Performance Oriented Mobility Assessment Scale Research Articles

Impact of Mild Level Exercise Program on Incidence of Falls, Gait and Balance Among Elderly People at Selected Rural Areas of Belagavi District.

Context: Exercises that are low-intensity can aid with balance and gait. Regular low-intensity exercise is a beneficial substitute for treating balance and gait issues brought on by ageing. Objective: To assess incidence of falls, gait and balance of elderly people before and after low intensity exercise program and to assess effectiveness of low intensity exercise program on incidence of falls, gait and balance of elderly people.
 Setting and design: The study was conducted in selected rural areas of Belgaum district and pre experimental one group pretest post test study design was used.
 Materials and Methods: Population was comprised of elderly people aged 60 years and above. The sample size was 30 and non probability purposive sampling technique was used to select the samples. Berg balance scale and Performance oriented mobility assessment scale for gait was used to assess gait and balance..
 Statistical Analysis used:Descriptiveand inferential statistics were used with the helpof SPSSversion 20.
 Results: In pretest12 (40%) of elders had incidence of fall during the one month prior to pre test and is reduced in post test as 7(23.3%) were had incidence of fall after one month to interventional program. The obtained value of ‘ t’ (29) = 6.97 for gait and ‘ t’ (29) = 2.65 for balance are found significant at 0.05 level of significance, indicating that the low intensity exercise program has helped elderly to improve their gait and balance.
 Conclusions: Low intensity exercise program helped elderly people to improve their gait and balance. So, such programs need to be implemented in community area to prevent incidence of fall and improve gait and balance among the elderly population.

Tinetti balance performance is associated with mortality in older adults with late-onset Parkinson’s disease: a longitudinal study

BackgroundParkinson’s disease (PD) is associated with a 3-fold mortality risk, which is closely related to advancing age. Evidence is lacking regarding the factors associated with the risks of mortality or nursing-home (NH) admission, in elderly patients with PD. We aimed at identifying the clinical characteristics associated with these outcomes, in older community-dwelling patients with late-onset PD.MethodsRetrospective, observational analysis of data from geriatric day hospital patients. Motor assessment included Unified Parkinson Disease Rating Scale (UPDRS) part III score, Tinetti Performance Oriented Mobility Assessment (POMA) balance and gait tests, and gait speed. Levodopa equivalent dose, comorbidity, cognitive performance, Activities of Daily Living performance were examined. Cox proportional hazards models were performed to identify the factors associated with mortality and NH admission rate (maximum follow-up time = 5 years).ResultsWe included 98 patients, mean age 79.4 (SD = 5.3) of whom 18 (18.3%) died and 19 (19.4%) were admitted into NH, over a median follow-up of 4 years. In multivariate Cox models, poor balance on the Tinetti POMA scale (HR = 0.82 95%CI (0.66–0.96), p = .023) and older age (HR = 1.12 95%CI (1.01–1.25), p = .044) were the only variables significantly associated with increased mortality risk. A Tinetti balance score below 11/16 was associated with a 6.7 hazard for mortality (p = .006). No specific factor was associated with NH admissions.ConclusionsAge and the Tinetti POMA score were the only factors independently associated with mortality. The Tinetti POMA scale should be considered for balance assessment and as a screening tool for the most at-risk individuals, in this population.

Functional loss and worsening geriatric assessment parameters are more common in dementia with Lewy bodies than Alzheimer's disease.

The main aim of this study was to compare older patients with Alzheimer's disease (AD) to those with dementia with Lewy bodies (DLB) according to their dependency in daily living activities and comprehensive geriatric assessment parameters. A total of 227 AD and 123 DLB patients underwent a geriatric assessment that included comorbidities, number of drugs used, falls, urinary incontinence, hand grip strength, Mini-Nutritional Assessment (MNA), Tinetti Performance Oriented Mobility Assessment Scale, Insomnia Severity Index (ISI), and Epworth Sleepiness Scale. Basic and instrumental activities of daily living were assessed by the Barthel Index and the Lawton scale, respectively. The mean age of the participants was 83.4 years, and 73% were female. There were no statistically significant differences between AD and DLB patients in age, gender, cognitive function, or comorbidities except for coronary artery disease (P < 0.05). The number of falls, drugs used, and ISI and Epworth scores were higher in patients with DLB than patients with AD (P < 0.05). DLB patients had lower MNA, Tinetti scale, and hand grip strength scores than AD patients. The ratio of patients highly dependent in basic daily activities as a whole was significantly greater in DLB than in AD (P < 0.05), but there was no significant difference in the overall levels of dependency in instrumental activities. DLB patients are more dependent on their caregivers than AD patients. Nutritional deterioration, sleep disorders, falls, balance and gait problems, decreased muscle strength, and multiple drug use are more common in those with DLB compared to those with AD. The management of older patients with DLB may be more difficult than older patients with AD.

