Environmental barriers perceived by the Finnish population with spinal cord injury: a cross-sectional survey.

STUDY DESIGN: Cross-sectional survey of the Finnish population with spinal cord injury (SCI). OBJECTIVES: To explore the frequencies of perceived environmental barriers (EB) that made participation harder for the Finnish population with SCI and to compare the occurrence of perceived EBs by gender, age, time since injury, and injury severity. SETTING: Participants were recruited from the registers of the three SCI outpatient clinics responsible for the lifelong care of people with SCI in Finland. METHODS: The self-administered Nottwil Environmental Factors Inventory Short Form (NEFI-SF) collected in the Finnish Spinal Cord Injury Study (FinSCI) (n = 1772) was used. Nonparametric tests and multinomial logistic regression models were utilized. RESULTS: 880 individuals responded to the NEFI-SF items (response rate 50%). Climate was perceived as a barrier by 72% and a serious one by 44% of the respondents. The rates regarding public access were 59% and 24%, private home access 46% and 18%, and long-distance transport 45% and 20%. Four out of ten respondents reported that finances, lack of assistive devices for short-distance transport, and political decisions restricted their participation. The NEFI-SF total scores were higher (meaning more perceived restrictions by EBs) for those more severely injured. CONCLUSIONS: Climate, access to public and private places, challenges with transport, finances, and political decisions were the EBs most frequently perceived to restrict participation by the Finnish population with SCI. Most EBs that were prominent causes of restrictions are modifiable. Greater accessibility to the built environment, equal services to all, and positive special treatment could reduce their effects.

Prevalence of comorbidities and secondary health conditions among the Finnish population with spinal cord injury.

STUDY DESIGN: A cross-sectional study. OBJECTIVES: To explore the prevalence of comorbidities, secondary health conditions (SHCs), and multimorbidity in the Finnish population with spinal cord injury (SCI). SETTING: The data were collected from the Finnish Spinal Cord Injury Study (FinSCI). Participants were identified from three SCI outpatient clinics responsible for the lifelong follow-up of persons with SCI in Finland, (n = 884 participants, response rate; 50%). METHODS: The FinSCI-questionnaire included a question from the National Study of Health, Well-being, and Service (FinSote) for screening 12 comorbidities. The reference data of the general population for that question were received from the Finnish Institute for Health and Welfare. The Spinal Cord Injury Secondary Condition Scale (SCI-SCS) was used to screen 16 SHCs. The data were analysed with univariate testing and multivariable negative binomial regression modelling. RESULTS: The most common comorbidities were high blood pressure/hypertension (38%), back problems (28%), and high cholesterol (22%). The most common SHCs were joint and muscle pain (81%), muscle spasms (74%), chronic pain (71%), and bowel problems (71%). The prevalence of comorbidities was highest among persons aged ≥76 years (mean; 2.0; scale range; 0-12). The prevalence of SHCs was highest in the severity of SCI group C1-4 AIS A, B, and C (mean; 8.9; scale range; 0-16). CONCLUSIONS: Further research on geriatrics in SCI, non-traumatic SCI, and knowledge of the needs of persons with cervical lesion AIS A, B, or C is required, due to the fact that the prevalence of multimorbidity is high in these groups.

Functional independence in the Finnish spinal cord injury population.

STUDY DESIGN: A cross-sectional survey of the Finnish population with spinal cord injury (FinSCI database). OBJECTIVES: To describe the functional independence of the population with spinal cord injury (SCI) in Finland and to identify how generic and lesion characteristics affect their functional independence. SETTING: The participants were recruited from the registers of three SCI outpatient clinics responsible for lifelong follow-up and care for people with SCI in Finland. METHODS: The data were retrieved from FinSCI (n = 1772). The response rate was 50% (n = 884). The Spinal Cord Independence Measure-Self Report (SCIM-SR) was used. The data were analyzed with univariate testing, factor analyses, and multiple linear regression models. RESULTS: The median (percentiles 25; 75) SCIM-SR total score was 76.0 (58.8; 89.0), and the score was 18.0 (13.0; 20:0) for the self-care sub-scale, 33.0 (25.0; 39.0) for the respiration and sphincter management sub-scale and 29.0 (16.0; 36.8) for the mobility sub-scale. The higher the neurological level in groups AIS A, B, and C, the lower the functional ability. Group AIS D at any injury level had the highest level of functional ability. Age and the number of years since injury negatively influenced the SCIM-SR scores for every sub-scale. CONCLUSION: Based on the International Spinal Cord Injury Core Data Set, the severity of SCI can differentiate persons with SCI according to their functional ability. The results suggest that SCI affects individuals' health more than ageing alone does, thereby reducing the functional ability and independence of persons with SCI over time.

