CI 0.30-0.43). Insufficient data prevented meta-analysis of the individual items. One study provided sufficient data to calculate incidence, with the following values for patients' self-reported dependencies: 32% for bathing, 27% for dressing, 27% for toileting, 30% for eating and 27% for transferring. The proxy reported the following values for patients' dependencies: 70% for bathing, 66% for dressing, 70% for toileting, 61% for eating and 59% for transferring. The review identified four assessment tools, two sets of tasks, and individual items assessing activities of daily living in such patients. Conclusions: Incidence of hospital-associated disability in older patients might be overestimated, due to the combination of disease-related disability and hospital-associated disability. The tools used to assess these patients presented some limitations. These results should be interpreted with caution as only one study reported adequate information to assess the HAD incidence. At the item level, the latter was higher when disability was reported by the proxies than when it was reported by patients. This review highlights the lack of systematic reporting of data used to calculate HAD incidence. The methodological quality and the risk of bias in the included studies raised some concerns.

Transcutaneous electrical diaphragmatic stimulation in mechanically ventilated patients: a randomised study.

BACKGROUND: Few specific methods are available to reduce the risk of diaphragmatic dysfunction for patients under mechanical ventilation. The number of studies involving transcutaneous electrical stimulation of the diaphragm (TEDS) is increasing but none report results for diaphragmatic measurements, and they lack power. We hypothesised that the use of TEDS would decrease diaphragmatic dysfunction and improve respiratory muscle strength in patients in ICU. METHODS: We conducted a controlled trial to assess the impact of daily active electrical stimulation versus sham stimulation on the prevention of diaphragm dysfunction during the weaning process from mechanical ventilation. The evaluation was based on ultrasound measurements of diaphragm thickening fraction during spontaneous breathing trials. We also measured maximal inspiratory muscle pressure (MIP), peak cough flow (PEF) and extubation failure. RESULTS: Sixty-six patients were included and randomised using a 1:1 ratio. The mean number of days of mechanical ventilation was 10 ± 6.8. Diaphragm thickening fraction was > 30% at the SBT for 67% of participants in the TEDS group and 54% of the Sham group (OR1.55, 95% CI 0.47-5.1; p = 0.47). MIP and PEF were similar in the TEDS and Sham groups (respectively 35.5 ± 11.9 vs 29.7 ± 11.7 cmH20; p = 0.469 and 83.2 ± 39.5 vs. 75.3 ± 34.08 L/min; p = 0.83). Rate of extubation failure was not different between groups. CONCLUSION: TEDS did not prevent diaphragm dysfunction or improve inspiratory muscle strength in mechanically ventilated patients. TRIAL REGISTRATION: Prospectively registered on the 20th November 2019 on ClinicalTrials.gov Identifier NCT04171024.

Reliability and measurement error of sensorimotor tests in patients with neck pain: a systematic review.

BACKGROUND: Neck pain is one of the leading causes of years lived with disability, and approximately half of people with neck pain experience recurrent episodes. Deficits in the sensorimotor system can persist even after pain relief, which may contribute to the chronic course of neck pain in some patients. Evaluation of sensorimotor capacities in patients with neck pain is therefore important. No consensus exists on how sensorimotor capacities of the neck should be assessed in physiotherapy. The aims of this systematic review are: (a) to provide an overview of tests used in physiotherapy for assessment of sensorimotor capacities in patients with neck pain; and (b) to provide information about reliability and measurement error of these tests, to enable physiotherapists to select appropriate tests. METHODS: Medline, CINAHL, Embase and PsycINFO databases were searched for studies reporting data on the reliability and/or measurement error of sensorimotor tests in patients with neck pain. The results for reliability and measurement error were compared against the criteria for good measurement properties. The quality of evidence was assessed according to the modified GRADE method proposed by the COSMIN group. RESULTS: A total of 206 tests for assessment of sensorimotor capacities of the neck were identified and categorized into 18 groups of tests. The included tests did not cover all aspects of the sensorimotor system; tests for the sensory and motor components were identified, but not for the central integration component. Furthermore, no data were found on reliability or measurement error for some tests that are used in practice, such as movement control tests, which apply to the motor component. Approximately half of the tests showed good reliability, and 12 were rated as having good (+) reliability. However, tests that evaluated complex movements, which are more difficult to standardize, were less reliable. Measurement error could not be evaluated because the minimal clinically important change was not available for all tests. CONCLUSION: Overall, the quality of evidence is not yet high enough to enable clear recommendations about which tests to use to assess the sensorimotor capacities of the neck.

