Tinetti Falls Efficacy Scale Research Articles

Examination of the Relationship Between Sensory Processing Skills, Kinesiophobia and Fear of Falling in Older Adults with Hypertension and Normotension

ABSTRACT Objectives The aim of the study was to investigate fear of falling, kinesiophobia, and sensory processing in older adults with hypertension and normotension. Methods Older adults, 62 with hypertension and 62 with normotension, aged 65–84 years were included in the study. The assessment of fear of falling was conducted using the Tinetti Falls Efficacy Scale, kinesiophobia was evaluated with the Tampa Kinesiophobia Scale, and sensory processing skills were analyzed with the Adolescent/Adult Sensory Profile. Results Significant differences were found between the groups in terms of vestibular processing, visual processing and activity level, fear of falling and kinesiophobia (p < .05). No significant differences were found between the groups with respect to taste/smell, tactile, and auditory processing skills. The findings revealed that older adults with hypertension exhibited diminished vestibular and visual processing abilities, reduced activity levels, and heightened concerns about falling and a tendency to experience kinesiophobia. Fear of falling and kinesiophobia were found to increase with decreasing vestibular processing skills and activity levels in both groups (p < .05). Regression analysis revealed that age, kinesiophobia, vestibular processing, and activity levels were significant determinants of fear of falling (p < .05). Conclusion It is recommended that older adults with hypertension be assessed in terms of sensory, functional, and mental health, with the objective of planning appropriate intervention approaches.

Investigation of physical activity, fear of falling, and functionality in individuals with lower extremity lymphedema.

To investigate the fear of falling, physical activity, and functionality in patients with lymphedema in the lower extremities. Sixty-two patients who developed stage 2-3 lymphedema in the lower extremities due to primary or secondary causes (age: 56.03 ± 7.83 years) and 59 healthy controls (age: 54.61 ± 5.43 years) were included in the study. The sociodemographic and clinical characteristics of all individuals included in the study were recorded. In both groups, fear of falling was evaluated with the Tinetti Falls Efficacy Scale (TFES), lower extremity functionality with the Lower Extremity Functional Scale (LEFS), and physical activity with the International Physical Activity Questionnaire-Short Form (IPAQ-SF). There was no statistically significant difference between the demographic characteristics of the groups (p > 0.05). The primary and secondary lymphedema groups had similar LEFS (p = 0.207, d = 0.16), IPAQ (p = 0.782, d = 0.04), and TFES (p = 0.318, d = 0.92) scores. However, the TFES score of the lymphedema group was significantly higher than that of the control group (p < 0.01, d = 0.52), while the LEFS (p < 0.01, d = 0.77) and IPAQ scores (p = 0.001, d = 0.30) were significantly higher in the latter. There was a negative correlation between LEFS and TFES (r = -0.714, p < 0.001) and between TFES and IPAQ (r = -0.492, p < 0.001). LEFS and IPAQ were positively correlated (r = 0.619, p < 0.001). It was determined that individuals with lymphedema developed a fear of falling, and their functionality was negatively affected. This negative effect on functionality can be attributed to reduced physical activity and an increased fear of falling.

The effect of body awareness on trunk control, affected upper extremity function, balance, fear of falling, functional level, and level of independence in patients with stroke

ABSTRACT Objectives This study was conducted to examine the effects of body awareness on trunk control, affected upper extremity function, balance, fear of falling, functional level, and level of independence in patients with stroke. Methods 35 individuals between the ages of 21 and 78 who were diagnosed with stroke were included in the study. The body awareness of the individuals participating in the study was determined with the Body Awareness Questionnaire (BAQ), trunk control with Trunk Impairment Scale (TIS), the affected upper extremity functions with Motor Activity Log-28 (MAL,-28), and Fugl-Meyer Upper Extremity Assessment (FMUEA), balance with Berg Balance Scale (BBS), fear of falling with Tinetti Falls Efficacy Scale (TFES), functional level with Barthel Activities of Daily Living Index (BI) and level of independence with Functional Independence Measures (FIM). Results For patients participating in the study, 26% were female, 74% were male and 43% showed left, 57% showed right hemisphere involvement. In simple linear regression analysis, BAQ measurement had a statistically significant effect on TIS (F = 25.439 p = 0.001), MAL-28 (F = 7.852 p = 0.008), FMUEA (F = 12.155 p = 0.001), BBS (F = 13.506 p = 0.001), TFES (F = 13.119 p = 0.001), BI (F = 19.977 p = 0.001) and FIM (F = 22.014 p = 0.001) in patients with stroke. Conclusions In conclusion, body awareness was found to be one of the factors affecting trunk control, affected upper extremity function, balance, fear of falling, functional level, and level of independence in patients with stroke. It was thought that there was a need for assessment of body awareness and include bodyawareness in rehabilitation programs in patients with stroke.

