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Dementia and Geriatric Cognitive... 2018Impairments of gait and balance often progress through the course of dementia, and are associated with increased risk of falls.
BACKGROUND
Impairments of gait and balance often progress through the course of dementia, and are associated with increased risk of falls.
SUMMARY
This systematic review provides a critical analysis of the evidence linking quantitative measures of gait and balance to fall risk in older adults with dementia. Various instrumented measures of gait and postural stability including gait speed and non-instrumented performance measures including Timed Up and Go were shown to be capable of distinguishing fallers from non-fallers. Key Messages: Existing reviews indicate that impairments of gait and balance are associated with increased risk of falls in cognitively intact older people. There are inconsistencies, however, regarding the characteristics most predictive of a fall. In order to advance fall prevention efforts, there is an important need to understand the relationship between gait, balance, and fall risk, particularly in high-risk populations such as individuals with dementia.
Topics: Accidental Falls; Aged; Aged, 80 and over; Dementia; Female; Gait; Geriatric Assessment; Humans; Male; Mobility Limitation; Postural Balance; Reproducibility of Results; Risk Assessment; Risk Factors
PubMed: 30041187
DOI: 10.1159/000490850 -
Brain and Behavior Jul 2018Physical fitness training after stroke is recommended in guidelines across the world, but evidence pertains mainly to ambulatory stroke survivors. Nonambulatory stroke... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Physical fitness training after stroke is recommended in guidelines across the world, but evidence pertains mainly to ambulatory stroke survivors. Nonambulatory stroke survivors (FAC score ≤2) are at increased risk of recurrent stroke due to limited physical activity. This systematic review aimed to synthesize evidence regarding case fatality, effects, experiences, and feasibility of fitness training for nonambulatory stroke survivors.
METHODS
Eight major databases were searched for any type of study design. Two independent reviewers selected studies, extracted data, and assessed study quality, using published tools. Random-effects meta-analysis was used. Following their separate analysis, qualitative and quantitative data were synthesized using a published framework.
RESULTS
Of 13,614 records, 33 studies involving 910 nonambulatory participants met inclusion criteria. Most studies were of moderate quality. Interventions comprised assisted walking (25 studies), cycle ergometer training (5 studies), and other training (3 studies), mainly in acute settings. Case fatality did not differ between intervention (1.75%) and control (0.88%) groups (95% CI 0.13-3.78, p = 0.67). Compared with control interventions, assisted walking significantly improved: fat mass, peak heart rate, peak oxygen uptake and walking endurance, maximum walking speed, and mobility at intervention end, and walking endurance, balance, mobility, and independent walking at follow-up. Cycle ergometry significantly improved peak heart rate, work load, peak ventilation, peak carbon dioxide production, HDL cholesterol, fasting insulin and fasting glucose, and independence at intervention end. Effectiveness of other training could not be established. There were insufficient qualitative data to draw conclusions about participants' experiences, but those reported were positive. There were few intervention-related adverse events, and dropout rate ranged from 12 to 20%.
CONCLUSIONS
Findings suggest safety, effectiveness, and feasibility of adapted fitness training for screened nonambulatory stroke survivors. Further research needs to investigate the clinical and cost-effectiveness as well as experiences of fitness training-especially for chronic stroke survivors in community settings.
Topics: Adult; Exercise Therapy; Female; Humans; Mobility Limitation; Physical Fitness; Research Design; Stroke; Stroke Rehabilitation; Survivors
PubMed: 29920979
DOI: 10.1002/brb3.1000 -
Developmental Medicine and Child... Oct 2018To identify and critically appraise standardized measures of power mobility skill used with children (18y or younger) with mobility limitations and explore the measures'... (Review)
Review
AIM
To identify and critically appraise standardized measures of power mobility skill used with children (18y or younger) with mobility limitations and explore the measures' application for 'exploratory', 'operational', and 'functional' learners.
