Balance Confidence Research Articles

The minimally clinically important difference in the 2-minute walk test for people in the subacute phase after a stroke

ABSTRACT Background The 2-Minute Walk Test (2MWT) is a simple and reliable test used by clinicians to assess gait function in people with stroke (pwST). No studies established the minimal clinically important difference (MCID) of the 2MWT. Objective To determine the MCID of the 2MWT in subacute pwST using data from a longitudinal cohort study. Methods PwST within 180 days of stroke onset were recruited from the Italian National Health System (NHS) rehabilitation services across the country. Participants underwent physical therapy to improve balance and gait according to their specific needs. The 2MWT was used to assess gait performance at the beginning (T0) and after a minimum of 10 rehabilitation sessions (T1). The Global Perceived Effect (GPE), Activities-specific Balance Confidence Scale (ABC) and the ABC_gait were used to assess balance confidence and the perceived effect of the intervention at T1. Results 51 pwST (69 ± 12 years; 66.7% males) were included in the analysis. Statistically significant improvements were observed in 2MWT, ABC, and ABC_gait scores after rehabilitation using the Wilcoxon signed-rank test. Using an anchor-based approach the receiver operating characteristic (ROC) curves were calculated to establish the MCID. The MCID of the 2MWT was 31 meters with an Area under the curve (AUC) = 0.74 [0.60–0.89], a specificity of 71% and a sensitivity of 63%. Conclusions An improvement of 31 meters on the 2MWT can be considered clinically significant in subacute pwST undergoing rehabilitation. This study provides valuable insights for clinicians to assess walking performance in pwST and determine clinically meaningful changes post-rehabilitation.

Is lateral external perturbation training more beneficial for protective stepping responses than voluntary stepping training in stroke? A pilot randomized control study

The study examined whether lateral perturbation training could improve stepping performance and balance in individuals post-stroke. Thirty-one participants with hemiparesis were randomly allocated to PERT (external perturbation) or VOL (voluntary stepping) step training. The PERT and VOL group consisted of 80 step trials predominantly in the lateral direction, with a small proportion of steps in the anterior/posterior direction. Outcome measures based on step type (medial and lateral) included step initiation time, step length, step clearance, step velocity during an induced waist pull perturbation and voluntary step, and clinical balance assessments. The PERT group initiated a lateral step faster with the non-paretic leg during the induced waist pull perturbation step (P = 0.044) than the VOL group after training. Both groups improved the non-paretic step length and step velocity during lateral steps. During the voluntary steps, the PERT group significantly initiated a voluntary step faster. No significant changes were observed in the paretic leg. Both groups significantly improved on the Community Balance & Mobility Scale and Activities Specific Balance Confidence Scale. Overall, we demonstrated that an exercise to improve stepping performance with external perturbations might provide more benefits in protective stepping responses than training with voluntary steps for individuals with a stroke.

Relationship of Pain, Depression, Fatigue, and Sleep Problems with Functional Capacity, Balance, and Fear of Falling in Women with Fibromyalgia: Cross-Sectional Study.

(1) Background: Fibromyalgia (FM) is a syndrome marked by chronic widespread pain, fatigue, sleep issues, and other symptoms. Interventions like physical exercise can potentially enhance physical function in individuals with FM. This study aimed to assess physical function, perceived physical fitness, balance confidence, and fear of falling in women with FM based on their levels of pain, depression, fatigue, and sleep problems. (2) Methods: Participants underwent a series of tests and questionnaires to evaluate physical and perceptual aspects. These included the Time Up and Go, Four Step Square Test, 6-Minute Walking Test, Maximum Handgrip Strength, Back Scratch, International Fitness Scale, Activities-Specific Balance Confidence Scale, and Fall Efficacy Scale-International. Participants were categorised by the severity of their pain, depression, fatigue, and sleep problems (mild, moderate, severe). A Kruskal-Wallis test assessed intergroup differences, while Spearman's rho evaluated correlations between the study variables and symptom levels. (3) Results: Perceived physical condition varied significantly with symptom severity. Symptoms and sleep problems were notably linked to fear of falling, though no significant differences emerged in the physical tests. (4) Conclusions: In women with fibromyalgia, symptom severity was primarily related to perceptual and subjective aspects of physical condition and fall safety.

