Late-Life Function And Disability Instrument Research Articles

Responsiveness of the late life disability instrument to pulmonary rehabilitation in people with COPD

PurposeTo establish the responsiveness of the disability component of the Late Life Function and Disability Instrument (LLDI) and its Computer Adaptive Test (LLDI-CAT) in people with chronic obstructive pulmonary disease (COPD). MethodParticipants completed the LLDI, LLDI-CAT and measures of physical function, health-related quality of life (HRQOL) and symptom severity before and after pulmonary rehabilitation (PR), and global rating of change (GRC) scales at the end of PR. Responsiveness was explored by calculating correlations between LLDI and LLDI-CAT change scores and change scores on the other measures, and calculating the area under the receiver operating characteristic curve (AUC) for the ability of the LLDI and LLDI-CAT to discriminate between participants who were improved versus unchanged. We hypothesized fair correlations (−0.3 to −0.5 or 0.3 to 0.5) with other measures and considered an AUC≥0.7 acceptable. Minimal important differences (MIDs) were estimated using anchor- and distribution-based approaches. ResultsFifty participants (mean (SD) age 69.8 (7.9) years) completed the study. Only the limitation dimension of the LLDI showed improvement at follow-up (z = 2.4, p = 0.018) and was able to discriminate between participants who were improved versus unchanged (AUC 0.7 (95% CI 0.6–0.9)). Correlations between change scores were as hypothesized between the participation measures and measures of at least two other constructs. ConclusionThis study provides MID values for the LLDI and LLDI-CAT to support their clinical application. The limitation dimension of the LLDI appears to be particularly responsive to PR in people with COPD.

Utility of the Late Life Function and Disability Instrument (LLFDI) in rehabilitation services for older adults

Employing Foreign Educated Nurses (FENs) helps address Registered Nurse (RN) shortages in long-term care (LTC) in the United States (US). However, examination of factors explaining differences in their employment outcomes relative to US Educated Nurses (USENs) is limited. This study uses 2018 National Sample Survey of Registered Nurses data to compare income, work hours, job satisfaction, and human capital, defined as personal characteristics (knowledge, work experience) and behaviors (job mobility), of FENS and USENs working full-time in LTC. A human capital score, consisting of highest nursing education, skill certifications, state licensures, years of experience, multi-state employment history, and multi-lingual status was constructed. Covariates included nurse demographics, direct care role, and ability to practice to full scope. Covariate-adjusted group differences in employment outcomes and human capital were compared using ANCOVA and logistic regression. Mediation analyses explored whether human capital explained FEN vs USEN differences. FENs earned higher hourly wages (p=0.0169), worked fewer hours annually (p=0.0163), and reported greater human capital (p<.0001) compared to USENs. FENs and USENs, however, had similar annual salaries (p=0.3101) and job satisfaction (p=0.1674). Human capital mediated FEN vs USEN effects on hourly wages but not annual work hours. FENs’ higher levels of human capital partially account for FEN vs USEN differences in hourly wages. Application of the human capital concept advanced our ability to examine differences in employment outcomes and highlight aspects of the value that FENs contribute to LTC settings.

Remote Monitoring Activity Trajectory-Associated Weight Loss and Functional Ability in Obese Older Adults

Functional decline in older adults can often be mitigated by physical activity. As older adults increasing adopt wearable technology, an understanding of how remotely monitored activity is associated with clinical outcomes is needed. Data was analyzed from two cohorts of older adults with obesity (□65 years, BMI (□30kg/m2)) who completed weekly dietary and exercise-based weight loss interventions (n=93). Follow-up time varied between cohorts (n=37: 12-weeks; n=56: 16 weeks). All participants were provided a Fitbit to monitor physical activity. Baseline and follow up weight, 6-minute walk distance, grip strength, and Late Life Function and Disability Instrument (LLFDI) were collected. We used k-means clustering for longitudinal data to identify physical activity trajectories from Fitbit steps at the daily level. Linear regression models tested for differences in each outcome between trajectories, adjusting for age and sex. Baseline characteristics did not vary across cohorts: mean age 72.7±4.5 years, 76.5% were female, and mean BMI was 36.4±5.1 kg/m2. Two physical activity trajectories were identified, termed high and low activity based on differences in mean daily steps (7,476±4,117 vs. 2,960±2,453, p <0.001). Participants in the high activity group experienced a 2.4% reduction in weight (p <0.001) and a 4.74% increase in LLFDI score (p=0.007) relative to the low activity cluster. Other outcomes were not significantly different between trajectories. These results demonstrate the potential for remote monitoring data to elucidate longitudinal trends in weight and functional ability. As such, older adults’ use of wearable technology may facilitate improvements in weight and functional ability in the community.

