Showing papers in "Journal of Geriatric Physical Therapy in 2020"

Use of the BESTest and the Mini-BESTest for Fall Risk Prediction in Community-Dwelling Older Adults Between 60 and 102 Years of Age.

Abstract: Background and purpose Reference values for the Balance Evaluation Systems Test (BESTest) and the Mini-Balance Evaluation Systems Test (Mini-BESTest) need to be established to predict falls in older adults during every stage of aging. The purpose of this study was to determine the cutoff scores for the BESTest and the Mini-BESTest for community-dwelling older adults in order to predict fall risk. Methods A total of 264 older adults, of both sexes, between the ages of 60 and 102 years, were divided into 4 groups according to age range. After evaluation, participants received telephone follow-up for 6 months to record the number of fall episodes. To define the reference values of the tests in relation to fall risk prediction, a receiver operating characteristic curve was drawn to identify the area under the curve and the sensitivity and specificity of the tests. Statistical analyses were done using SPSS (Version 16.0-SPSS Inc) with a significance level of 5% (P ≤ .05). Results The cutoff scores to identify older adults with fall risk according to the BESTest and the Mini-BESTest in the different age groups were 99 and 25 points, respectively, for people 60 to 69 years of age, 92 and 23 points for the age group of 70 to 79 years, 85 and 22 points for people 80 to 89 years of age, and 74 and 17 points for people 90 years of age or older. Conclusion The BESTest and the Mini-BESTest are good tools for predicting fall risk in the 6 months following an initial evaluation in community-dwelling Brazilian older adults. The study also determined that cutoff values vary for different age groups.

Modified 30-Second Sit-to-Stand Test: Reliability and Validity in Older Adults Unable to Complete Traditional Sit-to-Stand Testing.

Abstract: Background and purpose Sit-to-stand tests measure a clinically relevant function and are widely used in older adult populations. The modified 30-second sit-to-stand test (m30STS) overcomes the floor effect of other sit-to-stand tests observed in physically challenged older adults. The purpose of this study was to examine interrater and test-retest intrarater reliability for the m30STS for older adults. In addition, convergent validity of the m30STS, as well as responsiveness to change, was examined in older adults undergoing rehabilitation. Methods In phase I, 7 older adult participants were filmed performing the m30STS. The m30STS was standardized to allow hand support during the rise to and descent from standing but required participants to let go of the armrests with each stand. Ten physical therapists and physical therapist assistants independently scored the filmed m30STS twice, with 21 days separating the scoring sessions. In phase II, 33 older adults with comorbidities admitted to physical therapy services at a skilled nursing facility were administered the m30STS, Berg Balance Scale, handheld dynamometry of knee extensors, and the modified Barthel Index at initial examination and discharge. Results In phase I, the m30STS was found to be reliable. Interrater reliability using absolute agreement was calculated as intraclass correlation coefficient (ICC)2,1 = 0.737 (P ≤ .001). Test-retest intrarater reliability using absolute agreement was calculated as ICC2,k = 0.987 (P ≤ .001). In phase II, concurrent validity was established for the m30STS for the initial (Spearman ρ = 0.737, P = .01) and discharge (Spearman ρ = 0.727, P = .01) Berg Balance Scale as well as total scores of the modified Barthel Index (initial total score Spearman ρ = 0.711, P = .01; discharge total score Spearman ρ = 0.824, P = .01). The initial m30STS predicted 31.5% of the variability in the discharge Berg Balance Scale. The m30STS did not demonstrate significant correlation with body weight-adjusted strength measures of knee extensors measured by handheld dynamometry. The minimal detectable change (MDC90) was calculated to be 0.70, meaning that an increase of 1 additional repetition in the m30STS is a change beyond error. Conclusion The m30STS is a reliable, feasible tool for use in a general geriatric population with a lower level of function. The m30STS demonstrated concurrent validity with the Berg Balance Scale and modified Barthel Index but not with knee extensor strength to body weight ratio. One repetition of the m30STS was established as the MDC90 as change beyond error.

Assessment of Gait Speed in Older Adults

Abstract: Background and purpose Gait speed is an important measure of functional ability and has been widely used in older adults as an indicator of frailty. However, the diversity in measurement protocols in clinical settings creates variability in outcome measures. The aim of this study was to systematically review the literature relating to the measurement of gait speed in older adults, to propose a protocol suitable for use in clinical and community settings. Methods A total of 5 electronic English databases were searched (PubMed, EMBASE, AMED, CINAHL, and SPORTDiscus) using key words and synonyms related to gait speed. Results Fifty relevant articles were identified, with variability being found between studies in the essential elements (timing device, walking distance, timing points, use of walking aids, pace of performance, and total tests recorded) of gait measurement. The majority of studies used unspecified timing devices while others used electronic gait mats or infrared beams linked to electronic stopwatches. Walking distance was assessed over distances between 2.4 and 15 m, with 4 m most commonly used. Most studies permitted the use of walking aids, with assessments being repeated at a usual pace, and the maximum value recorded in meters per second. Conclusion A standardized measurement protocol is proposed for measuring gait speed in older adults.

The Additive Effects of Creatine Supplementation and Exercise Training in an Aging Population: A Systematic Review of Randomized Controlled Trials.

Abstract: Background and purpose The role of creatine supplementation in young athletes and bodybuilders is well established including ergogenic properties of muscular hypertrophy, strength, power, and endurance. Whether the benefits of creatine supplementation translate to an aging population with moderate training stimulus remains unclear especially in regard to gender, creatine dose, and duration. This systematic review assessed whether creatine supplementation combined with exercise results in additive improvements in indices of skeletal muscle, bone, and mental health over exercise alone in healthy older adults. Methods PubMed, CINAHL, and Web of Science databases were utilized to identify randomized controlled trials of creatine supplementation combined with exercise in an aging population with additional predetermined inclusion and exclusion criteria. Two reviewers independently screened the titles and abstracts, reviewed full-text articles, and performed quality assessments using the Physiotherapy Evidence Database scale. Results and discussion Seventeen studies were comprehensively reviewed according to categories of strength, endurance, functional capacity, body composition, cognition, and safety. These studies suggest that any additive ergogenic creatine effects on upper and/or lower body strength, functional capacity, and lean mass in an older population would require a continuous and daily low-dose creatine supplementation combined with at least 12 weeks of resistance training. Potential creatine specific increases in regional bone mineral density of the femur are possible but may require at least 1 year of creatine supplementation combined with moderate resistance training, and additional long-term clinical trials are warranted. The limited data suggested no additive effects of creatine over exercise alone on indices of mental health. The beneficial effects of creatine supplementation are more consistent in older women than in men. Conclusions Creatine monohydrate is safe to use in older adults. While creatine in conjunction with moderate- to high-intensity exercise in an aging population may improve skeletal muscle health, additional studies are needed to determine the effective dosing and duration paradigm for potential combined creatine and exercise effects on bone and cognition in older adults.