Incidence of Acquired Nontraumatic Spinal Cord Injury in Finland: A 4-Year Prospective Multicenter Study.

OBJECTIVES: To evaluate the incidence and epidemiologic characteristics of acquired nontraumatic spinal cord injury (NTSCI) in Finland. DESIGN: Prospective 4-year epidemiologic multicenter study. SETTING: Two of the 3 spinal cord injury (SCI) centers in Finland responsible for acute care, immediate rehabilitation, and lifelong follow-up for all SCI patients in a population of 3,073,052 (as of 2013). PARTICIPANTS: All newly diagnosed NTSCI patients (N=430) admitted to Tampere University Hospital between 2012 and 2015 and Oulu University Hospital between 2013 and 2016 based on the evaluation of the designated rehabilitation teams. Patients with NTSCI resulting from congenital etiologies or progressive neurologic diseases were excluded. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Incidence and variables, according to the International SCI Core Data Set and the International Standards for Neurological Classification of SCI, including etiology and the severity of injury. RESULTS: The incidence of NTSCI was 54.1 per million per year. NTSCI was more common in men (n=260, 60.5%) than women (n=170, 39.5%). The mean age was 62.0±14.6 years old. Degenerative causes were the most common etiology (n=219, 50.9%), followed by malignant (n=88, 20.5%) and benign (n=41, 9.5%) neoplasms. The injury resulted in tetraplegia in 177 patients (41.1%) and paraplegia in 249 patients (57.9%). American Spinal Injury Association Impairment Scale grade D injuries were common, with an incidence of 71% (n=304). Specialized inpatient rehabilitation was needed in 44% (n=189) of the cases. CONCLUSIONS: There are no previous studies on the epidemiology of NTSCI in Finland, and international reporting has been limited. The incidence of NTSCI in our study was substantially higher than in most previous studies, which was likely owing to our study including individuals with less severe lesions who did not require inpatient rehabilitation.

Epidemiology of traumatic spinal cord injury in Finland.

STUDY DESIGN: Prospective cohort study. OBJECTIVES: To determine the incidence and evaluate the characteristics of newly injured patients admitted to two spinal cord injury (SCI) centers during a 4-year period. SETTING: Oulu and Tampere University Hospital, Finland. METHODS: A dedicated multidisciplinary team evaluated all of the patients with new traumatic SCI (TSCI). The data were recorded according to the International Spinal Cord Injury Core Data Sets. RESULTS: In a 4-year period, 346 new patients with TSCI were admitted to the study centers. In the Oulu and Tampere University Hospitals' catchment areas, the mean annual incidence of TSCI was 36.6 per million. The leading causes of injury were low-level falls (36.2%), high-level falls (25.5%), and transport-related accidents (19.2%). In the patients >60 years, 72.6% were injured by falling and the proportion of low-level falls was 49.7%. In the patients ≤60 years old, 47.4% were alcohol-related. The proportion of cervical injuries in the patients >60 years was 77.1%, while in the patients ≤60 years the proportion was 59.6%. The incidence of TSCI was higher during the Summer and Autumn months. CONCLUSION: The mean annual incidence of TSCI was 36.6 per million corresponding to 200 new annual cases in Finland. Incomplete tetraplegia due to falling among elderly was overrepresented in the study population. Alcohol-consumption preceded injury in nearly half of the cases in the younger population. The prevention should focus on alcohol-related injuries and falls in the elderly.

Physical function and lean body mass as predictors of bone loss after hip fracture: a prospective follow-up study.

