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A single session of trip-specific training modifies trunk control following treadmill induced balance perturbations in stroke survivors.
Nevisipour, M, Grabiner, MD, Honeycutt, CF
Gait & posture. 2019;:222-228
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Abstract
BACKGROUND Individuals with stroke are at significant risk of falling. Trip-specific training is a targeted training approach that has been shown to reduce falls in older adults and amputees by enhancing the compensatory stepping response required to prevent a fall. Still, individuals with stroke have unique deficits (e.g. spasticity) which draws into question if this type of training will be effective for this population. OBJECTIVE Evaluate if a single session of trip-specific training can modify the compensatory stepping response (trunk movement, step length/duration, reaction time) of individuals with chronic stroke. METHODS Sixteen individuals with unilateral chronic stroke participated in a single session of trip-specific training consisting of 15 treadmill perturbations. A falls assessment consisting of 3 perturbations was completed before and after training. Recovery step kinematics measured during the pre- and post-test were compared using a repeated measures design. Furthermore, Fallers (those who experienced at least one fall during the pre- or post-test) were compared to Non-fallers. RESULTS Trip-specific training decreased trunk movement post perturbation. Specifically following training, Trunk flexion was 48 and 19 percent smaller on the small and medium perturbations at the end of the first compensatory step. Fallers (9 out of 16 subjects) post-training resembled Non-Fallers pre-training. Specifically, Trunk flexion at the completion of the first step during small and medium perturbations was not different between Fallers post-training and Non-Fallers pre-training. Still enthusiasm was tempered because Trunk flexion at the largest perturbation (where most falls occurred) was not changed and therefore total falls were not reduced as a result of this training. SIGNIFICANCE Our results indicate that trip-specific training modifies the dynamic falls response immediately following trip-like treadmill perturbations. However, the incidence of falls was not reduced with a single training session. Further study of the implications and length of the observed intervention effect are warranted.
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Effects of a 6-Week Faroese Chain Dance Programme on Postural Balance, Physical Function, and Health Profile in Elderly Subjects: A Pilot Study.
Hofgaard, J, Ermidis, G, Mohr, M
BioMed research international. 2019;:5392970
Abstract
The present pilot study investigates the impact of a Faroese chain dance intervention on health profile, mobility, and postural balance in elderly subjects. Healthy elderly subjects (n=27; age 75 ± 5 yrs) were randomised into an intervention group (IG) and a control group (CG). IG performed twice-weekly sessions of Faroese chain dance over 6 weeks. Dancing sessions lasted 30 min in the initial 3 weeks and 45 min in the final 3 weeks. Health profile was determined before and after intervention by measuring blood pressure, resting heart rate, muscle mass, and body fat content. Postural balance was evaluated using the Berg Balance Scale (BBS) and Fullerton Advanced Balance Scale (FAB) tests, while mobility was assessed using the Short Physical Performance Battery (SPPB), the Timed Up & Go (TUG) test, the 6-min walk test, and the 30-s sit-to-stand test. Systolic and diastolic blood pressure were lowered (9 ± 6 and 6 ± 3 mmHg, respectively) in IG, with a tendency (P=0.07) for a greater change score than in CG. Mean arterial pressure declined (P<0.05) by 7 ± 3 mmHg in IG, which tended (P=0.09) to be greater than in CG. IG improved (P<0.05) on BBS and FAB scores by 3.6 ± 2.1% and 15.8 ± 8.3%, with the change score for FAB being greater (P<0.05) than in CG (0.3 ± 1.6). Moreover, the postintervention SPPB score was improved (P<0.05) more in IG (13.9 ± 7.4%) compared to CG, while performance in the 30-s sit-to-stand, 6-min walk, and TUG tests improved (4-15%; P<0.05) in IG only. Body fat content was reduced (P<0.05) from 36.3 ± 2.8% to 34.8 ± 2.8% in IG, with no between-group differences and no change in CG (34.1 ± 2.8% to 33.7 ± 3.1%). In conclusion, a 6-week Faroese chain dance programme lowers blood pressure and improves postural balance and physical function in elderly.
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Process outcomes of a multifaceted, interdisciplinary knowledge translation intervention in aged care: results from the vitamin D implementation (ViDAus) study.
