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- 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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| 2. |
- Rosendahl, Erik
(författare)
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Fall prediction and a high-intensity functional exercise programme to improve physical functions and to prevent falls among older people living in residential care facilities
- 2006
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Impairments in balance, mobility, and lower-limb strength are common in the growing population of older people and can lead to dramatic consequences for the individual, such as dependency in activities of daily living, admission to nursing home, falls, and fractures. The main purposes of this thesis were, among older people in residential care facilities, to validate a fall-risk assessment tool and to evaluate a high-intensity functional weight-bearing exercise pro-gramme regarding its applicability as well as its effect on physical functions and falls. The prediction accuracy of the Downton fall risk index within 3, 6 and 12 months was evaluated among 78 residents, aged 65 years or more, at one residential care facility. The participants were assessed as having either a low or high fall risk according to the index and were followed-up for falls using two different fall definitions related to the cause of the fall. With all falls included, a significant prognostic separation was found between the low- and the high-risk group at 3, 6 and 12 months. A definition in which falls precipitated by acute illness, acute disease, or drug side-effects were excluded did not improve the accuracy of the fall prediction. The effect on physical functions of a high-intensity functional exercise programme was evaluated in a randomised controlled trial among 191 older people, dependent in activities of daily living, with a Mini-Mental State Examination score of ten or more, and living in nine residential care facilities. Participants were randomised to an exercise programme or a control activity, including 29 supervised sessions over 3 months, as well as to an intake of a milk-based 200 ml protein-enriched energy supplement (7.4 g protein per 100 g) or a placebo drink immediately after each session. The Berg Balance Scale, usual and maximum gait speed, and one-repetition maximum in lower-limb strength in a leg press machine were followed up at 3 and 6 months by blinded assessors and analysed using the intention-to-treat principle. Significant long-term effects of the high-intensity functional exercise programme were seen in balance, gait ability and lower-limb strength in comparison with the control activity. The intake of the protein-enriched energy supplement did not increase the effect of the training. The evaluation of the applicability of the exercise programme showed that there was a high rate of attendance, a relatively high achieved intensity in the exercises, and only two serious adverse events, neither of which led to manifest injury or disease, despite that most of the participants had severe cognitive or physical impairments. The applicability of the programme was not associated with the participants’ cognitive function. The evaluation of the fall-prevention effect of the exercise programme, during the 6 months following the intervention, showed that neither fall rate nor proportion of participants who sustained a fall differed between the exercise programme and the control activity, when all participants were compared. However, among participants who improved their balance during the intervention period, a significant reduction in fall rate was seen in favour of the exercise group. In conclusion, among older people living in residential care facilities, the Downton fall risk index appears to be a useful tool for predicting residents sustaining a fall, irrespective of the cause of the fall, even with a perspective of only a few months. A high-intensity functional exercise programme is applicable for use, regardless of cognitive function, and has positive long-term effects on balance, gait ability, and lower-limb strength. An intake of a protein-enriched energy supplement immediately after the exercise does not appear to increase the effect of the training. Participants who improve their balance function due to the exercise programme may reduce their risk of falling.
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| 3. |
- Sjödahl Hammarlund, Catharina, et al.
(författare)
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Gait improvement in unilateral transfemoral amputees by a combined psychological and physiotherapeutic treatment
- 2001
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Ingår i: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1651-2081 .- 1650-1977. ; 33:3, s. 114-118
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Tidskriftsartikel (refereegranskat)abstract
- A conscious therapeutic approach was used combining methods in physiotherapy with psychological awareness to re-educate nine transfemoral amputees during 10 months in outdoor environments. All were rehabilitated trauma or tumour cases, mean age 33 years, and had worn their prostheses for more than 18 months. The method aimed at integrating the prosthesis in normal movements and increasing body awareness. Gait was measured with a three-dimensional motion analysis system. Self-selected comfortable and brisk gait speed increased from mean 0.95 m/s and 1.29 m/s before to 1.40 m/s and 1.65 m/s after treatment, respectively. The results remained at a 6-month follow-up. Before treatment three participants used walking-aids and all had problems with low-back pain. After treatment none needed walking-aids and almost all low-back pain had disappeared. Seven participants learnt to jog. Results indicate that this new approach may add skills, mostly on participation level, to lead a relatively normal life.
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| 4. |
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| 5. |
- Andriesse, Hanneke, et al.
