Systematic design of health monitoring systems centered on older adults and ADLs.

BACKGROUND: Older adults face unique health challenges as they age, including physical and mental health issues and mood disorders. Negative emotions and social isolation significantly impact mental and physical health. To support older adults and address these challenges, healthcare professionals can use Information and Communication Technologies (ICTs) such as health monitoring systems with multiple sensors. These systems include digital biomarkers and data analytics that can streamline the diagnosis process and help older adults to maintain their independence and quality of life. METHOD: A design research methodology is followed to define a conceptual model as the main artifact and basis for the systematic design of successful systems centered on older adults monitoring within the health domain. RESULTS: The results include a conceptual model focused on older adults' Activities of Daily Living (ADLs) and Health Status, considering various health dimensions, including social, emotional, physical, and cognitive dimensions. We also provide a detailed instantiation of the model in real use cases to validate the usefulness and feasibility of the proposal. In particular, the model has been used to develop two health systems intended to measure the degree of the elders' frailty and dependence with biomarkers and machine learning. CONCLUSIONS: The defined conceptual model can be the basis to develop health monitoring systems with multiple sensors and intelligence based on data analytics. This model offers a holistic approach to caring for and supporting older adults as they age, considering ADLs and various health dimensions. We have performed an experimental and qualitative validation of the proposal in the field of study. The conceptual model has been instantiated in two specific case uses, showing the provided abstraction level and the feasibility of the proposal to build reusable, extensible and adaptable health systems. The proposal can evolve by exploiting other scenarios and contexts.

A semi-automatic mHealth system using wearable devices for identifying pain-related parameters in elderly individuals.

BACKGROUND: Mobile health systems integrating wearable devices are emerging as promising tools for registering pain-related factors. However, their application in populations with chronic conditions has been underexplored. OBJECTIVE: To design a semi-automatic mobile health system with wearable devices for evaluating the potential predictive relationship of pain qualities and thresholds with heart rate variability, skin conductance, perceived stress, and stress vulnerability in individuals with preclinical chronic pain conditions such as suspected rheumatic disease. METHODS: A multicenter, observational, cross-sectional study was conducted with 67 elderly participants. Predicted variables were pain qualities and pain thresholds, assessed with the McGill Pain Questionnaire and a pressure algometer, respectively. Predictor variables were heart rate variability, skin conductance, perceived stress, and stress vulnerability. Multiple linear regression analyses were conducted to examine the influence of the predictor variables on the pain dimensions. RESULTS: The multiple linear regression analysis revealed that the predictor variables significantly accounted for 27% of the variability in the affective domain, 14% in the miscellaneous domain, 15% in the total pain rating index, 10% in the number of words chosen, 14% in the present pain intensity, and 16% in the Visual Analog Scale scores. CONCLUSION: The study found significant predictive values of heart rate variability, skin conductance, perceived stress, and stress vulnerability in relation to pain qualities and thresholds in the elderly population with suspected rheumatic disease. The comprehensive integration of physiological and psychological stress measures into pain assessment of elderly individuals with preclinical chronic pain conditions could be promising for developing new preventive strategies.

Attentional Resources and Independence in Basic and Instrumental Activities of Daily Living in Individuals with Intellectual Disabilities.

The relationship between attentional resources and functionality in individuals with intellectual disabilities (IDs) is clinically relevant. This study aimed to examine the possible relationship between the degree of ID and attentional resources, and to evaluate whether attentional resources predict the performance of basic and instrumental activities of daily living (ADL) in individuals with mild and moderate ID. This study, which employed a descriptive, cross-sectional, observational design, was conducted between July 2019 and May 2020. The sample consisted of 166 individuals divided into three groups: moderate ID, mild ID, and those without ID. These groups were compared for attentional functions (p < 0.001), obtaining an effect size ranging from medium to large. The results indicated that 40% of the variance in basic ADL performance was explained by the age of the participants, degree of disability, and sustained attention in individuals with ID. Additionally, 64% of the variance in instrumental ADL performance was explained by sustained, divided, and executive attention. Therefore, attentional resources appear to be associated with the performance of basic and instrumental ADL in individuals with mild and moderate ID.