Effects of Dual Task Training Versus PNF Pattern on Balance and Cognition in Geriatric Population

The aim of this study is to examine the effects of Dual task training versus Proprioceptive Neuromuscular Facilitation (PNF) training on balance and cognition in geriatric population. There is growing evidence of the involvement of executive control in the maintenance of balance in older people. Balance is considered as one of the risk factors for fall especially in older adults. Proprioceptive Neuromuscular Facilitation training is one of the effective way to maintaining balance. PNF pattern exercise can activate joint sense by moving almost all joints of the body simultaneously. This is an experimental design with pre and post comparative study. This was conducted in the Physiotherapy Outpatient department in ACS Medical College and Hospital. The study duration was about 12 weeks. The subjects between the age group of 65 – 85 years of both sex those without orthopedic problems were included in this study. The subjects with severe dementia, severe cardiac problems, who had undergone recent surgery were excluded from the study. 50 Geriatric individuals were selected and divided into two groups in which Group AReceived Dual Task Training and Group B received PNF training for a period of 12 weeks. The outcome measures were Balance and cognition. The outcome tools were Berg Balance Scale, Falls Efficacy Scale, Brief Cognitive Rating Scale and Performance Oriented Mobility Assessment Scale. On comparing Pretest and Post test within Group A and Group B on Fall Efficacy Scale, Berg Balance Scale, Performance Oriented Mobility Assessment and Brief Cognitive Rating Scale shows highly significant difference in Mean values at P &lt;0.001. Thus this study concludes that Dual Task training increases Balance and Cognition in Geriatric population

Reliability &amp;amp; Validity of Mini-BESTest Scale Compared with POMA Scale to Assess Balance &amp;amp; Coordination in Patients with Parkinson’s Disease

Background: Parkinson’s disease (PD) is a progressive neurodegenerative disorder of the aging population and affects mobility, locomotion, and balance. There are multiple tools available for assess balance parameters in PD. BBS, POMA, Mini-BESTest scale and PIGD are most important and recommended tools to assess balance parameters. Mini-BESTest scale assess all 4 components of the balance parameters but psychometric properties of this scale on parkinson’s disease population was not found. Need of the study: There is no valid data available for reliability and con-current validity of Mini-BESTest scale on Indian population of PD.Methodology61 patient of PD stage 1 to 3 were included in this study. They were assessed by two scale (1=Mini-BESTest scale, 2 = Tinetti Performance Oriented Mobility Assessment scale(POMA)) for test-retest reliability, interrater reliability and con-current validity by 2 different raters. The data was analysed with ICC value and Cronbach’s Alpha for reliability and spearmen’s correlation for validity. Result: Mini-BESTest scale has excellent test-retest and interrater reliability and moderate to high correlation for con-current validity. Conclusion: Mini-BESTest scale is valid and reliable tool for assess balance in PD. Funding Statement: None to declare. Declaration of Interests: None to declare. Ethics Approval Statement: This study was approved by the ethics committee at Shri B.G. Patel College of Physiotherapy.

Speed and temporal adaptations during nonmotorized treadmill walking in Parkinson disease and nondisabled individuals.

Few studies have explored the potential of gait analysis and training in nonmotorized treadmill (NMT) in Parkinson's disease (PD) patients. We investigated (a) the walking strategy adopted by patients with PD on NMT and (b) how balance may influence spatiotemporal gait parameters. We enrolled 12 patients with PD of modified Hoehn and Yahr stage 2-3 and 13 nondisabled individuals as controls. All participants were evaluated using Tinetti's performance oriented mobility assessment scale, freezing of gait questionnaire, modified falls efficacy scale, and the timed up and go test. They were asked to ambulate with comfortable and maximal speeds on the NMT. The gait parameters acquired on the NMT included walking speed, cadence (CAD), step length, and vertical ground reaction force, which were calculated for intragroup and intergroup comparisons. The PD group took on with higher contribution of CAD and less contribution of step length to increase walking speed as compared with control group. The postural stability is correlated significantly positively to the CAD at the setting of maximal speed in the PD group. Moreover, a significantly lower ratio of vertical ground reaction force/body weight was noted in the PD group during both comfortable and maximal walking speeds compared with the nondisabled controls. Our study outcomes clearly support the perceived benefits of NMT to differentiate spatiotemporal gait parameters between PD and controls. NMT may potentially be useful to evaluate the recovery of physical activities in PD receiving medications and/or rehabilitation.

