| 21. |
- Moe-Nilssen, Rolf, et al.
(författare)
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Criteria for evaluation of measurement properties of clinical balance measures for use in fall prevention studies
- 2007
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Ingår i: Journal of Evaluation In Clinical Practice. - : Blackwell Publishing. - 1356-1294 .- 1365-2753. ; 14:2, s. 236-240
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Tidskriftsartikel (refereegranskat)abstract
- Work Package 3 of the Prevention of Falls Network Europe has evaluated measurement properties of clinical balance measures to be used to: (1) select participants for interventions with the goal to prevent falls in older people, and (2) assess the results of such intervention on balance function.Inclusion in a fall prevention study may be based on measures identifying subjects who have impaired balance or increased risk of future falls. We propose that an appropriate statistical method to analyse discriminative ability of a balance measure is discriminant analysis or logistic regression analysis. The optimal cut‐off score is best determined by plotting a receiver‐operating‐characteristic curve for different cut‐off values. The evaluation of predictors for risk of future falls should be based on a study design with a prospective data collection of falls.Sensitivity to change is a measurement property needed to evaluate the outcome of an intervention. The standardized response mean is frequently encountered in the literature and is recommended as a statistical measure of sensitivity to change in the context of an intervention study.Adequate reliability is a prerequisite for consistent measurement. Relative reliability may be reported as an intraclass correlation coefficient and absolute reliability as the within‐subject standard deviation (sw), also called standard error of measurement. When measurement error is proportional to the score, calculation of a coefficient of variation can be considered.In a second paper, the authors will evaluate clinical balance measures for use in fall prevention studies based upon criteria recommended in this report.
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| 22. |
- Nordin, Ellinor, 1959-
(författare)
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Assessment of balance control in relation to fall risk among older people
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Falls and their consequences among older people are a serious medical and public health problem. Identifying individuals at risk of falling is therefore a major concern. The purpose of this thesis was to evaluate measurement tools of balance control and their predictive value when screening for fall risk in physically dependent individuals ≥65 years old living in residential care facilities, and physically independent individuals ≥75 years old living in the community. Following baseline assessments falls were monitored during six months in physically dependent individuals based on staff reports, and during one year in physically independent individuals based on self reports. In physically dependent individuals test-retest reliability of the Timed Up&Go test (TUG) was established in relation to cognitive impairment. Absolute reliability measures exposed substantial day-to-day variability in mobility performance at an individual level despite excellent relative reliability (ICC 1.1 >0.90) regardless of cognitive function (MMSE ≥10). Fifty-three percent of the participants fell at least once during follow-up. Staff judgement of their residents’ fall risk had the best prognostic value for ruling in a fall risk in individuals judged with ‘high risk’ (positive Likelihood ratio, LR+ 2.8). Timed, and subjective rating of fall risk (modified Get Up&Go test, GUG-m) were useful for ruling out a high fall risk in individuals with TUG scores <15 seconds (negative LR, LR- 0.1) and GUG-m scores of ‘no fall risk’ (LR- 0.4), however few participants achieved such scores. In physically independent individuals balance control was challenged by dual-task performances. Subsequent dual-task costs in gait (DTC), i.e. the difference between single walking and walking with a simultaneous second task, were registered using an electronic mat. Forty-eight percent of the participants fell at least once during follow-up. A small prognostic guidance for ruling in a high fall risk was found for DTC in mean step width of ≤3.7 mm with a manual task (LR+ 2.3), and a small guidance for ruling out a high fall risk with DTC in mean step width of ≤3.6 mm with a cognitive task (LR- 0.5). In cross-sectional evaluations DTC related to an increased fall risk were associated with: sub-maximal physical performance stance scores (Odds Ratio, OR, 3.2 to 3.8), lower self-reported balance confidence (OR 2.6), higher activity avoidance (OR 2.1), mobility disability (OR 4.0), and cautious walking out-door (OR 3.0). However, these other measures of physical function failed to provide any guidance to fall risk in this population of seemingly able older persons. In conclusion – Fall risk assessments may guide clinicians in two directions, either in ruling in or in ruling out a high fall risk. A single cut-off score, however, does not necessarily give guidance in both directions. Staff experienced knowledge is superior to a single assessment of mobility performance for ruling in a high fall risk. Clinicians need to consider the day-to-day variability in mobility when interpreting the TUG score of a physically dependent individual. DTC of gait can, depending on the type of secondary task, indicate a functional limitation related to an increased fall risk or a flexible capacity related to a decreased fall risk. DTC in mean step width seems to be a valid measure of balance control in physically independent older people and may be a valuable part of the physical examination of balance and gait when screening for fall risk as other measures of balance control may fail to provide any guidance of fall risk in this population.
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| 23. |
- Nordin, Ellinor, et al.
