The Frail’BESTest: an adaptation of the “balance evaluation system test” for frail older adults; Concurrent validity, responsiveness, validity for fall prediction and detection of slower walkers

Background The Frail’BESTest was developed in order to include frail older adults when they are using the BESTest. Recently, psychometrics properties (internal coherence, systems usefulness, complementarity and inter-rater reliability) of the Frail’BESTest were tested. To complete these analyses, this study will aim the assessment of its concurrent validity, responsiveness, predictive validity on falls occurrence, and slower walkers detection. Methods The correlation between the Frail’BESTest and the Gait Speed Test permitted to assess concurrent validity. The variation between the initial test score and the score obtained after the completion of a rehabilitation program was used to evaluate responsiveness with MANOVA analysis and standard response mean (SRM) calculation. Predictive validity was assessed with receiver-operating characteristic curves and area under the curve (AUC) analysis regarding falls occurrence. Slower walkers detection thresholds were computed by receiver-operating characteristic curves for the Frail’BESTest and the Tinetti test. Results The concurrent validity of the test was good (r = 0.74; p < 0.001). The Standard Error of measurement was at 2.81 points and the Minimal Detectable Change at 7.79 points for the total score of the Frail’BESTest. The SRM was at 0.41 for the Tinetti test and 0.56 for the Frail’BESTest. The AUC, computed according to fall occurrence, was at 0.71 for the Gait Speed test, 0.673 for the Tinetti test and 0.693 for the Frail’BESTest. Both the Tinetti (AUC = 0.87) and the Frail’BESTest (AUC = 0.88) were found suitable for tracking slower walkers. Conclusion Concurrent validity and responsiveness of the Frail’BESTest were good. As for the Tinetti and the Frail’BESTest, they were unable to predict efficiently falls occurrence in the tested sample. The Frail’BESTest seems enough sensitive to spot the slower walkers efficiently, using a 15/20 threshold method. The Frail’BESTest was found to be a valid and responsive clinical test, therefore it can be recommended as an outcome measure in clinical practice.

The effects of physiotherapy using proprioceptive neuromuscular facilitation techniques on the gait of patients after hip and knee arthroplasty: a case report.

Background: Gait disturbances are a major problem for patients after arthroplasty. After the surgery, walking speed, the rhythm of locomotion, and the length of the steps are significantly reduced. One of the therapeutic methods used in gait re-education is proprioceptive neuromuscular facilitation (PNF). Aim of the study: This study aimed to evaluate the effects of physiotherapy using PNF techniques on the gait of patients after hip and knee arthroplasty. Case report: A 60-year-old woman with advanced osteoarthritis that received bilateral hip and right knee arthroplasties was examined. Before and after the therapy, the following tests were performed: measurement of the range of motion (ROM) of hip and knees joints in the sagittal plane using a goniometer, assessment of the symmetry of the lower limbs loading using the two scales test, assessment of the risk of falls using the “Timed Up and Go” test, assessment of balance and gait using the Tinetti test, and assessment of pain intensity using the visual analogue scale (VAS). Rehabilitation was comprised of 15 PNF therapies, including scapular and pelvic PNF patterns. The stabilization of the upper and lower trunk, lifting, shifting of the body’s weight from one foot to another, gait cycle (the stance phase and the swing phase), walking forward, backward, and sideways, and walking up/down the stairs were also used. After the therapy, the flexion ROM in both hip and knees joints was improved. The lower limb symmetry index decreased from 1.167 to 1.121, and the sum of the points obtained in the Tinetti test increased from 22 to 26. Pain in the joints also decreased from 6 on the VAS scale to 4. However, the result obtained in the “Timed Up and Go” test after the therapy was increased by 0.5 s compared to before the therapy. Conclusions: After hip and knee arthroplasties, physiotherapy using PNF techniques improved the gait and functional status of the patient. Continuation of this research using a larger number of patients is needed.

Assessment of static and dynamic balance in patients after total hip arthroplasty based on the Tinetti Test

Introduction: A degenerative disease of a hip joint (osteoarthritis) is a chronic affliction which causes progressive degeneration of a hip joint and tissue located around it. It inflicts limitation of locomotor skills, deteriorates life quality to a significant extent, and prevents a patient from normal activities in daily life. In Poland, more than 3 million people suffer from osteoarthritis. The disease symptoms are pain, limitation of mobility scope in a joint, postural and gait disorders, and positioning of a lower limb in non-functional position. The aim of the study was to analyze the gait pattern and to assess the static and dynamic balance of people qualified for hip joint arthroplasty, as well as possibility of falling.Material and methods: The Tinetti Test has been used for the research in question. This test has been completed in patients awaiting for hip joint arthroplasty, and once more on a third day upon completion of arthroplasty, in the Department and Clinic of Orthopaedics, Traumatology and Oncology of Locomotor System of the Pomeranian Medical University in Szczecin. This test has included a group of 31 – 11 women and 20 men.Results: The mean age of the research group was 65.1 years. The intensity of pain in the hip joint, based on the VAS scale before and after the procedure, was 6.53 and 5.22 points, respectively. The average number of points obtained by the patient in the Tinetti Test before the surgery was 22.71 points. On the third day of hip surgery, the mean number of points decreased to 18.81 points.Conclusions: Patients treated with alloplastic surgery of a hip joint show lower static and dynamic balance. Upon completion of the surgery, the patients are more prone to fall. The patients with completed hip joint arthroplasty show symptoms of locomotor system disorders.

