Modified Falls Efficacy Scale Research Articles

Reduced Anxiety and Depression and Improved Mood in Older Adults Living in Care Homes After Participating in Chair Yoga.

Providing opportunities for older adults to engage in physical and mental activity is important to support healthy aging. The present preliminary study investigated the feasibility of accessible chair yoga for older adults in care homes. Chair yoga participants (n = 17) were assessed before and after attending twice weekly chair yoga sessions for 8weeks, while control participants (n = 16) underwent the assessments only. Participant ages ranged from 80 to 101years and included those living with mild to severe dementia. Anxiety and depression measured by the Hospital Anxiety and Depression Scale (HADS), and negative affect measured by the Positive and Negative Affect Schedule (PANAS), improved in the chair yoga but not the control group. Balance confidence (Modified Falls Efficacy Scale) and Health-related Quality of Life (EQ-5D-3L) were unchanged. Chair yoga is a feasible activity for older care home residents, including those living with dementia, with the potential to improve mental well-being.

Impact of sensory reweighting strategies on postural control using the sensory organization test in older adults with and without fall risks.

The Sensory Organization Test (SOT), an integral part of computerized dynamic posturography, plays a crucial role in evaluating postural stability under various altered sensory conditions. Despite its importance, there have been noted inconsistencies in the results pertaining to equilibrium and sensory system evaluations. This study aimed to compare four sensory analysis scores and equilibrium indices between older adults with and without fall risks. The study included 34 participants identified as being at risk of falls and 42 control subjects. To categorize individuals between the two groups, we performed area under the receiver operating characteristic curve analyses. This classification was based on scores from the Modified Falls Efficacy Scale (MFES) and the composite scores obtained from the SOT. In addition, we used the Tampa Scale for Kinesiophobia (TSK) as well as the level of disability. The fall risk group demonstrated significantly higher TSK scores (39.39± 15.24 for control group vs. 54.65±10.70 for fall risk group; t=-5.09, p=0.001). The groups demonstrated a significant interaction on the equilibrium index (F=4.59, p=0.03), which was lower in the fall risk group in Condition 6 with a moving surface and surround and eyes open (t=2.29, p=0.01). The fall risk group demonstrated a higher somatosensory score (t=-1.73, p=0.04). The fall risk group had a lower equilibrium index score in Condition six of the SOT, which was useful for identifying deficits in vestibular function to integrate sensory information under challenging conditions for postural adaptation. This strategy suggested that the fall risk group could compensate for their risk of falls by utilizing more effective somatosensory reweighting strategies compared with the control group.

Compensatory latency time delays during consecutive perturbations in older adults with and without kinesiophobia

BackgroundFear of movement has been related to lower limb activation patterns in older adults. However, insight into consecutive perturbations on stepping strategy while considering fall-related confidence is unknown. Research questionAre there latency time delays following three consecutive slip perturbations between subjects with and without kinesiophobia when considering limb dominance and fall efficacy differences? MethodsThere were 15 older adults with kinesiophobia and 15 age- and body mass index (BMI)-matched control subjects. The subjects stood on the platform during three consecutive perturbations (250, 300, and 400 msec excursions), which were produced by a Bertec device. The subjects completed questionnaires to evaluate the psychological features of their fall-related fear (Tampa Scale for Kinesiophobia: TSK) as well as the modified fall efficacy scale (FES). The latency times (msec) measured the time it took for a subject to respond to a translation. ResultsOverall, the results of the FES demonstrated a moderate negative association with the TSK (r = −0.52, p = 0.004). There was a significant group difference for the FES (t = 2.78, p = 0.01). The FES demonstrated significant positive correlation coefficients (ranging from 0.40 to 0.51) and significant negative correlation coefficients (ranging from −0.41 to −0.61), except for the slow perturbations. The groups demonstrated a significant interaction on consecutive latency times and limb side (F = 5.84, p = 0.02). The latency time during the fast perturbations on the dominant limb (F = 5.53, p = 0.02) was significantly shorter in the kinesiophobia group. SignificanceThe control group demonstrated confidence during fall-related activities, but the latency times were significantly different between groups when considering the dominant limb following repeated slip perturbations. The kinesiophobia group demonstrated shorter latency times on the dominant limb to protect against potential fall-risks from perturbations. The group interactions on limb side and consecutive perturbations need to be considered with fall-related confidence and improved standing balance in older adults with kinesiophobia.

