bluuebunny/crossref_metadata_2025 huggingface dataset:
The use of ultrasound as a research tool in acupunture: a literature review
Authors: M. Sánchez Lorenzo , R. Seoane Pardo
Published: December 2019

Background and Aims Ultrasound is a non-invasive test which enables a fast real time exam, which is both dynamic and accessible. In contrast, the mechanisms of functioning of acupuncture have not been completely understood. The aim of this review was to determine the various uses assigned to ultrasound in acupuncture research.

Material and Methods A literature search was performed in PubMed, Cochrane Library, PEDro and ScienceDirect databases. Manual searches were performed in the following journals: Evidence-Based Complementary and Alternative Medicine, Acupuncture Medicine, Medical Acupuncture and The Journal of Alternative and Complementary Medicine. The search terms “ultrasonography” and “Acupuncture” were used, related with AND. Research studies in humans were included in which ultrasound was used to assess some aspect of the acupuncture intervention. No time limit was established and the languages were limited to Spanish, English, Galician or Portuguese. The data extraction was performed by two independently blinded evaluators.

Results A total of 46 studies were included for the analysis. B Mode is the most used form of imaging, followed by Doppler and elastography. In total, 18 studies performed an analysis of vascular parameters. Doppler was commonly used, with a dominance of transcranial Doppler methods, although B mode was also used to measure the transverse diameter of blood vessels. In 11 studies, B mode was used alone or combined with Doppler to obtain measures of safety, precision, location of target structures and needle position regarding sensitive structures. Seven studies used elastography. Five studies quantified tissue movement and another quantified muscle stiffness using elastography and B mode. A further study also included Doppler for the measurement of blood flow. Six studies evaluated visceral conditions. One study evaluated gastric emptying and the five remaining studies focused on the genitourinary sphere such as the rate of pregnancy, fetal position, prostate characteristics, intrapelvic venous congestion and bladder emptying. From the musculoskeletal point of view, 4 studies were located. Two studies evaluated the thickness parameter of the common extensor tendon of the epicondyle and two layers of connective tissue, respectively. One study concluded that the application of acupuncture can influence the viscoelastic properties of the tendon and one remaining study informed of the positive association between ultrasound as an assessment tool and follow up tool in acupuncture treatments.

Conclusions In this field of study, ultrasound has been used to obtain objective outcomes and adopt safety guidelines related to acupuncture procedures.
Action of galvanic currents on needles during percutaneous needle electrolysis
Authors: R. Margalef , F. Minaya Muñoz , F. Valera Garrido , M. Santafe M.
Published: December 2019

Background The use of galvanic currents (GC), during percutaneous needle electrolysis (PNE) can make needles release metals and therefore decrease their diameter and increase resistance. If this were very marked, this could increase the temperature of the needle during use of the same. Furthermore, the loss of materials such as zinc, can trigger allergic reactions in people who are sensitive to these metals.

Aim to evaluate modifications of needles during the application of GC in PNE.

Methods The resistance was evaluated using a Digital multimeter Velleman DVM92. The GC was generated using the Physio Invasiva device by Prim (3 mA during 3 seconds, 3 applications were performed). For each needle, resistance of the proximal and distal area was evaluated (insertion) and the % of variation was calculated. 20 Physio Invasiva Needles measuring 0.30 × 40mm were evaluated and inserted in mice. A Quante 600 scanningmicroscope was used as well as a microanalysis device based on diffusion by RX Oxford Instruments (Universidad Rovira i Virgili). The protocols used were: A) 3mA during 3 seconds and 3 applications (Physio Invasiva by BRUMA Center-Tarragona (6 needles) and from the MV Clinic-Madrid (9 needles) in humans and from the UHN laboratory UHN (10 needles) in animals; B) 3mA during 3 seconds and 10 applications, 5 needles were evaluated in animals; C) 3mA during 3 seconds and 50 applications, 5 needles were evaluated in animals.

Results No change was obtained in the proximal-distal resistance (0.4% ± 3.33). No loss of any of the metals occurred in the needles subjected to the protocol of 3/3/3 nor the protocol 3/ 3/10. However, in the 3/ 3/10 protocol, statistically significant losses were obtained for all the metals present.

Conclusion Physio Invasiva needles measuring 0.30 × 40mm do not shed metals nor modify their morphology during the intervention, therefore, the needle diameter of the needle does not decrease. Only exceptionally, when the number of applications is large, is there a loss of material.
Acupuncture points and cutaneous perforating vessels identified with thermography
Authors: F. Soares Parreira , M. Pereira Barbosa , D. Álvarez Prats , O. Carvajal Fernández
Published: December 2019

Aim To confirm the presence of perforating cutaneous vessels (PCV) in different acupuncture points (AP) in the upper limb using thermography.

Material and Methods A cross-sectional analytic study in the upper limb of voluntary subjects (n = 7). In total, 91 AP were analyzed, as well as 91 control points (CP), one per each AP. In each subject, first the AP and corresponding CP were marked, and in second place, the real and thermographic images were captured. In the real images, the AP and CP were marked with circles. Thereafter, software was used to fuse the real image with the AP and the CP and the thermographic image with the PCV to observe the presence or lack of the same in the AP and CP.