METHOD
Five electronic databases were searched along with hand-searching for peer-reviewed articles published in English to July 2017 (updated 31st August 2017). Key terms included power(ed) mobility, power(ed) wheelchair, and database-specific terms. Studies included at least one child with a disability, and a detailed description of the measure of power mobility skill. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was followed with inclusion criteria set a priori. Two reviewers independently screened titles, abstracts, and full-text articles.
RESULTS
Of 96 titles, 24 articles met inclusion criteria, describing nine measures of power mobility skill. The Wheelchair Skills Checklist, the Powered Mobility Program (PMP), and the Power Mobility Training Tool were augmented by three adaptations of the PMP. Two additional measures were further developed to create a third, the Assessment of Learning Powered mobility use. Validity evidence related primarily to content development while reliability evidence was reported on only two measures.
INTERPRETATION
All measures are in the initial stages of development and testing. Research investigating the measures' appropriateness for different types of learners and environments is warranted.
WHAT THIS PAPER ADDS
There are four distinct measures of paediatric power mobility skill: three task-based, one process-based. Power mobility learners may be divided into three groups: exploratory, operational, and functional. Application of measures of power mobility skill differs for these three groups.
Topics: Adolescent; Child; Disabled Children; Humans; Learning; Mobility Limitation; Motor Skills; Wheelchairs
PubMed: 29542110
DOI: 10.1111/dmcn.13709 -
European Journal of Physical and... Aug 2018Musculoskeletal disorders (MSDs) are a burden on the healthcare system. Exercise therapy is an important part of MSD rehabilitation. Motion detection systems are... (Review)
Review
INTRODUCTION
Musculoskeletal disorders (MSDs) are a burden on the healthcare system. Exercise therapy is an important part of MSD rehabilitation. Motion detection systems are developed to support exercise therapy settings. This systematic review aimed: 1) at investigating which types of motion detection systems have been used as a technological support for exercise therapy; 2) at investigating the characteristics of motion detection supported exercise therapy in relation to its clinical indications; and 3) at evaluating the effectiveness of motion detection supported exercise therapy, in MSD rehabilitation.
EVIDENCE AQCUISITION
A systematic literature search for RCTs was performed in six databases (PubMed, CINAHL, EMBASE, ACM, Cochrane, and IEEE). Studies eligible for inclusion had to evaluate exercise therapy for persons with MSDs, provide a motion detection system capable of as well measuring active movement of the participant during exercise therapy as evaluating the movement in order to provide qualitative feedback, and should present at least one measure of the following ICF function (pain, muscle strength, mobility), activity (disease-related functional disability, balance) or participation (quality of life) level. Two reviewers independently screened articles, appraised study quality, extracted data, and evaluated effectiveness of selected outcome measures. This review was registered in the International prospective register of systematic reviews (Prospero) under registration number CRD42016035273.
EVIDENCE SYNTHESIS
Nine RCTs (N.=432 participants) were included. Eight different motion detection technologies were used such as an accelerometer, gyroscope, magnetometer etc. All systems provided visual feedback. Knee disorders were evaluated most frequently, followed by low back pain and shoulder disorders. Therapy consisted of mobility, balance or proprioception exercises. Main outcomes were pain, disability, mobility and muscle strength. Motion detection supported exercise therapy showed similar or enhanced results on all outcomes compared to conventional exercise therapy. However, a limitation of this study was the low methodological quality of the studies.
CONCLUSIONS
To date, a variety of motion detection systems have been developed to support the rehabilitation of MSDs. Results show similar effectiveness of motion detection supported exercise therapy compared to conventional exercise therapy. More research is needed to provide insight in the added value of motion detection systems in musculoskeletal rehabilitation.
Topics: Evidence-Based Medicine; Exercise Therapy; Female; Humans; Male; Motion Perception; Muscle Strength; Musculoskeletal Diseases; Musculoskeletal Manipulations; Pain Measurement; Randomized Controlled Trials as Topic; Recovery of Function; Sensitivity and Specificity; Treatment Outcome
PubMed: 29517185
DOI: 10.23736/S1973-9087.18.04614-2 -
Journal of Physiotherapy Jan 2018Does physical exercise training improve physical function and quality of life in people with cognitive impairment and dementia? Which training protocols improve physical... (Meta-Analysis)
Meta-Analysis
QUESTION
Does physical exercise training improve physical function and quality of life in people with cognitive impairment and dementia? Which training protocols improve physical function and quality of life? How do cognitive impairment and other patient characteristics influence the outcomes of exercise training?
