Fall History Research Articles

Effect of a Perturbation-Based Balance Training Session on Adaptive Locomotor Response in Older Adults With a History of Falls.

To assess the adaptive response of older adults with a history of falls in a single Perturbation-Based Balance Training (PBT) session by examining the margin of stability (MoS) and the number of falls. Thirty-two older adults with a history of falls underwent a treadmill walking session lasting 20-25min. During the PBT protocol, participants experienced 24 unexpected perturbations delivered in two ways: acceleration or deceleration of the treadmill belt, with 12 perturbations in each direction. The MoS in the anteroposterior direction was assessed for the first and last perturbations of the session, during the perturbation step (N) and the recovery step (REC), along with the number of falls during the training session. There was no statistically significant difference in MoS between the first and last perturbations (acceleration and deceleration) for steps N and REC. Regarding the number of falls, a significant reduction was found when comparing the first half with the second half of the training session (p = .033). There were 13 falls in the first half and only three in the second half of the PBT session. Older adults with a history of falls exhibited an adaptive response with a reduction in the number of falls during a single session of PBT despite not showing changes in the MoS.

Exploring Responsiveness to Highly Challenging Balance and Gait Training in Parkinson's Disease.

Exercise potentially improves gait, balance, and habitual physical activity in Parkinson's disease (PD). However, given the heterogeneous nature of the disease, it is likely that people respond differently to exercise interventions. Factors determining responsiveness to exercise interventions remain unclear. To address this uncertainty, we explored the responsiveness to our highly challenging balance and gait intervention (HiBalance) in people with PD. Thirty-nine participants with mild-moderate PD who underwent the HiBalance intervention from our randomized controlled trial were included. We defined response in three domains: (1) balance based on Mini-BESTest, (2) gait based on gait velocity, and (3) physical activity based on accelerometry-derived steps per day. In each domain, we explored three responsiveness levels: high, low, or non-responders according to the change from pre- to post-intervention. Separate Random Forests for each responder domain classified these responsiveness levels and identified variable importance. Only the Random Forest for the balance domain classified all responsiveness levels above the chance level indicated by a Cohen's kappa of "slight" agreement. Variable importance differed among the responsiveness levels. Slow gait velocity indicated high responders in the balance domain but showed low probabilities for low and non-responders. For low and non-responders, fall history or no falls, respectively, were more important. Among three responder domains and responsiveness levels, we could moderately classify responders in the balance domain, but not for the gait or physical activity domain. This can guide inclusion criteria for balance-targeted, personalized intervention studies in people with PD.

Association between Falls, Fear of Falling and Depressive Symptoms in Community-Dwelling Older Adults.

Longevity increases pose public health challenges, especially in managing falls and their psychological impacts on older adults. Limited evidence exists on the relationship between a fear of falling (FOF), previous falls, and depressive symptoms among community-dwelling older adults. To evaluate the association between falls, FOF, and depressive symptoms in community-dwelling older adults. This cross-sectional study, conducted in 2018, included 400 older adults from a Basic Health Unit in São Paulo, Brazil. The Geriatric Depression Scale (GDS-15) and the International Falls Efficacy Scale (FES-I) were used, along with self-report questionnaires on fall history. Linear and logistic regression were used to analyze the relationships between variables. The mean age was 75.2 (SD = 8.53) years, with 63.2% being female. Depressive symptoms were observed in 18.3% of the participants, while 90.5% reported a fear of falling (FOF). More than half (63.0%) experienced falls, with 49.5% occurring in the last year. Factors such as the female gender, negative health perceptions, and functional dependence were associated with depressive symptoms. Adjusted analyses indicated that both a fear of falling (FOF) (B = 0.043; p = 0.012) and a history of falls (B = 0.725; p = 0.015) were associated with depressive symptoms. Falls, FOF, and depressive symptoms are interlinked among older adults, underscoring the need for targeted interventions to improve their mental and physical health.

