Self-reported Mobility Research Articles

Day-to-Day Mobility, Affect, and Stress Couplings in Swiss Older Adults

The Mobility, Activity, and Social Interactions Study (MOASIS) is part of a global effort to more closely examine indicators of functional ability in relation to person characteristics and life contexts as proposed by the WHO’s healthy aging definition. In MOASIS, sensor-based and self-reported mobility and activity indicators were used to capture functional ability in 153 community-dwelling older adults aged 65-91 over 30 days. The present study examines daily time out-of-home and place diversity and its within-person associations with positive and negative affect and stress. Initial between-person analyses indicate that mobility is only weakly related to indicators of physical and mental health. We propose that the health- and well-being implications of mobility more strongly play out in daily life and at the within-person level, and will examine general health, cognitive ability, and marital status as intrinsic capacity moderators accounting for some of the expected interindividual heterogeneity.

The Pathways to Healthy Ageing: Evidence From Longitudinal Studies and Real-Time Data

The WHO has replaced its active ageing policy framework developed in 2002 with the new Healthy Ageing framework developed in 2015 and declared the decade between 2020 and 2030 as the Decade of Healthy Ageing. Healthy Ageing framework emphasizes the pivotal role of functional ability (FA) among older adults and conceptualizes that FA can be determined by intrinsic capacity (IC), environments (EN), and their interaction. WHO calls for global research to advance theoretical understanding of Healthy Ageing framework and translate the evidence into policy actions. This symposium provides the latest findings on Healthy Ageing from multi-country studies using real-time data and longitudinal study design. Dr. Röcke explored daily time-out-of-home and place visit diversity with daily emotional and stress processes in Zurich, using sensor-based and self-reported mobility and activity indicators to capture FA. Dr. Lu investigated the EN and 4-year trajectories of IC and their impact on FA trajectories among older adults in Hong Kong. Dr. Liu explored the longitudinal associations between neighborhood physical EN and depressive symptoms of older adults in Hong Kong and the moderating effects of terrain slope and declining daily activity of living. Dr. Guo investigated the relationship between perceived EN (environmental cognition) and mental health and the mediating roles of physical activity and place attachment. Dr. Chan explored neighborhood physical EN and cognition among older people and identified whether this association varies among different older age groups. Based on these findings, this symposium will discuss the future research direction on Healthy Ageing and its policy implication.

Risk Factors for Mobility Decline in Community-Dwelling Older Adults: A Systematic Literature Review.

Mobility is essential to maintaining independence for older adults. This systematic review aimed to summarize evidence about self-reported risk factors for self-reported mobility decline; and to provide an overview of published prognostic models for self-reported mobility decline among community-dwelling older adults. Databases were searched from inception to June 2, 2020. Studies were screened by two independent reviewers who extracted data and assessed study quality. Sixty-one studies (45,187 participants) were included, providing information on 107 risk factors. High-quality evidence and moderate/large effect sizes for the association with mobility decline were found for older age beyond 75 years, the presence of widespread pain, and mobility modifications. Moderate-high quality evidence and small effect sizes were found for a further 21 factors. Three model development studies demonstrated acceptable model performance, limited by high risk of bias. These findings should be considered in intervention development, and in developing a prediction instrument for practical application.

Abstract 14021: Brief Composite Mobility Index Predicts Post-Stroke Fallers After Hospital Discharge

Introduction: Community-dwelling, ambulatory stroke survivors fall at very high rates in the first 3-6 months. Current inpatient clinical assessments for fall risk have inadequate predictive accuracy. We found that a pre-discharge obstacle-crossing test has excellent specificity (87%) but lacks acceptable sensitivity (67%) for identifying would-be fallers and non-fallers post discharge. Hypothesis: We assessed the hypothesis that combining the obstacle-crossing test with other highly discriminatory mobility factors would compensate for the obstacle-test’s fair sensitivity and yield an instrument with superior prediction accuracy. Methods: 45 ambulatory stroke survivors (60±11 years old, 15±11 days post stroke) being discharged home completed a battery of mobility and dynamic balance performance-based and self-reported measures 1-3 days prior to discharge. After discharge, participants were prospectively followed for 3 months and classified as fallers (≥1 fall) or non-fallers at 3 months. Four pre-discharge measures with the largest effect sizes for differentiating fallers and non-fallers (obstacle-crossing test, Walk-12, 5-meter gait speed, and paretic-limb Step Test score) were combined into a composite index. Results: The composite index significantly differentiated those who subsequently fell (11.1±4.5 points) from non-fallers (4.8±4.1 points, d =1.46, p<0.001). A person with an index discharge score of 11 was 6 times more likely to fall in the first 3-months post discharge than a person with a score of 5. The goodness of fit of the regression model with the composite index was significantly better than the model with only the obstacle-crossing test, χ 2 (1) = 6.036, p=0.014. Furthermore, whereas the obstacle-crossing test had acceptable discrimination (AUC 0.75, 95% CI 0.60-0.90), the composite index had excellent discrimination ability (AUC 0.85, 95% CI 0.74-0.96). Conclusion: Strategic aggregation of performance-based and self-reported mobility measures, including a novel and demanding obstacle-crossing test, can predict post-discharge fallers with excellent accuracy. This brief tool is highly pragmatic for inpatient use and may facilitate identification of high-risk stroke survivors before the first fall.