BACKGROUND: Predictors of bone deterioration after hip fracture have not been well characterized. The aim of this study was to examine the associations of physical function and lean body mass (LBM) with loss of bone density and strength in older people recovering from a hip fracture. METHODS: A total of 81 over 60-year-old, community-dwelling men and women operated for a hip fracture participated in this 1-year prospective follow-up study. Distal tibia total volumetric bone mineral density (vBMDTOT, mg/cm3) and compressive strength index (BSI, g2/cm4) and mid-tibia cortical vBMD (vBMDCO, mg/cm3) and bending strength index (SSI, mm3) were assessed in both legs by peripheral quantitative computed tomography (pQCT) at baseline (on average 10 weeks after fracture) and at 12 months. At baseline, LBM was measured with a bioimpedance device and physical function with the Short Physical Performance Battery (SPPB) and perceived difficulty in walking outdoors. Robust multivariable linear regression models were used to estimate the associations of physical function and LBM with the change in bone parameters at 12-months. RESULTS: The mean change in distal tibia vBMDTOT and BSI in both legs ranged from - 0.9 to - 2.5%. The change in mid-tibia vBMDCO and SSI ranged from - 0.5 to - 2.1%. A lower SPPB score, difficulty in walking outdoors and lower LBM predicted greater decline in distal tibia vBMDTOT in both legs. A lower SPPB score and difficulty in walking outdoors were also associated with a greater decline in distal tibia BSI in both legs. At the midshaft site, a lower SPPB score and lower LBM were associated with greater decline in SSI on the fractured side. CONCLUSIONS: Older hip fracture patients with low physical function and lower LBM may be at risk for greater decline in tibia bone properties during the first post-fracture year. Acknowledgement of the risk factors could assist in developing interventions and care to promote bone health and overall recovery. TRIAL REGISTRATION: ISRCTN, ISRCTN53680197. The trial was registered retrospectively but before the recruitment was completed. Registered March 3, 2010.

Effect of a social intervention of choice vs. control on depressive symptoms, melancholy, feeling of loneliness, and perceived togetherness in older Finnish people: a randomized controlled trial.

OBJECTIVES: This study examined effects of a social intervention on depressive symptoms, melancholy, loneliness, and perceived togetherness in community-dwelling Finnish older people. METHOD: Promotion of mental well-being in older people (GoodMood; ISRCTN78426775) was a single-blinded randomized control trial lasting 1.5 years. Two hundred and twenty-three persons aged 75-79 years reporting symptoms of loneliness or melancholy were randomized into intervention and control groups. The intervention group was allowed to choose among supervised exercise, social activity, or personal counseling. Follow-up measurements were conducted at the end of 6-month intervention, and at 3, 6, and 12 months post intervention. RESULTS: Number of depressive symptoms remained unchanged, while loneliness and melancholy decreased in both the intervention and control groups during the study (p < 0.001). Social integration increased in the intervention group but not in controls (p = 0.041). Attachment and guidance increased in both groups (p < 0.001). CONCLUSION: The intervention did not alleviate depressed mood. Positive changes over time were observed in loneliness, feelings of melancholy, attachment, and guidance but these occurred independently of the intervention. Our secondary analysis suggests that the intervention increased perceived social integration. In sum, the effects of the intervention were moderate only and did not expedite further overcoming depressive mood or loneliness.

Associations between the dimensions of perceived togetherness, loneliness, and depressive symptoms among older Finnish people.

OBJECTIVES: We studied the associations between perceived togetherness, depressive symptoms, and loneliness over a six-month period among 222 people aged 75-79 who reported loneliness or depressive mood at baseline. METHOD: The present cross-lagged models utilized baseline and six-month follow-up data of a randomized controlled trial that examined the effects of a social intervention on loneliness and depression (ISRCTN78426775). Dimensions of perceived togetherness, i.e. attachment, social integration, guidance, alliance, nurturance, and reassurance of worth, were measured with the Social Provisions Scale, depressive symptoms with a short form of the Geriatric Depression Scale, and loneliness with a single item. RESULTS: After controlling for baseline loneliness and depressive symptoms, baseline higher attachment in all participants and baseline higher opportunity for nurturance in the social intervention group predicted lower depressive mood at follow-up. No cross-lagged associations between the dimensions of perceived togetherness at baseline and loneliness at follow-up were observed. In addition, depressive symptoms and loneliness at baseline tended to negatively predict the dimensions of perceived togetherness at follow-up. DISCUSSION: Depressive symptoms and loneliness appear to be precursor for perceived togetherness, rather than dimensions of perceived togetherness to be antecedents of loneliness and depressiveness among older people.