The prediction model of fall risk for the elderly based on gait analysis

IntroductionEarly screening and identification are crucial for fall prevention, and developing a new method to predict fall risk in the elderly can address the current lack of objectivity in assessment tools.MethodsA total of 132 elderly individuals over 80 years old residing in some nursing homes in Shanghai were selected using a convenient sampling method. Fall history information was collected, and gait data during a 10-meter walk were recorded. Logistic regression was employed to establish the prediction model, and a nomogram was used to assess the importance of the indicators. The Bootstrap method was utilized for internal validation of the model, while the verification set was used for external validation. The predictive performance of the model was evaluated using the area under the ROC curve, calibration curve, and decision curve analysis (DCA) to assess clinical benefits.ResultsThe incidence of falls in the sample population was 36.4%. The Tinetti Gait and Balance Test (TGBT) score (OR = 0.832, 95% CI: 0.734,0.944), stride length (OR = 0.007, 95% CI: 0.000,0.104), difference in standing time (OR = 0.001, 95% CI: 0.000,0.742), and mean stride time (OR = 0.992, 95% CI:0.984,1.000) were identified as significant factors. The area under the ROC curve was 0.878 (95% CI: 0.805, 0.952), with a sensitivity of 0.935 and specificity of 0.726. The Brier score was 0.135, and the Hosmer-Lemeshow test (χ2 = 10.650, P = 0.222) indicated a good fit and calibration of the model.ConclusionThe TGBT score, stride length, difference in standing time, and stride time are all protective factors associated with fall risk among the elderly. The developed risk prediction model demonstrates good discrimination and calibration, providing valuable insights for early screening and intervention in fall risk among older adults.

Moving the needle on implementing fall prevention programs in Saudi Arabia: assessing knowledge and perceptions of fall risk among community-dwelling older women

BackgroundSaudi Arabia, like many nations globally, is experiencing a demographic shift towards an aging population. With this demographic shift, falls and the fear of falling (FOF) emerge as serious public health concerns among community-dwelling older adults. Addressing misconceptions and enhancing awareness regarding fall risks among older adults holds significant importance, offering insights for informing targeted interventions and enhancing well-being. This study aimed to examine knowledge and perceptions of fall risk among community-dwelling older women in Saudi Arabia.MethodsA cross-sectional study was conducted with 150 Saudi older women, with a mean age (SD) of 63.98 (4.90) years. Participants completed questionnaires assessing fall history, fall knowledge, fall perception, the Falls Efficacy Scale-International (FES-I), Timed Up and Go (TUG), and the Barthel Index. Fall knowledge and perception were assessed using previously constructed statements translated into Arabic and carried out in interviewer-administered forms.ResultsNearly half of the participants reported experiencing at least one fall in the previous 12 months. Despite good knowledge of falls, some gaps were identified, particularly regarding the awareness of social isolation as a consequence of falls. Participants demonstrated positive perceptions towards fall prevention programs but also highlighted misconceptions regarding aging and falls. FOF was prevalent, with higher levels identified among participants without a history of falls.ConclusionMultidimensional strategies are needed to address falls and FOF among community-dwelling older women in Saudi Arabia. Leveraging existing knowledge and perceptions towards fall prevention and implementing evidence-based interventions can reduce the burden of falls and enhance health outcomes in older adults. Future research should focus on diverse samples and evaluate the feasibility of implementing fall prevention interventions within Saudi Arabia's healthcare systems.

Breathlessness, Frailty, and Sarcopenia in Older Adults

BackgroundBreathlessness shares aging mechanisms of frailty and sarcopenia. Research questionAre frailty and sarcopenia associated with breathlessness itself? Study design and MethodsWe analyzed data from a population-based, prospective cohort study of 780 community-dwelling older adults. Breathlessness was defined using the modified Medical Research Council Dyspnea Scale (≥2 points) and the Chronic Obstructive Pulmonary Disease Assessment Test (≥10 points). Frailty was defined by frailty index (FI), frailty phenotype, and FRAIL questionnaire. Sarcopenia was defined by the Asian Working Group for Sarcopenia 2019. Sarcopenia phenotype score quantifies the number of criteria met. The associations of frailty and sarcopenia with breathlessness was evaluated by logistic regression analyses. Adjusted odds ratio (aOR) were calculated, accounting for age, sex, chronic airway disease, smoking status, body mass index, lung functions, socioeconomic status (living alone, income, education), comorbid conditions (hypertension, diabetes, malignancy, myocardial infarction, heart failure), and other geriatric contributors (cognitive dysfunction, depression, malnutrition, polypharmacy, fall history in the past year). Institutionalization-free survival was compared by log-rank test. ResultsThe prevalence of frailty is higher in the breathlessness group compared to non-breathlessness group (42.6% vs. 10.5% by FI, 26.1% vs. 8.9% by frailty phenotype, and 23.0% vs. 4.2% by FRAIL) and sarcopenia (38.3% vs. 26.9%), with P < 0.01 for all comparisons. The multivariable logistic regression analyses showed that frailty (FI [aOR: 9.29], FRAIL questionnaire [aOR: 5.21], and frailty phenotype [aOR: 3.09]) and sarcopenia phenotype score (score 2 [aOR: 2.00] and score 3 [aOR: 2.04] compared to score 0) were associated with breathlessness. The cumulative incidence of institutionalization-free survival was higher in the breathlessness group than counterparts (P = 0.02). InterpretationThe findings suggest that frailty and sarcopenia strongly contribute to breathlessness in community-dwelling older adults. Measuring sarcopenia and frailty in older adults may offer opportunities to prevent age-related breathlessness.