Assessing Static Balance, Balance Confidence, and Fall Rate in Patients with Heart Failure and Preserved Ejection Fraction: A Comprehensive Analysis.

Chronic heart failure (CHF) is a complex clinical syndrome, associated with frailty, higher fall rates, and frequent hospitalizations. Heart Failure (HF) and preserved ejection fraction (HFpEF) is defined as a condition where a patient with HF have a diagnosis of left ventricular ejection fraction (LVEF) of ≥ 50%. The risk of HFpEF increases with age and is related to higher non-cardiovascular mortality. The aim of this study was to evaluate static balance and examine the effect of task difficulty on the discriminating power of balance control between patients with HFpEF (Patients with HFpEF) and their healthy controls. Moreover, the associations between static balance parameters, balance confidence, falls, lean muscle mass, and strength were assessed. Seventy two patients with HFpEF (mean age: 66.0 ± 11.6 years) and seventy two age- and gender-matched healthy individuals (mean age: 65.3 ± 9.5 years) participated in this study. Participants underwent a 30 s bilateral stance (BS) test and a 20 s Tandem-Romberg stance (TRS) on a force platform, evaluating the Range and Standard Deviation of Center of Pressure (COP) displacement parameters in both axes. Balance confidence was evaluated by the Activities-Specific Balance Confidence (ABC) Scale, and the number of falls during the last year was recorded. Lower limb strength was measured using an isokinetic dynamometer, isometric leg strength, and a Sit-to-Stand test. Bioelectrical impedance analysis was conducted to assess lean fat mass, lean fat mass index, and lean%. Patients with HFpEF presented with lower static balance in BS and TRS compared to healthy controls (p < 0.05), lower balance confidence by 21.5% (p < 0.05), and a higher incidence of falls by 72.9% (p < 0.05). BS was a better descriptor of the between-group difference. Furthermore, static balance, assessed in controlled lab conditions, was found to have little if no relationship to falls, strength, lean muscle mass, and balance confidence. Although no correlation was noted between the static balance parameters and falls, the fall rate was related to balance confidence, age, muscle strength, and lean fat.

Are clinical tests and biomechanical measures of gait stability able to differentiate fallers from non-fallers in hereditary spastic paraplegia?

IntroductionBalance and gait impairments are common in people with hereditary spastic paraplegia (HSP) and often result in falls. Measures that identify patients at risk of falling are clinically relevant, but relatively unexplored in HSP. Here, we evaluated the potential of different balance and gait constructs to (1) identify differences between healthy controls and people with HSP and (2) discriminate between fallers and non-fallers with HSP. MethodsWe included 33 people with pure-HSP and 15 healthy controls. We assessed balance confidence (six-item Activities-specific Balance Confidence scale), clinical balance capacity (Mini-Balance Evaluation Systems Test) and gait capacity (ten-meter Walk Test). Biomechanical measures included spatiotemporal gait variability, mediolateral Margin of Stability (MoS), Foot Placement Deviation (FPD), and Local Divergence Exponents (LDEs) of trunk and pelvis, derived from treadmill-walking at comfortable and fixed gait speeds. People with HSP logged their falls during a fifteen-week period and were categorized as ‘faller’ (≥1 fall) or ‘non-faller’. ResultsPeople with HSP had significantly lower balance confidence, balance capacity, and gait capacity compared to age-matched controls. People with HSP also showed reduced gait stability, reflected by increased spatiotemporal gait variability, FPD, and LDEs of trunk and pelvis. Overall, 44% of people with HSP were categorized as ‘faller’. Balance confidence (AUC:0.84) and balance capacity (AUC:0.75) discriminated fallers from non-fallers, whereas none of the biomechanical measures significantly differed. ConclusionBalance confidence, clinical balance and gait capacity, and biomechanical measures are affected in HSP, but clinical measures showed potential to differentiate fallers from non-fallers in people with HSP.

