Intra-assessor reliability and measurement error of ultrasound measures for foot muscle morphology in older adults using a tablet-based ultrasound machine

BACKGROUND: To gain insight into the role of plantar intrinsic foot muscles in fall-related gait parameters in older adults, it is fundamental to assess foot muscles separately. Ultrasonography is considered a promising instrument to quantify the strength capacity of individual muscles by assessing their morphology. The main goal of this study was to investigate the intra-assessor reliability and measurement error for ultrasound measures for the morphology of selected foot muscles and the plantar fascia in older adults using a tablet-based device. The secondary aim was to compare the measurement error between older and younger adults and between two different ultrasound machines. METHODS: Ultrasound images of selected foot muscles and the plantar fascia were collected in younger and older adults by a single operator, intensively trained in scanning the foot muscles, on two occasions, 1–8 days apart, using a tablet-based and a mainframe system. The intra-assessor reliability and standard error of measurement for the cross-sectional area and/or thickness were assessed by analysis of variance. The error variance was statistically compared across age groups and machines. RESULTS: Eighteen physically active older adults (mean age 73.8 (SD: 4.9) years) and ten younger adults (mean age 21.9 (SD: 1.8) years) participated in the study. In older adults, the standard error of measurement ranged from 2.8 to 11.9%. The ICC ranged from 0.57 to 0.97, but was excellent in most cases. The error variance for six morphology measures was statistically smaller in younger adults, but was small in older adults as well. When different error variances were observed across machines, overall, the tablet-based device showed superior repeatability. CONCLUSIONS: This intra-assessor reliability study showed that a tablet-based ultrasound machine can be reliably used to assess the morphology of selected foot muscles in older adults, with the exception of plantar fascia thickness. Although the measurement errors were sometimes smaller in younger adults, they seem adequate in older adults to detect group mean hypertrophy as a response to training. A tablet-based ultrasound device seems to be a reliable alternative to a mainframe system. This advocates its use when foot muscle morphology in older adults is of interest. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13047-022-00510-1

The effect of interventions anticipated to improve plantar intrinsic foot muscle strength on fall-related dynamic function in adults:A systematic review

BACKGROUND: The plantar intrinsic foot muscles (PIFMs) have a role in dynamic functions, such as balance and propulsion, which are vital to walking. These muscles atrophy in older adults and therefore this population, which is at high risk to falling, may benefit from strengthening these muscles in order to improve or retain their gait performance. Therefore, the aim was to provide insight in the evidence for the effect of interventions anticipated to improve PIFM strength on dynamic balance control and foot function during gait in adults. METHODS: A systematic literature search was performed in five electronic databases. The eligibility of peer-reviewed papers, published between January 1, 2010 and July 8, 2020, reporting controlled trials and pre-post interventional studies was assessed by two reviewers independently. Results from moderate- and high-quality studies were extracted for data synthesis by summarizing the standardized mean differences (SMD). The GRADE approach was used to assess the certainty of evidence. RESULTS: Screening of 9199 records resulted in the inclusion of 11 articles of which five were included for data synthesis. Included studies were mainly performed in younger populations. Low-certainty evidence revealed the beneficial effect of PIFM strengthening exercises on vertical ground reaction force (SMD: − 0.31-0.37). Very low-certainty evidence showed that PIFM strength training improved the performance on dynamic balance testing (SMD: 0.41–1.43). There was no evidence for the effect of PIFM strengthening exercises on medial longitudinal foot arch kinematics. CONCLUSIONS: This review revealed at best low-certainty evidence that PIFM strengthening exercises improve foot function during gait and very low-certainty evidence for its favorable effect on dynamic balance control. There is a need for high-quality studies that aim to investigate the effect of functional PIFM strengthening exercises in large samples of older adults. The outcome measures should be related to both fall risk and the role of the PIFMs such as propulsive forces and balance during locomotion in addition to PIFM strength measures. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13047-021-00509-0

Ageism in the discourse and practice of designing digital technology for older persons:A scoping review

Background and Objectives Involving older persons in the design process of digital technology (DT) promotes the development of technologies that are appealing, beneficial, and used. However, negative discourse on aging and ageism are potential underlying factors that could influence which and how DTs are designed and how older persons are involved in the design process. This scoping review investigates the explicit and implicit manifestations of ageism in the design process of DT. Research Design and Methods Seven databases were screened for studies reporting on the design of DT with older persons between January 2015 and January 2020. Data regarding study and DT characteristics, discourse about older persons, and their involvement in the design process were extracted, coded, and analyzed using critical discourse analysis. Results Sixty articles met the inclusion criteria and were included in the analysis. Various forms of exclusion of older persons from the design process were identified, such as no or low involvement, upper-age limits, and sample biases toward relatively “active,” healthy and “tech-savvy” older persons. Critical discourse analysis revealed the use of outdated language, stereotypical categorizations, and/or design decisions based on ageism in 71.7% of the studies. Discussion and Implications A discrepancy was found between an “ideal” discourse regarding the involvement of older persons throughout the design process and actual practice. Manifestations of ageism, errors, and biases of designing DT with older persons are discussed. This article calls for more authentic inclusion of older persons and higher awareness toward the implications of ageism in the design process of DT

