Minimal clinically important difference for comfortable speed as a measure of gait performance in patients undergoing inpatient rehabilitation after stroke.

[Purpose] The purpose of this retrospective study was to determine the minimal clinically important difference for comfortable gait speed for patients with stroke. [Subjects] Data were analyzed from 35 patients undergoing inpatient rehabilitation. [Methods] Two characteristics of gait were measured, assistance required and comfortable gait speed. Patients were grouped as either experiencing or not experiencing a decrease of 2 or more levels of assistance required over the course of rehabilitation. Receiver operating characteristic curve analysis was used to identify the change in gait speed that best differentiated between patients who did and did not experience the requisite decrease in assistance required for gait. [Results] Twenty-one patients decreased 2 or more levels of assistance whereas 14 did not. Walking speed increased significantly more in the group who experienced a decrease in assistance of at least 2 levels. The receiver operating characteristic curve analysis showed a change in walking speed of 0.13 m/s best distinguished between patients who did versus did not experience a reduction in assistance required. [Conclusion] An improvement in gait speed of 0.13 m/s or more is clinically important in patients with stroke.

Feasibility of a Modified Otago Exercise Program for Older Adults With Cognitive Vulnerability.

Cognitive vulnerability, that is, clinically significant symptoms of dementia, depression, or delirium, puts older adults at high risk for physical inactivity and falls. Programs addressing activity and falls are needed. The purpose was to determine feasibility of an in-home, modified, Otago Exercise Program (OEP) for those with cognitive vulnerability, based on acceptability (retention and adherence), safety (pain intensity and falls), and potential positive effects (change in short physical performance battery (SPPB)). This secondary analysis of a randomized controlled trial included 80 participants who received the OEP; 64 completed it, 48% had depression, 22% had dementia, and 30% had a combination dementia/depression/delirium. Adherence to home exercise was low to moderate; pain was stable over 16 weeks; 31% of participants reported falls unrelated to OEP. SPPB increased from 6.95 to 7.74 (p < .01); age by time and diagnosis by time interactions were not significant. The modified OEP shows promising feasibility for older adults with cognitive vulnerability.

A comparison of two Tai Chi interventions tailored for different health outcomes.

OBJECTIVES: We compared the health benefits of two different Tai Chi interventions tailored for improving blood pressure (BP) (PRESSURE) or balance (BALANCE). DESIGN: randomized controlled trial. SETTING: Community dwelling older adults (≥60yr) practiced Tai Chi at the fitness center of a continuous care community. INTERVENTIONS: We tailored PRESSURE to emphasize breathing techniques and mental relaxation and BALANCE to emphasize movement principles that challenged balance. Subjects were randomized to PRESSURE (n = 12), BALANCE (n = 13), or CONTROL (n = 10). Tai Chi was practiced 3 sessions/wk, 60 min/session for 12 wk. CONTROL performed normal daily activities. MAIN OUTCOME MEASURES: We compared the change in cardiometabolic health, balance, and functional fitness between groups with ANCOVA using baseline values, age, and body mass index as covariates. RESULTS: Subjects were physically active, Tai Chi naive (97.1 %), white, mostly female (82.9 %), and older (78.9 ± 5.7 yr) with resting systolic BP (SBP) of 126.5 ± 14.4 mmHg and diastolic BP of 69.3 ± 8.4 mmHg. PRESSURE significantly improved Chair Sit-to-Stand Test (CSTS) (1.0 ± 1.8 vs.-0.6 ± 0.8times/30s,p = 0.03) versus CONTROL, and gait speed (12.8±43.3 vs.-24.1±22.4cm/sec, p = 0.02) versus BALANCE. Meanwhile, BALANCE significantly improved Single Leg Stance Test (5.4±18.0 vs.-8.2±10.3 s, p = 0.049) and CSTS (1.0±1.7 vs.-0.6±0.8times/30s, p = 0.03), and tended to lower SBP (-4.2±16.0 vs. 3.5±8.3mmHg, p = 0.052) versus CONTROL. CONCLUSION: Within 3 months, Tai Chi improved several health outcomes independent of the type of practice among physically active, Tai Chi naive older adults. Therefore, healthcare and exercise professionals may recommend Tai Chi to physically active older adults without specifying the type of practice.

The prone bridge test: Performance, validity, and reliability among older and younger adults.

