Activities-specific Balance Confidence Score Research Articles

Motor and Non-motor Symptoms Associated With Exercise Behavior in Parkinson's Disease Patients: Factors Differ Between Patients With and Without Postural Instability.

Background: Exercise is an important treatment for Parkinson's disease (PD). Therefore, recognizing determinants of exercise behavior for PD based on disease stage is essential. We sought to find whether the determinants differ based on presence of postural instability (PI), which is indicative of disease stage in PD.Methods: We enrolled patients at Samsung Medical Center from September 2019 to November 2020, who had the ability to perform exercise [modified Hoehn and Yahr (HY) stage ≤ 3]. All the motor and non-motor symptoms were investigated. The exercise of the PD patients was evaluated using the Physical Activity Scale of the Elderly (PASE)-leisure score. We classified patients into PD without PI (HY stage 1 – 2) and PD with PI (HY stage 2.5 – 3) groups. Multivariate linear regression was performed using backward elimination in each group to determine factors associated with PASE-leisure score.Results: A total of 233 patients were enrolled. In the PD without PI group (n = 177), the positive determinant of exercise was Activities-Specific Balance Confidence (ABC) score (β = 0.142, p = 0.032), and the negative determinants were fatigue score (β = −0.228, p = 0.018), female (β = −6.900, p = 0.016) and currently employed status (β = −6.072, p = 0.046). In the PD with PI group (n = 56), the positive determinant was non-motor symptom scale (NMSS) score (β = 0.221, p = 0.017) and disease duration (β = 1.001, p = 0.036), while the negative determinants were UPDRS part 3 score (β = −0.974, p < 0.001), UPDRS part 4 score (β = −2.192, p = 0.002), and age (β = −1.052, p < 0.001).Conclusion: Different motor and non-motor symptoms were associated with the exercise in PD patients with and without PI. When encouraging PD patients to exercise, personalized and different strategies should be applied based on the presence of PI.

Walking while talking: validation in older adults with lower-limb amputation.

Walking while talking (WWT) is a dual-task (cognitive and motor) performance test that has not yet been validated in older adults with lower-limb amputation (LLA). WWT is composed of two sections: WWT-simple (walking while reciting every letter of the alphabet) and WWT-complex (walking while reciting every other letter of the alphabet). To determine the validity, and provide normative data and a new scoring system for the WWT test in older adults with LLA. Baseline cross-sectional data were collected from 56 community-living older adults (≥50 years old) with LLA at rehabilitation hospitals in Vancouver, BC, London, ON, and Edmonton, AB, Canada. Time and number of recited letters and errors during both sections were recorded. A new score was developed based on all these variables. Correlations of the recorded times with the Activities-specific Balance Confidence (ABC) scale and the 2-Minute Walk Test (2MWT) score were used to evaluate the validity of the WWT test. As hypothesized, the times for both sections of the WWT were negatively correlated with both the ABC and 2MWT scores. Positive correlations were observed between the scores developed for both WWT sections with the 2MWT score. Times taken to complete each section of the WWT test were correlated with the 2MWT and the ABC scale scores, providing evidence for the validity of the WWT test. We also provided a scoring method that is more objective and in line with the dual-task nature of the test.

Comparisons of tai chi and Iyengar yoga intervention effects on muscle strength, balance, and confidence in balance.

The aim of the study is to compare a 16-week tai chi and Iyengar yoga program effects on muscle strength, static and dynamic balance, and balance confidence in elderly people. A total of 48 participants (≥60 years old) without mobility-impairing neurological disease, dementia, cardiovascular disease/symptoms during moderate exercise, poorly controlled hypertension, or balance-impairing drug use. Participants were divided into a tai chi group, an Iyengar yoga group, and a control group (eight males and eight females per group), using a restricted randomization scheme generated by software. While the former two undertook 16-week exercise programs, the control group received general education. Maximum concentric strength was measured with an isokinetic dynamometer. The one-legged stand with eyes closed, "8 feet up and go," and Activities-specific Balance Confidence (ABC) scale were used to assess static balance, dynamic balance, and balance confidence in daily activities, respectively. Both programs improved all measures significantly with tai chi being more effective for increasing knee flexor strength (P=0.045) and extensor strength (P=0.032) and ABC score (P=0.034); Iyengar yoga was more effective for improving static balance (P=0.014) and dynamic balance (P=0.025; all P values here vs. the other program). Tai chi and Iyengar yoga can improve strength, balance, and balance confidence among older people. Both are suitable exercise choices for older adults.