(författare)
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Prognostic validity of the Timed Up-and-Go test : a modified Get-Up-and-Go test, staff's global judgement and fall history in evaluating fall risk in residential care facilities
- 2008
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Ingår i: Age and Ageing. - : Oxford University Press (OUP). - 0002-0729 .- 1468-2834. ; 37:4, s. 442-448
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: to evaluate and compare the prognostic validity relative to falls of the Timed Up-and-Go test (TUG), a modified Get-Up-and-Go test (GUG-m), staff's judgement of global rating of fall risk (GLORF) and fall history among frail older people. Design: cohort study, 6-month prospective follow-up for falls. Participants: 183 frail persons living in residential care facilities in Sweden, mean age 84 years, 73% women. Methods: the occurrence of falls during the follow-up period were compared to the following assessments at baseline: the TUG at normal speed; the GUG-m, a rating of fall risk scored from 1 (no risk) to 5 (very high risk); the GLORF, staff's rating of fall risk as 'high' or 'low'; a history of falls in the previous 6 months. These assessment tools were evaluated using sensitivity, specificity and positive and negative likelihood ratios (LR+ to rule in and LR- to rule out a high fall risk). Results: 53% of the participants fell at least once. Various cut-off values of the TUG (12, 15, 20, 25, 30, 35, 40 s) and the GUG-m showed LR+ between 0.9 and 2.6 and LR- between 0.1 and 1.0. The GLORF showed an LR+ of 2.8 and an LR- of 0.6 and fall history showed an LR+ of 2.4 and an LR- of 0.6. Conclusions: in this population of frail older people, staff judgement of their residents' fall risk as well as previous falls both appear superior to the performance-based measures TUG and GUG-m in ruling in a high fall risk. A TUG score of less than 15 s gives guidance in ruling out a high fall risk but insufficient information in ruling in such a risk. The grading of fall risk by GUG-m appears of very limited value.
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| 24. |
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| 25. |
- Nordin, Ellinor, et al.
(författare)
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Timed Up&Go Test : Reliability in Older People dependent in Activities of Daily Living - Focus on Cognitive State
- 2006
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Background and Purpose: It is unknown how cognitive impairment affects the reliability of Timed Up&Go Test (TUG). The aim of the present study was to investigate the expected variability of Timed Up&Go in older persons, dependent in activities of daily living (ADL), and with different levels of cognitive state. The hypothesis was that cognitive impairment would increase the variability of TUG scores.Subjects: Seventy-eight persons with multiple impairments, dependent in ADL and living in residential-care facilities were included in this study. The subjects were 84.8±5.7 (mean±SD) years old, and their Mini-mental State Examination score was 18.7±5.6. Methods: TUG assessments were performed on three different days. Intra- and inter rater analyses were carried out. Results: Cognitive impairment was not related to the size of the variability of TUG scores. There was a significant relationship between the variability and the time taken to perform TUG (p<0.001). The intraclass correlation were greater than .90, and were similar within and between raters. In repeated measurements at the individual level, an observed value of 10 seconds was expected to vary from 7 to 15 seconds, and an observed value of 40 seconds was expected to vary from 26 to 61 seconds for 95% of the observations. Discussion and Conclusions: The measurement error of a TUG assessment is substantial for a frail, older person dependent in ADL, regardless of the level of cognitive function, when verbal cuing is permitted during testing. The variability increases with the time to perform TUG. Despite high intraclass correlation coefficients, the ranges of expected variability can be wide and are similar within and between raters. Physical therapists should be aware of this variability before they interpret the TUG score for a particular patient.
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| 26. |
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| 27. |
- Nyberg, Lars, et al.
(författare)
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The development of a virtual reality system to study tendency of falling among older people
- 2005
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Ingår i: International Journal on Disability and Human Development. - 1565-012X. ; 4:3, s. 239-243
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Tidskriftsartikel (refereegranskat)abstract
- Injuries related to falls are a major threat to the health of older persons. A fall may result not only in an injury but also in a decreased sense of autonomy in the daily life. To be able to prevent such falls, a need to further understand the complex mechanisms involved in balance and walking is needed. Here we present an immersive virtual reality system, in which a person can move around while being subjected to various events, which may influence balance and walking
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| 28. |
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| 29. |
- Rosendahl, Erik, et al.
(författare)
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A high-intensity functional exercise program is applicable for older people with cognitive impairment
- 2007
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Ingår i: Research and practice in Alzheimer's disease. - Paris : Serdi publisher. - 2914377991 ; , s. 212-215
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Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- Maintaining or improving physical functions among older people with cognitive impairment in effective ways is of great importance, since cognitive decline is associated with a decline in physical performance. Training at high intensity has a greater effect than at a lower intensity, but there are few studies evaluating high-intensity training among older people with severe cognitive impairment. However, results from a recent study (the FOPANU Study) among older people dependent in activities of daily living and living in residential care facilities showed that a high-intensity functional weigh-bearing program had positive long-term effects on balance, gait ability and lower-limb strength. The mean score for the Mini-Mental State Examination was 18 (range 10-29) and 52% of the participants had a dementia disease. Regarding the applicability of the exercise program, no statistically significant differences in attendance, intensity or adverse events were observed when participants with dementia were compared with participants without dementia. A main clinical implication of the FOPANU Study is that people with severe cognitive impairment can be offered high-intensity functional exercise programs.
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| 30. |
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