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Journal of Geriatric Physical Therapy
Journal Prestige (SJR): 0.691  Citation Impact (citeScore): 2 Number of Followers: 14  Hybrid journal (It can contain Open Access articles)ISSN (Print) 1539-8412 - ISSN (Online) 2152-0895 Published by LWW Wolters Kluwer  [297 journals]
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- Editor's Message: The Journal as a “Change AGEnt”: Using Language,
Framing, and Emphasis to Combat Ageism-
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Abstract: No abstract available
PubDate: Fri, 01 Jul 2022 00:00:00 GMT-
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- Skeletal Muscle Adaptations Following 80 Weeks of Resistance Exercise in
Older Adults-
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Authors: Miller; Ryan M.; Bemben, Debra A.; Bemben, Michael G.
Abstract:
Background and Purpose: We followed and documented skeletal muscle adaptations from 4 resistance exercise (RE) prescriptions in older adults over the course of a 2-year, 80-week training study.Methods: Forty-three older men and women—65.2 (3.5) years, 167.2 (7.5) cm, and 72.5 (14.7) kg—completed one of the following RE prescriptions: high-load 2 days per week (HL2D; n = 12), low-load 2 days per week (LL2D; n = 9), high-load 3 days per week (HL3D, n = 12), or low-load 3 days per week (LL3D, n = 10). High-load prescriptions consisted of 3 sets of 8 repetitions with 80% 1-repetition maximum (1-RM) and low-load prescriptions completed 3 sets of 16 repetitions with 40% 1-RM. Each session consisted of 12 exercises targeting major muscle groups and training loads were adjusted every fifth week to maintain progressive overload. Participants completed 40 weeks of supervised training, had a 2-month break, and then resumed another 40 weeks of supervised training. Bone-free lean body mass (BFLBM) and appendicular lean mass (ALM) were assessed via dual-energy x-ray absorptiometry and muscle cross-sectional area (mCSA) of the rectus femoris with diagnostic ultrasound across the intervention.Results and Discussion: Groups responded similarly with significant increases in total strength (54.9%), upper body strength (42.7%), lower body strength (61.5%), and specific strength (50.3%, strength/BFLBM) over 80 weeks (all P < .001). Significant increases for BFLBM (3.0%), ALM (3.5%), and mCSA (48.7%) were also observed (all P ≤ .019). The only difference among groups indicated HL3D displaying significantly greater percent increase than LL2D for ALM (P = .043).Conclusions: Resistance exercise performed 2 or 3 days per week with moderate to heavy loads can improve muscle strength and induce small but perhaps clinically significant increases in BFLBM and mCSA in older adults over a 2-year period of supervised training.
PubDate: Fri, 01 Jul 2022 00:00:00 GMT-
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- Effects of Photobiomodulation/Laser Therapy Combined With Resistance
Training on Quadriceps Hypertrophy and Strength, and Postural Balance in
Older Women: A Randomized, Triple-Blinded, Placebo-Controlled Study-
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Authors: Rodrigues; Claudiane Pedro; Jacinto, Jeferson Lucas; Roveratti, Mirela Casonato; Merlo, Jeanne Karlette; Soares-Caldeira, Lúcio Flávio; Silva Ribeiro, Alex; Nunes, João Pedro; Junior, Eros de Oliveira; Aguiar, Andreo Fernando
Abstract:
Background and Purpose: Physical and therapeutic strategies to maintain and rehabilitate skeletal muscle mass, strength, and postural balance are clinically relevant to improve the health, well-being, and quality of life of older adults. The purpose of this study was to investigate the effects of photobiomodulation (PBM)/laser therapy combined with a resistance training (RT) program on quadriceps hypertrophy and strength, and postural balance in older women.Methods: In a randomized, triple-blinded, placebo-controlled design, twenty-two older women (age 66.6 ± 5.2 years) were engaged in a supervised 10-wk RT program (2 times per week) involving unilateral leg extension exercise, in which each leg of the same participant was randomly assigned to receive active (λ = 808 nm, optical output = 100 mW, total energy = 42 J) or placebo laser PBM immediately before the RT sessions. Maximal dynamic strength by unilateral knee extension 1-repetition maximum (1RM), muscle hypertrophy by vastus lateralis muscle thickness, and postural balance by one-legged stance test on a force platform were assessed before and after the training program.Results: Significance statistical analysis revealed a similar improvement (time P = .003) from pre- to posttraining for muscle hypertrophy and strength, and postural balance between active and placebo laser conditions. However, clinical interpretation for muscle hypertrophy showed a moderate effect (effect size [ES] = 0.58) for the active laser and a small effect (ES = 0.38) for the placebo laser. Clinical difference was not noticed between conditions for other analyzed variables.Conclusions: These findings indicate that RT alone can be clinically important for counteracting the deleterious effects of aging on muscle size, strength, and balance, and that applying laser PBM therapy before the RT sessions may further improve gains in muscle hypertrophy.