Corrigendum: History of falls and fear of falling are predictive of future falls: Outcome of a fall rate model applied to the Swiss CHEF trial cohort.

[This corrects the article DOI: 10.3389/fragi.2022.1056779.].

First Steps Towards a Risk of Bias Corpus of Randomized Controlled Trials.

Risk of bias (RoB) assessment of randomized clinical trials (RCTs) is vital to conducting systematic reviews. Manual RoB assessment for hundreds of RCTs is a cognitively demanding, lengthy process and is prone to subjective judgment. Supervised machine learning (ML) can help to accelerate this process but requires a hand-labelled corpus. There are currently no RoB annotation guidelines for randomized clinical trials or annotated corpora. In this pilot project, we test the practicality of directly using the revised Cochrane RoB 2.0 guidelines for developing an RoB annotated corpus using a novel multi-level annotation scheme. We report inter-annotator agreement among four annotators who used Cochrane RoB 2.0 guidelines. The agreement ranges between 0% for some bias classes and 76% for others. Finally, we discuss the shortcomings of this direct translation of annotation guidelines and scheme and suggest approaches to improve them to obtain an RoB annotated corpus suitable for ML.

Physical activity based on daily step-count in inpatient setting in stroke and traumatic brain injury patients in subacute stage: A cross-sectional observational study.

BACKGROUND: Daily step-count is important post-insult in the subacute phase to influence neuroplasticity, functional recovery and as a predictive factor for activity level one-year post event. OBJECTIVE: Measure daily step-count in subacute patients follow-ing brain injury in an inpatient neurorehabilitation setting and compare these to evi-dence-based recommendations. METHODS: 30 participants measured of daily step-count over a seven-day period, throughout the day to assess when and how activity varied. Step-counts were analyzed in sub-groups based on walking ability using the Functional Ambulation Categories (FAC). Correlations between steps-count and FAC level, walking speed, light touch, joint position sense, cognition, and fear of falling were calculated. RESULTS: Median (IQR) daily steps for all patients was 2512 (568.5,4070.5). Not independently walkers took 336 (5-705), the value is below the recommendation. Participants walking with assistance took 700 (31-3080), significantly below recommended value (p = 0.002), independent walkers took 4093 (2327-5868) daily steps, significantly below recommended value (p = < 0.001). Step-count showed moderate to high and statistically-significant correlations: positive for walking speed, joint position sense, negative for fear of falling, and number of medications. CONCLUSIONS: Only 10% of all participants reached the recommended daily steps. Interdisciplinary team-work and strategies to increase daily activity between therapies may be crucial to achieve recommended step-levels in subacute inpatient settings.

Effectiveness of Educational Interventions to Increase Skills in Evidence-Based Practice among Nurses: The EDITcare Systematic Review.

BACKGROUND: Using evidence-based practice (EBP) improves the implementation of safe, high-quality healthcare for patients, reduces avoidable costs, and plays a crucial role in bridging knowledge-action gaps and reducing health inequities. EBP combines the best available evidence in the relevant literature with patient preferences and values and healthcare professionals' (HCPs) expertise. METHODS: Systematic searches of ten bibliographic databases, unpublished works, and the Grey Literature Report sought studies published up to 30 September 2022. RESULTS: The 15 studies retained involved 2712 nurses. Three types of effective educational interventions were identified: (1) multifaceted educational strategies incorporating mentoring and tutoring; (2) single educational strategies, often delivered online; and (3) multifaceted educational strategies using the five steps of EBP. Eleven primary outcomes (EBP beliefs, EBP self-efficacy, perceived EBP implementation, EBP competencies, EBP knowledge, EBP skills, EBP attitudes, EBP behaviors, EBP desire, EBP practice, and perceptions of organizational culture and readiness) were assessed using 13 qualitative and quantitative instruments. CONCLUSIONS: Ensuring the successful implementation of EBP requires effective educational strategies. Computer-based learning seems the most cost-effective and efficient strategy, when considering caregivers' characteristics, the clinical field, and educational interventions across the pre-, peri-, and post-implementation processes.