Utilizing the ZeroG TRiP Module During Inpatient Rehabilitation: Balance Recovery in Acute Stroke Patients – A Pilot Study

<h3>Research Objectives</h3> To determine if inducing safe postural-perturbations with the TRiP-module during standing and ambulation exercises in the ZeroG body-weight support system, more effectively improves patient balance than ZeroG without these perturbations. <h3>Design</h3> Study was an unblinded randomized control pilot study. <h3>Setting</h3> Study was conducted at Gaylord Specialty Healthcare, a long-term acute care rehabilitation hospital located in Wallingford, Connecticut, USA. <h3>Participants</h3> Inpatient stroke rehabilitation patients were considered for the study if their Berg Balance Scale score was ≥ 21/56. Consented participants were randomly assigned to either the ZeroG or ZeroG+TRiP group. <h3>Interventions</h3> ZeroG interventions consisted of balance activities including ambulation, marching, side-stepping, retro-ambulation, step-taps, and step-ups. ZeroG+TRiP interventions included these same activities, with the addition of a sudden and brief assistive or resistive force in the lateral, anterior, or posterior direction. Participants completed eight-sessions over two-weeks, starting at TRiP level-one and progressing to level-ten based on the participant's progress and therapist's discretion. <h3>Main Outcome Measures</h3> The main study outcomes were the Activities-Specific Balance Confidence (ABC) and Berg Balance Scale assessments. <h3>Results</h3> Institutional Berg Balance data from 2018 served as a historical Standard of Care (SOC) baseline. SOC, ZeroG, and ZeroG+TRiP groups displayed improved post-intervention Berg Balance scores (p≤0.0025), however, the post-intervention scores were not different between groups. Calculating the Berg Balance score percent change [mean(SD)n], the ZeroG+TRiP [66.95%(43.78%)14] and ZeroG groups [53.29%(24.13%)15] were significantly greater than the SOC group [28.31%(17.25%)30] (p≤0.0178), with no difference between the ZeroG groups (p=0.6669). The post intervention ABC assessment scores were similarly improved (p≤0.0438), with no difference between ZeroG groups. <h3>Conclusions</h3> Participants in both ZeroG groups demonstrated similar Berg Balance Scale and ABC score improvements, indicating the TRiP Module is not detrimental to post-acute stroke rehabilitation and can be safely used. This pilot-study then provides the rationale for conducting a larger study to better assess if the TRiP protocol provides an additional benefit to stroke patients during inpatient rehabilitation. <h3>Author(s) Disclosures</h3> Aretech, LLC provided financial assistance for protected time to complete the administrative work associated with this pilot study. Authors have no other disclosures.

The Activities-specific Balance Confidence (ABC) Scale in Youth with Visual Impairments: Psychometrics and a Population-specific Short Form

ABSTRACT Falls are a significant medical and economical concern worldwide. Younger individuals with visual impairment (VI) may be more susceptible to falling and fall-related injuries when compared to peers without a VI. Self-perceived balance confidence is a psychological construct that may predict and/or mediate fall- or other health-related outcomes in youth with VI. However, extensive psychometric vetting of falls-related self-efficacy self-report inventories (such as the Activity-specific Balance Confidence Scale [ABC]) have not occurred in youth with VI. In line with classical test theory, the purposes of this study were to examine the immediate measurement properties of ABC scores in youth with VI and to derive and analyze a short version of the ABC in youth with VI (N=101). Total and item-level ABC (and the newly developed ABC-6VI) scores presented with strong-to-acceptable forms/levels of reliability and validity. ABC-6VI scores appear to have certain psychometric limitations (i.e., increased variability; decreased stability).