PubDate: Fri, 01 Jul 2022 00:00:00 GMT-
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- Construct Validity, Test-Retest Reliability, Sensitivity to Change, and
Feasibility of the Patient-Specific Functional Scale in Acutely
Hospitalized Older Patients With and Without Cognitive Impairment-
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Authors: Heldmann; Patrick; Hummel, Saskia; Bauknecht, Laura; Bauer, Jürgen M.; Werner, Christian
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Background and Purpose: The Patient-Specific Functional Scale (PSFS) is an individualized patient-reported outcome measure designed to assess the limitations and changes in self-determined functional activities most important to an older patient in the acute care setting. However, its clinimetric properties have not yet been evaluated in these patients. The study aimed to investigate the construct validity, test-retest reliability, sensitivity to change, and feasibility of the PSFS in acutely hospitalized older patients with and without cognitive impairment (CI).Methods: The clinimetric properties of the PSFS were investigated by secondary data analysis from a prospective observational cohort study examining physical activity and mobility in acutely hospitalized older patients. In this analysis, 120 older patients—83.0 (6.4) years—with and without CI (Mini-Mental State Examination [MMSE] score 18-23, n = 52, and MMSE ≥24, n = 68, respectively) receiving early multidisciplinary geriatric rehabilitation in acute care were included. Construct validity was assessed by Spearman correlations (rs) with the Activity-specific Balance Confidence Scale (ABC-6), Short Falls Efficacy Scale-International (Short FES-I), EuroQoL-5 Dimensions (EQ-5D), Short Physical Performance Battery (SPPB), de Morton Mobility Index (DEMMI), and Barthel Index (BI); test-retest reliability within 24 hours by intraclass correlation coefficients (ICCs); sensitivity to change by standardized response means (SRMs) calculated for treatment effects, and feasibility by completion rates/times and floor/ceiling effects.Results: The PSFS showed fair to moderate correlations with all construct variables in patients with CI (rs = 0.31 to 0.53). In patients without CI, correlations were fair for the ABC-6, FES-I, EQ-5D, and BI (rs = 0.27 to 0.36 ), but low for the SPPB and DEMMI (rs =−0.04 to 0.14). Test-retest reliability (both: ICC = 0.76) and sensitivity to change (CI: SRM = 1.10, non-CI: SRM = 0.89) were excellent in both subgroups. Excellent feasibility was documented by high completion rates (>94%), brief completion times (
PubDate: Fri, 01 Jul 2022 00:00:00 GMT-
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- Reliability, Validity, and Minimal Detectable Change of the Backward Walk
Test in Older Adults With Dementia-
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Authors: Chan; Wayne L. S.; Cheung, Yue To; Lee, Yin Wing; Teo, Ai Mei; Wo, Hui Kiu; Wong, Yui
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Background and Purpose: The backward walk test (BWT) has been used to evaluate the balance, gait, and fall risk for older adults, but its psychometric properties in older adults with dementia have not been investigated. This study aims to examine the test-retest and interrater reliability, construct and known-group validity, and absolute and relative minimal detectable changes at the 95% level of confidence (MDC95) of the BWT in older adults with dementia.Methods: This study was a cross-sectional study with repeated measures. Thirty older adults with a mean age of 83.3 years and a diagnosis of dementia who were able to walk backward independently for at least 3 m were recruited from day care and residential care units. The BWT was conducted on 3 separate testing occasions within 2 weeks under 2 independent raters using a modified progressive cueing system. The 10-m walk test (10MWT), Berg Balance Scale (BBS), and Timed