Understanding “Fear Of Falling” And How It Impacts Older Persons Motivation To Engage In Fall Prevention Exercise Interventions

Abstract Background Fear of falling can cause older persons to restrict their activities, which drives reduced strength and balance and increases their falls risk. Falls can have a significant effect on older persons in terms of loss of confidence, ongoing falls risk and ultimately, a poorer quality of life (Oliver et al, 2010). Fall prevention exercise interventions can help reduce the risk of falling in older adults by up to 34% (Sherrington et al, 2020). This study aims to explore the prevalence of fear of falling in older adults both before and after attending a community-based fall prevention exercise programme. The programme consisted of an evidence-based Physiotherapy led 10-week strength and balance class, followed by a 16-week exercise instructor led strength and balance class. Methods A 2-part qualitative study. Part 1: Prior to commencing the class each participant completed a rating of their fear of falling measured by ConfBal (a validated 10 item Balance Confidence scale). Part 2: Questionnaire assessing their experience of the classes and corresponding change in balance scores. Results 17 older adults completed the programme. Surveys were returned by 8/17 to date (47%). Mean pre-intervention ConfBal score of 20, mean post intervention score of 15 (8/17 participants to date), average 4-point improvement after intervention was statistically significant (p=0.008). Reported benefits of falls prevention exercise classes include peer-peer discussion of functional ability, gaining confidence by exercising in a group environment, practising functional exercises relating to day-to-day tasks, and building social relationships. Conclusion Fear of falling amongst community dwelling older adults is common but group exercise improves confidence as well as boosting social interactions. Participation in fall prevention exercise programmes can help to better support older people as they age which may influence better health outcomes in our communities.

Associations of Usual and Fast Gait Speed With Physical Performance and Balance Confidence in Community-Dwelling Older Adults: Implications for Assessment.

Gait speed is a robust measure that offers many advantages clinically. However, decisions concerning its utilization exist, including whether to assess usual or fast gait speed. The current study aimed to identify whether usual or fast gait speed was more strongly associated with physical performance measures and balance confidence. A secondary aim was to explore these relationships within subgroups based on fall risk status. This was an observational study with a cross-sectional design involving 57 community-dwelling older adults (77.2% female; mean age = 68.8, SD = 6.5 years, range = 60-87 years) who were assessed on the following variables: usual and fast gait speed, knee extension strength, step execution time, 6-minute walk test (6MWT), and Activities-specific Balance Confidence Scale (ABC-6). Spearman ρ correlations were computed to determine bivariate associations of usual and fast gait speed with physical performance measures and balance confidence for the whole sample and within subgroups based on fall risk [lower fall risk (n = 28) vs higher fall risk (n = 29)]. Multiple linear regression models were estimated with either usual or fast gait speed as key predictors of knee extension strength, step execution time, 6MWT, and ABC-6. Stronger correlations were observed for fast gait speed compared with usual gait speed with all physical performance measures and balance confidence for the entire sample and within the higher fall risk group. Multiple regression results indicated that models with fast rather than usual gait speed as the key predictor explained more of the variance in 6MWT ( R2 = 64.5% vs 45.6%), ABC-6 ( R2 = 28.5% vs 25.4%), step execution time ( R2 = 24.9% vs 19.0%), and knee extension strength ( R2 = 15.7% vs 7.2%). Fast gait speed showed stronger associations and better predictive capabilities compared with usual gait speed with physical performance measures and balance confidence in older adults. Despite being measured less often than usual gait speed, fast gait speed assessment warrants additional consideration.

A - 2 Risk Factors for Reduced Mobility and Falls in Older Adults: the Role of Medication Use and Cognitive Impairment

