Longitudinal analysis of the relationship between physical function and mortality in ambulatory older men

Background. Low physical performance is an important characteristic of frailty and sarcopenia. In this study, we wanted to assess and compare the predictive value of physical function measurements for all-cause mortality in older men. Methods. Data are from a longitudinal study of a population-based sample of 352 ambulatory older men aged 71 to 86 at study baseline. The Rapid disability rating scale-2, 36-Item short form health survey, Hand grip strength, Five times sit-to-stand test, Standing balance, and Timed Up and Go test were determined at baseline. Associations with all-cause mortality were assessed using Cox proportional hazard analyses. Age, BMI, smoking status, education, physical activity, and cognitive status were included as confounders. Follow-up exceeded 15 years. Results. The mean age of participants was 76 ± 4.2 years. Average follow-up duration was 184 ± 2 months. Seventy-eight percent (273) of the 352 men died during follow-up, with a median survival time of 110 months. All examined physical function measurements were associated with all-cause mortality. The Timed Up and Go test was the best predictor (adjusted HR per SD increase = 1.58, 95% CI = 1.40-1.79, P < 0.001) for global mortality. Conclusions. Our findings demonstrate that physical function measurements are important in the evaluation of older persons. We encourage the use of the Timed Up and Go test as a reliable, quick and feasible screening tool in clinical settings

Is the timed-up and go test feasible in mobile devices? A systematic review

The number of older adults is increasing worldwide, and it is expected that by 2050 over 2 billion individuals will be more than 60 years old. Older adults are exposed to numerous pathological problems such as Parkinson’s disease, amyotrophic lateral sclerosis, post-stroke, and orthopedic disturbances. Several physiotherapy methods that involve measurement of movements, such as the Timed-Up and Go test, can be done to support efficient and effective evaluation of pathological symptoms and promotion of health and well-being. In this systematic review, the authors aim to determine how the inertial sensors embedded in mobile devices are employed for the measurement of the different parameters involved in the Timed-Up and Go test. The main contribution of this paper consists of the identification of the different studies that utilize the sensors available in mobile devices for the measurement of the results of the Timed-Up and Go test. The results show that mobile devices embedded motion sensors can be used for these types of studies and the most commonly used sensors are the magnetometer, accelerometer, and gyroscope available in off-the-shelf smartphones. The features analyzed in this paper are categorized as quantitative, quantitative + statistic, dynamic balance, gait properties, state transitions, and raw statistics. These features utilize the accelerometer and gyroscope sensors and facilitate recognition of daily activities, accidents such as falling, some diseases, as well as the measurement of the subject's performance during the test execution.info:eu-repo/semantics/publishedVersio

Identifying a cut‐off point for normal mobility: a comparison of the timed ‘up and go' test in community‐dwelling and institutionalised elderly women

Background: physical mobility testing is an essential component of the geriatric assessment. The timed up and go test measures basic mobility skills including a sequence of functional manoeuvres used in everyday life. Objectives: to create a practical cut‐off value to indicate normal versus below normal timed up and go test performance by comparing test performance of community‐dwelling and institutionalised elderly women. Setting and participants: 413 community‐dwelling and 78 institutionalised mobile elderly women (age range 65-85 years) were enrolled in a cross‐sectional study. Measurements: timed up and go test duration, residential and mobility status, age, height, weight and body mass index were documented. Results: 92% of community‐dwelling elderly women performed the timed up and go test in less than 12 seconds and all community‐dwelling women had times below 20 seconds. In contrast only 9% of institutionalised elderly women performed the timed up and go test in less than 12 seconds, 42% were below 20 seconds, 32% had results between 20 and 30 seconds and 26% were above 30 seconds. The 10th-90th percentiles for timed up and go test performance were 6.0-11.2 seconds for community‐dwelling and 12.7-50.1 seconds for institutionalised elderly women. When stratifying participants according to mobility status, the timed up and go test duration increased significantly with decreasing mobility (Kruskall‐Wallis‐test: p<0.0001). Linear regression modelling identified residential status (p<0.0001) and physical mobility status (p<0.0001) as significant predictors of timed up and go performance. This model predicted 54% of total variation of timed up and go test performance. Conclusion: residential and mobility status were identified as the strongest predictors of timed up and go test performance. We recommend the timed up and go test as a screening tool to determine whether an in‐depth mobility assessment and early intervention, such as prescription of a walking aid, home visit or physiotherapy, is necessary. Community‐dwelling elderly women between 65 and 85 years of age should be able to perform the timed up and go test in 12 seconds or les