Effects of Nature-Based Multisensory Stimulation on Pain Mechanisms in Women with Fibromyalgia Syndrome: A Randomized Double-Blind Placebo-Controlled Trial.

BACKGROUND: The term "nature-based sensory stimuli" refers to the sensory information produced by biotic and abiotic agents from natural environments. The literature has reported the beneficial effects of these agents on various pain dimensions in non-clinical populations. AIMS: To evaluate the potential analgesic effects of nature-based multisensory stimulation in women with fibromyalgia syndrome. METHODS: A randomized, double-blind, placebo-controlled, parallel-group trial with a 1:1 allocation ratio was conducted. Forty-two women with fibromyalgia syndrome interacted with either different plant species with flowers, stones, and soil organic matter or their synthetic imitations for 30 minutes. Outcome measurements were performed before and after the intervention, including clinical pain intensity using the Numeric Rating Scale, cold pain thresholds using the Cold Pressor Test, mechanical hyperalgesia and wind-up using a monofilament, and pressure pain thresholds using a pressure algometer. RESULTS: Analyses revealed group × time interactions for clinical pain intensity (F = 7.915, p = .008), cold-water immersion time (F = 7.271, p = .010), mechanical hyperalgesia (F = 4.701, p = .036), and pressure pain threshold (p ≤ .017). Between-group differences were found in clinical pain intensity (p = .012), cold pain thresholds (p = .002), and pressure pain thresholds (p < .05). The experimental group exhibited reduced clinical pain intensity (p = .001) and increased pressure pain thresholds (p ≤ .034). CONCLUSIONS: Women with fibromyalgia syndrome may benefit from multisensory stimulation using biotic and abiotic agents from natural environments for 30 minutes. Interacting with flowering plants and soil components appears to induce analgesic effects.

The Association between Executive Function and Performing Instrumental Daily Activities in People with Intellectual Disabilities.

Institutionalized individuals with intellectual disabilities have few opportunities to participate in instrumental activities of daily living (IADLs), which probably affects higher cognitive functions, or vice versa. The objectives of this study were to evaluate the possible difference in the ability to perform IADLs and executive functioning between individuals with and without intellectual disabilities and to determine if executive functions are associated with the performance of IADLs in people with intellectual disabilities. This was a multi-center cross-sectional study, conducted between July 2019 and May 2020. Participants with intellectual disabilities were recruited from four centers for people with intellectual disabilities. Adults without these disabilities were gathered from several community centers. The sample consisted of 90 individuals with moderate intellectual disabilities and 79 individuals with no intellectual disability. Executive functions were evaluated using the Wechsler Adult Intelligence Scale-WAIS-IV, the INECO Frontal Screening test, the Semantic Verbal Fluency Test, and the Behavioural Assessment of the Dysexecutive Syndrome-BADS-Scale. The performance of the IADLs was assessed by the Lawton and Brody Scale. The results showed that the higher the function in instrumental activities, the lower the impairment of executive functions. Executive functions accounted for 81% of the total variance in the ability to perform the IADLs. In conclusion, individuals with moderate intellectual disabilities demonstrated limitations in executing the IADLs, which were partially associated with low performance in executive functions. This information could help in the development of evidence-based intervention programs and facilitate the formulation of appropriate support strategies to enhance participation in these activities.

Benefits of Adaptive Sport on Physical and Mental Quality of Life in People with Physical Disabilities: A Meta-Analysis.

Adaptive sports could produce multiple health benefits in people with physical disabilities. The aim is to evaluate if adaptive sports practice has an influence on physical and mental quality of life. A meta-analysis was performed using electronic databases and other sources. A within- and between-group analysis for physical and mental quality of life was conducted. Standardized mean difference (SMD) was used as a measure of the mean size effect. The statistical heterogeneity, the risk of bias, and the quality of evidence were evaluated. Eight studies met the inclusion criteria and four of them were included in the meta-analysis. In mental quality of life, significant differences were observed in the within-group analysis (SMD = 0.71, p < 0.001) and between people practicing adaptive sports and those not engaging in them (SMD = 0.62, p = 0.009). In physical quality of life, significant differences were also found between pre- and post-practice of adaptive sports (SMD = 1.03, p = 0.007). The engagement in adaptive sports showed a positive impact on the mental quality of life among adults with physical disabilities. However, the positive effect of adaptive sports practice on physical quality of life was shown only in the pre-post-test analysis. Further studies are required to validate the obtained findings.

