Comparison of programs for determining temporal-spatial gait variables from instrumented walkway data: PKmas versus GAITRite

BACKGROUND: Measurement of temporal-spatial gait variables is common in aging research with several methods available. This study investigated the differences in temporal-spatial gait outcomes derived from two different programs for processing instrumented walkway data. METHOD: Data were collected with GAITRite® hardware from 86 healthy older people and 44 older people four months following surgical repair of hip fracture. Temporal-spatial variables were derived using both GAITRite® and PKmas® processing programs from the same raw footfall data. RESULTS: The mean differences between the two programs for most variables were negligible, including for Speed (mean difference 0.3 ± 0.6 cm/sec, or 0.3% of the mean GAITRite® Speed). The mean absolute percentage difference for all 18 gait variables examined ranged from 0.04% for Stride Duration to 66% for Foot Angle. The ICCs were almost perfect (≥0.99) for all variables apart from Base Width, Foot Angle, Stride Length Variability, Step Length Variability, Step Duration Variability and Step Width Variability, which were all never-the-less above 0.84. There were systematic differences for Base Width (PKmas® values 1.6 cm lower than GAITRite®) and Foot Angle (PKMAS® values 0.7° higher than GAITRite®). The differences can be explained by the differences in definitions and calculations between the programs. CONCLUSIONS: The study demonstrated that for most variables the outcomes from both programs can be used interchangeably for evaluation of gait among older people collected with GAITRite® hardware. However, validity and reliability for Base Width and Foot Angle derived by PKMAS® would benefit from further investigation

Effect of in-hospital comprehensive geriatric assessment (CGA) in older people with hip fracture : the protocol of the Trondheim Hip Fracture Trial

Background: Hip fractures in older people are associated with high morbidity, mortality, disability and reduction in quality of life. Traditionally people with hip fracture are cared for in orthopaedic departments without additional geriatric assessment. However, studies of postoperative rehabilitation indicate improved efficiency of multidisciplinary geriatric rehabilitation as compared to traditional care. This randomized controlled trial (RCT) aims to investigate whether an additional comprehensive geriatric assessment of hip fracture patients in a special orthogeriatric unit during the acute in-hospital phase may improve outcomes as compared to treatment as usual in an orthopaedic unit. Methods/design: The intervention of interest, a comprehensive geriatric assessment is compared with traditional care in an orthopaedic ward. The study includes 401 home-dwelling older persons >70 years of age, previously able to walk 10 meters and now treated for hip fracture at St. Olav Hospital, Trondheim, Norway. The participants are enrolled and randomised during the stay in the Emergency Department. Primary outcome measure is mobility measured by the Short Physical Performance Battery (SPPB) at 4 months after surgery. Secondary outcomes measured at 1, 4 and 12 months postoperatively are place of residence, activities of daily living, balance and gait, falls and fear of falling, quality of life and depressive symptoms, as well as use of health care resources and survival. Discussion: We believe that the design of the study, the randomisation procedure and outcome measurements will be of sufficient strength and quality to evaluate the impact of comprehensive geriatric assessment on mobility and other relevant outcomes in hip fracture patients

Exploring life-space in the nursing home. An observational longitudinal study

Background Traditional performance-based measurements of mobility fail to recognize the interaction between the individual and their environment. Life-space (LS) forms a central element in the broader context of mobility and has received growing attention in gerontology. Still, knowledge on LS in the nursing home (NH) remains sparse. The aim of this study was to identify LS trajectories in people with dementia from time of NH admission, and explore characteristics associated with LS over time. Methods In total, 583 people with dementia were included at NH admission and assessed biannually for 3 years. LS was assessed using the Nursing Home Life-Space Diameter. Association with individual (age, sex, general medical health, number of medications, pain, physical performance, dementia severity, and neuropsychiatric symptoms) and environmental (staff-to-resident ratio, unit size, and quality of the physical environment) characterises was assessed. We used a growth mixture model to identify LS trajectories and linear mixed model was used to explore characteristics associated with LS over time. Results We identified four groups of residents with distinct LS trajectories, labelled Group 1 (n = 19, 3.5%), Group 2 (n = 390, 72.1%), Group 3 (n = 56, 10.4%), Group 4 (n = 76, 14.0%). Being younger, having good compared to poor general medical health, less severe dementia, more agitation, less apathy, better physical performance and living in a smaller unit were associated with a wider LS throughout the study period. Conclusion From NH admission most NH residents’ LS trajectory remained stable (Group 2), and their daily lives unfolded within their unit. Better physical performance and less apathy emerged as potentially modifiable characteristics associated with wider LS over time. Future studies are encouraged to determine whether LS trajectories in NH residents are modifiable, and we suggest that future research further explore the impact of environmental characteristics.publishedVersio

Is long-bout sedentary behaviour associated with long-term glucose levels 3 months after acute ischaemic stroke? A prospective observational cohort study