MTUG: an Instrumented Timed Up and Go Extended Test.

Background The aim of this study was to, using the inertial sensor found in the iPhone4®, locate in the ten meter Extended Timed Get Up and Go test the series of kinematic variables deriving from accelerometry and from angular velocity and displacement which show the greatest level of precision in order to discriminate between two groups of elderly persons (frail and physically active) compared to the traditionally used variable, namely time. Methods This study used the transversal analytical approach in an attempt to locate the series of kinematic variables which showed the highest degree of precision in order to discriminate between two groups. Firstly, the differences between the two groups (frail elderly persons and healthy elderly persons) were analyzed using variance analysis. The statistical significance level was established at p<0.05. Secondly, Receiver Operating Characteristic (ROC) curves were drawn up in order to evaluate the level of precision in the predictive capability of the kinematic variables compared to the traditionally used variable, namely time. Results In phases Si-St and T-St-Si, the results indicate that the variables for acceleration showed greater sensitivity in terms of discriminating between the population groups in the study than the angular velocity and displacement data; specifically, they were the minimum acceleration variables in motion axes x, z and y. In sub-phases GG and GC, accelerations in the x axis showed greater discrimination sensitivity between the frail and the controls. For the turning phase, the minimum acceleration variables which obtained area values below the curve greater than for time were the accelerations in the z and y axes. Conclusions The readings deriving from acceleration and angular velocity and displacement during the ETGUG test present a higher degree of precision in discrimination capability between a group of frail and a group of physically active elderly persons, in a more sensitive manner than the variable traditionally used in this test, namely time.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

Uji Tingkat Resiko Jatuh pada Lansia Pasca Stroke dengan Menggunakan Tes Timed Up and Go di Rumah Sakit Al-Huda Kabupaten Banyuwangi

Latar Belakang: Stroke merupakan gangguan suplai darah di otak yang sering disebabkan oleh pecahnya pembuluh darah atau tersumbat oleh gumpalan. Hilangnya kekuatan otot, adanya koordinasi pada satu bagian tubuh saja serta adanya vertigo pada lansia pasca stroke dapat menyebabkan peningkatan resiko jatuh. Jatuh merupakan suatu kejadian yang dilaporkan oleh penderita atau saksi mata yang melihat kejadian sehingga penderita mendadak terbaring atau terduduk dilantai. Untuk mengetahui seberapa besar tingkat resiko jatuh pada lansia pasca stroke digunakan tes yang disebut dengan tes timed up and go. Metode: Penelitian ini menggunakan metode penelitian deskriptif kualitatif. Populasi dalam penelitian ini adalah para lansia pasca stroke yang berada di Rumah Sakit Al-Huda Kabupaten Banyuwangi, dengan jumlah sampel sebanyak 26 lansia. Sampel dalam penelitian ini diperoleh dengan teknik sampling yaitu purposive sampling. Hasil: Hasil analisis dari penelitian uji tingkat resiko jatuh pada lansia pasca stroke dengan menggunakan tes timed up and go didapatkan hasil bahwa 31% lansia pasca stroke mempunyai resiko jatuh yang rendah dan 69% lainnya mempunyai resiko jatuh yang tinggi. Hal ini menunjukkan bahwa tes timed up and go mempunyai nilai validitas yang sangat baik untuk menguji resiko jatuh pada lansia pasca stroke. Kesimpulan: Dari hasil penelitian diatas menunjukkan lansia pasca stroke mempunyai resiko jatuh yang tinggi. Kata Kunci: Stroke, jatuh, timed up and g