Patient reported outcomes in ALS: characteristics of the self-entry ALS Functional Rating Scale-revised and the Activities-specific Balance Confidence Scale

Objective: This study characterized two patient-reported outcome measures (PROMs): a patient-facing adaptation of the revised amyotrophic lateral sclerosis (ALS) Functional Rating Scale (“self-entry ALSFRS-R”) and the Activities-specific Balance Confidence (ABC) Scale. Methods: ALS patients presenting to clinic completed PROMs that included (1) the self-entry ALSFRS-R, (2) the Activities-specific Balance Confidence Scale (ABC Scale), and (3) a question about falls. PROM data were compared to one another and to the traditional ALSFRS-R collected by trained evaluators in clinic (“standard ALSFRS-R”). Results: Over the data collection period, 449 ALS patients completed at least one of the three PROMs. Self-entry vs. standard ALSFRS-R total scores (n = 183) had high agreement (intraclass correlation (ICC)=0.81, 95% CI = 0.67, 0.88). Self-entry ALSFRS-R total scores were significantly higher than standard ALSFRS-R total scores (2.3 points, p < 0.001). In a subset of participants who contributed data at two timepoints, the average ALSFRS-R decline was not significantly different between methods (n = 49). ABC scores correlated highly with self-entry and standard ALSFRS-R Gross Motor subdomain scores (Pearson’s r = 0.72, p < 0.001 and Pearson’s r = 0.76, p < 0.001, respectively; n = 130). ABC score was negatively correlated with the number of reported falls within the last month (Spearman’s r=–0.40; p < 0.001; n = 130). A 10-point decrease in ABC score increased odds of a reported fall by 16%. Conclusions: In a multidisciplinary clinic setting, self-entry and standard ALSFRS-R scores were similar, but not interchangeable. Self-entry scores were higher than standard ALSFRS-R scores but declined at a similar rate to the standard ALSFRS-R. ABC scores correlated with self-reported fall history and thus may provide useful data for clinical care.

The Impact of Tai Chi on Motor Function, Balance, and Quality of Life in Parkinson's Disease: A Systematic Review and Meta-Analysis.

Objective Parkinson's disease adversely affects function and quality of life, leading to increased mortality. The practice of Tai Chi has been associated with multifaceted improvements in health-related fitness. Considering the limited number of clinical studies included in previous reviews, inconsistent methodological quality, and inconclusive results, this meta-analysis aims to assess the effects of Tai Chi in patients with Parkinson's disease. Method Four English language databases and four Chinese databases were systematically searched for existing randomized controlled trials (RCTs) of Tai Chi in Parkinson's disease from database inception through August 1, 2020. Methodological quality was appraised with the Cochrane Risk of Bias tool. A meta-analysis of comparative effects was performed using the Review Manager v.5.3 software. Results Seventeen published RCTs totaling 951 subjects were included. Results showed that Tai Chi has a statistically significant effect on the outcomes of gait velocity, unified Parkinson's disease rating scale (UPDRS) motor score, activities-specific balance confidence (ABC) score, and Berg Balance Scale (BBS). The effects on the Timed Up and Go Test (TUGT) and Parkinson's Disease Questionnaire-39 (PDQ-39) were not statistically significant. Conclusions This systematic review and meta-analysis of Parkinson's disease and Tai Chi suggests Tai Chi is a relatively safe activity that can result in gains in general motor function and improve bradykinesia and balance. It has no statistically significant advantage for quality of life and functional mobility. Further randomized trials with larger sample sizes and of higher methodological quality are needed to confirm these results and to assess the feasibility of Tai Chi intervention for potential different clinical applications.

Can Dizziness Handicap Inventory and Activities-Specific Balance Confidence Scores Assess Vestibular Loss After Vestibular Schwannoma Excision?

Evaluate and compare the Dizziness Handicap Inventory with Activities-specific Balance Confidence scores shortly after vestibular schwannoma excision. Retrospective database review. Tertiary care center. Adults undergoing vestibular schwannoma excision between January 2015 and December 2019. Diagnostic, therapeutic, and rehabilitative. Postoperative change in Dizziness Handicap Inventory scores and Activities-specific Balance Confidence scores 2 to 3 weeks after surgical intervention in relation to preoperative vestibular testing. A total of 49 patients met inclusion criteria. The average change in the Dizziness Handicap Inventory was 6 (p = 0.07, 95% CI 0-13). This was weakly correlated to preoperative caloric testing values (r = -0.31, p = 0.03), but not cervical vestibular evoked myogenic potentials (cVEMP) values (r = -0.17, p = 0.23). The average change in Activities-specific Balance Confidence was -10% (p = 0.007, 95% CI -3 to -17%). This change was moderately correlated with preoperative caloric values (r = 0.42, p = 0.006), but it was not correlated with cVEMP (r = 0.07, p = 0.66). In vestibular schwannoma patients, factors other than preoperative vestibular function likely affect postoperative Dizziness Handicap Inventory and Activities-specific Balance Confidence scores. The change in Activities-specific Balance Confidence was slightly more consistent with expected physiological vestibular loss, and it represents another tool in a multidisciplinary vestibular evaluation of the postoperative patient.