Up and Go test (TUG) were used to assess the gait, balance, and mobility performances of the participants.Results and Discussion: The BWT had excellent test-retest reliability—intraclass correlation coefficient (ICC) = 0.96—and interrater reliability (ICC = 0.97-0.97) in the participants. Moderate correlations between the BWT and BBS (Spearman's ρ = 0.60) and strong correlations between the BWT and 10MWT (ρ= 0.84) and TUG (ρ=−0.82) were found. The BWT could distinguish between the participants who ambulated with walking aids and those who did not (P = .005). The participants who had experienced a fall in the past year did not differ significantly in the BWT compared with those who had not fallen (P = .36). The absolute and relative MDC95 of the BWT in the participants were 0.10 m/s and 39.3%, respectively.Conclusions: The BWT is reliable and valid in assessing balance and gait performances in older adults with dementia. Further investigation is needed to determine whether the BWT can identify those with an increased risk of falls.
PubDate: Fri, 01 Jul 2022 00:00:00 GMT-
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- Stakeholder and Data-Driven Fall Screen in a Program of All-Inclusive Care
for the Elderly: Quality Improvement Initiative-
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Authors: Gustavson; Allison M.; Falvey, Jason R.; LeDoux, Cherie V.; Stevens-Lapsley, Jennifer E.
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Background and Purpose: The Program of All-Inclusive Care for the Elderly (PACE) delivers community-based long-term care services to low-income, nursing home eligible adults. In the PACE population, one of the most common reasons for hospitalizations is falls. The purpose of this quality improvement study was to create a stakeholder-driven process for developing a fall risk screen and evaluate how well this process discriminated injurious and noninjurious fallers.Methods: The quality improvement design was a prospective, longitudinal data collection for 5 PACE programs in Colorado. Physical therapists collected the Short Physical Performance Battery (SPPB) on participants at least annually. The Kotter practice change framework guided the processes for practice and organizational change in developing and implementing a fall screen.Results and Discussion: An iterative, stakeholder, and data-driven process allowed our team of researchers and a PACE program to establish a fall risk screen to stratify PACE participants. We provided feedback to PACE staff regarding screening rates and results on discrimination of faller status to promote continued uptake of screening and discussion regarding next steps. Rehabilitation therapists screened 66% of the PACE population, and participants were stratified into high risk (1-7 points) or low risk (8-12 points) based on the SPPB. Participants with low SPPB scores had 79% greater risk of a fall (risk ratio [RR] = 1.8; 95% confidence interval [CI], 1.5-2.1) and 86% greater risk of an injurious fall (RR = 1.9; 95% CI, 1.4-2.4), compared with those with high SPPB scores.Conclusions: Our study describes a collaboration to address fall rates in a PACE population. Program of All-Inclusive Care for the Elderly clinicians can use the identified cut-offs to stratify PACE populations at risk for falls and allocate scarce rehabilitation resources efficiently to best serve participants at highest risk, while using less resource-intensive interventions for those at lower risk.
PubDate: Fri, 01 Jul 2022 00:00:00 GMT-
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- Rapid Inhibition Accuracy and Leg Strength Are Required for
Community-Dwelling Older People to Recover Balance From Induced Trips and
Slips: An Experimental Prospective Study-
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Authors: Okubo; Yoshiro; Duran, Lionne; Delbaere, Kim; Sturnieks, Daina L.; Richardson, James K.; Pijnappels, Mirjam; Lord, Stephen R.