Results When all the AP and CP were analyzed globally, significant differences were observed among these regarding the proportion of points which coincided with PCV (p 0.001). It is possible to verify that in the AP, the percentage of coincidence with PCV is 68.1% and in the control points this is 41.8%. This relationship is demonstrated by the risk ratio and odds ratio values and the confidence intervals (95%CI). Thus, it was verified that in AP the probability (risk) of coincidence with PCV is 1.63 [1.23; 2.16] times greater to the probability in the CP. In the same manner, due to the odds ratio, it is still possible to observe that in the AP the chance (odds) of coincidence with PCV is 2.98 [1.63; 5.47] times greater to the CP. It is also shown that for the AP the likelihood of coinciding with perforating vessels is 7.50 [1.31; 43.03] times greater compared to coinciding with CP.

Discussion The presence of PCV in the area of AP must be treated with greater care, both due to the physiology of the same as well as its importance in clinical medicine. Although the precise location of the PCV varies, thermography is a useful tool to evaluate a patient and subsequently apply treatment.

Conclusions Overall, a strong statistical difference was found regarding the presence of PCV in the location of AP in the upper limb.
Relationship between the anteroposterior diameter of the patellar tendon. Pain and functionality in volleyball players
Authors: A. Calvo Gonell , L. Macia Soler , J. Moncho
Published: December 2019

Introduction and Aim Overuse injuries in volleyball represent between 50% and 80% of total injuries, of which, 80% are patellar tendinopathies. Volleyball is the sport with the greatest prevalence of patellar tendinopathy, estimated at 44.6%, followed by basketball with 31.9%. The tendon thickness bears a close and direct relationship with abnormal and diffuse images with accumulation of ground substance, and affecting both sexes, although less marked in women.

Aim To determine whether the antero-posterior diameter of the patellar tendon in volleyball players is associated with a greater sensation of pain and reduced functionality.

Material and Methods An observational, descriptive, cross-sectional study on volleyball players. The scores on the VISA-P scale, the visual analog scale (VAS) and, using musculoskeletal ultrasound, the anteroposterior diameter of the patellar tendon at 5 and 10 mm distal to the inferior pole of the patella. Multiple linear regression models were constructed to adjust the effect of the anteroposterior diameter on the VAS and the VISA-P scores.

Results The final sample comprised 112 players. The anteroposterior diameter was greater in men and was significantly associated with scores on the VAS and the VISA-P for both tendons, and therefore, the greater the score of the diameter, the greater the score on the VAS and the lesser the score on the VISA-P.

Conclusions The measurement of the antero-posterior diameter of the patellar tendon using musculoskeletal ultrasound may be useful for the prevention of sports injuries in volleyball players, as it is significantly associated with a greater perception of pain and reduced functionality.
Adverse effects of percutaneous needle electrolysis in carpal tunnel syndrome
Authors: JM Segura León , F. Medina i Mirapeix , F. Valera Garrido
Published: December 2019

Background Percutaneous needle electrolysis is a physical therapy technique which has shown to be useful for the treatment of nerve entrapments. The aim of the present study was to analyze the possible adverse effects and the follow-up pattern after the application of percutaneous needle electrolysis in carpal tunnel syndrome.

Material and Methods A descriptive observational study conducted at the Traumatology Service of the Ciudad Real Hospital, in patients with a medical diagnosis of carpal tunnel syndrome confirmed by electromyography (gold standard).

Percutaneous needle electrolysis was applied under ultrasound guidance in the superficial and deep interphase of the median nerve in its passage through the carpal tunnel, applied with a frequency of once every seven days over four weeks.

The week after each intervention, the follow-up pattern of the adverse effects variables was gathered, grouped in the following categories: type of adverse effect, moment of appearance, prevalence period, impact and causality.

At 1.5 weeks and 6 weeks after the last intervention, the following variables were gathered: presence of painful or hypertrophic scar, stiffness at the level of the wrist, hand or fingers, infection of the wound, alteration of reflex sympathetic trophism, symptoms related with a nerve lesion, symptoms related with a tendon lesion, post intervention effusion. The McNemar test was used for comparative measures between the first, second, third and fourth intervention, without significant variations (p < 0.05).

Results 30 cases participated in the study, of which one subject had to abandon the treatment after the first application because of apprehension in relation to following through with treatment.

Of the 117 intervention applied, one vegetative reaction was recorded, which was transitory and without consequences. Pain appeared during the intervention in 96.5% of the interventions, after the intervention pain was present in 56%, whereas pain experienced days after the intervention occurred in 28.4%. No cases required further medical intervention, and there were no irreversible cases, independent of the cause. For the remaining variables, the records were negative in all interventions.

No adverse effects were described for any cases at the follow up at 1.5 and 6 weeks post-intervention.