Home-based rehabilitation programme compared with traditional physiotherapy for patients at risk of poor outcome after knee arthroplasty: the CORKA randomised controlled trial

ObjectivesTo evaluate whether a home-based rehabilitation programme for people assessed as being at risk of a poor outcome after knee arthroplasty offers superior outcomes to traditional outpatient physiotherapy.DesignA prospective, single-blind,...

Association between patient-reported functional measures and incident falls

Lower extremity muscle strength, and functional limitations are important modifiable predictors of falls, but are often examined using performance based measures. We examined the association between self-reported physical function limitations, determined using Late-Life Function and Disability Instrument(LLFDI) and incident falls in community-dwelling elderly individuals. 283 older adults participants were included in this analysis. Physical function limitations were defined as a person’s difficulty in completing items of the lower extremity function domain and composite scores of the LLFDI. Information on falls was obtained through a standardised questionnaire. At one-year follow-up, 15.2% (43) of the participants experienced their first fall. In the multivariable analysis, individuals who reported difficulties in items of lower extremity function domain were more likely to experience a fall (incidence rate ratio[IRR]: ranging between 2.43 and 7.01; all P ≤ 0.046). In addition, decreasing advanced lower extremity function scores (IRR: 1.70, 95% confidence interval[CI]): 1.04, 2.78) and overall function component score (IRR: 2.05, 95% CI: 1.22, 3.44) were associated with higher risk of incident falls. Physical function limitations, determined using LLFDI, were associated with incident falls. Our findings provide further evidence that the LLFDI function component has the potential to be used as a self-assessment tool for fall risk.

Frequency of But Not Capacity for Participation in Everyday Activities Is Associated With Cognitive Impairment in Late Life.

We examined features of everyday activities (capacity and frequency) between older adults with and without cognitive impairment over 12 months. Participants aged ≥60 years and at risk for depression were included (n = 260); 26% (n = 69) had an acquired cognitive impairment at baseline. Cognitive impairment was defined as one standard deviation below norms on the Repeatable Battery for the Assessment of Neuropsychological Status. Features of everyday activities were measured by a computerized adaptive test version of Late-Life Function and Disability Instrument (LLFDI) at six time points (baseline, 6 weeks, 3, 6, 9, 12 months). There were significant between-group differences in activity frequency (p = .04), but not activity capacity (p = .05). The group difference in activity frequency exceeded minimal detectable changes (MDC90 = 3.7) and reached moderate clinical meaningfulness (∆ at six time points = 3.7-4.7). Generalized linear mixed models revealed no Group × Time interactions on activity capacity and frequency (p = .65 and p = .98). Practitioners may assess changes in activity frequency to monitor cognitive status of clients even when there is no loss of activity capacity.

The Association of Pain Phenotype with Neuromuscular Impairments and Mobility Limitations Among Older Primary Care Patients: A Secondary Analysis of the Boston Rehabilitative Impairment Study of the Elderly.