Tenofovir Induced Bilateral Femoral Neck Stress Fracture

Case: A 47 year old male, came with history of bilateral hip pain ,insidious in onset gradually progressive, with difficulty in walking unassisted since 2 years. No history of fall/ trauma. Patient is known case of retroviral disease and on ART (TLE regimen ) since 2 years. Relevant radiographs were done and was diagnosed with bilateral neck of femur stress fracture (Tenofovir induced) associated with hypophosphatemia. ART regimen was changed to (Abacavir ,Lamivudine , Dolutegravir) . Patient on regular follow up every 2 months with serial radiographs. . On 6 months follow up patient is symptomatically improved with healing bilateral neck of femur stress fracture.

A machine learning approach to determine the risk factors for fall in multiple sclerosis

BackgroundFalls in multiple sclerosis can result in numerous problems, including injuries and functional loss. Therefore, determining the factors contributing to falls in people with Multiple Sclerosis (PwMS) is crucial. This study aims to investigate the contributing factors to falls in multiple sclerosis using a machine learning approach.MethodsThis cross-sectional study was conducted with 253 PwMS admitted to the outpatient clinic of a university hospital between February and August 2023. A sociodemographic data collection form, Fall Efficacy Scale (FES-I), Berg Balance Scale (BBS), Fatigue Severity Scale (FSS), Expanded Disability Status Scale (EDSS), Multiple Sclerosis Impact Scale (MSIS-29), and Timed 25 Foot Walk Test (T25-FW) were used for data collection. Gradient-boosting algorithms were employed to predict the important variables for falls in PwMS. The XGBoost algorithm emerged as the best performed model in this study.ResultsMost of the participants (70.0%) were female, with a mean age of 40.44 ± 10.88 years. Among the participants, 40.7% reported a fall history in the last year. The area under the curve value of the model was 0.713. Risk factors of falls in PwMS included MSIS-29 (0.424), EDSS (0.406), marital status (0.297), education level (0.240), disease duration (0.185), age (0.130), family type (0.119), smoking (0.031), income level (0.031), and regular exercise habit (0.026).ConclusionsIn this study, smoking and regular exercise were the modifiable factors contributing to falls in PwMS. We recommend that clinicians facilitate the modification of these factors in PwMS. Age and disease duration were non-modifiable factors. These should be considered as risk increasing factors and used to identify PwMS at risk. Interventions aimed at reducing MSIS-29 and EDSS scores will help to prevent falls in PwMS. Education of individuals to increase knowledge and awareness is recommended. Financial support policies for those with low income will help to reduce the risk of falls.

Unusual spinal injury in a child caused by a wooden foreign body.

Traumatic penetrating spinal injuries with wooden objects are rare. A 6-year-old boy presented with history of fall from tree 1month back. It resulted in a penetrating injury at the lumbosacral area, followed by a discharging sinus without any neurological deficit. Radiological imaging showed a foreign body at the spinous process level traversing L4-5 and is lodged in L3-4 intervertebral body causing listhesis of L3 over L4. The wooden stick was retrieved with a meticulous surgical procedure. Proper imaging and early surgery are necessary to prevent any complications and early recovery.