Conclusions No adverse effects were described at the end of the intervention in the short to mid term. Regarding the follow-up pattern, the pain followed a highly homogeneous course, there were no irreversible adverse effects requiring intervention, and no relationship was found with any cause on behalf of the patient.
Updating and validating quality prescribing indicators for use in Australian general practice
Authors: Dang Cuu Phuong Linh , Toh Li Shean , Cooling Nick , Jackson Shane , Curtain Colin , Thompson Angus , Peterson Gregory
Published: December 2019

This study aims to update and validate quality prescribing indicators (QPIs) for Australian general practice. The study comprised two phases: (1) developing preliminary potential QPIs based on the 2006 National Prescribing Service (NPS) MedicineWise indicators, published literature, international indicators and guidelines, and through qualitative focus group discussions; and (2) validating the proposed QPIs through a two-round online survey using the Delphi technique. The Delphi panel included four GPs, four pharmacists and two clinical pharmacologists. The Delphi panel rated the potential QPIs for their validity, importance and feasibility using a 1–10 Likert scale. In round one, all proposed QPIs presented as ‘prescribing rules’ achieved high scores regarding validity, importance and feasibility No rule was eliminated and three new rules were introduced. Rules were reworded into ‘prescribing indicators’ for round two, which resulted in 35 indicators being accepted and two indicators being eliminated. The final QPIs also include seven drug–drug interactions, which received high scores in round one. In conclusion, 42 QPIs were nominated for use in Australian general practice, based on their validity, importance and feasibility. If implemented, these QPIs have the potential to assist in efforts to improve the quality and safety of medicines management.
A routine-based framework implementing workload control to address recurring disturbances
Authors: Shoaib-ul-Hasan Sayyed , Macchi Marco , Pozzetti Alessandro , Carrasco-Gallego Ruth
Published: December 2019

This research focuses on responsiveness in high variety manufacturing environments. To achieve it, the article proposes to develop Dynamic Response Capabilities (DRCs) of the manufacturing system defined as the abilities to readjust the planned operating parameters of workload, capacity,
and lead time, in the wake of disturbances. To inform their development, built on the Workload Control theory, a routine-based framework is proposed. The framework supports an integrated approach for the implementation of adaptive decision-making routines for workload, capacity, and lead time
readjustments at different stages in the order fulfilment process. Findings from two empirical cases show the appropriateness of the framework to develop and utilise DRCs in different settings of disturbances. Results of a simulation study, with one of the case companies, also shows the effectiveness
of the framework to drive performance improvements in presence of recurring disturbances leading to demand variability.
Deepening Andre Delbecq’s legacy: Inspiring undergraduate students to serve humankind
Authors: Le Long , Mark Fusco S.J.
Published: December 2019

In the past, the typical business school professional saw little need to even broach the spiritual calling. However, Andre’s vocational journey as a scholar-teacher significantly contributed to this change, and many of his colleagues are continuing and looking forward to the possibilities
of Andre’s work. Through a Jesuit-lay friendship with the second author, the first author began to take Andre’s call in integrating business as a noble vocation at the undergraduate business level. In connecting classroom assignments and activities with Andre’s scholarship,
undergraduate business students were invited to consider what kind of person they would want to be and what kind of world they would want to live in. Here, the article chronicles the work of Andre that inspired changes in the first author’s pedagogy toward coursework that embraces the
discipline to make profits along with the discipline to be human – crossing geographical, political, cultural and religious boundaries – in order to meet the world’s needs.
Phenomenology
Authors: Ruthrof Horst
Published: December 2019

Phenomenological literary theory has its roots in Edmund Husserl’s studies of the directional acts of consciousness in the first half of the 20th century and Roman Ingarden’s The Literary Work of Art and The Cognition of the Literary Work of Art, arguing that literary works can come into existence only in the act of reading. Under the influence of Martin Heidegger, phenomenology absorbed hermeneutic insights from Dilthey, Gadamer, and Ricoeur, as well as existentialist features, foremost from Jean-Paul Sartre, with Merleau-Ponty contributing a corporeal accent by reiterating Husserl’s distinction between the biophysical body (Körper) and the animate body (Leib). George Poulet of the Geneva school and the early Yale critics added an author-oriented form of literary criticism, while Ingarden’s work was taken up by the Konstanz school theorists Wolfgang Iser and Hans Robert Jauss, the latter challenging ontological approaches by a historically anchored form of reception aesthetics. In the United States, the idea of phenomenology in literature has been prominently pursued by Maurice Natanson. At the same time, phenomenological literary theory is undergoing a revival in the wake of the neo-phenomenology of Hermann Schmitz, notably in such writings as Rita Felski’s Uses of Literature.
01 Prediction of Falls in Community-Dwelling Older People using an Accelerometer: The Results of a 1-Year Prospective Study
Authors: Osaka Hiroshi , Fujita Daisuke , Kobara Kenichi , Yoshimura Yosuke , Matsumoto Hiromi , Suehiro Tadanobu
Published: December 2019

Background

Fall preventive exercise for community-dwelling older people in Japan has a certain effect. The purpose of this study was to examine the predictors of fall risk in older people engaging in preventive exercise.

Methods

In this prospective study, we recruited 162 community-dwelling older people. We had them complete a self-report questionnaire containing items on weekly exercise frequency, exercise duration, exercise efficacy, amount of pain, number of diagnosis chronic diseases, health anxiety level, vision impairment, difficulty using the stairs, insomnia, fear of falling, history of falls, and forgetfulness, as well as the Falls Efficacy Scale. Walking speed and trunk acceleration during walking were also measured in all participants. From trunk acceleration, we calculated five gait parameters: fluctuation, weight shift, lateral balance, anteroposterior balance, and rhythm. Participants were classified as fallers or non-fallers according to the incidence of falls over a 1-year period from baseline assessment.