The effects of physiotherapy using proprioceptive neuromuscular facilitation techniques on the gait of patients after hip and knee arthroplasty: a case report

Background Gait disturbances are a major problem for patients after arthroplasty. After the surgery, walking speed, the rhythm of locomotion, and the length of the steps are significantly reduced. One of the therapeutic methods used in gait re-education is proprioceptive neuromuscular facilitation (PNF). Aim of the study This study aimed to evaluate the effects of physiotherapy using PNF techniques on the gait of patients after hip and knee arthroplasty. Case report A 60-year-old woman with advanced osteoarthritis that received bilateral hip and right knee arthroplasties was examined. Before and after the therapy, the following tests were performed: measurement of the range of motion (ROM) of hip and knees joints in the sagittal plane using a goniometer, assessment of the symmetry of the lower limbs loading using the two scales test, assessment of the risk of falls using the “Timed Up and Go” test, assessment of balance and gait using the Tinetti test, and assessment of pain intensity using the visual analogue scale (VAS). Rehabilitation was comprised of 15 PNF therapies, including scapular and pelvic PNF patterns. The stabilization of the upper and lower trunk, lifting, shifting of the body’s weight from one foot to another, gait cycle (the stance phase and the swing phase), walking forward, backward, and sideways, and walking up/down the stairs were also used. After the therapy, the flexion ROM in both hip and knees joints was improved. The lower limb symmetry index decreased from 1.167 to 1.121, and the sum of the points obtained in the Tinetti test increased from 22 to 26. Pain in the joints also decreased from 6 on the VAS scale to 4. However, the result obtained in the “Timed Up and Go” test after the therapy was increased by 0.5 s compared to before the therapy. Conclusions After hip and knee arthroplasties, physiotherapy using PNF techniques improved the gait and functional status of the patient. Continuation of this research using a larger number of patients is needed.

Impaired Subjective Visual Vertical and Increased Visual Dependence in Older Adults With Falls

Aging affects the vestibular system and may disturb the perception of verticality and lead to increased visual dependence (VD). Studies have identified that abnormal upright perception influences the risk of falling. The aim of our study was to evaluate subjective visual vertical (SVV) and VD using a mobile virtual reality-based system for SVV assessment (VIRVEST) in older adults with falls and evaluate its relationship with clinical balance assessment tools, dizziness, mental state, and depression level. This study included 37 adults &gt;65 years who experienced falls and 40 non-faller age-matched controls. Three tests were performed using the VIRVEST system: a static SVV, dynamic SVV with clockwise and counter-clockwise background stimulus motion. VD was calculated as the mean of absolute values of the rod tilt from each trial of dynamic SVV minus the mean static SVV rod tilt. Older adults who experienced falls manifested significantly larger biases in static SVV (p = 0.012), dynamic SVV (p &lt; 0.001), and VD (p = 0.014) than controls. The increase in static SVV (odds ratio = 1.365, p = 0.023), dynamic SVV (odds ratio = 1.623, p &lt; 0.001) and VD (odds ratio = 1.460, p = 0.010) tilt by one degree significantly related to falls risk in the faller group. Fallers who had a high risk of falling according to the Tinetti test exhibited significantly higher tilts of dynamic SVV than those who had a low or medium risk (p = 0.037). In the faller group, the increase of the dynamic SVV tilt by one degree was significantly related to falls risk according to the Tinetti test (odds ratio = 1.356, p = 0.049). SVV errors, particularly with the dynamic SVV test (i.e., greater VD) were associated with an increased risk of falling in the faller group. The VIRVEST system may be applicable in clinical settings for SVV testing and predicting falls in older adults.