The Impact of Upper Limb Apraxia on General and Domain-Specific Self-Efficacy in Post-Stroke Patients.

BACKGROUND: Upper limb apraxia (ULA) is a neurological syndrome characterized by the inability to perform purposeful movements. ULA could impact individuals' perceptions, including perceived self-efficacy. The aim of this study is to investigate whether ULA is related to general self-efficacy and self-efficacy for managing symptoms in post-stroke patients. METHODS: A cross-sectional study was conducted involving 82 post-stroke patients. Regression analyses were implemented using a stepwise model including seven dimensions of ULA: imitation (non-symbolic, intransitive, and transitive), pantomime (non-symbolic, intransitive, and transitive), and dimension of apraxic performance in activities of daily living. These dimensions were independent variables, while general self-efficacy and symptom management self-efficacy dimensions were dependent variables. RESULTS: The findings revealed that intransitive imitation accounted for 14% of the variance in general self-efficacy and 10% of self-efficacy for managing emotional symptoms. Transitive imitation explained 10% of the variance in self-efficacy for managing global symptoms and 5% for social-home integration symptoms. The combination of intransitive imitation, non-symbolic pantomime, and alterations in activities of daily living performance associated with ULA explained 24% of the variance in cognitive self-efficacy. CONCLUSIONS: Hence, ULA dimensions seem to be related to the levels of general perceived self-efficacy and self-efficacy for managing symptoms among post-stroke patients.

Impact of prolonged sitting interruption strategies on shear rate, flow-mediated dilation and blood flow in adults: A systematic review and meta-analysis of randomized cross-over trials.

Prolonged sitting has been shown to affect endothelial function. Strategies that promote interruption of sitting have shown varying results on the shear rate (SR), flow-mediated dilation (FMD) and blood flow (BF). Thus, we conducted a systematic review and meta-analysis to 1) increase the existing knowledge of the impact of sitting interruption in the prevention of endothelial dysfunction in adults and 2) determine the effect of the sitting interruption strategies on SR, FMD, BF. Literature search was carried out through 7 databases. A random effects model was used to provide the overall mean difference with a 95%CI, and forest plots were generated for pooled estimates of each study outcome. Assessment of biases was performed using ROB2 and considerations for crossover trials. Prolonged sitting interruption strategies showed a significant effect in increasing SR (MD: 7.58 s-1; 95% CI: 3.00 to 12.17), FMD (MD: 1.74%; 95% CI: 0.55 to 2.93) and BF (MD: 12.08 ml/min; 95% CI: 7.61 to 16.55) when compared with the uninterrupted prolonged sitting condition. Prolonged sitting interruption strategies significantly increase SR, FMD and BF, therefore, they represent a considerable effective preventive method on endothelial dysfunction caused by acute exposure to uninterrupted prolonged sitting.

The association of musculoskeletal complaints and individual and work-related factors with work ability in Chilean white-collar and blue-collar workers.

Objective. The maintenance of good work ability has proven to have a positive effect on health, quality of work and productivity. There is little evidence regarding the association between musculoskeletal complaints, individual and work-related factors, and work ability in blue-collar and white-collar workers. Methods. A cross-sectional study of hospital and university workers (n = 360) was performed to determine the association between musculoskeletal complaints, individual and work-related factors, and work ability; two multiple linear regression models were created. Results. In white-collar workers, musculoskeletal complaints of the dorsal/lumbar region (ß = -0.259) and the wrist/hand segment (ß = -0.151) were significantly associated with reduced work ability. A higher body mass index (ß = -0.227) was also negatively associated with the dependent variable. In blue-collar workers, musculoskeletal complaints of the dorsal/lumbar region (ß = -0.317) and the elbow/forearm segment (ß = -0.171) were significantly associated with lower work ability. Increased age (ß = -0.204) was associated with reduced work ability in this group. No significant correlations were found between work-related factors and work ability. Conclusions. Musculoskeletal complaints and individual factors, but not work-related factors, are associated with work ability in Chilean blue-collar and white-collar workers. Nevertheless, the variables that explain the change in work ability are different between these groups.