Clarifying the relationship between pain phenotypes and physical function in older adults may enhance screening and treatment for functional decline in primary care settings. To investigate the association of more severe pain phenotypes with neuromuscular impairments or mobility limitations among older community-dwelling primary care patients. Cross-sectional analysis. The Boston Rehabilitative Impairment Study of the Elderly. Adults aged 65 years or older. We counted the number of musculoskeletal pain locations (none, single site, multisite, or widespread) using the McGill Pain Questionnaire and identified pain intensity tertiles using the Brief Pain Inventory. Neuromuscular attributes (trunk extensor muscle endurance, and leg speed, strength, strength asymmetry, and range of motion) and mobility (Short Physical Performance Battery [SPPB]) were assessed with performance-based measures. Additionally, self-reported mobility was measured on the Late Life Function and Disability Instrument (LLFDI). For neuromuscular attributes and LLFDI, scores in the lowest tertile indicated neuromuscular impairment or mobility limitations, respectively. For SPPB, a score <7 (of 12) indicated severe mobility limitations. Among 430 participants (mean age = 77) most were female (68%), white (83%), and had either multisite (50%) or widespread (14%) pain. After adjusting for baseline characteristics, widespread pain (compared to none) was associated with slow leg speed (adjusted odds ratio, 95% confidence interval: aOR = 2.33, 1.03-5.27), limited ankle range of motion (aOR = 2.15, 1.03-4.47) and mobility limitations on LLFDI (aOR = 3.85, 1.81-8.19). Being in the highest pain intensity tertile, versus lowest tertile, was associated with poor trunk extensor muscle endurance (aOR = 2.49, 1.41-4.39), limited ankle range of motion (aOR = 2.15, 1.25-3.71), and mobility limitations on SPPB (aOR = 2.56, 1.45-4.52), and LLFDI (aOR = 4.70, 2.63-8.40). Among ambulatory, older primary care patients, more severe pain phenotypes are associated with neuromuscular impairments identified on physical testing and mobility limitations on validated measures.

Home-based tele-rehabilitation presents comparable positive impact on self-reported functional outcomes as usual care: The Singapore Tele-technology Aided Rehabilitation in Stroke (STARS) randomised controlled trial

Introduction The aim of this research was to evaluate the impact of a novel tele-rehabilitation system on self-reported functional outcomes compared to usual care during the first three months after stroke. Methods A parallel, two-arm, evaluator-blinded, randomised controlled trial was conducted. Adults aged ≥40 years who had suffered a stroke within four weeks of the start of the study were recruited from the general community. The intervention group received access to a novel tele-rehabilitation system and programme for three months. The primary outcome measures utilised were the frequency and limitation total scores of the Late-Life Function and Disability Instrument (LLFDI) at three months. Results A total of 124 individuals were recruited. The mean differences in the LLDFI frequency and limitation total scores at three months comparing the intervention and control groups were –3.30 (95% confidence interval (CI) –7.81 to 1.21) and –6.90 (95% CI –15.02 to 1.22), respectively. Adjusting for the respective baseline covariates and baseline Barthel Index also showed no significant difference between interventions in the LLFDI outcomes. Discussion The intervention and control groups self-reported similar improvements in functional outcomes. Tele-rehabilitation may be a viable option to provide post-stroke rehabilitation services in Singapore while reducing barriers to continue rehabilitation conventionally after discharge from hospital and encouraging more participation.

Patient-reported outcome measurement in community-acquired pneumonia: feasibility of routine application in an elderly hospitalized population