INTRODUCTION: The prone bridge maneuver, or plank, has been viewed as a potential alternative to curl-ups for assessing trunk muscle performance. The purpose of this study was to assess prone bridge test performance, validity, and reliability among younger and older adults. METHOD: Sixty younger (20-35 years old) and 60 older (60-79 years old) participants completed this study. Groups were evenly divided by sex. Participants completed surveys regarding physical activity and abdominal exercise participation. Height, weight, body mass index (BMI), and waist circumference were measured. On two occasions, 5-9 days apart, participants held a prone bridge until volitional exhaustion or until repeated technique failure. Validity was examined using data from the first session: convergent validity by calculating correlations between survey responses, anthropometrics, and prone bridge time, known groups validity by using an ANOVA comparing bridge times of younger and older adults and of men and women. Test-retest reliability was examined by using a paired t-test to compare prone bridge times for Session1 and Session 2. Furthermore, an intraclass correlation coefficient (ICC) was used to characterize relative reliability and minimal detectable change (MDC95%) was used to describe absolute reliability. RESULTS: The mean prone bridge time was 145.3 ± 71.5 s, and was positively correlated with physical activity participation (p ≤ 0.001) and negatively correlated with BMI and waist circumference (p ≤ 0.003). Younger participants had significantly longer plank times than older participants (p = 0.003). The ICC between testing sessions was 0.915. CONCLUSION: The prone bridge test is a valid and reliable measure for evaluating abdominal performance in both younger and older adults.

Reducing Risks for Older Adults With an Interprofessional Community-Academic Partnership: A Case Study.

As the older adult population in the United States increases and diversifies, understanding and reducing risks for hospitalization and institutionalization can reduce burdens for this vulnerable population. Using evidence-based assessment tools to understand medical, psychosocial, pharmacologic, and functional status can aid an interprofessional team to best evaluate older adults at risk. By providing culturally competent care for a diversifying older adult demographic, attention to social determinants can improve health equity for this population. This article describes in a case study exemplar, how one such interprofessional collaborative practice program, Geriatric Outreach and Training with Care (GOT Care!) provides a comprehensive assessment for high-risk older adults, identifies and documents these risks, and shares recommendations and rationale with the primary care provider toward risk reduction and improvement of outcomes.

Effect of Exercise Training on Cardiac Biomarkers in At-Risk Populations: A Systematic Review.

BACKGROUND: Studies have demonstrated beneficial effects of exercise on cardiovascular disease biomarkers for healthy individuals; however, a comprehensive review regarding the effect of exercise on cardiovascular disease biomarkers in at-risk populations is lacking. METHODS: A literature search was performed to identify studies meeting the following criteria: randomized controlled study, participants with pathology/activity limitations, biomarker outcome (total cholesterol, high-density lipoprotein, low-density lipoprotein, C-reactive protein, insulin, triglycerides, or glucose), and exercise intervention. Means and standard deviations from each biomarker were used to calculate standardized Cohen's d effect sizes with 95% confidence intervals. RESULTS: In total, 37 articles were included. The majority (44/57; 77%) of data points demonstrated moderate to strong effects for the reduction in total cholesterol, triglycerides, and low-density lipoprotein, and elevation in high-density lipoprotein following exercise. The majority of data points demonstrated strong effects for reductions in blood glucose (24/30; 80%) and insulin (23/24; 96%) levels following exercise intervention. CONCLUSION: Evidence is heterogeneous regarding the influence of exercise on cardiovascular disease biomarkers in at-risk patients, which does not allow a definitive conclusion. Favorable effects include reductions in triglycerides, total cholesterol, low-density lipoprotein, glucose, and insulin, and elevation in high-density lipoprotein following exercise intervention. The strongest evidence indicates that exercise is favorable for the reduction in glucose and cholesterol levels among obese patients, and reduction of insulin regardless of population.

Minimal clinically important difference for change in comfortable gait speed of adults with pathology: a systematic review.

RATIONALE, AIMS AND OBJECTIVES: Walking speed is an important performance variable, but information on the minimal clinically important difference (MCID) for the measure has not been consolidated. In this review, we aimed to summarize information on the MCID for change in comfortable gait speed measurements for patients with pathology. METHODS: Relevant literature was identified by searches of four databases (PubMed, Web of Knowledge, CINAHL and Scopus), hand searches and consultation with an expert. Inclusion required that articles reported a MCID for comfortable gait speed measurements. Articles were excluded if the MCID was not determined using receiver operating characteristic (ROC) curve analysis. Articles were abstracted for information on participants, interventions, gait speed documentation and the determination of MCID. Quality was assessed using a hybrid 9-item (0-18 point) instrument. RESULTS: Seven articles were selected based on inclusion and exclusion criteria. The populations studied included stroke (n = 3), hip fracture (n = 2), multiple sclerosis (n = 1) and mixed (n = 1). Using 13 different anchors the studies reported MCIDs of 0.08-0.26 m s(-1) . All but three of these MCIDs were between 0.10 and 0.20 m s(-1) . All MCIDs for which the area under the ROC curve exceeded 0.70 were between 0.10 and 0.17 m s(-1) . CONCLUSIONS: Changes in gait speed of 0.10 to 0.20 m s(-1) may be important across multiple patient groups.