Background and purpose Sedentary behaviour is a risk factor for vascular disease and stroke patients are more sedentary than their age-matched peers. The association with glucose levels, as a potential mediator, is unclear, and we have investigated the association between long-bout sedentary behaviour and long-term glucose levels in stroke survivors. Methods This study uses data from the Norwegian Cognitive Impairment After Stroke study, a multicentre cohort study. The patients were recruited at hospital admission for acute stroke, and the follow-up was done at the outpatient clinic. Sedentary behaviour—being in a sitting or reclining position—was registered 3 months after stroke using position transition data from the body-worn sensor activPAL attached to the unaffected thigh. A MATLAB script was developed to extract activity data from 08:00 to 10:00 for 4 days and to categorise the data into four bout-length categories. The primary outcome was glycated haemoglobin (HbA1c), analysed at 3 months. Regression models were used to analyse the association between HbA1c and sedentary behaviour in the whole population and stratified based on a diagnosis of diabetes mellitus (DM). Age, body mass index and the use of antidiabetic drugs were added as covariates into the models. Results From a total of 815 included patients, 379 patients fulfilled the inclusion criteria for this study. We found no association between time in sedentary behaviour and HbA1c in the whole stroke population. We found time in sedentary behaviour in bouts of ≥90 min to be associated with a higher HbA1c in patients with DM. Conclusion Long-bout sedentary time is associated with a higher HbA1c in patients with DM 3 months after ischaemic stroke. Future research should investigate the benefit of breaking up sedentary time as a secondary preventive measure.publishedVersio

Plasma Inflammatory Biomarkers Are Associated With Poststroke Cognitive Impairment: The Nor-COAST Study

Background: Inflammation is proposed to be involved in the pathogenesis of poststroke cognitive impairment. The aim of this study was to investigate associations between concentrations of systemic inflammatory biomarkers after ischemic stroke and poststroke cognitive impairment. Methods: The Nor-COAST study (Norwegian Cognitive Impairment After Stroke) is a prospective observational multicenter cohort study, including patients hospitalized with acute stroke between 2015 and 2017. Inflammatory biomarkers, including the TCC (terminal C5b-9 complement complex) and 20 cytokines, were analyzed in plasma, collected at baseline, 3-, and 18 months poststroke, using ELISA and a multiplex assay. Global cognitive outcome was assessed with the Montreal Cognitive Assessment (MoCA) scale. We investigated the associations between plasma inflammatory biomarkers at baseline and MoCA score at 3-, 18-, and 36-month follow-ups; the associations between inflammatory biomarkers at 3 months and MoCA score at 18- and 36-month follow-ups; and the association between these biomarkers at 18 months and MoCA score at 36-month follow-up. We used mixed linear regression adjusted for age and sex. Results: We included 455 survivors of ischemic stroke. Higher concentrations of 7 baseline biomarkers were significantly associated with lower MoCA score at 36 months; TCC, IL (interleukin)-6, and MIP (macrophage inflammatory protein)-1α were associated with MoCA at 3, 18, and 36 months (P<0.01). No biomarker at 3 months was significantly associated with MoCA score at either 18 or 36 months, whereas higher concentrations of 3 biomarkers at 18 months were associated with lower MoCA score at 36 months (P<0.01). TCC at baseline and IL-6 and MIP-1α measured both at baseline and 18 months were particularly strongly associated with MoCA (P<0.01). Conclusions: Higher concentrations of plasma inflammatory biomarkers were associated with lower MoCA scores up to 36 months poststroke. This was most pronounced for inflammatory biomarkers measured in the acute phase following stroke.publishedVersio

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

Gait following Hip Fracture: Identification of key characteristics of gait and interventions to maximise gait recovery

