Assessing Gait & Balance in Adults with Mild Balance Impairment:G&B App Reliability and Validity

Smartphone applications (apps) that utilize embedded inertial sensors have the potential to provide valid and reliable estimations of different balance and gait parameters in older adults with mild balance impairment. This study aimed to assess the reliability, validity, and sensitivity of the Gait&amp;Balance smartphone application (G&amp;B App) for measuring gait and balance in a sample of middle- to older-aged adults with mild balance impairment in Pakistan. Community-dwelling adults over 50 years of age (N = 83, 50 female, range 50-75 years) with a Berg Balance Scale (BBS) score between 46/56 and 54/56 were included in the study. Data collection involved securing a smartphone to the participant's lumbosacral spine. Participants performed six standardized balance tasks, including four quiet stance tasks and two gait tasks (walking looking straight ahead and walking with head turns). The G&amp;B App collected accelerometry data during these tasks, and the tasks were repeated twice to assess test-retest reliability. The tasks in quiet stance were also recorded with a force plate, a gold-standard technology for measuring postural sway. Additionally, participants completed three clinical measures, the BBS, the Functional Reach Test (FRT), and the Timed Up and Go Test (TUG). Test-retest reliability within the same session was determined using intraclass correlation coefficients (ICCs) and the standard error of measurement (SEM). Validity was evaluated by correlating the G&amp;B App outcomes against both the force plate data and the clinical measures using Pearson's product-moment correlation coefficients. To assess the G&amp;B App's sensitivity to differences in balance across tasks and repetitions, one-way repeated measures analyses of variance (ANOVAs) were conducted. During quiet stance, the app demonstrated moderate reliability for steadiness on firm (ICC = 0.72) and compliant surfaces (ICC = 0.75) with eyes closed. For gait tasks, the G&amp;B App indicated moderate to excellent reliability when walking looking straight ahead for gait symmetry (ICC = 0.65), walking speed (ICC = 0.93), step length (ICC = 0.94), and step time (ICC = 0.84). The TUG correlated with app measures under both gait conditions for walking speed (r -0.70 and 0.67), step length (r -0.56 and -0.58), and step time (r 0.58 and 0.50). The BBS correlated with app measures of walking speed under both gait conditions (r 0.55 and 0.51) and step length when walking with head turns (r = 0.53). Force plate measures of total distance wandered showed adequate to excellent correlations with G&amp;B App measures of steadiness. Notably, G&amp;B App measures of walking speed, gait symmetry, step length, and step time, were sensitive to detecting differences in performance between standard walking and the more difficult task of walking with head turns. This study demonstrates the G&amp;B App's potential as a reliable and valid tool for assessing some gait and balance parameters in middle-to-older age adults, with promise for application in low-income countries like Pakistan. The app's accessibility and accuracy could enhance healthcare services and support preventive measures related to fall risk.</p

Prediction of Post Stroke recovery: Artificial intelligence could be a key of success

Madam, Stroke is a leading cause of death and disability around the globe and particularly in low- and middle-income countries, and this burden is increasing. (1) Its incidence in Pakistan, is also increasing daily and shares a significant burden by contributing to an exponential expenditure of resources, finances, community manpower, health services and overall economy. (2) Overall disability burden can be reduced remarkably, if early recovery prediction can be formulated for stroke parameters such as upper limb impairment, swallowing, Shoulder Abduction and Finger Extension (SAFE) score, Motor Evoked Potential (MEP) status, National Institute of Health Stroke Scale (NIHSS) scoring. Existing relevant evidences for the early prediction of stroke recovery, reported the use of blood biomarker as an objective indicator. And among them, some serve as a guide in decision-making for clinical practice, such as: Brain natriuretic peptide (BNP), D-Dimer, and have potential in improving the diagnosis and the management of patients with stroke. MRI findings have also made an accurate prognosis about behavioral outcomes after stroke based on the severity of cognitive impairments. (3) For predicting recovery after stroke, various algorithms approaches have also been done since last 10 years and among Predict Recovery Potential (PREP2), (GRAVo) and (PRESS) models of prediction, studies have supported that the PREP2 algorithm was regarded as potentially valid.  To date, only one approach has combined biomarkers within the first few days after stroke to make predictions for individual patients. The Predict Recovery Potential (PREP) algorithm predicts upper-limb functional outcomes by combining biomarkers, neurophysiological and neuroimaging measures to make a prognosis. PREP2 algorithm is probably the easiest approach to operationalize among predictive models and serves as a benchmark for predicting motor recovery after stroke. (4) So, till now, there is no consensus among both clinicians and scientists on how to apply a specific predictive model in clinical routine or research protocols, in which biological and psycho-social factors can be collectively incorporated with Artificial intelligence. Hence these steps are mandatory to be implemented in predictive models considering all the factors mentioned above- and including other factors like cost, knowledge, interface development, resources, time and expertise of both scientists and clinicians. ---Continu