Short-Physical Performance Battery (SPPB) score is associated with falls in older outpatients.

The capacity of Short-Physical Performance Battery (SPPB) test to discriminate between fallers and non-fallers is controversial, and has never been compared with fall risk assessment-specific tools, such as Performance-Oriented Mobility Assessment (POMA). To verify the association of SPPB and POMA scores with falls in older outpatients. 451 older subjects (150 males, mean age 82.1 ± 6.8) evaluated in a geriatric outpatient clinic for suspected frailty were enrolled in this cross-sectional study. Self-reported history of falls and medication history were carefully assessed. Each participant underwent comprehensive geriatric assessment, including SPPB, POMA, Geriatric Depression Scale (GDS), mini-mental state examination (MMSE) and mini-nutritional assessment-short form (MNA-SF). Multivariate logistic regression and receiver-operating characteristic (ROC) analyses were performed to determine the factors associated with the status of faller. 245 (54.3%) subjects were identified as fallers. They were older and had lower SPPB and POMA test scores than non-fallers. At ROC analysis, SPPB (AUC 0.676, 95% CI 0.627-0.728, p < 0.001) and POMA (AUC 0.677, 95% CI 0.627-0.726, p < 0.001) scores were both associated with falls. At multivariate logistic regression models, SPPB total score (OR 0.83, 95% CI 0.76-0.92, p < 0.001), POMA total score (OR 0.94, 95% CI 0.91-0.98, p = 0.002) and SPPB balance score alteration (OR 2.88, 95% CI 1.42-5.85, p = 0.004), but not POMA balance subscale score alteration, were independently associated with recorded falls, as also GDS, MMSE and MNA-SF scores. SPPB total score was independently associated with reported falls in older outpatients, resulting non-inferior to POMA scale. The use of SPPB for fall risk assessment should be implemented.

Evaluation of psychometric properties of Tinetti performance-oriented mobility assessment scale in subjects with knee osteoarthritis.

Objective:The objective of this study was to determine the psychometric properties of the Tinetti Performance-Oriented Mobility Assessment (POMA) scale to measure balance and gait impairments in individuals with knee osteoarthritis (OA).Methods:A convenient sample of 25 individuals with bilateral OA knee were recruited. The convergent validity was determined by correlation analysis between scores of Berg Balance Scale (BBS) with balance subscale (POMA-B) and the Timed Up and Go Test (TUGT) with gait subscale (POMA-G). The intrarater reliability [intraclass correlation coefficient (ICC 3,1)], the Bland–Altman plots limits of agreement (LOA), the standard error of measurement (SEM), minimum detectable change (MDC) and ceiling/floor effects were determined.Results:Score of BBS was significantly correlated with POMA-B scores, rs = 0.63, p = 0.001, whereas TUGT showed a negative correlation with POMA-G, rs = −0.481, p = 0.020, showing moderate convergent validity. ICC results of the total POMA scale (POMA-T), POMA-B, and POMA-G were 0.96, 0.93, and 0.96, respectively, indicating high test retest reliability. SEM, for POMA-T, POMA-B, and POMA-G was 0.35, 0.27, and 0.35, respectively; MDC values were 0.97 for POMA-T, 0.75 for POMA-B, and 0.63 for POMA-G.Conclusion:The findings indicate that the POMA is a valid and reliable tool to assess balance and gait impairments in people with OA knee.