A machine learning approach for semi-automatic assessment of IADL dependence in older adults with wearable sensors.

BACKGROUND AND OBJECTIVE: The assessment of dependence in older adults currently requires a manual collection of data taken from questionnaires. This process is time consuming for the clinicians and intrudes the daily life of the elderly. This paper aims to semi-automate the acquisition and analysis of health data to assess and predict the dependence in older adults while executing one instrumental activity of daily living (IADL). METHODS: In a mobile-health (m-health) scenario, we analyze whether the acquisition of data through wearables during the performance of IADLs, and with the help of machine learning techniques could replace the traditional questionnaires to evaluate dependence. To that end, we collected data from wearables, while older adults do the shopping activity. A trial supervisor (TS) labelled the different shopping stages (SS) in the collected data. We performed data pre-processing techniques over those SS and analyzed them with three machine learning algorithms: k-Nearest Neighbors (k-NN), Random Forest (RF) and Support Vector Machines (SVM). RESULTS: Our results confirm that it is possible to replace the traditional questionnaires with wearable data. In particular, the best learning algorithm we tried reported an accuracy of 97% in the assessment of dependence. We tuned the hyperparameters of this algorithm and used embedded feature selection technique to get the best performance with a subset of only 10 features out of the initial 85. This model considers only features extracted from four sensors of a single wearable: accelerometer, heart rate, electrodermal activity and temperature. Although these features are not observational, our current proposal is semi-automatic, because it needs a TS labelling the SS (with a smartphone application). In the future, this labelling process could be automatic as well. CONCLUSIONS: Our method can semi-automatically assess the dependence, without disturbing daily activities of elderly people. This method can save clinicians' time in the evaluation of dependence in older adults and reduce healthcare costs.

Psychometric properties of the Spanish version of the Sleep Hygiene Index.

The Sleep Hygiene Index (SHI) has shown adequate psychometric properties in samples from several countries but has not been validated in Spanish. The aims of the study were to translate the original (i.e., English) version of the SHI into Spanish and to evaluate the psychometric properties of this instrument (i.e., factor structure, internal consistency reliability, and concurrent, predictive, and discriminant validity) in Spanish adults. The overall sample, comprising 548 university students, was divided into two groups based on their self-reported insomnia symptoms (Insomnia Severity Index) because sleep hygiene has been shown to be closely related to insomnia. The Pittsburgh Sleep Quality Index and the Stanford Sleepiness Scale were used for testing concurrent validity. The Depression, Anxiety, and Stress Scale was used for testing predictive validity. Three items were dropped from the original SHI scale due to their low factor loadings. The principal component analysis revealed a four-factor solution for the SHI, accounting for 65.58% of the total variance in the overall sample, for 65.34% in the noninsomnia group, and for 63.50% in the insomnia group. Factor 1 comprised items regarding sleep-disrupting behaviors; Factor 2 comprised items regarding cognitive activation; Factor 3 comprised items about bedroom comfort; and Factor 4 comprised items on sleep/wake time. Omega coefficient indices for the SHI ranged from 0.751 to 0.878 in the overall sample, from 0.734 to 0.822 in the noninsomnia group, and from 0.724 to 0.835 in the insomnia group. The Spanish version of the SHI can be regarded as a reliable tool with adequate concurrent and predictive validity for assessing sleep hygiene in Spanish people with or without insomnia symptoms.

Effectiveness of a Functional Rehabilitation Program for Upper Limb Apraxia in Poststroke Patients: A Randomized Controlled Trial.

