-
Gait & Posture May 2018Since pregnant women may have potentially greater difficulty maintaining balance, their stability has been investigated by some researchers. However, there is no... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Since pregnant women may have potentially greater difficulty maintaining balance, their stability has been investigated by some researchers. However, there is no consensus considering the results. The purpose of our investigation was to compare all the experimental studies focusing on the analysis of gait that have been conducted over the last years to assess their methodological issues and changes induced by pregnancy.
METHODS
The PRISMA Guidelines incorporating a risk of bias and strength of recommendations were used as a methodological template for this review. Literature searches were conducted using the following databases: PubMed, Embase, SPORTDiscus, Scopus. After limiting the search to meet the inclusion criteria, 25 articles remained in the final analysis.
RESULTS
Some authors emphasised that adaptations due to pregnancy are recognised to provide safety and stability. Thus, they consistently reported reduced walking velocity as a result of lower frequency and smaller length of the steps. Longer contact times were reflected by the shortened peak forces. Plantar loads were redistributed from the rearfoot (decrease) to the midfoot and forefoot (increase) throughout pregnancy. Another adjustment was an increase of base of support to improve lateral gait stability which allows to compensate increased medio-lateral ground reaction force. During the course of pregnancy the increase of anterior body mass and hormonal changes enhance some realignments of the pelvis and lumbar spine. Methodological approaches varied across the included studies. The critical appraisal identified some areas of weaknesses that should be considered for designing the future investigations.
CONCLUSIONS
Since many gait parameters are interrelated, in order to understand the cause-and-effect relationships an integrative and complete analysis of multiple factors is required.
Topics: Female; Foot; Gait; Humans; Mothers; Pregnancy; Reference Values; Walking
PubMed: 29500941
DOI: 10.1016/j.gaitpost.2018.02.024 -
International Journal of Environmental... Aug 2016The aim of this review is to evaluate the health and social effects of accessible home environments for people with functional limitations, in order to provide evidence... (Review)
Review
The aim of this review is to evaluate the health and social effects of accessible home environments for people with functional limitations, in order to provide evidence to promote well-informed decision making for policy guideline development and choices about public health interventions. MEDLINE and nine other electronic databases were searched between December 2014 and January 2015, for articles published since 2004. All study types were included in this review. Two reviewers independently screened 12,544 record titles or titles and abstracts based on our pre-defined eligibility criteria. We identified 94 articles as potentially eligible; and assessed their full text. Included studies were critically appraised using the Mixed Method Appraisal Tool, version 2011. Fourteen studies were included in the review. We did not identify any meta-analysis or systematic review directly relevant to the question for this systematic review. A narrative approach was used to synthesise the findings of the included studies due to methodological and statistical heterogeneity. Results suggest that certain interventions to enhance the accessibility of homes can have positive health and social effects. Home environments that lack accessibility modifications appropriate to the needs of their users are likely to result in people with physical impairments becoming disabled at home.
Topics: Architectural Accessibility; Housing; Humans; Mobility Limitation
PubMed: 27548194
DOI: 10.3390/ijerph13080826 -
Journal of the American Academy of... Jun 2017Degraded hearing in older adults has been associated with reduced postural control and higher risk of falls. Both hearing loss (HL) and falls have dramatic effects on... (Review)
Review
BACKGROUND
Degraded hearing in older adults has been associated with reduced postural control and higher risk of falls. Both hearing loss (HL) and falls have dramatic effects on older persons' quality of life (QoL). A large body of research explored the comorbidity between the two domains.
PURPOSE
The aim of the current review is to describe the comorbidity between HL and objective measures of postural control, to offer potential mechanisms underlying this relationship, and to discuss the clinical implications of this comorbidity.
DATA COLLECTION AND ANALYSIS
PubMed and Google Scholar were systematically searched for articles published in English up until October 15, 2015, using combinations of the following strings and search words: for hearing: Hearing loss, "Hearing loss," hearing, presbycusis; for postural control: postural control, gait, postural balance, fall, walking; and for age: elderly, older adults.
RESULTS
Of 211 screened articles, 7 were included in the systematic review. A significant, positive association between HL and several objective measures of postural control was found in all seven studies, even after controlling for major covariates. Severity of hearing impairment was connected to higher prevalence of difficulties in walking and falls. Physiological, cognitive, and behavioral processes that may influence auditory system and postural control were suggested as potential explanations for the association between HL and postural control.
CONCLUSIONS
There is evidence for the independent relationship between HL and objective measures of postural control in the elderly. However, a more comprehensive understanding of the mechanisms underlying this relationship is yet to be elucidated. Concurrent diagnosis, treatment, and rehabilitation of these two modalities may reduce falls and increase QoL in older adults.