Walking related performance fatigability in persons with knee osteoarthritis; an important yet neglected outcome

Published in May - 202

Effects of glucosamine and chondroitin sulfate supplementation in addition to resistance exercise training and manual therapy in patients with knee osteoarthritis: a randomized controlled trial

Objective: To determine the added benefits of short-term glucosamine and chondroitin sulfate supplementation in combination with manual therapy and resistance exercise training in the management of knee osteoarthritis. Method: The parallel-design, double-blind randomised controlled trial was conducted from January to September 2020 at the Foundation University Institute of Rehabilitation Sciences and Fauji Foundation Hospital, Rawalpindi, Pakistan, and comprised knee osteoarthritis patients of either gender having radiological evidence of grade III or less on Kellgren classification. The subjects were randomly allocated experimental group A and control group B. Both the groups received manual therapy and resistance exercise training, while group A additionally received glucosamine and chondroitin sulfate supplementation for 4 weeks. Study outcomes included pain, function, quality of life, range of motion, strength, fall risk, skeletal muscle mass, visceral fat area, body fat, intracellular water ratio, and segmental lean and fat mass. Data was analysed using SPSS 21. Results: Of the 24 subjects, there were 12(50%) in each of the two groups. Both groups had 9(75%) men and 3(25%) women. In terms knee osteoarthritis grade, there was no significant difference between the groups (p=1.00). No significant differences were observed in any of the outcome measures neither at the halfway mark, nor post-intervention between the groups (p>0.05) except for percentage change in segmental lean mass of the right leg at the 2nd week and of the left leg at the 4th week (p<0.05). ---Continu

Body composition profiling and obesity analysis of healthy adults: a cross-sectional study

Obesity as depicted by changes in the body composition is considered a global epidemic of the 21st century, predisposing to cardiometabolic diseases. This analytical cross-sectional study evaluated body composition parameters in both genders and conducted an obesity analysis of healthy adult Pakistani population. Using non-probability purposive sampling technique, data was collected from 205 healthy adults (aged 18-45 years), who had not been participating in any structured exercise or dietary regime over the last six months. Body composition was assessed using bioelectrical impedance analyser. For data analysis, descriptive statistics, Mann-Whitney U-test and one-sample T-test were applied. The mean body mass index was 24.3±4.93 kg/m2. Body composition components which were significantly higher in males included soft lean mass, fat-free mass index, skeletal muscle mass index and bone mineral content, whereas females had significantly higher percentage of body fat (PBF), visceral fat area and fat mass index (p<0.05). ---Continu

Scoping review of existing evaluations of smokeless tobacco control policies: What is known about countries covered, level of jurisdictions, target groups studied and instruments evaluated?

OBJECTIVE: The implementation of smokeless tobacco control policies lags behind those for smoking. This scoping review summarises the studies that evaluated public policies on smokeless tobacco regulation (SLT) and provides an overview of the jurisdictional level, target groups and policy instruments. METHODS: Seven databases were systematically searched for studies reporting on public policies regulating SLT. All studies were independently screened by two reviewers. Data extraction was performed using a predefined extraction form. Extraction was replicated for 10% of the identified studies for quality assurance. A narrative synthesis of the included studies was used to analyse and interpret the data. The protocol was published beforehand with the OSF. RESULTS: 40 articles comprising 41 studies were included. Most of the studies reported in the articles were conducted in the USA (n=17) or India (n=14). Most studies reported outcomes for students (n=8), retailers/sellers (n=8) and users/former users (n=5). The impact of public policies on smokeless tobacco use in general was most frequently assessed (n=9), followed by the impact of taxes (n=7), product bans (n=6), sales/advertising bans near educational institutions (n=4) and health warnings (n=3) on consumer behaviour. CONCLUSIONS: There are major gaps in the evaluation of smokeless tobacco regulation studies that need to be filled by further research to understand the observed outcomes. WHO reporting on FCTC implementation should be linked to studies evaluating smokeless tobacco control measures at all levels of jurisdictions and in countries that are not members of the WHO FCTC or do not provide data. IMPLICATION: Large gaps in the evaluation of SLT control policies exists. For some countries, WHO FCTC evaluations are available for different levels of jurisdictions. In countries with a strong federal structure, there is a lack of data that goes beyond the national level to provide a more detailed look at compliance, indirect effects or implementation gaps. More research is needed at all levels of jurisdictions, that add to the work of the WHO to understand what works for which target group, how the different levels of jurisdiction interact, how the real-world context can be incorporated, and what indirect effects may occur

Additional file 2: of Behaviour change intervention for smokeless tobacco cessation: its development, feasibility and fidelity testing in Pakistan and in the UK

Data on fidelity to Behavioural Change Intervention. (PDF 79 kb