Abstract Objective Sedative and anticholinergic (AC) medication use and cognitive impairment impose risk of gait imbalance and falls in older adults, but their combined effects on mobility have not been assessed. Method This cross-sectional study of 392 outpatients (age = 72 ± 7.7; 60.5%women; 93%White; education = 14 ± 3 years) characterized AC use (Anticholinergic Cognitive Burden Scale [ACB]) and number of sedative medications. Balance confidence (Activities-specific Balance Confidence Scale), walking decline compared to 5 years prior (0–3 scale), and recurrent falls (dichotomized by ≥2) were self-reported. Neuropsychological performance was averaged into a norm-adjusted composite (COG). T-tests and Pearson correlations assessed bivariate relationships across medication use, COG, and mobility. Multivariate models regressed falls, balance confidence, and gait changes (in separate models) on COG and medication use (ACs and sedatives examined separately), controlling for covariates. Results Most patients (70%–85%) used ≥1 sedative or AC medication. Few (12%) reported recurrent falls (range = 0–30), but balance confidence was reduced (M = 77.68 ± 21.31%) with mild walking declines reported (M = 1.34 ± 1.03). More sedative medication use and higher ACB scores were bivariately related to worse COG and mobility, and stronger COG was associated with better mobility (p’s ≤ 0.004). Worse COG (β = 0.196, p = 0.002) and more medication use, both sedatives (β = −0.246, p = 0.002) and ACB (β = −0.147, p = 0.047), independently predicted worse balance confidence. Higher ACB (β = 0.182, p = 0.022) and worse COG (β = −0.193, p = 0.007) uniquely predicted walking decline. Each sedative medication increased odds of falls by 27.4% (adjOR = 1.274, p = 0.034). Conclusion AC/sedative medication use and cognitive impairment pose complementary risks for compromised mobility. Clinicians should be alert to AC/sedative use and cognitive impairment in older patients at risk of falls.

A quick balance assessment tool for all clinical settings: validity and reliability of the Hungarian version of the activities-specific balance confidence scale

ABSTRACT Background The Activities-specific Balance Confidence Scale was developed for testing the balance confidence of elderly individuals, and it has been used extensively for evaluating various patients. No such scale has been adapted for the Hungarian population. Objective To translate and culturally adapt the Activities-specific Balance Confidence Scale and test the reliability and validity of the Hungarian version. Methods The study included 167 independently mobile subjects, of whom 39 filled in the questionnaire twice, 1 week apart. Beaton’s six-step principle was applied for cross-cultural adaptation. Reliability was assessed by internal consistency measured by Cronbach's alpha and through test–retest analysis. Types of validity evaluated were concurrent validity using the Berg Balance Scale and cross-cultural validity. Results Excellent internal consistency was shown by Cronbach’s alpha = 0.977. Test–retest analysis resulted in an Intra-Class Correlation Coefficient of 0.962 (0.865–0.961, 95% CI, p < .001) for the whole test; no floor or ceiling effects were found. The convergent validity of the scale was tested by Spearman’s rank correlation analysis using the Berg Balance scale for external validation and showed a strong positive correlation (Rho = 0.755, p < .001). Receiver Operating Characteristic curve analysis showed an Area Under the Curve of 0.821 (CI 95% 0.75, 0.892). Mean detectable change based on the 95% confidence interval was 10.49% on the scale ranging from 0 to 100%. Conclusions The Hungarian version of the Activities-Specific Balance Confidence Scale provides a valid and reliable picture of the patients’ self-assessed balance. It is recommended both for clinicians and for clinical studies.

A predictive model for functionality improvement after stroke rehabilitation

ObjectiveThis study develops a simple predictive model for identifying stroke patients who have a better chance of showing improved activities of daily living (ADL) outcomes following a stroke. MethodsThe cohort of 489 stroke patients was divided into testing and training groups. Multivariate logistic regression analysis was conducted for each model. Four models were compared using the C statistic (AUC), Akaike's information criterion (AIC), and other metrics. The best model was assessed using a nomogram. ResultsUnivariate analysis revealed that several variables measured significantly higher at discharge than at admission, including manual muscle testing, standing, and so on. Multivariate logistic regression analysis revealed that activities-specific balance confidence, Brunnstrom recovery stage for lower extremities, standing, the mini-balance evaluation systems test, and the Hamilton anxiety scale were independent predictors of ADL. Model 1 was found to be more accurate for the prediction of ADL (AUC: training, 0.916 [0.889−0.943] and test, 0.887 [0.806−0.968]; AIC: training, 257.42 and test, 76.79) than model 2 (AUC: training, 0.850 [0.894−0.806] and test, 0.819 [0.715−0.923]; AIC: training, 314.44 and test, 83.78), model 3 (AUC: training, 0.862 [0.901−0.823] and test, 0.830 [0.731−0.929]; AIC: training, 307.76 and test, 86.55), and model 4 (AUC: training, 0.862 [0.901−0.823] and test, 0.833 [0.733−0.932]; AIC: training, 305.8 and test, 86.28). ConclusionA multivariate model can be used to predict functionality improvement, as measured by ADL, following hospitalization with a stroke.