THE EFFECT OF FEAR OF FALLING OF OLDER STROKE SURVIVORS ON THEIR SELF-EFFICACY AND QUALITY OF LIFE: A CROSS-SECTIONAL STUDY

Introduction: The study was conducted to examine the effect of fear of falling on self-efficacy and quality of life in older stroke survivors. Methods: A descriptive cross-sectional study design was used. One hundred and twenty-one older adults who had had a stroke and admitted to hospital between March and December 2021 were included. Data were collected using the Sociodemographic Characteristics Form, Stroke Specific Quality of Life Scale, Tinetti Falls Efficacy Scale, Stroke Self-Efficacy Questionnaire, Barthel Activities of Daily Living Index, and Standardized Mini Mental Test. Descriptive statistics, numbers, percentages, means, Pearson correlation analysis, and simple linear regression analysis were used. Results: The mean age of participants was 74.19±6.66 years, Tinetti Falls Efficacy score was 47.67±17.38, Stroke Self Efficacy Questionnaire score was 22.49±7.64, and Stroke Specific Quality of Life Scale score was 3.13 ± 0.68. A statistically significant negative correlation was found between fear of falling and self-efficacy (r:-0.849; p &lt; 0.001) and fear of falling and quality of life (r:-0.846; p &lt; 0.001). The simple linear regression analysis indicates that Tinetti Falls Efficacy Scale had a statistically significant effect on Stroke Self Efficacy Questionnaire (p &lt; 0.001). Tinetti Falls Efficacy Scale had a significant effect on Stroke Specific Quality of Life Scale (p &lt; 0.001). Conclusion: Fear of falling in older stroke survivors significantly affects their self-efficacy and quality of life. It is recommended that fear of falling should be evaluated in detail and comprehensively in older stroke survivors. Keywords: Aged; Fear; Self Efficacy; Stroke; Quality of Life.

Self-reported symptom causes of mobility difficulty contributing to fear of falling in older adults.

Self-reported symptom causes of mobility difficulty that contribute to fear of falling (FOF) in older adults has not been fully explored as an area for intervention. Identify the prevalence of self-reported symptoms causing mobility difficulties and to examine the difference in FOF by symptom category. Conduct a secondary data analysis of a population-based cohort of community-dwelling older adults, ≥ 70years, enrolled in the MOBILIZE Boston study. The analysis included 242 older adults reported difficulty walking ¼ mile (0.4km) and/or climbing one flight of stairs. Participants identified the main symptom cause of the mobility difficulty from a list of 32 symptoms, grouped into five categories. FOF was measured using the Tinetti Falls Efficacy Scale. Pain was the primary symptom causing mobility difficulty (38%), followed by endurance (21%), weakness (13%), balance (9%), and other (3%). Although a greater proportion of participants who identified balance as the primary symptom category had significantly higher FOF compared to others, there was a greater number overall who reported pain as their main symptom who also had FOF. Therefore,pain contributed to a higher relative burden of FOF in the population than did balance symptoms. Various symptoms affect mobility and are associated with FOF, a known fall risk factor. Many older adults identify pain as the main cause of their mobility difficulty and report FOF. Improving pain symptoms for older adults may improve mobility and reduce fear of falling, potentially averting further decline in mobility and independence.

Changes in Gait Self-Efficacy, Fear of Falls, and Gait Four and Eight Months after Bariatric Surgery.