Prosthetic device and service satisfaction, quality of life, and functional performance in lower limb prosthesis clients.

The aim of this study was to characterize the relationship between prosthetic device and service satisfaction, health-related quality of life (HRQOL), and functional movement in a diverse population of lower limb prosthesis users. An online survey was conducted on individuals with lower limb amputation between September and October 2021. Sample validated questionnaires assessing demographic and clinical features, satisfaction, functional outcomes, and quality of life were analyzed using path analysis. Participants were 1736 individuals with lower limb amputation. Overall, 44% of participants reported dissatisfaction with prosthetic device, whereas 37% were dissatisfied with prosthetic service. Low functional mobility was reported by 58% of participants and 61% reported low HRQOL. Lower extremity functional status (β = 0.55), HRQOL (β = 0.08), Activities-specific Balance Scale (β = 0.22), and modified fall efficacy scale (β = -0.07) are significantly associated with prosthetic device satisfaction (P < 0.0005, R2 = 0.47). Satisfaction with provider service was significantly associated with lower extremity functional status (β = 0.44) and balance confidence (β = 0.18) (P < 0.0005, R2 = 0.34). Civilians, veterans, and service members reported low functional mobility, low quality of life, and moderate levels of dissatisfaction with their lower extremity prosthetic device and provider service. Improvements in mobility, balance, quality of life, and fall efficacy may enhance device satisfaction. Functional mobility and balance improvements may increase ratings of provider service. This study provides feedback that may improve clinical decisions on lower limb prosthesis patient care.

Daily walking kinematic characteristics of the elderly in different residential settings: experimental study on Chinese community-living elderly and long-term nursing home residents.

Long-term nursing home (NH) care helps NH residents with their daily activities and improves their quality of life, but negatively affects their independent physical activities and increases the risk of dangerous events. Dangerous events in the elderly usually occur in the conversion of walking periods when forward striding has already happened, but the body has not yet entered a completely steady walking. Compare the gait characteristics in Chinese long-term NH residents and community-living elderly during the walking Transitional Period (TP) and Stabilization Period (SP). 32 long-term NH residents and 33 age- and sex-matched community-living elderly were recruited. The 30-Second Chair Stand Test (30-s CST), Timed Up and Go Test (TUGT), and Modified Falls Efficacy Scale (MFES) were used to assess their body function. The Xsens MVN BIOMECH system was used to collect and analyze the gait parameters of participants. Compared to community-living elderly, NH residents had fewer numbers of 30-s CST, took more time to complete TUGT, and lower MEFS scores. NH residents showed slower gait speed (P < 0.001), less peak hip flexion (P = 0.022) and extension (P = 0.003), knee internal rotation (P = 0.023), and ankle plantarflexion (P = 0.001) and internal rotation (P = 0.007) angles during walking. When walking progressed from TP to SP, NH residents showed increased ankle dorsiflexion (P < 0.001), decreased hip internal rotation (P < 0.001), and community-living elderly had increased hip extension (P = 0.005) angles. Chinese long-term NH residents had reduced lower extremities strength and postural balance, and higher fear of falling compared to community-living elderly. Their walking performance also showed high fall risk. Besides, long-term NH residents adopted a distal strategy to propel the body forward, which may be a compensatory measure to compensate for inadequate proximal joint control from forward walking to stable walking, and long-term NH residents have reduced postural stability during this process.

Evaluating the Usability and Equivalence of Electronic Patient-Reported Outcome Measures for Individuals with a Lower-Limb Amputation.

