App-based Self-administrable Clinical Tests of Physical Function: Development and Usability Study

BACKGROUND: Objective measures of physical function in older adults are widely used to predict health outcomes such as disability, institutionalization, and mortality. App-based clinical tests allow users to assess their own physical function and have objective tracking of changes over time by use of their smartphones. Such tests can potentially guide interventions remotely and provide more detailed prognostic information about the participant's physical performance for the users, therapists, and other health care personnel. We developed 3 smartphone apps with instrumented versions of the Timed Up and Go (Self-TUG), tandem stance (Self-Tandem), and Five Times Sit-to-Stand (Self-STS) tests. OBJECTIVE: This study aimed to test the usability of 3 smartphone app-based self-tests of physical function using an iterative design. METHODS: The apps were tested in 3 iterations: the first (n=189) and second (n=134) in a lab setting and the third (n=20) in a separate home-based study. Participants were healthy adults between 60 and 80 years of age. Assessors observed while participants self-administered the tests without any guidance. Errors were recorded, and usability problems were defined. Problems were addressed in each subsequent iteration. Perceived usability in the home-based setting was assessed by use of the System Usability Scale, the User Experience Questionnaire, and semi-structured interviews. RESULTS: In the first iteration, 7 usability problems were identified; 42 (42/189, 22.0%) and 127 (127/189, 67.2%) participants were able to correctly perform the Self-TUG and Self-Tandem, respectively. In the second iteration, errors caused by the problems identified in the first iteration were drastically reduced, and 108 (108/134, 83.1%) and 106 (106/134, 79.1%) of the participants correctly performed the Self-TUG and Self-Tandem, respectively. The first version of the Self-STS was also tested in this iteration, and 40 (40/134, 30.1%) of the participants performed it correctly. For the third usability test, the 7 usability problems initially identified were further improved. Testing the apps in a home setting gave rise to some new usability problems, and for Self-TUG and Self-STS, the rates of correctly performed trials were slightly reduced from the second version, while for Self-Tandem, the rate increased. The mean System Usability Scale score was 77.63 points (SD 16.1 points), and 80-95% of the participants reported the highest or second highest positive rating on all items in the User Experience Questionnaire. CONCLUSIONS: The study results suggest that the apps have the potential to be used to self-test physical function in seniors in a nonsupervised home-based setting. The participants reported a high degree of ease of use. Evaluating the usability in a home setting allowed us to identify new usability problems that could affect the validity of the tests. These usability problems are not easily found in the lab setting, indicating that, if possible, app usability should be evaluated in both settings. Before being made available to end users, the apps require further improvements and validation

Quantification of outdoor mobility by use of accelerometer-measured physical behaviour

Hip fractures in older persons are associated with both low levels of daily physical activity and loss of outdoor mobility. The aim of this study was to investigate if accelerometer-based measures of physical behaviour can be used to determine if people undertake outdoor walking and to provide reference values for physical behaviour outcomes related to outdoor mobility in this population. Older persons (n=245) aged ≥70 years one year after hip fracture participated. Six objective outcome measures of physical behaviour collected by a thigh-mounted activity monitor were compared with self-reported outdoor mobility assessed with the Nottingham Extended ADL scale. All measures of time and length in upright (standing and walking) were significantly lower in participants who reported not to walk outdoors (p<0.001). A set of cut-off points for the different physical behaviour variables was generated. Maximum length of upright events discriminated best between groups, with 31 minutes as a threshold to determine if a person is more likely to report that they walk outdoors (sensitivity: 0.805, specificity: 0.704, AUC: 0.871), or 41 minutes or more to determine if a person is more likely to report outdoor walk on their own (sensitivity: 0.802, specificity: 0.833, AUC: 0.891). Physical behaviour variables from activity monitoring can provide information about patterns of physical behaviour related to outdoor activity performance

Comprehensive geriatric care for patients with hip fractures: a prospective, randomised, controlled trial

