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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 -
The Cochrane Database of Systematic... Sep 2010Contractures are a common complication of neurological and musculoskeletal conditions, and are characterised by a reduction in joint mobility. Stretch is widely used for... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Contractures are a common complication of neurological and musculoskeletal conditions, and are characterised by a reduction in joint mobility. Stretch is widely used for the treatment and prevention of contractures. However, it is not clear whether stretch is effective.
OBJECTIVES
To determine the effects of stretch on contractures in people with, or at risk of, contractures.
SEARCH STRATEGY
Electronic searches were conducted on CENTRAL, DARE, HTA (The Cochrane Library); MEDLINE; CINAHL; EMBASE; SCI-EXPANDED; and PEDro (April 2009).
SELECTION CRITERIA
Randomised controlled trials and controlled clinical trials of stretch applied for the purpose of treating or preventing contractures were included.
DATA COLLECTION AND ANALYSIS
Two review authors independently selected trials, extracted data, and assessed risk of bias. The primary outcomes of interest were joint mobility and quality of life. The secondary outcomes were pain, spasticity, activity limitation and participation restriction. Outcomes were evaluated immediately after intervention, in the short term (one to seven days) and in the long term (> one week). Effects were expressed as mean differences or standardised mean differences with 95% confidence intervals (CI). Meta-analyses were conducted with a random-effects model.
MAIN RESULTS
Thirty-five studies with 1391 participants met the inclusion criteria. No study performed stretch for more than seven months. In people with neurological conditions, there was moderate to high quality evidence to indicate that stretch does not have clinically important immediate (mean difference 3 degrees ; 95% CI 0 to 7), short-term (mean difference 1 degrees ; 95% CI 0 to 3) or long-term (mean difference 0 degrees ; 95% CI -2 to 2) effects on joint mobility. The results were similar for people with non-neurological conditions. For all conditions, there is little or no effect of stretch on pain, spasticity, activity limitation, participation restriction or quality of life.
AUTHORS' CONCLUSIONS
Stretch does not have clinically important effects on joint mobility in people with, or at risk of, contractures if performed for less than seven months. The effects of stretch performed for periods longer than seven months have not been investigated.
Topics: Contracture; Humans; Joints; Muscle Stretching Exercises; Quality of Life; Randomized Controlled Trials as Topic; Range of Motion, Articular; Time Factors
PubMed: 20824861
DOI: 10.1002/14651858.CD007455.pub2 -
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 -
Journal of Clinical Nursing Nov 2007This paper summarizes the results of a systematic literature review to examine the quality and content of the evidence relating to nursing approaches to improving the... (Review)
Review
AIMS
This paper summarizes the results of a systematic literature review to examine the quality and content of the evidence relating to nursing approaches to improving the mobility and movement of older people.
BACKGROUND
Older people experiencing health breakdown often develop problems with movement and mobility and nurses play a role in helping patients to either adapt to or overcome these difficulties.
METHODS
Electronic searches were undertaken of Medline, CINAHL, Amed and Cochrane Database of systematic reviews. Papers about nursing approaches to promoting mobility and movement were critically appraised using quality assessment checklists. Papers addressing safe moving and handling, falls prevention, health promotion, rehabilitation or teamworking in general were excluded.
RESULTS
Sixteen research and 33 informational papers were included and comprise the review. Many research papers used weak designs and small sample sizes, limiting their ability to control for important confounding variables. Although numerous studies examined effectiveness, only one used a randomised controlled trial design. Papers were grouped into four interlinked sets. These were promoting mobility and preventing immobility; walking and exercise; neuro-developmental principles; and rehabilitation patient handling.
CONCLUSIONS
Specific foci for nursing assessment and interventions to promote patients' mobility have been identified. However, the fragmented nature of the evidence makes it difficult to make recommendations for nursing practice. Future research should be conducted by multi-professional research teams to identify the most effective approaches to promoting patients' mobility and to explore overlaps between different members of the rehabilitation team.
RELEVANCE TO CLINICAL PRACTICE
Regaining the ability to move and walk is often a key concern for patients who have suffered health breakdown. Although nurses provide patients with assistance the evidence available does little to direct nurses as to the best approach towards mobility rehabilitation. It is important that nurses play a role in measuring the efficacy of different interventions to promote rehabilitation.