BackgroundCommunity-acquired pneumonia (CAP) is a leading cause of morbidity and mortality worldwide, but few studies have evaluated the feasibility of routine patient-reported outcome measures (PROMs) in this illness. This study investigates the feasibility and limitations of three credible PROM instruments in a representative hospitalized cohort to identify potential barriers to routine application.MethodsA sample of multimorbid hospitalized subjects meeting a standardized CAP definition was recruited. Demographic and clinical data of those able and unable to participate in PROM assessment were compared. The EQ-5D-5L, CAP-Sym 18 Questionnaire, and Late-Life Function and Disability Instrument (LLFDI) were administered (via face-to-face interview) at admission and discharge and (via phone interview or mail) at 30 and 90 days post-discharge. Feasibility measures included the proportion of individuals able to participate in assessment, attrition rates, data completeness, and instrument completion times. Scores at admission and 30 days post-discharge were examined for association with age.ResultsOf 82 subjects screened, 44 (54%) participated. Cognitive impairment (n = 12, 15%) commonly precluded participation. Seventeen (39%) participants were lost to follow-up by 90 days. Missing data at item level was negligible for all instruments, regardless of the mode of completion. Completion of the three instruments collectively in a face-to-face interview took a median of 17 min (IQ range 13–21) per participant. The burden of reported symptoms at admission was higher for younger participants aged 18–74 years (mean (standard deviation)) CAP-Sym 18 score at admission 34.2 (18.6) vs. 19.0 (11.3) for those aged ≥ 75 years.ConclusionsRoutine application of PROMs can provide valuable information relating to multiple aspects of clinical recovery for individuals hospitalized with CAP. However, heterogeneous demographic characteristics and complex underlying health status introduce challenges to feasibility and interpretability of these instruments in this population.Trial registrationClinicalTrials.gov, NCT02835040.

Functional Performance and Balance in the Oldest-Old.

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

Somatic and anxiety symptoms of depression are associated with disability in late life depression

Objectives: To assess the relationships of somatic and anxiety symptoms of depression with functional disability in a sample of older adults with late life depression.Method: Data were analyzed from 78 older adults aged 65–88 with current major depression. Somatic and anxiety symptoms from the 24-item Hamilton Depression Rating Scale (HDRS) were summed to create variables measuring severity of these symptoms. Other symptoms of depression were also assessed using the remaining items of the HDRS. Current physical health burden was assessed using the Functional Comorbidity Index (FCI). Disability was measured with the Late Life Function and Disability Instrument (LLFDI) total limitation score. A linear regression analysis was performed to assess the association of somatic and anxiety symptoms with disability independent of other factors.Results: The model accounted for 26.6% of variance in disability, (F(6,51) = 3.1, p = .01). Somatic (B = −1.9, p = .004) and anxiety (B = −3.7, p = .04) symptoms of depression were significantly associated with disability. Other depressive symptoms and physical illness burden were not associated with disability.Discussion: In older adults with major depression, somatic and anxiety symptoms of depression are associated with disability. Identification and treatment to remission of these symptoms may improve functional outcomes among older depressed adults.

Hip muscle strength and protection against structural worsening and poor function and disability outcomes in knee osteoarthritis

Examine associations of hip abductor strength with (1) cartilage damage worsening in the tibiofemoral and patellofemoral compartments 2 years later, and (2) poor function and disability outcomes 5 years later. Participants had knee osteoarthritis (K/L≥2) in at least one knee. Hip abductor strength was measured using Biodex Dynamometry. Participants underwent 3.0T MRI of both knees at baseline and 2 years later. Baseline-to-2-year cartilage damage progression, defined as any worsening of WORMS cartilage damage score, was assessed at each tibiofemoral and patellofemoral surface. LLFDI (Late-Life Function and Disability Instrument) and Chair-Stand-Rate were recorded at baseline and 5-year follow-up; outcomes analyzed using quintiles. Poor outcomes were defined as remaining in the same low-function quintiles or being in a worse quintile at 5-year follow-up. We analyzed associations of baseline hip abductor strength with cartilage damage worsening and function and disability outcomes using multivariable log-binomial models. 275 knees from 164 persons [age=63.7 (SD=9.8) years, 79.3% women] comprised the structural outcome sample, and 187 persons [age=64.2 (9.7), 78.6% women] the function and disability outcomes sample. Greater baseline hip abductor strength was associated with reduced risks of baseline-to-2-year medial patellofemoral and lateral tibiofemoral cartilage damage worsening [adjusted relative risks (RRs) range: 0.80-0.83) and with reduced risks of baseline-to-5-year poor outcomes for Chair-Stand-Rate and LLFDI Basic Lower-Extremity Function and Disability Limitation (adjusted RRs range: 0.91-0.94). Findings support a beneficial role of hip abductor strength for disease modification and for function and disability outcomes, and as a potential therapeutic target in managing knee osteoarthritis.