Background: Most patients with hip fractures are characterised by older age (>70 years), frailty, and functional deterioration, and their long-term outcomes are poor with increased costs. We compared the effectiveness and cost-effectiveness of giving these patients comprehensive geriatric care in a dedicated geriatric ward versus the usual orthopaedic care. Methods: We did a prospective, single-centre, randomised, parallel-group, controlled trial. Between April 18, 2008, and Dec 30, 2010, we randomly assigned home-dwelling patients with hip-fractures aged 70 years or older who were able to walk 10 m before their fracture, to either comprehensive geriatric care or orthopaedic care in the emergency department, to achieve the required sample of 400 patients. Randomisation was achieved via a web-based, computer-generated, block method with unknown block sizes. The primary outcome, analysed by intention to treat, was mobility measured with the Short Physical Performance Battery (SPPB) 4 months after surgery for the fracture. The type of treatment was not concealed from the patients or staff delivering the care, and assessors were only partly masked to the treatment during follow-up. This trial is registered with ClinicalTrials.gov, number NCT00667914. Findings: We assessed 1077 patients for eligibility, and excluded 680, mainly for not meeting the inclusion criteria such as living in a nursing home or being aged less than 70 years. Of the remaining patients, we randomly assigned 198 to comprehensive geriatric care and 199 to orthopaedic care. At 4 months, 174 patients remained in the comprehensive geriatric care group and 170 in the orthopaedic care group; the main reason for dropout was death. Mean SPPB scores at 4 months were 5·12 (SE 0·20) for comprehensive geriatric care and 4·38 (SE 0·20) for orthopaedic care (between-group difference 0·74, 95% CI 0·18–1·30, p=0·010). Interpretation: Immediate admission of patients aged 70 years or more with a hip fracture to comprehensive geriatric care in a dedicated ward improved mobility at 4 months, compared with the usual orthopaedic care. The results suggest that the treatment of older patients with hip fractures should be organised as orthogeriatric care.måsjekke

Robustness of In-Laboratory and Daily-Life Gait Speed Measures over One Year in High Functioning 61- To 70-Year-Old Adults

Introduction: Gait speed is a simple and safe measure with strong predictive value for negative health outcomes in clinical practice, yet in-laboratory gait speed seems not representative for daily-life gait speed. This study aimed to investigate the interrelation between and robustness of in-laboratory and daily-life gait speed measures over 12 months in 61- to 70-year-old adults. Methods: Gait speed was assessed in laboratory through standardized stopwatch tests and in daily life by 7 days of trunk accelerometry in the PreventIT cohort, at baseline, and after 6 and 12 months. The interrelation was investigated using Pearson's correlations between gait speed measures at each time point. For robustness, changes over time and variance components were assessed by ANOVA and measurement agreement over time by Bland-Altman analyses. Results: Included were 189 participants (median age 67 years [interquartile range: 64-68], 52.2% females). In-laboratory and daily-life gait speed measures showed low correlations (Pearson's r = 0.045-0.455) at each time point. Moreover, both in-laboratory and daily-life gait speed measures appeared robust over time, with comparable and smaller within-subject than between-subject variance (range 0.001-0.095 m/s and 0.032-0.397 m/s, respectively) and minimal differences between measurements over time (Bland-Altman) with wide limits of agreement (standard deviation of mean difference range: 0.12-0.34 m/s). Discussion/Conclusion: In-laboratory and daily-life gait speed measures show robust assessments of gait speed over 12 months and are distinct constructs in this population of high-functioning adults. This suggests that (a combination of) both measures may have added value in predicting health outcomes

Tailored implementation of national recommendations on fall prevention among older adults in municipalities in Norway (FALLPREVENT trial): a study protocol for a cluster-randomised trial

Background: Despite substantial research evidence indicating the effectiveness of a range of interventions to pre- vent falls, uptake into routine clinical practice has been limited by several implementation challenges. The complexity of fall prevention in municipality health care underlines the importance of flexible implementation strategies tailored both to general determinants of fall prevention and to local contexts. This cluster-randomised trial (RCT) investigates the effectiveness of a tailored intervention to implement national recommendations on fall prevention among older home-dwelling adults compared to usual practice on adherence to the recommendations in health professionals.Methods: Twenty-five municipalities from four regions in Norway will be randomised to intervention or control arms. Each municipality cluster will recruit up to 30 health professionals to participate in the study as responders. The tailored implementation intervention comprises four components: (1) identifying local structures for implementation, (2) establishing a resource team from different professions and levels, (3) promoting knowledge on implementation and fall prevention and (4) supporting the implementation process. Each of these components includes several implementation activities. The Consolidated Framework for Implementation Research (CFIR) will be used to categorise determinants of the implementation process and the Expert Recommendations for Implementing Change (ERIC) will guide the matching of barriers to implementation strategies. The primary outcome measure for the study will be health professionals’ adherence to the national recommendations on fall prevention measured by a questionnaire. Secondary outcomes include injurious falls, the feasibility of the intervention, the experiences of the implementation process and intervention costs. Measurements will be carried out at baseline in August 2023, post-intervention in May 2024 and at a follow-up in November 2024.Discussion: This study will provide evidence on the effectiveness, intervention costs and underlying processes of change of tailored implementation of evidence-based fall prevention recommendations.Trial registration: The trial is registered in the Open Science Registry: https://doi.org/10.17605/OSF.IO/JQ9T5. Regis- tered: March 03, 2023.<br/