Abstract Hip fractures are associated with severe decline in gait function and can represent a dramatic change in life situation for older people. At present, knowledge is scarce on type, timing and organisation of interventions to maximise gait recovery after hip fractures, and few intervention studies have included measures of gait characteristics beyond gait speed. The overall aim of this thesis is to identify and describe relevant gait characteristics in older community-dwelling people who have sustained a hip fracture, and to provide a better base of knowledge for the development of more targeted interventions to maximise gait recovery after hip fracture. This thesis is based on four papers, the first two with a methodological approach and the last two with a clinical approach. Paper I aims to examine to which extent spatial and temporal gait characteristics are comparable when analysed with different software-products, while paper two aims to identify the most relevant gait characteristics to describe gait recovery following hip fracture. Paper III is an evaluation of the long term effect of early multidisciplinary and multicomponent hospital intervention on gait, while paper IV is a protocol paper describing the rationale for a municipality based exercise trial targeting gait control, including also data on inclusion and attrition rate. Data were collected through two randomised controlled clinical trials including a total of 620 community-dwelling older adults with hip fracture: i) The Trondheim Hip fracture Trial comparing comprehensive geriatric care with conventional orthopaedic care, and ii) the EvaHip trial, aiming to evaluate the added effect of a home based exercise programme delivered four months following the fracture, compared with routine practice in the municipality. Data on spatial and temporal gait characteristics were collected using an instrumented walkway (GAITRite®) four and 12 months following the fracture. Results showed high level of agreement for gait variables between software-products. Four gait domains; Pace/rhythm, postural control, variability and asymmetry, and four corresponding key gait variables; double support time, walk ratio, step velocity variability and single support asymmetry were identified using a factor analysis approach. Gait characteristics following hip fracture demonstrated reduced gait control, increased fall risk and high energy costs of walking. Significant group differences in favour of participants who had received comprehensive geriatric care in the early preoperative and postoperative stages were found for double support, walk ratio and asymmetry. Inclusion and attrition rate reported in the protocol paper indicated that a relatively high proportion of community-dwelling older adults were able to participate in an exercise programmes when performed in a home setting, but that participants who refused to participate had lower pre-fracture cognitive function compared to those who were randomised. Results from the hospital study showed that a relatively short multicomponent intervention improved gait outcome as long as one year following the fracture and suggest that targeting the vulnerability of these patients in the early stage is important for long-term gait outcomes. Inclusion an attrition rate reported in the protocol article indicates that reduced cognitive function is a barrier for participation in municipality based rehabilitation programmes. Further work should aim to develop integrated care pathways covering both hospital and municipality rehabilitation and to develop better tailored and targeted interventions to maximise gait recovery. Norsk sammendrag Gangfunksjon etter hoftebrudd Identifisering av gangkarakteristika og intervensjoner for å optimalisere gangfunksjon - I Norge er det vel 9000 hoftebrudd hvert år. Årlige kostnader er 4.5 milliard og det vil være en stor samfunnsøkonomisk gevinst knyttet til bedring av behandlings- og rehabiliteringstilbudet for denne gruppen. Hoftebrudd rammer i all hovedsak eldre. Et hoftebrudd representerer ofte en dramatisk endring i livssituasjon, tap av selvstendighet i daglige funksjoner og økt hjelpebehov. Få gjenvinner samme gangfunksjon som før bruddet, flertallet blir avhengig av ganghjelpemidler og risikoen for nye fall er betydelig. Tapet av funksjon er ofte større enn hva skaden alene skulle tilsi, og dette forklares gjerne med at eldre med hoftebrudd representerer en særlig sårbar gruppe pasienter. I dag er det begrenset kunnskap om hvilke type behandling og rehabilitering som kan bidra til å redusere funksjonstapet og optimalisere gangfunksjon hos denne sårbare pasientgruppen. Avhandlingen er basert på gangdata fra totalt 620 hoftebrudds pasienter, inkludert i to ulike klinisk randomiserte studier, en med fokus på sykehusbehandling og en med fokus på fysioterapi i kommunal regi. Fire ulike gangkarakteristika: dobbel standfase, gangratio, variabilitet og asymmetri ble identifisert ved hjelp av faktoranalyse, og blir foreslått som gode indikatorer på gangkvalitet etter et hoftebrudd. Resultatene viste at pasienter som hadde fått behandling på en geriatrisk sengepost i forbindelse med hoftebruddet hadde bedre gangkvalitet et år etter bruddet, rapporterte bedre mobilitet og det var flere som fremdeles var i stand til å gå et år etter, sammenlignet med pasienter som hadde fått standard behandling på en ortopedisk sengepost. Treningsstudien viste at en stor andel av eldre som har hatt hoftebrudd er i stand til å gjennomføre et relativt intensivt treningsprogram når det foregår i hjemmet under veileding av fysioterapeut. Det ser imidlertid ut som kognitiv svikt kan være en barriere for deltagelse, noe som indikerer at dette er en gruppe som krever ekstra oppmerksomhet. Disse funnene indikerer at mange eldre med hoftebrudd i dag ikke får et optimalt tilbud med tanke på å gjenvinne gangfunksjon, og at det er et potensiale for å bedre behandlings og rehabiliteringstilbudet ved å innføre modeller basert på geriatrisk utredning og behandling

Associations between changes in gait parameters, balance, and walking capacity during the first 3 months after stroke: a prospective observational study