Exercise With Unstable Objects: A Descriptive Survey Among Health Care and Fitness Professionals

Exercise with unstable objects is a popular intervention used by health care and fitness professionals. Understanding different professional beliefs and usage patterns might provide insight for future research and development of evidence-based guidelines. The purpose of this survey study was to document the perceptions, beliefs, and the use of exercise with unstable objects among health care and fitness professionals in the United States. Six hundred and sixteen respondents completed the survey. Most respondents used unstable objects for musculoskeletal postinjury fitness/return to performance (72%). Most believed the main therapeutic effects were enhanced motor control (88%), balance (86%), and somatosensory (85%) function. Most reported using the foam pad (80%) and BOSU (84%). The most used subjective measure was the Activities-specific Balance Confidence scale. Most respondents used single limb stance (85%) to measure static motor control and the single leg squat assessment (51%) for dynamic motor control. Respondents used variables such as dynamic movement, repetition and sets, and time during training. Respondents considered recent injury or surgery and neurological or vestibular conditions as the top precautions. Respondents considered acute injury or surgery and neurological or vestibular conditions as the top contraindications. This survey provides insight into health care and fitness professionals perceptions, beliefs, and use of exercise with unstable objects.

Analysis of the Moderating Effect of Walk Ratio on the Relationship Between Bone Mineral Density and Fall Efficacy and Balance Confidence in Elderly

PURPOSE: This study aimed to analyze the moderating effect of the walk ratio (WR), a quantitative indicator of gait pattern, on the relationship between bone mineral density (BMD), fall efficacy scale (FES) score, and activity-specific balance confidence (ABC) in the elderly.METHODS: A total of 275 participants were categorized based on BMD into normal, osteopenia, and osteoporosis groups, and based on WR levels into high 25%, middle 50%, and low 25% groups. Logistic regression analysis was performed to determine the odds ratios (OR) for decreased FES and ABC exposure based on BMD and WR levels. To examine the moderating effect of WR on the relationship among BMD, FES, and ABC, a moderation analysis using Process Macro Model 1 was performed.RESULTS: After adjusting for age and sex, individuals with osteopenia (FES, OR=2.738, p=.013; ABC, OR=4.020, p=.002) and osteoporosis (FES, OR=4.550, p=.001; ABC, OR=5.015, p=.001) showed significantly higher ORs for decreased FES and ABC compared to those in the normal group, while individuals in the high WR group (FES, OR=0.389, p=.015; ABC, OR=0.235, p&lt;.001) and middle WR group (FES, OR=0.519, p=.040; ABC, OR=0.389, p=.004) exhibited significantly lower ORs for decreased FES and ABC compared to those in the low WR group. Furthermore, moderation analysis indicated that regardless of covariates, the impact of decreased BMD on FES and ABC varied depending on the level of WR (FES, β=3.185, p=.017; ABC, β=4.570, p=.012).CONCLUSIONS: This study suggests that the decline in FES and ABC scores due to decreased BMD can be mitigated by a high WR. These findings highlight the need for strategies to enhance the walking function and prevent fractures in elderly patients with osteoporosis.

Balance confidence classification in people with a lower limb amputation using six minute walk test smartphone sensor signals.

The activities-specific balance confidence scale (ABC) assesses balance confidence during common activities. While low balance confidence can result in activity avoidance, excess confidence can increase fall risk. People with lower limb amputations can present with inconsistent gait, adversely affecting their balance confidence. Previous research demonstrated that clinical outcomes in this population (e.g., stride parameters, fall risk) can be determined from smartphone signals collected during walk tests, but this has not been evaluated for balance confidence. Fifty-eight (58) individuals with lower limb amputation completed a six-minute walk test (6MWT) while a smartphone at the posterior pelvis was used for signal collection. Participant ABC scores were categorized as low confidence or high confidence. A random forest classified ABC groups using features from each step, calculated from smartphone signals. The random forest correctly classified the confidence level of 47 of 58 participants (accuracy 81.0%, sensitivity 63.2%, specificity 89.7%). This research demonstrated that smartphone signal data can classify people with lower limb amputations into balance confidence groups after completing a 6MWT. Integration of this model into the TOHRC Walk Test app would provide balance confidence classification, in addition to previously demonstrated clinical outcomes, after completing a single assessment and could inform individualized rehabilitation programs to improve confidence and prevent activity avoidance.