Validation of the German version of the STarT-MSK-Tool: A cohort study with patients from physiotherapy clinics.

BACKGROUND: The STarT-MSK-Tool is an adaptation of the well established STarT-Back-Tool, used to risk-stratify patients with a wider range of musculoskeletal presentations. OBJECTIVE: To formally translate and cross-culturally adapt the Keele STarT-MSK risk stratification tool into German (STarT-MSKG) and to establish its reliability and validity. METHODS: A formal, multi-step, forward and backward translation approach was used. To assess validity patients aged ≥18 years, with acute, subacute or chronic musculoskeletal presentations in the lumbar spine, hip, knee, shoulder, or neck were included. The prospective cohort was used with initial data collected electronically at the point-of-consultation. Retest and 6-month follow-up questionnaires were sent by email. Test-retest reliability, construct validity, discriminative ability, predictive ability and floor or ceiling effects were analysed using intraclass correlation coefficient, and comparisons with a reference standard (Orebro-Musculoskeletal-Pain-Questionnaire: OMPQ) using correlations, ROC-curves and regression models. RESULTS: The participants' (n = 287) mean age was 47 (SD = 15.8) years, 51% were female, with 48.8% at low, 43.6% at medium, and 7.7% at high risk. With ICC = 0.75 (95% CI 0.69; 0.81) test-retest-reliability was good. Construct validity was good with correlations for the STarT-MSKG-Tool against the OMPQ-Tool of rs = 0.74 (95% CI 0.68, 0.79). The ability of the tool [comparison OMPQ] to predict 6-month pain and disability was acceptable with AUC = 0.77 (95% CI 0.71, 0.83) [OMPQ = 0.74] and 0.76 (95% CI 0.69, 0.82) [OMPQ = 0.72] respectively. However, the explained variance (linear/logistic regression) for predicting 6-month pain (21% [OMPQ = 17%]/logistic = 29%) and disability (linear = 20%:[OMPQ = 19%]/logistic = 26%), whilst being comparable to the existing OMPQ reference standard, fell short of the a priori target of ≥30%. CONCLUSIONS: The German version of the STarT-MSK-Tool is a valid instrument for use across multiple musculoskeletal conditions and is availabe for use in clinical practice. Comparison with the OMPQ suggests it is a good alternative.

Is Internal Rotation Measurement of the Hip Useful for Ruling in Cam or Pincer Morphology in Asymptomatic Males? A Diagnostic Accuracy Study.