Vestibular rehabilitation therapy in combination with transcranial direct current stimulation (tDCS) for treatment of chronic vestibular dysfunction in the elderly: a double-blind randomized controlled trial

IntroductionDizziness and imbalance are common dysfunctions in the elderly. Vestibular rehabilitation therapy is an effective method to alleviate chronic dizziness in patients with vestibular dysfunction. Transcranial direct current stimulation has reportedly improved balance function in patients with vestibular dysfunction. ObjectiveThis study was conducted to investigate the therapeutic efficacy of vestibular rehabilitation combined with transcranial direct current stimulation in elderly patients with vestibular dysfunction. MethodsIn a double-blinded randomized controlled trial, 36 elderly patients with chronic vestibular dysfunction were randomly assigned to either vestibular rehabilitation and transcranial direct current stimulation (n = 18) or vestibular rehabilitation alone (n = 18) group. The transcranial stimulation protocol consisted of multisession bifrontal electrical stimulation of the dorsolateral prefrontal cortex (2 mA intensity and 20 min duration), followed by rehabilitation exercises. The vestibular rehabilitation protocol consisted of habituation and adaptation exercises combined with gait exercises during a three week period. The primary outcome of this study was the dizziness handicap inventory score, and the secondary outcomes were activities-specific balance confidence and Beck anxiety inventory scores. ResultsFor the dizziness handicap score, the repeated-measures analysis of variance showed a significant main effect of “time”, “stimulation” and stimulation × time interaction effect. There was a significant reduction in the overall dizziness handicap score with “time” for both the groups, which was more pronounced in the vestibular rehabilitation and electrical stimulation group. In terms of activities-specific balance confidence change scores, we found a significant main effect of “time” and “stimulation” main factors, but this effect for stimulation × time interaction was not significant. For the Beck anxiety score, we observed a significant main effect of “time”, but no evidence for the main effect of the “stimulation” factor. ConclusionBifrontal transcranial direct current stimulation in combination with vestibular rehabilitation therapy is a promising approach to improve chronic vestibular symptoms in the elderly.

The Effects of a Wearable Sensory Prosthesis on Gait and Balance Function After 10 Weeks of Use in Persons With Peripheral Neuropathy and High Fall Risk - The walk2Wellness Trial.

BackgroundSensory peripheral neuropathy (PN) is associated with gait, balance problems and high fall risk. The walk2Wellness trial investigates effects of long-term, home-based daily use of a wearable sensory prosthesis on gait function, balance, quality of life and fall rates in PN patients. The device (Walkasins®, RxFunction Inc., MN, United States) partially substitutes lost nerve function related to plantar sensation providing directional tactile cues reflecting plantar pressure measurements during standing and walking. We tested the null hypothesis that the Functional Gait Assessment (FGA) score would remain unchanged after 10 weeks of use.MethodsParticipants had PN with lost plantar sensation, gait and balance problems, an FGA score < 23 (high fall risk), and ability to sense tactile stimuli above the ankle. Clinical outcomes included FGA, Gait Speed, Timed Up&Go (TUG) and 4-Stage Balance Test. Patient-reported outcomes included Activities-Specific Balance Confidence (ABC) scale, Vestibular Disorders Activities of Daily Living Scale, PROMIS participation and satisfaction scores, pain rating, and falls. Evaluations were performed at baseline and after 2, 6, and 10 weeks. Subjects were not made aware of changes in outcomes. No additional balance interventions were allowed.ResultsForty-five participants of 52 enrolled across four sites completed in-clinic assessments. FGA scores improved from 15.0 to 19.1 (p < 0.0001), normal and fast gait speed from 0.86 m/s to 0.95 m/s (p < 0.0001) and 1.24 m/s to 1.33 m/s (p = 0.002), respectively, and TUG from 13.8 s to 12.5 s (p = 0.012). Four-Stage Balance Test did not improve. Several patient-reported outcomes were normal at baseline and remained largely unchanged. Interestingly, subjects with baseline ABC scores lower than 67% (high fall risk cut-off) increased their ABC scores (49.9% to 59.3%, p = 0.01), whereas subjects with ABC scores above 67% showed a decrease (76.6% to 71.8%, p = 0.019). Subjects who reported falls in the prior 6 months (n = 25) showed a decrease in the number of fall-risk factors (5.1 to 4.3, p = 0.023) and a decrease in fall rate (13.8 to 7.4 falls/1000 days, p = 0.014). Four pre-study non-fallers (n = 20) fell during the 10 weeks.ConclusionA wearable sensory prosthesis presents a new way to treat gait and balance problems and manage falls in high fall-risk patients with PN.Trial registrationClinicalTrials.gov (#NCT03538756).