Predicting Walking Capacity Outcomes After Moderate to High Intensity Locomotor Training in Chronic Stroke.

Moderate-to-high intensity locomotor training (M-HIT) is strongly recommended in stroke rehabilitation but outcomes are variable. This study aimed to identify baseline clinical characteristics that predict change in walking capacity following M-HIT in chronic stroke. This analysis used data from the HIT-Stroke Trial (N=55), which involved up to 36 sessions of either moderate or high intensity locomotor training. A prespecified model assessed how well baseline motor impairment (Fugl-Meyer lower limb motor scale [FM-LL]), comfortable gait speed (CGS), and balance confidence (Activities Balance Confidence scale [ABC]), independently explain changes in 6-minute walk distance (Δ6MWD), while controlling for treatment group. Exploratory analysis tested additional baseline covariates using the all-possible regressions procedure. The prognostic value of each potential covariate was assessed by its average contribution to the explained variance in Δ6MWD (Δ pseudo-R 2 ). With the prespecified model, 8-week Δ6MWD was significantly associated with baseline FM-LL (β=5.0 [95% CI: 1.4, 8.6]) and ABC (β=0.7 [0.0, 1.4]), but not CGS (β=-44.6 [-104.7, 15.6]). The exploratory analysis revealed the top 7 covariates with the highest mean Δ pseudo-R 2 were: FM-LL, pain-limited walking duration, ABC, the use of an assistive device, fatigue, depression, and recent walking exercise history >2 days per week. On average, participants with less motor impairment and higher balance confidence have greater walking capacity improvements after M-HIT in chronic stroke. Additional negative prognostic factors may include pain-limited walking duration, use of an assistive device, fatigue, depression, and recent walking exercise but these exploratory findings need to be confirmed in future studies.

Video exposure through virtual reality can improve older people's ability to manage postural instability caused by distortive visual environments.

In older adults, age-related degenerative processes and disorders often degrade some sensory systems more than others, which can make postural control disproportionally dependent on one kind of sensory information. The study aims were to investigate 1) the postural stability when healthy older adults were repeatedly exposed to a video in an immersive virtual reality (VR) environment, and 2) the relationship between stability during VR video exposure and self-reported physical activity, balance confidence, and nausea during VR. Twenty-seven older adults (18 females, mean age 71.3 years (SD 4.4)) watched a 120-second VR video 5 times with 10 minutes between sessions, while standing on a force platform recording their stability. The first VR video session produced a marked stability challenge, reflected by significantly increased use of anteroposterior and lateral total (p<0.001) and high frequency (p<0.001) energy compared with the control test quiet stance eyes open. However, repeated VR video sessions produced a multidimensional decrease in used total (p<0.001), low (p = 0.002), and high frequency energy (p<0.001). Participants used more energy in anteroposterior compared with lateral direction across sessions within all spectral ranges (p<0.001). Participants with higher physical activity level used less low frequency energy in anteroposterior direction during VR video session 1 (p = 0.033). No association was seen between balance confidence or nausea during VR and energy used during VR video sessions 1 and 5. Healthy older adults adapt fast to distortive visual environments, and thus, CNS can utilize the information provided by a few repeated VR video sessions into suitable movement strategies that have a simultaneous multidimensionally positive effect. VR may introduce numerous opportunities to customize novel rehabilitation approaches to address when the visual system causes and/or suffers from issues. However, a common problem for the older adult was that about 33% of the participants became nauseated by the VR video stimuli.