Results

Of all participants, 19 (11.7%) were classified as fallers and 143 (88.3%) as non-fallers. In comparing the fallers and non-fallers, we found significant differences in their exercise duration, exercise efficacy, amount of pain, history of falls, walking speed, and the gait parameters of weight shift and anteroposterior balance. A logistic regression analysis revealed that walking speed (odds ratio: 0.049, 95% confidence interval [CI]: 0.005-0.265, p=0.008) and weight shift (odds ratio: 0.021, 95%CI: 0.000-0.877, p=0.043) were predictors of falls.

Conclusion

The gait parameter of weight shift is the amplitude ratio of the auto-correlation function from vertical acceleration. This gait parameter is an original metrics and might show the temporal structure around the terminal stance. Measurement of gait parameters, in addition to physical performance, using an accelerometer seems beneficial for fall risk identification among community-dwelling older people engaged in fall preventive exercise.
03 Standing Postural Control in the Older Adult using Proposed Virtual Light Touch Contact System
Authors: Shimatani Koji , Sakata Mami , Mitani Ryoma , Shima Keisuke
Published: December 2019

Background

We proposed a novel standing-function evaluation system based on Virtual Light Touch Contact (VLTC). In this approach, virtual partition with virtual inertia, viscosity, stiffness is set around the subject. When the subject touches the virtual partition, virtual force is estimated. And virtual force is feed backed to fingertip in the form of vibrotactile stimulation. Random on/off control of virtual forces from the virtual partition enabled evaluation of standing function based on the presence or absence of somatic sensory stimulation to the fingers.

Purpose

The purpose of this study was to investigate the adults’ postural control during quiet standing using our VLTC system.

Method

The participants were 60 adults (72.7±7.6 y/o). We used our proposed vibrotactile stimulation device and a Kinect 2 sensor (Microsoft) and a Wii Balance Board (Nintendo) are utilized to determine the centre of pressure (COP). We measured quiet standing with closed eyes and legs using a VLTC system. We compered body sway using total sway length (TSL), rectangular area (RA), average velocity (AVel), and average vector (AVec) of COP in each of the 60's, (22 participants) 70's (28 participants), 80's (10 participants).

Results

The TSL and AVel in the 60’s was significantly smaller than that in the 80’s (p<0.05). And the TLS and AVel in the 70's tended to be smaller than that in the 80's (p=0.07). The other parameters were non-significant.

Conclusion

We showed that body sway increased when the old adults were quiet standing with VLTC system. Stability of the human posture by LTC is due to an increased amount of feedback, especially from the somatosensory system, among the system required for postural adjustment. Authors assume that the old adults could not depend on VTC system due to the decreased in fingertip somatosensory function, and the old adult’s body sway was increased.
05 Shoe Insole Intervention to Reduce Falls and Injuries
Authors: Nagano Hanatsu , Sarashina Eri , Mizukami Katsuyoshi , Begg Rezaul
Published: December 2019

Despite a number of strategies to minimise falls risks, older adults tend to avoid voluntary and continuous engagement into interventions without cost effectiveness and simplicity. Shoe-insole modification may be a practical intervention if it alters foot geometry inside a shoe and improves gait patterns to prevent falls. The current study designed a shoe-insole structure with 2.2 dorsiflexion and 4.5 eversion built-in inclinations on the entire insole surface. Ankle dorsiflexion is fundamental for higher swing foot clearance to reduce tripping falls. Eversion support may also regulate excessive lateral foot centre of pressure (CoP) excursion to prevent ankle sprain and associated falls. Three young male participants (Age: 21 ± 3 yrs., Height: 1.70 ±.08m, Body Mass: 65.3 ± 2.65kg) conducted gait testing on an 8m walkway repeatedly to collect 60 step cycles for both non-insole and insole conditions. Optotrak motion capture system (NDI) recorded swing foot clearance at 100 Hz while AMTI force plates obtained ground reaction forces data, therefore CoP movements. Minimum foot clearance (MFC) was defined as the local minimum vertical toe-ground clearance during mid-swing, where higher MFC prevents tripping falls. The tested insole increased MFC by .20cm on average, considered to effectively reduce tripping falls. Lateral CoP excursion (lateral displacement from initial CoP location at heel contact to the most lateral CoP location during the initial phase of loading response) was reduced by 1.18cm (61%) due to insole walking, possibly indicating the lower risk of ankle sprain and sideways balance loss. Despite these positive effects, further validation is necessary with a sufficient sample size including the older population. It is also essential to consider negative aspects of continuous dorsiflexion and eversion support. For example, the tested insole may disturb functionally important supination. Prior to practical use, human trials for a prolonged period of time are required for insole intervention.
06 Development of Indexes Derived from Lower Trunk Angular Velocity During Modify Sit-to-Stand Test in the Community Elderly
Authors: Shota Koyama , Tsuyoshi Asai , Kensuke Oshima , Yoshihiro Fukumoto , Hiroki Kubo
Published: December 2019

Background

The sit-to-stand test (STS) is a representative motor test. In most of STS, the time taken to complete the test was used as its score, and its quality of motion has not been focused. In the present study, we measured the lower trunk angular velocity using gyro sensor during STS and computed the angular velocity-based indices (AV-index). We investigated its test-retest reliability and concurrent validity.