DESIGN
Systematic review with meta-analysis of randomised trials.
PARTICIPANTS
People with mild cognitive impairment or dementia as the primary diagnosis.
INTERVENTION
Physical exercise.
OUTCOME MEASURES
Strength, flexibility, gait, balance, mobility, walking endurance, dual-task ability, activities of daily living, quality of life, and falls.
RESULTS
Forty-three clinical trials (n=3988) were included. According to the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) system, the meta-analyses revealed strong evidence in support of using supervised exercise training to improve the results of 30-second sit-to-stand test (MD 2.1 repetitions, 95% CI 0.3 to 3.9), step length (MD 5cm, 95% CI 2 to 8), Berg Balance Scale (MD 3.6 points, 95% CI 0.3 to 7.0), functional reach (3.9cm, 95% CI 2.2 to 5.5), Timed Up and Go test (-1second, 95% CI -2 to 0), walking speed (0.13m/s, 95% CI 0.03 to 0.24), and 6-minute walk test (50m, 95% CI 18 to 81) in individuals with mild cognitive impairment or dementia. Weak evidence supported the use of exercise in improving flexibility and Barthel Index performance. Weak evidence suggested that non-specific exercise did not improve dual-tasking ability or activity level. Strong evidence indicated that exercise did not improve quality of life in this population. The effect of exercise on falls remained inconclusive. Poorer physical function was a determinant of better response to exercise training, but cognitive performance did not have an impact.
CONCLUSION
People with various levels of cognitive impairment can benefit from supervised multi-modal exercise for about 60minutes a day, 2 to 3days a week to improve physical function. [Lam FMH , Huang MZ, Liao LR, Chung RCK, Kwok TCY, Pang MYC (2018) Physical exercise improves strength, balance, mobility, and endurance in people with cognitive impairment and dementia: a systematic review. Journal of Physiotherapy 64: 4-15].
Topics: Accidental Falls; Activities of Daily Living; Cognitive Dysfunction; Dementia; Exercise; Humans; Mobility Limitation; Muscle Strength; Physical Endurance; Postural Balance; Quality of Life
PubMed: 29289581
DOI: 10.1016/j.jphys.2017.12.001 -
Cancer Treatment Reviews Dec 2017People with cancer frequently report limitation in Activities of Daily Living (ADLs); essential activities required to live independently within society. Although... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
People with cancer frequently report limitation in Activities of Daily Living (ADLs); essential activities required to live independently within society. Although several studies have assessed ADL related disability, variability in assessment, setting, and population means evidence is difficult to interpret. We aimed to determine the prevalence of ADL related disability, overall and by setting, and the most commonly affected ADLs in people living with cancer.
METHODS
We searched twelve databases to June 2016 for observational studies assessing ADL disability in adults with cancer. Data on study design, population, ADL instruments and disability (difficulty with or requiring assistance in ≥1 activity) were extracted, summarised, and pooled to estimate disability prevalence with 95% confidence intervals (95% CI) overall and by setting.
RESULTS
Forty-three studies comprising 19,246 patients were included. Overall, 36.7% (95% CI 29.8-44.3, 18 studies) and 54.6% (95% CI 46.5-62.3, 15 studies) of patients respectively reported disability relating to basic and instrumental ADLs. Disability was marginally more prevalent in inpatient compared to outpatient settings. The Katz Index (18 studies) and Lawton IADL Scale (11 studies) were the most commonly used instruments. Across the activities studied, the most frequently affected basic ADLs were personal hygiene, walking and transfers, and instrumental ADLs were housework, shopping and transportation.
CONCLUSIONS
About one-third and half of adults with cancer respectively have difficulty or require assistance to perform basic and instrumental ADLs. These findings highlight the need for rehabilitation focused on functional independence, and underscore the importance of professionals skilled in occupational assessment and therapy within cancer services.