Topics: Accidental Falls; Aged; Female; Gait; Hearing Loss; Humans; Male; Middle Aged; Mobility Limitation; Postural Balance; Quality of Life; Sensation Disorders; Walking
PubMed: 28590900
DOI: 10.3766/jaaa.16044 -
Age and Type of Task-Based Impact of Mental Fatigue on Balance: Systematic Review and Meta-Analysis.Journal of Motor Behavior 2024The role of cognition in balance control suggests that mental fatigue may negatively affect balance. However, cognitive involvement in balance control varies with the... (Meta-Analysis)
Meta-Analysis Review
The role of cognition in balance control suggests that mental fatigue may negatively affect balance. However, cognitive involvement in balance control varies with the type or difficulty of the balance task and age. Steady-state balance tasks, such as quiet standing, are well-learned tasks executed automatically through reflex activities controlled by the brainstem and spinal cord. In contrast, novel, and challenging balance tasks, such as proactively controlling balance while walking over rugged terrain or reacting to unexpected external perturbations, may require cognitive processing. Furthermore, individuals with preexisting balance impairments due to aging or pathology may rely on cognitive processes to control balance in most circumstances. This systematic review and meta-analysis investigated the effect of mental fatigue on different types of balance control tasks in young and older adults. A literature search was conducted in seven electronic databases and 12 studies met eligibility criteria. The results indicated that mental fatigue had a negative impact on both proactive (under increased cognitive load) and reactive balance in young adults. In older adults, mental fatigue affected steady-state and proactive balance. Therefore, mentally fatigued older individuals may be at increased risk of a loss of balance during steady-state balance task compared to their younger counterparts.
Topics: Young Adult; Humans; Aged; Postural Balance; Aging; Walking; Cognition; Mental Fatigue
PubMed: 38189442
DOI: 10.1080/00222895.2023.2299706 -
Muscle & Nerve Mar 2017No treatments for axonal peripheral neuropathy are approved by the United States Food and Drug Administration (FDA). Although patient- and clinician-reported outcomes... (Review)
Review
INTRODUCTION
No treatments for axonal peripheral neuropathy are approved by the United States Food and Drug Administration (FDA). Although patient- and clinician-reported outcomes are central to evaluating neuropathy symptoms, they can be difficult to assess accurately. The inability to identify efficacious treatments for peripheral neuropathies could be due to invalid or inadequate outcome measures.
METHODS
This systematic review examined the content validity of symptom-based measures of diabetic peripheral neuropathy, HIV neuropathy, and chemotherapy-induced peripheral neuropathy.
RESULTS
Use of all FDA-recommended methods to establish content validity was only reported for 2 of 18 measures. Multiple sensory and motor symptoms were included in measures for all 3 conditions; these included numbness, tingling, pain, allodynia, difficulty walking, and cramping. Autonomic symptoms were less frequently included.
CONCLUSIONS
Given significant overlap in symptoms between neuropathy etiologies, a measure with content validity for multiple neuropathies with supplemental disease-specific modules could be of great value in the development of disease-modifying treatments for peripheral neuropathies. Muscle Nerve 55: 366-372, 2017.
Topics: Diabetic Neuropathies; HIV Infections; Humans; Peripheral Nervous System Diseases
PubMed: 27447116
DOI: 10.1002/mus.25264 -
Geriatrics & Gerontology International Jan 2016The aim of the present study was to systematically review the literature on the predictive value of handgrip strength as a marker for vulnerability. Furthermore, we... (Meta-Analysis)
Meta-Analysis Review
AIM
The aim of the present study was to systematically review the literature on the predictive value of handgrip strength as a marker for vulnerability. Furthermore, we aimed to update a recent systematic review on the association between handgrip strength and mortality.
METHODS
Literature searches using Cochrane, PubMed and Embase databases, and searching reference lists of included studies. Eligible studies were observational longitudinal studies presenting handgrip strength at baseline as an independent variable and its association with cognition, depression, mobility, functional status, hospitalization or mortality at follow up in a general population aged 60 years and older. With respect to mortality, we updated a recent systematic review.
RESULTS
We included 34 articles. Most of them involved the association between handgrip strength and cognition (n = 9), functional status (n = 12), mobility (n = 6) or mortality (n = 22), and mainly found a positive relationship, meaning that higher handgrip strength at baseline is protective for declines in these outcome measures. Statistical pooling was carried out for functional status and mortality, with a pooled ratio for functional status of 1.78 (95% CI 1.28-2.48) for categorical variables (high vs low handgrip strength) and 0.95 (95% CI 0.92-0.99) for handgrip strength as a continuous variable. The pooled hazard ratio for mortality was 1.79 (95% CI 1.26-2.55) for categorical variables and 0.96 (95% CI 0.93-0.98) for continuous variables.