ABSTRACT Introduction Electronic versions of patient-reported outcome measures (PROMs) seem to have a clear administrative logging advantage to traditional paper versions. However, most of them have not been formally evaluated for their suitability to replace paper outcome measures for assessment of individuals with lower-limb amputations. The aim of this study is to examine the usability and equivalence of electronic to paper versions of PROMs suitable for use in prosthetic clinical care and research for persons with lower-limb loss. Methods In this cross-sectional study, 10 participants remotely completed the following PROMs online and then on paper: Orthotic and Prosthetic User Survey (OPUS), Modified Falls Efficacy Scale (MFES), Prosthetic Evaluation Questionnaire (PEQ), Patient Health Questionnaire–9 (PHQ-9), and Community Participation Indicators (CPI). Participants also answered open-ended and standardized questions regarding the usability of the electronic surveys. Wilcoxon signed rank tests, comparisons to minimum detectable change, intraclass correlation coefficients, and Bland-Altman plots were used to evaluate differences between the two survey versions, meaningful changes in scores, reliability, and systematic biases, respectively. Results Electronic surveys had fewer missing or ambiguous responses than paper surveys; however, the PEQ Social Burdens subscale could not be evaluated due to error in the creation of the electronic survey. No significant differences were found between scores of the two versions for any of the measures, but multiple participants had meaningful changes in the Appearance and Sounds PEQ subscales. All measures demonstrated acceptable reliability between versions, except the Appearance, Perceived Response, and Sounds subscales of the PEQ. No systematic biases in scores or usability concerns were found for any measures. Conclusions This study analysis showed that most of the electronic PROMs studied are easily used and demonstrate equivalence to the paper versions. However, the PEQ Appearance, Perceived Response, Sounds, and Social Burden subscales require further evaluation. Clinical Relevance Except for the PEQ, electronic versions of the PROMs in this study can likely be used interchangeably with paper versions among individuals with lower-limb loss.

Neighborhood safety, fall indices, physical activity level and social participation restrictions from a population of community-dwelling older adults in Nsukka, Enugu State, Nigeria

BackgroundRestriction in physical activity (PA) and social participation restriction (PR) can be heightened in the presence of fear of fall (FOF), fall experience, and perceived unsafe neighborhood, particularly among older adults. Despite the enormous benefits of social participation and physical activity, many older adults remain vulnerable to participation restriction and this probably accounts for a significant proportion of health challenges for older adults.ObjectiveThis study investigated the relationship between neighborhood safety (NS), fall indices, physical activity, and social participation restriction among older adults from selected communities in Nsukka, Enugu state, Nigeria.MethodsThis was a cross-sectional survey of 170 recruited via consecutive non-probability sampling techniques. Socio-demographic variables, co-morbidities, and fall prevalence were obtained using a self-administered questionnaire. The study instruments include the PA neighborhood environment scale – Nigeria (PANES-N), PA scale for elderly (PASE), Participation scale (PS), Modified fall efficacy scale (MFES), and Fall risk assessment tool (FRAT) and fall indices.Statistical analysisDescriptive statistics of mean and standard deviations, frequency counts, and percentages were used to analyze the socio-demographic variables, and Inferential statistics of Spearman rank order correlation were used to determine the relationship among the neighborhood safety, fall indices, physical activity level, and participation restrictions.ResultsPR has a negative relationship with NS (r = -0.19, p- 0.01), and fall efficacy (r = -0.52, p- 0.001). However, PR has a positive relationship with fall risk (r = 0.36, p = 0.001).ConclusionParticipation restriction is negatively correlated with neighborhood safety, fall efficacy, and PA. The PR has a positive relationship with fall risk (FR).

Influencing factors of fear of falling among glaucoma patients in west China: a cross-sectional study.

To investigate the current situation and influencing factors of fear of falling in glaucoma patients in western China. In this cross-sectional study, glaucoma patients treated in the Ophthalmology Department of West China Hospital of Sichuan University were conducted to investigate the demographic data, visual acuity, visual field, activities of daily living, risk of falling, fear of falling and psychological states. Generalized linear model was used for multivariate analysis with fear of falling as dependent variable and other factors as independent variables. The mean score of the Chinese version modified Fall Efficacy Scale (MFES) was 7.52±2.09 points. Univariate analysis and multivariate analysis showed that the history of falls within one year, visual acuity, visual field, risk of falling, activities of daily living and psychological states had statistically difference on fear of falling (P<0.05). Glaucoma patients in west China have relatively high risk of fear of falling. History of falling within 1y, severe visual function impairment, high risk of falling, incapable of independence of daily living, and abnormal psychological state are risk factors of fear of falling among glaucoma patients.