Topics: Activities of Daily Living; Aged; Aged, 80 and over; Disability Evaluation; Disabled Persons; Humans; Middle Aged; Neoplasms
PubMed: 29125982
DOI: 10.1016/j.ctrv.2017.10.006 -
International Journal of Rehabilitation... Dec 2017Older adults with reduced physical capacity are at greater risk of progression to care dependency. Progressive resistance strength exercise and multimodal exercise have... (Meta-Analysis)
Meta-Analysis Review
Older adults with reduced physical capacity are at greater risk of progression to care dependency. Progressive resistance strength exercise and multimodal exercise have been studied to restore reduced physical capacity. To summarize the best evidence of the two exercise regimes, this meta-analysis study appraised randomized-controlled trials from published systematic reviews. Medline, Embase, and the Cochrane Database of Systematic Review and Cochrane Central Register of Controlled Clinical Trials were searched for relevant systematic reviews. Two reviewers independently screened the relevant systematic reviews to identify eligible trials, assessed trial methodological quality, and extracted data. RevMan 5.3 software was used to analyze data on muscle strength, physical functioning, activities of daily living, and falls. Twenty-three eligible trials were identified from 22 systematic reviews. The mean age of the trial participants was 75 years or older. Almost all multimodal exercise trials included muscle strengthening exercise and balance exercise. Progressive resistance exercise is effective in improving muscle strength of the lower extremity and static standing balance. Multimodal exercise is effective in improving muscle strength of the lower extremity, dynamic standing balance, gait speed, and chair stand. In addition, multimodal exercise is effective in reducing falls. Neither type of exercise was effective in improving activities of daily living. For older adults with reduced physical capacity, multimodal exercise appears to have a broad effect on improving muscle strength, balance, and physical functioning of the lower extremity, and reducing falls relative to progressive resistance exercise alone.
Topics: Accidental Falls; Aged; Disabled Persons; Exercise Therapy; Gait; Humans; Mobility Limitation; Muscle Strength; Muscle Weakness; Postural Balance; Walking Speed
PubMed: 29023317
DOI: 10.1097/MRR.0000000000000249 -
Clinical & Experimental Optometry Jul 2018Many patient-reported outcome measures (PROMs) have been developed and/or used to measure the impact of amblyopia and strabismus on quality of life (QoL). Identifying...
BACKGROUND
Many patient-reported outcome measures (PROMs) have been developed and/or used to measure the impact of amblyopia and strabismus on quality of life (QoL). Identifying the one with superior quality is important for evaluating the effectiveness of novel therapy for amblyopia and for directing improved clinical decision-making in adults considering strabismic surgery. Therefore, the aim of this review is to identify all PROMs previously developed/used to study the impact of amblyopia and/or strabismus on QoL and to appraise the quality and comprehensiveness of content of the disease-specific instruments.
METHODS
A systematic search was carried out in the electronic databases of PubMed, Cochrane, Web of Science and PsycINFO. The quality of content and measurement properties of all the disease-specific instruments were assessed using established quality standards. Further, the content of the instruments were examined for comprehensiveness by categorising each item across the eight ophthalmic QoL domains (activity limitation, concerns, emotional well-being, social well-being, economic, convenience, symptoms and mobility).
RESULTS
Seventy-one PROMs were identified, out of which 32 were amblyopia- and/or strabismus-specific. Out of all the disease-specific instruments, just four have been subjected to modern psychometric tests and only the adult strabismus questionnaire (AS-20) demonstrated good measurement properties. Most of the amblyopia-specific instruments measured the impact of the treatment of amblyopia on children, while most of the strabismus-specific instruments measured concerns related to appearance and treatment outcome in adults. All instruments have gaps in their content and failed to address QoL comprehensively.
CONCLUSION
All the existing amblyopia- and/or strabismus-specific instruments fall short of desired quality and/or comprehensiveness of content. The review identifies the need for developing an instrument with superior quality and discusses potential directions of future research.
