Balance Outcome Measures Research Articles

Does wobble board training improve balance in older adults? A systematic review

Background Falls are a common and costly problem, with poor balance a significant contributor. Wobble boards are commonly used for balance enhancement. However, the efficacy of wobble board training is not well understood, particularly in the older adult. Objectives To appraise and synthesise literature pertaining to the effect of wobble board training on balance in older adults. Methods A systematic search of Medline, Scopus, EBSCO, CINAHL, Science Direct, and Google Scholar databases was conducted up to August 2020. Articles comparing balance before and after wobble board training were included and quality appraised using the modified Downs and Black checklist. Results Six relevant studies (n = 129) were identified for review: four randomised-controlled-trials, one pilot-study and one repeated-measures design. The overall weighted average percentages, calculated from those studies where possible suggested an improvement in Berg Balance Scale (or similar) was 4.4% and for timed-up and go, 6.3%. Mean effect sizes ranged from 0.09 to 0.96. Overall, there is conflicting evidence to support wobble training for balance improvement in older adults. Magnitude of real change was often small questioning the impact of such small improvements on overall balance function. Effect sizes for balance enhancement through wobble board training were modest, with the largest effects on multi-modal balance outcome measures, such as the Berg Balance Scale. The results indicate that if wobble board programmes are simple and of a sufficient ‘within session’ duration, then some improvements in balance can be demonstrated within 3-weeks. Conclusions The evidence suggests conflicting results for the improvement of balance with wobble board training in older adults. Where effects were seen their magnitude was modest. Future studies should focus on determining the optimal wobble board programme to enhance balance.

The relationship between plantar sensation and muscle onset during automatic postural responses in people with multiple sclerosis and healthy controls

BackgroundPlantar sensation is critical for balance control in people with multiple sclerosis (PwMS). While previous research has described its impact on standing balance, the influence of plantar sensation during automatic postural responses (APRs) is not well understood in PwMS. The purpose of this study was to characterize the relationship between plantar sensation and APRs in PwMS and controls. A secondary aim was to determine whether the relationship between plantar sensation and APRs is different across PwMS and control groups. Methods122 PwMS and 48 age-matched controls underwent forward and backward support-surface perturbations from stance. The onset of the tibialis anterior (TA) and medial gastrocnemius (MG) were the primary reactive balance outcome measures for backward and forward losses of balance, respectively. Plantar sensation was measured as the vibration sensation threshold (VT). ResultsAs expected, PwMS had significantly higher (i.e., worse) VT (p<0.001) and an increased MG and TA onset latency (TA: p<0.001, MG: p = 0.01) compared to the control group. A higher VT was related to increased MG (p<0.001) and TA latency (p<0.001) across all participants. However, no moderating effect of group (control or PwMS) was observed for the relationship between VT and muscle onset (MG: p = 0.14; TA: p = 0.34). ConclusionPwMS demonstrated poorer plantar sensation and delayed muscle onset during APRs compared to controls. Plantar sensation was also related to muscle onset after perturbations in all participants. Although this relationship was not moderated by group, this may be related to the lack of dynamic range of VT scores in controls. These results indicate that plantar sensation may be related to reactive balance and provides insight into a potential contributing factor of delayed automatic postural responses in people with MS.

A Computational Framework Towards the Tele-Rehabilitation of Balance Control Skills.

Mobility has been one of the most impacted aspects of human life due to the spread of the COVID-19 pandemic. Home confinement, the lack of access to physical rehabilitation, and prolonged immobilization of COVID-19-positive patients within hospitals are three major factors that affected the mobility of the general population world-wide. Balance is one key indicator to monitor the possible movement disorders that may arise both during the COVID-19 pandemic and in the coming future post-COVID-19. A systematic quantification of the balance performance in the general population is essential for preventing the appearance and progression of certain diseases (e.g., cardiovascular, neurodegenerative, and musculoskeletal), as well as for assessing the therapeutic outcomes of prescribed physical exercises for elderly and pathological patients. Current research on clinical exercises and associated outcome measures of balance is still far from reaching a consensus on a “golden standard” practice. Moreover, patients are often reluctant or unable to follow prescribed exercises, because of overcrowded facilities, lack of reliable and safe transportation, or stay-at-home orders due to the current pandemic. A novel balance assessment methodology, in combination with a home-care technology, can overcome these limitations. This paper presents a computational framework for the in-home quantitative assessment of balance control skills. Novel outcome measures of balance performance are implemented in the design of rehabilitation exercises with customized and quantifiable training goals. Using this framework in conjunction with a portable technology, physicians can treat and diagnose patients remotely, with reduced time and costs and a highly customized approach. The methodology proposed in this research can support the development of innovative technologies for smart and connected home-care solutions for physical therapy rehabilitation.