Method

Seventy-eight older people in community-dwelling were participated. Basic-health-related-information and the previous one-year fall-history were obtained by a questionnaire. As motor-function tests, One Leg Standing test (OLS), 3 minutes walking test (3MWT), Timed Up and Go test (TUG) were performed. Additionally, Modify Five-Times-STS was performed twice, the lower trunk angular velocity during the tests were measured using gyro sensor. From the obtained-signal waveforms in the sagittal plane (SP), root mean square (RMS) and coefficient of auto correlation (AC), the mean impact at sitting timing (STS impact) in Modify Five-Times-STS were computed. The intra-class correlation coefficient (ICC) was calculated for the test-retest reliability of the AV-indices. The coefficients of Pearson’s correlation were computed between AV-indices and the Five-Times-STS score, and scores of motor-function tests.

Result

The ICC of STS impact and RMS in SP were 0.85. The ICC of the other AV-index were lower than 0.5. The RMS in SP was significantly associated with OLS (r = 0.24), and 3MWT (r = 0.36), TUG (r = −0.32). Additionally, the STS impact was significantly associated with 3MWT (r = 0.54).

Conclusions

The test-retest reliability of two AV-index (STS impact and RMS in SP) is good. The concurrent validity of AV-index is partly confirmed.
101 Younger and Older Inpatient Fallers: What’s the Difference?
Authors: Pok Wen Kin Alan , Chong Gar Mit
Published: December 2019

Background

Falls are in important adverse event occurring in patients admitted to hospital, with potentially devastating consequences. An effective prevention and intervention programme may be devised by looking at the characteristics of falls in an institution.

Objective

To identify the differences between falls in older and younger patients in the medical wards of a tertiary hospital.

Methods

This is a retrospective cross-sectional study of data collected from the hospital Incidence Reporting system and Falls Intervention Team, looking at patients who had fallen in the Hospital Kuala Lumpur Medical Wards from January 2015 until December 2019. Parameters were codified as: patient age [young (≤50), pre-old (51-60), old (>60)], sex, mental status pre-fall (alert, confused, drowsy), nursing shift where the fall occurred (morning, afternoon, night), time of week (weekday, weekend), location of fall (toilet, bedside, walkway, others), activity pre-fall (toileting, transferring, physiotherapy, sitting, walking, others) and injury sustained (major, minor, none). Data analysis was performed using the Chi-square test with SPSS v22.

Results

There were 457 inpatient fallers during the study period. Most of the fallers were old (57.3%), whilst 18.3% were pre-old and 24.6% were young. 62.8% fallers were male, and there were significantly more male fallers at all age groups (p 0.028). There was no significant difference between the age groups with regards to nursing shift (p 0.319), time of week (p 0.461), site (p 0.216), activity (p 0.457), mental status (p 0.479) nor injury (p 0.632).

Conclusion

Most fallers were old and male, but there was no significant difference between the circumstances and characteristics of falls between older and younger inpatients. This suggests that falls prevention and intervention measures may be applied generally to all age groups.

References

Cameron ID et al. Interventions for preventing falls in older people in nursing care facilities and hospitals. Cochrane Database 2010.
103 Physical Performance among Community-Dwelling Older People in Senawang
Authors: Ibrahim Amirah Fatin , Teoh Gaik Kin , Chong Mei Chan , Tan Maw Pin , Muda Siti Mariam , Khoo Phaik Lin
Published: December 2019

Introduction

Older adults may remove themselves voluntarily from social activities due to health concerns and physical limitations that leads to loneliness. Additionally, loneliness is associated with poorer health among older adults. Therefore, this study aims to improve health status among community-dwelling older adults in the sub-urban area through this social participation project by creating awareness on empowering the older adults in managing their health and social life.

Methods

This is a community-based participatory research (CBPR) applying both quantitative and qualitative approaches. Quantitative data was obtained with a standardized data collection document and obtained during a series of health screening programs. The data was analyzed using descriptive statistics.

Key results

87 older adults participated in two health screening events. The mean age was 66 ± 6.5 (SD) years, median BMI was 26.5 (IQR=6.4), mean systolic blood pressure was 141 ± 14.6 (SD) mmHg, median diastolic blood pressure was 78 (IQR=10) mmHg, median timed up and go was 10 (IQR=3) seconds, median trail-making test A was 45.8 (IQR=24.4) seconds, median trail-making test B was 115.8 (IQR=99.3) seconds. The mean hand grip strength for male was 30.76 ± 5.1 (SD) kg for right hand and 31.87 ± 24.5 (SD) kg for left hand. The mean hand grip strength for female was 18.40 ± 5.1 (SD) kg for right hand and 17.14 ± 5.0 (SD) kg for left hand.