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Background and Purpose: Falls can result in bone fractures and disability, presenting a serious threat to quality of life and independence in older adults. The majority of falls in community-living older adults occur while walking and are often caused by trips and slips. The study aimed to identify the specific sensorimotor and psychological factors required for older adults to recover balance from trips and slips.Methods: Forty-one older adults aged 65 to 87 years were assessed on sensorimotor (knee extension strength, proprioception, postural sway, and edge contrast sensitivity), reaction (simple reaction time, stepping, and catching reaction inhibition), and psychological (general anxiety and concern about falling) measures. Using a harness system, participants walked at 90% of their usual pace on a 10-m walkway that could induce trips and slips in concealed and changeable locations. Post-perturbation responses resulting in more than 30% of body weight being recorded by the harness system were defined as falls. Poisson regressions were used to test associations between the sensorimotor, reaction, and psychological measures and number of falls.Results: Fifty-one falls occurred in 25 of 41 participants. Poisson regression revealed body mass index, lower-limb proprioception, knee extension strength, rapid inhibition accuracy, concern about falling, and anxiety were significantly associated with the rate of falls. Other measures including postural sway were not statistically significant. Using stepwise Poisson regression analyses, normalized knee extension strength (rate ratio [RR]: 0.68, 95% confidence interval [CI]: 0.47-0.98), and rapid inhibition accuracy (RR: 0.64, 95% CI: 0.46-0.87) were independently associated with falls.Conclusion: Our findings suggest rapid inhibition accuracy and adequate leg strength are required for older adults to recover balance from trips and slips. The mechanisms for balance recovery during daily life activities are likely different from those for static balance, suggesting the need for task-specific assessments and interventions for fall prevention in older adults.
PubDate: Fri, 01 Jul 2022 00:00:00 GMT-
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- Older Adults' Perceptions Regarding the Role of Physical Therapists in
Fall Prevention: A Qualitative Investigation-
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Authors: Vincenzo; Jennifer L.; Patton, Susan Kane; Lefler, Leanne L.; Falvey, Jason R.; McElfish, Pearl A.; Curran, Geoffrey; Wei, Jeanne
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Background and Purpose: Falls are a leading cause of injury, morbidity, and mortality among older adults. Physical therapists are underutilized for fall prevention despite strong evidence and recommendations regarding their effectiveness. The purpose of this study was to explore older adults' awareness of and perceptions regarding the role of physical therapists for fall prevention. A secondary purpose of the study was to identify barriers to utilization of preventive rehabilitation services.Methods: A qualitative, descriptive, phenomenological approach was used. Participant demographics and fall history were obtained with a standard questionnaire. Four focus groups were conducted with 27 community-dwelling older adults (average age = 78 years). Focus groups were recorded, transcribed, and coded using thematic analysis.Results: Surveys indicated 37% of participants experienced a fall in the last year and 26% reported sustaining an injury. Four main themes and 5 subthemes about older adults' perceptions of physical therapy providers emerged: (1) awareness of fall prevention (subthemes: I can or have taken action to prevent falls, I don't think about it, and I am more careful); (2) learning how to fall and being able to get up from the floor; (3) limited knowledge regarding the role of physical therapists for fall prevention; and (4) a physical therapist should be seen for a specific problem, or after a fall (subthemes: perceived need and costs, and access requires a doctor's prescription).Conclusion: Older adults lack awareness about the role of physical therapists for fall prevention, believing they should only seek treatment from a physical therapist to address a specific problem, or after a fall. The profession should consider addressing misconceptions and underutilization by educating the public that physical therapists can and do play an important role in the prevention of falls. Being explicit about the prevention of falls throughout an older adults' episode of care may further help reinforce the role of physical therapists for fall prevention and improve dissemination of this knowledge.