Reliability of functional outcome measures in adults with neurofibromatosis 1

Objectives: To determine intra-rater and inter-rater reliability of functional outcome measures in adults with neurofibromatosis 1 (NF1) and to ascertain how closely objective and subjective measures align. Methods: Forty-nine ambulant adults with NF1 aged 16 years and over were included in this observational study. Median age 31 years (range 16-66), 29 females, 20 males. Participants were video-recorded or photographed performing four functional outcome measures. Four raters from the Neurofibromatosis centre multi-disciplinary team independently scored the measures to determine inter-rater reliability. One rater scored the measures a second time on a separate occasion to determine intra-rater reliability. The measures evaluated were the functional reach, timed up and go, ten metre walk and a modified nine-hole peg tests. Participants also completed a disease specific quality of life questionnaire (INF1-QOL). Results: Inter-rater reliability and intra-rater reliability scores (intra-class coefficient, ICC) were similar for each outcome measure. Excellent rater agreement (ICC r ≥ 0.9) was found for the functional reach, timed up and go and the 10 metre walk tests. Rater agreement was good for the modified 9-hole peg test; ICC r= 0.75 for intra-rater reliability and 0.76 for inter-rater reliability. The timed up and go and the 10 metre walk tests correlated highly with perceived mobility challenges in the quality of life questionnaire (INF1-QOL). Conclusions: The functional reach, timed up and go and 10 metre walk tests are potentially useful outcome measures for monitoring NF1 treatment and will be assessed for validity and reliability in future multi-centre studies

Extended Timed Up and Go assessment as a clinical indicator of cognitive state in Parkinson\u27s disease

Objective: To evaluate a modified extended Timed Up and Go (extended-TUG) assessment against a panel of validated clinical assessments, as an indicator of Parkinson’s disease (PD) severity and cognitive impairment. Methods: Eighty-seven participants with idiopathic PD were sequentially recruited from a Movement Disorders Clinic. An extended-TUG assessment was employed which required participants to stand from a seated position, walk in a straight line for 7 metres, turn 180 degrees and then return to the start, in a seated position. The extended-TUG assessment duration was correlated to a panel of clinical assessments, including the Unified Parkinson’s Disease Rating Scale (MDS-UPDRS), Quality of Life (PDQ-39), Scales for Outcomes in Parkinson’s disease (SCOPA-Cog), revised Addenbrooke’s Cognitive Index (ACE-R) and Barratt’s Impulsivity Scale 11 (BIS-11). Results: Extended-TUG time was significantly correlated to MDS-UPDRS III score and to SCOPA-Cog, ACE-R (p\u3c0.001) and PDQ-39 scores (p\u3c0.01). Generalized linear models determined the extended-TUG to be a sole variable in predicting ACE-R or SCOPA-Cog scores. Patients in the fastest extended-TUG tertile were predicted to perform 8.3 and 13.4 points better in the SCOPA-Cog and ACE-R assessments, respectively, than the slowest group. Patients who exceeded the dementia cut-off scores with these instruments exhibited significantly longer extended-TUG times. Conclusions: Extended-TUG performance appears to be a useful indicator of cognition as well as motor function and quality of life in PD, and warrants further evaluation as a first line assessment tool to monitor disease severity and response to treatment. Poor extended-TUG performance may identify patients without overt cognitive impairment form whom cognitive assessment is needed

MTUG: an Instrumented Timed Up and Go Extended Test.