Discussion

The results may represent a portion of community-dwelling older adults who are actively engage in community activities such as religious classes, weddings or events. Therefore, the results showed normal values for all physical and mental tests. However, 61% of the participants were overweight or obese and had higher mean systolic blood pressure suggesting the need for more education and awareness on health management.
109 Thai Traditional Game-Based Exercise for Gait and Balance of People with Parkinson's Disease
Authors: Khongprasert Surasa
Published: December 2019

Falls and recurrent falls are serious complications for people with PD. Poor standing balance, impaired ambulation, impaired lower-limb motor planning, postural instability and falling in previous year are associated with falling in PD. Exercise based computer game (Exergaming) have been used for motor rehabilitation to promote gait and balance and can encourage therapeutic activity. However, many commercially available games are not affordable for some people with Parkinson ’s disease. The aim of this study was to evaluate the effectiveness of Thai Traditional game (TTG) based exercise on gait and balance in people with Parkinson ’s disease. A total of 22 participants with PD (mild –moderate severity) were randomly assigned to either a TTG group or a control group. Participants in TTG completed 1 hour, 3 sessions a week for 10 weeks. The TTG comprises 10 games involved instruction in sit to standing, slow and fast walking speed, turning, weight shifting, reaching, obstacle stepping, cognition, clapping and singing. Gait and balance were assessed before and after the training sessions. Measures included the Berg Balance Scale (BBS), Balance platform, Timed Up and Go (TUG) and The GaitRite walkway. Participants in TTG groups showed significantly improved BBS, TUG, gait velocity and sagittal mean sway with eyes open (p <0.05). Thai Traditional Game based exercise incorporated therapeutic movement could lead improvement in gait and balance and participants seem to enjoy playing as an activity while maintaining their functionality. Future studies should incorporate larger groups and focus on long-term compliance and follow-up.
110 Lower Hand Grip Strength Influences Falls Risk in Malaysians Aged 55 and above with Diabetes
Authors: Mat Sumaiyah Mat , Kamaruzzaman Shahrul Bahyah , Chin Ai-Vyrn , Tan Maw Pin
Published: December 2019

Background

Diabetes mellitus (DM) is a highly prevalent NCD affecting 20-30% of worldwide population with a rapidly rising prevalence in LMICs. It has been suggested that DM is one of the important risk factors for falls in older people attributed to complications. However, only a handful studies has evaluated the mechanisms of falls in diabetes.

Aim

To determine the potential mediating factors for falls individuals with diabetes mellitus

Methods

Cross-sectional analysis was conducted using the Malaysian Elders Longitudinal Study (MELoR) first wave data. The MELoR study recruited Klang Valley residents aged >55 years. DM was defined as fasting hyperglycaemia (serum fasting glucose > 6.66 mmol/l) or HbA1c > 42 mmol/mol (6.1%) or self-reported diabetes by participants or consumption of hypoglycaemic medications. Falls were identified by enquiring about the presence of fall in the past 12 months. Physical measurements obtained were hand grip strength (HGS), timed-up-and-go (TUG) and functional reach.

Result

Of 1579 participants, mean (SD) age 68.85 (7.48) years and 901 (57.1%) female, DM was present in 796 (50.4%) participants while 363 (22.9%) had falls in the past 12months. DM was associated with 35% of increased odds of falls compared to those without DM (odds ratio (95% CI)= 1.35 (1.07-1.71)). The association was remained significant after adjustment of demographic differences, body mass index and TUG. The associations were, however, attenuated after the inclusion of HGS in the model.

Conclusion

Weaker HGS appeared to account for the increased risk of falls in individuals aged 55 ears and above with DM. Reduced HGS is a marker including in the frailty phenotype. It is unclear why HGS rather than TUG, which is a composite measure of gait speed, lower limb girdle and dynamic balance mediated the relationship. A prospective study is required to determine the temporal relation between HGS and falls in diabetes.
117 Study of Development and Validation of the Multi-Sensor based Kiosk Performing Short Physical Performance Battery Automatically
Authors: Jung Heewon , Lim Jae-Young , Park Jihong
Published: December 2019

Background

Short physical performance battery (SPPB) is a well-accepted clinical test to assess vulnerability in older adults. We aimed to develop and validate a multi-sensor based kiosk (e-SPPB kiosk) which can perform automated measurement for SPPB.

Methods

The e-SPPB kiosk was developed to measure 3 components of SPPB of standing balance, gait speed, and chair stand test with embedded sensors and algorithms. Feasibility and reliability of the e-SPPB kiosk was assessed with the manually measured SPPB (m-SPPB) by a physical therapist in participants aged 65 or older recruited from the outpatient rehabilitation clinic of the Seoul National University Bundang Hospital, Seongnam, Korea, from November 2018 to April 2019.

Results

In 34 participants with mean age of 73.6 (standard deviation [SD] 5.4), mean of e-SPPB total score was 10.1 (SD 2.2) and mean of m-SPPB total score was 10.2 (SD 2.3). Concordance between e-SPPB and m-SPPB total score was 0.94 (P<0.001) and agreement by Kappa was 0.65 (P<0.001). Agreements for components of e-SPPB and m-SPPB were 0.68 (P<0.001), 0.73 (P<0.001), 0.92 (P<0.001) for standing balance, gait speed and chair stand test, respectively.

Conclusion

In older adults, physical performance measured by the e-SPPB kiosk correlated to m-SPPB measured by a single physical therapist. In multicenter studies for older people with physical performance as an outcome or selection criterion, e-SPPB kiosk can be used to reduce possible inter-rater variabilities of SPPB.
118 Use of Smart Wearable Devices for Gait Assessment Among Older Chinese
Authors: Zhong Runting , Rau Pei-Luen Patrick
Published: December 2019

Introduction

This study used smart bracelets and smartphones for gait assessment and analysis.