Effect of Sensory Integrity and Cognitive Functions on Fall History, Balance and Quality of Life in Elderly Individuals

Abstract Objectives The aim of this study is to examine the effects of sensory integrity and cognitive functions on fall history, balance and quality of life in elderly individuals. Materials and Methods After obtaining the sociodemographic information of the elderly individuals included in the study; Pattern Copying, Kinesthesia and Right-Left Discrimination, which is a subtest of the Ayres Southern California Sensory Integrity Test to evaluate sensory integrity, the Standing Balance Test for balance abilities, the Hodkinson Mental Test for cognitive abilities, the history of falling in the last year for fall situations, and the EuroQol General Quality of Life Scale (EQ-5D-3L) were used to assess the quality of life and life satisfaction. Results The study involved 44 volunteers with a mean age of 69.52±4.25 years. Cognitive ability, standing balance, and life satisfaction of elderly individuals with a fall history were worse than those without a fall history. The study also found that cognition and life satisfaction were affected by fall history. Older individuals who were more successful in pattern copying had better balance. A moderate correlation was found between cognitive ability and pattern copying (r=0.591), balance (rdominant=0.385; rnondominant=0.403), and quality of life (r=−0.399) (p&lt;0.05). Conclusion The results suggest that elderly individuals need sensory integration and cognitively supportive treatment approaches to improve balance functions and reduce fall risk.

Development and External Validation of a Machine Learning–based Fall Prediction Model for Nursing Home Residents: A Prospective Cohort Study

ObjectivesTo develop and externally validate a machine learning–based fall prediction model for ambulatory nursing home residents. The focus is on predicting fall occurrences within 6 months after baseline assessment through a binary classification task, aiming to provide staff with an effective and user-friendly fall-risk assessment tool. DesignProspective cohort study. Setting and ParticipantsA total of 864 older residents living in 4 nursing homes between May 2022 and March 2023 in China. MethodsPotential fall-risk predictors were collected through in-person interviews and assessments of anthropometric and physical function. Participants were followed for 6 months, with falls recorded by trained nurses. Seven machine learning algorithms, including Logistic Regression (LR), Gradient Boosting Machine (GBM), eXtreme Gradient Boosting (XGBoost), Random Forest (RF), Support Vector Machine (SVM), Neural Networks (NN), and Decision Tree (DT), were used to develop prediction models. Performance was evaluated using the area under the receiver operating characteristic curve (ROC-AUC) and Precision-Recall curve (PR-AUC), with calibration assessed via a calibration curve. Feature importance was visualized using SHapley Additive exPlanations (SHAP). ResultsThe 6 selected predictors were balance, grip strength, fatigue, fall history, age, and comorbidity. The ROC-AUC for the models ranged from 0.710 to 0.750, PR-AUC from 0.415 to 0.473, sensitivity from 0.704 to 0.914, and specificity from 0.511 to 0.687 in the validation cohort. The LR model was converted into a nomogram. Conclusions and ImplicationsThe machine learning–based fall-prediction models effectively identified nursing home residents at high risk of falls. The developed nomogram can be integrated into clinical practice to enhance fall risk assessment protocols, ultimately improving patient safety and care in nursing homes.

Activity and Participation Are Associated With Future Falls, Hospitalizations, and Emergency Visits in Community-Dwelling Older Adults.

Activity and participation are important for older adults as they are associated with well-being and quality of life. Falls, emergency department (ED) visits, and hospitalizations are adverse health outcomes that impact older adults. Limited research has investigated whether measurement of activity and participation are related to adverse health events in community dwelling older adults. This study sought to examine the association between activity and participation with falls, ED visits, and hospitalization over 1year in community dwelling older adults. A secondary analysis of a longitudinal clinical trial of 341 community dwelling older adults was conducted. The sample mean age was 80.9 (SD = 7.7) years and 83% were female. One-year risk of falls was associated with baseline Late Life Function and Disability Instrument (LLFDI) components of overall function and disability (frequency and limitations dimensions). Incident rate ratios (IRRs) and 95% CIs were calculated. For each five-point higher score (clinically meaningful difference) in activity as measured by LLFDI-overall function (adjusted for age, race, sex, comorbidities and fall history), there was an 18% lower rate of falls (IRR = 0.82, 95% CI = 0.74-0.92), 12% reduction in hospitalizations (IRR = 0.88; 95% CI = 0.77-0.99), and 11% lower rate of emergency room visits (IRR = 0.89, 95% CI = 0.81-0.98). Greater participation as measured by the LLFDI limitations dimension was related to fewer falls (IRR = 0.93, 95% CI = 0.87-1.00) and hospitalizations (IRR = 0.91, 95% CI = 0.83-0.99). Greater activity and participation are associated with a lower incidence of falls, ED visits, and hospitalizations representing an important consideration for targeted physical therapist interventions. Physical therapists are uniquely positioned to identify and address reduced activity and participation. If activity and participation are specifically targeted and improved through physical therapy, undesirable distal health outcomes might be prevented or minimized. Greater activity and participation were found to be related to lower rate of falls, ED visits, and hospitalizations in a sample of 341 older adults who lived in the community.