Topics: Amblyopia; Databases, Factual; Humans; Patient Reported Outcome Measures; Psychometrics; Quality of Life; Strabismus; Surveys and Questionnaires
PubMed: 28636173
DOI: 10.1111/cxo.12553 -
Archives of Physical Medicine and... Aug 2017To examine the effect of home- and community-based physical activity interventions on physical functioning among cancer survivors based on the most prevalent physical... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To examine the effect of home- and community-based physical activity interventions on physical functioning among cancer survivors based on the most prevalent physical function measures, randomized trials were reviewed.
DATA SOURCES
Five electronic databases-Medline Ovid, PubMed, CINAHL, Web of Science, and PsycINFO-were searched from inception to March 2016 for relevant articles.
STUDY SELECTION
Search terms included community-based interventions, physical functioning, and cancer survivors. A reference librarian trained in systematic reviews conducted the final search.
DATA EXTRACTION
Four reviewers evaluated eligibility and 2 reviewers evaluated methodological quality. Data were abstracted from studies that used the most prevalent physical function measurement tools-Medical Outcomes Study 36-Item Short-Form Health Survey, Late-Life Function and Disability Instrument, European Organisation for the Research and Treatment of Cancer Quality-of-Life Questionnaire, and 6-minute walk test. Random- or fixed-effects models were conducted to obtain overall effect size per physical function measure.
DATA SYNTHESIS
Fourteen studies met inclusion criteria and were used to compute standardized mean differences using the inverse variance statistical method. The median sample size was 83 participants. Most of the studies (n=7) were conducted among breast cancer survivors. The interventions produced short-term positive effects on physical functioning, with overall effect sizes ranging from small (.17; 95% confidence interval [CI], .07-.27) to medium (.45; 95% CI, .23-.67). Community-based interventions that met in groups and used behavioral change strategies produced the largest effect sizes.
CONCLUSIONS
Home and community-based physical activity interventions may be a potential tool to combat functional deterioration among aging cancer survivors. More studies are needed among other cancer types using clinically relevant objective functional measures (eg, gait speed) to accelerate translation into the community and clinical practice.
Topics: Breast Neoplasms; Community Health Services; Disability Evaluation; Exercise; Health Promotion; Humans; Mobility Limitation; Neoplasms; Quality of Life; Randomized Controlled Trials as Topic; Residence Characteristics; Survivors
PubMed: 28427925
DOI: 10.1016/j.apmr.2017.03.017 -
Medicine Mar 2017The aim of this review is to synthesize the evidence on the effects of aquatic exercise interventions on physical function and fitness among people with spinal cord... (Review)
Review
OBJECTIVE
The aim of this review is to synthesize the evidence on the effects of aquatic exercise interventions on physical function and fitness among people with spinal cord injury.
DATA SOURCE
Six major databases were searched from inception till June 2015: MEDLINE, CINAHL, EMBASE, PsychInfo, SPORTDiscus, and Cochrane Center Register of Controlled Trials.
STUDY APPRAISAL AND SYNTHESIS METHODS
Two reviewers independently rated methodological quality using the modified Downs and Black Scale and extracted and synthesized key findings (i.e., participant characteristics, study design, physical function and fitness outcomes, and adverse events).
RESULTS
Eight of 276 studies met the inclusion criteria, of which none showed high research quality. Four studies assessed physical function outcomes and 4 studies evaluated aerobic fitness as outcome measures. Significant improvements on these 2 outcomes were generally found. Other physical or fitness outcomes including body composition, muscular strength, and balance were rarely reported.
CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS
There is weak evidence supporting aquatic exercise training to improve physical function and aerobic fitness among adults with spinal cord injury. Suggestions for future research include reporting details of exercise interventions, evaluating other physical or fitness outcomes, and improving methodological quality.
Topics: Body Composition; Exercise; Health Status; Humans; Mobility Limitation; Muscle Strength; Physical Fitness; Postural Balance; Spinal Cord Injuries; Swimming; Water
PubMed: 28296754
DOI: 10.1097/MD.0000000000006328