Walker, P, Kifley, A, Kurrle, S, Cameron, ID
BMC geriatrics. 2019;(1):177
Abstract
BACKGROUND Vitamin D supplement use is recommended best practice in residential aged care facilities (RACFs) for the prevention of falls, however has experienced delays in uptake. Following successful international efforts at implementing this evidence into practice, the ViDAus study sought to replicate this success for the Australian context. The aim of this paper is to report on the process outcomes of implementing this intervention. METHODS Forty-one RACFs were engaged in a multifaceted, interdisciplinary knowledge translation intervention. This focused on raising awareness to improve knowledge on vitamin D, and supporting facilities to identify barriers and implement locally devised strategies to improve the uptake of evidence based practice (EBP). RESULTS Staff members of participating facilities (n = 509 including nursing, care and allied health staff) were well engaged and accepting of the intervention, though engagement of servicing general practitioners (GPs) (n = 497) and pharmacists (n = 9) was poor. Facilities each identified between three and eight strategies focused on raising awareness, identifying residents to target for vitamin D and creating referral pathways depending upon their own locally identified barriers and capacity. There was variable success at implementing these over the 12-month intervention period. Whilst this study successfully raised awareness among staff, residents and their family members, barriers were identified that hindered engagement of GPs. CONCLUSIONS The intervention was overall feasible to implement and perceived as appropriate by GPs, pharmacists, facility staff, residents and family members. More facilitation, higher-level organisational support and strategies to improve RACF access to GPs however were identified as important improvements for the implementation of vitamin D supplement use. TRIAL REGISTRATION Retrospectively registered (ANZCTR ID ACTRN12616000782437 ) on 15 June 2016.
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[Journal Club].
Dovjak, P, Püllen, R
Zeitschrift fur Gerontologie und Geriatrie. 2016;(5):455-7
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Functional Impairments Mediate Association Between Clinical Fracture Risk and Type 2 Diabetes Mellitus in Older Women.
Lee, RH, Pieper, CF, Colón-Emeric, C
Journal of the American Geriatrics Society. 2015;(8):1546-51
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Abstract
OBJECTIVES To examine the effect of functional impairments in older women with diabetes mellitus (DM) on incident clinical fractures. DESIGN Secondary analysis of two large prospective cohort studies. SETTING North Carolina Established Populations for Epidemiologic Studies of the Elderly (EPESE) and Women's Health Initiative (WHI) clinical trials. PARTICIPANTS EPESE included 2,704 community-dwelling women aged 65 and older; WHI clinical trials included 68,125 postmenopausal women. MEASUREMENTS Women with DM at baseline were compared with women without in successive Cox proportional hazards models. Functional limitations were determined according to self-reported difficulties with activities of daily living (ADLs) and physical activities. RESULTS The risk of any clinical fracture during the study period was greater in women with DM, after controlling for age, race and ethnicity, and body mass index, in the EPESE (hazard ratio (HR) = 1.36, 95% confidence interval (CI) = 1.08-1.72) and WHI (HR = 1.29, 95% CI = 1.19-1.39) cohorts. After inclusion of functional limitations, the greater risk of fracture associated with DM decreased in the EPESE (HR = 1.25, 95% CI = 0.98-1.59) and WHI (HR = 1.21, 95% CI = 1.12-1.31) cohorts. In participants with DM, difficulties with moderate physical activities, such as bending or stooping, walking several blocks, and heavy housework, were significantly associated with incident fracture (P < .05). CONCLUSION Older women with DM are at greater risk of clinical fractures than those without, independent of bone mineral density. Greater functional impairment in moderate physical activities mediates this greater fracture risk in part, although there remains an unexplained residual DM-associated risk for fracture.
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Prevention of falls and fractures in old people by administration of calcium and vitamin D, randomized clinical trial.
