Effectiveness of fall prevention interventions in the elderly population in a community dwelling: A systematic review

Enquadramento: As quedas nas pessoas idosas representam o principal motivo de admissão ao serviço de urgência, de incapacidade, de institucionalização e morte. Face ao impacte que a queda pode ter na saúde e qualidade de vida da pessoa idosa e aos elevados custos que lhe estão associados, vários programas de intervenção têm sido implementados, visando a sua prevenção no contexto comunitário. O objetivo desta pesquisa foi identificar a evidência produzida sobre os programas/as intervenções que se têm revelado eficazes na prevenção de quedas, em idosos com 75 e mais anos, não institucionalizados. Metodologia: Foi realizada uma revisão sistemática da literatura, conduzida segundo as orientações do grupo Cochrane. Para esta pesquisa foram considerados estudos que cumprissem os seguintes critérios: i) participantes com idade ≥ 75 anos, residentes na comunidade, com capacidade cognitiva e independência nas AVD´s, ii) intervenções únicas ou multifacetadas dirigidas à prevenção das quedas, iii) estudos experimentais, quasi-experimentais (com grupo controlo) e RSL. A pesquisa foi realizada nas bases de dados EBSCO HOST, SCOPUS e Web of Science, entre abril e maio de 2021. Foram considerados ainda estudos em português, inglês e espanhol, publicados após 2015. Para a apresentação da seleção dos estudos recorreu-se ao fluxograma PRISMA. A análise dos estudos, a extração dos dados e a avaliação da qualidade metodológica foi realizada por dois revisores independentes. Resultados: Dos 416 estudos inicialmente identificados, com base nos critérios pré-definidos e após análise dos mesmos, nenhum estudo foi selecionado. Conclusão: A não identificação de estudos primários que respondam à questão orientadora da revisão é um achado relevante para a comunidade científica, pois indicia lacunas no conhecimento sobre a problemática no grupo populacional em estudo. Para uma tomada de decisão baseada na melhor evidência, emerge a necessidade de estudos de desenho experimental, para responder a questões sobre eficácia de uma intervenção terapêutica.Framework: Falls in the elderly represent the main reason for admission to the emergency service, disability, institutionalization and death. Given the impact that a fall can have on the health and quality of life of the elderly and the high costs associated with it, several intervention programs have been implemented, aiming at its prevention in the community context. The objective of this research was to identify the evidence produced about the programs/interventions that have proven to be effective in preventing falls, in non-institutionalized elderly people aged 75 and over. Methodology: A systematic review of the literature was carried out, conducted according to the guidelines of the Cochrane group. For this research, studies that met the following criteria were considered: i) participants aged ≥ 75 years, living in the community, with cognitive capacity and independence in ADLs, ii) single or multifaceted interventions aimed at preventing falls, iii) studies experimental, quasi-experimental (with control group) and RSL. The research was carried out in the EBSCO HOST, SCOPUS and Web of Science databases, between April and May 2021. Studies in Portuguese, English and Spanish, published after 2015 were also considered. PRISMA flowchart. Study analysis, data extraction and assessment of methodological quality were performed by two independent reviewers. Results: Of the 416 studies initially identified, based on predefined criteria and after their analysis, no study was selected. Conclusion: The non-identification of primary studies that answer the guiding question of the review is a relevant finding for the scientific community, as it indicates gaps in knowledge about the problem in the population group under study. For decision-making based on the best evidence, the need for experimental design studies to answer questions about the effectiveness of a therapeutic intervention emerges

Instrumented shoes for daily activity monitoring in healthy and at risk populations

Daily activity reflects the health status of an individual. Ageing and disease drastically affect all dimensions of mobility, from the number of active bouts to their duration and intensity. Performing less activity leads to muscle deterioration and further weakness that could lead to increased fall risk. Gait performance is also affected by ageing and could be detrimental for daily mobility. Therefore, activity monitoring in older adults and at risk persons is crucial to obtain relevant quantitative information about daily life performance. Activity evaluation has mainly been established through questionnaires or daily logs. These methods are simple but not sufficiently accurate and are prone to errors. With the advent of microelectromechanical systems (MEMS), the availability of wearable sensors has shifted activity analysis towards ambulatory monitoring. In particular, inertial measurement units consisting of accelerometers and gyroscopes have shown to be extremely relevant for characterizing human movement. However, monitoring daily activity requires comfortable and easy to use systems that are strategically placed on the body or integrated in clothing to avoid movement hindrance. Several research based systems have employed multiple sensors placed at different locations, capable of recognizing activity types with high accuracy, but not comfortable for daily use. Single sensor systems have also been used but revealed inaccuracies in activity recognition. To this end, we propose an instrumented shoe system consisting of an inertial measurement unit and a pressure sensing insole with all the sensors placed at the shoe/foot level. By measuring the foot movement and loading, the recognition of locomotion and load bearing activities would be appropriate for activity classification. Furthermore, inertial measurement units placed on the foot can perform detailed gait analysis, providing the possibility of characterizing locomotion. The system and dedicated activity classification algorithms were first designed, tested and validated during the first part of the thesis. Their application to clinical rehabilitation of at risk persons was demonstrated over the second part. In the first part of the thesis, the designed instrumented shoes system was tested in standardized conditions with healthy elderly subjects performing a sequence of structured activities. An algorithm based on movement biomechanics was built to identify each activity, namely sitting, standing, level walking, stairs, ramps, and elevators. The rich array of sensors present in the system included a 3D accelerometer, 3D gyroscope, 8 force sensors, and a barometer allowing the algorithm to reach a high accuracy in classifying different activity types. The tuning parameters of the algorithm were shown to be robust to small changes, demonstrating the suitability of the algorithm to activity classification in older adults. Next, the system was tested in daily life conditions on the same elderly participants. Using a wearable reference system, the concurrent validity of the instrumented shoes in classifying daily activity was shown. Additionally, daily gait metrics were obtained and compared to the literature. Further insight into the relationship between some gait parameters as well as a global activity metric, the activity âcomplexityâ, was discussed. Participants positively rated their comfort while using the system... (Please refer to thesis for full abstract