The cost effectiveness of personalized dietary advice to increase protein intake in older adults with lower habitual protein intake: a randomized controlled trial

PurposeTo examine the cost effectiveness of dietary advice to increase protein intake on 6-month change in physical functioning among older adults.MethodsIn this multicenter randomized controlled trial, 276 community-dwelling older adults with a habitual protein intake < 1.0 g/kg adjusted body weight (aBW)/d were randomly assigned to either Intervention 1; advice to increase protein intake to ≥ 1.2 g/kg aBW/d (PROT, n = 96), Intervention 2; similar advice and in addition advice to consume protein (en)rich(ed) foods within half an hour after usual physical activity (PROT + TIMING, n = 89), or continue the habitual diet with no advice (CON, n = 91). Primary outcome was 6-month change in 400-m walk time. Secondary outcomes were 6-month change in physical performance, leg extension strength, grip strength, body composition, self-reported mobility limitations and quality of life. We evaluated cost effectiveness from a societal perspective.ResultsCompared to CON, a positive effect on walk time was observed for PROT; – 12.4 s (95%CI, – 21.8 to – 2.9), and for PROT + TIMING; – 4.9 s (95%CI, – 14.5 to 4.7). Leg extension strength significantly increased in PROT (+ 32.6 N (95%CI, 10.6–54.5)) and PROT + TIMING (+ 24.3 N (95%CI, 0.2–48.5)) compared to CON. No significant intervention effects were observed for the other secondary outcomes. From a societal perspective, PROT was cost effective compared to CON.ConclusionDietary advice to increase protein intake to ≥ 1.2 g/kg aBW/d improved 400-m walk time and leg strength among older adults with a lower habitual protein intake. From a societal perspective, PROT was considered cost-effective compared to CON. These findings support the need for re-evaluating the protein RDA of 0.8 g/kg BW/d for older adults.Trial registrationThe trial has been registered at ClinicalTrials.gov (NCT03712306). Date of registration: October 2018. Registry name: The (Cost) Effectiveness of Increasing Protein Intake on Physical Functioning in Older Adults. Trial Identifier: NCT03712306.

Mobility Deviations in Adults With Human Immunodeficiency Virus: A Cross-Sectional Assessment Using Gait Analysis, Functional Performance, and Self-Report.

BackgroundLittle is known about how human immunodeficiency virus (HIV) affects walking biomechanics, or about associations between HIV-related gait deviations, functional performance, and self-reported outcomes. This paper reports on (1) gait biomechanics and variability in people with HIV (PWH) and (2) associations with clinical tests, self-reported function, and falls.MethodsA cross-sectional study tested consecutively sampled PWH (n = 50) and HIV-seronegative participants ([SNP] n = 50). Participants underwent 3-dimensional gait analysis, performed clinical tests (short walk and single leg stance tests with and without dual tasking, chair-rise tests, and a physical performance battery), and completed questionnaires about function and falls. Between-group comparisons were done using analysis of covariance. Linear correlations between gait variability, clinical tests, and patient-reported outcomes were established.ResultsPeople with HIV and SNP had comparable median ages (PWH = 36.6, interquartile range [IQR] = 32.0–45.6]; SNP = 31.1, IQR = 23.2–45.1). Compared with SNP, PWH walked slower (adjusted mean difference [MD] = −0.2 meters per second [m/s], 95% confidence interval [CI] = −0.3 to −0.1) with greater variability (adjusted MD = 14.7 variability score points, 95% CI = 9.9–19.5). Moreover, PWH were slower in five-times sit-to-stand (5STS) performance (adjusted MD = 1.9 seconds, 95% CI = 1.00–2.9). Significant deviations in hip kinematics (increased flexion; adjusted MDs = 2.4°–2.8°, P = .012–.016) and knee kinematics (reduced flexion; adjusted MDs = 2.3°–3.7°, P = .007–.027) were found in PWH during dual-task (DT) walking. The PWH’s 5STS moderately correlated with larger gait variability (usual pace r = −0.5; dual task r = −0.6), poorer self-reported mobility (r = 0.4) and self-care function (r = 0.5), and fear of falling (P = .003).ConclusionsPeople with HIV presented with biomechanical deviations suggestive of a slowed and variable gait, especially under cognitive challenges. Five-times STS may be useful to screen for gait deviations in PWH.

