No-fall Group Research Articles

Real-World Evidence for Risk Factors of Bruises and Fractures from Falls in Patients with Overactive Bladder: A Medical Record Analysis.

To identify the risk factors for bruises and fractures from falls in patients with overactive bladder (OAB). We evaluated 1136 patients with OAB and aged ≥50 years who visited our hospital. Age, sex, frequency of nocturnal urination, and urinary incontinence type were investigated in the 360 eligible patients. Patients were divided into three groups: those patients without falls (no-fall group), those with fall bruises (bruise group), and those with fall fractures (fracture group). The risk factors for bruises and fractures in patients with OAB were evaluated using the logistic regression analysis. In addition, association between the bruises or fractures from falls and the behavior around urination during the night was investigated. The multivariate logistic regression analysis showed that female sex (odds ratio (OR) 2.888, p = 0.030) and nocturnal urination frequency ≥3 times/night (OR vs. ≤2 times/night, 2.940; p = 0.040) were significantly associated with bruises. Nocturnal urination frequency ≥3 times/night (OR vs. ≤2 times/night, 2.835; p = 0.026) and urge incontinence (OR 3.415, p = 0.016) were significantly associated with fractures. Behavior around urination during the night was significantly associated with fractures (p = 0.009). In the real-world clinical setting, increasing nocturnal urination frequency is a common risk factor for bruises and fractures. Also, female sex and urge incontinence were the risk factors for bruises and fractures, respectively. OAB patients with urge incontinence would especially require aggressive intervention to prevent fractures during night-time voiding.

Differences in Improvement of Physical Function in Older Adults with Long-Term Care Insurance with and without Falls: A Retrospective Cohort Study.

(1) Background: This study examined the differences in changes in physical function with and without falls after daycare use among frail older adults with long-term care insurance (LTCI). (2) Methods: In this retrospective cohort study, 82 of 96 consecutive daycare center users met the inclusion criteria. The participants were divided into two groups based on the presence or absence of falls 6-12 months after use. Participant characteristics in the fall and non-fall groups and physical function at baseline and six months in each group were compared. Using analysis of covariance, we analyzed physical function and its changes between the two groups, and cut-off values were calculated using receiver operating characteristic curves. (3) Results: Gait speed, timed up-and-go test, and 30 s chair stand test (CS30) improved significantly over six months in the no-fall group (n = 70) and all participants (n = 82) (p < 0.01). Gait speed in the fall group (n = 12) improved significantly over six months (p = 0.04). The fall group had significantly lower adjusted ΔCS30 scores than the no-fall group (p = 0.03), with a cutoff value of 2 (p = 0.024). (4) Conclusions: In older adults with LTCI, physical function with and without falls after daycare use differed by ΔCS30, with a cutoff value of 2.

Association between Sedentary Time and Falls among Middle-Aged Women in Japan.

There are many reports on the risk of falls in older adults but none regarding the risk among middle-aged people. We aimed to determine fall risk factors among middle-aged women. The participants comprised 1421 women aged 40 to 64 years; anthropometric and other measurements were obtained, and lifestyle factors were examined using a self-administered questionnaire. The participants were categorized into two groups (No-fall and Fall/Almost-fall) based on their questionnaire responses. The No-fall and Fall/Almost-fall groups comprised 1114 and 307 participants, respectively. Body mass index, abdominal circumference measurements, and prevalence of dyslipidemia were significantly higher in the Fall/Almost-fall group. Additionally, those in the Fall/Almost-fall group had a shorter two-step test, experienced difficulty performing the 40 cm single-leg sit-to-stand test, and had higher 25-question Geriatric Locomotive Function Scale (GLFS-25) scores than those in the No-fall group. The results of the adjusted logistic regression analysis indicated that physical activity, higher GLFS-25 scores, and sedentary time of more than seven hours were all risk factors for falling or almost falling. Longer sedentary time is a new risk factor for falls among middle-aged women. It is necessary for people to be concerned with their sedentary behavior, such as by reducing or interrupting continuous sedentary time.

Innovative System for Evaluation and Rehabilitation of Human Imbalance.