Meaningful Change Estimates for the Late-Life Function and Disability Instrument in Older Adults.

The Late-Life Function and Disability Instrument (LLFDI) is a well-validated and frequently used patient-reported outcome for older adults. The aim of this study was to estimate the minimal clinically important difference (MCID) of the LLFDI-Function Component (LLFDI-FC) and its subscales among community-dwelling older adults with mobility limitations. We performed a secondary analysis of the Boston Rehabilitative Impairment Study of the Elderly, a longitudinal cohort study of older adults with mobility limitations residing in the community. The MCID for each LLFDI-FC scale over 1 year of follow-up was estimated using both anchor- and distribution-based methods, including mean change scores on a patient-reported global rating of change in function scale, the standard error of measurement (SEM), and the minimal detectable change with 90% confidence (MDC90). Data from 320 older adults were used in the analysis (mean age 76 years, 69% female, mean of four chronic conditions). Meaningful change estimates for "small change" based on the global rating of change and SEM were 2, 3, 4, and 4 points for the LLFDI-FC overall function scale and basic lower-extremity, advanced lower-extremity, and upper-extremity subscales, respectively. Estimates for "substantial change" based on the global rating of change and minimal detectable change with 90% confidence were 5, 6, 9, and 10 points for the overall function scale and basic lower-extremity, advanced lower-extremity, and upper-extremity subscales, respectively. This study provides the first MCID estimates for the LLFDI-FC, a widely used patient-reported measure of function. These values can be used to interpret the outcomes of longitudinal investigations of functional status in similar populations of community-dwelling older adults.

Which Neuromuscular Attributes Are Associated With Changes in Mobility Among Community-Dwelling Older Adults With Symptomatic Lumbar Spinal Stenosis?

ObjectivesTo identify neuromuscular attributes associated with mobility and changes in mobility over 2 years of follow-up among patients with and without symptomatic lumbar spinal stenosis (SLSS). DesignSecondary analysis of a longitudinal cohort study. SettingOutpatient rehabilitation center. ParticipantsCommunity-dwelling older adults ≥65 years with self-reported mobility limitations (N=430). SLSS was determined using self-reported symptoms of neurogenic claudication and imaging-detected lumbar spinal stenosis. InterventionsNot applicable. Main Outcome MeasureBasic and advanced mobility as measured by the Late-Life Function and Disability Instrument (LLFDI). ResultsAmong 430 community-dwelling older adults, 54 (13%) patients met criteria for SLSS, while 246 (57%) did not. On average LLFDI basic and advanced mobility scores decreased significantly from baseline through year 2 for participants with SLSS (basic: P=.04, 95% CI 0.18, 5.21; advanced P=.03, 95% CI 0.39, 7.84). Trunk extensor muscle endurance (trunk endurance) and leg strength were associated with baseline basic mobility (R2=0.27, P<.001) while leg strength and knee flexion range of motion (ROM) were associated with baseline advanced mobility among participants with SLSS (R2=0.47, P<.001). Among participants without SLSS trunk endurance, leg strength and ankle ROM were associated with baseline basic mobility (R2=0.38, P<.001), while trunk endurance, leg strength, leg strength asymmetry, and knee flexion ROM were associated with advanced mobility (R2=0.20, P<.001). Trunk endurance and leg strength were associated with change in basic mobility (R2=0.29, P<.001), while trunk endurance and knee flexion ROM were associated with change in advanced mobility (R2=0.42, P<.001) among participants with SLSS. Among participants without SLSS trunk endurance, leg strength, knee flexion ROM, and ankle ROM were associated with change in basic mobility (R2=0.22, P<.001), while trunk endurance, leg strength, and knee flexion ROM were associated with change in advanced mobility (R2=0.36, P<.001). ConclusionsPatients with SLSS experience greater impairment in the neuromuscular attributes: trunk endurance, leg strength, leg strength asymmetry, knee flexion and extension ROM, and ankle ROM compared to patients without SLSS. Differences exist in the neuromuscular attributes associated with mobility at baseline and decline in mobility over 2 years of follow-up for patients with and without SLSS. These findings may help guide rehabilitative care approaches for patients with SLSS.