Balance and mobility assessment for ruling-out the peripheral neuropathy of the lower limbs in older adults

The peripheral neuropathy of the lower limbs (PNLL) is an important cause of balance and mobility impairment in older adults. The nerve conduction study (NCS) is the gold standard for PNLL diagnosis. Aim of this work is to establish the sensitivity (Sn) and the specificity (Sp) of the balance and mobility examination for the PNLL in older adults.This study consecutively recruited 72 participants (>65years) who accessed to the clinical neurophysiology outpatient clinic for suspected PNLL. Participants were given the NCS and four clinical tests. Mobility was evaluated by the Timed Up and Go (TUG) test, the Performance Oriented Mobility Assessment (POMA) and the de Morton Mobility Index (DEMMI). In addition the Clinical Evaluation of Static Upright Stance (CELSIUS) scale was developed for a selective evaluation of static balance.Based on the NCS, 36% of participants had PNLL. The CELSIUS scale (cutoff: 19.5/24), the TUG test (cutoff: 9.6s) and the DEMMI scale (cutoff: 17.5/19) have high Sn (0.92÷0.96), but low Sp (0.28÷0.43) for the PNLL in the older adult. POMA scale (cutoff: 14.5/16) has low Sn (0.73), but acceptable Sp (0.85). In addition, CELSIUS, DEMMI and TUG negative likelihood ratios are 0.13, 0.17 and 0.12, respectively.Balance and mobility examination have high sensitivity for PNLL. CELSIUS score>19/24, DEMMI score>17/19 or TUG time≤9.6s substantially reduce PNLL likelihood. These clinical measures are thus recommended for ruling-out PNLL in the older adult.

Correlation between Performance Oriented Mobility Assessment Scale and Activity Specific Balance Confidence Scale in Elderly Individual

Correlation between Performance Oriented Mobility Assessment Scale and Activity Specific Balance Confidence Scale in Elderly Individual

Effect of Core Muscle Strengthening on Balance and Quality of Life in Geriatric Patient

Introduction & Rationale: The core stability is capability of the muscles of the trunk to stabilize the lower spine during movement it maintains the human body in stable and erect posture. Aging leads to loss of balance and stability hence Core strengthening program help elderly to independence in life activity & also improve the balance and quality of life. Effect of core muscle strengthening was evaluated in present study.METHODOLOGY Aims and Objectives: To determine the effect of core muscle strengthening on balance with the help of performance oriented mobility assessment (POMA) scale and assess quality of life with SF-12 questionnaire in geriatrics. Study Design: It is a community based longitudinal study Subjects: Inclusion criteria: Both sex and age > 60 year who are clinically stable and functionally independent. Exclusion criteria: Subjects with conditions leading to incapacitation and functional impairment, with neurological conditions having altered balance, peripheral neuropathies, under psychiatric treatment, or impaired cognitive status. Sample Size: Thirty subjects were enrolled in the study Study factors: A routine history and clinical examination was carried out for selecting the subjects and basic demographic data was recorded. Pressure biofeedback was used to teach the subjects, an abdominal 'drawing-in' maneuver and a visual feedback was provided to understand the core muscle activation. Intervention: The subjects underwent a graded core muscle strengthening exercise protocol for 8 weeks period. Outcome Factors: The outcome factors were the effectiveness of core strengthening on balance and quality of life were recorded with the help of POMA scale and SF-12 questionnaire respectively after the interventional exercises for 8 weeks. Results: The mean age of the subjects was 75.3 years, with SD. 6.456. Statistically significant improvements in total score on POMA scale improved from 22.5 to 24.83, p value Conclusion:Core muscle strengthening program is effective in improving balance and quality of life in geriatrics subjects.

Reliability and validity of the Turkish version of the Performance-Oriented Mobility Assessment I

Abstract The Performance-Oriented Mobility Assessment (POMA)-I is widely used assessment tool for evaluation of balance and gait properties. The aim of this study was to translate POMA-I to Turkish and to assess its reliability and validity. People with amputated lower extremities using prosthetics, those who underwent orthopedic surgery within the last 6 months, those dependent on wheel chairs and also bed-ridden patients, subjects with dementia and Alzheimer’s disease, and illiterate people were excluded. After translation into Turkish, the Turkish version of the scale was applied on the participants at 2-week intervals. Volunteers ≥65 years of age were enrolled in the study. Internal consistencies of POMA subscale scores of postural balance and gait, and total score were calculated using Cronbach’s α coefficient. The Turkish version was evaluated with respect to inter- and intrarater reliability and test–retest reliability intraclass correlation coefficient (ICC). For validation, Pearson’s correlation coefficient between POMA and Berg Balance Scale (BBS) and Timed Up and Go Test (TUGT) was estimated. Eighty participants enrolled in the study with a mean age of 76.5 ± 6.75 years. In the reliability evaluation of the scale, considering postural balance, gait, and total score, Cronbach’s α coefficients were found to be 0.72, 0.83, and 0.88, respectively. ICCs were detected above 0.70 for test–retest reliability and also for interrater and intrarater reliability. In validation study POMA total score had a strong positive correlation with BBS total score (r = 0.86, p &lt; 0.0001), and also a negative correlation with TUGT (r = −0.75, p &lt; 0.0001). According to the results of this study, the Turkish version of the POMA-I scale has been found to be a reliable and a valid scale for elderly Turkish people.