After bariatric surgery, individuals improve walking characteristics related to fall risk. However, little is known about psychosocial factors, such as gait self-efficacy and fear of falling, after surgery. Our objectives were to (1) examine how weight loss affects psychosocial factors and gait four and eight months after bariatric surgery, as well as (2) determine if there is a relationship between gait self-efficacy and fear of falling. Fourteen adults scheduled to undergo bariatric surgery completed three visits: before surgery, four and eight months after surgery. Gait self-efficacy was measured with the Modified Gait Efficacy Scale, and fear of falls was measured with the Tinetti Falls Efficacy Scale. Gait measures were collected during five conditions: initial baseline and final baseline on flat ground, and crossing obstacles of three heights. Gait self-efficacy or fear of falling did not change after surgery. However, both four and eight months after surgery, higher gait self-efficacy and lower fear of falling were correlated with longer and faster steps during all conditions (all ps < 0.05). Focusing interventions on psychosocial measures related to gait may yield longer lasting improvements in walking after surgery, ultimately resulting in a decreased fall risk and higher quality of life.

Yaşlı bireylerde tek-görev, çift-görev ve ardışık fiziksel-bilişsel eğitimin düşme riski ve denge performansı üzerine etkileri: randomize çalışma

Purpose: This study aimed to examine the effects of single-task, dual-task and successive physical-cognitive training on fall risk, balance, and gait performances in elderly.Methods: A total of 45 healthy older adults (73.0±4.6 years; 6 male and 39 female) underwent one of three interventions 3 times a week for 4 weeks. Group-1 performed single-task balance and gait exercises. Group-2 performed cognitive activity, balance, and gait exercises simultaneously. Group-3 performed successive cognitive activities and balance and gait exercises. Gait speed under single-task and dual-task conditions, Berg Balance Scale, Timed up and Go test, and Tinetti's Falls Efficacy Scale scores were evaluated before and after 4 weeks of interventions.Results: Gait speed under single-task condition, Timed up and Go Test, and Berg Balance Scale scores were improved in all groups (p&amp;lt;0.05). Gait speed under dual-task condition was improved in Groups-2 and 3 (p&amp;lt;0.05). Group-3 had greater improvement in Berg Balance Scale and Timed up and Go test scores than Group-2. Tinetti's Falls Efficacy Scale was improved in Group-1 and 3 after training while the improvement was greater in Group-3 (p=0.001).Conclusion: The present study suggests that an intervention involving cognitive and physical activities results in greater improvement in gait speed than interventions involving physical activities alone. However, successive physical-cognitive training may be more effective in reducing fear of fall and improving balance skills in elderly.

Evde ve Huzurevlerinde Yaşayan Yaşlılar Arasında Düşme Korkusu, Düşme Riski, Düşme Davranışı ve Bakım Bağımlılığı Açısından Farklılıklar: Karşılaştırmalı-Tanımlayıcı Araştırma

Aim: The aim of the study is to determine the fear of falling, the risk of falling, the behaviour of falling and the dependence on care in older people living in nursing homes and homes and to evaluate the relationship between them.&#x0D; Material and Method: The study was a comparative-descriptive design. It was conducted in Nursing Home (64) and Family Health Center (64) with 128 elderly individuals. In the study, Tinetti Falls Efficacy Scale, The In-Home Safety Conditions Assessment Form for Falls, The Falls Behavioral Scale for Older People, The Care Dependency Scale were used. The data was collected by the researcher using the face-to-face interview technique and observation method by making home and nursing home visits.&#x0D; Results: The Tinetti Fall Activity Scale scores of the elderly living in the home were higher than the scale scores of the elderly living in the nursing home but the difference between them was not significant (p&gt;0.05). The total falls risk scores and the falling behaviour scale scores of the older people living in the home were higher than the total falls risk scores of the older people living in the nursing home (p

The Effect of 2 Different Dual-Task Balance Training Methods on Balance and Gait in Older Adults: A Randomized Controlled Trial.