Reduced adaptability to balance perturbations in older adults with probable cognitive impairment after a severe fall.

Falls in older individuals often result from unexpected balance disturbances during walking, necessitating the analysis of recovery strategies for effective falls prevention. This becomes particularly crucial for individuals with cognitive impairment, who face a higher fall risk compared to cognitively healthy adults. Hence, our study aimed to compare the recovery response to standardized walking perturbations on a treadmill between older adults with cognitive impairment and cognitively healthy older adults. 36 individuals with a recent history of a severe fall, leading to an emergency department visit without subsequent admission, were stratified into two groups (with and without probable cognitive impairment) based on scores of the Montreal Cognitive Assessment. Recovery performance was quantified using force plate data from a perturbation treadmill (M-Gait, Motek Medical B.V., Amsterdam, the Netherlands), specifically evaluating the number of steps needed to restore step length and width to pre perturbation baseline across two trials of nine different perturbations. Individuals with cognitive impairment (n = 18, mean age: 74.7) required significantly (p = 0.045, Cohen's d = 0.69) more steps to recover total steps after perturbations compared to cognitively healthy individuals (n = 18, mean age: 69.7). While step width recovery was similar between the groups, those with probable cognitive impairment required significantly more steps to recover their step length (p = 0.039, Cohen's d = 0.72). Thus, our findings indicate that older adults with probable cognitive impairment manifest inferior gait adaptability, especially in adapting step length, potentially underscoring a critical aspect for effective falls prevention in this population.

Incidence of Fall and its Associated Factor: A Single Centre Experience

INTRODUCTION: Patient falls during hospitalisation can cause catastrophic injuries and remain one of the major patient-safety issues faced by hospitals. This study was designed to determine the inpatient falls rate and the association between fall-related injury and sociodemographic variables. MATERIALS AND METHODS: A retrospective record review was conducted for a one-time inpatient fall in a single centre between January 2017 and December 2019. Pearson chi-square or Fisher's exact test were performed to assess association between the categorical variables. RESULTS: There were 44 inpatient falls who fell one time between January 2017 and December 2019. The inpatients fall rate was 3.0 per 10000 patient-days from 2017 to 2019. Overall, the patients who fell experienced an injury (n=24, 55%). There was no significant difference between age group, gender, time of fall, assisted type, history of fall, fall risk assessment, mental status, the department involved, and injurious fall outcome. CONCLUSION: Our study showed a low incidence of fall rate per 10000 patient-days for 2017-2019. More than half of the fallers experienced an injurious fall. The highest fall rate was noted in the surgical based departments. However, there was no significant difference between injurious fall outcomes and sociodemographic variables. Risk assessments and management strategies should focus on education, particularly bed safety.

Demographic Comparisons of Self-Reported Fall Risk Factors Among Older Adults Attending Outpatient Rehabilitation.