Assessment of sleep quality in fibromyalgia syndrome and its effect on postural balance and functional status.

Patients with fibromyalgia syndrome (FMS) often have sleep problems and balance disorders. The aim of the study was to examine sleep quality and balance disorders and the relationship between sleep quality and balance, functional status and the frequency of falls in patients with FMS. Fifty women with FMS and 50 healthy women were included in the study. Sleep quality was assessed with the numeric rating scale (NRS) and the Pittsburgh Sleep Quality Index (PSQI) and balance and balance self-confidence were assessed with the Berg Balance Scale (BBS) and Activities-Specific Balance Confidence (ABC) Scale, respectively. Functional status and symptom severity of patients were assessed with the Fibromyalgia Impact Questionnaire (FIQ) and the Symptom Impact Questionnaire (SIQR). The number of falls in the last six months were recorded. In the patient group, sleep quality scores were significantly higher, and BBS and ABC scores were significantly lower than the control group. NRS scores were significantly correlated with the BBS, FIQ, and SIQR scores, and the PSQI scores were significantly correlated with the BBS and ABC scores and the number of falls in FMS. This study showed that the prevalence of sleep and balance disorders is higher in FMS patients. A relationship was reported between the sleep quality and balance and functional status and frequency of falls.

The Postural Stability Measures Most Related to Aging, Physical Performance, and Cognitive Function in Healthy Adults.

Background Different measures have been used to quantify body balance; some of which use technology to measure postural sway, others are physical performance or self-reported. However, there is little information on the best postural sway measures associated with aging, physical performance, and cognitive function measures. Objective To evaluate the relationship between postural sway measures and aging, physical performance, and cognitive function measures. Methods A total of 51 subjects (53% female, mean age 53.2 ± 21 years) participated in this cross-sectional study. The participants completed the Activities-specific Balance Confidence (ABC) Scale questionnaire, the Functional Gait Assessment (FGA), the Montreal Cognitive Assessment (MoCA) test, and gait speed. Afterward, the participants performed 8 balance exercises, and their postural sway was measured using a force plate. Spearman's rank correlation coefficient was used to examine the relationship between the study variables. Results Age was negatively associated with cognitive function, gait speed, ABC scores, and FGA scores. In addition, cognitive ability was associated positively with ABC scores (r = 0.38, p ≤ 0.01). Age, FGA scores, and gait speed were significantly associated with the postural sway of the AP direction in some exercises and in all exercises in the ML directions (p < 0.05). The cognitive function and ABC scores were significantly associated with only postural sway measures in the ML direction (p < 0.05). Conclusion The postural sway measures in the lateral direction had more and stronger associations with age, physical performance, and cognitive function measures compared to those in the AP direction.

Explanatory factors of balance confidence in persons with multiple sclerosis: Beyond the physical functions