Physical Activity After a Hip Fracture: Effect of a Multicomponent Home-Based Rehabilitation Program-A Secondary Analysis of a Randomized Controlled Trial.

OBJECTIVES: To investigate the effect of a yearlong multicomponent rehabilitation program on the level of physical activity (PA) and the maintenance of the level of PA over 1-year follow-up among older people recovering from a recent hip fracture. DESIGN: Secondary analysis of a randomized, controlled, parallel-group trial. SETTING: Home-based rehabilitation; measurements in university laboratory. PARTICIPANTS: Community-dwelling people (N=81) aged ≥60 years recovering from a hip fracture. Participants were randomly assigned to an intervention (n=40) or a control (n=41) group, on average, 42±23 days after discharge from the hospital. INTERVENTION: A yearlong intervention included evaluation and modification of environmental hazards, guidance for safe walking, nonpharmacologic pain management, a progressive home exercise program, PA counseling, and standard care. MAIN OUTCOME MEASURES: The outcome was the level of PA, which was assessed with the questionnaire (a modified Grimby scale) at baseline, and 3, 6, 12, and 24 months after baseline. Three PA categories were defined: inactivity, light PA, and moderate to heavy PA. Physical function was assessed using the Short Physical Performance Battery (SPPB) at baseline. The effects of the intervention were analyzed with generalized estimating equations. RESULTS: In the intervention group, a significant increase was observed in the level of PA after the intervention (interaction P=.005) and after 1-year follow-up (P=.021) compared with the standard care only. The benefit was particularly evident among the participants with a baseline SPPB score of ≥7 (interaction P<.001). CONCLUSIONS: The 12-month individualized multicomponent rehabilitation program increased PA among older patients with hip fracture. The increase was found to be maintained at the 1-year follow-up.

[Update on current care guidelines. The tendon disorders of the shoulder]. / Kaypa Hoite-Suosituksen Paivitystiivistelma. Olkapään jännevaivat.

Degenerative rotator cuff tendon disease (tendinopathy) is the most common disorder of the shoulder. A full-thickness tear of the rotator cuff may be caused by degeneration, or it may develop due to an acute trauma. The typical symptoms include pain and functional deficiencies. Diagnostics is based on clinical findings. The primary radiologic imaging is x-ray. Degenerative tendon diseases are primarily treated conservatively in primary health care, the most important treatment modality is physiotherapy-guided therapeutic rehabilitation. Surgical treatment is considered in full-thickness rotator cuff tears, especially after traumatic onset.

Sense of coherence: effect on adherence and response to resistance training in older people with hip fracture history.

Our aim was to study the effects of sense of coherence (SOC) on training adherence and interindividual changes in muscle strength, mobility, and balance after resistance training in older people with hip fracture history. These are secondary analyses of a 12-week randomized controlled trial of progressive resistance training in 60- to 85-year-old community-dwelling people 0.5-7 years after hip fracture (n = 45; ISRCTN34271567). Pre- and posttrial assessments included SOC, knee extension strength, walking speed, timed up-and-go (TUG), and Berg Balance Scale (BBS). Group-by-SOC interaction effects (repeated-measures ANOVA) were statistically significant for TUG (p = .005) and BBS (p = .040), but not for knee extension strength or walking speed. Weaker SOC was associated with poorer training adherence (mixed model; p = .009). Thus, more complicated physical tasks did not improve in those with weaker SOC, independently of training adherence. Older people with weaker SOC may need additional psychosocial support in physical rehabilitation programs to optimize training response.

Balance confidence was associated with mobility and balance performance in older people with fall-related hip fracture: a cross-sectional study.

OBJECTIVE: To study the relationship between balance confidence, a concept closely related to fear of falling, mobility and balance performance, and perceived mobility limitation in older people after a fall-related hip fracture. DESIGN: Cross-sectional analyses of pretrial data of 2 randomized controlled trials of physical rehabilitation. SETTING: University research center. PARTICIPANTS: Community-dwelling people aged over 60 years, 6 weeks to 7.5 years after a fall-related hip fracture (N=130). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The main outcome was the self-reported Activities-specific Balance Confidence (ABC) scale score. Assessments also included perceived ability to walk outdoors or climb 1 flight of stairs, and assessments of self-preferred walking speed, modified Timed-Up-and-Go test, and Berg Balance Scale. RESULTS: Higher ABC scale scores were related to better mobility and balance performance (ρ>.47) and perceived mobility function (ρ>.54). In univariate general linear models, all associations also remained significant after adjustment for age, sex, time since fracture, number of chronic diseases, and either level of physical activity or muscle strength of the fractured leg. An ABC scale score <85 points identified those with mobility and balance limitation across measures. CONCLUSIONS: In people who have had a fall-related hip fracture, an independent relationship exists between balance confidence and mobility and balance performance as well as perceived mobility function. Since lack of balance confidence may compromise rehabilitation and recovery, the ABC scale may help to identify older hip fracture patients with mobility and balance limitation.