Measuring balance, lower extremity strength and gait in the elderly: Construct validation of an instrument

The purpose of the study was to determine the degree to which scores of a modified version of the ‘Timed Get Up and Go’ test (TGUG) were associated with other measures of functional performance. Thirty-seven community-dwelling older women (72.3 ± 5.5 years) volunteered to participate. Subjects were assessed when performing the modified TGUG test. Correlations between the performance-oriented mobility assessment (POMA), single-leg balance, five chair rises, fast and normal gait speed, knee extension and flexion strength, and the modified TGUG were conducted. Total time to perform the modified TGUG test was significantly correlated with normal and fast gait speed ( p < 0.05). The Pearson correlation coefficients were −0.841 and −0.748, respectively. The time needed to perform several tasks of the modified TGUG test significantly correlated with five chair rises, and with right knee extensor strength ( p < 0.05). Points obtained in the assessment questionnaire correlated significantly to points obtained in the POMA scale ( p < 0.05). The Pearson correlation coefficient was 0.795. Based on the strength of the correlations obtained between components of the modified TGUG and the comparison tests, concurrent, criterion validity of the modified TGUG has been established.

P063 The repeatability of observational gait analysis in clinical lower limb prosthetics

The peripheral neuropathy of the lower limbs (PNLL) is an important cause of balance and mobility impairment in older adults. The nerve conduction study (NCS) is the gold standard for PNLL diagnosis. Aim of this work is to establish the sensitivity (Sn) and the specificity (Sp) of the balance and mobility examination for the PNLL in older adults.This study consecutively recruited 72 participants (>65 years) who accessed to the clinical neurophysiology outpatient clinic for suspected PNLL. Participants were given the NCS and four clinical tests. Mobility was evaluated by the Timed Up and Go (TUG) test, the Performance Oriented Mobility Assessment (POMA) and the de Morton Mobility Index (DEMMI). In addition the Clinical Evaluation of Static Upright Stance (CELSIUS) scale was developed for a selective evaluation of static balance.Based on the NCS, 36% of participants had PNLL. The CELSIUS scale (cutoff: 19.5/24), the TUG test (cutoff: 9.6 s) and the DEMMI scale (cutoff: 17.5/19) have high Sn (0.92 ÷ 0.96), but low Sp (0.28 ÷ 0.43) for the PNLL in the older adult. POMA scale (cutoff: 14.5/16) has low Sn (0.73), but acceptable Sp (0.85). In addition, CELSIUS, DEMMI and TUG negative likelihood ratios are 0.13, 0.17 and 0.12, respectively.Balance and mobility examination have high sensitivity for PNLL. CELSIUS score > 19/24, DEMMI score > 17/19 or TUG time ≤ 9.6 s substantially reduce PNLL likelihood. These clinical measures are thus recommended for ruling-out PNLL in the older adult.

Cognitive status and ambulatory rehabilitation outcome in geriatric patients

To determine the effect of admission cognitive status on gait and stair climbing rehabilitation outcome in geriatric patients. Before-after trial. A total of 179 geriatric patients (139 women and 40 men; age range 67-97 years) consecutively admitted to a geriatric inpatient rehabilitation regimen (mean length of stay 28.7 (standard deviation 13.9) days). Assessment of admission cognitive status by the Mini-Mental State Examination (MMSE); determination of the ambulatory status before and after rehabilitation by the Performance-Oriented Mobility Assessment (POMA) and standardized judgements about stair climbing ability. Approximately two-thirds of the patients demonstrated functional ability improvements in at least 5 points at the individual level during rehabilitation (as measured by the total POMA scale (POMA-T)). However, at rehabilitation discharge cognitively impaired patients still demonstrated a 3.4 times (95% confidence interval=1.4-8.6) higher chance of increased fall risk and only 24% of the cohort was able to negotiate stairs with slight or no limitations. Although cognitively impaired patients demonstrated an functional overall intervention response comparable with cognitively intact patients the present study evidenced that the geriatric cohort with reduced mental status (MMSE >17) are at greater risk of falling and have a greater need for supervision, both in hospital and at discharge.