POS0469 FALL RISK ASSESSMENT IN RHEUMATOID ARTHRITIS PATIENTS

Background:Rheumatoid arthritis patients may have an increased risk of falls due to changes caused by the disease such as muscle weakness, joint impairment, reduced mobility and postural instability.Objectives:The aim of this study was to analyze the occurrence of falls in RA patients and its risk factors.Methods:Between January2020 and July 2020, 51 patients with RA were included in the study. fall history, and the number of falls within the past 12 month were questioned. All participants were assessed with Timed Up and Go Test (TUGT), One-Leg Stand Test (OLST), Walking and Talking Test (WTT), Sternal Push Test (SPT), Tinetti Test (TT), Four Test Balance Scale (FTBS), The Short Falls Efficacy Scale-International (FES-I), Pain Severity and Patient Global Assessment (PGA) by Visual Analog Scale (VAS), disability by the Health Assessment Questionnaire (HAQ), and disease activity by Disease Activity Score in 28 joints (DAS28) were evaluated in for for each patient. The Kolmogorov-Smirnov, Mann-Whitney and chi-square tests were performed with a significance level of P ≤ 0.05.Results:22 patients had at least one or more falls. The average age was 54.9±11.5 years with a female predominance (sex ratio = 0.13). Comparing the two groups of patients: those with a history of falls and those without, patients with previous falls were mainly married women (p=0.57), with a low intellectual level (p=0.63). The body mass index in this group was higher (p=0.01) with respectively a higher number of painful and swollen joints (p=0.16, p=0.07); the mean HAQ was higher (p=0.03), and the mean VAS was more important (p=0.05). 12/22 patients had co-morbidities and were poly-medicated.20/22 had joint feet deformities (hallux valgus was the most common deformity). 21/22 were on low dosage corticosteroid therapy. The mean TUGT was 18.5 seconds (>14 seconds). The OLST was less than 5 seconds in 12/22, the sternal push test was positive in 9/22, WTT was positive in 6/22 and the mean tinetti test was 22.4±5.4 suggesting a high risk of falls. The average Short FES-I was 14.6 ±4.4 reflecting a high fear of falls in this group of patients.Conclusion:Knowledge about risk factors can help to identify high-risk patients in order to decrease their risk of falling, thus preventing fall-related injuries.Disclosure of Interests:None declared

Assessment of the Impact of Training on the Stabilometric Platform Using the Biofeedback Method on Improving Balance and Functional Efficiency of Patients After a Stroke

Introduction: Postural balance disorders are one of the most common motor symptoms in patients after stroke, which affect the limitation of patients mobility and their ability to perform everyday activities. Balance disorders require comprehensive neurorehabilitation. Aim: The aim of the study was to assess the effect of exercises on the stabilometric platform using the biofeedback method on improving balance and functional performance in patients after stroke. Material and Methods: The study involved 75 patients after ischemic stroke aged from 35-80 years. Two groups were created: a study and control group. The study group consisted of patients in whom a comprehensive rehabilitation program was implemented, consisting of physical therapy, kinesitherapy, speech therapy and psychological consultation, complemented by the use of modern neurorehabilitation solutions, including a platform for balance training. The control group included patients in whom a comprehensive therapy program was implemented, but without training on a stabilometric platform. Functional assessment of patients was performed using selected scales and tests: Barthel Scale, Tinetti Test and Berg Balance Scale. Results: Patients after stroke, in whom a comprehensive physiotherapy program was implemented using the training on the Tecnobody stabilometric platform, obtained a statistically significant improvement in all parameters describing the ability to maintain balance. Also in the Tinetti Test in the gait evaluation section, Berg Balance Scale and Barthel Scale the improvement was statistically significant. Conclusions: The program used on the stabilometric platform had a significantly better impact on improving ability to maintain balance and everyday functioning of patients after stroke.

Chronic cerebrovascular disease: the role of venous disorders and the possibility of pathogenetic correction

Aim: to evaluate the efficacy and safety of the L-lysine escinate venotropic drug in the treatment of cephalgic, atactic and asthenic syndromes in patients with chronic cerebral ischemia, mainly caused by venous disorders. Patients and Methods: the study involved 60 patients with a diagnosis of chronic cerebral ischemia with signs of chronic venous insufficiency. All patients were randomly divided into two groups consisting of 30 people. Patients in the main group received L-lysine escinate, and the control group received Vinpocetine. The drugs were administered by intravenous drip for 10 days. A dynamic assessment was performed using a modified subjective scale of asthenia evaluation (MFI-20), 100 mm long visual analogue scale (VAS) for headache, subjective neurological impairment scale (SNIS), and Tinetti test. An ophthalmic examination with an assessment of the fundus vessels and an ultrasound duplex scanning of head vessels (veins) were also conducted. Results: it was shown that L-lysine escinate therapy showed a statistically more significant reduction in the severity of headache (according to VAS) and an improved stability measured by Tinetti test versus during Vinpocetine treatment. There were no significant differences in the level of asthenia (MFI-20), the severity of emotional disorders, and the SNIS score. Also, the number of patients with dilated fundus veins significantly decreased during treatment in the main group (p<0.05), which was not the case in the control group. According to ultrasound duplex scanning data, the venous flow velocity through the veins of Rosenthal and angular veins during L-lysine escinate therapy was significantly higher (p<0.05) than in patients receiving Vinpocetine. Conclusion: the inclusion of vasotropic drugs (in particular, the L-lysine escinate venotonic drug) in the treatment regimen of patients with chronic brain ischemia seems appropriate, especially if there are signs of venous insufficiency. KEYWORDS: systemic venous insufficiency, chronic cerebrovascular disease, venous dyscirculation, glymphatic system, L-lysine escinate, Vinpocetine. FOR CITATION: Schukin I.A., Fidler M.S., Koltsov I.A. Chronic cerebrovascular disease: the role of venous disorders and the possibility of pathogenetic correction. Russian Medical Inquiry. 2020;4(9):544–551. DOI: 10.32364/2587-6821-2020-4-9-544-551.