Physical Activity After Surgery for Severe Obesity: The Role of Exercise Cognitions

# The Author(s) 2010. This article is published with open access at Springerlink.com Background Physical activity after bariatric surgery is associated with sustained weight loss and improved quality of life. Some bariatric patients engage insufficiently in physical activity. This may be due to exercise cognitions, i.e., specific beliefs about benefits of and barriers to physical exercise. The aim of this study was to examine whether and to what extent both physical activity and exercise cognitions changed at 1 and 2 years post-surgery and whether exercise cognitions predict physical activity. Methods Forty-two bariatric patients (38 women, 4 men; mean age 38±8 years, mean body mass index prior to surgery 47±6 kg/m 2) filled out self-report instruments to examine physical activity and exercise cognitions pre- and post-surgery

Different Mechanisms Underlie Post-menarchial Increase in Depression and Weight

Contains fulltext : 99254.pdf (publisher's version ) (Open Access)Background Depression and being overweight are correlated health problems in adulthood. Adolescence is a significant period for the onset and increase of depression and obesity, especially among girls. Pubertal development also occurs with concomitant increases in weight. Thus, it is not yet clear whether the association between depression and being overweight can be explained by pubertal development. Purpose We examined the association between depressive mood, body weight, and pubertal status in adolescent girls. Method The design was cross-sectional. In 962 young adolescent Dutch girls (age range, 11.9-15.9) weight and height measurements were used to calculate height, age, and gender-standardized body weight (zBMI). Questionnaires assessed depressive mood (the Center for Epidemiological Studies-Depression, CES-D, inventory) and menarcheal status (pre or post). Results The correlation between menarcheal status and body weight (r = 0.34, p < 0.001) was not affected by depressive mood, and the correlation between menarcheal status and depressive mood (r = 0.20, p < 0.001) was not affected by body weight. A small correlation between depressive mood and body weight (r = 0.12, p < 0.01) largely disappeared after controlling for menarche. Conclusion Menarcheal status largely explains the association between weight and depression. It is independently associated with both BMI and depression, suggesting that different mechanisms underlie the post-menarcheal increased prevalence of depression and overweight.6 p

Improved antiretroviral treatment outcome in a rural African setting is associated with cART initiation at higher CD4 cell counts and better general health condition

Background Data on combination antiretroviral therapy (cART) in remote rural African regions is increasing. Methods We assessed prospectively initial cART in HIV-infected adults treated from 2005 to 2008 at St. Francis Designated District Hospital, Ifakara, Tanzania. Adherence was assisted by personal adherence supporters. We estimated risk factors of death or loss to follow-up by Cox regression during the first 12 months of cART. Results Overall, 1,463 individuals initiated cART, which was nevirapine-based in 84.6%. The median age was 40 years (IQR 34-47), 35.4% were males, 7.6% had proven tuberculosis. Median CD4 cell count was 131 cells/μl and 24.8% had WHO stage 4. Median CD4 cell count increased by 61 and 130 cells/μl after 6 and 12 months, respectively. 215 (14.7%) patients modified their treatment, mostly due to toxicity (56%), in particular polyneuropathy and anemia. Overall, 129 patients died (8.8%) and 189 (12.9%) were lost to follow-up. In a multivariate analysis, low CD4 cells at starting cART were associated with poorer survival and loss to follow-up (HR 1.77, 95% CI 1.15-2.75, p = 0.009; for CD4 100 cells/μl). Higher weight was strongly associated with better survival (HR 0.63, 95% CI 0.51-0.76, p < 0.001 per 10 kg increase). Conclusions cART initiation at higher CD4 cell counts and better general health condition reduces HIV related mortality in a rural African setting. Efforts must be made to promote earlier HIV diagnosis to start cART timely. More research is needed to evaluate effective strategies to follow cART at a peripheral level with limited technical possibilities

Understanding user practices when drawing up requirements:The case of designing assistive devices for mobility

Patients with orthopedic problems often use assistive devices, e.g., ankle-foot orthoses and therapeutic footwear, to support their mobility. However, many users are not satisfied with their devices or do not use them at all, resulting in a decrease of quality of life. It has been shown that a main cause for dissatisfaction and non-use lies in the process of drawing up requirements. It appears that orthopedic engineers have too little insight in the different areas of life of patients leading to deficient design requirements. In this article a general approach—the so-called Triple I model—is presented to understand the different areas of life of patients. This model offers, in line with and directed by the intention of the International Classification of Functioning, Disability and Health (ICF) model three perspectives or ‘pairs of lenses’ to analyze these areas of life: the identity, the interests of key stakeholders or social actors, and the underlying societal ideals. The Triple I model is elaborated for assistive devices and offers an associated methodology to orthopedic engineers to systematically map the different areas of life of patients, to understand the requirements for every area, and to explore the conditions. In case of assistive devices five different areas of life have to be investigated: daily living at home, work, transport, social and spiritual activities, sport and leisure