BACKGROUND: Cam and pincer morphologies are associated with limited internal rotation. However, the routine clinical examination for hip rotation has limited reliability. A more standardized method of measuring hip rotation might increase test-retest and interobserver reliability and might be useful as a screening test to detect different hip morphologies without the need for imaging. We developed an examination chair to standardize the measurement of internal hip rotation, which improved interobserver reliability. However, the diagnostic test accuracy for this test is unknown. QUESTION/PURPOSE: Is a standardized method of determining internal hip rotation using an examination chair useful in detecting cam and pincer morphology with MRI as a reference standard? METHODS: A diagnostic test accuracy study was conducted in a sample of asymptomatic males. Using an examination chair with a standardized seated position, internal rotation was measured in 1080 men aged 18 to 21 years who had been conscripted for the Swiss army. The chair prevents compensatory movement by stabilizing the pelvis and the thighs with belts. The force to produce the internal rotation was standardized with a pulley system. Previous results showed that the measurements with the examination chair are similar to clinical assessment but with higher interobserver agreement. A random sample of 430 asymptomatic males was invited to undergo hip MRI. Of those, 244 White European males responded to the invitation and had a mean age of 20 ± 0.7 years and a mean internal rotation of the hip of 33° ± 8.5°. Using MRI as the reference standard, 69% (169 of 244) had a normal hip, 24% (59 of 244) a definite cam morphology (Grades 2 and 3), 3% (8 of 244) an increased acetabular depth, and 3% (8 of 244) a combination of both. One experienced radiologist graded cam morphology as follows: 0 = normal, 1 = mild, 2 = moderate, and 3 = severe. Pincer morphology was defined by increased acetabular depth (≤ 3 mm distance between the center of the femoral neck and the line connecting the anterior and posterior acetabular rims). The intraobserver agreement was substantial (weighted κ of 0.65). A receiver operating characteristic (ROC) curve was fitted, and sensitivity, specificity, and likelihood ratios were estimated for different internal rotation cutoffs. RESULTS: For cam morphology, the area under the ROC curve was 0.75 (95% CI 0.67 to 0.82). Internal hip rotation of less than 20° yielded a positive likelihood ratio of 9.57 (sensitivity 0.13, specificity 0.99), and a value of 40° or more resulted in a negative likelihood ratio of 0.36 (sensitivity 0.93, specificity 0.20). The area under the curve for detecting the combination of cam and pincer morphologies was 0.87 (95% CI 0.74 to 1.0). A cutoff of 20° yielded a positive likelihood ratio of 9.03 (sensitivity 0.33, specificity 0.96). CONCLUSION: This examination chair showed moderate-to-good diagnostic value to rule in hip cam morphology in White European males. However, at the extremes of the 95% confidence intervals, diagnostic performance would be poor. Nonetheless, we believe this test can contribute to identifying cam morphologies, and we hope that future, larger studies-ideally in more diverse patient populations-will seek to validate this to arrive at more precise estimates of the diagnostic performance of this test. LEVEL OF EVIDENCE: Level III, diagnostic study.

12 weeks high intensity interval training versus moderate intensity continuous training in chronic low back pain subjects: a randomised single-blinded feasibility study.

BACKGROUND: Currently, very little is known about the effects of an endurance high intensity interval training (HIIT) in chronic low back pain patients. Therefore, the feasibility and safety of the HIIT must be assessed first before Currently, very little is known about the effects of an endurance high intensity interval training in chronic low back pain patients. Therefore, the feasibility and safety of the HIIT has to be assessed first before it can be integrated safely into research and daily practice it can be integrated safely into research and daily practice. This study aims to answers the question if high intensity interval training and moderate intensity continuous training (MICT) have comparable adherence and feasibility. METHODS: Participants (age from 29 to 69 years) with non-specific chronic low back pain were recruited in this randomised, single-blinded, allocation concealed, feasibility study. The participants trained 30 min on a cycle ergometer for 12 weeks. One group had HIIT and the other MICT. RESULTS: Of 45 screened subjects 30 participated. The adherence rate was 94% in the HIIT group (median 0.94, IQR 0.23) versus 96% in the MICT group (median 0.96, IQR 0.08), without between-group differences: estimated median of the difference of - 0,01 [95% CI, - 0.11 to 0.06; p = 0.76]. Similar results in enjoyability (median 3, IQR 1 vs median 2, IQR 1.8) and willingness to continue the training (median 3, IQR 1 vs median 3, IQR 0.4). Both groups improved in pain and disability, without between-group differences in pain [median of the difference, 0.5; 95% CI, - 1 to 2; p = 0.95] nor in disability [median of the difference, 1.78; 95% CI, - 6.44 to 9.56; p = 0.64]. CONCLUSION: There were no differences in adherence rates. HIIT is as feasible as MICT in non-specific chronic low back pain and can be used in future larger trials to deepen the knowledge about HIIT in this specific population. TRIAL REGISTRATION: ClinicalTrials.gov, NCT04055545 . Registered 13 August 2019.

Determining the Optimal Virtual Reality Exergame Approach for Balance Therapy in Persons With Neurological Disorders Using a Rasch Analysis: Longitudinal Observational Study.