The purpose of this study was to compare the effects of integrated and consecutive cognitive dual-task balance training in older adults on balance, fear of falling, and gait performance. Fifty-eight participants (age >65years) were randomly assigned to an integrated dual-task training group (IDTT) (n = 29) and consecutive dual-task training group (CDTT) (n = 29). Balance exercises and cognitive tasks were performed simultaneously by the IDTT group and consecutively by the CDTT group for 8weeks. Balance was assessed using the Berg Balance Scale as a primary outcome measure and the Timed "Up & Go" Test (TUG) (standard-cognitive), fear of falling was assessed using the Tinetti Falls Efficacy Scale, and gait speed was assessed using the 10-Meter Walk Test (10MWT) (under single-task and dual-task conditions). All tests were performed before and after the training. There was no difference in group-time interaction in the Berg Balance Scale, TUG-standard, 10MWT-single task, and 10MWT-dual task tests. Group-time interaction was different in the TUG-cognitive and Tinetti Falls Efficacy Scale scores. Also, the effect of time was significantly different in all scales except for the 10MWT-single task in both groups. At the end of the 8-week training period, the impact of integrated and consecutive dual-task balance training on balance and gait performance in older adults was not statistically significantly different. This study suggests that consecutive dual-task balance training can be used as an alternative method to increase balance performance and gait speed in older adults who cannot perform integrated dual-task activities. There were no significant differences between the effects of the 2 dual-task training methods on balance and gait speed, suggesting that the consecutive dual-task balance training method can be used to improve the balance and gait of older adults. CDTT can be performed safely and considered as an alternative method for use in many rehabilitation training programs with older adults who cannot perform simultaneous activities.

Symptoms Contributing to Mobility Limitations and Fear of Falls in Older Adults.

Mobility limitations in older adults are associated with negative outcomes including fear of falls (FOF) and poorer quality of life. However, self-reported symptoms contributing to mobility difficulty have not been fully explored as an area for intervention. The study aimed to identify the prevalence of self-reported symptom causes of difficulty walking and stair-climbing. In addition, we examined associations between symptoms and FOF in a population-based cohort of community-dwelling older adults in the MOBILIZE Boston Study. Of the 243 older adults who reported difficulty with walking one quarter of a mile or climbing stairs, 67% were women, 72% were white, average age=79.4y (SD=5.7). FOF was measured with the Tinetti Falls Efficacy Scale. Pain was most commonly reported as the primary symptom responsible for mobility difficulty (38.4%) followed by endurance (21.1%), multiple symptoms (15.6%), weakness (13.2%), balance (8.7%), other symptoms (2.9%). Factorial ANCOVA determined gender differences in associations between symptoms and FOF, adjusting for age. In pairwise comparisons, women who identified balance as their primary symptom had higher FOF than women identifying endurance (p=.017), pain (p=.015), other (p=.017), or multiple (p=.050) symptoms. There were no FOF differences for women identifying balance compared to weakness as the primary issue (p=.395). Men who identified balance as their primary symptom had higher FOF than those who identified pain (p=.036); no other FOF differences were noted in men identifying balance compared to other symptoms. Understanding common symptoms experienced by older adults, and symptoms associated with greatest FOF, will assist in developing tailored interventions for mobility improvement.

Investigation of the relationship between physical activity, kinesiophobia and fear of falling in older adults with chronic pain

Aims This study aims to investigate the relationship between physical activity, fear of movement and fear of falling in older adults with chronic pain. Materials and methods The study includes 163 older adults aged 65 years and over, who live in a private nursing home. The cognitive functions of the individuals who participated in the study were evaluated with the mini-mental examination scale (MMES), fears of movement with the Tampa Scale of Kinesiophobia (TSK), fear-avoidance behaviour with the Fear-avoidance Beliefs Questionnaire (FABQ), physical activity levels with the Physical Activity Scale for Older (PASE), and the fears of falling were assessed with Tinetti’s Falls Efficacy Scale (FES). Results In the correlation analysis, there was a weak correlation between age and fall risk (r = 0.349, p < 0.001), and PASETotal score (r = –0.020, p = 0.011). There was a weak positive correlation between Tinetti FES and FABQ scores (r = 0.349, p < 0.001), and kinesiophobia value (r = 0.259, p < 0.001), there was a weak negative correlation between Tinetti FES and PASETotal (r = –0.241, p = 0.002). A positive mid correlation was determined between kinesiophobia and the FABQ scores (r = 0.41, p < 0.001). The established regression model was found to be significant (F = 12.175; p < 0.001). Among the independent variables included in the model, FABQTotal (t = 3.589; p < 0.0001) and PASETotal (t = –3.325; p < 0.0001) significantly affected the fear of falling. Conclusion The presence of chronic pain in older adults who have problems related to physical activity, fear of falling, and kinesiophobia due to advancing age may affect social participation, functional level, and quality of life significantly. Therefore, pain should be addressed in older adults and should be considered as an important issue in rehabilitation programs.