(författare)
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Validity and responsiveness of the Clubfoot Assessment Protocol (CAP). A methodological study
- 2006
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Ingår i: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 7:28
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Tidskriftsartikel (refereegranskat)abstract
- Background: The Clubfoot Assessment Protocol (CAP)is a multi dimensional instrument designed for longitudinal follow up of the clubfoot deformity during growth. Item reliability has shown to be sufficient. In this article the CAP's validity and responsiveness is studied using the Dimeglio classification scoring as a gold standard. Methods: Thirty-two children with 45 congenital clubfeet were assessed prospectively and consecutively at ages of new-born, one, two, four months and two years of age. For convergent/divergent construct validity the Spearman's correlation coefficients were calculated. Discriminate validity was evaluated by studying the scores in bilateral clubfeet. The floor-ceiling effects at baseline (untreated clubfeet) and at two years of age(treated clubfeet) were evaluated. Responsiveness was evaluated by using effect sizes (ES) and by calculating if significant changes (Wilcoxons signed test) had occurred between the different measurement occasions. Results: High to moderate significant correlation were found between CAP mobility I and morphology and the Dimeglio scores (rs = 0.77 and 0.44 respectively). Low correlation was found between CAP muscle function, mobility II and motion quality and the Dimeglio scoring system (rs = 0.20, 0.09 and 0.06 respectively). Of 13 children with bilateral clubfeet, 11 showed different CAP mobility I scores between right and left foot at baseline (untreated) compared with 5 with the Dimeglio score. At the other assessment occasions the CAP mobility I continued to show higher discrimination ability than the Dimeglio. No floor effects and low ceiling effects were found in the untreated clubfeet for both instruments. High ceiling effects were found in the CAP for the treated children and low for the Dimeglio. Responsiveness was good. ES from untreated to treated ranged from 0.80 to 4.35 for the CAP subgroups and was 4.68 for the Dimeglio. The first four treatment months, the CAP mobility I had generally higher ES compared with the Dimeglio. Conclusion: The Clubfoot Assessment Protocol shows in this study good validity and responsiveness. The CAP is more responsive when severity ranges between mild-moderate to severe, while the Dimeglio focuses more on the extremes. The ability to discriminate between different mobility status of the right and left foot in bilaterally affected children in this population was higher compared with the Dimeglio score implicating a better sensitivity for the CAP.
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| 6. |
- Bergland, A, et al.
(författare)
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Predictors of falls in the elderly by location
- 2003
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Ingår i: Aging clinical and experimental research. - 1720-8319. ; 15:1, s. 43-50
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Tidskriftsartikel (refereegranskat)abstract
- Background and aims: In the elderly, balance and walking impairments are assumed to play an important role in causing falls. We have assessed prospectively the predictive ability of health, function and balance variables regarding falls and their location. Methods: Falls which occurred during one year in a random sample of 307 women aged 75 years and over (mean 80.8 years, response rate 74.5%) living in the community were recorded and related to baseline registrations of health, medication and tests of walking and balance. Results: In all, 155 women (50.5%) reported 308 falls. Outdoor falls were significantly more frequent than indoor falls (57.5 vs 42.5%). The variables having had a fall before the start of the study, osteoporosis, hypertension, feeling depressed, unable to climb 40 cm high steps and walking slowly, all independently predicted a higher number of falls overall. Regarding fall location, having experienced a fall before study start was associated with more falls indoors as well as outdoors. Vision impairment, symptoms of depression, a faster comfortable walking speed, and being able to cope with higher steps were all independent predictors of more outdoor falls also after adjustment for outdoor exposure. A slower comfortable walking speed, a higher amplitude of the center of pressure movements in the frontal plane, a poorer score on the Timed Up & Go test, multi-morbidity, poor cognition and hypertension were independent risk factors for indoor falls. Neither number of drugs used nor any specific medication appeared as independent risk factors for falls in this study. Conclusions: The findings of this study suggest that risk factors for indoor and outdoor falls are different. Location of fall may be an important confounder in studies of predictors of falls in the elderly which should encompass this type of information.
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| 7. |
- Bergland, B, et al.
(författare)
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Validity of an Index of Self-reported Walking for Balance and Falls in Elderly Women
- 2002
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Ingår i: Advances in Physiotherapy. - : Informa UK Limited. - 1651-1948 .- 1403-8196. ; 4:2, s. 65-73
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Tidskriftsartikel (refereegranskat)abstract
- We have examined concurrent and prospective validity of an index of self-reported walking (RW) of 307 home-dwelling women aged 75 years and above, of whom 155 in 1 year had in all 308 falls of which 13% resulting in fractures. It consists of five items concerning various aspects of self-reported walking identified by factor analysis. The sum score on this ''RW-index'' correlated moderately ( r = 0.32-0.62) with a number of clinical tests of bal ance. With force plate measures of balance, the highest correlations were with the length of the path of centre of pressure (COP) in the frontal ( r = 0.26, 95% confidence interval (CI) = 0.19-0.33) and in the sagittal plane ( r = 0.24, 95% CI = 0.14-0.34). The COP measures, which were taken under dual task conditions, also had rather low correlations with the clinical tests of balance and walking, the highest one being 0.27, between tandem stance and the length of the COP path in the frontal plane. To have a poorer score on the RW-index predicted more falls (odds ratio (OR) = 1.83, p = 0.03), and fall-related fractures (OR = 1.83, p = 0.03) during a 1-year follow-up. The results show that easily collected clinical information provided by older people regarding walking and balance contributes in identifying subjects at increased risk of falling and fall-related fractures.
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| 8. |
- Gustafson, Yngve, et al.
(författare)
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Fall och höftfraktur hos äldre går att förebygga
- 2006
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Ingår i: Läkartidningen. - 0023-7205. ; 103:40, s. 2997-2999
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Tidskriftsartikel (refereegranskat)abstract
- Efter snart 30 år av forskning måste även vi i Sverige tillämpa den evidens som finns för att förhindra fallolyckor, frakturer och onödigt lidande. Stora samhällsekonomiska besparingar är möjliga.
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