&lt;b&gt;Introduction:&lt;/b&gt; Mobile posturography is based on wearable inertial sensors; it allows to test static stability (static posturography) and gait disturbances. &lt;/br&gt; &lt;/br&gt; &lt;b&gt;Aim:&lt;/b&gt; The aim of this work was to present the results of research on the innovative MEDIPOST system used for diagnosis and rehabilitation of balance disorders. &lt;/br&gt; &lt;/br&gt; &lt;b&gt;Material and methods:&lt;/b&gt; Fourteen articles published in influenced foreign journals were presented and discussed. The deve-lopment and construction of the device was preceded by a literature review and methodological work. The Dizziness Handi-cap Inventory (DHI) questionnaire was translated and validated. The methodology of posturography with head movements with a frequency of 0.3 Hz was also developed in the group with chronic vestibular disorders. Simultaneous measurements were performed (static posturogrphy vs. MEDIPOST) in the CTSIB-M (Modified Clinical Test of Sensory Interaction in Balance) test in healthy subjects and patients with unilateral peripheral dysfunction.&lt;/br&gt; &lt;/br&gt; &lt;b&gt;Results:&lt;/b&gt; In the posturography with head movements the improvement of sensitivity (67 to 74%) and specificity (65 to 71%) was noted. In the CTSIB-M test the intraclass correlation coefficients for both methods were 0.9. The greatest differences between examinations were observed for the mean angular velocity in the tests on the foam (trials no. 3 and 4), in particular on the foam with eyes closed (trial no. 4 - sensitivity 86.4%, specificity 87.7%). Two functional tests were analyzed: the Swap Seats test and the 360 degree turn test. In the former, the results are studied from 6 sensors - 86% of the true positives and 73% of the true negatives for the fall/ no-fall group classification. The second test differentiates people with vestibular impairment and healthy people. It can be analyzed with 1 (sensitivity 80%) and 6 sensors (sensitivity 86%, specificity 84%). Currently, the MEDIPOST device is in the development and certification phase.

Accelerometry-based gait analysis predicts falls among patients with a recent fracture who are ambulatory: a 1-year prospective study.

The aim of this prospective study was to assess whether accelerometry-based gait analysis is associated with the incidence of falls among individuals who are ambulatory and recently had a fracture, and to compare the ability to discriminate body function and structure and activity measures. A total of 100 patients who fulfilled our inclusion criteria were enrolled. At hospital discharge, the following outcomes were assessed: timed-up-and-go test, five-times-sit-to-stand test, one-leg standing test, 5-m gait test, and gait analysis using a wireless three-axis accelerometer. Root mean square (RMS) and autocorrelation (AC) values were analyzed on the basis of the acceleration waveform. Follow-up assessment of falls and subsequent fractures was performed 12 months after the fracture. Eighty-five percent of the participants completed the follow-up at 12 months. During the 12 months of follow-up, 61 falls were reported by 34 patients (31 women, three men), for a fall rate of 40.0% (34/85). The fall group had significantly poorer body function and structure and activity measures compared with the no-fall group. In accelerometry-based gait analysis, RMS and AC in the vertical axis and RMS in the anteroposterior axis were significantly lower in the fall group compared with the no-fall group. Multivariate logistic regression analysis showed that only AC in the vertical axis was a significant predictor of falls. This finding suggests that trunk acceleration AC in the vertical axis showed good discriminative ability for predicting the incidence of falls among patients who are ambulatory and recently had a fracture.

Changes of the Incidence of falls in Patients with Rheumatoid Arthritis after Orthopaedic Lower Limb Surgery

Introduction: Orthopaedic lower limb surgeries are often performed for joint pain or destruction in rheumatoid arthritis (RA), however, there were few studies for incidences and risk factors of falls after lower limb surgeries in RA. The aim of current study was to examine the incidences of falls and to analyze the risk factors for falls in patients with RA after lower limb surgeries. Methods: Self-reported questionnaires were completed by 141 patients. The incidence of falls in patients who underwent lower limb surgeries (71 cases, 1 surgery) were compared to patients with no history of surgery. Results: The incidence rate of falls in surgery group was significantly fewer when compared to no-surgery group (9.8% vs. 38.6%, p<0.01). Among the patients with history of surgery, DAS 28-CRP (4) and tender joint counts were significantly higher in the fall group than in the no-fall group. After the surgery, the frequency of falls decreased in 30% of the patients. Walking ability improved in 34% of the patients after surgery. Tender joint counts and DAS28- CRP(4) were significant risk factors for falls, on the other hand, the history of lower limb surgery was protective factor against falls (OR 0.04, p<0.01). Conclusion: The walking ability clearly improved after surgery in one third of the patients, which may resulted in decreased incidence of falls. Several patients had high disease activity even after surgery, which may be the reason why the frequency of falls increased in 6% of the patients after surgery.