BackgroundBalance confidence is considered a psychological element of falls and balance-demanding activities. The relationship of balance confidence with physical factors has been investigated; however, psychosocial correlates are not well known. The aim was to investigate the relationship between balance confidence and physical and psychosocial factors and to reveal the determinants of balance confidence in persons with MS (pwMS). MethodsA total of 445 pwMS were enrolled in the study. Balance confidence was assessed with the Activities-Specific Balance Confidence (ABC) Scale. Psychosocial-based measures included the Modified Fatigue Impact Scale (MFIS), Epworth Sleepiness Scale (ESS), Beck Depression Scale (BDI), and Symbol Digit Modalities Test (SDMT). The Godin Leisure-Time Exercise Questionnaire (GLTEQ), Timed 25-Foot Walk (T25FW), Six-Minute Walk Test (6MWT), and Single Leg Stance Test (SLS) were used to assess physical functions. ResultsThere was a significant correlation between the ABC score and all physical and psychosocial measures (p<0.05). Hierarchical linear regression analyses indicated that psychosocial factors were significantly associated with ABC accounting for 41% of the variance. The addition of physical variables explained an additional 35% of variance over psychosocial variables. The MFIS, SDMT, BDI, T25FW, 6MWT, and SLS were significantly predictive of the ABC. ConclusionThis study emphasizes the importance of considering both physical and psychosocial factors for understanding balance confidence in pwMS. Besides, intervention strategies for enhancing balance confidence should aim to improve fatigue, depression, and cognition in addition to physical components.

Reliability of the Lateral Step-Up Test and Its Correlation with Motor Function and Activity in Chronic Stroke Survivors.

Background The Lateral Step-Up Test (LSUT) has been used to evaluate the closed kinetic chain functional muscle strength in people with orthopaedic or neurological conditions. No study has systematically investigated the intrarater, interrater, and test-retest reliabilities of this measure in stroke survivors. In addition, correlations of the LSUT count with other stroke-specific impairment and function measurements remain unidentified. Objectives This study was aimed at investigating (1) the interrater, intrarater, and test-retest reliability of the LSUT; (2) minimum detectable change in LSUT counts; and (3) correlation between LSUT counts and stroke-specific impairment and function measurements. Methods Thirty-three stroke survivors were assessed with LSUT and a battery of stroke-specific impairment and function measurements, including Fugl-Meyer assessment of lower extremity (FMA-LE), lower limb muscle strength, Five Times Sit-to-Stand Test (FTSTS), Berg Balance Scale (BBS), Timed Up and Go Test (TUG), and Activities-specific Balance Confidence (ABC) scale, by two assessors. Their performance on LSUT was reassessed 1 week later to establish the test-retest reliability. The intraclass correlation coefficient (ICC) was used to assess the reliability of LSUT, and Spearman's rho was used to quantify the strength of correlations between LSUT counts and secondary outcomes. Results The LSUT counts exhibited good to excellent intrarater, interrater, and test-retest reliability (ICC: 0.869–0.991). The minimum detectable change in the average LSUT count was 1 step. LSUT counts correlated significantly with the FMA-LE score, lower limb muscle strength (except for the hip abductors), FTSTS time, BBS score, TUG time, and ABC score. Conclusions The LSUT is a reliable, valid, and easily administered measure of the closed kinetic chain functional muscle strength of stroke survivors.

Effects of Vestibular Rehabilitation and Pharmacological Therapy in Patients with Vestibular Migraine

Objectives: The objectives of this study were to compare the results of pharmacologic management options and vestibular rehabilitation (VR) programs in the context of dizziness, balance problems, and headache in patients with vestibular migraine. Materials and Methods: Sixty patients with migraine with vestibular symptoms were evaluated in three groups in the neurology, physical medicine, and rehabilitation and otorhinolaryngology clinics of a medical school hospital. The groups were defined as routine pharmacologic therapy (PT), VR, or both. Patients were evaluated with static posturography, the Dizziness Handicap Inventory (DHI), and the Activities-Specific Balance Confidence (ABC) Scale as primary outcome measures and symptom frequency and severity (headaches and vertigo attacks) as secondary outcome measures. In-group and between-group comparisons were made using relevant statistical methods. Results: DHI scores were significantly reduced (P &lt; 0.001) in all treatment groups. ABC scores increased significantly (P &lt; 0.001) in patients taking PT and those on VR + PT. Posturographic examinations revealed that sway velocity values recorded on foam with eyes closed, which targets vestibular assessment, were significantly reduced (P &lt; 0.001) in groups taking VR either alone or with PT. VR benefited patients with migraine in terms of headaches, vertigo attack frequency, intensity, and duration. Conclusion: Patients with predominant vestibular disorders can benefit from VR alone, and patients with combined symptoms (headache and vertigo) can benefit from pharmacologic and rehabilitation therapies.