Racial Differences in the Effect of HIV Status on Motor and Pulmonary Function and Mobility Disability in Older Adults.

Older Black adults face a disproportionate burden of HIV prevalence, but less is known about racial disparities in age-related outcomes in HIV. We assessed the effect of HIV status and race on motor and pulmonary function, as well as how they contribute to mobility disability. Community-based study; Chicago, IL METHODS: Participants were 363 community-dwelling adults age ≥ 50years, 48% living with HIV, and 68% Black. Participants with HIV were recruited from a specialty HIV clinic, and participants without HIV (comparable on key demographic, lifestyle, and behavioral characteristics) were recruited from the community.Measures included motor function summarized by 10 motor performance measures, pulmonary function summarized by 3 measures assessed using handheld spirometry, and self-reported mobility disability. In fully adjusted linear models, HIV was associated with better motor (β = 9.35, p &lt; 0.001) and pulmonary function (β = 16.34, p &lt; 0.001). For pulmonary function, the effect of HIV status was moderated by race (interaction between Black race and HIV status: β = - 11.66, p = 0.02), indicating that better pulmonary function among participants with HIV was less evident among Black participants. In fully adjusted models, odds of mobility disability did not differ by race, HIV status, or pulmonary function; better motor function was associated with lower odds of mobility disability (OR = 0.91 per 1-point higher, 95% CI 0.88-0.93). Better motor and pulmonary function exhibited by participants with HIV could reflect access to medical care. Racial differences in lung function among participants with HIV indicate potential disparities in prevention or treatment of pulmonary disease or underlying risk factors.

Impacts of COVID-19 on individuals’ mobility behavior in Pakistan based on self-reported responses

IntroductionThe COVID-19 pandemic has been extremely disturbing mobility behavior due to travel restrictions and perceived COVID-19 threats. Recently, researchers from developed countries have shown interest in quantifying the impacts of the COVID-19 on individuals' mobility; however, similar research themes in lower income developing countries like Pakistan have not been sufficiently explored. Therefore, the objectives of the study are; 1) to explore the changes in self-reported individual's mobility behavior—trip frequencies by mode and by purpose in three COVID-19 severity periods; 2) to quantify the effects of respondents' personal (i.e., age, gender, education, and living place), and perceived details (i.e., safety perceptions, the COVID-19 threat perceptions) on the change in mobility behavior in the COVID-19 severity change; 3) to analyze the willingness to use public transportation in the post-pandemic period. Methods: A web-based questionnaire survey was conducted from September 2020 to November 2020, resulting in 565 responses. Descriptive analysis, random parameter bivariate probit modeling, and structural equation modeling are adopted to achieve the objectives. Results: The results reflect the change in individuals' mobility behavior in three severity periods of COVID-19, including before outbreak, during the most serious period, and after the most serious period. A substantial reduction in individuals' mobility was observed during the most serious period, which is recovering back to normal. The results also indicate the relationship of individuals' personal and perceived characteristics with the change in mobility in COVID-19 severity changes from before-to-serious and from the serious-to-after most serious period. Conclusion: The COVID-19 pandemic has been affecting individuals' mobility behavior in Pakistan. The study's findings provide insightful information for the transportation agencies to better prepare for sustainable transportation management in the post-pandemic era.