System Immersion in Virtual Reality-Based Rehabilitation of Motor Function in Older Adults: A Systematic Review and Meta-Analysis

Background: As the elderly population continues to grow, so does the demand for new and innovative solutions to tackle age-related chronic diseases and disabilities. Virtual Reality (VR) has been explored as a novel therapeutic tool for numerous health-related applications. Although findings frequently favors VR, methodological shortcomings prevent clinical recommendations. Moreover, the term “VR” is frequently used ambiguously to describe e.g., video games; the distinction remains vague between immersive VR (IVR) systems and non-immersive VR (NVR). With no distinct demarcation, results of outcome measures are often pooled in meta-analyses, without accounting for the immersiveness of the system.Objective: This systematic review focused on virtual reality-based rehabilitation of older adults (+60) in motor rehabilitation programs. The review aims to retrospectively classify previous studies according to the level of immersion, in order to get an overview of the ambiguity-phenomenon, and to utilize meta-analyses and subgroup analyses to evaluate the comparative efficacy of system immersion in VR-based rehabilitation.Methods: Following PRISMA guidelines, we conducted a systematic search for randomized controlled trials, describing virtual rehabilitation or video games interventions for older adults (+60). Main outcomes were pain, motivation, mobility, balance, and adverse events.Results: We identified 15 studies which included 743 patients. Only three studies utilized IVR. The rest used various NVR-equipment ranging from commercial products (e.g., Nintendo Wii), to bespoke systems that combine tracking devices, software, and displays. A random effects meta-analysis of 10 studies analyzed outcome measures of mobility, balance, and pain. Protocols and dosage varied widely, but outcome results were in favor of immersive and non-immersive interventions, however, dropout rates and adverse events were mostly in favor of the control.Conclusions: We initialize a call-for-action, to distinguish between types of VR-technology and propose a taxonomy of virtual rehabilitation systems based on our findings. Most interventions use NVR-systems, which have demonstrably lower cybersickness-symptoms than IVR-systems. Therefore, adverse events may be under-reported in RCT-studies. An increased demand for IVR-systems highlight this challenge. Care should be given, when applying the results of existing NVR tools to new IVR-technologies. Future studies should provide more detail about their interventions, and future reviews should differentiate between NVR and IVR.

Standing and Walking Balance in Patients with Chronic Shoulder Pain: A Case-control Study.

Background:Patients with shoulder pain may have proprioceptive and balance deficits. However, studies on balance in patients with shoulder pain are scarce.Objective:This study aims to investigate if patients with chronic shoulder pain demonstrate deficits in standing and walking balance and to study the relationship between outcome measures of balance and age and body mass index (BMI).Materials and Methods:This case–control study was conducted at Dammam Medical Complex, Dammam, Saudi Arabia, between March and November 2018. The study recruited patients (n = 15) with chronic shoulder pain (>4 months) and healthy controls (n = 15) matched for age, gender and BMI. Standing balance was tested using a Challenge Disc test, the Romberg test and timed unipedal stance test (UPST). Walking balance was assessed using the timed up and go (TUG) test, stance phase duration and center of pressure (COP) deviation. Independent t-tests were used to investigate the differences between the two groups in demographic data and all the outcome measurements. Pearson correlation coefficients were used for correlation analysis.Results:No statistically significant differences were found between the two groups in any outcome of the standing balance (P ≥ 0.095) or walking balance (P ≥ 0.160). However, medium effect sizes were found for the UPST (η2: ≥0.06), Challenge Disc (η2: 0.06), TUG (Cohen's d: 0.54) and COP deviation (Cohen's d: 0.53). There was a moderate correlation between BMI and Challenge Disc (P = 0.025) and between age and Challenge Disc (P = 0.012) in both the groups.Conclusion:Patients with chronic shoulder pain had lower balance measurements compared with healthy people, although this difference was not statistically significant.