Home-Based Exergame Program to Improve Physical Function, Fall Efficacy, Depression and Quality of Life in Community-Dwelling Older Adults: A Randomized Controlled Trial.

This study aimed to investigate the effects of home-based exergame programs on physical function, fall efficacy, depression, and health-related quality of life in community-dwelling older adults. Fifty-seven participants aged 75 years or older were divided into control and experimental groups. The experimental group received a home-based exergame program that included balance and lower-extremity muscle strength for 8 weeks. The participants exercised at home for 50 min three times a week and were monitored through a video-conference application. Both groups received online education on musculoskeletal health once a week, whereas the control group did not exercise. Physical function was assessed using the one-leg standing test (OLST), Berg balance scale (BBS), functional reaching test (FRT), timed up-and-go test (TUGT), and five-times sit-to-stand (FTSTS). Fall efficacy was assessed using the modified falls efficacy scale (MFES). Depression was assessed using the geriatric depression scale (GDS). Health-related quality of life was assessed using a 36-item short-form health survey (SF-36). The experimental group showed an overall improvement in OLST, BBS, FRT, TUGT, and FTSTS (p < 0.05). MFES was significantly increased in the experimental group after the intervention (p < 0.05). The GDS significantly decreased in the experimental group after the intervention (p < 0.05). In SF-36, role limitations due to physical health, general health, and fatigue (energy and fatigue) items improved in the experimental group after intervention (p < 0.05). An 8-week home-based exergame program improved physical function, fall efficacy, depression, and health-related quality of life in older adults. The study was registered on ClinicalTrials.gov (NCT05802537).

The effect of a gait and balance training program on an unstable mudflats surface in older adults: A randomized controlled pilot study.

Balance training on an unstable support surface has been known to improve postural control. The aim of this study was to investigate the effect of a gait and balance training program on an unstable mudflats surface in older adults. A total of 28 older people were assigned to participate in a gait and balance training program on an unstable mudflats surface (experimental group) or on firm ground (control group). All participants received the training program for 55 minutes per session, 2 sessions per day for 5 days. The primary outcomes were the Berg Balance Scale (BBS) and single-leg stance (SLS) test. Secondary outcomes were Timed Up and Go (TUG), 10-meter walk test (10MWT), Modified Falls Efficacy Scale (MFES), Motricity Index (MI) of the lower extremities, and medical research council (MRC) scale of lower extremities. SLS with eyes open and the MRC of the left and right ankles showed a large effect size whereas the MI of the left and right lower extremities and MRC of the left and right knees showed a medium effect size in the experimental group. Intergroup differences in changes from baseline to after the exercise program included a large effect size of the SLS with eye open and MI of the right lower extremity and a medium effect size of the MI of the left lower extremity and MRC of the right ankle and left hip. Muscle strength and balance of older people could be improved with gait and balance training on an unstable mudflat surface.

Relationship between fall history and toe grip strength in older adults with knee osteoarthritis in Japan: A cross-sectional study.

Knee osteoarthritis (KOA), one of the most common musculoskeletal diseases in older adults, is associated with a high incidence of falls. Similarly, toe grip strength (TGS) is associated with a history of falls in older adults; however, the relationship between TGS and falls in older adults with KOA who are at risk of falling is not known. Therefore, this study aimed to determine if TGS is associated with a history of falls in older adults with KOA. The study participants, older adults with KOA scheduled to undergo unilateral total knee arthroplasty (TKA), were divided into two groups: non-fall (n = 256) and fall groups (n = 74). Descriptive data, fall-related assessments, modified Fall Efficacy Scale (mFES), radiographic data, pain, and physical function including TGS were evaluated. The assessment was conducted on the day before performing TKA. Mann-Whitney and chi-squared tests were performed to compare the two groups. Multiple logistic regression analysis was performed to determine the association of each outcome with the presence or absence of falls. Mann-Whitney U test revealed that the fall group had statistically significantly lower height, TGS on the affected and unaffected sides, and mFES. Multiple logistic regression analysis revealed that the incidence of fall history is associated with TGS on the affected side; the weaker the affected TGS of the KOA, the more likely the individual is to fall. Our results indicate that TGS on the affected side is related to a history of falls in older adults with KOA. The significance of evaluating TGS among patients with KOA in routine clinical practice was demonstrated.