Operational definition of Active and Healthy Ageing (AHA): A conceptual framework

Health is a multi-dimensional concept, capturing how people feel and function. The broad concept of Active and Healthy Ageing was proposed by the World Health Organisation (WHO) as the process of optimizing opportunities for health to enhance quality of life as people age. It applies to both individuals and population groups. A universal Active and Healthy Ageing definition is not available and it may differ depending on the purpose of the definition and/or the questions raised. While the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) has had a major impact, a definition of Active and Healthy Ageing is urgently needed. A meeting was organised in Montpellier, France, October 20-21, 2014 as the annual conference of the EIP on AHA Reference Site MACVIA-LR (Contre les Maladies Chroniques pour un Vieillissement Actif en Languedoc Roussillon) to propose an operational definition of Active and Healthy Ageing including tools that may be used for this. The current paper describes the rationale and the process by which the aims of the meeting will be reached. Health is a multi-dimensional concept, capturing how people feel and function. The broad concept of Active and Healthy Ageing was proposed by the World Health Organisation (WHO) as the process of optimizing opportunities for health to enhance quality of life as people age. It applies to both individuals and population groups. A universal Active and Healthy Ageing definition is not available and it may differ depending on the purpose of the definition and/or the questions raised. While the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) has had a major impact, a definition of Active and Healthy Ageing is urgently needed. A meeting was organised in Montpellier, France, October 20-21, 2014 as the annual conference of the EIP on AHA Reference Site MACVIA-LR (Contre les Maladies Chroniques pour un Vieillissement Actif en Languedoc Roussillon) to propose an operational definition of Active and Healthy Ageing including tools that may be used for this. The current paper describes the rationale and the process by which the aims of the meeting will be reached

Intra-assessor reliability and measurement error of ultrasound measures for foot muscle morphology in older adults using a tablet-based ultrasound machine

Background To gain insight into the role of plantar intrinsic foot muscles in fall-related gait parameters in older adults, it is fundamental to assess foot muscles separately. Ultrasonography is considered a promising instrument to quantify the strength capacity of individual muscles by assessing their morphology. The main goal of this study was to investigate the intra-assessor reliability and measurement error for ultrasound measures for the morphology of selected foot muscles and the plantar fascia in older adults using a tablet-based device. The secondary aim was to compare the measurement error between older and younger adults and between two different ultrasound machines. Methods Ultrasound images of selected foot muscles and the plantar fascia were collected in younger and older adults by a single operator, intensively trained in scanning the foot muscles, on two occasions, 1–8 days apart, using a tablet-based and a mainframe system. The intra-assessor reliability and standard error of measurement for the cross-sectional area and/or thickness were assessed by analysis of variance. The error variance was statistically compared across age groups and machines. Results Eighteen physically active older adults (mean age 73.8 (SD: 4.9) years) and ten younger adults (mean age 21.9 (SD: 1.8) years) participated in the study. In older adults, the standard error of measurement ranged from 2.8 to 11.9%. The ICC ranged from 0.57 to 0.97, but was excellent in most cases. The error variance for six morphology measures was statistically smaller in younger adults, but was small in older adults as well. When different error variances were observed across machines, overall, the tablet-based device showed superior repeatability. Conclusions This intra-assessor reliability study showed that a tablet-based ultrasound machine can be reliably used to assess the morphology of selected foot muscles in older adults, with the exception of plantar fascia thickness. Although the measurement errors were sometimes smaller in younger adults, they seem adequate in older adults to detect group mean hypertrophy as a response to training. A tablet-based ultrasound device seems to be a reliable alternative to a mainframe system. This advocates its use when foot muscle morphology in older adults is of interest

The role of ageism in the acceptance and use of digital technology

Technology acceptance models associate older age with lower intention to use digital technology although this assumption is often stereotypically-based and not sufficiently tested with older persons. This study investigated the association of ageism (rather than chronological age) with behavioral intention and actual use of technology within the theoretical framework of the Unified Theory of Acceptance and Use of Technology (UTAUT-2) model. 374 Dutch-speaking participants aged 50–97 completed the UTAUT-2 questionnaire, Expectations Regarding Aging, Attitudes Toward Older Adults Using Technology (ATOAUT-11) and experienced ageism scales. A path analysis found that expectations regarding aging partially mediated the association of age with negative attitudes. Mixed results were found regarding the fit of the new UTAUT-2-Ageism model. Negative ATOAUT moderated the associations of Effort Expectancy, Facilitating Conditions, and Habit with Behavioral Intention to use technology, and the explained variance increased. Further research is warranted to fully identify the potential role of ageism in technology acceptance