Background The aim of this study was to, using the inertial sensor found in the iPhone4®, locate in the ten meter Extended Timed Get Up and Go test the series of kinematic variables deriving from accelerometry and from angular velocity and displacement which show the greatest level of precision in order to discriminate between two groups of elderly persons (frail and physically active) compared to the traditionally used variable, namely time. Methods This study used the transversal analytical approach in an attempt to locate the series of kinematic variables which showed the highest degree of precision in order to discriminate between two groups. Firstly, the differences between the two groups (frail elderly persons and healthy elderly persons) were analyzed using variance analysis. The statistical significance level was established at p<0.05. Secondly, Receiver Operating Characteristic (ROC) curves were drawn up in order to evaluate the level of precision in the predictive capability of the kinematic variables compared to the traditionally used variable, namely time. Results In phases Si-St and T-St-Si, the results indicate that the variables for acceleration showed greater sensitivity in terms of discriminating between the population groups in the study than the angular velocity and displacement data; specifically, they were the minimum acceleration variables in motion axes x, z and y. In sub-phases GG and GC, accelerations in the x axis showed greater discrimination sensitivity between the frail and the controls. For the turning phase, the minimum acceleration variables which obtained area values below the curve greater than for time were the accelerations in the z and y axes. Conclusions The readings deriving from acceleration and angular velocity and displacement during the ETGUG test present a higher degree of precision in discrimination capability between a group of frail and a group of physically active elderly persons, in a more sensitive manner than the variable traditionally used in this test, namely time.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tec

Effects of a falls exercise intervention on strength, power, functional ability and bone in older frequent fallers: FaME (Falls Management Exercise) RCT secondary analysis

OBJECTIVES: Falls Management Exercise (FaME) has been shown to reduce falls in frequent fallers and in lower risk sedentary older people. The effects of FaME on the strength, power, physical function and bone health of frequently falling older women are yet to be established. METHODS: This paper reports secondary analysis of data from the original randomised controlled trial of FaME in 100 community dwelling women aged ≥65 years with a history of ≥3 falls in the previous year. Intervention was group delivered, weekly one hour tailored dynamic balance and strength exercise classes and home exercise for nine months. OUTCOME MEASURES INCLUDED: strength (handgrip, quadriceps, hamstrings, hip abductors, ankles), lower limb explosive power and functional tests (timed up and go, functional reach, timed floor rise and balance), analysed using Linear Mixed Model analysis. Bone Mineral Density (BMD) at hip and spine was measured in a smaller sub-group and analysed using t-tests. RESULTS: Significant time*group interactions in all measures of strength, except isometric ankle dorsiflexion, concentric hamstring and eccentric quadriceps strength. These improvements in strength equated to average improvements of 7-45%. There were also significant improvements in explosive power (W/kg) (18%, p=0.000), timed up and go (16%, p=0.000), functional reach (17%, p=0.000), floor rise (10%, p=0.002) and eyes closed static balance (56%, p=0.000). There was a significant loss of hip BMD in the control group (neck of femur p&lt;0.05; ward's triangle p&lt;0.02). CONCLUSION: The FaME intervention improves lower limb strength, power and clinically relevant functional outcomes in frequently falling older women

Peak expiratory flow mediates the relationship between handgrip strength and timed up and go performance in elderly women, but not men

OBJECTIVE: The aim of the present study was to verify if there is sex difference in the associations among handgrip strength, peak expiratory flow (PEF) and timed up and go (TUG) test results. METHODS: The sample included 288 consecutive elderly men (n=93) and women (n=195). Functional capacity was measured using the TUG test, and muscle strength was measured based on handgrip. Moreover, as a measure of current health status, PEF was evaluated. Linear regression procedures were performed to analyze the relationships between handgrip and both PEF and TUG test results, with adjustment for confounders, and to identify the possible mediating role of PEF in the association between handgrip strength and TUG test results. RESULTS: In men, handgrip strength was associated with both PEF and TUG performance (p<0.01). After adjustment for PEF, the relationship between handgrip strength and TUG performance remained significant. In women, handgrip strength was also associated with both PEF and TUG performance (p<0.01). However, after adjustment for PEF, the relationship between handgrip strength and TUG performance was no longer significant. CONCLUSION: Mobility in the elderly is sex dependent. In particular, PEF mediates the relationship between handgrip strength and TUG performance in women, but not in men