Effects of progressive resistance training on physical disability among older community-dwelling people with history of hip fracture.

BACKGROUND AND AIMS: Hip fracture is a common trauma in older people, and often leads to decreased muscle strength and increased physical disability. This randomized controlled trial examined whether three months of progressive resistance training (PRT) can reduce physical disability among older people with a history of hip fracture. METHODS: A population-based sample of 60-85-year-old community- dwelling persons, with hip fractures sustained on average three years earlier, were enrolled in the study. Of 78 people participating in laboratory assessments, those without contraindications for participation in resistance training were randomly assigned to a training group (TG, n=22) or a control group (CG, n=21). TG took part in resistance training for three months twice a week. Training focused on lower limb muscles. Disability was assessed by a validated questionnaire containing six questions on activities of daily living (ADL) and nine on instrumental activities of daily living (IADL). A sum score was calculated separately for both items. High scores indicated more difficulties. Group differences were analysed with the Mann-Whitney and Chi-square tests. The effects of PRT on disability were tested with the McNemar test and by covariance analysis (ANCOVA). RESULTS: TG and CG were comparable with respect to gender, age, chronic diseases, BMI, time since fracture, self-reported health, and level of physical activity at baseline. The ADL sum score in TG was 1.8 (2.0) at baseline and 1.1 (1.3) after follow-up; in CG values were 1.7 (1.8) and 1.5 (1.8) (ANCOVA p=0.034). IADL sum scores in TG were 3.9 (4.6) at baseline and 2.2 (3.8) after follow-up, and in CG 3.4 (3.6) and 2.4 (2.3) (ANCOVA p=0.529). CONCLUSIONS: Progressive resistance training reduced self-reported difficulties in ADL, even several years after fracture. More research is still needed on how to prevent physical disability among community-dwelling older people, especially after hip fracture.

Effects of intensive strength-power training on sense of coherence among 60-85-year-old people with hip fracture: a randomized controlled trial.

BACKGROUND AND AIMS: Older people with disabilities are at increased risk of psychological health decline. There are no earlier studies on the effects of resistance training on sense of coherence (SOC) among older people with a history of hip fracture. The aim of this study is to test the effects of intensive 12-week strength-power training on SOC among older adults after hip fracture. METHODS: A clinical sample of 60-85-year-old community-dwelling men and women was studied, 0.5. to 7.0 years after hip fracture. Forty-six had no contraindications for participation and were randomized into training (n=24) and control groups (n=22). The training group participated in a 12-week, individually tailored, strength-power training program, twice a week in a senior gym and supervised by an experienced physiotherapist. SOC was assessed with Antonovsky's short 13-item scale. Data were collected at baseline and after intervention. RESULTS: Intensive 12-week strength-power training had no effect on participants' SOC level. CONCLUSIONS: Results indicated no change in SOC after 12-week physical exercise training among participants after hip fracture. Further studies on SOC among older people with disabilities and potential ways of increasing it are needed.

Physical health among the Finnish spinal cord injury population according to the Patient Reported Outcome Measurement Information System (PROMIS®).