López-Torres Hidalgo, J, ,
BMC public health. 2011;:910
Abstract
BACKGROUND There are many studies that associate vitamin D serum levels in older persons with muscle strength, physical performance and risk of fractures and falls. However, current evidence is insufficient to make a general recommendation for administrating calcium and vitamin D to older persons. The objective of this study is to determine the effectiveness of calcium and vitamin D supplementation in improving musculoskeletal function and decreasing the number of falls in person aged over 65 years. METHODS/DESIGN Phase III, randomized, double blind, placebo-controlled trial to evaluate the efficacy of already marketed drugs in a new indication. It will be performed at Primary Care doctor visits at several Healthcare Centers in different Spanish Health Areas. A total of 704 non-institutionalized subjects aged 65 years or older will be studied (sample size calculated for a statistical power of 80%, alpha error 0.05, annual incidence of falls 30% and expected reduction of 30% to 20% and expected loss to follow up of 20%). The test drug containing 800 IU of vitamin D and 1000 mg of calcium will be administered daily. The control group will receive a placebo. The subjects will be followed up over two years. The primary variable will be the incidence of spontaneous falls. The secondary variables will include: consequences of the falls (fractures, need for hospitalization), change in calcidiol plasma levels and other analytical determinations (transaminases, PTH, calcium/phosphorous, albumin, creatinine, etc.), change in bone mass by densitometry, change in muscle strength in the dominant hand and change in musculoskeletal strength, risk factors for falls, treatment compliance, adverse effects and socio-demographic data. DISCUSSION The following principles have been considered in the development of this Project: the product data are sufficient to ensure that the risks assumed by the study participants are acceptable, the study objectives will probably provide further knowledge on the problem studied and the available information justifies the performance of the study and its possible risk for the participants.If calcium and vitamin D supplementation is effective in the prevention of falls and fractures in the elderly population, a recommendation may be issued with the aim of preventing some of the consequences of falls that affect quality of life and the ensuing personal, health and social costs. TRIAL REGISTRATION ClinicalTrials.gov: NCT01452243
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A simple gait-stabilizing device reduces outdoor falls and nonserious injurious falls in fall-prone older people during the winter.
McKiernan, FE
Journal of the American Geriatrics Society. 2005;(6):943-7
Abstract
OBJECTIVES To determine whether Yaktrax Walker (YW), a nonmedical gait-stabilizing device, prevents outdoor falls and injurious falls in fall-prone older people during the winter. DESIGN Prospective, randomized, interventional trial. SETTING Community-based, northern United States, winter, outdoors. PARTICIPANTS Ambulatory, community-dwelling, fall-prone people aged 65 and older. INTERVENTION Participants were randomized to wear YW or their usual winter footwear (UWF) outdoors during the winter of 2003/2004. MEASUREMENTS The number of indoor and outdoor slips, falls, and injurious falls was recorded daily in a fall diary. Winter footwear satisfaction survey was completed after study completion. RESULTS One hundred nine subjects completed 10,724 diary days. Mean age was 74.2. There were 93 indoor slips, 13 indoor falls, 714 outdoor slips, and 62 outdoor falls. The tendency for both groups to slip/fall indoors was comparable. The relative risk (RR) of outdoor slip for YW was 0.50 (P<.04) for all diary days and 0.61 (P=.14) when only days walked on snow and ice was the exposure variable. The RR of outdoor fall for YW was 0.42 (P<.03) when only days walked on snow and ice was the exposure variable. RR of injurious falls per day walked on snow and ice for YW was 0.13 (P<.02). Twelve of 19 outdoor falls occurred when YW subjects were not wearing their assigned device. No serious injury or fracture occurred in either group. The number needed to treat for the YW to prevent one nonserious injurious fall in one winter was six. CONCLUSION YW may reduce the risk of outdoor winter falls, and of nonserious injurious falls, in older community-dwelling people with a history of previous falls.
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Low-dose vitamin D prevents muscular atrophy and reduces falls and hip fractures in women after stroke: a randomized controlled trial.
Sato, Y, Iwamoto, J, Kanoko, T, Satoh, K
Cerebrovascular diseases (Basel, Switzerland). 2005;(3):187-92
Abstract
OBJECTIVE Vitamin D supplementation is suggested to reduce the risk of falls among ambulatory or institutionalized elderly subjects. The present study was undertaken to address the reduced risk of falls and hip fractures in patients with long-standing stroke by vitamin D supplementation. METHODS Ninety-six elderly women with poststroke hemiplegia were followed for two years. Patients were randomly assigned to one of the two groups, and 48 patients received 1,000 IU ergocalciferol daily, and the remaining 48 received placebo. The number of falls per person and incidence of hip fractures were compared between the two groups. Strength and tissue ATPase of skeletal muscles on the nonparetic side were assessed before and after the study. RESULTS At baseline, serum 25-hydroxyvitamin D levels were in the deficient range (<10 ng/ml) in all patients; and vitamin D treatment enhanced serum 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D levels. Vitamin D treatment accounted for a 59% reduction in falls (95% CI, 28-81%; p = 0.003). There were increases in the relative number and size of type II muscle fibers and improved muscle strength in the vitamin D-treated group. Hip fractures occurred in 4 of 48 placebo group and 0 in 48 vitamin D2 group during the 2-year study period (log-rank, p = 0.049). CONCLUSION Vitamin D may increase muscle strength by improving atrophy of type II muscle fibers, which may lead to decreased falls and hip fractures.