Identify the prevalence and prevalence differences of fall risk factors by sex, clinic rurality, and race/ethnicity among older adults (≥65 years old) receiving outpatient rehabilitation. Our secondary analysis used Electronic Health Record data of 108,751 older adults attending outpatient rehabilitation (2018-2022) within a large health system across 7 states and completed the Stay Independent Questionnaire. The mean age was 73.3 (±6.36), 58.1% were female, 84.3% were non-Hispanic White, and 88.8% attended an urban clinic. Fall risks were identified via the Centers for Disease Control and Prevention's Stay Independent Questionnaire. Older adults had a high prevalence of fall risks (44.3%), including history of falls (34.9%). The most prevalent fall-risk factors were impaired strength, gait, and balance. Compared to males, females had a higher prevalence of reporting a fall (4.3%), a fall with injury (9.9%), worrying about falling 9.1%), rushing to the toilet (8.5%), trouble stepping onto a curb (8.4%), taking medicine for sleep or mood (6.0%), feeling sad or depressed (5.3%), and feeling unsteady (4.6%). Males reported a higher prevalence of losing feeling in feet (9.4%), ≥1 fall in the past year (8.1%), and using hands to stand up (4.4%). Compared to White older adults, Native American/Alaska Natives had the highest prevalence of fall history (43.8%), Hispanics had the highest prevalence of falls with injury (56.1%), and Hispanics and Blacks had a higher prevalence of reporting 11/12 Stay Independent Questionnaire risk factors. Older adults receiving outpatient rehabilitation have a high prevalence of fall risks, including falls and difficulties with strength, balance, or gait. Findings indicate that rehabilitation providers should perform screenings for these impairments, including incontinence and medication among females, loss of feeling in the feet among males, and all Stay Independent Questionnaire -related fall risk factors among Native American/Alaska Natives, Hispanics, and Blacks.

River linear inversion to assess drainage base-level fall history in North-western Apennines and implications on the Alessandria Basin tectonic activity

Drainage network systems are responsive elements to recent active tectonics from among all the topographic features. In geodynamically active areas, fluvial landscapes can record different processes through the formation and current presence of features related to spatial-temporal variation in base-level fall and vertical incision of stream channels. This study focuses on the tectonic evolution of the Alessandria Basin, a synorogenic tectonic basin located at the junction between the Alps and the Apennines, that experienced progressive subsidence during the overthrusting of the Monferrato Thrust Front (the westernmost outer arc of the Apennine belt) onto the Po Foreland Basin. Even though several studies have assessed the Neogene tectonic evolution at a regional scale, rates and timing of the Quaternary activity are still poorly understood in terms of both Alps/Apennines uplift and activity of the compressive front of the Monferrato Arc. In this paper, we applied the method of the river profile linear inversions to reconstruct the base-level fall history of 6 catchments that drain into the Alessandria Basin. We used nine 10Be-derived basin-average denudation rates to constrain the erodibility parameter needed to infer base-level fall rates from χ-transformed river profiles. The results describe the tectonic history of the area in the last ∼5 Ma, documenting increases in base-level fall rate with an initial peak between 3 and 2.5 Ma, and a second between 2 and 1.5 Ma. While the first peak is coeval with the uplift phase that involved most of the northern-central Apennine, the second one suggests an acceleration in subsidence of the Alessandria Basin concurrently with the uplift of the Monferrato Thrust Front.

Pigmented villonodular synovitis of knee with concomitant partial tear of anterior cruciate ligament in skeletally immature patient: A case report

Pigmented villonodular synovitis (PVNS) is benign but locally aggressive proliferative disorder that affects synovial joint, tendon sheaths, and bursae. PVNS is rare in child, while concurrent Anterior Cruciate Ligament (ACL) tear in PVNS is uncommon finding. Previous study reported ACL tear might be a risk factor in adult PVNS but lack of record for pediatric PVNS. We report a case of uncommon concomitant ACL partial tear in an already rare pediatric PVNS. A nine-year old female with pain and swelling on left knee, occurred intermittent every 2 months for 1 year prior to surgery. There was moderate knee movement restriction with history of fall from bicycle 1 year before surgery. No history of knee instability was reported. X-ray only denote joint swelling, while MRI shows intraarticular bodies suspected synovial chondromatosis with hyperintense signal sign of partial ACL tear. The patient underwent arthroscopic evaluation which exhibit intraarticular hyperemic and hypertrophic synovium with loosening anteromedial ACL bundle. Arthroscopic synovectomy was then performed followed by range of motion training and muscle strengthening rehabilitation program. Post-operative histopathological result confirms PVNS assessment. 1 year follow up post-surgery shows no recurrence of pain or swelling with free movement of left knee joint and no disturbance or instability while walking. In this case, partial ACL tear may contribute as risk factor of PVNS in child. Arthroscopic synovectomy with physical rehabilitation program shows good functional result with no recurrence at 1-year follow up.