OBJECTIVE: The aim of this study is to assess the physical health in the Finnish Spinal cord injury (SCI) population using the Patient Reported Outcome Measurement Information System (PROMIS®) and make a comparison to the general United States (US) population. Furthermore, the aim is to explore the associations between pain interference, pain intensity, sleep disturbance, and fatigue and physical function. DESIGN: Cross-sectional study. This study is part of the Finnish Spinal Cord Injury (FinSCI) community survey study. SETTING: Community, Finland. PARTICIPANTS: 884 persons with SCI. INTERVENTIONS: Not applicable. OUTCOME MEASURES: Physical health was measured with custom Patient Reported Outcome Measure System (PROMIS®) short forms. RESULTS: Higher age and lesion level indicated more severe physical function impairments. Persons ≥46 years exhibited more pain interference symptoms compared to younger participants. On average, the Finnish SCI population had 1.3 SD lower physical function and 0.9 SD higher pain interference T-scores compared to the US general population (P < 0.001). The most significant association was observed between pain interference and physical function (r = -0.364, P < 0.001). CONCLUSIONS: The present study provides a description of the state of physical health in the Finnish spinal cord injury population, as well as the associations between the physical health areas. The results highlight the substantiality of pain management in terms of improving physical function. TRIAL REGISTRATION NUMBER: NCT04649814.

Health-related factors for work participation in persons with spinal cord injury in Finland.

OBJECTIVE: To explore work participation and the health-related factors affecting work participation among the Finnish Spinal Cord injury (FinSCI) study population (n = 884). METHODS: A cross-sectional explorative observational study in the FinSCI community survey applying Patient-Reported Outcomes Measurement Information System (PROMIS®) forms on Social Health and Global Health. Analyses of socio-demographic and injury-related data were performed. RESULTS: Employment among the study population (n = 452) was 26.5%. Physical, Mental, Social and General Health were better in the employed group compared with work-age persons not working. Logistic regression showed that work participation was related to all health domains, but Physical Health and Ability to Participate in Social Roles and Activities in Social Health were the strongest indicators of likelihood of being at work. Paraplegia and young age were associated with increased likelihood of work participation. CONCLUSION: The first national survey among people with spinal cord injury in Finland shows low level of employment. The results suggest that pain, physical function, and ability to participate in social roles should be monitored by health and vocational professionals when assessing a person's likelihood of being in work.

Physical inactivity and pain in older men and women with hip fracture history.

Hip fracture patients often suffer from pain for several months after surgery. This may lead to physical inactivity and subsequent mobility limitation and disability. The purpose of this study was to investigate the association between severe musculoskeletal pain and the level of physical activity in older people with a history of hip fracture. Data were collected from 60- to 85-year-old (n = 78) community-dwelling people, 0.7-7.5 years after hip fracture. Physical activity was assessed with the Yale Physical Activity Survey (YPAS). According to the YPAS summary index distribution, the participants were divided into the physically inactive and physically active groups. Musculoskeletal pain in the lower back, hip or knee region was assessed by the Visual Analog Scale. Pain was defined as severe pain if the subject rated the pain 66 mm or over (upper third of the scale) in at least one of the relevant body regions in the lower body. Thirty-three subjects (42%) experienced severe pain in the lower body, of whom 23 (70%) reported severe pain in the operated hip. Twenty-three patients (30%) used pain medication prescribed by a physician. The level of musculoskeletal pain was significantly higher in the physically inactive (62%) than in the physically active (31%) group (p = 0.011). Logistic regression analysis showed that people with severe pain had over three times (OR: 3.5, 95% CI: 1.30-9.39) the risk for physical inactivity compared to those with less or no pain. Multivariate adjustments for balance confidence, time since fracture, number of chronic diseases and type of surgery did not materially change the estimate (OR: 3.0, 95% CI: 1.00-9.30). Pain is an important associated factor of physical inactivity in older people with a hip fracture history. Pain management may be important in restoring and sustaining the level of physical activity after hip fracture. Further prospective and experimental studies are, however, needed to explore the causality between pain and physical activity as well as the role of pain management and physical activity interventions in preventing mobility limitation and disability among older people recovering from hip fracture.

Promoting mobility after hip fracture (ProMo): study protocol and selected baseline results of a year-long randomized controlled trial among community-dwelling older people.