Physical Functioning in Older Breast Cancer Survivors

The largest age group of breast cancer survivors (BCS) in the U.S. is comprised of women ages 65+, who are susceptible to age-related decrements in physical function accelerated by cancer treatment toxicities. Though exercise is known to reverse age-related functional limitations, older BCS may be heterogeneous in baseline functioning which may affect the efficacy of exercise to reverse functional declines. PURPOSE: Determine the efficacy of each aerobic and resistance training to improve physical function in older BCS, considering baseline physical functioning. METHODS: Older, early-stage, BCS (mean age=72), who underwent chemo- or radio-therapy in the previous 2 years were randomized to 12 months of supervised, group aerobic (AER) or resistance (RES) training or control (CON) flexibility exercise, followed by 6 months of home-based training. Physical function was assessed by the Physical Performance Battery (PPB), 5x chair stand time (sec), maximum bench and leg press (kg), and 4-meter usual walk speed (m/sec) tests and self-reported lower-body function with the Late-Life Function and Disability Instrument (LLFDI). A linear mixed effects model was used to assess function after 12 and 18 months on the full sample and only in BCS with PPB scores ≥9. RESULTS: 114 BCS were enrolled and randomized to AER (n=37), RES (n=39), or CON (n=38). Within the full sample there was a significant improvement in bench press strength at 12 months (p=0.03) and PPB at 18 months in RES vs CON. After removing participants with low baseline physical functioning (n=79), the following additional significant differences were found between: 1) RES (αmean=2.72±1.7) and CON (αmean=-3.06±2.0) for self-report physical function at both 12 (p=0.04) and 18 months (p=0.005), 2) AER (αmean=0.4±0.0) and CON (αmean=-0.03±0.0) at 12-months for average walk speed and, 3) AER (αmean=0.32±0.3) and RES (αmean=0.50±0.2) at 18 months, for chair time (p=0.05). CONCLUSIONS: Although AE and RT are efficacious in improving physical function in older BCS across a range of baseline physical functioning, broader improvements may only be possible among women with better functioning and thus capable of achieving a greater dose of exercise. Older BCS may need to be stratified into groups based on their initial functioning, then matched to appropriate training.

Motor Control-based Group Exercise: Can It be Delivered as Effectively by Lay Leaders?

On the Move (OTM), a motor control-based group exercise program for community-dwelling older adults, has produced greater gains in mobility than a standard group exercise program when delivered by research leaders. The purposes of this study were:1) to examine the effectiveness of OTM versus a standard program when delivered by lay leaders and 2) to compare the outcomes of OTM when delivered by research versus lay leaders. Community-dwelling, medically stable older adults who could walk household distances participated. OTM consisted of warm-up, timing and coordination, strengthening, and stretching exercises. The seated standard program consisted of warm-up, aerobic, strengthening and stretching exercises. The primary outcome(s) of function and disability was the Late Life Function and Disability Instrument (LLFDI), and for walking ability were the Six Minute Walk Test and gait speed. 126 participants (mean age = 80.7±7.8 years, gait speed = 0.91 m/s) were randomized to OTM (n=49) or standard (n=77) programs. When taught by lay leaders, there were no significant between-intervention group differences in any of the outcomes (p>0.10). Comparing OTM outcomes between leaders, there was a statistical but not clinically meaningful difference in LLFDI disability (1.87±0.89, p=0.04) when taught by research versus lay leader, and moderate differences (p=0.06) in LLFDI overall function (1.89±1.02) and gait speed (0.05±0.03). Qualitative interview responses suggest that instructor-related concerns may have impacted program outcomes. When delivered by lay leaders OTM was not more effective than a standard program for improving function, disability, and mobility in older adults. Health promotion programs designed to improve mobility in community-dwelling older adults and based on a motor control theoretical background, may be best taught by rehabilitation professionals.