Sex-specific 25-hydroxyvitamin D threshold concentrations for functional outcomes in older adults: PRoject on Optimal VItamin D in Older adults (PROVIDO)

Threshold serum 25-hydroxyvitamin D [25(OH)D] concentrations for extraskeletal outcomes are uncertain and could differ from recommendations (20-30 ng/mL) for skeletal health. We aimed to identify and validate sex-specific threshold 25(OH)D concentrations for older adults' physical function. Using 5 large prospective, population-based studies-Age, Gene/Environment Susceptibility-Reykjavik (n=4858, Iceland); Health, Aging, and Body Composition (n=2494, United States); Invecchiare in Chianti (n=873, Italy); Osteoporotic Fractures in Men (n=2301, United States); and Study of Osteoporotic Fractures (n=5862, United States)-we assessed 16,388 community-dwelling adults (10,376 women, 6012 men) aged≥65 y. We analyzed 25(OH)D concentrations with the primary outcome (incident slow gait: women <0.8 m/s; men <0.825 m/s) and secondary outcomes (gait speed, incident self-reported mobility, and stair climb impairment) at median 3.0-y follow-up. We identified sex-specific 25(OH)D thresholds that best discriminated incident slow gait using machine learning in training data (2/3 cohort-stratified random sample) and validated using the remaining (validation) data and secondary outcomes. Mean age in the cohorts ranged from 74.4 to 76.5 y in women and from 73.3 to 76.6 y in men. Overall, 1112/6123 women (18.2%) and 494/3937 men (12.5%) experienced incident slow gait, 1098/7011 women (15.7%) and 474/3962 men (12.0%) experienced incident mobility impairment, and 1044/6941 women (15.0%) and 432/3993 men (10.8%) experienced incident stair climb impairment. Slow gait was best discriminated by 25(OH)D<24.0 ng/mL compared with 25(OH)D≥24.0 ng/mL in women (RR: 1.29; 95% CI: 1.10, 1.50) and 25(OH)D<21.0 ng/mL compared with 25(OH)D≥21.0 ng/mL in men (RR: 1.43; 95% CI: 1.01, 2.02). Most associations between 25(OH)D and secondary outcomes were modest; estimates were similar between validation and training datasets. Empirically identified and validated sex-specific threshold 25(OH)D concentrations for physical function for older adults, 24.0 ng/mL for women and 21.0 ng/mL for men, may inform candidate reference concentrations or the design of vitamin D intervention trials.

What Cut-Point in Gait Speed Best Discriminates Community-Dwelling Older Adults With Mobility Complaints From Those Without? A Pooled Analysis From the Sarcopenia Definitions and Outcomes Consortium.

Cut-points to define slow walking speed have largely been derived from expert opinion. Study participants (13 589 men and 5043 women aged ≥65years) had walking speed (m/s) measured over 4-6 m (mean ± SD: 1.20 ± 0.27 m/s in men and 0.94 ± 0.24 m/s in women.) Mobility limitation was defined as any self-reported difficulty with walking approximately 1/4 mile (prevalence: 12.6% men, 26.4% women). Sex-stratified classification and regression tree (CART) models with 10-fold cross-validation identified walking speed cut-points that optimally discriminated those who reported mobility limitation from those who did not. Among 5043 women, CART analysis identified 2 cut-points, classifying 4144 (82.2%) with walking speed ≥0.75 m/s, which we labeled as "fast"; 478 (9.5%) as "intermediate" (walking speed ≥0.62 m/s but <0.75 m/s); and 421 (8.3%) as "slow" (walking speed <0.62 m/s). Among 13 589 men, CART analysis identified 3 cut-points, classifying 10 001 (73.6%) with walking speed ≥1.00 m/s ("very fast"); 2901 (21.3%) as "fast" (walking speed ≥0.74 m/s but <1.00 m/s); 497 (3.7%) as "intermediate" (walking speed ≥0.57 m/s but <0.74 m/s); and 190 (1.4%) as "slow" (walking speed <0.57 m/s). Prevalence of self-reported mobility limitation was lowest in the "fast" or "very fast" (11% for men and 19% for women) and highest in the "slow" (60.5% in men and 71.0% in women). Rounding the 2 slower cut-points to 0.60 m/s and 0.75 m/s reclassified very few participants. Cut-points in walking speed of approximately 0.60 m/s and 0.75 m/s discriminate those with self-reported mobility limitation from those without.