Quality of life among community-dwelling elderly persons with a history of previous falls

ObjectiveThe aim of this research was to study perception of health-related quality of life (HRQL) among community-dwelling elderly persons with a history of accidental falls. Materials and methodsA descriptive analysis was made based on 198 community-dwelling elderly persons aged 65–75 (mean age 69.5 years, 48.5% female). A survey was used in order to find relevant information concerning age, gender, illnesses, falls and HRQL using the EuroQol-5D (EQ-5D) protocol. Qualitative results were presented as percentages, with a 95% confidence interval. Continuous data were compared with Mann–Whitney U test. ResultsThere are a greater percentage of subjects with illnesses within the group having a background of falls (FG – fall-group) than in the no-fall group (NFG). There are a higher percentage of subjects with EQ-5D limitations in the FG group (mobility 59.4%, self-care 29.0%, usual activities 60.6%, pain/discomfort 87.5% and anxiety/depression 62.5%) than in the NFG (mobility 28.8%, self-care 11.3%, usual activities 22.9%, pain/discomfort 65.4%, anxiety/depression 28.9%). A statistically significant difference of 20 points was found between groups in favor of NFG in terms of EQ-5D’ Visual Analog Scale score (P<.000) (FG 51.36±22.79, NFG 71.65±18.93). ConclusionsElderly persons having a history of falls in the last 12 months have poorer perception of HRQL than those without these events. Further investigations are needed in order to clarify if this is related to the falling itself or some other variables such as chronic illnesses.

AB0297 Changes of the incidence of falls in patients with rheumatoid arthritis after orthopaedic lower limb surgery

BackgroundSome studies reported that patients with rheumatoid arthritis (RA) have a high risk of falls compared with healthy aged people1)2). Pain in the lower extremities and impairment in walking were...

Prediction of Falls Using a 3-m Zigzag Walk Test

[Objective] This study investigated the applicability of a 3-m zigzag walk test for the prediction of falls and examined the relationships among fall history, the 3-m zigzag walk test, 10-m walk, and age. [Subjects] A total of 50 elderly individuals (23 males and 27 females) aged 65 and over, who were able to walk independently, were studied. [Methods] Four poles made of PET bottles were placed on a 3-m walkway in a straight line to create a zigzag course, and the time needed to walk it was measured. The best results on days 1 and 2 were adopted for the fall and no-fall groups, and intra-rater reproducibility was evaluated by calculating the intra-class correlation coefficient and performing the paired t-test. For comparison of the time needed to walk the zigzag between the 2 groups, the unpaired t-test was performed. The relationships between the times needed to walk the 3-m zigzag and 10 m and age were analyzed by calculating the correlation coefficient with fall history as the dependent variable, in multiple logistic regression analysis with the times needed to walk the 3-m zigzag and 10 m and age as independent variables. For the optimal classification of the fall and no-fall groups, cutoffs were calculated based on the ROC curve. [Results] The paired t-test results did not show differences between measurements, and the ICC was 0.97 in the fall, and 0.94 in the no-fall groups. The fall group needed significantly more time than the no-fall group to walk the 3-m zigzag. Further, the Pearson product-moment correlation coefficient revealed a significant correlation between the times needed to walk the 3-m zigzag and 10 m, while no correlation was observed between the time needed to walk the 3-m zigzag and age (r=0.225). The time needed to walk the 3-m zigzag was extracted as a factor associated with fall history in multiple logistic regression analysis, with an odds ratio of 0.377. Its significance as a variable was p<0.01. In the Hosmer-Lemeshow test of the study model, the rate of discrimination between the predicted and actual values was 82.0%. [Conclusion] The cutoff time to walk the 3-m zigzag was estimated to be 10.5 seconds, suggesting that this model may be a valid index for the prediction of falls.

Assessment of the Fall Risk for the Elderly by Probe Reaction Time During Rhythmic Stabilization

[Purpose] The purpose of this study was to examine physical factors associated with falls by the elderly. We hypothesized that elderly people who had experienced at least one fall in the past 12 months would show a delayed response in the probe reaction time (P-RT) during rhythmic stabilization (RS) compared with elderly people with no history of falls. [Subjects] The subjects were 81 elderly people (37 males, 44 females) , and the subjects were divided into two groups: a Fall group and a No-fall group. [Methods] The simple reaction time (SRT), the P-RT during RS, the maximal resistance force of RS (Max. RF) , the resistance force of RS during P-RT (RF during P-RT) , the trail marking test part-A (TMT-A), and the timed up and go test (TUG) were evaluated. [Results] The Fall group showed longer SRT and P-RT times than the No-fall group and its RF during P-RT was decreased. In logistic regression analysis with fall as the dependent variable, the P-RT was identified as a significant factor, and the cut-off value of the P-RT was 639 ms as evaluated by the Receiver-Operating-Characteristic (ROC) curve. [Conclusion] We found that P-RT is both reliable and useful for the evaluation of the fall risk of the elderly.