Long-term effects of self-reported physical function and disability after participation in an individually adjusted and specific progressive balance training programme for older adults with fear of falling and tendency to fall

Purpose: To evaluate the long-term effects from a 12-week balance-training programme on self-rated physical function and disability in healthy older adults with a tendency to fall and fear of falling.Method: RCT, 59 participants, 67–93 years (42 women). The participants were randomised to an exercise group (n = 38) and a control group (n = 21). The intervention consisted of a specific and progressive balance-training programme three times/week for 12 weeks and was evaluated using the Late-Life Function and Disability Instrument (LLFDI) before training, directly after the training period and 6 and 12 months thereafter training. Data were analysed using a mixed model.Results: Significant effects were found regarding physical function:‘Functioning total’, ‘Basic lower extremity’ and ‘Advanced lower extremity’ in favour for the Exercises group. The exercise group improved significantly from baseline to directly after the training. At the 6 months follow-up, the effects had decreased to values similar to before the training, and remained unchanged until the 12 months follow-up. No significant effects regarding disability were found. The control group remained unchanged over time.Conclusion: No long-term effects were found for physical function or disability assessed with the LLFDI after participation in a specific and progressive balance-training programme for healthy older adults.

Is Preoperative Functional Status Associated with Postoperative Mortality and Morbidity in Elective Open Heart Patients?

Background: Cardiac surgery, even when planned, has the potential for adverse outcomes, such that several factors are taken into consideration to help surgeons and their patients discuss the potential risks weighed against the expected recovery. Preoperative functional status and its influence on cardiac surgery, if any, have not been adequately evaluated to date. This study aimed to examine the relationship between preoperative functional status and postoperative mortality and morbidity in elective open heart patients. Methods: Preoperative baseline data (n = 43 subjects) were obtained to calculate Society of Thoracic Surgeons (STS) mortality and morbidity risk scores and preoperative functional status was measured using the Late-Life Function and Disability Instrument (LLFDI). Follow-up data were abstracted at one year postoperative to calculate actual mortality and morbidity events. Ordinary least squares and negative binomial regression analyses were conducted to assess the relationship between the LLFDI preoperative score to the STS mortality and morbidity risk scores. Results: Mortality risk was significant, F (1, 39) = 4.75, p = 0.035, with an adjusted R2 = 0.086, and Function Total (measured by LLFDI) yielded a significant negative association with mortality risk, β = −0.329. Morbidity was found to be significant, F (1, 40) = 4.89, p = 0.033, with an adjusted R2 = 0.087 and Function Total yielded a significant negative association with morbidity risk, β = −0.328, as well. Estimation of the counts for postoperative complications as estimated by Function Total failed to reach significance (Wald χ2 = 0.34, p = 0.56), which provided a pseudo R2 = 0.009. Probabilities for frequencies of adverse events (major complications), therefore, could not be reliably calculated. Conclusion: Preoperative diminished functional status, as measured by the LLFDI, is associated with an increased risk of mortality and morbidity in patients undergoing elective cardiac surgery. The risks and benefits of cardiac surgery should be weighed carefully and include a patient's preoperative functional status, especially in the case of an elective procedure.

Mobile Phone-Based Measures of Activity, Step Count, and Gait Speed: Results From a Study of Older Ambulatory Adults in a Naturalistic Setting.