BACKGROUND: Virtual reality (VR) exergames have gained popularity in the rehabilitation of persons with neurological disorders as an add-on therapy to increase intensity of training. Intensity is strongly dependent on the motivation of the patient. Motivation can be increased by delivering variation within training and challenging exercises. However, patients are often underchallenged, as exergame difficulty often does not match the patient's ability. A Rasch analysis can establish hierarchy of exergame items in order to assist the delivery of patient-centered therapy. OBJECTIVE: The aim of this study was to apply the Rasch model to create a hierarchical order of existing VR balance exergames and to relate these exergames to the abilities of persons with neurological disorders, in order to deliver challenge and variation. METHODS: A total of 30 persons with stroke and 51 persons with multiple sclerosis (MS) were included in the study. All participants performed a training program, lasting 3 weeks for persons with MS and 4 weeks for persons with stroke, in which they performed VR balance exergames with a movement recognition-based system (MindMotion GO; MindMaze SA). VR exercise scores, Berg Balance Scale scores, and clinical descriptive data were collected. Berg Balance Scale and device scores were analyzed with the Rasch model using a repeated-measures approach to examine whether the distribution of exercise scores fitted the Rasch model. Secondly, a person-item map was created to show the hierarchy of exercise difficulty and person ability. RESULTS: Participants completed a selection of 56 balance exercises (ie, items), which consisted of a combination of various balance tasks and levels (ie, exercises). Using repeated measures, this resulted in a count of 785 observations. Analysis showed strong evidence for unidimensionality of the data. A total of 47 exercises (ie, items) had a sufficiently good fit to the Rasch model. Six items showed underfit, with outfit mean square values above 1.5. One item showed underfit but was kept in the analysis. Three items had negative point-biserial correlations. The final model consisted of 47 exercises, which were provided for persons with low to moderate balance ability. CONCLUSIONS: The VR exercises sufficiently fitted the Rasch model and resulted in a hierarchical order of VR balance exercises for persons with stroke and MS with low to moderate balance ability. In combination with the Berg Balance Scale, the results can guide clinical decision-making in the selection of patient-focused VR balance exercises. TRIAL REGISTRATION: ClinicalTrials.gov NCT03993275; https://clinicaltrials.gov/ct2/show/NCT03993275.

Evaluation of the psychometric properties of the Swiss French version of the Older People's Quality of Life questionnaire (OPQOL-35-SF).

BACKGROUND: The proportion of the world population aged over 65 years is increasing in the world population. Quality of life is an important factor in the biopsychosocial management of older patients. The Older People's Quality of Life-35 (OPQOL-35) questionnaire was developed specifically for assessment of the quality of life of older people. The aim of this study is to evaluate the psychometric properties of a Swiss French version of the OPQOL-35 questionnaire (OPQOL-35-SF). METHODS: Forward-backward procedure was used to translate the original questionnaire from English into Swiss French. A sample of older people then completed the questionnaire. Construct validity of the OPQOL-35-SF was evaluated by comparing the results with those from three other questionnaires [World Health Organisation Quality of Life in older people questionnaire (WHOQOL-OLD), Control, Autonomy, Self-realization, Pleasure in 12 questions (CASP-12), and EuroQol-5-dimensions-5-levels (EQ-5D-5L)] and two visual analogue scales (health and quality of life). The structure of the OPQOL-35-SF questionnaire was assessed using exploratory and confirmatory factor analysis. To evaluate the reliability the OPQOL-35-SF questionnaire was completed a second time after 7-23 days. RESULTS: A total of 264 older people completed all the questionnaires at the first session, and 262 completed the OPQOL-35-SF again at the second session. Mean age of participants was 76.8 (standard deviation (SD) = 7.1) years. The majority of participants were women (73.9%). The Kaiser-Meyer-Olkin Measure of Sampling Adequacy (KMO) was 0.86 and Bartlett's test of sphericity was significant (p < 0.001). The result of Exploratory Factor Analysis (EFA) revealed 8 factors with eigenvalues greater than one, which explained 58% of the observed variance. All items had an acceptable loading (< 0.30) in at least one factor. The convergent validity presented low to moderate correlations (rho: 0.384-0.663). Internal consistency was good (Cronbach's alpha 0.875 for test and 0.902 for retest). Test-retest reliability presented an intra-class correlation coefficient, two-way random effects, absolute agreement, single rater (ICC2.1) of 0.83 [95% confidence interval (CI) 0.78-0.87]. CONCLUSIONS: The Swiss French version of the OPQOL-35 questionnaire shows good psychometric properties, which permit its use in clinical practice or research. A supplementary sample would be necessary for a better distribution of the items in the different factors.