Clinical and laboratory measures of balance and comparison of balance performances according to postural instability and gait disorders in individuals with Parkinson’s disease

Purpose/aim Primary aim was to investigate the association between laboratory measures of balance and clinical balance tests in individuals with Parkinson’s disease (PD). The secondary aim was to compare the balance performances according to postural instability and gait disorders (PIGD). Materials and methods Sixty-four individuals with PD were included in the study. Clinical data were investigated using modified Hoehn and Yahr Scale and Unified Parkinson's Disease Rating Scale (UPDRS). Berg Balance Scale (BBS), Timed Up&Go Test (TUG), Five Times Sit-to-Stand Test (FTSST) were used for clinical measures of balance. Laboratory measures of balance were evaluated by Balance Master System including the modified Clinical Test of Sensory Interaction of Balance (mCTSIB), Limits of Stability Test (LOS), Sit to Stand Test (STS), and Tandem Walk Test (TW). The relationship between clinical and laboratory measures of balance was determined. After participants were divided into two groups based on UPDRS: patients with and without PIGD, their balance performance was compared. Results There were significant correlations between BBS and mCTSIB, LOS-Movement Velocity, and LOS-Endpoint Excursion. FTSST was correlated with STS-Weight Transfer and STS-Rising Index, and TUG was correlated with TW-Speed. Patients with PIGD had worse scores of balance assessments including FTSST, LOS-Movement Velocity, STS-Rising Index. Conclusion Laboratory measures are associated with clinical balance tests and they may reflect clinical balance outcome measures. Furthermore, PIGD may negatively affect balance performance in patients with PD.

Balance and Fall Risk Outcome Measures for Patients 65 Years or Older in the Outpatient Physical Therapy Setting: What Are the Current Trends?

Background &amp; Objectives: Occurrence of falls in older adults contributes to increased morbidity and mortality, exponential healthcare costs, and reduced quality of life. Utilization of outcome measures for screening and assessing fall risk in older patients contributes to reduced fall-related injuries, deaths, and healthcare costs, while promoting improved mobility and health status. The purpose of this study was to explore the utilization of outcome measures assessing balance and fall risk in patients 65 years and up within the outpatient physical therapy setting. Secondary aims included determining the most frequently used outcome measures as well as examining any associations between demographic variables and clinicians’ screening habits.

Effects of Exercise-Based Interventions on Fall Risk and Balance in Patients With Chronic Obstructive Pulmonary Disease: A SYSTEMATIC REVIEW.

Chronic obstructive pulmonary disease (COPD) is a highly prevalent disease characterized by airflow limitation and is associated with decreased balance and increased fall risk. Since falls are related to increased mortality, interventions targeting balance and fall risk could reduce morbidity and mortality. The objective of this review was to systematically assess the effects of exercise-based interventions on fall risk and balance in patients with COPD. PubMed, Web of Science, EMBASE, and CINAHL were screened for randomized controlled trails and within-group studies evaluating effects of exercise-based interventions on fall risk or balance in patients with COPD. Data were presented in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Fifteen studies were identified, 6 randomized controlled trails and 9 within-group studies. All interventions reported positive effects on balance outcomes. No studies reported fall risk. Taking current recommendations of balance outcome measures in patients with COPD into account, pulmonary rehabilitation combined with balance training had the highest effect size. Nine papers had concerns regarding bias, mostly due to the lack of blinding outcome assessors. Exercise-based interventions have a positive effect on balance in patients with COPD. Pulmonary rehabilitation with balance training seems to have the most beneficial effect on balance. The effects on fall risk, as well as the long-term intervention effects remain unclear. A standardized balance assessment and research on long-term effects and fall risk are recommended.