OBJECTIVE: To analyze the effectiveness of a home-based restorative and compensatory upper limb apraxia (ULA) rehabilitation program. DESIGN: Randomized controlled trial. SETTING: Neurology Unit of San Cecilio Hospital and 2 private and specialized health care centers. PARTICIPANTS: Community dwelling participants (N=38) between the ages of 25 and 95 years old (sex ratio, 1:1) with unilateral mild-to-moderate poststroke lesions (time of evolution since stroke, 12.03±8.98mo) and secondary ULA. INTERVENTIONS: Participants were randomly assigned to an 8-week combined ULA functional rehabilitation group (n=19) 3 days per week for 30 minutes or to a traditional health care education protocol group (n=19) once a month for 8 weeks. Both interventions were conducted at home. MAIN OUTCOME MEASURES: Sociodemographic and clinical data, Barthel Index (primary outcome), Lawton and Brody Scale, observation and scoring activities of daily living, the De Renzi tests for ideational and ideomotor apraxia and imitating gestures test, recognition of gestures, test for upper limb apraxia , and stroke-specific quality of life scale were assessed at 3 time points: baseline, posttreatment (8wk), and follow-up (8wk). RESULTS: There were statistically significant differences among the groups regarding ideomotor apraxia, imitating gestures, global recognition of gestures, intransitive gestures, and comprehension of gesture production (P<.05) in favor of the experimental group. However, no statistically significant differences were found between the groups regarding functionality or quality of life (P>.05). Regarding the within-group effect, statistically significant differences were found in all neuropsychological outcomes at posttreatment and follow-up (P<.05). CONCLUSION: A functional rehabilitation program was found to be superior to a traditional health care education program and resulted in improvements in neuropsychological functioning in ULA poststroke. Conventional education showed an insufficient effect on apraxia recovery. Further studies with larger sample sizes are needed to determine the effect of rehabilitation strategies on functionality and quality of life of poststroke ULA patients.

Eficacia de la higiene postural, economía articular y adaptaciones en discapacidad física: ensayo clínico aleatorizado / Efficacy of postural hygiene, joint economy and adaptations in physical disability: randomized controlled trial

OBJETIVOS: evaluar la efectividad de un programa de intervención mediante el uso de técnicas de higiene postural, economía articular y adaptaciones del hogar en personas con discapacidad física. MÉTODOS: ensayo clínico aleatorizado controlado simple ciego. Para la recogida de los datos se utilizarán el cuestionario del dolor Mcgill, la escala Quick-Dash, la escala Golberg de ansiedad y depresión y la escala de autoeficacia general percibida. El estudio durará tres meses en los que se realizarán tres evaluaciones: basal, postratamiento y de seguimiento. La intervención tendrá una duración de tres meses. La muestra estará formada por pacientes atendidos y atendidas en dos hospitales universitarios de la provincia de Granada en España. DISCUSIÓN: con este estudio se espera que las personas participantes del estudio mejoren su salud en las funciones y áreas evaluadas

OBJECTIVE: To evaluate the effectiveness of an intervention program through the use of postural hygiene techniques, joint economy and home adaptations in people with physical disabilities. METHODS: Single-blind, randomized controlled clinical trial. To collect the data, evaluation instruments such as the Mcgill pain questionnaire, the Upper limb disability questionnaire, the Golberg scale of anxiety and depression, and the general perceived self-efficacy scale will be used. The study will last three months in which three evaluations will be carried out: basal, post-treatment and follow-up. The intervention will last for three months. The sample will consist of patients treated in two university hospitals in the province of Granada in Spain. DISCUSSION: With this study, it is expected that patients will improve their quality of life as well as functionality in activities of daily living

Construction, Factor Structure, and Internal Consistency Reliability of the Hospital Physical Therapy Perceived Satisfaction Questionnaire (H-PTPS).

Patient satisfaction is a crucial aspect in the evaluation of the quality of health care provided by health services and units, especially in patients that require physical rehabilitation. This study aims to design and analyze the factor structure and internal consistency reliability of the Hospital Physical Therapy Perceived Satisfaction Questionnaire (H-PTPS) measuring the level of physical therapy patient satisfaction in hospital rehabilitation services. This study has a multicenter cross-sectional survey design. This study used the structural validity and internal consistency domains from COSMIN (consensus-based standards for the selection of health status measurement instruments) guideline. The H-PTPS questionnaire consists of 20 closed questions. A sample of 384 adult patients from physical therapy units from three Spanish public hospitals completed this questionnaire. A factor structure and internal consistency reliability analysis were performed. The factor analysis including the 20 items of the H-PTPS showed an adequacy index of 0.922 according to the Kaiser-Meyer-Olkin measure and the Barlett test allowed us to reject the null hypothesis (p < 0.001). In the rotated component matrix, four specific factors were obtained, explaining 66.75% of the accumulated variance. All factors present satisfactory internal reliability, achieving Cronbach's alpha indices and Omega coefficients higher than 0.74. The H-PTPS questionnaire has shown a four-factor solution with satisfactory reliability evaluating the satisfaction of Spanish patients treated in physical therapy units in the hospital rehabilitation services.