75 Functional Mobility and Balance Confidence as Correlates of Fall Risk in Older Adults Attending a Primary Health Care Clinic

Abstract Background Fall is one of the leading cause of unintentional injury among older adults. Information regarding functional mobility and balance confidence as correlates of fall risk in older adults attending a primary health care clinic is limited. This information is vital for fall screening and prevention. We aimed to examine if functional mobility and balance confidence were correlates of fall risk in older adults attending a primary health care clinic. Methods 106 older adults (≥60 years old) attending a primary health care clinic at Cheras, Malaysia participated in this cross-sectional study. Socio-demographic details and falls history were obtained using a structured questionnaire. Functional mobility and balance confidence were assessed using Timed Up and Go (TUG) test and Activities-Specific Balance Confidence (ABC) scale respectively. Fallers were categorised based on history of at least a fall in the past 12 months. Differences between faller and non-faller groups were distinguished using Independent T and Mann Whitney tests. Binomial logistic regression and receiver operating curve were performed to identify if functional mobility and balance confidence were correlates of falls risk and the cut off values for measures were obtained. Results TUG test and ABC scores differed significantly between the two groups (p&amp;lt; 0.05). Both TUG test and ABC scale were identified as correlates of falls risk with r, R2 of 0.98, 0.26 (p&amp;lt; 0.001) and 0.95, 0.12 (p&amp;lt; 0.05) respectively. Cut off value of 9.02 seconds and above for TUG test and 82.81% and below for ABC score were identified as risk factor of falls among older adults. Conclusion The cut off values obtained from our study can be used as reference to screen older adults at risk of falls in Malaysian primary health care settings. Early fall risk screening and management is a part of falls prevention strategy in older adults.

POOR PHYSICAL FUNCTION EXPLAINS INCREASED WRIST FRACTURE RISK IN COMMUNITY DWELLING OBESE ICELANDIC ADULTS

Background: The associations between obesity, physical function, falls and fractures are unclear. Aim: The aim was to investigate whether obese adults have poorer sensory function, physical function as well as higher fracture risk than normal weight peers; and whether confounders explain potential differences between body mass index (BMI) categories. Methods: A case-control study was conducted using 98 wrist fracture cases (50-75 years) and 48 matched controls. Measurements included among others: anthropometrics, sensory function (Semmes-Weinstein-Monofilaments), physical function (Five-times-sit-to-stand test (FTSTS), questionnaires on previous fractures and fall history, the Activities-Specific-Balance-Confidence (ABC) and the Dizziness-Handicap-Inventory (DHI) scales. Results: Obese participants had lower physical function (FTSTS: +2.8sec,P<0.001), lower tactile sensitivity (monofilaments:+3.4 g,P=0.013), poorer ABC score (14.0,P<0.001), higher DHI score (11.6,P<0.001) and experienced more falls the previous 12 months (+0.8,P=0.006) compared to normal weight subjects. According to crude logistic regression analysis, the hazard ratios for wrist fracture in overweight and obese subjects were 2.7 (P=0.012) and 5.6 (P=0.002), respectively. When FTSTS was included in the statistical model (HR:1.7,P=0.004), it reduced the hazard ratios of overweight and obesity close to 1. Lifetime fractures (HR:5.5,P<0.001) and fall history (HR:4.3,P<0.001) were associated with an increased fracture risk independently from the BMI categories. Conclusion: Obese individuals have poorer physical function, higher risk of falls and increased wrist fracture risk compared to normal weight peers. Lower physical function is the main driver for the increased risk in obese subjects. Lifetime fractures and fall history are associated with an fracture independently from obesity.

Haptic perception of verticality correlates with postural and balance deficits in patients with Parkinson's disease