Hip Muscle Strengthening for Knee Osteoarthritis: A Systematic Review of Literature.

Abstract: Background and purpose Osteoarthritis (OA) of the knee joint results in chronic pain and functional decline among older adults. Hip muscle weakness has been observed in persons with knee OA and is claimed to increase the medial compartment loading on the knee joint. Although individual studies are available, no review has yet integrated the literature on the benefits of hip muscle strengthening for persons with knee OA. This review aims to systematically summarize the current evidence on the effectiveness of hip muscle strengthening on knee pain, lower extremity function, and biomechanical measures of the knee in persons with knee OA. Methods An extensive electronic literature search was conducted in the databases PubMed, Scopus, Cumulative Index to Nursing and Allied Health (CINAHL), Cochrane Central Register of Controlled Trials (CENTRAL), and Physiotherapy Evidence Database (PEDro) to identify the published trials in the English language from January 1990 to August 2017. Randomized controlled trials that studied the effectiveness of hip muscle strengthening in persons with knee OA on knee pain, physical function, and biomechanical measures of the knee were considered for inclusion. The key word combinations were knee osteoarthritis, degenerative arthritis, arthralgia, muscle strengthening, and resistance training using the Boolean operators AND, OR. Two reviewers independently performed the study selection, and a third reviewer intervened when the consensus was not attained. Quality assessment of the included studies was carried out using the PEDro scale. Results and discussion The search produced 774 results, from which 81 full-text articles were studied. Five randomized controlled trials of good methodological quality, including 331 participants, were included in the review. The effectiveness of hip muscle strengthening was assessed in isolation, combination, and comparison with other lower extremity exercise. Overall, the studies reported clear benefits of hip muscle strengthening on knee pain, physical function, and hip muscle strength. However, hip muscle strengthening was ineffective in improving the biomechanical measures such as dynamic alignment and knee adduction (also known as valgus) moment. Conclusion The current review identified strong, high-quality evidence to recommend hip muscle strengthening in the conservative management of persons with knee OA. Further research is needed to establish the underlying mechanisms for the clinical benefits.

Tai Chi Combined With Resistance Training for Adults Aged 50 Years and Older: A Systematic Review.

Abstract: Background and purpose Despite Tai Chi and resistance training being recommended as suitable exercise for older adults, there are no systematic reviews synthesizing the effectiveness of a combination of Tai Chi and resistance training on health promotion of older adults. This study aimed to review the existing literature regarding the effect of Tai Chi and resistance training on physical health, mental health, pain, health-related quality of life, and age-related impairment in adults aged 50 years and older. Methods A systematic review was conducted to report the health outcomes of Tai Chi combined with resistance training research in adults aged 50 years and older. Articles were identified by searching PubMed, Scopus, Web of Science, CINAHL, MEDLINE, Physiotherapy Evidence Database (PEDro), and the Cochrane library using search terms representing "Tai Chi" and "resistance" and "older adults." Quantitative experimental studies with participants aged 50 years and older, where one of the interventions was Tai Chi and resistance training, were included. Results and discussion The literature search yielded 648 articles from which 7 met the inclusion criteria. Collectively, the studies involved 703 participants aged 50 years and older, including healthy older adults, older adults with history of falls, postmenopausal women, and people diagnosed with end-stage hip osteoarthritis. Studies included different Tai Chi forms in combination with various types of resistance training. Training sessions were 2 to 7.5 h/wk and lasted between 12 weeks and 12 months. After long-term Tai Chi and resistance training, the participants showed significant improvement in upper and lower extremity muscle strength, aerobic endurance, balance, and mobility. However, 1 study failed to show improvement in Functional Movement Screening compared with traditional Tai Chi and nonexercise groups. No study examined the effects of Tai Chi and resistance training on health-related quality of life, fear of falling, or mental health in adults aged 50 years and older. Conclusions The review supports that Tai Chi in combination with resistance training improves physical function and muscle strength in adults aged 50 years and older.

A Knowledge Translation Intervention Designed and Implemented by a Knowledge Broker Improved Documented Use of Gait Speed: A Mixed-Methods Study.

Abstract: BACKGROUND AND PURPOSE Although outcome measures are a valuable part of physical therapy practice, there is a gap in routine outcome measurement use by physical therapists (PTs). Knowledge brokers (KBs) are individuals who can collaborate with PTs to facilitate outcome measure use. The purpose of this study was to determine whether an intervention tailored by an external KB, cocreated with the PTs and supported by the supervisor, would increase the use of gait speed by PTs working at an inpatient subacute rehabilitation hospital. METHODS A mixed-methods study was conducted with 11 PTs. The 2-month intervention included education, documentation changes, audit and feedback, goal setting, and organizational support. Use of the 4-meter walk test was measured through chart audits and was self-assessed with the Goal Attainment Scale. Proportions were calculated to determine the number of times gait speed was documented by the PTs both at initial examination (IE) and at discharge. A repeated-measures analysis of variance was used to determine significant differences from baseline (3-month retrospective chart audit), 0 to 2, 2 to 4, 4 to 6, and 6 to 8 months. A Wilcoxon signed rank test was used to determine significant differences in self-reported use on the Goal Attainment Scale month 0 to month 2. Focus groups immediately following the intervention (month 2) and at follow-up (month 9) were used to determine barriers to measuring gait speed and perceptions of the intervention. Open coding was used to identify key themes. A comparison group of per diem PTs was trained by the supervisor between months 4 and 8, using the approach developed by the KB. The comparison group was included as their training may have influenced the experimental groups' outcome. Chart audit data for the comparison group from months 0 to 2, 2 to 4, 4 to 6, and 6 to 8 were reported descriptively. RESULTS AND DISCUSSION Documentation of the 4-meter walk test significantly improved from the 3-month retrospective chart audit at baseline (0% IE, 0% discharge) to months 0 to 2 at IE (mean = 71%, SD = 31 %, F = 9.30, P < .001) and discharge (mean = 66%, SD = 30%, F = 14.16, P < .001) and remained significantly higher at months 6 to 8 follow-up for IE (mean= 63%, SD 21%) and discharge (mean=59%, SD 32%). Eleven PTs participated in the focus group at month 2 and reported that the knowledge translation strategies including documentation changes, environmental cues, and social support helped facilitate their behavior change. Lack of space and the patient's activity limitations were barriers. The PTs significantly improved self-reported use of gait speed using the Goal Attainment Scale from month 0 to month 2 at IE: -2 to 0 (0% use to 50%) (Z = -2.842, P = .004) and discharge: -2 to 1 (0% use to 75%) (Z = -2.448, P = .014). The comparison group increased documented use of gait speed from 0% to 25% at IE and 47% at discharge between months 6 and 8. CONCLUSION The KB, with supervisor support, successfully collaborated with the PTs to tailor an intervention to address local barriers to consistently use the 4-meter walk test. The PTs significantly improved the documented use of gait speed following the intervention. The PTs reported that the intervention facilitated outcome measure use although barriers to using gait speed remained.