Assessment of Vestibular System and Balance Function in Patients with Pseudoexfoliation Syndrome

Introduction: This study aims to evaluate the balance and vestibular system of patients with pseudoexfoliation syndrome. Materials and Method: A prospective case–control study was performed in a university hospital. The study population consisted of 37 patients (16 patient group, 21 control group). The Modified Clinical Test of Sensory Interaction Balance was performed in four conditions: 1) eyes open, firm surface; 2) eyes closed, firm surface; 3) eyes closed, foam surface; and 4) eyes open, foam surface. The Equilibrium Score, Anteroposterior Stability Index, Mediolateral Stability Index were employed for all conditions in both groups. Scores were compared between and within groups. Additionally, the physical activity of the patients with pseudoexfoliation syndrome was assessed using questionnaires based on the Turkish versions of the Modified Falls Efficacy Scale and the Physical Activity Scale for the Elderly. Results: There were no significant differences in terms of stability index and equilibrium scores with eyes open or closed conditions between the two groups; the only difference was in the mean mediolateral stability index score in the eyes open, firm surface condition with low scores in the pseudoexfoliation group (p=0.01). In the group analysis, patients with pseudoexfoliation had a significant increase in the equilibrium scores when their eyes were closed in the firm and foam surface conditions (p=0.001 for both). Conclusion: The central nervous system redistributes its dependence on sensory information when vision is compromised in patients with pseudoexfoliation syndrome. Their somatosensory input might deteriorate in some way but not the vestibular system. Keywords: Dizziness; Glaucoma; Aged.

Reliability and validity of the Arabic version of the modified falls efficacy scale

Purpose The purpose of this study was to adapt Modified Falls Efficacy Scale (MFES) into Arabic and determine the reliability and validity of the instrument. Materials and methods The study was conducted in two phases: (i) translation and adaptation by the systematic approach of the ‘forward-back’ translation method and (ii) psychometric testing of the Arabic version of the Modified Falls Efficacy Scale among 207 community-dwelling older adults (≥ 60 years). Results The Arabic version of the Modified Falls Efficacy Scale demonstrated excellent internal consistency (Cronbach’s alpha = 0.98) and test–retest reliability scores (ICC = 0.96, 95% CI; 0.95–0.97). And also showed strong correlations with both the Falls Efficacy International (r = −0.82) and the activities-specific Balance Confidence Scale (r = 0.87). Sampling adequacy for factor analysis was proven by a Kaiser–Meyer–Olkin value of 0.962. Goodness-of-fit (GFI) statistics for the model were in the acceptable range (Chi-Square/Degree of Freedom (CMIN/DF) = 2.59, Goodness-of-fit index (GFI) = 0.9, Comparative Fit Index (CFI) = 0.97, Root Mean Square Error of Approximation (RMSEA) = 0.79). Conclusion The Arabic version of the Modified Falls Efficacy Scale has demonstrated excellent psychometric qualities to measure the level of fear of falling.

Cross-Sectional Analysis of Fall-Related Factors with a Focus on Fall Prevention Self-Efficacy and Self-Cognition of Physical Performance among Community-Dwelling Older Adults

This study aimed to determine how fall prevention self-efficacy and degree of deviation in self-cognition of physical performance, which have recently received attention for their potential to explain falls in combination with a wide variety of fall-related factors, as well as affect falls. Older adults using day-care services (n = 27 with six men, mean age: 81.41 ± 7.43 years) were included in this study. Fall history in the past year, the modified fall efficacy scale (MFES), and physical performance and cognition errors were examined by evaluating the functional reach test (FRT), the stepping over test, and the timed up and go test (TUG), along with a questionnaire. In the fall (n = 14) and non-fall (n = 13) groups, logistic regression analysis using Bayesian statistical methods was used to identify factors associated with falls. The odds ratios for the MFES ranged from 0.97 to 1.0, while those of cognition-error items ranged from 3.1 to 170.72. These findings suggested that deviation in self-cognition of physical performance, particularly overestimation of timed cognitive ability, was a factor with more explanatory power for fall history. Future studies should analyze differences by disease and age group, which were not clarified in this study, to identify more detailed fall risk factors.