The association between trunk muscle endurance, balance and falls self-efficacy in women with osteoporotic vertebral fractures: an exploratory analysis from a pilot randomized controlled trial

Background Trunk muscle endurance may be associated with balance and falls self-efficacy for people with osteoporosis. However, all previous studies have examined trunk muscle strength rather than endurance. Purpose To explore the relationships between trunk muscle endurance and standing balance and falls self-efficacy for women with vertebral fractures. Materials and Methods This is an exploratory, secondary analysis of baseline data of a pilot randomized controlled trial in Ontario, Canada. Thirty-one women with osteoporosis, aged 65 years or older, with at least one vertebral fracture were included. The associations between balance (Balance Outcome Measure for Elder Rehabilitation) and trunk muscle endurance (Timed Loaded Standing Test) and falls self-efficacy (Falls Efficacy Scale International) and trunk muscle endurance were tested via Spearman rank order correlation with Fisher’s z transformations. Results Trunk muscle endurance was correlated with better balance performance on the Balance Outcome Measure for Elder Rehabilitation [Spearman correlation coefficient, 0.71; 95% confidence interval: 0.47–0.85; p < 0.001], but not with falls self efficacy (Spearman correlation coefficient; –0.22; 95% confidence interval: –0.53 to 0.14; p = 0.23). Conclusions Trunk muscle endurance was moderately associated with better standing balance performance but not falls self-efficacy, highlighting the importance of trunk muscle endurance for standing balance for older adults with osteoporosis and vertebral fractures. Implications for Rehabilitation Older adults with osteoporosis and vertebral fractures who have better trunk muscle endurance may also have better standing balance. There was no association between trunk muscle endurance and how confident a person is that they will not fall while completing various activities of daily living. Trunk muscle endurance training could be included as part of a standing balance rehabilitation program for this population.

Augmenting Clinical Outcome Measures of Gait and Balance with a Single Inertial Sensor in Age-Ranged Healthy Adults.

Gait and balance impairments are linked with reduced mobility and increased risk of falling. Wearable sensing technologies, such as inertial measurement units (IMUs), may augment clinical assessments by providing continuous, high-resolution data. This study tested and validated the utility of a single IMU to quantify gait and balance features during routine clinical outcome tests, and evaluated changes in sensor-derived measurements with age, sex, height, and weight. Age-ranged, healthy individuals (N = 49, 20–70 years) wore a lower back IMU during the 10 m walk test (10MWT), Timed Up and Go (TUG), and Berg Balance Scale (BBS). Spatiotemporal gait parameters computed from the sensor data were validated against gold standard measures, demonstrating excellent agreement for stance time, step time, gait velocity, and step count (intraclass correlation (ICC) > 0.90). There was good agreement for swing time (ICC = 0.78) and moderate agreement for step length (ICC = 0.68). A total of 184 features were calculated from the acceleration and angular velocity signals across these tests, 36 of which had significant correlations with age. This approach was also demonstrated for an individual with stroke, providing higher resolution information about balance, gait, and mobility than the clinical test scores alone. Leveraging mobility data from wireless, wearable sensors can help clinicians and patients more objectively pinpoint impairments, track progression, and set personalized goals during and after rehabilitation.

Rehabilitation interventions for improving balance following stroke: An overview of systematic reviews.

BackgroundThe aim of this study was to synthesize evidence from systematic reviews, to summarise the effects of rehabilitation interventions for improving balance in stroke survivors.MethodsWe conducted an overview of systematic reviews (SRs). We included Cochrane Systematic Reviews and non-Cochrane Systematic Reviews of randomized-controlled clinical trials and not-randomized clinical trials, in all types of stroke, comparing the effects of interventions, control interventions and no interventions on balance-related outcomes. We conducted a comprehensive search of electronic databases, from inception to December 2017. Data extracted included: number and type of participants, type of intervention, control intervention, method of assessing risk of bias of primary studies, balance outcome measures and results of statistical meta-analyses. Methodological quality of included reviews was assessed using AMSTAR 2. A narrative description of the characteristics of the SRs was provided and results of meta-analyses summarised with reference to their methodological quality.Results51 SRs (248 primary studies and 10,638 participants) met the inclusion criteria and were included in the overview. All participants were adults with stroke. A wide variety of different balance and postural control outcomes were included. 61% of SRs focussed on the effectiveness of physical therapy, 20% virtual reality, 6% electromechanical devices, 4% Tai-Chi, whole body vibration and circuit training intervention, and 2% cognitive rehabilitation. The methodology of 54% of SRs were judged to be of a “low or critically low” quality, 23% “moderate” quality and 22% “high” quality.ConclusionsThere are 51 SRs of evidence relating to the effectiveness of interventions to improve balance in people with stroke, but the majority of these are of poor methodological quality, limiting our ability to draw clear implications. Only 22% of these SRs were judged to be of high quality, highlighting the need to address important methodological issues within rehabilitation research.