History of falls and fear of falling are predictive of future falls: Outcome of a fall rate model applied to the Swiss CHEF Trial cohort.

Background: A third of adults aged 65 years and older fall every year, and falls are a common cause of unintentional injuries. Accurate identification of people at risk of falling is an important step in the implementation of preventive strategies. Objective: Our aim was to investigate the association of fall risk factors with number of reported falls in terms of incidence rate ratios and to develop a fall rate prediction model. Methods: In the randomized controlled trial Swiss CHEF, multiple fall risk variables were assessed in community-dwelling older adults at baseline examination, including age, sex, body mass index, fear of falling, number of falls during the prior 12 months, scores on several physical performance tests, comorbidities, and quality of life. Over the following 6 months, interventions were administered in the form of three home-based exercise programs. Participants were subsequently followed up for another 6 months. Falls were reported prospectively using monthly calendars. Incidence rate ratios were derived via negative binomial regression models. Variable selection for the prediction model was conducted using backward elimination and the least absolute shrinkage and selection operator method; the model with the smallest prediction error was then identified. Results: Associations with the number of reported falls were found for number of prior falls, fear of falling, balance and gait deficits, and quality of life. The final model was derived via backward elimination, and the predictors included were prior number of falls and a measure of fear of falling. Outcome: Number of prior falls and fear of falling can be used as predictors in a personalized fall rate estimate for community-dwelling older adults. Recurrent fallers having experienced four or more falls are especially at risk of falling again.

German version of the Chelsea Critical Care Physical Assessment Tool (CPAx-GE): translation, cross-cultural adaptation, validity, and reliability.

PURPOSE: To translate and cross-culturally adapt the Chelsea Critical Care Physical Assessment tool from English to German (CPAx-GE) and to examine its validity and reliability. MATERIALS AND METHODS: Following a forward-backward translation including an expert round table discussion, the measurement properties of the CPAx-GE were explored in critically ill, mechanically ventilated adults. We investigated construct, cross-sectional, and cross-cultural validity of the CPAx-GE with other measurement instruments at pre-specified timepoints, analysed relative reliability with intraclass correlation coefficients (ICCs) and determined absolute agreement with the Bland-Altman plots. RESULTS: Consensus for the translated CPAx-GE was reached. Validity was excellent with >80% of the pre-specified hypotheses accepted at baseline, critical care, and hospital discharge. Interrater reliability was high (ICCs > 0.8) across all visits. Limit of agreement ranged from -2 to 2 points. Error of measurement was small, floor, and ceiling effects limited. CONCLUSIONS: The CPAx-GE demonstrated excellent construct, cross-sectional, and cross-cultural validity as well as high interrater reliability in critically ill adults with prolonged mechanical ventilation at baseline, critical care, and hospital discharge. Consequently, the CPAx-GE can be assumed equal to the original and recommended in the German-speaking area to assess physical function and activity of critically ill adults across the critical care and hospital stay. Trial registration: German Clinical Trials Register (DRKS) identification number: DRKS00012983 (https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00012983), registered on 20 September 2017, first patient enrolled on 21 November 2017.Implications for rehabilitationEarly rehabilitation of critically ill patients is recommended to prevent and treat the subsequent functional disability, but a suitable measurement instrument for the German-speaking area is lacking.The translated, cross-culturally adapted German CPAx demonstrated excellent validity and reliability in assessing physical function and activity in critically ill adults.Cross-sectional validity of the CPAx has been newly established and allows the use of this tool at clinically relevant time-points in the course of a critical illness.The CPAx-GE can therefore be used in clinical practice by German-speaking therapists to assess physical function and activity during early rehabilitation in the ICU and hospital.