Method

Two hundred and twenty-eight older Chinese (mean age 69.3 ± 7.5 years) participated in this study. Participants wore either a smartphone or smart bracelet on their lower back while performing the gait test. They walked at a comfortable speed, at a comfortable speed and serially subtracting by three, and at a fast speed. This study measured gait parameters including speed, step frequency, acceleration root mean square (RMS), step regularity, symmetry and variability. Older adults were classified into pre-frail and non-frail groups based on the FRAIL SCALE (Kan et al., J Nutr Health Aging, 2008, 12, 29–37). We interviewed twenty-eight participants and three medical professionals and developed a smart app for gait assessment.

Results

It is fast and convenient to use smart wearable devices for gait assessment and analysis. The average speed (1.27m/s) of older Chinese seemed faster compared with older adults from literatures (Capistrant et al., Journal of the American Geriatrics Society, 2014, 62(2), 329-335). Acceleration RMS was correlated with speed (Pearson r = .65–.76, p < .001) and could be a proxy of speed. Pre-frail older adults had significantly decreased speed, RMS, and step regularity compared with non-frail counterparts (ps < .05); step frequency, RMS, regularity, symmetry and variability were significantly different between walking types (ps < .001).

The smart app records gait data of 30 seconds and generate a real-time gait assessment report including step frequency, RMS, regularity, symmetry and variability after the gait test. Overall, the acceptability from older adults is positive with participants indicating the app was easy to use and useful.

Conclusion

The application is a useful tool for older Chinese to track their gait quality in home care.
119 Clinical Decision Support System (CDSS) on Medication-Related Fall Risk: Wishes and Needs of European Physicians
Authors: Ploegmakers Kim , Linn Annemiek , Medlock Stephanie , Van der Velde Nathalie , Van Weert Julia
Published: December 2019

Background

Medication is the second most important cause of falls in older adults, after mobility impairments. Doctors struggle to withdraw Fall Risk Increasing Drugs (FRIDs). They tend to overestimate the beneficial effect of medication and underestimate the risk of side effects. With an online survey we explored if 1) European doctors want digital support during medication review of older fallers by presentation of a personalized fall risk estimation of a patient and 2) what potential barriers and facilitators exist for the use of a Clinical Decision Support System (CDSS) that communicates fall risk.

Methods

We performed online surveys in 10 European countries among 359 European physicians who care for older fallers. 68% of the participants were geriatricians.

Results

88% of physicians would like to receive help with performing a medication review. Barriers for usage that were mentioned most frequently were: technical issues (74%), indicating a reason when overriding an alert (62%) and unclear advice (60%). Most important facilitators were if the system: is beneficial to patient care (75%), is user friendly (74%) and fits into the workflow (66%)

Conclusion

most physicians would like to receive help from a CDSS when performing a medication review. For a successful implementation the barriers and facilitators found must be taken into account during development of the system as well as differences between countries.
122 3OLLIN: APP to Assess the Risk of Falls in Older Adults
Authors: Parra-Rodríguez Lorena
Published: December 2019

Objective

To develop an app for Android smartphones (named 3Ollin) that assess the fall risk through the automated analysis of three physical performance (PP) tests and the history of falls of the participant.

Design

Cross-sectional design.

Setting

Community-dwelling older adults studied at the Functional Evaluation Laboratory at the National Institute of Geriatrics in Mexico.

Participants

Older adults (n=223) living in Mexico City were included. The participants were recruited from groups of pensioners from the National Autonomous University of Mexico, church groups, and other community programs.

Measurements

Data were collected about demographics, comorbidities, cognitive status, nutritional status, dependency and PP variables. The 3Ollin app evaluates the PP of the participants through the history of falls, the Timed Up and Go, the 30-second chair stand, and the 4-stage balance tests. The app incorporates them into the CDC’s Algorithm for Fall Risk Screening, Assessment, and Intervention.

Methods

All participants were evaluated by trained staff. The app has a registration system for users and patients, allows to perform the PP tests, acquires the data from the sensors signals, and sends and stores the information in the server of the National Institute of Geriatrics in Mexico.

Results

The mean age of the studied population was 73.5±7.0 years, 77.6% were women, and 37.2% did not complete the 4-stage balance test. The mean percentage error (MPE) between the gait speed measured through the GAITRite walkway (ms=103.5±26.1 cm/s) and the 3Ollin app (ms=100.0±30.3 cm/s) was 10.7%. The MPE between the number of chair lifts in 30 s according to the evaluator's observations (mCL=15±6 repetitions), and the 3Ollin app (mCL=19±6 repetitions) was 23.4%. Additionally, 87% were correctly classified according to the 3Ollin app.

Conclusions

This design first step of the 3Ollin app probed to offer a valid, efficient, costless performance evaluation, without the need of a laboratory environment.
126 Development of a Falls Prediction Tool for People with Diabetes Mellitus
Authors: Wettasinghe Asha , Dissanayake Dilshani , Allet Lara , Katulanda Prasad , Lord Stephen
Published: December 2019

Introduction

Diabetes mellitus (DM), aging and falls have been recognized as a growing and a challenging triad. Despite many tools to assess risk of falls, they may not be applicable for fall risk assessment in DM patients. The aim of the study was to develop a low- cost tool to predict the faller status of DM people.