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Screening elderly women for risk of future fractures--participation rates and impact on incidence of falls and fractures.
Barr, RJ, Stewart, A, Torgerson, DJ, Seymour, DG, Reid, DM
Calcified tissue international. 2005;(4):243-8
Abstract
We have assessed the acceptability of a method for screening for risk of future hip fracture in elderly women. After receipt of an initial response to a mailed risk-factor questionnaire sent out to 5,306 women, women were randomly assigned to active or control groups. The active group was invited to participate in a screening visit that comprised a life-style questionnaire and a quantitative ultrasound heel scan. General practitioners (GPs) of women who were found to be in the lowest quartile of broadband ultrasound attenuation and/or who had two or more risk factors for hip fracture were advised to prescribe a calcium and vitamin D supplement. A second mailed questionnaire was sent to both groups 1 to 3 years later. Compared with the control group, the active group had a 56% lower risk of fracture (odds ratio [OR], 0.44; 95% confidence interval [CI], 0.24-0.81 adjusted age, weight, and treatment status). At follow-up, the proportion of fallers in the active group (25.3%) was lower than that in the control group (29.6%) (P = 0.064). The control group was found to have a higher rate of falls at follow-up than the active group (95% CI, 0.02-0.22); no difference was found at baseline (95% CI, -0.08 to +0.14). The screening method used was found to be acceptable to the majority of elderly women in this study. Screening the elderly in this way together with simple advice on treatment appears to reduce the age-associated increase in fall rates and the number of subsequent fractures. This form of screening may provide a cost-effective method to reduce falls and fractures in free-living elderly women. However, no such cost-effectiveness analysis has been performed to date.
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Treatment with alfacalcidol in elderly people significantly decreases the high risk of falls associated with a low creatinine clearance of <65 ml/min.
Dukas, L, Schacht, E, Mazor, Z, Stähelin, HB
Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 2005;(2):198-203
Abstract
We previously observed that a creatinine clearance (CrCl) of <65 ml/min is a significant and independent risk factor for the number of fallers and falls in a community-dwelling elderly population and postulated that this increased risk is due to the associated significant lower D-hormone serum levels. To test our hypothesis, we investigated in a post hoc analysis of a double-blind randomized study whether treatment with alfacalcidol, a synthetic prodrug of the D-hormone, can reduce the high incidence of fallers and the high risk of falls associated with low CrCl. Of 378 Swiss community-dwelling women (n=191) and men (n=187), aged 70 years and older, 191 received randomly 1 microg capsules of alfacalcidol (AlphaD3: Teva), and 187 received one capsule of placebo daily. With the help of questionnaires we regularly assessed the incidence and frequency of falls. The risk of becoming a faller and the risk of falling were assessed in multivariate-controlled logistic regression models according to treatment groups and according to a CrCl cut-off of 65 ml/min. The presented results are from ITT analyses. In participants with a CrCl of <65 ml/min, the 36 weeks of treatment with alfacalcidol was, compared with placebo, associated with a significant reduction in the number of fallers (14/72 versus 25/70; OR 0.26, 95% CI 0.08-0.80, P=0.019), and a significant reduction of the number of falls (16/72 versus 28/70; OR 0.29, 95% CI 0.09-0.88, P=0.028). No such association was observed in participants with a CrCl of >or=65 ml/min (for fallers 26/120 versus 21/116; OR 0.92 95% CI 0.34-2.52, P=0.875; for falls 32/120 versus 23/116; OR 0.93 95% CI 0.34-2.54, P=0.885). In the placebo group frequency of falls was dependent on CrCl (P=0.006), whereas in the alfacalcidol treatment group frequency of falls was independent of CrCl (P=0.494). No cases of clinically relevant hypercalcemia were observed. In a community-dwelling population of elderly men and women with a CrCl of <65 ml/min, treatment with alfacalcidol can significantly and safely reduce the low CrCl associated increased number of fallers and the high risk of falls.