BACKGROUND: To cope at their homes, community-dwelling older people surviving a hip fracture need a sufficient amount of functional ability and mobility. There is a lack of evidence on the best practices supporting recovery after hip fracture. The purpose of this article is to describe the design, intervention and demographic baseline results of a study investigating the effects of a rehabilitation program aiming to restore mobility and functional capacity among community-dwelling participants after hip fracture. METHODS/DESIGN: Population-based sample of over 60-year-old community-dwelling men and women operated for hip fracture (n = 81, mean age 79 years, 78% were women) participated in this study and were randomly allocated into control (Standard Care) and ProMo intervention groups on average 10 weeks post fracture and 6 weeks after discharged to home. Standard Care included written home exercise program with 5-7 exercises for lower limbs. Of all participants, 12 got a referral to physiotherapy. After discharged to home, only 50% adhered to Standard Care. None of the participants were followed-up for Standard Care or mobility recovery. ProMo-intervention included Standard Care and a year-long program including evaluation/modification of environmental hazards, guidance for safe walking, pain management, progressive home exercise program and physical activity counseling. Measurements included a comprehensive battery of laboratory tests and self-report on mobility limitation, disability, physical functional capacity and health as well as assessments for the key prerequisites for mobility, disability and functional capacity. All assessments were performed blinded at the research laboratory. No significant differences were observed between intervention and control groups in any of the demographic variables. DISCUSSION: Ten weeks post hip fracture only half of the participants were compliant to Standard Care. No follow-up for Standard Care or mobility recovery occurred. There is a need for rehabilitation and follow-up for mobility recovery after hip fracture. However, the effectiveness of the ProMo program can only be assessed at the end of the study. TRIAL REGISTRATION: Current Controlled Trials ISRCTN53680197.

Postural balance and self-reported balance confidence in older adults with a hip fracture history.

BACKGROUND: Balance dysfunction and loss of balance confidence have been associated with functional limitations and loss of independency in daily tasks. This study examined various aspects of postural balance and balance confidence between older adults with a hip fracture history and their non-fractured counterparts. A comprehensive assessment of balance capacity in older adults with a hip fracture history may help to identify aspects of postural balance that play an important role in the mobility recovery and the avoidance of further falls. METHODS: The present study comprised 79 community-dwelling older adults with a hip fracture history and 31 non-fractured subjects of the same age, who participated in balance tests including both force platform measures and functional balance testing (Berg Balance Scale, BBS). In addition, balance confidence was assessed with the Activities-Specific Balance Confidence (ABC) scale. RESULTS: Persons with a hip fracture history had a markedly poorer balance control and were significantly less confident maintaining their balance during daily activities compared to the controls. Sixty percent of the subjects in the hip fracture group versus 87% of the non-fracture group (chi(2) test, p = 0.003) were able to perform the semi-tandem standing with their eyes closed. Significantly lower scores in the BBS (hip fracture group 46.3 vs. non-fracture group 52.9) and ABC (hip fracture group 59.4 vs. non-fracture group 77.5%) tests were found among the hip fracture subjects compared to the controls. In addition, the performance time in the lateral weight-shifting task (hip fracture group 13.4 vs. non-fracture group 8.4 s) was significantly slower compared to the controls. CONCLUSIONS: Balance impairments along with the loss of balance confidence are persistent problems among community-dwelling older adults with a history of hip fracture and may contribute to mobility limitations and the risk of falling. These areas of function and behaviour in older adults with a hip fracture history should be taken into consideration when planning effective, well-targeted rehabilitation programs.

Health-related quality of life and physical activity in persons at high risk for type 2 diabetes.

PURPOSE: The aim of this study was to compare the health-related quality of life (HRQOL) of persons at risk for type 2 diabetes to that of the Finnish general population. In addition, the associations between physical activity and HRQOL at-risk persons were studied. METHODS: One hundred thirty-two at-risk persons were recruited from health care centres in Central Finland. Participants filled out questionnaires including demographic characteristics, HRQOL (SF-36), frequency of vigorous physical activity (< or =2 times a week, once a week, less than once a week) and comorbidities. RESULTS: HRQOL of at-risk persons differed significantly from that of the Finnish population in four of the eight dimensions of SF-36. Compared with reference values of the general population, the values of at-risk persons were worse for general health and pain, but better for mental health and role limitation (emotional) dimensions. Among at-risk persons those physically more active had less depressiveness and lower body weight. HRQOL decreased linearly with decreasing physical activity in all dimensions. CONCLUSIONS: People with elevated risk for type 2 DM have reduced HRQOL in general health and body pain dimensions, but mental health and emotional role dimensions were better compared with that of the population. Among at-risk persons, the benefits of physical activity on HRQOL were seen in all HRQOL dimensions. Regular exercise and body weight control may improve subjective health and reduce risk for type 2 DM and its consequences.