Score Distributions of the Balance Outcome Measure for Elder Rehabilitation (BOOMER) in Community-Dwelling Older Adults With Vertebral Fracture.

We sought to evaluate the Balance Outcome Measure for Elder Rehabilitation (BOOMER) in community-dwelling women 65 years and older with vertebral fracture and to describe score distributions and potential ceiling and floor effects. This was a secondary data analysis of baseline data from the Build Better Bones with Exercise randomized controlled trial using the BOOMER. A total of 141 women with osteoporosis and radiographically confirmed vertebral fracture were included. Concurrent validity and internal consistency were assessed in comparison to the Short Physical Performance Battery (SPPB). Normality and ceiling/floor effects of total BOOMER scores and component test items were also assessed. Exploratory analyses of assistive aid use and falls history were performed. Tests for concurrent validity demonstrated moderate correlation between total BOOMER and SPPB scores. The BOOMER component tests showed modest internal consistency. Substantial ceiling effect and nonnormal score distributions were present among overall sample and those not using assistive aids for total BOOMER scores, although scores were normally distributed for those using assistive aids. The static standing with eyes closed test demonstrated the greatest ceiling effects of the component tests, with 92% of participants achieving a maximal score. While the BOOMER compares well with the SPPB in community-dwelling women with vertebral fractures, researchers or clinicians considering using the BOOMER in similar or higher-functioning populations should be aware of the potential for ceiling effects.

Efficacy of Bare foot Exercise Versus Common Footwear Exercise in Subjects with Plantar Fasciitis

The aim of the study is to determine the efficacy of barefoot exercise vs. common footwear exercise in subjects with plantar fasciitis. An objective of the study is to find the efficacy of barefoot exercise versus common footwear exercise on pain with numerical pain rating scale among subjects with plantar fasciitis and to find the efficacy of barefoot exercise versus common footwear exercise on balance outcome measure for elder rehabilitation (BOOMER) among subjects with plantar fasciitis. Methodology: 20 patients with plantar fasciitis were selected based on the inclusion and exclusion criteria. The collected data were tabulated and analyzed using descriptive and inferential statistics. To all parameters mean and standard deviation (SD) was used. Paired t-test was used to analyze significant changes within the groups. Unpaired t-test was used to analyze significant changes between the two groups. It has been concluded that barefoot exercise (GROUP A) is more effective than common footwear exercise (GROUP B) in decreasing pain, and increasing balance in subjects with plantar fasciitis.

Yoga to prevent mobility limitations in older adults: feasibility of a randomized controlled trial

BackgroundThe loss of mobility during aging impacts independence and leads to further disability, morbidity, and reduced life expectancy. Our objective was to examine the feasibility and safety of conducting a randomized controlled trial of yoga for older adults at risk for mobility limitations.MethodsSedentary older adults (n = 46; age 60–89) were recruited and randomized to either yoga or a health education comparison group. Yoga sessions (60-min) occurred 2x weekly, and 90-min health education sessions occurred weekly, for 10 weeks. The primary outcomes were recruitment rate, intervention attendance, and retention at assessments. Adverse event rates and participant satisfaction were also measured. Physical performance measures of gait, balance, and strength and self-report outcome measures were administered at baseline and 10-weeks.ResultsRecruitment lasted 6 months. Retention of participants at the 10-week follow-up was high (89% - performance measures; 98% - self-report questionnaires). Attendance was good with 82% of yoga and 74% of health education participants attending at least 50% of the sessions. No serious adverse events were reported. Patient satisfaction with the interventions was high. The mean effect size for the physical performance measures was 0.35 with some over 0.50. The mean effect size for self-report outcome measures was 0.36.ConclusionsResults indicate that it is feasible to conduct a larger RCT of yoga for sedentary older adults at risk for mobility problems. The yoga and comparison interventions were safe, well accepted, and well attended. Effect sizes suggest yoga may have important benefits for this population and should be studied further.Trial RegistrationClinicalTrials # NCT03544879; Retrospectively registered 4 June, 2018.