BackgroundCellular mobile telephone technology shows much promise for delivering and evaluating healthcare interventions in cost-effective manners with minimal barriers to access. There is little data demonstrating that these devices can accurately measure clinically important aspects of individual functional status in naturalistic environments outside of the laboratory.ObjectiveThe objective of this study was to demonstrate that data derived from ubiquitous mobile phone technology, using algorithms developed and previously validated by our lab in a controlled setting, can be employed to continuously and noninvasively measure aspects of participant (subject) health status including step counts, gait speed, and activity level, in a naturalistic community setting. A second objective was to compare our mobile phone-based data against current standard survey-based gait instruments and clinical physical performance measures in order to determine whether they measured similar or independent constructs.MethodsA total of 43 ambulatory, independently dwelling older adults were recruited from Nebraska Medicine, including 25 (58%, 25/43) healthy control individuals from our Engage Wellness Center and 18 (42%, 18/43) functionally impaired, cognitively intact individuals (who met at least 3 of 5 criteria for frailty) from our ambulatory Geriatrics Clinic. The following previously-validated surveys were obtained on study day 1: (1) Late Life Function and Disability Instrument (LLFDI); (2) Survey of Activities and Fear of Falling in the Elderly (SAFFE); (3) Patient Reported Outcomes Measurement Information System (PROMIS), short form version 1.0 Physical Function 10a (PROMIS-PF); and (4) PROMIS Global Health, short form version 1.1 (PROMIS-GH). In addition, clinical physical performance measurements of frailty (10 foot Get up and Go, 4 Meter walk, and Figure-of-8 Walk [F8W]) were also obtained. These metrics were compared to our mobile phone-based metrics collected from the participants in the community over a 24-hour period occurring within 1 week of the initial assessment.ResultsWe identified statistically significant differences between functionally intact and frail participants in mobile phone-derived measures of percent activity (P=.002, t test), active versus inactive status (P=.02, t test), average step counts (P<.001, repeated measures analysis of variance [ANOVA]) and gait speed (P<.001, t test). In functionally intact individuals, the above mobile phone metrics assessed aspects of functional status independent (Bland-Altman and correlation analysis) of both survey- and/or performance battery-based functional measures. In contrast, in frail individuals, the above mobile phone metrics correlated with submeasures of both SAFFE and PROMIS-GH.ConclusionsContinuous mobile phone-based measures of participant community activity and mobility strongly differentiate between persons with intact functional status and persons with a frailty phenotype. These measures assess dimensions of functional status independent of those measured using current validated questionnaires and physical performance assessments to identify functional compromise. Mobile phone-based gait measures may provide a more readily accessible and less-time consuming measure of gait, while further providing clinicians with longitudinal gait measures that are currently difficult to obtain.

Long-term effects of a progressive and specific balance-training programme with multi-task exercises for older adults with osteoporosis: a randomized controlled study

Objective: To evaluate long-term effects of balance-training on concerns about falling, gait, balance performance, and physical function in older adults with osteoporosis and increased risk of falling. Design: Randomized controlled trial, including three groups (training, training+physical activity, and control group), with follow-ups at three, nine, and 15 months. Short-term, three-month follow-up, benefits for those who fulfilled the first follow-up (n = 69) have previously been reported. Setting: Stockholm, Sweden. Participants: A total of 96 elderly, age 66–87, with verified osteoporosis. Interventions: Balance-training programme including dual- and multitasks, with or without supplementary physical activity, three times/week over 12 weeks. Measurements: Concerns about falling Falls Efficacy Scale -International (FES-I), walking at preferred speed with and without a cognitive dual-task and at fast speed, balance tests (one-leg stance and modified figure-of-eight), and physical function Late-Life Function and Disability Instrument (LLFDI). Results: Participants in the training group maintained positive effects throughout the study period for concerns about falling (baseline vs. 15 months, median 27.5 vs. 23 points, p < 0.001) and walking performance (baseline vs. 15 months, p ⩽ 0.05 with an improvement of 0.9–1.4 m/s). The Training+physical activity group declined to baseline values at the nine-month follow-up, and were even lower at the 15-month follow-up for concerns about falling (median 26 vs. 26 points), walking performance (changes of −0.02 to 0.04 m/s), and physical function (mean 44.0 vs. 42.9 points). The control group remained unchanged throughout the study period. Conclusions: This balance-training programme reduced concerns about falling, and also improved gait in older adults with osteoporosis and increased risk of falling in a long-term perspective – important issues for fall prevention.