CONCLUSIONS
Handgrip strength has a predictive validity for decline in cognition, mobility, functional status and mortality in older community-dwelling populations.
Topics: Age Factors; Aged; Cognition; Geriatric Assessment; Hand Strength; Humans; Middle Aged; Mobility Limitation; Mortality; Predictive Value of Tests; Prognosis
PubMed: 26016893
DOI: 10.1111/ggi.12508 -
The Journals of Gerontology. Series A,... Apr 2022A systematic review and meta-analysis was performed to evaluate the short- and long-term effects of exercise therapy on physical function, independence, and well-being... (Meta-Analysis)
Meta-Analysis
Exercise Therapy Is Effective at Improving Short- and Long-Term Mobility, Activities of Daily Living, and Balance in Older Patients Following Hip Fracture: A Systematic Review and Meta-Analysis.
BACKGROUND
A systematic review and meta-analysis was performed to evaluate the short- and long-term effects of exercise therapy on physical function, independence, and well-being in older patients following hip fracture and, secondly, whether the effect was modified by trial-level characteristics such as intervention modality, duration, and initiation timepoint.
METHOD
Medline, CENTRAL, Embase, CINAHL, and PEDro were searched up to November 2020. Eligibility criteria were randomized controlled trials investigating the effect of exercise therapy on physical function, independence, and well-being in older patients following hip fracture, initiated from time of surgery up to 1 year.
RESULTS
Forty-nine studies involving 3 905 participants showed a small-to-moderate effect of exercise therapy at short term (end of intervention) on mobility (standardized mean difference [SMD] 0.49, 95% confidence interval [CI]: 0.22-0.76); activities of daily living (ADL) (SMD 0.31, 95% CI: 0.16-0.46); lower limb muscle strength (SMD 0.36, 95% CI: 0.13-0.60); and balance (SMD 0.34, 95% CI: 0.14-0.54). At long term (closest to 1 year), small-to-moderate effects were found for mobility (SMD 0.74, 95% CI: 0.15-1.34), ADL (SMD 0.42, 95% CI: 0.23-0.61), balance (SMD 0.50, 95% CI: 0.07-0.94), and health-related quality of life (SMD 0.31, 95% CI: 0.03-0.59). Certainty of evidence was evaluated using Grading of Recommendations Assessment, Development and Evaluation ranging from moderate to very low, due to study limitation and inconsistency.
CONCLUSION
We found low certainty of evidence for a moderate effect of exercise therapy on mobility in older patients following hip fracture at end of treatment and follow-up. Further, low evidence was found for small-to-moderate short-term effect on ADL, lower limb muscle strength and balance.
CLINICAL TRIALS REGISTRATION NUMBER
CRD42020161131.
Topics: Activities of Daily Living; Aged; Exercise Therapy; Hip Fractures; Humans; Quality of Life; Randomized Controlled Trials as Topic
PubMed: 34387664
DOI: 10.1093/gerona/glab236 -
British Journal of Sports Medicine Mar 2016To determine the effect of structured exercise on overall mobility in people after hip fracture. To explore associations between trial-level characteristics and overall... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
To determine the effect of structured exercise on overall mobility in people after hip fracture. To explore associations between trial-level characteristics and overall mobility.
DESIGN
Systematic review, meta-analysis and meta-regression.
DATA SOURCES
MEDLINE, EMBASE, CINAHL, the Cochrane Central Register of Controlled Trials, the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register and the Physiotherapy Evidence Database to May 2014.
STUDY ELIGIBILITY CRITERIA, PARTICIPANTS AND INTERVENTIONS
Randomised controlled trials of structured exercise, which aimed to improve mobility compared with a control intervention in adult participants after surgery for hip fracture were included.
DATA EXTRACTION AND SYNTHESIS
Data were extracted by one investigator and checked by an independent investigator. Standardised mean differences (SMD) of overall mobility were meta-analysed using random effects models. Random effects meta-regression was used to explore associations between trial-level characteristics and overall mobility.
RESULTS
13 trials included in the meta-analysis involved 1903 participants. The pooled Hedges' g SMD for overall mobility was 0.35 (95% CI 0.12 to 0.58, p=0.002) in favour of the intervention. Meta-regression showed greater treatment effects in trials that included progressive resistance exercise (change in SMD=0.58, 95% CI 0.17 to 0.98, p=0.008, adjusted R2=60%) and delivered interventions in settings other than hospital alone (change in SMD=0.50, 95% CI 0.08 to 0.93, p=0.024, adjusted R2=49%).
CONCLUSIONS AND IMPLICATIONS
Structured exercise produced small improvements on overall mobility after hip fracture. Interventions that included progressive resistance training and were delivered in other settings were more effective, although the latter may have been confounded by duration of interventions.