PubDate: Fri, 01 Jul 2022 00:00:00 GMT-
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- Mobility Limitation in Older Adults Residing in Nursing Homes in Brazil
Associated With Advanced Age and Poor Nutritional Status: An Observational
Study-
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Authors: Torres de Araújo; José Rodolfo; Macedo Ferreira, Lidiane Maria de Brito; Jerez-Roig, Javier; Costa de Lima, Kenio
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Background and Purpose: Mobility is a basic human need, and its limitation compromises health status, especially in older adults from developing countries and residing in nursing homes. This study aims to determine the prevalence and factors associated with mobility limitation in older adults residing in nursing homes.Methods: A cross-sectional study was conducted with 305 older adults (≥60 years) residing in 10 nursing homes in Northeast Brazil. Mobility limitation was evaluated using the “walking” item of the Barthel index. Sociodemographic/economic data concerning the participants and institutions, as well as conditions that could influence the mobility state of the older adults, were collected. The χ2 test and multiple logistic regression were performed using a significance level of 5%.Results and Discussion: The prevalence of mobility limitation was 65.6% (95% confidence interval [CI], 59.6-70.4). Walking dependence was identified in 39.7% of the sample (26.9% wheelchair users and 12.8% bedridden), while 25.9% walked with assistance (16.7% with maximal assistance and 9.2% with minimal assistance). Mobility limitation was significantly associated with malnutrition/risk of malnutrition (1.86, 95% CI, 1.54-2.26, P < .001) and age ≥81 years (1.35, 95% CI, 1.12-1.63, P = .002).Conclusion: Mobility limitation has a high prevalence among older adults residing in nursing homes in Brazil, and is associated with advanced age and poor nutritional status. Health professionals should advocate for the maintenance of mobility and adequate nutritional support.
PubDate: Fri, 01 Jul 2022 00:00:00 GMT-
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- Physical Therapy and Health Care Utilization for Older Adults With Lumbar
Spinal Stenosis-
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Authors: Schmidt; Catherine T.; Ogarek, Jessica; Resnik, Linda
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Background and Purpose: Lumbar spinal stenosis (LSS) is associated with high health care utilization for older adults. Physical therapy (PT) offers low medical risk and reduced cost burden with functional outcomes that appear to be equivalent to higher risk interventions such as surgery. However, it is unknown whether receipt of PT following incident LSS diagnosis is associated with reduced health care utilization. The objectives of this study were to: (1) compare health characteristics for Medicare beneficiaries who received outpatient PT within 30 days of incident LSS diagnosis to those who did not; (2) compare the 1-year utilization rates for specific health care services for these 2 groups; and (3) quantify the likelihood of progression to specific health services based on the receipt of PT.Methods: This was a retrospective cohort study using nationally representative claims data for Medicare Part B beneficiaries between 2007 and 2010. Lumbar spinal stenosis was determined using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. Beneficiaries 65 years and older were classified into 2 groups (PT and no PT) based on receipt of PT within 30 days of initial diagnosis. Baseline characteristics were identified at incident diagnosis. Hazard ratios (HRs) were estimated for the risk of receiving health services outcomes including spinal surgery, spinal injections, chiropractic care, advanced imaging, spinal radiographs, opioid medication, nonopioid analgesics, and hospitalizations beginning on day 31 up to 1 year following incident LSS diagnosis.Results and Discussion: Among 60 646 Medicare beneficiaries with incident LSS who met the inclusion criteria, 1124 were classified in the PT group and 59 522 in the no PT group. Compared with the PT group, beneficiaries in the no PT group had a greater risk of having hospitalizations (HR = 1.40), opioid medications (HR = 1.29), spinal surgery (HR = 1.29), and spinal radiographs (HR = 1.19) within 1 year.Conclusions: Fewer than 2% of Medicare beneficiaries received PT within 30 days of initial LSS diagnosis. Receipt of PT was associated with less utilization of higher risk and costly health services for 1 year. These results may inform practitioners when making early decisions about rehabilitative care for older adults with LSS.
PubDate: Fri, 01 Jul 2022 00:00:00 GMT-
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