Influences of Age, Obesity, and Adverse Drug Effects on Balance and Mobility Testing Scores in Ambulatory Older Adults.

The adverse effects of drugs may influence results on tests of mobility and balance, but the drug-specific impact is not identified when using these tests. We propose that a quantitative drug index (QDI) will assist in assessing fall risk based on these tests, when combined with other fall risk variables. Fifty-seven community-dwelling older adults who could walk independently on a treadmill and had Mini-Mental State Examination (MMSE) scores equal to or greater than 24 participated. Mobility and balance outcome measures included the Balance Evaluation Systems Test (BESTest), Berg Balance Scale (BBS), Timed Up and Go (TUG) and cognitive dual task TUG (TUGc). Fall history, current drug list, and Activity-Specific Balance Confidence (ABC) scale scores were also collected. Body mass index (BMI) was calculated. The QDI was derived from the drug list for each individual, and based on fall-related drug adverse effects. Multiple linear regression analyses were conducted using age, BMI, and QDI as predictor variables for determining mobility and balance test scores, and ABC scale scores. Subsequently, participants were divided into (QDI = 0) low-impact drug group (LIDG) and (QDI > 0) high-impact drug group (HIDG) for Mann-Whitney 2-group comparisons. Age, BMI, and QDI were all significant (P < .001) independent variables in multiple regression analyses for mobility and balance test scores, but not for the ABC scale. Separately, the 2 group comparisons for the BESTest, BBS, TUG, and TUGc demonstrated that HIDG scored significantly (P < .05) worse on these tests compared with the LIDG. Drug counts were also significantly higher for the HIDG than for the LIDG. In contrast, age, BMI, MMSE, and reported falls in the last 12 months were not significantly different between groups. Age, BMI, and QDI-all contributed independently to the mobility and balance test scores examined, and may provide health care professionals a screening tool to determine whether additional mobility and balance testing is required. In addition, the QDI is a more precise marker of adverse effects of drugs compared with drug counts, as the latter does not quantitate the influence of drugs on physiologic function.

Concurrent exergaming and transcranial direct current stimulation to improve balance in people with Parkinson\u2019s disease: study protocol for a randomised controlled trial

BackgroundPeople with Parkinson’s disease (PD) commonly experience postural instability, resulting in poor balance and an increased risk of falls. Exercise-based video gaming (exergaming) is a form of physical training that is delivered through virtual reality technology to facilitate motor learning and is efficacious in improving balance in aged populations. In addition, studies have shown that anodal transcranial direct current stimulation (a-tDCS), when applied to the primary motor cortex, can augment motor learning when combined with physical training. However, no studies have investigated the combined effects of exergaming and tDCS on balance in people with PD.Methods/designTwenty-four people with mild to moderate PD (Hoehn and Yahr scale score 2–4) will be randomly allocated to receive one of three interventions: (1) exergaming + a-tDCS, (2) exergaming + sham a-tDCS or (3) usual care. Participants in each exergaming group will perform two training sessions per week for 12 weeks. Each exergaming session will consist of a series of static and dynamic balance exercises using a rehabilitation-specific software programme (Jintronix) and 20 minutes of either sham or real a-tDCS (2 mA) delivered concurrently. Participants allocated to usual care will be asked to maintain their normal daily physical activities. All outcome measures will be assessed at baseline and at 6 weeks (mid-intervention), 12 weeks (post-intervention) and 24 weeks (3-month follow-up) after baseline. The primary outcome measure will be the Limits of Stability Test. Secondary outcomes will include measures of static balance, leg strength, functional capacity, cognitive task-related cortical activation, corticospinal excitability and inhibition, and cognitive inhibition.DiscussionThis will be the first trial to target balance in people with PD with combined exergaming and a-tDCS. We hypothesise that improvements in balance, functional and neurophysiological outcome measures, and neurocognitive outcome measures will be greater and longer-lasting following concurrent exergaming and a-tDCS than in those receiving sham tDCS or usual care.Trial registrationAustralian New Zealand Clinical Trials Registry, ACTRN12616000594426). Registered on 9 May 2016.