Screening tools to expedite assessment of frailty in people receiving haemodialysis: a diagnostic accuracy study

BackgroundFrailty is associated with multiple adverse outcomes in stage-5 chronic kidney disease (CKD-5) and upwards of one third of people receiving haemodialysis (HD) are frail. While many frailty screening methods are available in both uremic and non-uremic populations, their implementation in clinical settings is often challenged by time and resource constraints. In this study, we explored the diagnostic accuracy of time-efficient screening tools in people receiving HD.MethodsA convenience sample of 76 people receiving HD [mean age = 61.1 years (SD = 14), 53.9% male] from three Renal Units were recruited for this cross-sectional study. Frailty was diagnosed by means of the Fried phenotype. Physical performance-based screening tools encompassed handgrip strength, 15-ft gait speed, timed up and go (TUG), and five-repetition sit to stand (STS-5) tests. In addition, participants completed the SF-36 Health Survey, the short-form international physical activity questionnaire and the Tinetti falls efficacy scale (FES) as further frailty-related measures. Outcome measures included the area under the curve (AUC), sensitivity, specificity, positive (PPV) and negative predictive values (NPV). The diagnostic performance of screening tools in assessing fall-risk was also investigated.ResultsOverall, 36.8% of participants were classified as frail. All the examined instruments could significantly discriminate frailty status in the study population. Gait speed [AUC = 0.89 (95%CI: 0.81–0.98), sensitivity = 75%, specificity = 93%] and TUG [AUC = 0.90 (95%CI: 0.80–0.99), sensitivity = 89%, specificity = 85%] exhibited the highest diagnostic accuracy. There was a significant difference in gait speed AUC (20%, p = 0.013) between participants aged 65 years or older (n = 36) and those under 65 years of age (n = 40), with better discriminating performance in the younger sub-group. The Tinetti FES was the only instrument showing good diagnostic accuracy (AUCs≥0.80) for both frailty (sensitivity = 82%, specificity = 79%) and fall-risk (sensitivity = 82%, specificity = 71%) screening.ConclusionsThis cross-sectional study revealed that time- and cost-efficient walking performance measures can accurately be used for frailty-screening purposes in people receiving HD. While self-selected gait speed had an excellent performance in people under 65 years of age, TUG may be a more suitable screening method for elderly patients (≥65 years). The Tinetti FES may be a clinically useful test when physical testing is not achievable.

Exercise programme to improve quality of life for patients with end-stage kidney disease receiving haemodialysis: the PEDAL RCT.

Whether or not clinically implementable exercise interventions in haemodialysis patients improve quality of life remains unknown. The PEDAL (PrEscription of intraDialytic exercise to improve quAlity of Life in patients with chronic kidney disease) trial evaluated the clinical effectiveness and cost-effectiveness of a 6-month intradialytic exercise programme on quality of life compared with usual care for haemodialysis patients. We conducted a prospective, multicentre randomised controlled trial of haemodialysis patients from five haemodialysis centres in the UK and randomly assigned them (1 : 1) using a web-based system to (1) intradialytic exercise training plus usual-care maintenance haemodialysis or (2) usual-care maintenance haemodialysis. The setting was five dialysis units across the UK from 2015 to 2019. The participants were adult patients with end-stage kidney disease who had been receiving haemodialysis therapy for > 1 year. Participants were randomised to receive usual-care maintenance haemodialysis or usual-care maintenance haemodialysis plus intradialytic exercise training. The primary outcome of the study was change in Kidney Disease Quality of Life Short Form, version 1.3, physical component summary score (from baseline to 6 months). Cost-effectiveness was determined using health economic analysis and the EuroQol-5 Dimensions, five-level version. Additional secondary outcomes included quality of life (Kidney Disease Quality of Life Short Form, version 1.3, generic multi-item and burden of kidney disease scales), functional capacity (sit-to-stand 60 and 10-metre Timed Up and Go tests), physiological measures (peak oxygen uptake and arterial stiffness), habitual physical activity levels (measured by the International Physical Activity Questionnaire and Duke Activity Status Index), fear of falling (measured by the Tinetti Falls Efficacy Scale), anthropometric measures (body mass index and waist circumference), clinical measures (including medication use, resting blood pressure, routine biochemistry, hospitalisations) and harms associated with intervention. A nested qualitative study was conducted. We randomised 379 participants; 335 patients completed baseline assessments and 243 patients (intervention, n = 127; control, n = 116) completed 6-month assessments. The mean difference in change in physical component summary score from baseline to 6 months between the intervention group and control group was 2.4 arbitrary units (95% confidence interval -0.1 to 4.8 arbitrary units; p = 0.055). Participants in the intervention group had poor compliance (49%) and very poor adherence (18%) to the exercise prescription. The cost of delivering the intervention ranged from £463 to £848 per participant per year. The number of participants with harms was similar in the intervention (n = 69) and control (n = 56) groups. Participants could not be blinded to the intervention; however, outcome assessors were blinded to group allocation. On trial completion the primary outcome (Kidney Disease Quality of Life Short Form, version 1.3, physical component summary score) was not statistically improved compared with usual care. The findings suggest that implementation of an intradialytic cycling programme is not an effective intervention to enhance health-related quality of life, as delivered to this cohort of deconditioned patients receiving haemodialysis. The benefits of longer interventions, including progressive resistance training, should be confirmed even if extradialytic delivery is required. Future studies also need to evaluate whether or not there are subgroups of patients who may benefit from this type of intervention, and whether or not there is scope to optimise the exercise intervention to improve compliance and clinical effectiveness. Current Controlled Trials ISRCTN83508514. This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 40. See the NIHR Journals Library website for further project information.