Examination of the Measurement Equivalence of the Functional Assessment in Acute Care MCAT (FAMCAT) Mobility Item Bank Using Differential Item Functioning Analyses

ObjectiveTo assess differential item functioning (DIF) in an item pool measuring the mobility of hospitalized patients across educational, age, and sex groups. DesignMeasurement evaluation cohort study. Content experts generated DIF hypotheses to guide the interpretation. The graded response item response theory (IRT) model was used. Primary DIF tests were Wald statistics; sensitivity analyses were conducted using the IRT ordinal logistic regression procedure. Magnitude and impact were evaluated by examining group differences in expected item and scale score functions. SettingHospital-based rehabilitation. ParticipantsHospitalized patients (N=2216). InterventionsNot applicable. Main Outcome MeasuresA total of 111 self-reported mobility items. ResultsTwo linking items among those used to set the metric across forms evidenced DIF for sex and age: “difficulty climbing stairs step-over-step without a handrail (alternating feet)” and “difficulty climbing 3-5 steps without a handrail.” Conditional on the mobility state, the items were more difficult for women and older people (aged ≥65y). An additional 18 items were identified with DIF. Items with both high DIF magnitude and hypotheses related to age were difficulty “crossing road at a 4-lane traffic light with curbs,” “jumping/landing on one leg,” “strenuous activities,” and “descending 3-5 steps with no handrail.” Although DIF of higher magnitude was observed for several items, the scale-level effect was relatively small and the exposure rate for the most problematic items was low (0.35, 0.27, and 0.20). ConclusionsThis was the first study to evaluate measurement equivalence of the hospital-based rehabilitation mobility item bank. Although 20 items evidenced high magnitude DIF, 5 of which were related to stairs, the scale-level effect was minimal; however, it is recommended that such items be avoided in the development of short-form measures. No items with salient DIF were removed from calibrations, supporting the use of the item bank across groups differing in education, age, and sex. The bank may thus be useful to assist clinical assessment and decision-making regarding risk for specific mobility restrictions at discharge as well as identifying mobility-related functions targeted for postdischarge interventions. Additionally, with the goal of avoiding long and burdensome assessments for patients and clinical staff, these results could be informative for those using the item bank to construct short forms.

Neighborhood environmental attributes and walking mobility decline: A longitudinal ecological study of mid-to-older aged Australian adults.

ObjectivesCross-sectional studies have found some built environmental attributes to be associated with residents’ lower levels of mobility (functional capacity to walk outside the home). However, less is known about what environmental attributes are related to mobility decline. This longitudinal study examined area-level associations of specific environmental attributes with mid-to-older aged adults’ changes in walking mobility.MethodsData collected from 4,088 adults (aged 46–71 years at baseline) who participated in a cohort study in Brisbane, Australia were used. The outcome was the change in self-reported mobility score (SF-36) from 2013 to 2016, which were aggregated at the neighborhood (N = 156) and suburb (N = 99) levels, due to the known lack of sensitivity in SF-36 subscales to individual changes. Linear regression analysis examined associations of mobility change with seven environmental attributes measured at baseline (residential density, intersection density, land use mix, density of walking/bike paths, park density, bus stop density, density of social incivilities), adjusting for confounding variables.ResultsParticipants on average reported 4% of mobility decline during the 3-year study period. It was found that greater land use diversity was consistently associated with less decline in walking mobility, while greater density of social incivilities was associated with more decline in walking mobility. The latter finding was significant only at the neighborhood level. No consistent associations were observed for residential density, intersection density, density of walking/bike paths, park density, and bus stop density.DiscussionOur findings suggest that mid-to-older aged adults who live in areas with lower land use diversity and more social incivilities may be at risk of developing mobility limitations. Recommended policies to slow residents’ mobility decline and to achieve aging in place include improving these environmental attributes where needed and advising older adults to relocate to safer, mixed-use neighborhoods.

Using a microprocessor knee (C-Leg) with appropriate foot transitioned individuals with dysvascular transfemoral amputations to higher performance levels: a longitudinal randomized clinical trial