Current practices of physiotherapists in Switzerland regarding fall risk-assessment for community-dwelling older adults: A national cross-sectional survey.

Background: Falls can strongly impact older people's quality of life, health, and lifestyle. Multifactorial assessment can determine an individual's risk of falling as the first step for fall prevention intervention. Physiotherapists have an essential role to play in assessing fall risk by older adults living in the community. In the absence of published data on this topic in Switzerland, this study investigated the current practices of physiotherapists to determine whether those are in line with recommendations. Methods: An anonymous cross-sectional survey was undertaken among physiotherapists practising in Switzerland between the 21st of November and the 31st of December 2020. A priori and exploratory hypotheses were tested. Responses to open-ended questions were grouped into themes for analysis. Results: A total of 938 questionnaires from all three language regions of Switzerland was analysed. Participants worked in different settings, with a higher representation of private practice self-employees (56%). Standardised fall risk assessments or instruments were used by 580 (62%) participants, while 235 (25%) preferred subjective assessment of fall risk only. Differences in fall risk assessment were observed according to the workplace setting (adjusted OR 1.93, 95% CI 1.37 to 2.7) and education level (trend test, p<0.001). The standardised assessments most frequently employed were the Berg Balance Scale (58%), the Timed-Up-and-Go (57%) and the Tinetti Balance Assessment tool (47%). Risk factors for falls were frequently queried, particularly history of falls (88%), home hazards (84%), and functional ability (81%). Technical resources (40%), knowledge (30%), and time (22%) were common barriers to implement a systematic fall risk assessment. Conclusions: This study provides an overview of the current practices of physiotherapists in Switzerland in fall risk assessment. There is still room to optimise the standardisation and systematisation of this assessment to implement a best practice strategy and prevent avoidable falls.

Development of an exercise programme for balance abilities in people with multiple sclerosis: a development of concept study using Rasch analysis.

BACKGROUND: People with multiple sclerosis (PwMS) frequently have impaired balance from an early stage of the disease. Balance difficulties can be divided into categories; although, to date, these lack scientific foundation. Impaired balance in PwMS can be addressed using specific and challenging exercises. Such exercises should provide an optimal challenge point; however, the difficulty of balance exercises is often unknown, making it difficult to target the exercises to an individual's abilities. The aims of this study were: to develop an exercise programme for PwMS relating the exercises to the balance problem categories; to establish the order of difficulty of exercises in each category and; to evaluate the content and structural validity of the exercise programme. METHODS: A "construct map" approach was used to design and develop an exercise programme for PwMS. Potentially relevant balance exercises were identified, then a framework was set up, comprising four dimensions (subsequently reduced to three dimensions) of balance exercises. The relevance, comprehensibility, and comprehensiveness of the exercise programme were rated by 13 physiotherapists, who also linked 19 key exercises to balance categories. A total of 65 PwMS performed the 19 balance exercises, rated their difficulty and commented on the relevance and comprehensibility of each exercise. A Rasch model was used to evaluate the relative difficulty of the exercises. To assess fit of the data to the Rasch model a rating scale model was used, which is a unidimensional latent trait model for polytomous item responses. RESULTS: Evaluation by the physiotherapists and PwMS indicated that the content validity of the exercise programme was adequate. Rasch analysis showed that the latent trait "balance exercises in PwMS" comprised three subdimensions ("stable BOS", "sway" and "step and walk"). The 19 balance exercises showed adequate fit to the respective dimensions. The difficulties of the balance exercises were adequate to cover the ability spectrum of the PwMS. CONCLUSION: A balance exercise programme for PwMS comprising three dimensions of balance exercises was developed. Difficulty estimates have been established for each of the exercises, which can be used for targeted balance training. Content and structural validity of the programme was adequate.