Adaptability to Balance Perturbations During Walking as a Potential Marker of Falls History in Older Adults

Given that falls most commonly occur during walking due to unexpected balance perturbations like trips and slips, walking-based balance assessment including walking stability and adaptability to such perturbations could be beneficial for fall risk assessment in older adults. This cross-sectional study reanalyzed data from two larger studies conducted with the same walking protocol. Participants completed unperturbed walking trials at speeds of 0.4 m/s up to 1.8 m/s in 0.2 m/s steps. Ten unannounced treadmill belt acceleration perturbations were then applied while participants walked at equivalent stability, assessed using the margins of stability. Retrospective (12 months) falls incidence was collected to divide participants into people with and without a history of falls. Twenty older adults (mean age 70.2 ± 2.9 years) were included in this analysis; eight people with one or more recent falls and 12 people without, closely matched by sex, age and height. No significant differences were found in unperturbed walking parameters or their variability. Overall perturbation-recovery step behavior differed slightly (not statistically significant) between the groups after the first perturbation and differences became more pronounced and significant after repetition of perturbations. The No-Falls group significantly reduced the number of recovery steps needed across the trials, whereas the Falls group did not show these improvements. People with a previous fall tended to have slightly delayed and more variable recovery responses after perturbation compared to non-fallers. Non-fallers demonstrate more signs of adaptability to repeated perturbations. Adaptability may give a broader indication of the ability of the locomotor system to respond and improve responses to sudden walking perturbations than unperturbed walking variability or recovery to a single novel perturbation. Adaptability may thus be a more useful marker of falls history in older adults and should be considered in further research

Reduced muscle strength, exercise intolerance and disabling symptoms in sarcoidosis

Purpose of review: This review focuses on innovations in the field of assessment and treatment of muscle weakness and exercise intolerance in sarcoidosis and the association between these and fatigue, dyspnea and quality of life (QoL). Recent findings: Muscle strength and exercise intolerance are prevalent in patients with sarcoidosis. Exercise testing can be used to identify the presence of strength deficits and exercise intolerance. Routinely performed clinical tests, including lung function tests and imaging methods, are only weakly related to these nonspecific health complaints. Assessment of exercise capacity might also be useful for the early detection of parenchymal involvement and diagnosis of sarcoidosis-associated pulmonary hypertension. Both muscle weakness and exercise intolerance have been suggested as underlying causes of fatigue and dyspnea complaints, resulting in reduced QoL. Research is required to find out whether a multidisciplinary rehabilitation program is of clinical benefit in the management of sarcoidosis patients. Summary: This review underlines the added value of physical testing in the management of sarcoidosis patients, especially in those with unexplained physical complaints

Criterion Validity and Responsiveness of the Steep Ramp Test to Evaluate Aerobic Capacity in Survivors of Cancer Participating in a Supervised Exercise Rehabilitation Program

Objective: To evaluate the criterion validity and responsiveness of the steep ramp test (SRT) compared with the cardiopulmonary exercise test (CPET) in evaluating aerobic capacity in survivors of cancer participating in a rehabilitation program.Design: A prospective cohort study in which survivors of cancer performed an SRT and CPET before (T=0) and after (T=1) a 10-week exercise rehabilitation program. Peak work rate achieved during the SRT (SRT-WRpeak) was compared with peak oxygen consumption measured during the CPET (CPET-VO(2)peak), which is the criterion standard for aerobic capacity. Correlation coefficients were calculated between SRT-WRpeak and CPET-VO(2)peak at T=0 to examine criterion validity and between changes in SRT-WRpeak and CPET-VO(2)peak from T=0 to T=1 to determine responsiveness. Receiver operating characteristic analysis was performed to examine the ability of the SRT to detect a true improvement (6%) in CPET-VO(2)peak.Setting: University medical center.Participants: Survivors of cancer (N=106).Interventions: Exercise rehabilitation.Main Outcome Measures: Correlation coefficients between CPET-VO2peak and SRT-WRpeak and between changes in CPET-VO2peak and SRTWRpeak.Results: An r of 0.86 (N=106) was found for the relation between SRT-WRpeak and CPET-VO(2)peak at T=0. An r of 0.51 was observed for the relation between changes in SRT-WRpeak and CPET-VO(2)peak (n=59). Receiver operating characteristic analysis showed an area under the curve of 0.74 for the SRT to detect a true improvement in CPET-VO(2)peak, with an optimal cutoff value of +0.26 W/kg (sensitivity 70.7%, specificity 66.7%).Conclusions: Because SRT-WRpeak and CPET-VO(2)peak were strongly correlated, the SRT seems a valid tool to estimate aerobic capacity in survivors of cancer. The responsiveness to measure changes in aerobic capacity appears moderate. Nevertheless, the SRT seems able to detect improvement in aerobic capacity, with a cutoff value of 0.26 W/kg. (C) 2021 The Authors. Published by Elsevier Inc. on behalf of The American Congress of Rehabilitation Medicine

Conservative management of proximal humeral fractures: can poor functional outcome be related to standard transscapular radiographic evaluation?

HYPOTHESIS: Functional outcome after conservative management is predicted by changes in angulation of the fractured humeral head and can be used for individual patients to predict functional outcome. MATERIALS AND METHODS: Standard anteroposterior (AP) and transscapular (Y) radiographs were used to evaluate 55 patients with minimally displaced proximal humeral fractures during the first week of conservative treatment. Functional outcome was determined by the Constant-Murley and Disabilities of Arm, Shoulder and Hand (DASH) scores. The relationship between the variables and the radiographic evaluation was assessed by the Pearson correlation coefficient. Receiver operator curve (ROC) analysis and logistic regression analysis defined the optimal value for abnormalities on radiographic evaluation as an outcome predictor. RESULTS: Mean (SD) angulations at time of the fracture were 53 degrees (19 degrees ) on AP view and 59 degrees (21 degrees ) on Y-view. After 1 week, these angulations were 47 degrees (20 degrees ) and 62 degrees (21 degrees ), respectively. Significant correlations between Constant-Murley (R(2)=0.43, P=.007) and DASH (R(2)=0.43, P=.04) outcome scores and the angulation of the humeral head fragment on the Y view, and not with AP angulation were found. The optimum predictive angulation at the Y view at time of fracture was 55 degrees or less for predicting adverse functional outcome with an area under the ROC curve of 0.78 (95% confidence interval [CI], 0.64-0.93; P=.006). Regression analysis showed that angulations on the initial Y view and after 1 week were the most important predictors of the functional outcome at a median of 2.2 years of follow-up. CONCLUSION: This study indicated that radiographic evaluation in patients with minimally displaced proximal humeral fractures is helpful in prediction functional outcome during conservative treatment