Characteristics of falls and their fear in older adults requiring long-term care.

[Purpose] Older adults requiring long-term care have a higher rate of falls than older adults who do not. This study aimed to examine the relationship between falls and fear of falling and their characteristics from the perspective of older adults requiring long-term care based on a sub-item in the Modified Falls Efficacy Scale. [Participants and Methods] This study included 51 older adults who were certified as needing long-term care. Fear of falling was measured using the Modified Falls Efficacy Scale. The Modified Falls Efficacy Scale and basic information, such as cognitive function, history of falls, level of care required, and age, were collected and analyzed based on the fall or non-fall groups. [Results] The fall and non-fall groups had 27 and 24 participants, respectively. Comparisons between the groups showed significant differences in the Modified Falls Efficacy Scale scores. Binomial logistic regression analysis results showed that "crossing the street (pedestrian crossing)" was significantly associated with falls (odds ratio=0.75). [Conclusion] In this study, falls were associated with fear of falling; specifically, among the Modified Falls Efficacy Scale items, "crossing the street (pedestrian crossing)" was significantly associated with falls.

Change in Daily Steps and Self-efficacy of Online Interactive Exercise Classes for Community-dwelling Older Adults in Japan: A Preliminary Study.

This study aimed to (1) examine the feasibility of an online interactive exercise class for community-dwelling older adults and (2) preliminarily examine changes in physical activity and self-efficacy. Participants were 25 community-dwelling older adults aged 65 years or older, but due to 5 dropouts, the final number of participants for analysis was 20 (mean age 76.9 ± 5.7 years). The intervention program was conducted for 40 minutes each session, twice a week for four consecutive weeks, using the LINE group call (LINE Corporation, Japan). An online questionnaire was used to assess participant characteristics, modified Fall Efficacy Scale score, modified Gait Efficacy Scale (m-GES) score, self-rated health, and daily steps, which were compared pre- and post-intervention using the Wilcoxon signed-rank sum and chi-square tests. The Wilcoxon signed-rank sum test showed significant improvement in the m-GES score and daily steps. The chi-square test showed that self-rated health was significantly greater in the maintenance/increase group. Online interactive exercise classes are feasible for community-dwelling older individuals. These results also suggest the possibility of using telehealth to improve physical activity and self-efficacy.

Effect of a fall prevention strategy for the older patients: Aquasi-experimental study.

To explore the effect of a fall prevention strategy on older patients based on the Patient Engagement Framework. A longitudinal quasi-experimental quantitative design. Older patients who met the inclusion criteria were recruited from geriatric, oncology, neurology and cardiology departments of a teaching general hospital in China. Development of a fall prevention intervention strategy for older patients was based on the Patient Engagement Framework. Patients in the intervention group were given this fall prevention strategy (N=58), and those in the control group were given conventional measures (N=58). The following indicators were compared between the two groups after intervention: (a) number of falls; (b) Knowledge-Attitude-Practice (KAP) score; (c) Modified Fall Efficacy Scale score. After the implementation of an intervention strategy in older patients, the number of falls decreased from 3 to 0; the score of KAP and Modified Fall Efficacy Scale was promoted (p < .05).

Ditangquan exercises based on safe-landing strategies prevent falls and injury among older individuals with sarcopenia.

BackgroundSarcopenia is the age-related loss of skeletal muscle mass and function; it is a risk factor for falls among older individuals. Few studies have focused on training such individuals to adopt a safe-landing strategy that would protect them from fall-related injuries. Ditangquan is a traditional Chinese martial art comprising movements that conform to the principles of safe landing. This study aims to investigate the effectiveness of Ditangquan in preventing fall-related injuries among older individuals with sarcopenia.MethodsA total of 70 participants (21 males and 49 females with sarcopenia) between 60 and 80 years of age were recruited from three local communities and randomly assigned to the Ditangquan exercise group (DG) or the control group (CG) in a 1:1 ratio. Three times a week for 24 weeks, both the DG and CG received an hour of conventional exercise and an hour of Ditangquan exercise based on safe landing. Primary outcomes were the modified falls efficacy scale (MFES), the number of falls, and fall injuries; the secondary outcome was the Timed Up & Go (TUG) test.ResultsThe DG had significantly fewer falls (1 vs. 8, P = 0.028) and fall injuries (0 vs. 6, P = 0.025) than the CG. Furthermore, at the end of the study, the DG had a significantly improved MFES (mean difference: 32.17 scores; 95% CI: 21.32, 43.02; P <0.001) and TUGT (mean difference: −4.94 s; 95% CI: −7.95, −1.93; P = 0.002) as compared with the CG.ConclusionDitangquan exercise based on the safe-landing strategy effectively improves the functional mobility of the elderly, reduces the occurrence of falls and injuries, and increases the individual's confidence in preventing falls.