Stand Tall-A Virtual Translation of the Otago Exercise Program.

Abstract: Background and purpose The Otago Exercise Program (OEP) is effective at preventing falls and fall-related injuries. The resources and personnel required for program delivery and challenges inherent in monitoring participant adherence and compliance pose significant barriers to increasing the number of older adults participating in the OEP. Alternative delivery systems using virtual platforms may pose a solution. The purposes of this article were to (1) describe the "Stand Tall" intervention, a virtual translation of the OEP; (2) describe Stand Tall participant characteristics and fall-related risk at baseline; and (3) identify changes in physical performance measures associated with fall risk from baseline to 8-week follow-up. Methods This was a quasi-experimental, single-group, pretest-posttest design. Forty-two older adults at risk for falls were recruited. Participants were oriented to Stand Tall by study personnel and then monitored and progressed virtually with face to face check-ins. Participants independently logged in and completed a prescribed a set of exercises 3 times a week for 30 minutes for a total of 8 weeks. Results and discussion The average participant age was 75.0 (9.1) years and self-reported 2.3 (1.7) chronic conditions. There were more men than women (52.4%) in the study. Participants were primarily non-Hispanic white (90.5%), had a college education (61.9), 40% reported falling in the past 6 months, and 60% screened positive for mild cognitive impairment. Participants were beginning to show decline in function with average single-leg stance less than 10 seconds and 30-second chair rise scores below normative values. Participants demonstrated high adherence rates (>88%) and significant improvements in physical performance measures associated with fall risk. These results may be limited to a less frail population and the study was not powered to demonstrate a reduction in falls. Conclusions Results support that an avatar-delivered version of the OEP is effective, feasible, viable, and enjoyable for community-dwelling older adults. These types of platforms should be considered as potential mechanisms to increase availability of fall prevention programs.

Characteristics of Older Adults Who Are Unable to Perform a Floor Transfer: Considerations for Clinical Decision-Making.

Abstract: BACKGROUND AND PURPOSE The ability to get down to and up from the floor or to perform a floor transfer (FT) is a vital and useful skill for older adults at risk of falling. Little is known about the health-related factors that separate older adults who can perform FT independently from those who cannot. Therefore, the specific aims of this cross-sectional study are to (1) describe and compare health-related factors among older adults who were independent, assisted, or dependent in FT performance; and (2) establish the parallel reliability between self-reported and actual performance of FT. METHODS A total of 46 community-dwelling adults ages 65 to 96 years were recruited using a stratified sampling technique based on self-reported levels of FT ability: independent (n = 15), assisted (n = 15), or dependent (n = 15). Participants were asked to perform the actual FT test and were categorized according to test result as independent (n = 18), assisted (n = 10), or dependent (n = 17). Sociodemographic and health-related factors of participants were separated into the 3 FT test outcome groups. The Kruskal-Wallis test was used to compare these factors across the 3 FT test outcome groups. The quadratic-weighted κ coefficient was calculated to determine the agreement between self-reported FT ability and FT test performance. RESULTS Significant differences were observed among the FT test outcome groups based on all sociodemographic and health-related factors (P < .05). Older adults who were dependent in FT were older and dependent in instrumental activities of daily living (IADL, 100%). Also, this group required some type of help during basic activities of daily living (ADL, 35.3%), which reflected a homebound status and the need for caregiver support, including the use of 2-handed assistive devices during ambulation. More than half the participants in this category had fallen at least once in the past 6 months. Conversely, older adults who were independent in FT were younger and living independently in the community (83.3%). The parallel reliability between the self-reported FT ability and actual FT test performance was 0.92 (95% confidence interval, 0.88-0.97). CONCLUSION Sociodemographic and health-related factors were significantly different among older adults who demonstrated varying abilities on the FT test. This study has shown that the self-reported FT ability and actual FT test performance represented reliable alternative forms to assess the ability to transfer from a standing to a supine position on the floor and then back to an erect position. Evaluation of FT ability and/or performance is recommended as a standard component of geriatric functional assessment to make more informed clinical decision in providing effective physical therapy interventions.

A Comparison of the Responsiveness of the Postural Assessment Scale for Stroke and the Berg Balance Scale in Patients With Severe Balance Deficits After Stroke.

Abstract: Background and purpose Previous evidence that the Postural Assessment Scale for Stroke (PASS) and the Berg Balance Scale (BBS) have similar responsiveness is doubtful. Compared with the BBS, the PASS has more items assessing basic balance abilities (such as postural transition during lying and sitting), so it should be more likely to detect changes in patients with severe balance deficits. We aimed to compare the responsiveness of the PASS and the BBS in patients with stroke who have severe balance deficits. Methods The PASS and BBS scores of 49 patients with severe balance deficits at 14 and 30 days after stroke were retrieved. The group-level responsiveness was examined with the standardized response mean (SRM). The individual-level responsiveness was examined by the proportion of patients who achieved clinically significant improvements (ie, their pre-post change scores in the PASS/BBS exceeded the minimal detectable change with 95% confidence of each measure). The responsiveness of the 2 measures was compared using the bootstrap approach. Results and discussion The comparisons of responsiveness showed significant differences between the PASS and the BBS at both the group and individual levels. At the group level, the PASS indicated moderate changes in balance function (SRM = 0.79), but the BBS indicated only small changes (SRM = 0.39). At the individual level, the PASS showed that 42.9% of patients had clinically significant improvements, while the BBS showed that only 6.1% of patients had clinically significant improvements. Conclusions Compared with the BBS, the PASS was better able to detect balance improvements in patients having severe balance deficits. The PASS is recommended as an outcome measure to detect change in balance in patients with stroke who have severe balance deficits.

Ranking Barriers, Motivators, and Facilitators to Promote Physical Activity Participation of Persons With Dementia: An Explorative Study

Abstract: BACKGROUND AND PURPOSE Community-dwelling persons with dementia are inactive most of the day. The purpose of this study was to rank the barriers, motivators, and facilitators that hamper or promote physical activity (PA) participation for persons with dementia. This could provide knowledge that can be used to design effective interventions to promote PA participation for persons with dementia. METHODS Twenty community-dwelling persons with dementia, mean (SD) age = 79 (5.4) years, 25% female, mean (SD) Mini-Mental Status Examination score = 23 (3.5); their informal caregivers, N = 20, mean (SD) age = 70 (11.5) years, 85% female; and an expert group of physiotherapists, N = 15, mean (SD) age = 41 (12.4) years, 73% female, were asked to rank preselected barriers, motivators, and facilitators of PA participation for persons with dementia. These statements were categorized at the intrapersonal, interpersonal, and community levels. RESULTS AND DISCUSSION Persons with dementia and their informal caregivers selected only motivators and facilitators as being important for PA participation, with the motivator "beneficial health effects" considered the most important. The experts had a different perspective on PA participation; half of their ranked top 10 most important factors were barriers to PA participation for persons with dementia. This could be explained by the more critical role of a therapist, focusing on symptom control and treatment of disability; in this case, the elimination of barriers to maintain PA participation in their patients. Furthermore, all groups prioritized statements at the intrapersonal level. CONCLUSIONS The results of this study suggest a difference in perspective between the more optimistic view of persons with dementia and their informal caregivers and the more critical view of physiotherapy experts regarding the most important factors that influence PA participation. In addition, there was a strong focus on the individual characteristics that influence PA behavior that warrant personalized interventions to promote PA in persons with dementia.