Background: Independent ambulation is a common rehabilitation goal after stroke, requiring adequate balance and efficiency of gait. Spatiotemporal gait parameters are expected to improve in the first 3 months and their association with balance and efficiency of gait may provide useful insights into the recovery of safe and independent mobility. Objective: Examine the associations between changes in spatiotemporal gait parameters, balance, and walking capacity during the first 3 months after stroke. Methods: This prospective observational study included participants diagnosed with stroke. Within the first 2 weeks after stroke onset and again 3 months (±2 weeks) later, gait was assessed using a GAITRite mat at self-selected gait speed, balance using the Berg Balance Scale (BBS), and walking capacity using the 6-minute walk test (6 MWT). Changes in gait parameters, balance, and walking capacity were assessed using paired sample t-tests, and linear regression analyses were used to assess associations between changes in spatiotemporal gait parameters, BBS, and 6MWT. Results: Seventy-nine participants (mean (SD) age 75.4 (8.5) years; 44 men) were included. Gait parameters, balance, and walking capacity all improved during follow-up. The bivariate regression analyses showed associations between improvements in all gait parameters, except walk ratio, with improvement in balance, and in all gait parameters with improvement in walking capacity. Only gait speed was associated with balance (13.8 points, 95% CI 0.5, 27.8, p = .0042) and walking capacity (256 m, 95% CI 173,340, p < .001) in the multivariate analyses. Conclusion: Improved spatiotemporal gait parameters were associated with improved balance and walking capacity within the first 3 months after stroke

The Risk of Selection Bias in a Clinical Multi-Center Cohort Study. Results from the Norwegian Cognitive Impairment After Stroke (Nor-COAST) Study

Purpose: The Norwegian Cognitive Impairment After Stroke (Nor-COAST) study aimed to estimate the prevalence and incidence of neurocognitive disorder in an unselected stroke cohort. The aim of the present study was to investigate whether selection bias occurred by comparing baseline characteristics from participants with non-participants in Nor-COAST. Patients and Methods: Nor-COAST is a prospective cohort multi-center study, recruiting participants from five Norwegian hospitals. Patients with the diagnosis of acute stroke were screened for inclusion. Baseline data from the participants recruited between May 2015 and March 2017 were compared to corresponding data from those not participating in Nor-COAST but registered in the Norwegian Stroke Registry. Regression analysis was used to assess whether age, stroke severity, sex and stroke subtype were independently associated with inclusion in the study. Results: Out of 2505 available patients, 815 (32.5%) were included in Nor-COAST. There were no differences between participants and non-participants with respect to age (mean (SD) age 73.5 (11.7) versus 74.2 (14.5) years) or sex (44.8% versus 46.9% women). A significantly larger proportion of the participants were independent prior to stroke (87% versus 78%), had mild strokes (69% versus 55%) and suffered from cerebral infarction (90% versus 84%). The regression analysis showed decreased odds ratio (OR) of being included for those with higher degree of pre-stroke dependency (OR 0.895, 95% CI 0.825 to 0.971, p=0.007) and a more severe stroke (OR 0.952, 95% CI 0.939 to 0.966, p< 0.001). Conclusion: The participants in Nor-COAST had a better pre-stroke health condition and milder strokes compared to non-participants. However, the participants should be regarded as representative of the majority of the stroke population which suffers from mild strokes. Nevertheless, baseline information for non-participants should be available also in future clinical studies to make it easier to identify which part of the stroke population the results can be generalized to

Forebyggende gruppetrening for hjemmeboende eldre: hvem deltar og hva gir motivasjon til å delta?

Artikkelen rapporterer en studie hvor hensikten var å beskrive deltakerne i treningsgruppene og hvilke faktorer som oppleves som viktige for deltakelse.Bakgrunn: i årene framover vil andelen eldre i befolkningen øke. Kommunene utfordres til å utvikle tjenester i et mer forebyggende perspektiv. Forebyggende gruppetrening har eksistert i Trondheim siden 2006, og benyttes i dag av cirka 300 eldre. Målet med studien var å beskrive deltakerne i treningsgruppene og hvilke faktorer som oppleves som viktige for deltakelse. Design: kvalitetsutviklingsprosjekt i praksisfeltet med mikset design. Metode: et spørreskjema med spørsmål om helsetilstand, bekymring for å falle og hjelp fra helsetjenesten i kommunen ble benyttet. Fokusgruppeintervjuer ble gjennomført for å belyse viktige faktorer for deltakelse. Resultat: 135 deltakere besvarte spørreskjema og 23 deltakere deltok i fokusgruppeintervju. Deltakernes gjennomsnittsalder var 77.8 år (89 % kvinner). 90 % hadde deltatt i mer enn ett år, og nesten halvparten i over tre år. Deltakerne benyttet treningstilbud i lokalmiljøet, og 80 % gikk vanligvis til og fra trening. Kvaliteten på tilbudet, gruppetilhørigheten og nærmiljølokalisering fremheves som de viktigste faktorene for å fortsette treningen over tid. Deltakerne fortalte at treningen ga positiv effekt for hverdagslivet deres, og ønsket at flere ble kjent med tilbudet. Konklusjon: deltakerne framhever kvaliteten på tilbudet og betydningen treningen har for hverdagslivet deres, og at det sosiale aspektet ved treningen er viktig