Topics: Exercise Therapy; Female; Geriatric Nursing; Humans; Male; Mobility Limitation; Quality Assurance, Health Care; Rehabilitation Nursing
PubMed: 17931325
DOI: 10.1111/j.1365-2702.2007.02000.x -
Gait & Posture Oct 2016Ageing is associated with declines in cognitive function and mobility. The extent to which this relationship encompasses the subdomains of cognition and mobility remains... (Meta-Analysis)
Meta-Analysis Review
Ageing is associated with declines in cognitive function and mobility. The extent to which this relationship encompasses the subdomains of cognition and mobility remains unclear, however. We searched MEDLINE and EMBASE databases for cross-sectional studies examining the association between objective mobility measures (gait, lower-extremity function, balance) and cognitive function (global, executive function, memory, processing speed) in healthy older adults. Of the 642 studies identified, 26 studies met the inclusion criteria, with a total of 26,355 participants. For each feature of physical mobility, the relation to each aspect of cognition was reviewed. In the context of each association, we summarised the results to date and performed random-effects meta-analyses of published data. Reviewed findings suggest that individuals with better mobility perform better on assessments of global cognition, executive function, memory and processing speed. Not all measures of mobility were equally associated with cognitive function, however. Although there was a larger number of gait and lower-extremity function studies, and this may have driven findings, most studies examining balance and cognition measures reported no significant results. Meta-analyses on reported associations supported results by revealing significant, albeit small, effect sizes in favour of a positive association between performance on mobility measures and cognitive assessments. Future research should aim to establish the mechanisms driving this relationship, as this may identify predictors of age-related impairments.
Topics: Aged; Cognition; Cognitive Aging; Cross-Sectional Studies; Executive Function; Gait; Humans; Lower Extremity; Memory; Mobility Limitation; Postural Balance
PubMed: 27621086
DOI: 10.1016/j.gaitpost.2016.08.028 -
Archives of Physical Medicine and... Jun 2017To synthesize the evidence for differences in cognitive motor interference (CMI) between persons with multiple sclerosis (MS) and those without MS by using systematic... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To synthesize the evidence for differences in cognitive motor interference (CMI) between persons with multiple sclerosis (MS) and those without MS by using systematic review and meta-analysis.
DATA SOURCES
EMBASE, PubMed, ScienceDirect, Scopus, SPORTDiscus, and Web of Science. Our focused literature search was informed by past systematic reviews of CMI during walking in MS.
STUDY SELECTION
The key terms searched included Multiple sclerosis and synonyms of motor function (eg, Gait disorders, Gait, Walking, Balance, or Fall) and motor and cognitive functions (eg, Cognitive motor interference or Thinking).
DATA EXTRACTION
From the 116 abstract-identified articles, 13 experimental studies were selected for the final analysis and were rated using the Quality Assessment of Diagnostic Accuracy Studies tool. A meta-analysis was performed for all considered outcomes.
DATA SYNTHESIS
The results yielded a small overall effect size (ES) of .08 (SE=.17; 95% confidence interval, -.25 to .40; z=.49; P>.05), which indicated a nonsignificant minimal difference in CMI between persons with MS and those without MS. The moderator analysis for motor task (mobility task: ES, .22; postural task: ES, -.11) was not significantly different between persons with MS and those without MS. The moderator analysis for cognitive task (verbal fluency task: ES, .66; mental tracking task: ES, .04; discrimination and decision-making task: ES, -.30) resulted in a significant difference in CMI between persons with MS and those without MS (P<.05).
CONCLUSIONS
We provide evidence that overall there is a minimal difference in CMI between persons with MS and those without MS.
Topics: Cognition; Gait; Humans; Mobility Limitation; Multiple Sclerosis; Physical Therapy Modalities; Postural Balance; Psychomotor Performance; Severity of Illness Index; Walking
PubMed: 27543046
DOI: 10.1016/j.apmr.2016.07.018 -
Journal of Oral Rehabilitation Oct 2023Orthognathic surgery is done to treat a variety of dentofacial abnormalities, but a wide gap still remains on how it can result in temporomandibular joint dysfunction... (Review)
Review
Prevalence of Temporomandibular Disorders in Orthognathic Surgery patients: A systematic review conducted according to PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions.
BACKGROUND
Orthognathic surgery is done to treat a variety of dentofacial abnormalities, but a wide gap still remains on how it can result in temporomandibular joint dysfunction (TMD). The primary goal of this review was to assess the effects of various orthognathic surgical techniques on the emergence or exacerbation of TMJ dysfunction.
METHODS
A comprehensive search was conducted across several databases using Boolean operators and MeSH keywords related to temporomandibular joint disorders (TMDs) and orthognathic surgical interventions, with no limitation on the year of publication. Two independent reviewers screened the identified studies based on predetermined inclusion and exclusion criteria, followed by a risk of bias assessment using a standardised tool.