BackgroundIndividuals with transfemoral amputations who are considered to be limited community ambulators are classified as Medicare functional classification (MFCL) level K2. These individuals are usually prescribed a non-microprocessor controlled knee (NMPK) with an appropriate foot for simple walking functions. However, existing research suggests that these individuals can benefit from using a microprocessor controlled knee (MPK) and appropriate foot for their ambulation, but cannot obtain one due to insurance policy restrictions. With a steady increase in older adults with amputations due to vascular conditions, it is critical to evaluate whether advanced prostheses can provide better safety and performance capabilities to maintain and improve quality of life in individuals who are predominantly designated MFCL level K2. To decipher this we conducted a 13 month longitudinal clinical trial to determine the benefits of using a C-Leg and 1M10 foot in individuals at K2 level with transfemoral amputation due to vascular disease. This longitudinal clinical trial incorporated recommendations prescribed by the lower limb prosthesis workgroup to design a study that can add evidence to improve reimbursement policy through clinical outcomes using an MPK in K2 level individuals with transfemoral amputation who were using an NMPK for everyday use.MethodsTen individuals (mean age: 63 ± 9 years) with unilateral transfemoral amputation due to vascular conditions designated as MFCL K2 participated in this longitudinal crossover randomized clinical trial. Baseline outcomes were collected with their current prosthesis. Participants were then randomized to one of two groups, either an intervention with the MPK with a standardized 1M10 foot or their predicate NMPK with a standardized 1M10 foot. On completion of the first intervention, participants crossed over to the next group to complete the study. Each intervention lasted for 6 months (3 months of acclimation and 3 months of take-home trial to monitor home use). At the end of each intervention, clinical outcomes and self-reported outcomes were collected to compare with their baseline performance. A generalized linear model ANOVA was used to compare the performance of each intervention with respect to their own baseline.ResultsStatistically significant and clinically meaningful improvements were observed in gait performance, safety, and participant-reported measures when using the MPK C-Leg + 1M10 foot. Most participants were able to achieve higher clinical scores in gait speed, balance, self-reported mobility, and fall safety, while using the MPK + 1M10 combination. The improvement in scores were within range of scores achieved by individuals with K3 functional level as reported in previous studies.ConclusionsIndividuals with transfemoral amputation from dysvascular conditions designated MFCL level K2 benefited from using an MPK + appropriate foot. The inference and evidence from this longitudinal clinical trial will add to the knowledgebase related to reimbursement policy-making.Trial registration This study is registered on clinical trials.gov with the study title “Functional outcomes in dysvascular transfemoral amputees” and the associated ClinicalTrials.gov Identifier: NCT01537211. The trial was retroactively registered on February 7, 2012 after the first participant was enrolled.

Body Weight, BMI, Percent Fat and Associations with Mortality and Incident Mobility Limitation in Older Men.

How different measures of adiposity are similarly or differentially related to mobility limitation and mortality is not clear. In total, 5849 community-dwelling men aged ≥65 years (mean age: 72 years) were followed mortality over 10 years and self-reported mobility limitations (any difficulty walking 2–3 blocks or with climbing 10 steps) at six contacts over 14 years. Baseline measures of adiposity included weight, BMI and percent fat by DXA. Appendicular lean mass (ALM, by DXA) was analyzed as ALM/ht2. Proportional hazards models estimated the risk of mortality, and repeated measures generalized estimating equations estimated the likelihood of mobility limitation. Over 10 years, 27.9% of men died; over 14 years, 48.0% of men reported at least one mobility limitation. We observed U-shaped relationships between weight, BMI, percent fat and ALM/ht2 with mortality. There was a clear log-linear relationship between weight, BMI and percent fat with incident mobility limitation, with higher values associated with a greater likelihood of mobility limitation. In contrast, there was a U-shaped relationship between ALM/ht2 and incident mobility limitation. These observational data suggest that no single measure of adiposity or body composition reflects both the lowest risk of mortality and the lowest likelihood for developing mobility limitation in older men.

Effect of Functional Electrical Stimulation Cycling Exercise on Lower Limb Strength Asymmetry in Persons With Multiple Sclerosis.