Outcomes of a Physical Therapist-Led, Statewide, Community-Based Fall Risk Screening.

Abstract: Background and purpose Falls are the leading cause of morbidity and mortality among US older adults and result in considerable medical and social consequences. Community-based screenings are a type of intervention that provides accessible fall risk screening and education at no cost to the participants. However, little is known about whether or how participants change behavior after screening events. Therefore, the purpose of this study was to quantify and characterize participant risk-reducing behaviors after community-based fall risk screenings. Methods Participants were recruited during 22 community-based fall risk screening events in 2017 led by physical therapists. The screenings were conducted using a modified version of the Centers for Disease Control and Prevention Stopping Elderly Accidents, Deaths, and Injuries (CDC STEADI) toolkit. Screenings included risk reduction education via group format and individual recommendations tailored to fall risk classification based on the screening outcomes. For the study, questionnaires were used at baseline to collect demographics and screening results and at 1-month and 5-month follow-up to assess risk reduction behavior change. Descriptive statistics characterized behavior change and assessed outcome differences by baseline fall risk level. Logistic regression analyses examined factors impacting behavior change after screening. Results and discussion At baseline, 123 participants enrolled and 104 (84.6%) responded at 1- and 5-month follow-up. By 1 month, 50.0% of participants had adopted at least 1 fall risk-reducing behavior, which increased to 64.9% by 5 months. Moderate or high fall risk was significantly associated with adopting a new behavior change by 5 months compared with those with low fall risk (P = .04). The odds of adopting a fall risk reduction strategy by 5 months increased with higher education (odds ratio: 2.5, 95% confidence interval: 1.0-6.0) and moderate/high fall risk (odds ratio: 3.0, 95% confidence interval: 1.3-7.2) in a logistic regression model adjusted by age and sex. Conclusions Screening and education using the STEADI toolkit during community-based screenings result in short- and long-term behavior change to reduce fall risk among older adults, particularly those with moderate to high fall risk. Further research is needed to identify barriers and incentives among participants who do not make fall-related behavioral changes after screening.

Evaluating Effectiveness of an Acute Rehabilitation Program in Hospital-Associated Deconditioning.

Abstract: BACKGROUND AND PURPOSE: Acute hospitalization can result in significant decline in functional ability, known as hospital-associated deconditioning. Older adults are most vulnerable, with resultant functional difficulties and increased risk of institutionalization. This study evaluates the effectiveness of a multidisciplinary acute rehabilitation program in hospital-associated deconditioning on routinely collected outcome data to examine its impact to determine whether a controlled trial is warranted. METHODS: We conducted a retrospective review of the hospital database for the national rehabilitation clinical registry for 2013 and 2014. We analyzed responses from patient feedback questionnaires over a 2-year period to assess patient experience of the rehabilitation program. RESULTS AND DISCUSSION: The analysis included 289 patients referred to our acute rehabilitation program. Most patients were aged 81-90 years, representing 47% (n = 137) of all admissions. The main impairment group was deconditioning (54%). The median entry time to the acute rehabilitation program for this impairment group was 5 days from admission and length of stay in the rehabilitation program was 9 days. Many of these patients (57%) were directly discharged home, with only 21% needing transfer for inpatient rehabilitation. The average Functional Independence Measure score gain was 22 for the patients directly discharged home, with an average discharge Functional Independence Measure score of 94/126. Of the patient feedback responses received (response rate: 24%), 96% rated the program as very good or good. We observed improved functional outcomes among program participants, with the majority directly discharged home, reduced transfer to rehabilitation hospitals, and patient acceptance of this acute rehabilitation program. CONCLUSION: These promising results suggest that a more rigorous evaluation of this acute rehabilitation program in the management of hospital-associated deconditioning is warranted.

Multimodal Interventions Including Rehabilitation Exercise for Older Adults With Chronic Musculoskeletal Pain: A Systematic Review and Meta-analyses of Randomized Controlled Trials

Abstract: Background and Purpose: Musculoskeletal disorders (MSKDs) are the most common causes of disabilities for older adults. The aim of this systematic review and meta-analysis is to assess the effectiveness of multimodal interventions including exercise rehabilitation for older adults with chronic MSKDs. Methods: A literature search was conducted up to February 2019 in 5 bibliographical databases to identify randomized controlled trials (RCTs) that compared multimodal interventions including exercise rehabilitation with usual medical care or no intervention. Randomized controlled trials were assessed with the Cochrane risk-of-bias tool. Meta-analyses were performed and pooled mean differences (MDs) or standardized mean differences (SMDs) were calculated. Results: Sixteen RCTs (n = 2322 participants) were included. One RCT was considered at low risk of bias, 8 had some conMultimodal Interventions Including Rehabilitation Exercise for Older Adults With Chronic Musculoskeletal Pain: A Systematic Review and Meta-analyses of Randomized Controlled Trials Amélie Kechichian, PT, MSc1,2; Simon Lafrance, PT, MSc1,3; Eveline Matifat, PT, MSc1; François Dubé, PT, MSc3,4; David Lussier, MD4,5; Patrick Benhaim, MD4,5; Kadija Perreault, PT, PhD6,7; Johanne Filiatrault, OT, PhD3,4; Pierre Rainville, PhD4,8; Johanne Higgins, OT, PhD3,9; Jacqueline Rousseau, OT, PhD3,4; Julie Masse, OT, MSc3; François Desmeules, PT, PhD1,3 1Maisonneuve-Rosemont Hospital Research Center, University of Montreal Affiliated Research Center, Montreal, Quebec, Canada. 2Pierre and Marie Curie University, Sorbonne University, Paris, France. 3School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada. 4Institut Universitaire de Gériatrie de Montréal, CIUSSS Centre-Sud-de-l’Ile-de-Montréal, Montreal, Quebec, Canada. 5Department of Medicine, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada. 6Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, Quebec, Canada. 7Department of Rehabilitation, Faculty of Medicine, University of Laval, Quebec, Canada. 8Departement of Stomatology, Faculty of Dental Medicine, University of Montreal, Montreal, Quebec, Canada. 9Center for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Quebec, Canada. DOI: 10.1519/JPT.0000000000000279 F.D. is a CIHR and FRQS research scholar. This project was funded to F.D. as a CIHR young investigator in rehabilitation award. The funding bodies were not involved in the design of the study, data collection, analysis, interpretation of data, and in writing the manuscript. The authors declare no conflict of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.jgptonline.com). Address correspondence to: François Desmeules, PT, PhD, Centre de Recherche de l’Hôpital Maisonneuve-Rosemont (CRHMR), 5415 Blvd L’Assomption, Pav. Rachel Tourigny, Porte 4163, Montréal, QC H1T 2M4, Canada (f.desmeules@umontreal.ca). Copyright © 2020 Academy of Geriatric Physical Therapy, APTA. cerns of bias, and 7 had a high risk of bias. Participants suffered from hip or knee osteoarthritis (OA) (n = 12 RCTs), low back pain (LBP) (n = 2 RCTs) and generalized chronic pain (GCP) (n = 2 RCTs). Multimodal interventions were significantly more effective than usual care to decrease pain (visual analog scale, out of 10 points) in the short term, MD: −0.71 (95% confidence interval [CI] −1.08 to −0.34, n = 900), and in the long term: MD: −0.52 (95% CI −0.98 to −0.05, n = 575), but these differences are not considered clinically important. In terms of disabilities, multimodal interventions were also significantly more effective than usual care. The SMDs were −0.47 (95% CI −0.61 to −0.34, n = 903) and −0.29 (95% CI −0.46 to −0.13, n = 568) for OA trials in the short and long terms, respectively, and −0.47 (95% CI −0.81 to −0.12, n = 211) for LBP and GCP trials in the short term. The magnitude of these effects may be considered as small to moderate.