Self-Efficacy, Pain Intensity, Rheumatic Disease Duration, and Hand Functional Disability on Activities of Daily Living.

BACKGROUND: Knowledge regarding the possible influence of self-efficacy, pain intensity and disease duration on hand functional disability could promote new intervention strategies for activities of daily living (ADLs) in patients with rheumatic disease (RD). These approaches could prevent the health problems and socioeconomic costs associated with these diseases. OBJECTIVE: The aims of this study were to evaluate if there are differences between the levels of perceived self-efficacy, pain intensity and disease duration among people with RD and non-RD diseases, and to analyze if hand functional disability in ADLs is related to self-efficacy, pain intensity and disease duration in a sample of patients with RD. METHODS: A multicenter, observational, cross-sectional study was conducted on a total sample of 335 participants over 50 years old (176 patients with RD and 159 individuals with non-RD). The Duruöz Hand Index, the General Perceived Self-Efficacy Scale, the Rheumatic Diseases Self-Efficacy Scale (RDS-ES), the Visual Analog Scale (VAS), and the mean time of evolution in years of the disease (disease duration) were used to analyze the possible relationships surrounding hand functional disability in ADLs. RESULTS: The comparison analysis showed significant differences between the RD/non-RD sample for the General Perceived Self-Efficacy Scale, RDS-ES, and VAS scores (p < .001). The multiple regression results showed that age, General Perceived Self-Efficacy Scale scores, RDS-ES scores, VAS scores, and disease duration (or a combination of some of them) explained the variability of hand functional disability in almost 68% of kitchen tasks, 44% of dressing tasks, 46% of hygiene and other tasks, and 47% of office tasks. DISCUSSION: Our study shows that general and domain-specific self-efficacy, pain intensity, and disease duration are predictors of the dimensions of hand functional disability in patients with RD. Early evaluation of these components with an interdisciplinary approach would help to manage hand disability properly.

The Relationship between Psychological Well-Being and Psychosocial Factors in University Students.

Determining what factors influence the psychological well-being of undergraduate university students may provide valuable information to inform the development of intervention programs and targeted learning activities. The objective of this study was to investigate the correlation between psychological well-being in university students and their self-reported learning styles and methodologies, social skills, emotional intelligence, anxiety, empathy and self-concept. The final sample consisted of 149 Spanish university students, with an average age of 21.59 years (SD = 4.64). Psychological well-being dimensions, along with learning style and methodology preferences, social skills, level of social responsibility, emotional intelligence, state and trait anxiety, empathy and levels of self-concept were measured using a series of validated self-report scales. The results indicate that the total variance explained by the university students' psychological well-being factors were as follows: i) self-acceptance dimension (R2 = 0.586, F(6,99) = 23.335, p < 0.001); ii) positive relationships dimension (R2 = 0.520, F(6,99) = 17.874, p < 0.001); iii) autonomy dimension (R2 = 0.313, F(4,101) = 11.525, p < 0.001); iv) environmental mastery dimension (R2 = 0.489, F(4,101) = 24.139, p < 0.001); v) personal growth dimension (R2 = 0.354, F(4,101) = 13.838, p < 0.001); and vi) purpose-in-life dimension (R2 = 0.439, F(4,101) = 19.786, p < 0.001). The study findings may be used to inform new educational policies and interventions aimed at improving the psychological well-being of university students in the international context.

The Effect of Proprioceptive Exercises on Balance and Physical Function in Institutionalized Older Adults: A Randomized Controlled Trial.