Omuz Ağrısı Olan İnme Hastalarında Hareket Korkusu, Denge ve Düşme Korkusu Arasındaki İlişki

Objective: Shoulder pain is a common problem after stroke and causes functional limitations in patients. Pain leads to keep away from the movement and physical activities. The aim of this study was to evaluate the fear of movement in stroke patients with shoulder pain and to investigate its relationship with balance and fear of falling. Material and Methods: Forty six stroke patients were included in the study and divided into two groups, with and without shoulder pain. Fear of movement was evaluated by the Tampa Scale for Kinesiophobia, functional balance was by the Berg Balance Scale and fear of falling was by the Tinetti's Falls Efficacy Scale. Results: The mean age of patients with and without pain were 65.60±11.37 years and 60.56±14.18 years respectively. In the shoulder painful group, it was determined that there was a negative correlation between balance and the fear of movement (r=-0.417; p=0.048) and that there was a positive correlation between the fear of falling and the fear of movement (r=0.429; p=0.041). In the shoulder painless group, there was no significant correlation (p>0.05). There was a statistically significant difference between the kinesiophobia values of two groups (p˂0.05). Conclusion: When balance problems and falls observed in stroke patients are combined with pain and fear of movement, it becomes important to take into account and evaluate the fear of movement in rehabilitation practices.

Disability Prevention Program Improves Life-Space and Falls Efficacy: A Randomized Controlled Trial

Life-space and falls efficacy are essential to physical independence and consistently predict disabilities. However, it remains unknown whether the CAPABLE, a disability prevention program, improves life-space and falls efficacy in older adults. We evaluated the effects of a home-based disability prevention program on life-space (N=194) and falls efficacy (N=233) among low-income older adults with restricted daily activities. The CAPABLE intervention consists of up to 6 one-hour home visits with an Occupational Therapist (OT), up to 4 one-hour home visits with a Register Nurse (RN), and up to $1300 worth of home repairs, modifications, and assistive devices with a handyman, during four months. Life-space and falls efficacy were measured by the Telephone Assessment of Mobility for homebound older adults and the Tinetti Falls Efficacy Scale at baseline and five months, respectively. Multinomial logistic regression and generalized linear models were used for data analyses. Participants in both samples were, on average, 75 years, predominantly black (86%) and female (85%-86%). Compared to participants in the control group, participants receiving the intervention were more likely to have improved (Odds Ratio [OR]: 2.10, 95% CI: 1.06-4.20) or unchanged overall life-space (OR: 2.62, 95% CI: 1.10-6.27) vs. decreased overall life-space. Participants who received the intervention also had significantly higher falls efficacy in performing daily activities (exponentiated coefficient: 1.11, 95% CI: 1.04-1.19). Life-space and falls efficacy can be significantly improved by CAPABLE program. These findings provide more evidence for the reasons for the increased physical independence.