Application and the Effect of the Triple Prerehabilitation Nursing Model in the Perioperative Period of Knee Arthroplasty in Diabetic Patients.

Objective The aim of the study was to explore the application and the effect of the triple prerehabilitation nursing model in the perioperative period of knee arthroplasty in diabetic patients. Methods The prospectively included 60 patients with diabetes who underwent total knee replacement were admitted from August 2021 to April 2022 and were divided into 2 groups according to the (1 : 1) ratio. The control group was mainly given routine nursing care. On the basis of the control group, the observation group received triple prerehabilitation nursing. The postoperative knee flexion, hospital for the special surgery knee score (HSS), the daily living ability (Barthel) score, the modified fall efficacy scale (MFES) score, the recovery of the lower-limb muscle strength, and the incidence of complications were compared between the two groups. Results The knee flexion degree and lower-limb muscle recovery of the observation group were better than those of the control group at 3 d, 7 d, and 14 d after operation (P < 0.05). The HSS score, Barthel score, and MFES score of the observation group were higher than those of the control group (P < 0.05). There was no significant difference in postoperative complications between the two groups (P > 0.05). Conclusion The triple prerehabilitation nursing care for diabetic patients undergoing total knee replacement can promote the recovery of limb function.

The Incidence and Risk Factors of Falls During Pregnancy

Background: During pregnancy, many hormonal, anatomical, and musculoskeletal changes occur. These changes alter the postural balance and increase the risk of falls. Falls during pregnancy can cause maternal and foetal injuries. In our analysis, we focused on women who fell as a result of gait and balance alterations. The primary objective of this study was to evaluate the incidence of falls in our study population. The secondary objective was to identify the risk factors for falls during pregnancy. Methods: 165 healthy singleton pregnant women were included in the study. The participants were asked to complete a questionnaire regarding their sociodemographic information, baseline health status and medical history, a detailed interview about potential falls during pregnancy, and a Modified Falls Efficacy Scale (MFES) questionnaire. A blood sample was taken to determine the baseline total circulating 25-hydroxyvitamin D (25(OH)D) level. Based on the evaluation of the questionnaires, we then divided the participants into two groups—the first group consisted of women who experienced a fall during pregnancy, and the rest of the participating pregnant women were included in the control group. Comparing the two groups, we analysed selected demographic data and a number of other variables including weight gain, the amount of exercise performed during pregnancy, and the participants’ vitamin D levels. Results: The incidence of falls in our study was 12.73%. We found that age was the only statistically significant independent risk factor for falls during pregnancy (p-value: 0.0267). We found no statistical difference between the two groups regarding their levels of serum vitamin D. We also compared relevant variables in patients who feared the possibility of a fall and those who did not. We concluded that this fear was mainly associated with participants with BMI &gt;25 (p-value: 0.0037 [RR: 2.31; 95% CI: 1.24–4.33]), while the feeling of improved postural stability was observed in women with regular exercise patterns (defined as physical exercise more than a 3 times per week) (p-value: 0.0377 [RR: 0.17; 95% CI: 0.03–1.22]). Conclusions: We did not manage to establish any isolated risk factors of falls during pregnancy except that of a higher age. In contrast to other studies, we did not confirm that regular exercise lowers the risk of falls, only that it improves self-confidence in the postural stability of pregnant women. Further study with objective quantification of postural and dynamic stability of pregnant women by using computerised static posturography may help to identify more accurately the risk group of pregnant patients. This will be the aim of our further work.