Exploring the Relationship Between Timed Up and Go Test Times and Fall History in an Inpatient Geriatric Psychiatry Unit: A Retrospective Case-Control Study.

Abstract: BACKGROUND AND PURPOSE Inpatient geriatric psychiatry units have the highest fall rates in the acute care setting and most falls in this population occur during the mobility tasks of transfers and ambulation. The Timed Up and Go (TUG) test includes these 2 specific functional tasks and has been used to predict falls in other geriatric populations but has never been tested in an inpatient geriatric psychiatry unit. The purpose of this study was to determine whether the TUG time measurements of inpatient geriatric psychiatry patients were associated with falling. METHODS The study was a retrospective chart review using a case-control design. The sample was obtained from patients admitted to 1 inpatient geriatric psychiatry unit during the 4-month study period. RESULTS The total sample size was N = 62 and included older adults with (N = 29; "fallers") and without (N = 33; "nonfallers") a history of falls in the 6 months prior to admission. The mean age of fallers (M = 75.8, SD = 9.6) was not significantly different from the age of nonfallers (M = 74.0, SD = 7.6), P = .424. Both groups had higher proportions of female subjects; nonfallers were 75.8% (n = 25) female and fallers were 69.0% (n = 20) female. Most nonfallers (84.8%) completed the TUG testing without an assistive device, while most fallers (48.3%) used a walker. A significant difference was found between the TUG times of nonfallers and fallers, U = 737.00, z = 3.65, P < .001, r = 0.46. Fallers took longer to complete the TUG test (median = 26.5) than nonfallers (median = 13.6). The TUG time explanatory variable was statistically significant, P = .002. Increasing TUG times were associated with an increased likelihood of patient falls (odds ratio = 1.10). The optimal TUG cutoff score was 16.5 seconds, with 79.3% sensitivity and 72.7% specificity. CONCLUSIONS The TUG time measurement was found to be associated with falling. A cutoff time of 16.5 seconds is recommended to identify nonfallers from fallers in the inpatient geriatric psychiatry setting.

Validity of Visual Assessment of Sit to Stand After Hip Fracture

Abstract: Background and Purpose:When treating older adults post–hip fracture, physical therapists routinely assess the sit-to-stand (STS) task using observational analysis. Studies have demonstrated that significant movement asymmetries in ground reaction force production of the fractured lower limb persist

Pain-Reducing Effects of Physical Therapist-Delivered Interventions: A Systematic Review of Randomized Trials among Older Adults with Dementia

Abstract: Background and purpose Pain is common among older adults with dementia. There are nonpharmacological options for managing pain in this population. However, the effects of physical therapist-delivered interventions have not been summarized. The purpose of this systematic review was to summarize the literature on physical therapist-delivered interventions in randomized trials for reducing pain among older adults with dementia. Methods A systematic search of MEDLINE/PubMed, CINAHL, PsycINFO, and Web of Science was conducted for randomized trials of pain management in individuals 60 years or older with medically diagnosed dementia of any severity. Included studies addressed the effects of nonpharmacological physical therapist-delivered interventions on pain outcomes. Pain outcomes included patient or caregiver self-report, observational or interactive measures. Independent reviewers extracted relevant data and assessed methodological quality using the PEDro scale. Results and discussion Three studies (total = 222 participants; mean age range = 82.2-84.0 years; 178 [80.2%] females) met inclusion criteria. PEDro scores ranged from 4 to 8/10. Interventions included passive movement and massage. Pain outcomes included the observational measures Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC), Pain in Advanced Dementia (PAINAD), and Doloplus-2 Scale. Passive movement did not show better results when compared with no treatment, while massage showed pain-reducing effects in 1 study compared with no treatment. Conclusions The evidence supporting pain-reducing physical therapy interventions for patients with dementia is limited. There is a clear gap in knowledge related to evidence-based physical therapy for managing pain in this population. Future studies should examine active physical therapist-delivered interventions and utilize interactive pain measures.

Development and Evaluation of a Post-Hip Fracture Instructional Workshop for Caregivers.

Abstract: Background and purpose A hip fracture is an unexpected traumatic event. Caregivers of patients with an acute hip fracture have only short time to learn the new skills of postoperative care and handling of the patient. This sudden responsibility changes the life of the caregivers who perceive a higher level of preoccupation about the care of their family member/friend. The objective of this study was to develop and test feasibility for a post-hip fracture inpatient instructional workshop for caregivers of older adults with hip fracture and to establish their knowledge of hip fracture recovery and perceptions of the utility and satisfaction with the workshop. Methods This 2-part study was conducted at the University Hospital of Granada, Spain, from September 2016 to April 2017. We invited caregivers of patients (60 years of age or older) hospitalized for a surgically treated fall-related hip fracture to attend an informational and skill development hospital-based workshop (60-90 minutes in duration) on postdischarge management strategies. Following the workshop, we invited caregivers to complete a questionnaire to obtain their knowledge about care after hip fracture and their perceived concerns. Furthermore, we requested that they provide feedback on workshop utility and satisfaction (0-10 points) and suggestions for improving the workshop. Results and discussion We delivered 42 workshops over an 8 month period. One hundred three caregivers attended the sessions and enrolled in the study, mean (SD) age: 52.1 (12.8) years. Sixty-nine percent of the caregivers were women. Caregivers' main concern was apprehension for delivering physical care to their family member/friend (75%), followed by lack of time (42%). Caregivers who were employed were 3.16 times as likely to be concerned about time availability to provide care for their family member/friend. The median (Q1, Q3) of both workshop utility and satisfaction was 10 (10, 10), minimum-maximum: 7 to 10. Conclusions Caregivers in this study stated that the workshop was useful and satisfactory. Because caregivers play such a vital role in recovery after hip fracture, providing knowledge and skill development as part of health care delivery may support more person-centered care.