Lower limb strength asymmetry (ie, significant difference between contralateral limbs) has been associated with mobility impairment in persons with multiple sclerosis (MS). However, whether an adaptive exercise modality can be used to modify lower limb strength and potentially improve mobility is unclear. The effect of functional electrical stimulation (FES) cycling on lower limb strength asymmetry in persons with MS with mobility impairment was assessed, and the association between change in lower limb strength asymmetries and changes in functional and self-reported mobility outcomes was explored. Eight adults with MS (Expanded Disability Status Scale scores, 5.5-6.5) were included. Outcomes included knee extensor and knee flexor strength asymmetry, Timed 25-Foot Walk (T25FW) test, 2-Minute Walk Test (2MWT), Timed Up and Go (TUG) test, and 12-item Multiple Sclerosis Walking Scale (MSWS-12). Participants received 24 weeks (3 times per week) of FES cycling or passive leg cycling. The FES condition demonstrated a small decrease in knee extensor (d = -0.33) and knee flexor (d = -0.23) strength asymmetry compared with passive leg cycling. With both groups combined, weak-to-strong associations were observed between change in knee extensor asymmetry and change in T25FW test time (rs = -0.43), 2MWT time (rs = -0.24), TUG test time (rs = 0.55), and MSWS-12 score (rs = 0.43). Moderate correlations were observed between change in knee flexor asymmetry and change in T25FW test time (rs = -0.31), TUG test time (rs = 0.33), and MSWS-12 score (rs = 0.35). FES cycling may be an efficacious exercise modality for reducing lower limb strength asymmetry and improving mobility in persons with MS.

Opioid Use Predicts Self-Reported Mobility in Older Adults with Chronic Lower Back Pain

Chronic low back pain (cLBP) prevalence increases with advancing age and is a leading contributor to mobility disability among older adults. Opioids are commonly prescribed treatments to reduce pain related symptoms. The rise in opioid use and misuse can enhance a variety of issues in the adult population; such as, lack of mobility and decrease in overall health and wellbeing. Few studies have examined the impact of opioid use on mobility in older adults with cLBP. Therefore, we sought to examine the relationship between self-reported opioid use and self-reported mobility. cLBP participants (n = 140) completed a series of questionnaires regarding pain intensity, interference, and disability including demographics, clinical pain assessment, and the Brief Pain Inventory-Short form. Pearson's chi-square tests, and regression-based analyses were conducted using SPSS version 26.0. Among cLBP participants, those who self-reported opioid use were more likely to have greater self-reported difficulty climbing stairs (χ2 = 16.6, p

A pilot study of aquatic prehabilitation in adults with knee osteoarthritis undergoing total knee arthroplasty \u2013 short term outcome

BackgroundKnee osteoarthritis (KOA) is increasingly more prevalent and significant number of patients require knee arthroplasty. Although knee arthroplasty is generally successful, it takes months to recover physical function. Preoperative physical function is known to predict postoperative outcomes and exercise can improve preoperative physical function. However, patients with KOA have difficulty exercise on land due to pain and stiffness, while water exercise can be better tolerated. We hypothesized that preoperative water exercise to improve preoperative physical function will improve postoperative outcomes after total knee arthroplasty (TKA).MethodsWe enrolled 43 participants who were scheduled for elective TKA in 4–8 weeks and scored at or below 50th percentile in mobility assessment tool-sf (MAT-sf). All enrolled participants were assessed on 1) clinical osteoarthritis symptom severity using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), 2) physical function using Short Physical Performance Battery (SPPB), 3) self-reported mobility using Mobility Assessment Tool-short form (MAT-sf), 4) depression using Geriatric Depression Scale-short form (GDS-sf), 5) cognitive function using Montreal Cognitive Assessment (MoCA). Blood samples for high-sensitivity-C-reactive protein (hs-CRP), tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) were stored at − 80 °C then all samples were analyzed together. All the enrolled participants were randomly assigned to the aquatic exercise intervention (AEI) or usual care group. Sixty minute sessions of AEI was conducted three times a week for 4–8 weeks. Participants in both groups were evaluated within 1 week before their scheduled surgery, as well as 4 weeks after the surgery.ResultsThe mean age was 67.1 (±6.2), 44% were female, 74% were White. There is no statistically significant difference in combined outcome of any complication, unscheduled ER visit, and disposition to nursing home or rehab facility by AEI. However, AEI was associated with more favorable outcomes: WOMAC scores (p < 0.01), chair-stand (p = 0.019), MAT-sf as well as improved depression (p = 0.043) and cognition (p = 0.008).Conclusion4–8 weeks of aquatic exercise intervention resulted in improved functional outcomes as well as improved depression and cognition in elderly patients undergoing TKA. A larger study is warranted to explore the role of water exercise in clinical and functional outcomes of TKA.

Secular trends in functional abilities, health and psychological well-being among community-dwelling 75- to 95-year-old cohorts over three decades in Helsinki, Finland.