Responsiveness of performance-based outcome measures for mobility, balance, muscle strength and manual dexterity in adults with myotonic dystrophy type 1.

To assess changes and responsiveness in outcome measures of mobility, balance, muscle strength and manual dexterity in adults with myotonic dystrophy type 1. A 9-year longitudinal study conducted with 113 patients. The responsiveness of the Timed Up and Go test, Berg Balance Scale, quantitative muscle testing, grip and pinch-grip strength, and Purdue Pegboard Test was assessed using criterion and construct approaches. Patient-reported perceived changes (worse/stable) in balance, walking, lower-limb weakness, stair-climbing and hand weakness were used as criteria. Predefined hypotheses about expected area under the receiver operating characteristic curves (criterion approach) and correlations between relative changes (construct approach) were explored. The direction and magnitude of median changes in outcome measures corresponded with patient-reported changes. Median changes in the Timed Up and Go test, grip strength, pinch-grip strength and Purdue Pegboard Test did not, in general, exceed known measurement errors. Most criterion (72%) and construct (70%) approach hypotheses were supported. Promising responsiveness was found for outcome measures of mobility, balance and muscle strength. Grip strength and manual dexterity measures showed poorer responsiveness. The performance-based outcome measures captured changes over the 9-year period and responsiveness was promising. Knowledge of measurement errors is needed to interpret the meaning of these longitudinal changes.

Investigation of the Effectiveness of a Preseason Strength and Conditioning “Prehab” Program for Collegiate Athletes: A Pilot Study

Objective: To investigate the effectiveness of a preseason strength and conditioning “Prehab” program on decreasing non-contact injuries and improving outcome measures of strength, agility, and balance in collegiate men’s and women’s basketball players, men’s and women’s soccer players, and women’s volleyball players. Methods: Forty-five National Collegiate Athletic Association Division I athletes participated. Participants performed a 10- week Prehab program consisting of five progressive levels advancing every two weeks. Exercises included lumbopelvic stabilization, scapular stabilization, plyometric training, and sport specific exercises. Test measures were taken before and after the Prehab intervention. Outcome measures included vertical jump height, number of push-ups, front/lateral plank time, single limb stance time, back extensor endurance time, thoracic spine rotation range of motion, number of single leg squats, Cross Hop test, Single Leg Crossover test, and closed kinetic chain upper extremity stability test (CKCUEST), as well as the number of non-contact injuries.Results: After completion of the Prehab program, participants showed significant improvement in vertical jump height, number of push-ups, front/lateral plank time, single limb stance time on the right, back extensor endurance time, thoracic spine rotation to the left, Single Leg Crossover test, and CKCUEST. Additionally, all other outcome measures showed a trend toward improvement. Participants experienced a total of 42 inseason repetitive stress injuries in the intervention year and 38 in the year after the intervention. Conclusion: Participation in the “Prehab” program led to a reduced number of in-season non-contact injuries and significant improvements in 9 of the 11 outcomes measures of strength, agility, and balance in collegiate athletes. The lack of significance in some of the outcome measures may be due to the small sample size. A repeat of this study using a randomized-control design with a larger sample size may yield more significant results.