Assessment of the Therapeutic Effect of Physiotherapy on Minimizing Imbalances of Geriatric Patients

Introduction: The progressing aging process and comorbidities worsen the efficiency of the balance system in the elderly, which leads to a weakening of stability and, as a consequence, to falls and injuries. The first ones lead to: worsening of functioning, reduced mobility, an increased risk of disease and mortality, therefore systematic physical activity and shaping the balance using physiotherapy, which can prevent dangerous falls is very important. Aim: Assessment of the therapeutic effect of physiotherapy on minimizing imbalances in geriatric patients. M aterial and Methods: The study group consisted of 46 people, including 32 women (69.6%) and 14 men (30.4%); average age of respondents – 72.5 years. They were patients of the Department of Rehabilitation of Poddębice Health Center, Ltd. The researchers used a self-made questionnaire, body mass to height index (BMI) and the Tinetti Test. Results: Patients with an elevated BMI (89.1%), as well as those taking more than 4 medication (78.3%), have had more falls over the past year (respectively 91.4% and 81.4%). After the use of comprehensive therapy, none of the patients achieved a worse result than before the physiotherapy while 91.3% of the respondents had an increase in the number of points scored in the Tinetti Test. The percentage of patients at high risk of falling reduced from 67.4% to 37%. There was also a decrease in the fear of walking (in 58.7%), falling (in 57.7%) and climbing stairs (in 47.9%). According to 78.3% of respondents, physiotherapy positively affected their independence and quality of life. Conclusions: The use of comprehensive physiotherapy reduces the fear of walking, climbing stairs and falling, which can be a good predictor of prevention. Both polypragmasia and an elevated body mass index (BMI) increase the risk of falling. Comprehensive physiotherapy of geriatric patients helps to improve balance and gait stereotype. Physiotherapy for the elderly helps improve the quality of life, independence, minimize imbalances, and thus reduce the risk of falls. Balance exercises play an important role in preventing falls.

Investigating the Effect of Cognitive and Sensorimotor Exercises on the Functional Balance of the Elderly

Background and aims: The elderly living in nursing homes have different motor situations compared with their peers, which can affect different motor functions. Investigating the characteristics of balance has always been of interest to researchers due to its importance in the functional independence of the elderly. Thus, the present research aimed to investigate the effect of cognitive and sensorimotor exercises on the functional balance of the elderly. Methods: This quasi-experimental study was performed with the intragroup comparison design, as well as pre- and post-test measurement stages in Iran during 2017. A total of 60 elders were chosen through the convenience sampling method. Accordingly, the subjects were matched in four groups after performing the pretest with demographic, physical activity readiness, and Mini-Mental State Examination questionnaires and Tinetti test. Each group performed eight exercise situations lasting for 5-10 seconds by taking the overload principle into account throughout 24 sessions. The statistical population of this research consisted of the elderly living in nursing homes under the supervision of the Welfare Organization of Shiraz, including 875 individuals. In general, 60 subjects were chosen through a voluntary method (age: 61.7 ± 7.6 years old, weight: 65.2± 16.2 kg, and height: 157.7± 6.7 cm). During the data collection, 14 subjects left the study for different reasons. The balance characteristics were measured by the Tinetti test. Finally, statistical analysis was performed through the difference of the scores of measurement stages and by one-way ANOVA and Tukey post hoc tests. Results: The comparison of cognitive, sensorimotor, and combined groups with the control group regarding the dependent variables of the research indicated that cognitive exercises have no significant effect on balance (P=0.103), while the sensorimotor (P=0.002) and combined (P=0.002) exercises were effective on balance. Conclusion: In general, the significance of the balance following sensorimotor and combined exercises compared to the insignificance of cognitive exercises can highlight the importance of sensorimotor exercises in the balance of the elderly living in nursing homes.