RESULTS
Five articles were considered for inclusion in this review. A greater number of females opted for surgical options than their male cohorts. Three studies were of prospective design, 1 of retrospective and 1 of observational type. Mobility on lateral excursion, tenderness on palpation, arthralgia and popping sounds were the TMD characteristics that showed significant differences. Overall, orthognathic surgical intervention did not show an increase in TMD signs and symptoms as compared to nonsurgical counterparts.
CONCLUSION
Though orthognathic surgery reported greater cases of some TMD symptoms and signs as compared to the nonsurgical cohorts in four studies, the conclusive evidence is debatable. Further studies are recommended with a longer follow-up period and greater sample size to determine the impact of orthognathic surgery on TMJ.
Topics: Female; Humans; Male; Orthognathic Surgery; Retrospective Studies; Prevalence; Temporomandibular Joint Disorders; Orthognathic Surgical Procedures; Temporomandibular Joint Dysfunction Syndrome
PubMed: 37309105
DOI: 10.1111/joor.13534 -
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 -
Gait & Posture Jan 2017Multiple Sclerosis (MS) results in postural instability and gait abnormalities which are associated with accidental falls. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Multiple Sclerosis (MS) results in postural instability and gait abnormalities which are associated with accidental falls.
OBJECTIVE
This systematic review and meta-analysis aims to quantify the effect of MS on gait to inform the development of falls prevention interventions.
METHODS
A systematic literature search identified case-control studies investigating differences in gait variables between people with MS and healthy controls. Meta-analysis examined the effect of MS on gait under normal and fast paced conditions.
RESULTS
Forty-one studies of people with Expanded Disability Status Scale (EDSS) 1.8 to 4.5 were included, of which 32 contributed to meta-analysis. A large effect of MS was found on stride length (Standardised Mean Difference, SMD=1.27, 95% CI{0.93, 1.61}), velocity (SMD=1.12, 95% CI{0.85, 1.39}), double support duration (SMD=0.85, 95% CI{0.51, 1.2}), step length (SMD=1.15, 95% CI{0.75, 1.5})and swing phase duration (SMD=1.23, 95% CI{0.06, 2.41}). A moderate effect was found on step width and stride time with the smallest effect found on cadence (SMD=0.43, 95% CI{0.14, 0.72}). All effect sizes increased for variables investigated under a fast walking pace condition (for example the effect on cadence increased to SMD=1.15, 95% CI{0.42, 1.88}).
CONCLUSIONS
MS has a significant effect on gait even for those with relatively low EDSS. This effect is amplified when walking at faster speeds suggesting this condition may be more beneficial for assessment and treatment. No studies investigated the association between these deficits and falls. Further investigation relating to the predictive or protective nature of these deficits in relation to falls is warranted.
Topics: Accidental Falls; Case-Control Studies; Gait Disorders, Neurologic; Humans; Mobility Limitation; Multiple Sclerosis; Postural Balance; Walking Speed
PubMed: 27693958
DOI: 10.1016/j.gaitpost.2016.09.026 -
NeuroImage. Clinical 2019Freezing of gait (FOG) is a paroxysmal gait disorder that often occurs at advanced stages of Parkinson's disease (PD). FOG consists of abrupt walking interruption and... (Review)
Review
Freezing of gait (FOG) is a paroxysmal gait disorder that often occurs at advanced stages of Parkinson's disease (PD). FOG consists of abrupt walking interruption and severe difficulty in locomotion with an increased risk of falling. Pathophysiological mechanisms underpinning FOG in PD are still unclear. However, advanced MRI and nuclear medicine studies have gained relevant insights into the pathophysiology of FOG in PD. Neuroimaging studies have demonstrated structural and functional abnormalities in a number of cortical and subcortical brain regions in PD patients with FOG. In this paper, we systematically review existing neuroimaging literature on the structural and functional brain changes described in PD patients with FOG, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We evaluate previous studies using various MRI techniques to estimate grey matter loss and white matter degeneration. Moreover, we review functional brain changes by examining functional MRI and nuclear medicine imaging studies. The current review provides up-to-date knowledge in this field and summarizes the possible mechanisms responsible for FOG in PD.
Topics: Brain; Gait Disorders, Neurologic; Humans; Magnetic Resonance Imaging; Neuroimaging; Parkinson Disease; Positron-Emission Tomography; Tomography, Emission-Computed, Single-Photon
PubMed: 31795038
DOI: 10.1016/j.nicl.2019.102059