Methods

People with DM (n=103) were recruited from diabetic clinics in Sri Lanka. Demographic, neuropathy status, contrast sensitivity (Melbourne Edge test) lower limb (LL) sensation, cognitive functions, fear of falling (Icon-FES), LL strength (maximal isometric quadriceps strength), hand reaction time, balance abilities (postural sway, maximal balance range, coordinated stability, unipedal stand time (UST) and tandem and near tandem standing ability), mobility (Timed up and go test-TUG) and gait parameters were assessed. Falls were prospectively recorded over six months. Data were analyzed using SPSS and STATA with negative binominal regression.

Results

Fall rates were significantly associated with DM symptoms (p=0.001) and examination scores (p=0.026), HbA1c (p=0.012), contrast sensitivity (p=0.033), TUG (p=0.006), quadriceps strength (p=0.015), sway path on floor eyes closed (p=0.002), sway on foam eyes opened (p=0.009), near tandem (p=0.006) and tandem (p=0.008) balance, UST (p=0.027), stride length (p=0.009), TUG times with cognitive task (p=0.007), dual task backward walking (p=0.005). A multivariate negative binomial regression model comprised two significant and independent variables influencing falls: quadriceps strength and tandem balance ability (likelihood ratio Chi square=12.43, p=0.002). For 1kg increase in quadriceps strength fall rates decreased by 0.94% and the presence of poor tandem balance increased fall rates by a factor of 2.48.

Discussion and Conclusion

We identified multiple factors that elucidate why people with DM fall. A simple, easy to use tool comprising two independent risk factors: tests of quadriceps strength and tandem balance ability are suggested as a simple screen for fall risk in this population. Such patients may then warrant further detailed assessment and a tailored intervention.
129 Effects of Physical Capacity, Executive Function, Mental Health and Polypharmacy on Gait and Falls Risks among Older Adults
Authors: Sarashina Eri , Mizukami Katsuyoshi , Begg Rezaul , Nagano Hanatsu
Published: December 2019

Falls prevention is an important healthcare topic in an ageing society due to serious and costly injuries. Gait biomechanics utilising 3D motion capture system can possibly identify fall-prone walking patterns. It is, therefore, important to reveal factors for negative gait changes and higher falls risks. A total of 54 community-dwelling senior citizens undertook a series of examinations: (i) fundamental gait assessment - step length, step width, double support time; (ii) the risk of tripping falls - minimum foot clearance (MFC); (iii) flat-foot contact - foot contact angle; (iv) fundamental physical tests - grip strength, functional reach, one-leg standing; (v) executive function - trail making test-A; (vi) Psychological health - General Health Questionnaire 12; (vii) falls history and (viii) polypharmacy. Pearson’s correlations were computed between gait data and the other potentially related factors. A reduced number of drugs (r = -.353, p < .01) and prolonged one-leg standing i.e. improved balance (r =.333, p < .05) demonstrated interlinks with greater step length, indicating the overall gait health. Step length was also strongly correlated with foot contact angle (r = .537, p < .01), which was further associated with one leg standing (r = .339, < .05). The risk of tripping (MFC) showed interrelations with one leg standing (r = .273, < .05) and functional reach (r = .289, < .05). Furthermore, step width was also correlated with one leg standing (r = -.289, < .05) and functional reach (r = -.278, < .05). Balance control capacity (one leg standing) and flexibility (functional reach) may be, therefore, closely related to gait control and tripping risks. While fundamental physical tests thus adequately reflected gait data, mental health and executive function were not correlated with gait data in the current study. Further investigation with a larger sample size will be required.
134 Reliability and Usability of Step Sensing System on Gait Speed and Stepping Accuracy Measurement: A Preliminary Evaluation
Authors: Jesadaporn Panas , Jayapravitra Yudh , Khumrin Piyapong
Published: December 2019

Background

Falls are the most common cause of injury among older people in Thailand. However, there are no established falls prevention programs in our community. Telehealth is one of the strategies to overcome this unmet need. We have developed the Step Sensing System (SSS) for measuring gait speed and stepping accuracy of multi target stepping task (MTST). This system comprises of the footstep sensing modules, controller box and analyzing computer. SSS records each footfall and compares with an assignment for each walking trail. The results will be sent to a cloud storage which are accessible by web-based and mobile applications. By using this technology, we are able to remotely access falls risk and monitor MTST performance in older people.

Methods

We placed footstep sensing modules under a 6-metre mat, then asked a 32-year-old healthy woman to walk across the mat for 4 trails: usual-pace, faster-pace, usual-pace with 1 assigned target and usual-pace with 2 assigned targets on an alternating sequence. We evaluated the system reliability by comparing gait speed and stepping accuracy on 3rd and 4th trails with video recorded by Intel RealsenseTM Depth Camera (model D415).

Results

SSS and video recording has excellent correlation for gait speed and stepping accuracy measurement (intraclass correlation coefficient [ICC] > 0.99, p value < 0.001). The user satisfaction measured by the System Usability Scale was 70/100.

Conclusions

SSS demonstrated promising results on gait speed and stepping accuracy measurement in controlled environment. For the next step, we plan to increase ability of gait measurement on various parameters and perform the validity assessment in community setting.