The fine structure of the comparative

The paper provides evidence for a more articulated structure of the comparative as compared with the one in Bobaljik (2012). We propose to split up Bobaljik's cmpr head into two distinct heads, C1 and C2. Looking at Czech, Old Church Slavonic and English, we show that this proposal explains a range of facts about suppletion and allomorphy. A crucial ingredient of our analysis is the claim that adjectival roots are not a-categorial, but spell out adjectival functional structure. Specifically, we argue that adjectival roots come in various types, differing in the amount of functional structure they spell out. In order to correctly model the competition between roots, we further introduce a Faithfulness Restriction on Cyclic Override, which allows us to dispense with the Elsewhere Principle

The long-term effect of being treated in a geriatric ward compared to an orthopaedic ward on six measures of free-living physical behavior 4 and 12 months after a hip fracture - a randomised controlled trial

Background This study is part of the Trondheim Hip Fracture Trial, where we compared free-living physical behavior in daily life 4 and 12 months following hip surgery for patients managed with comprehensive geriatric care (CGC) in a geriatric ward with those managed with orthopedic care (OC) in an orthopedic ward. Methods This is a single centre, prospective, randomized controlled trial. 397 hip fracture patients were randomized to CGC (n = 199) or OC (n = 198) in the Emergency Department with follow-up assessments performed four and 12 months post-surgery. Outcomes were mean upright time, number and length of upright events recorded continuously for four days at four and 12 months post-surgery by an accelerometer-based activity monitor. Missing data were handled by multiple imputation and group differences assessed by linear regression with adjustments for gender, age and fracture type. Results There were no group differences in participants’ pre-fracture characteristics. Estimated group difference in favor of CGC in upright time at 4 months was 34.6 min (17.4 %, CI 9.6 to 59.6, p = .007) and at 12 months, 27.7 min (13.9 %, CI 3.5 to 51.8, p = .025). Average and maximum length of upright events was longer in the CGC (p’s &lt; .042). No group difference was found for number of upright events (p’s &gt; .452). Conclusion Participants treated with CGC during the hospital stay improved free-living physical behavior more than those treated with OC both 4 and 12 months after surgery, with more time and longer periods spent in upright. Results support findings from the same study for functional outcomes, and demonstrate that CGC impacts daily life as long as one year after surgery

Walking on common ground: a cross-disciplinary scoping review on the clinical utility of digital mobility outcomes

Physical mobility is essential to health, and patients often rate it as a high-priority clinical outcome. Digital mobility outcomes (DMOs), such as real-world gait speed or step count, show promise as clinical measures in many medical conditions. However, current research is nascent and fragmented by discipline. This scoping review maps existing evidence on the clinical utility of DMOs, identifying commonalities across traditional disciplinary divides. In November 2019, 11 databases were searched for records investigating the validity and responsiveness of 34 DMOs in four diverse medical conditions (Parkinson’s disease, multiple sclerosis, chronic obstructive pulmonary disease, hip fracture). Searches yielded 19,672 unique records. After screening, 855 records representing 775 studies were included and charted in systematic maps. Studies frequently investigated gait speed (70.4% of studies), step length (30.7%), cadence (21.4%), and daily step count (20.7%). They studied differences between healthy and pathological gait (36.4%), associations between DMOs and clinical measures (48.8%) or outcomes (4.3%), and responsiveness to interventions (26.8%). Gait speed, step length, cadence, step time and step count exhibited consistent evidence of validity and responsiveness in multiple conditions, although the evidence was inconsistent or lacking for other DMOs. If DMOs are to be adopted as mainstream tools, further work is needed to establish their predictive validity, responsiveness, and ecological validity. Cross-disciplinary efforts to align methodology and validate DMOs may facilitate their adoption into clinical practice

Unagreement is an illusion

This is the author accepted manuscript. The final version is available from Springer via http://dx.doi.org/10.1007/s11049-015-9311-yThis paper proposes an analysis of unagreement, a phenomenon involving an apparent mismatch between a definite third person plural subject and first or second person plural subject agreement observed in various null subject languages (e.g. Spanish, Modern Greek and Bulgarian), but notoriously absent in others (e.g. Italian, European Portuguese). A cross-linguistic correlation between unagreement and the structure of adnominal pronoun constructions suggests that the availability of unagreement depends on whether person and definiteness are hosted by separate heads (in languages like Greek) or bundled on a single head (i.e. pronominal determiners in languages like Italian). Null spell-out of the head hosting person features high in the extended nominal projection of the subject leads to unagreement. The lack of unagreement in languages with pronominal determiners results from the interaction of their syntactic structure with the properties of the vocabulary items realising the head encoding both person and definiteness. The analysis provides a principled explanation for the cross-linguistic distribution of unagreement and suggests a unified framework for deriving unagreement, adnominal pronoun constructions, personal pronouns and pro