The Effects of Exergaming on Fear of Falling and the Balance Function in Anxious and Non-Anxious Older Adults: A Pilot Study

ABSTRACT Background Anxiety can exacerbate fear of falling and balance issues, potentially affecting intervention efficacy. This study examines exergaming’s impact on fear of falling and balance in anxious and non-anxious older adults. Materials and Methods Twenty older adults (10 anxious, 10 non-anxious) participated in six weeks of balance-oriented gaming. Fear of falling was assessed using the Falls Efficacy Scale and the Activities-specific Balance Confidence Scale. Balance was measured with the Berg Balance Scale and the Timed Up and Go Test before, after, and six weeks post-intervention. Results Both groups showed significant improvements in balance and mobility, sustained during follow-up. However, only the non-anxious group exhibited significant reductions in fear of falling and increased balance confidence. Anxiety was linked to reduced enjoyment, lower efficacy perception, and heightened tension during the intervention. Conclusion Exergaming improves balance and reduces fear of falling in non-anxious older adults. Anxiety may diminish these benefits. Clinical implications Assessing anxiety levels is crucial when prescribing exergaming interventions. Tailoring treatments to address anxiety could enhance outcomes.

Activities-specific balance confidence scale: a Rasch evaluation of the Arabic version in lower-limb prosthetic users

Purpose To evaluate the psychometric properties of the Arabic version of the Activities-Specific Balance Confidence Scale using the 5-option response categories for individuals with lower limb amputation (ABC-5/Ar). Materials and methods This was a methodological study on a convenience sample of individuals with unilateral lower-limb amputation attending outpatient rehabilitation centres in Saudi Arabia and Turkey (N = 155). Rasch analysis (WINSTEPS version 4.6.5) was used to examine the 5-categories rating scale structure, item fit, item difficulty hierarchy, person separation index, unidimensionality, local item dependency, and differential item functioning. Results The ABC-5/Ar 5-response option demonstrated an appropriate model fit. Most items fit the Rasch model, except for item #12 “walk in a crowded mall,” which showed an overfitting value of 0.63. The person separation indices 2.95 (Cronbach’s α = 0.96). Principal component analysis of residuals confirmed the unidimensionality of the scale; however, local dependency was detected between item #14 “Ride in escalator holding rail,” and item #15 “Ride in escalator not holding rail.” Conclusions The findings suggest that the ABC-5/Ar shows promise in assessing balance confidence in Arabic-speaking lower-limb prosthesis users. However, further studies with larger sample sizes and in diverse clinical contexts are needed to confirm its effectiveness in various clinical settings.

A Falls Prevention Program for People After Stroke in Guyana: An International Collaboration.

The objective was to describe the social, environmental, and cultural adaptations to an existing falls program and assess acceptability and preliminary effectiveness of the program in reducing fear, reducing falls, and improving function among individuals poststroke in Guyana. A quasi-experimental pilot study with a pretest/ posttest in-group design was developed through a collaboration of researchers in Guyana and the US. Participants took part in the falls prevention program for 8weeks. Outcome measures included a 10-meter walk test, Five Times Sit to Stand, and subjective questionnaires for falls incidence and balance confidence at the beginning and end. Twenty participants completed the study. One participant experienced medical complications and their data were excluded from analysis. Fifteen participants (78.9%) demonstrated improvements in comfortable and fast walking speed. Twelve participants completed the Five Times Sit to Stand Test. Eleven (91.67%) improved their time at posttest, with 9 (81.8%) demonstrating a clinically important improvement. Nineteen participants had sustained at least 1 fall prior to the study. Only 1 participant reported a fall during the program. Initially, the majority of participants (11/19) were very concerned about falling. At the end, only 1 was very concerned about falling, and the majority (15/19) were not concerned at all. Post-test surveys of participants indicated acceptability of the program. This pilot program helped reduce fall risk and improve confidence, gait speed and community mobility of the study participants. Future research at other rehabilitation departments in Guyana would help increase generalizability of the program. The program can be used clinically by physical therapists in Guyana both in departments and as a home program. Shared knowledge and experience of researchers considering research evidence and the environmental, social, and economic conditions of people living in Guyana were important in developing an effective program.