Exercise for Nonagenarians: A Systematic Review.

Abstract: Background Physical exercise has been identified as a health promotion strategy for the oldest old. However, scientific evidence regarding the benefits of exercise on nonagenarians is scarce. This systematic review aimed to evaluate the characteristics and methodological quality of investigations that have examined the effects of physical exercise on nonagenarians. Methods A systematic review and evidence synthesis were conducted. The MEDLINE/PubMed, CINAHL, Scopus, SPORTDiscus, and Cochrane Library were systematically searched up to November 2018. Investigations were included if they tested the effects of an exercise intervention on people 90 years or older. The methodological quality of the randomized controlled trials was evaluated using the PEDro scale. Quality appraisal tools developed by the National Heart, Lung and Blood Institute were used to evaluate the uncontrolled and observational investigations. Results Three randomized controlled trials, 1 retrospective study, 2 case reports, and 1 single-subject A-B design met the eligibility criteria. The methodological quality scores obtained from the scales ranged from poor to good. Most interventions were based on muscular strengthening, balance exercises, or a combination of both. No adverse effects were registered. In general, exercise showed a significant impact on muscular strength, while mixed effects were found regarding gait and balance. Pooled analyses indicated that interventions had significant improvements in global lower body functioning (standardized mean difference, SMD = 0.47; 95% confidence interval = 0.04, 0.90; P Conclusions Exercise is a feasible therapy for nonagenarians, which can lead to improvements in physical functioning. Future research should focus on the effects of aerobic interventions, as well as the impact that exercise has on the cognitive functioning of nonagenarians.

Validity and Reliability of Jump Height Measurements Obtained From Nonathletic Populations With the VERT Device.

Abstract: BACKGROUND AND PURPOSE Vertical jump (VJ) is commonly used to assess lower extremity power in athletic populations. A portable device called the VERT has been validated for this population, but not in nonathletic populations. We sought in this study to assess the clinimetric properties of VJ height measurements obtained with the VERT from older and younger nonathletes. METHODS Twenty-eight participants (14 older, 14 younger, evenly split between male and female) completed 2 submaximal and 3 maximal VJ trials wearing the VERT during 2 sessions separated by 5 to 9 days. During the first session, their VJ heights were also monitored using motion capture video. RESULTS Analysis revealed concurrent validity of the VERT against motion capture (intraclass correlation coefficient [ICC3,1] = 0.826-0.950) and known-groups validity of the VERT based on age and gender (P < .001). Strong parallel reliability against a second VERT device (ICC = 0.992) was demonstrated as was strong test-retest reliability (ICC = 0.968). CONCLUSIONS The VERT device provides valid and reliable measures of VJ height in nonathletic populations, including older adults. However, the VERT may not be suitable for recording the low jump heights of some older adults.

Medication Status and Gait Mechanics in Older Adults: A Multivariate Analysis

Abstract: Background and purpose Falls are the leading cause of unintentional deaths in older adults, with nearly one-third of adults older than 65 years falling annually. Previous work reveals that both medication status and gait changes are contributing factors to falls in older adults; however, it is unknown how these factors interact. Thus, the purpose of this investigation was to examine differences between gait biomechanics as a function of medication status in individuals older than 60 years with a self-reported history of falling. It was hypothesized that differences in gait mechanics would be observed as a function of the number of medications in these individuals. Methods A total of 384 participants, age, mean (SD) = 73.2 (4.2) years; height, mean (SD) = 173.09 (16.4) cm; mass, mean (SD) = 65.45 (5.78) kg, were recruited from across the Southwest United States (Texas, New Mexico, Arizona, Nevada, and California) by the Electronic Caregiver Mobile Fall Risk Assessment Laboratory. Data for cadence, gait velocity, stride length, swing time, and double-support time were collected using a Walkway gait analysis system. Factor analysis was employed to determine whether the gait characteristics were similar to those observed in previous studies. A multivariate analysis with a follow-up univariate analysis was employed to determine group differences in gait factors and variables according to medication number (≥4 medications, n = 262 vs ≤3 medications, n = 122). Results Results of the factor analysis reveal that the data analyzed in the current study are similar to those observed in previous studies, with cadence (factor loading coefficient [FLC] = 0.745), gait velocity (FLC = 0.922), stride length (FLC = 0.789 for left and 0.790 for right) loading positively on a "pace" factor, swing time (FLC = 0.728 for right and 0.683 for left), and double-support time (FLC= 0.723) loading positively on a "rhythm" factor. The results of the multivariate analysis of variance revealed differences in gait factors across groups according to medication status. Univariate follow-up tests reveal that double-support time is longer and stride length is shorter in persons taking 4 or more medications as compared with those on 3 or fewer medications. Conclusion The findings of this study indicate that certain abnormal gait parameters in participants with a history of falls are associated with taking 4 or more medications. Future studies should examine the extent to which gait changes and medications interact to predict falls.

Muscle Strength Is Associated With Muscle Mass in Patients With Esophageal Cancer Awaiting Surgery.

Abstract: Background and Purpose: Decreased muscle mass and muscle strength are independent predictors of poor postoperative recov- ery in patients with esophageal cancer. If there is an association between muscle mass and muscle strength, physiotherapists are able to measure muscle strength as an early predictor for poor postoperative recovery due to decreased muscle mass. Therefore, in this cross-sectional study, we aimed to investigate the association between muscle mass and muscle strength in predominantly older patients with esophageal cancer awaiting esophagectomy prior to neoadjuvant chemoradiation. Methods: In patients with resectable esophageal cancer eligible for surgery between March 2012 and October 2015, we used computed tomographic scans to assess muscle mass and compared them with muscle strength measures (hand- grip strength, inspiratory and expiratory muscle strength, 30 seconds chair stands test). We calculated Pearson correla- tion coefficients and determined associations by multivariate linear regression analysis. Results and Discussion: A tertiary referral center referred 125 individuals to physiotherapy who were eligible for the study; we finally included 93 individuals for statistical analysis. Mul- tiple backward regression analysis showed that gender (95% confidence interval [CI], 2.05-33.82), weight (95% CI, 0.39- 1.02), age (95% CI, −0.91 to −0.04), left handgrip strength (95% CI, 0.14-1.44), and inspiratory muscle strength (95% CI, 0.08-0.38) were all independently associated with muscle surface area at L3. All these variables together explained 66% of the variability (R2) in muscle surface area at L3 (P < .01). Conclusions: This study shows an independent association between aspects of muscle strength and muscle mass in patients with esophageal cancer awaiting surgery, and phys- iotherapists could use the results to predict muscle mass on the basis of muscle strength in preoperative patients with esophageal cancer.