Fall risk estimation for senile patients

Objective To investigate the discriminant validity and relativity of three scales applied in fall risk estimation for senile patients.Methods The timed up and go test (TUGT),the Morse Fall Scale (MFS) and the Berg Balance Scale (BBS) were used by two trained testers to evaluate the fall risk of 161 senile in-patients.The patients were divided into a falling group and a no-fall group based on their history of falling in the previous one year.Student's t-test was applied to compare the discriminant validity of the TUGT,MFS and BBS.Spearman's correlation coefficient was calculated to analyze the correlation among the three scales.Results The scores of patients in the falling group on the three scales were significantly different from those of the no-falls group.The correlation coefficients among the three scales were in the range 0.680-0.888.Conclusion The TUGT,MFS and BBS all showed high sensitivity and good discrimination in fall risks estimation for senile patients.The results with the three scales were highly correlated.Because the emphasis of these three scales is different,a suitable scale should be selected in clinical practice according to the characteristics of the senile patient. Key words: Senility; Falls; Timed up and go test; Berg Balance Scale; Morse Fall Scale

An Approach to Assessment of the Fall Risk for the Elderly by Probe Reaction Time during Walking

[Purpose] This study examined physical and cognitive factors associated with falls by the elderly. The authors hypothesized that, elderly people who experienced at least one fall in the past 12 months would show delayed probe reaction time (P-RT) during walking compared with elderly people with no history of falls. [Subjects] The subjects were 101 elderly people (27 males, 74 females), and the subjects were divided into two groups: a Fall group and a No-fall group. [Methods] We evaluated the probe reaction time, Trail Marking Test Part-A (TMT-A), Timed Up and Go Test (TUG), walking speeds at a self- determined pace, and the gait cycle time. [Results] The Fall group showed longer P-RT, TMT-A, TUG times and slower walking speeds than the No-fall group and its coefficient of variation (CV) of the time for a gait cycle was increased. In logistic regression analysis with fall as the dependent variable, the probe reaction time was identified as an significant factor, and the cut-off value of the probe reaction time was 406 ms as evaluated by the Receiver-Operating-Characteristic (ROC) curve. [Conclusion] It was found that probe reaction time is both reliable and useful for the evaluation of the fall risk for the elderly.

Relationship between Probe Reaction Time during Walking and Falls for Patients with Post-Stroke Hemiplegia

[Purpose] In this paper, we examined factors of physical function, reaction time and attention ability associated with falls. [Subjects] Twenty-seven young patients with post-stroke hemiplegia (males mean age 43.3±10.3 years), who had been receiving treatment at the China Rehabilitation Research Center, were divided into two groups: the Fall group and the No-fall group. [Methods] We evaluated the probe reaction time during walking, Trail Marking Test Part-A, Timed Up and Go Test, 10 m maximum walking speed, and the time of the walking cycle. [Results] The results show that the probe reaction time of the Fall group was slower, and the dispersion of the rhythm during walking was bigger than the No-fall group. In logistic regression analysis with fall as the dependent variable, the probe reaction time was identified as significant, and the cut-off value of the probe reaction time was 626 msec according to the ROC curve. [Conclusion] We consider that the probe reaction time is useful for the evaluation of falls risk in the patients with post-stroke hemiplegia.

Relationship between Probe Reaction Time of Physical Therapists and their Patient's Accidents

The purpose of this research was to investigate the relationship between the probe reaction time of physical therapists and their record of patient accidents involving falling. The measurement items were the simple reaction time, the probe reaction time, and the Trail Marking Test Part-A. The probe reaction time was measured while the subjects were walking at a self-determined velocity. The subjects were divided into two groups: 11 physical therapists who had experienced patient fall accidents at least once in the previous 12 months (Fall group: 9 males, 2 females); and 26 physical therapists with no history of patient fall accidents (No-fall group: 14 males, 12 females). Using a digital audio player (for sonic stimulation) and sound recording equipment, the probe reaction time was measured. The results show that the probe reaction time of the Fall group was slower than that of the No-fall group. The simple reaction time and Trail Marking Test Part-A were not significant different between the Fall and No-fall groups. In logistic regression analysis with fall accident as the dependent variable, only the probe reaction time was significant. The cut-off value of the probe reaction time was 328 ms by evaluation of receiver-operating-characteristic curve. It was found that the probe reaction time of physical therapists is reliable and useful for predicting the falling accident risk.