Evaluation of Race as a Predictor of Fear of Falling in Black Older Adults

Fear of falling (FOF) is a common issue and health concern reported by adults 65 years of age and older.There is mixed evidence about potential disparity in fall incident rates due to race and FOF, and it is unclear if and under what circumstance falls rates and risks differ by racial ethnicity. The purpose of this study is to determine if race predicts fear of falling in older adults at greater risk for falls; and to examine the relationship between activities of daily living (ADL) and mobility performance measures with FOF. A cross-sectional observational study was used to examine predictors of FOF among community dwelling-older adults using data from two longitudinal randomized clinical trials (RCT). Participants (N=259) had a mean age of 75.7 ±7.4, 78.8% female, 80.64% Black, and 77.03% White or Other, with ≥ 1 fall in the last 12 months. Subjects completed a demographic profile; the Tinetti and Short Falls Efficacy Scale to assess FOF; and activities of daily living (ADL) and mobility performance scales to assess function. The chi square analysis revealed Black older adults were two times more likely to report FOF (OR = 2.17, 95% CI = 1.14, 4.15; p=.05) in comparison to White older adults. The regression analysis demonstrated that race is a significant factor to predict FOF (OR = .67, 95% CI = 1.21, 3.24; p=.05); and the descriptive analysis revealed significantly worse ADL and mobility function scores within the high FOF group.

Disability Prevention Program Improves Life-Space and Falls Efficacy: A Randomized Controlled Trial.

To evaluate the effects of a home-based disability prevention program on life-space and falls efficacy among low-income older adults. Single-blind two-arm randomized controlled trial. Participants' homes. Participants were low-income cognitively intact older adults (≥65 years old) with restricted daily activities. Our analytic sample for life-space (n = 194) and falls efficacy (n = 233) varied as the life-space measure was introduced 4 months after the trial began. Up to six 1-hour home visits with an occupational therapist; up to four 1-hour home visits with a registered nurse; and up to $1,300 worth of home repairs, modifications, and assistive devices with a handyman, during a course of 4 months. Life-space was measured by the Homebound Mobility Assessment; falls efficacy was measured using the 10-item Tinetti Falls Efficacy Scale at baseline and 5 months. Participants were on average 75 years old, predominantly Black (86%) and female (85%-86%). Compared with participants in the control group, participants receiving the intervention were more likely to have improved versus decreased life-space in areas of bathroom (adjusted odds ratio (OR) = 3.95; 95% confidence interval (CI) = 1.20-12.97), front or back porch, patio, or deck (adjusted OR = 2.67; 95% CI = 1.05-6.79), stairs (adjusted OR = 4.09; 95% CI = 1.34-12.48), leaving the house for any reason other than for health care (adjusted OR = 2.40; 95% CI = 1.01-5.73), and overall life-space (adjusted OR = 2.15; 95% CI = 1.10-4.19). Participants who received the intervention also had an 11% improvement in falls efficacy in performing daily activities (exponentiated coefficient = 1.12; 95% CI = 1.04-1.21). Life-space and falls efficacy were improved through a multicomponent, person-directed, home-based disability prevention intervention. Findings suggest that this intervention should be translated into different settings to promote independent aging.

The PrEscription of intraDialytic exercise to improve quAlity of Life in patients with chronic kidney disease trial: study design and baseline data for a multicentre randomized controlled trial.

BackgroundExercise interventions designed to improve physical function and reduce sedentary behaviour in haemodialysis (HD) patients might improve exercise capacity, reduce fatigue and lead to improved quality of life (QOL). The PrEscription of intraDialytic exercise to improve quAlity of Life study aimed to evaluate the effectiveness of a 6-month intradialytic exercise programme on QOL and physical function, compared with usual care for patients on HD in the UK.MethodsWe conducted a prospective, pragmatic multicentre randomized controlled trial in 335 HD patients and randomly (1:1) assigned them to either (i) intradialytic exercise training plus usual care maintenance HD or (ii) usual care maintenance HD. The primary outcome of the study was the change in Kidney Disease Quality of Life Short Form (KDQOL-SF 1.3) Physical Component Score between baseline and 6 months. Additional secondary outcomes included changes in peak aerobic capacity, physical fitness, habitual physical activity levels and falls (International Physical Activity Questionnaire, Duke’s Activity Status Index and Tinetti Falls Efficacy Scale), QOL and symptom burden assessments (EQ5D), arterial stiffness (pulse wave velocity), anthropometric measures, resting blood pressure, clinical chemistry, safety and harms associated with the intervention, hospitalizations and cost-effectiveness. A nested qualitative study investigated the experience and acceptability of the intervention for both participants and members of the renal health care team.ResultsAt baseline assessment, 62.4% of the randomized cohort were male, the median age was 59.3 years and 50.4% were white. Prior cerebrovascular events and myocardial infarction were present in 8 and 12% of the cohort, respectively, 77.9% of patients had hypertension and 39.4% had diabetes. Baseline clinical characteristics and laboratory data for the randomized cohort were generally concordant with data from the UK Renal Registry.ConclusionThe results from this study will address a significant knowledge gap in the prescription of exercise interventions for patients receiving maintenance HD therapy and inform the development of intradialytic exercise programmes both nationally and internationally.Trial RegistrationISRCTN N83508514; registered on 17 December 2014.