Transcultural adaptation and psychometric validation of a European Spanish language version of the Falls Behavioral Scale

Abstract: Background and purpose The Falls Behavioral Scale (FaB) is considered a valid and reliable tool for measuring fall risk factors related to behavior among older people. It was originally developed and validated in Australia by Clemson et al. The purpose of this study was to perform a transcultural adaptation and validation of the FaB to European Spanish. Methods The transcultural adaptation of the questionnaire followed the methodology structured and validated by Beaton et al. The prefinal version in European Spanish was tested in a pilot study utilizing 15 participants. A total of 167 participants older than 60 years and capable of walking independently, with or without gait assistive devices, were recruited for the study. Internal consistency and reliability were analyzed using Cronbach α and the intraclass correlation coefficient (ICC) with a 95% confidence interval. Convergent validity was assessed using Spearman's coefficient, and correlations were evaluated with the European Spanish versions of the EuroQoL-5D (EQ-5D) and the Activities-Specific Balance Confidence Scale (ABC-16). Results Good internal consistency was obtained (α = .714) as was test-retest reliability of the overall questionnaire (ICC = 0.97). For each item, good test-retest reliability was achieved, obtaining values for ICC ranging between 0.63 and 0.91 (P Conclusion The European Spanish FaB was shown to be a valid and reliable tool for use with Spanish-speaking seniors.

The Value of Geriatric Physical Therapy: Excerpts from 'We Can Do Better': 2020 Carole B. Lewis Distinguished Lecture: Address to the APTA Geriatrics Membership at the Combined Sections Meeting, Denver, CO, February 13, 2020.

Abstract: Geriatric physical therapy variability of care negatively affects our value. For example, the public does not know how to determine the quality of a physical therapy encounter or a high-quality physical therapist. In short, older adults often do not know what to expect in their encounter with a physical therapist. Our value is hiding under a bushel basket! I believe the variability of care comes from not having a unifying approach to aging. Many therapists practice from the mechanistic approach of fixing. However, adopting a “fix it” approach can create unrealistic expectations and ultimate disappointment because aging can’t be fixed. Alternatively, the building capacity model promotes and strengthens older adults’ abilities while developing the skills that allow adaptation. Thus, abilities are retained in concert with the individual’s expectations and desires for function, activity, and participation. The building capacity model appeals to older adults’ self-perceptions and is the model that provides the most value to society. But to achieve this value, we need some consistency of practice. Therefore, I believe we need to establish a set of exemplars or standards that are informed by evidence, the models of Healthy Aging Initiative, World Health Organization, and the 4Ms framework, and of course the vision of the Academy. Exemplars inform quality benchmarks that can quantify our value and promote consistency of practice. With these exemplars, consumers can shop for effective practitioners and align their expectations. Exemplars can be used to inform geriatric content in the educational curriculum. The continuum of care, that is all settings, should reflect these 2020 Carole B. Lewis Distinguished Lecture Address to the APTA Geriatrics Membership at the Combined Sections Meeting, Denver, CO, February 13, 2020

Improving Interpretation of the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function Scale for Specific Tasks in Community-Dwelling Older Adults.

Abstract: Background and purpose New generic patient-reported outcomes like the Patient-Reported Outcomes Measurement Information System (PROMIS) are available to physical therapists to assess physical function. However, the interpretation of the PROMIS Physical Function (PF) T-score is abstract because it references the United States average and not specific tasks. The purposes of this study were to (1) determine convergent validity of the PROMIS PF scale with physical performance tests; (2) compare predicted performance test values to normative data; and (3) identify sets of PROMIS PF items similar to performance tests that also scale in increasing difficulty and align with normative data. Methods Community-dwelling older adults (n = 45; age = 77.1 ± 4.6 years) were recruited for this cross-sectional analysis of PROMIS PF and physical performance tests. The modified Physical Performance Test (mPPT), a multicomponent test of mostly timed items, was completed during the same session as the PROMIS PF scale. Regression analysis examined the relationship of mPPT total and component scores (walking velocity, stair ascent, and 5 times sit to stand) with the PROMIS PF scale T-scores. Normative data were compared with regression-predicted mPPT timed performance across PROMIS PF T-scores. The PROMIS PF items most similar to walking, stair ascent, or sit to stand were identified and then PROMIS PF model parameter-calibrated T-scores for these items were compared alongside normative data. Results and discussion There were statistically significant correlations (r = 0.32-0.64) between PROMIS PF T-score and mPPT total and component scores. Regression-predicted times for walking, stair ascent, and sit-to-stand tasks (based on T-scores) aligned with published normative values for older adults. Selected PF items for stair ascent and walking scaled well to discriminate increasing difficulty; however, sit-to-stand items discriminated only lower levels of functioning. Conclusions The PROMIS PF T-scores showed convergent validity with physical performance and aligned with published normative data. While the findings are not predictive of individual performance, they improve clinical interpretation by estimating a range of expected performance for walking, stair ascent, and sit to stand. These findings support application of T-scores in physical therapy testing, goal setting, and wellness plans of care for community-dwelling older adults.

Center of Pressure Trace and Sensory Components of the Limits of Stability Test in Older Adults With Vertebral Compression Fractures.

Abstract: Background and purpose Patients with vertebral compression fracture (VCF) usually exhibit impaired postural control and consequently are at an increased risk of falling. This study aimed to assess the sensory and kinematic components of the limits of stability (LOS) test in patients with VCF. Methods This study enrolled 13 adults with VCF (VCF group), 13 older adults without spinal deformity (NE group), and 13 young adults (NY group). The Biodex balance system was employed to calculate the balance score and the LOS of participants. An inertia motion system was used to record kinematic data. The center of pressure signals of postural stability and LOS were used to calculate the frequency power spectrum for interpreting the sensory component. Results Compared with the NY group, the VCF group exhibited a longer reaction time and lower balance scores and used a higher median frequency in the medial-lateral and anterior-posterior direction of body acceleration to perform the LOS test. The required ranges of hip rotation and pelvic pitch were significantly higher in the older adult group than in the NY group. In the postural stability test, the VCF group exhibited significantly higher frequency power in the 0.01- to 0.5-Hz band (visual and vestibular) under both the eyes-closed and eyes-open conditions than the other groups. In the LOS test, the VCF group also exhibited lower sensory component activity than the other groups, particularly in vestibular function (0.1-0.5 Hz). Conclusions Both musculoskeletal degeneration and sensory integration impairment may contribute to poor direction control and a longer reaction time in patients with VCF.

Effects of a Multimodal Exercise Program Plus Neural Gliding on Postural Control, Pain, and Flexibility of Institutionalized Older Adults: A Randomized, Parallel, and Double-Blind Study.