IntroductionPerception of verticality is fundamental for postural stability that is often impaired in patients with Parkinson's disease (PD). Haptic perception of verticality has not been fully investigated in PD. The aim of the study was to assess subjective haptic vertical (SHV) in PD patients in relation to postural and balance impairments. Methods39 PD patients (mean age 72.87 ± 5.78) and 28 gender and age-matched healthy elderly (ELD, mean age 69.16 ± 13.89) were enrolled. The Pull test and the Activities-specific Balance Confidence (ABC) were used for evaluating balance performance, whereas measurement of posture was performed using the Physical Analyzer System®. For evaluating SHV, participants were instructed to provide their subjective vertical by manipulating with two hands a road while standing with their eyes closed. ResultsSHV data showed that PD subjects had a greater deviation from the objective vertical than controls (p < 0.001). Significant differences in balance performance (ABC and Pull test) and postural alignment were found between PD and ELD. Only in PD participants, SHV deviations significantly correlated with the lateral inclination of the trunk (r = 0.618, p < 0.001), pull test (r = 0.519; p = 0.001) and ABC (r = 0.471, p = 0.002) scores. ConclusionsThe perception of verticality, driven by multimodal sensory integration, is defective in PD subjects. Deficits in SHV correlated with postural alignment and balance performances, independently from age, disease severity or cognitive decline. Our findings support that PD pathology is associated with a decline in haptic perception suggesting that perception per se might have a causal role in postural and balance deficits.

Functional Performance and Balance in the Oldest-Old.

The group of individuals 85 years and over (termed oldest-old) is the fastest-growing population in the Western world. Although daily functional abilities and balance capabilities are known to decrease as an individual grows older, little is known about the balance and functional characteristics of the oldest-old population. The aims of this study were to characterize balance control, functional abilities, and balance self-efficacy in the oldest-old, to test the correlations between these constructs, and to explore differences between fallers and nonfallers in this age group. Forty-five individuals living in an assisted living facility who ambulated independently participated in the study. The mean age was 90.3 (3.7) years. Function was tested using the Late-Life Function and Disability Instrument (LLFDI). Balance was tested with the mini-Balance Evaluation System Test (mini-BESTest) and the Timed Up and Go (TUG) test. Balance self-efficacy was tested with the Activities-Specific Balance Confidence (ABC) scale. The mean total function LLFDI score was 63.2 (11.4). The mean mini-BESTest score was 69.8% (18.6%) and the mean TUG time was 12.6 (6.9) seconds. The mean ABC score was 80.2% (14.2%). Good correlation (r > 0.7) was observed between the ABC and the function component of the LLFDI, as well as with the lower extremity domains. Correlations between the mini-BESTest scores and the LLFDI were fair to moderate (r's range: 0.38-0.62). Age and ABC scores were significant independent explanators of LLFDI score (P = .0141 and P = .0009, respectively). Fallers and nonfallers differed significantly across all outcome measures scores, except for TUG and for the "Reactive Postural Control" and "Sensory Orientation" domains of the mini-BESTest. The results of this study provide normative data regarding the balance and functional abilities of the oldest-old, and indicate a strong association between self-efficacy and function. These results emphasize the importance of incorporating strategies that maintain and improve balance self-efficacy in interventions aimed at enhancing the functional level of this cohort.

Can activities-specific balance confidence score and non-participation in rehabilitation programs predict occurrence of falls in Parkinson's disease?

Falls are common in Parkinson's disease (PD) resulting in increased disability and morbidity. Rehabilitation strategies and modification of falling risk factors can improve outcomes in PD. Our main aim was characterization of a PD population's subset at primary care level (Tables 1 and 2) and study possible associations with occurrence of falls. This study is cross-sectional and retrospective. The sample comprised every patient of a family health unit with diagnosis of PD. Sociodemographic factors, medical history, participation on rehabilitation programs (RP), physical activity, active recreational activities, occurrence of falls in the last year, Activities-Specific Balance Confidence (ABC) scale score, Barthel Index score and potential risk factors for falls were obtained through questionnaire application by phone and complemented with clinical records. A binomial logistic regression was performed to ascertain the effect of some of those variables on the likelihood of falls occurrence. Thirty-four participants were elected, of which 14.7% were physically active, 52.9% performed recreational activities and 44.1% participated in a RP in the last year. Fifty-four falls were reported in 18 patients in the last year. An ABC score cutoff of 55.0 to distinguish fallers from non-fallers was determined (sensibility 0.78, specificity 0.81) (Fig. 1). A logistic regression model explained 72.6% of falls occurrence ( P < 0.005, sensibility 0.83, specificity 0.87) (Table 3). Non-participation in RP had 33.2 times higher odds of falling occurrence in the last year. It's important to address and manage the fall risk at primary care level that requires a multidisplinary approach. Lower ABC scores and non-participation on rehabilitation programs were associated with occurrence of falls in PD. The quantification of fall risk may be used for selection of PD patients, which benefit the most from rehabilitation strategies.