A Multi-disciplinary approach to falls prevention in the elderly

Northern Ireland South Eastern Integrated Care Partnership – Multi-agency Falls Prevention Strategy Background: Falls are the most frequent and serious accident in people over 65. Falls are the MAIN cause of disability & death in people over 75. FEAR of falling dramatically reduces quality of life Strokes/TIAs and heart attacks are falling. Fractures from falls are RISING. Fragility fractures cost UK over £2billion/year. Large and rising elderly population Preventing Falls: NICE (2013) recommend that all older people who have had a fall or are identified as having gait or balance problems should have a multifactorial falls assessment and a multifactorial intervention plan. NICE have identified the following interventions as being common to successful multifactorial interventions: Strength and Balance training – shown to reduce Falls by 55% Home hazard assessment and intervention Vision assessment and referral Medication review with modification/withdrawal Implementation of evidence base requires a multi-professional and multi-agency approach to care provision and raised awareness among public and professionals. SE ICP Falls Multi-professional working group/partnership committee membership Patient & Carer representatives Falls Co-ordinator Community/voluntary representative Local Council representative Physiotherapists OTs GPs Pharmacists NIAS ( Northern Ireland Ambulance Service) ICP Project Manager Problems Identified: Lack of Follow up of patients who fall and call NIAS (N.I. Ambulance Service) Poor Access to Falls Prevention Services/ Strength & Balance Programmes Lack of Awareness of benefits of Fall Prevention Services Strength & Balance Programmes Actions: 12 month pilot to provide a co-ordinated Falls service across the entire south eastern locality in conjunction with NIAS (5 day and enhanced weekend service). Referrals made directly from NIAS to the service and all patients referred receive a multifactorial screening assessment by a Falls Assessor in their own home within 24hrs of a fall. If necessary onward referrals made to AHP, nursing, GP and voluntary sector services to address identified need. Patients also receive a medication review within 72hrs of the initial referral. Provision of Strength/Balance Programmes in a wide range of community settings including community centres and a GP surgery Outcomes: 170 NIAS referrals to Falls Prevention Team 1284 assessments completed April 2015-16 Strength & Balance Programmes for those at risk of Falls Raising awareness of programme benefits: Pharmacies/GPs/Community/Carers/ Reducing Falls, Reducing Fear, Reducing Fractures Saving NHS Resources Benefits of the service: Clients completing the strength & balance programme 67% improve on FES-I (fear of falling outcome measure) 54% improve on TUAG (balance and mobility outcome measure) Pharmacy – Medication review 61% recommendations made to GP by falls pharmacist were implemented Patient Experience: 73 year old lady referred from GP. No history of falls but significant fear of falls. Completed 12 week strength and balance program. “My confidence has grown, my balance is so much better now and I don’t have the same fear of falling. Since starting the class I can get to the bathroom in time.” Next Steps: Further expansion of strength/balance programme in a range of community settings-massive potential to address unmet need and produce significant health gain.

Does the addition of two exercise-focussed home visits to usual care improve outcomes for patients with balance impairments? A randomized controlled trial

Objective: To investigate whether two additional home visits improve outcomes for rehabilitation outpatients with balance impairments compared to usual care. Design: Randomized controlled trial. Setting: Outpatient rehabilitation. Participants: Fifty with balance impairments. Interventions: Both groups received usual care including weekly group exercise over eight weeks. The intervention group received two home visits to individualize home exercises. Outcome measures: Primary outcome measure was the Balance Outcome Measure for Elder Rehabilitation (BOOMER) score, and secondary outcomes included force platform measures using the NeuroCom Balance Master®, assessed at baseline, after intervention and three-month follow-up. Results: There was no between-group difference for BOOMER score. There were significant between-group differences in favour of the intervention group for limits of stability reaction time at week 9 (mean difference (MD) −0.27, 95% confidence interval (CI) −0.44 to −0.09) and week 22 (MD −0.28, 95% CI −0.45 to −0.10) and for limits of stability maximal excursion at week 9 (MD 8.66, 95% CI 1.67 to 15.65) and week 22 (MD 14.58, 95% CI 7.59 to 21.57). Significant between-group differences favoured the control group for Clinical Test of Sensory Interaction of Balance at week 9 (MD 0.40, 95% CI 0.13 to 0.66) and week 22 (MD 0.45, 95% CI 0.18 to 0.72) and step quick turn time at week 9 (MD 0.56, 95% CI 0.02 to 1.10). Conclusion: Two exercise-focussed home visits improved some dynamic balance outcomes in older patients with balance impairments. Some outcomes showed significant improvements with small effect sizes in favour of the control group which may be chance findings or because they completed a standard home exercise programme.