The Effectiveness of a Simple Approach to the Assessment of the Risk of Falls in the Elderly-Probe Reaction Time and the Dispersion of the Time for a Single Step during Marking Time-

This paper discusses the relationship of the probe reaction time (P-RT), the number of steps, and the step rhythm to the risk of falls. These three factors were measured while subjects marked time at a self-determined rate. The subjects were divided into three groups including 18 young subjects (Young group; 15 males, 3 females), 11 elderly subjects who had not experienced falls (Old no-fall group; 1 male, 10 females) and 8 elderly subjects who had experienced falls (Old fall group; 3 males, 5 females). Using a digital audio player (for sonic stimulation) and sound recording equipment, the probe reaction time and the sound of the foot touching the ground was measured. One-way analysis of the variance of the probe reaction time showed a significant effect in all groups, and post-hoc comparison of the means confirmed that the probe reaction time scores were significantly longer in the Old fall group than in the Young group or the Old no-fall group. The coefficient of variation (CV) of the time for a single step was calculated once for the right foot and once for the left foot, and revealed that the effect was significant for all groups. Two-way analysis of the variance was significant, and a post-hoc comparison of the means confirmed the differences between the groups. It was thus found that the probe reaction time and the coefficient of variation of the time for a single step are reliable and useful for evaluation of the risk of falls.

Influence of Sensory Inputs on Standing Balance in Community-Dwelling Elders with a Recent History of Falling

Vision and/or ankle somatosensory inputs often do not correlate with the position of the center of gravity. In this case, visual or somatosensory information may be in conflict with other sensory systems that convey a true sense of body orientation. The purpose of this study was to determine how conflicting visual and ankle somatosensory inputs influenced standing balance in elders with a history of falls. Forty-seven community-dwelling elders (8 male, 39 female), between 65 and 96 years of age (mean = 80.5, SD = 9.0), participated in this project. Subjects with two or more falls in the 6 months prior to study were assigned to a fall group (n = 16), whereas those with no history of falling during the same time interval were assigned to a no-fall group (n = 31). In order to remove any bias in the testing procedure, the tester was not aware of group assignments. Subjects were evaluated using a sensory organization test (SOT) for standing balance and a "Get Up and Go" test (GUGT) for general mobility. Analysis of covariance was used to evaluate the SOT scores (by group, vision, and surface condition) and the GUGT scores. Body sway is known to increase with the normal aging process, and for this reason, age was selected as a covariate. The association between the SOT total score and the GUGT score was evaluated using Spearman rank-order correlation coefficients. The results showed a significant interaction between group and surface conditions, which indicated a decreased stance duration for fallers on a compliant surface compared with the stance duration for nonfallers (adjusted mean faller stance duration = 53 seconds, SD = 42; mean nonfaller stance duration = 67 seconds, SD = 32). Subjects in the fall group also had significantly higher GUGT scores (which indicated poor mobility function) than did subjects in the nonfall group (adjusted mean faller GUGT score = 2.65, SD = 1.48; mean nonfaller GUGT score = 1.47, SD = 0.77). The Spearman correlation between total SOT scores and the GUGT scores was greater for fallers (r = -.67) than for nonfallers (r = -.44). Orientation input from the ankle appears to have greater importance for preventing falls compared with a visual reference. The SOT and GUGT may be useful in the field to establish criteria for screening elders in a fall-prevention program.

Patient Falls in the Acute Care Setting

A retrospective comparative chart audit was conducted to identify patient characteristics associated with falls in the acute care setting, to examine the extent to which the significant characteristics explained if falls occurred, and to test the ability of variables believed to be risk factors to predict falls. Patients aged 60 and older who fell during hospitalization (n = 331) were compared with a random sample of patients aged 60 and older who were hospitalized during the same time period but did not fall (n = 300). Two days of documentation were sampled: admission day and day preceding the fall for the fall group, and admission day and a random day of hospital stay for the no-fall group. Findings supported the idea that fall-prone patients can be identified and that significant differences between those who do and do not fall are evident at hospital admission. The findings also suggested an alteration in the constellation of characteristics nurses use to identify fall-prone patients. Of 11 variables representing standard risk factors, only 6 were significantly related to fall status; 5 entered the regression equation as significantly contributing to the 22% explained variance. When potential predictor variables were expanded to include additional patient characteristics, the explained variances for fall status were 31% from the admission day data and 34.5% from the fall/random day data.