Background: Life expectancy has increased markedly in the past decades. Thus, it is of great importance to understand how people are ageing and if the trajectories of health and disability are changing over time. This study aimed to examine trends in functional abilities and health in independent cohorts of people aged 75–95 over three decades. Methods: This Helsinki Ageing Study consists of repeated cross-sectional postal surveys examining independent cohorts of old people (75, 80, 85 and 90+ years old). This study combined data from four waves (1989, 1999, 2009 and 2019). Results: In the most recent wave, there was an increase in the portion of participants who were able to walk outdoors easily (75-year-olds p=0.03, 80-year-olds p=0.002, 85-year-olds p<0.001; p for linearity for the study year effect, all adjusted for sex). Fewer people in the youngest age group (75-year-olds) needed daily help from another person in 2019 compared to the earlier waves (p=0.02 for linearity for the study year). Over the past three decades, the proportions of self-reported good mobility have risen 8.7% (95% confidence interval (CI) 2.3–15.1) in 75-year-olds, 11.7% (95% CI 3.9–19.6) in 80-year-olds and 20.1% (95% CI 10.7–29.4) in 85-year-olds, after adjusting for sex. Furthermore, in 2019, more people rated their health as good and scored better in psychological well-being than in the previous waves among 75-, 80- and 85-year-olds. However, no improvements were found among 90+-year-olds in any of these variables. Conclusions: People between 75 and 85 years old are presently feeling and functioning better than their predecessors. This may be an important objective for both economics and health policy.

Development of a physical mobility prediction model to guide prosthetic rehabilitation.

Prosthetic rehabilitation decisions depend on estimating a patient's mobility potential. However, no validated prediction models of mobility outcomes exist for people with lower-limb amputation (LLA). To develop and test predictions for self-reported mobility after LLA, using the Prosthetic Limb Users Survey of Mobility (PLUS-M). This is a retrospective cohort analysis. Eight hundred thirty-one patient records (1,860 PLUS-M observations) were used to develop and test a neighbors-based prediction model, using previous patient data to predict the 6-month PLUS-M T-score trajectory for a new patient (based on matching characteristics). The prediction model was developed in a training data set (n = 552 patients) and tested in an out-of-sample data set of 279 patients with later visit dates. Prediction performance was assessed using bias, coverage, and precision. Prediction calibration was also assessed. The average prediction bias for the model was 0.01 SDs, average coverage was 0.498 (ideal proportion within the 50% prediction interval = 0.5), and prediction interval was 8.4 PLUS-M T-score points (40% improvement over population-level estimates). Predictions were well calibrated, with the median predicted scores falling within the standard error of the median of observed scores, across all deciles of the data. This neighbors-based prediction approach allows for accurate estimates of PLUS-M T-score trajectories for people with LLA.

Elevated IL-6 and CRP Levels Are Associated With Incident Self-Reported Major Mobility Disability: A Pooled Analysis of Older Adults With Slow Gait Speed.

Elevated interleukine-6 (IL-6) and C-reactive protein (CRP) are associated with aging-related reductions in physical function, but little is known about their independent and combined relationships with major mobility disability (MMD), defined as the self-reported inability to walk a quarter mile. We estimated the absolute and relative effect of elevated baseline IL-6, CRP, and their combination on self-reported MMD risk among older adults (≥68 years; 59% female) with slow gait speed (<1.0 m/s). Participants were MMD-free at baseline. IL-6 and CRP were assessed using a central laboratory. The study combined a cohort of community-dwelling high-functioning older adults (Health ABC) with 2 trials of low-functioning adults at risk of MMD (LIFE-P, LIFE). Analyses utilized Poisson regression for absolute MMD incidence and proportional hazards models for relative risk. We found higher MMD risk per unit increase in log IL-6 (hazard ratio [HR] = 1.26; 95% confidence interval [95% CI] 1.13-1.41). IL-6 meeting predetermined threshold considered to be high (>2.5 pg/mL) was similarly associated with higher risk of MMD (HR = 1.31; 95% CI 1.12-1.54). Elevated CRP (CRP >3.0 mg/L) was also associated with increased MMD risk (HR = 1.38; 95% CI 1.10-1.74). The CRP effect was more pronounced among participants with elevated IL-6 (HR = 1.62; 95% CI 1.12-2.33) compared to lower IL-6 levels (HR = 1.19; 95% CI 0.85-1.66). High baseline IL-6 and CRP were associated with an increased risk of MMD among older adults with slow gait speed. A combined biomarker model suggests CRP was associated with MMD when IL-6 was elevated.