Comparative analysis of cognitive and physical characteristics in late-onset, adult-onset and early-onset multiple sclerosis patients

BackgroundLate-onset multiple sclerosis (LOMS or L; MS) and early-onset MS (EOMS or E) are less common, and their prognosis can be different. To characterize the demographic and clinical features, and clinical outcomes of LOMS and EOMS patients, comparing them to adult-onset MS (AOMS or A) patients. MethodsThe study was conducted as a secondary analysis of a prospective study. The participants were divided into three groups according to age of MS onset: early onset (<18 years of age), adult-onset (20–40 years of age), and late-onset (>55 years of age). Demographic variables, oligoclonal bands, IgG index, and Expanded Disability Status Scale (EDSS) score in admission, first year, second year and current EDSS were evaluated. The Timed 25-Foot Walk Test (T25FW), Timed Up and Go (TUG), Multiple Sclerosis Walking Scale-12, Single Leg Standing Test, Activity-Specific Balance Confidence Scale, Nine-Hole Peg Test, Epworth Sleepiness Scale and Restless Legs Syndrome Severity Scale were performed. Appropriate statistical analysis was made. ResultsA total of 658 pwMS was included in the study and divided into three groups: EOMS (n = 117), AOMS (n = 499), and LOMS (n = 42). Statistically significant differences were determined between groups in terms of age [L (mean:59.86±5.45 years-y-)> A (36.87±9.12 y)> E(26.56±8.85 y), p < 0.001], education level, current EDSS score (L > E, p < 0.001), EDSS score in first admission, EDSS score in the first year, EDSS score in the second year (L > A > E, p < 0.001), reached an EDSS score 6 (E > L p = 0.001, E > A p = 0.015), disease duration (E > A, E > L, mean E = 11.66±9.7 y, A = 7.99±7.4 y, L = 6.31±4.67 y) time switching second-line treatment to the third line (E > L p < 0.001, A > L p = 0.002, mean E = 171.73±83.29 months-m-, A = 136.13±65.75 m, L = 65.85±45.96 m), number of relapses (A > E > L, median E = 4.0, A = 3.0, L = 2.0), distribution of MS type and oligoclonal band types. Significant differences were found in T25FW and TUG. Post-hoc analysis showed that participants in the LOMS group have longer T25FW (mean L = 7.8 ± 6.11, A = 6.25±5.09, E = 5.72±3.13, p = 0.011) and TUG (mean L = 11.01±5.53, A = 9.57±8.04, E = 8.38±5.51, p = 0.007) times than the AOMS and EOMS groups. ConclusionOur result revealed that individuals with LOMS face elevated disability levels and a heightened propensity to transition from first-line treatments to more advanced therapeutic interventions. LOMS have worse lower extremity functional status than AOMS and EOMS patient. Clinical evaluations and treatment choices require more attention in LOMS. However, according to the low number of LOMS in our cohort, these results were considered cautious, and more wide and multi-center studies must be designed.

The Effect of Total Knee Replacement on Dual-Task Gait Performance in Older Adults.

Total knee replacement (TKR) is a common solution for patients with advanced knee osteoarthritis (OA). Still, fall rates remain relatively high after surgery. TKR may alter pain and knee function, balance control, and proprioception. However, given the role of complex (dual-task) walking in fall prediction for older adults, it is unknown how TKR alters the attentional demand of walking in older adults. The goal of this study was to examine the effect of TKR on dual-task walking among older adults. Participants were evaluated 1month before surgery and 4.5months after surgery. Participants walked along an instrumented 7-meter path for 1minute with and without a cognitive task (serial-3 subtraction). Pain and knee function, knee proprioception, dynamic balance, and balance confidence, as well as dual-task costs (DTC) were compared before and after the surgery and factors associated with change in gait DTCs were assessed. Thirty-eight participants completed the study (age 72.6years, SD = 4.9; 11 men). A significant decrease in pain was found following TKR, with no change in balance, balance confidence, or proprioception. There were no differences in gait DTCs before and after the surgery. However, change in dynamic balance, specifically reactive postural control and dynamic gait, predicted changes in gait speed and stride time DTCs. The absence of an effect of TKR on gait DTCs can potentially underlie increased fall risk after TKR. Results from this study emphasize the significance of balance as a measure and focal point for rehabilitation after TKR. This study contributes to our understanding of the attentional cost of walking in people before and after TKR, as well as to factors associated with it. Results from this work can assist formulation of rehabilitation programs for people with knee OA.