Association of postural balance and falls in adult patients receiving haemodialysis: A prospective cohort study

BackgroundStatic postural balance performance is often impaired in people receiving haemodialysis (HD) for the treatment of stage-5 chronic kidney disease (CKD-5). However, the question as to whether lower postural balance is associated with adverse clinical outcomes such as falls has not been addressed yet. Research questionWe conducted a prospective cohort study to explore the association between static postural balance and falls in people receiving HD. We hypothesised that higher postural sway would be associated with increased odds of falling. MethodsSeventy-five prevalent CKD-5 patients receiving HD (age: 61.8 ± 13.4 years) from three Renal Units were enrolled in this prospective cohort study. At baseline, postural balance was assessed with a force platform in eyes open (EO) and eyes closed (EC) conditions. Centre of pressure (CoP) measures of range, velocity and area were taken for the analysis. Falls experienced by study participants were prospectively recorded during 12 months of follow-up. Secondary outcomes included timed-up and go, five-repetition sit-to-stand test and the Tinetti falls efficacy scale (FES). ResultsIn multivariable logistic regression analysis, higher CoP range in medial-lateral direction during EC was associated with increased odds of falling (OR: 1.04, 95 %CI: 1.00−1.07, p = 0.036). In ROC curve analysis, CoP velocity in EO exhibited the greatest prognostic accuracy (AUC: 0.69, 95 %CI: 0.55−0.82), however this was not statistically different from CoP measures of area and range. None of the postural balance measures exceeded the prognostic accuracy of the FES (AUC: 0.70, 95 %CI: 0.58−0.83, p = 0.005). SignificanceThis prospective cohort study showed that higher postural sway in medial-lateral direction was associated with increased odds of falling in people receiving HD. CoP measures of range, velocity and area displayed similar prognostic value in discriminating fallers from non-fallers. The overall utility of static posturography to detect future fall-risk may be limited in a clinical setting.

Walking to your right music: a randomized controlled trial on the novel use of treadmill plus music in Parkinson\u2019s disease

BackgroundRhythmic Auditory Stimulation (RAS) can compensate for the loss of automatic and rhythmic movements in patients with idiopathic Parkinson’s disease (PD). However, the neurophysiological mechanisms underlying the effects of RAS are still poorly understood. We aimed at identifying which mechanisms sustain gait improvement in a cohort of patients with PD who practiced RAS gait training.MethodsWe enrolled 50 patients with PD who were randomly assigned to two different modalities of treadmill gait training using GaitTrainer3 with and without RAS (non_RAS) during an 8-week training program. We measured clinical, kinematic, and electrophysiological effects of both the gait trainings.ResultsWe found a greater improvement in Functional Gait Assessment (p < 0.001), Tinetti Falls Efficacy Scale (p < 0.001), Unified Parkinson Disease Rating Scale (p = 0.001), and overall gait quality index (p < 0.001) following RAS than non_RAS training. In addition, the RAS gait training induced a stronger EEG power increase within the sensorimotor rhythms related to specific periods of the gait cycle, and a greater improvement of fronto-centroparietal/temporal electrode connectivity than the non_RAS gait training.ConclusionsThe findings of our study suggest that the usefulness of cueing strategies during gait training consists of a reshape of sensorimotor rhythms and fronto-centroparietal/temporal connectivity. Restoring the internal timing mechanisms that generate and control motor rhythmicity, thus improving gait performance, likely depends on a contribution of the cerebellum. Finally, identifying these mechanisms is crucial to create patient-tailored, RAS-based rehabilitative approaches in PD.Trial registrationNCT03434496. Registered 15 February 2018, retrospectively registered.