OBJECTIVES: To evaluate the efficacy of a proprioceptive exercise program on functional mobility, musculoskeletal endurance, dynamic and static balance, gait, and risk of falls in institutionalized older adults. DESIGN: Randomized, single-blind, controlled trial. SETTING: A Spanish nursing home in the autonomous community of Extremadura, Spain. PARTICIPANTS: An initial sample was created by recruiting 148 older adult volunteers. The final sample (N=42) was randomly divided into 2 groups. INTERVENTIONS: Both the control and experimental group received physical therapy treatment based on a combination of adapted exercises and other physical therapy techniques (physical therapy intervention program) for a period of 12 weeks. This program consisted of 45 minutes (group intervention) plus 100 minutes (individual intervention) a week, for a total of 36 sessions (29 hours). The experimental group received a proprioceptive training program during the same intervention period, which was conducted twice weekly (24 sessions), with each session lasting 55 minutes. MAIN OUTCOME MEASURES: Timed Up and Go (TUG), Cooper, Tinetti, 1-leg stance, and the Morse Fall Scale (MFS). RESULTS: Analysis of variance showed a time × group interaction in TUG score (F=10.41, P=.002), Cooper test (F=5.94, P=.019), Tinetti score (F=6.41, P=.015), and MFS scores (F=5.24, P=.028). Differences between groups were achieved for TUG scores (d=0.76), Tinetti scores (d=1.12), 1-leg stance test scores (d=0.77), and MFS scale scores (d=0.85). In the experimental group, within-group analyses showed pre- to post-treatment differences for TUG scores (d=0.72), Cooper test scores in meters (d=0.18), Tinetti scores (d=0.60), 1-leg stance scores (d=0.55), and MFS scores (d=0.42). CONCLUSIONS: A proprioceptive exercise program demonstrated significant improvements compared with the control group in areas such as functional mobility, musculoskeletal endurance, balance, gait, and risk of falls in institutionalized older adults. This study may help to enhance our understanding of the impact of a specific protocol for a proprioceptive rehabilitation program.

A Microservices e-Health System for Ecological Frailty Assessment Using Wearables.

The population in developed countries is aging and this fact results in high elderly health costs, as well as a decrease in the number of active working members to support these costs. This could lead to a collapse of the current systems. One of the first insights of the decline in elderly people is frailty, which could be decelerated if it is detected at an early stage. Nowadays, health professionals measure frailty manually through questionnaires and tests of strength or gait focused on the physical dimension. Sensors are increasingly used to measure and monitor different e-health indicators while the user is performing Basic Activities of Daily Life (BADL). In this paper, we present a system based on microservices architecture, which collects sensory data while the older adults perform Instrumental ADLs (IADLs) in combination with BADLs. IADLs involve physical dimension, but also cognitive and social dimensions. With the sensory data we built a machine learning model to assess frailty status which outperforms the previous works that only used BADLs. Our model is accurate, ecological, non-intrusive, flexible and can help health professionals to automatically detect frailty.

Intervención de terapia ocupacional en rizartrosis mediante técnicas de educación, protección articular y productos de apoyo / Occupational therapy in trapeziometacarpal osteoarthritis: a multimodal intervention

OBJETIVOS: evaluar la efectividad de una intervención multimodal de terapia ocupacional mediante el uso combinado de técnicas de educación para la salud, protección articular y dispositivos de apoyo en personas con rizartrosis. MÉTODOS: ensayo clínico no controlado. Para la recogida de los datos, se emplearon diversas escalas validadas al español como la escala Goldberg de ansiedad y depresión, el dinamómetro y la escala de autoeficacia en artrosis. El estudio durará 4 meses en los que se realizarán 3 evaluaciones pre, postratamiento y de seguimiento. Y una intervención mensual durante los 4 meses de duración del estudio. La muestra estará formada por pacientes diagnosticados de rizartrosis. DISCUSIÓN: se espera que la combinación de estas terapéuticas mejore tanto la calidad de vida de los pacientes como el retraso en la evolución natural de la enfermedad

OBJECTIVE: Effectiveness evaluation of an occupational therapy multimodal intervention through the combined use of health education techniques, joint protection and assistive technology in patients with trapeziometacarpal osteoarthritis. METHODS: Uncontrolled clinical trial. Data was collected through different scales: the Goldberg anxiety and depression scale, the osteoarthritis self-efficacy scale and also a hand-held dynamometry. The study will last 4 months in which 3 evaluations will be carried out, before and after treatment, and two months after the end of the intervention and a monthly intervention during the 4 months of the study. The sample will be made up of patients diagnosed with trapeziometacarpal osteoarthritis. DISCUSSION: The combination of these therapies is expected to improve patients' quality of life and to slow symptoms down