Effect of fear of falling on turning performance among patients with chronic stroke

BackgroundTurning difficulties have been reported in stroke persons, but studies have indicated that fall history might not significantly affect turning performance. Fear of falling (FOF) is common after a fall, although it can occur in individuals without a fall history. Research questionCould FOF have an impact on turning performance among chronic stroke patients? MethodsThis cross-sectional study recruited 97 stroke persons. They were instructed to perform 180° and 360° turns, and their performance was represented by angular velocity. FOF was evaluated using the Falls Efficacy Scale-International (FES-I). Falls that occurred 12 months prior to the study assessment were recorded. ResultsA higher FES-I score was significantly correlated with a decline in angular velocity in all turning tasks after adjustment for demographic data. The correlation remained significant after controlling for falls history. Participants with a high level of FOF exhibited significantly slower angular velocities during all turning tasks compared with those with a low level of FOF. Participants with a moderate level of FOF had a significantly slower angular velocity than did those with a low level of FOF during the 360° turn to the paretic side only. SignificanceA higher level of FOF, regardless of fall history, was significantly associated with a reduced angular velocity during turning. A high level of FOF affected turning performance in all tasks. Turning performance may not be affected by fall experience. Anxiety about falling may have a greater effect on turning performance than does fall history.

Daily life mobility detects frailty, falls, and functioning in ADT-treated prostate cancer survivors.

Androgen deprivation therapy (ADT) increases the risk of frailty, falls, and, poor physical functioning in prostate cancer survivors. Detection of frailty is limited to self-report instruments and performance measures, so unbiased tools are needed. We investigated relationships between an unbiased measure - daily life mobility - and ADT history, frailty, falls, and functioning in ADT-treated prostate cancer survivors. ADT-treated prostate cancer survivors (N=99) were recruited from an exercise clinical trial, an academic medical center, and the community. Participants completed performance measures and surveys to assess frailty, fall history, and physical functioning, then wore instrumented socks to continuously monitor daily life mobility. We performed a principal component analysis on daily life mobility metrics and used regression analyses to investigate relationships between domains of daily life mobility and frailty, fall history, and physical functioning. Daily life mobility metrics clustered into four domains: Gait Pace, Rhythm, Activity, and Balance. Worse scores on Rhythm and Activity were associated with increased odds of frailty (OR 1.59, 95% CI: 1.04, 2.49 and OR 1.81, 95% CI: 1.19, 2.83, respectively). A worse score on Rhythm was associated with increased odds of ≥1 falls in the previous year (OR 1.60, 95% CI: 1.05, 2.47). Worse scores on Gait Pace, Rhythm, and Activity were associated with worse physical functioning. Mobility metrics were similar between current and past users of ADT. Continuous passive monitoring of daily life mobility may identify prostate cancer survivors who have or are developing risk for frailty, falls, and declines in physical functioning.

Balance measures for fall risk screening in community-dwelling older adults with COPD: A longitudinal analysis

BackgroundChronic obstructive pulmonary disease (COPD) increases fall risk, but consensus is lacking on suitable balance measures for fall risk screening in this group. We aimed to evaluate the reliability and validity of balance measures for fall risk screening in community-dwelling older adults with COPD. MethodsIn a secondary analysis of two studies, participants, aged ≥60 years with COPD and 12-month fall history or balance issues were tracked for 12-month prospective falls. Baseline balance measures – Brief Balance Evaluation Systems Test (Brief BESTest), single leg stance (SLS), Timed Up and Go (TUG), and TUG Dual-Task (TUG-DT) test – were assessed using intra-class correlation (ICC2,1) for reliability, Pearson/Spearman correlation with balance-related factors for convergent validity, t-tests/Wilcoxon rank-sum tests with fall-related and disease-related factors for known-groups validity, and area under the receiver operator characteristic curve (AUC) for predictive validity. ResultsAmong 174 participants (73 ± 8 years; 86 females) with COPD, all balance measures showed excellent inter-rater and test-retest reliability (ICC2,1 = 0.88–0.97) and moderate convergent validity (r = 0.34–0.77) with related measures. Brief BESTest and SLS test had acceptable known-groups validity (p < 0.05) for 12-month fall history, self-reported balance problems, and gait aid use. TUG test and TUG-DT test discriminated between groups based on COPD severity, supplemental oxygen use, and gait aid use. All measures displayed insufficient predictive validity (AUC<0.70) for 12-month prospective falls. ConclusionThough all four balance measures demonstrated excellent reliability, they lack accuracy in prospectively predicting falls in community-dwelling older adults with COPD. These measures are best utilized within multi-factorial fall risk assessments for this population.