Abstract: Background and purpose The effect of adding neural mobilization to a multimodal program of exercises has not been investigated, despite its potential positive effects. The aim of this study was to compare the acute effects of a multimodal exercise program and neural gliding against a multimodal exercise program only, on pain intensity, gait speed, Timed Up and Go (TUG) test, lower limb flexibility, and static balance of institutionalized older adults. Methods Older adults who were institutionalized (n = 26) were randomized to receive a multimodal exercise program plus neural gliding or a multimodal exercise program only. Both interventions were delivered twice a week for 8 weeks. Participants were assessed for pain, gait velocity, balance, flexibility, and TUG at baseline and postintervention. Results A significant main effect of time for pain intensity (F1,24 = 8.95, P = .006), balance (F1,24 = 10.29, P = .004), and gait velocity (F1,24 = 5.51, P = .028) was observed, indicating a positive impact of both interventions. No other significant effects were found (TUG and flexibility; P > .05). Discussion A 45-minute multimodal exercise program, twice a week for 8 weeks, has a positive impact on pain intensity, balance, and gait velocity, but neural gliding has no additional benefit. It is unclear whether dose and type of neural mobilization may have had an impact on results. Considering the structural and physiological changes that tend to occur with age, future studies could explore the effects of neural tensioning or of higher doses of neural mobilization. Conclusions This study suggests that adding neural gliding to a multimodal exercise program has no additional benefit.

Caring Rehabilitation Climate, the Tripartite Efficacy Framework, and Adherence to Rehabilitation Programs Among Individuals With Parkinson's Disease: A Multiple Mediation Analysis.

Abstract: Background and Purpose: Adherence to physical therapy (PT) and secondary prevention programs (SPPs) is particularly low for individuals with Parkinson's disease. Preliminary research has linked perceptions of caring climates as well as enhanced tripartite efficacy perceptions to adherence during rehabilitation programs. In light of such preliminary research, the purpose of this study was threefold: (1) to examine relationships between perceptions of a caring climate and the 3 efficacy constructs within the tripartite model, (2) to examine the relationship between the tripartite efficacy constructs and adherence to PT/SPP exercises, and (3) to determine whether tripartite efficacy beliefs mediated the relationship between caring climate perceptions and adherence. Method: A total of 77 individuals with Parkinson's disease who were currently or recently enrolled in PT or an SPP were recruited and surveyed about their perceptions of the caring climate of their rehabilitation clinic, their tripartite efficacy perceptions, and their adherence to rehabilitation. Correlations and a multiple mediation analysis were conducted to address the purposes of this study. Results and Discussion: Results showed significant positive associations between all variables; however, all paths within the proposed mediation model were not significant. Specifically, the c paths linking the tripartite efficacy constructs with adherence were not significant. A follow-up analysis was undertaken to address potential suppression effects within the mediating variables, and this analysis revealed a statistically significant model with relation-inferred self-efficacy (RISE) as a sole mediator of the relationship between caring perceptions and adherence to rehabilitation. Conclusions: Several practical implications can be gleaned from the current study. First, practitioners should strive to enhance the caring climate of their clinic by employing techniques reported in previous literature, such as creating a supportive atmosphere, displaying benevolence, and paying attention. In addition, the results suggest that individuals' RISE perceptions, in particular, could be a viable target for enhancing adherence.

Sections of the Brief-Balance Evaluation Systems Test Relevant for Discriminating Fast Versus Slow Walking Speeds in Community-Dwelling Older Women.

Abstract: Background and purpose Walking speed can be used to identify characteristics of frailty in older adults. It has a strong positive correlation with balancing abilities. The Brief-Balance Evaluation Systems Test (Brief-BESTest) was developed to assess balancing functions of the 6 balance control systems in a short time. However, for community-dwelling older adults, the relationship between walking speed and the Brief-BESTest needs to be clarified. Even the cutoff scores for each Brief-BESTest section should be indicated for physical therapists to use it for effectively evaluating balance deficits. Our objective was to establish cutoff scores for individual Brief-BESTest sections, determine fast or slow walkers in community-dwelling older adults, and investigate the relationship between balance control systems and walking speed. Methods In a cross-sectional study involving 55 participants 77 years and older, the Brief-BESTest was evaluated after grouping the participants based on their walking speeds in public community centers. We compared the age, history of falls, handgrip strength, quadriceps strength, appendicular skeletal muscle mass index, comfortable walking speeds, and the Brief-BESTest scores between the fast- and slow-walking groups by using the independent t test, Fisher exact test, or Mann-Whitney U test. We also determined the receiver operating characteristic curves, and calculated the cutoff, area under the curve (AUC), sensitivity, and specificity of each section. Results All sections of the Brief-BESTest, except section I, were able to differentiate between fast and slow walkers in community-dwelling older women. Section VI showed the highest AUC (0.83) and the cutoff score for the fast- and slow-walker groups was 3.0 points (sensitivity = 0.85, specificity = 0.81). Sections III, IV, and V had moderate AUC (0.71-0.72). Sections I and II showed weak correlations with the walking speed. Conclusions Three sections (III, anticipatory postural adjustments; IV, postural responses; and VI, stability in gait) could differentiate between fast and slow walkers. Section VI was a particularly important balance function measurement that determined the walking speed with the highest accuracy. Therefore, it should be the first focus when physical therapists treat community-dwelling older adults.

Proximity of the Carotid Bifurcation to the Laryngeal Prominence: Results of a Cadaver Study and Recommendations for Safe Pulse Palpation.

Abstract: BACKGROUND/PURPOSE The carotid bifurcation (CB) is the location of the carotid sinus and the baroreceptors and is also a major site for atherosclerotic plaque formation. Health care providers have therefore been cautioned to avoid the CB during carotid pulse palpation (CPP) to prevent triggering the baroreflex, occluding an artery, or propagating a thrombus. Potential risks of adverse events during CPP may be greater for older adults due to age-related vascular changes and increased risk of baroreceptor hypersensitivity. The exact location of the CB relative to easily identifiable landmarks has, however, not been well-studied. The purpose of this descriptive study was to identify the location of the CB relative to key landmarks in a cadaver sample and to make recommendations allowing clinicians to avoid the CB during CPP. METHODS The CB and other regional landmarks in 17 male and 20 female cadavers were exposed by dissection and pins were placed at all landmarks. Digital calipers were then used to measure the distance between the CB and all landmarks. RESULTS AND DISCUSSION The mean vertical distance from the laryngeal prominence (LP) to the CB was 25.14 mm for females and 36.13 mm for males. No CBs were located below the LP. Ninety-four percent of female CBs and 100% of male CBs were located above the LP, and 74% of female subjects and 87% of male subjects had CBs greater than 20.00 mm superior to the LP. No clinically relevant relationships were found between the CB and any of the other measured landmarks. CONCLUSIONS Based on this cadaver sample, CPP below the level of the LP in a supine individual would be unlikely to compress the CB and thus unlikely to trigger the baroreflex or occlude the region of greatest atherosclerotic buildup. If a pulse is not palpable below the LP, moving vertically up to 1 cm above the LP in a supine individual would be likely to compress the CB in only a small number of cases.