Topics: Activities of Daily Living; Exercise Therapy; Hip Fractures; Humans; Mobility Limitation; Physical Therapy Modalities; Postural Balance; Quality of Life; Randomized Controlled Trials as Topic; Resistance Training; Walking
PubMed: 26036676
DOI: 10.1136/bjsports-2014-094465 -
Disability and Rehabilitation.... Oct 2023The overall aim of this systematic review was to identify and synthesise the best available evidence on effectiveness, resource use and costs involved in wheelchair...
OBJECTIVE
The overall aim of this systematic review was to identify and synthesise the best available evidence on effectiveness, resource use and costs involved in wheelchair interventions of adults with mobility limitations.
METHODOLOGY
This systematic review was undertaken in accordance with the Centre for Reviews and Dissemination Guidelines. The protocol for this systematic review was registered with PROSPERO International Prospective Register of Systematic reviews. The following PICOS eligibility criteria were considered: (P) Population was individuals with mobility limitations that live in their community (e.g., non-institutionalized), with aged 18 or older; (I) Intervention was mobility assistive technologies (MAT), such as manual and powered wheelchairs; (C) Comparators (Not Applied); (O) Outcome, the primary outcome of interest, was established as the cost-effectiveness of wheelchair interventions. Direct and indirect costs per unit of effect were expressed in terms of clinical outcome units, quality-adjusted life years gained, utility scores, quality of life measures and incremental cost-effectiveness ratios to inform the economic outcomes. (S) Study design was considered as a health economic evaluation (i.e., including cost-effectiveness analysis, cost-utility analysis and cost benefit analysis as well as partial economic evaluations). The Consolidated Health Economic Evaluation Reporting Standards - CHEERS, checklist was used for summarising and interpreting the results of economic evaluations.
RESULTS
Sixteen studies were included, two were identified as full health economic evaluations and 14 were considered partial health economic evaluations.
CONCLUSION
Only two full health economic analyses of wheelchair interventions have been conducted and both focussed on powered wheelchair provision. There are important gaps in current knowledge regarding wheelchair health economic methods and available outcome measures, which there is a great need for further research.Implication for RehabilitationSystematic reviews of health economic evaluation studies are useful for synthesising economic evidence about health interventions and provide insight in new research development.Organisations involved in the provision of wheelchairs should apply cost-effectiveness outcome measures to help raise the standard of provision, to support evidence-based practice, and to improve resource utilisation.
Topics: Humans; Cost-Benefit Analysis; Mobility Limitation; Quality of Life; Wheelchairs
PubMed: 34753399
DOI: 10.1080/17483107.2021.1993360 -
Annals of Physical and Rehabilitation... Feb 2023Wearable exoskeletons are a recently developed technology. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Wearable exoskeletons are a recently developed technology.
OBJECTIVES
The present systematic review aimed to investigate the effect of a wearable exoskeleton on post-stroke walking by considering its use in a gait training system and simply as an orthosis assisting walking.
METHODS
We systematically searched for randomised and quasi-randomised controlled trials in PubMed, Scopus, CINAHL and Embase databases from their earliest publication record to July 2021. We chose reports of trials investigating the effects of exoskeleton-assisted training or the effects of wearing an exoskeleton to assist walking. A meta-analysis was conducted to explore the benefits of the wearable exoskeleton on mobility capacity, walking speed, motor function, balance, endurance and activities of daily living.
RESULTS
We included 13 studies (492 participants) comparing exoskeleton-assisted training with dose-matched conventional gait training. Studies addressing the effect of wearing a wearable exoskeleton were unavailable. As compared with conventional gait training at the end of the intervention, exoskeleton-assisted training was superior for walking speed (mean difference [MD] 0.13 m/s, 95% CI 0.05; 0.21) and balance (standardized MD [SMD] 0.3, 95% CI 0.07; 0.54). The subgroup with chronic stroke (i.e., > 6 months) presented the outcome favouring exoskeleton-assisted training regarding overall mobility capacity (SMD 0.37, 95% CI 0.04; 0.69). At the end of follow-up, exoskeleton-assisted training was superior to conventional gait training in overall mobility (SMD 0.45, 95% CI 0.07; 0.84) and endurance (MD 46.23 m, 95% CI 9.90; 82.56).
CONCLUSIONS
Exoskeleton-assisted training was superior to dose-matched conventional gait training in several gait-related outcomes at the end of the intervention and follow-up in this systematic review and meta-analysis, which may support the use of exoskeleton-assisted training in the rehabilitation setting. Whether wearing versus not wearing a wearable exoskeleton is beneficial during walking remains unknown.
Topics: Humans; Exoskeleton Device; Activities of Daily Living; Stroke Rehabilitation; Gait; Stroke; Walking; Wearable Electronic Devices
PubMed: 35525427
DOI: 10.1016/j.rehab.2022.101674