To validate the “Life-Space Assessment in Persons with Cognitive Impairment” (LSA-CI) to assess m... more To validate the “Life-Space Assessment in Persons with Cognitive Impairment” (LSA-CI) to assess mobility within the environment including contextual factors in older persons without cognitive impairment. Excellent feasibility with 100% completion rate and average assessment duration of 4 min in 65 older persons. The LSA-CI composite score stood out with moderate to high construct validity, excellent test–retest reliability and moderate sensitivity to change. Analysis of sub-scores confirmed most of the composite score results. The LSA-CI represents a valid, reliable, responsive, and highly feasible assessment method in multi-morbid, older persons without cognitive impairment, and can be recommended for use in clinical practice and research. The “Life-Space Assessment in Persons with Cognitive Impairment” (LSA-CI) to assess mobility within the environment including frequency and independence in 1 week has been developed for and successfully validated in older persons with mild to moderate cognitive impairment. However, its psychometric properties in persons without cognitive impairment are unknown. This study aims to validate the LSA-CI in older persons without cognitive impairment. Comprehensive validation with construct validity, test–retest reliability and sensitivity to change of the LSA-CI including the main composite score and three sub-scores in community-dwelling older persons recruited during geriatric rehabilitation. Excellent feasibility with 100% completion rate and an average assessment duration of 4 min in 65 older, multimorbid persons (mean age: 81.4 ± 5.9 years; 72.3% female; average number of diagnoses: 11.1 ± 4.4). The LSA-CI composite score stood out with moderate to high construct validity (Spearman correlation coefficients |0.26|–|0.60|), excellent test–retest reliability (intraclass correlation coefficient 0.890) and moderate sensitivity to change (adjusted standardized response mean 0.70). Analysis of sub-scores confirmed most of the composite score results. The LSA-CI represents a valid, reliable, responsive, and highly feasible assessment method in multi-morbid, older persons without cognitive impairment, supporting the use of the LSA-CI in clinical practice and research.
Since muscle strength and coordination training in healthy elderly people has been effective in t... more Since muscle strength and coordination training in healthy elderly people has been effective in the primary prevention, a program for geriatric patients with falls is presented. Its aim is safer walking by an increase in muscular strength and improved coordination. The exclusion criteria and the size of the training program define a group of over 75 year old patients, who will be compared with a group with light physical exercise in a randomized fashion. The first results show a remarkable increase in strength and a low complication rate. The functional relevance of our program remains to be proven.
Background: Match or mismatch of objective physiological and subjectively perceived fall risk may... more Background: Match or mismatch of objective physiological and subjectively perceived fall risk may have serious consequences in patients with dementia (PwD) while research is lacking. Objective: To analyze mismatch of objective and subjective fall risk and associated factors in PwD. Method: Cohort study in a geriatric rehabilitation center. Objective and subjective risk of falling were operationalized by Tinetti’s Performance Oriented Mobility Assessment and the Falls Efficacy Scale-International. Four sub-groups according to objective and subjective fall risk were classified. Subgroups were compared for differences in clinical, cognitive, psychological, and behavioral variables. Results: In geriatric rehab patients with mild to moderate dementia (n = 173), two-thirds showed a mismatch of subjective versus objective risk of falling, independently associated with previous falls. Underestimation of objective fall risk (37.6%) was determined by lower activity avoidance (OR 0.39), less c...
Objective: The aim of the study is to assess the feasibility, sustainability, and effectiveness o... more Objective: The aim of the study is to assess the feasibility, sustainability, and effectiveness of task-specific memory exergame training on motor-cognitive performance in older adults. Materials and Methods: Fifty older adults (age: 78.8 ± 7.0 years) participated in a randomized controlled trial with a 10-week intervention and 3-month follow-up period. Both the intervention group (IG: n = 29) and control group (CG: n = 21) underwent a once-weekly exercise program, including strength and balance exercises, while the IG performed an additional exergame training, combining dynamic balance with visuospatial memory tasks. Outcome measures were completion time for distinct levels of memory exergame tasks without (condition 1) and with procedural support (condition 2) and (sub)-total game scores documented by a game-specific assessment strategy. Results: Significant improvements in the IG compared with the CG over the intervention period were found for completion times in most of the analyzed levels of condition 1 (P < 0.001-0.047; ηp2 = 0.238-0.335) and one level of condition 2 (P < 0.001, ηp2 = 0.267), for the subtotal game score of condition 1 (P = 0.002; ηp2 = 0.186), and for the total game score (P = 0.005; ηp2 = 0.162). Improvements were partially sustained 3 months after training cessation (P = 0.008-0.039, ηp2 = 0.095-0.174). Completion rates for initial levels were 86%-98%. No clinical events or safety issues were observed during the training. Conclusion: The study demonstrates that additional memory exergame training effectively, and sustainably, improves performance in complex motor-cognitive tasks involving dynamic balance and visuospatial memory in older adults.
Background: Cognitive impairment (CI) has been reported to negatively impact rehabilitation outco... more Background: Cognitive impairment (CI) has been reported to negatively impact rehabilitation outcomes. Knowledge about differences in rehabilitation received in dependence of CI as a potential mediating factor is limited. Objective: To analyze whether CI affects amount and frequency of rehabilitation received and if associations between CI and rehabilitation outcome are mediated by the provided amount of therapy. Methods: Observational cohort study in ward-based geriatric rehabilitation consecutively including 373 patients (mean age 82.0±6.69 years, mean MMSE 23.66±5.31). Outcome measures were amount, frequency, and type of multi-professional therapy sessions and rehabilitation outcome assessed with the Barthel Index (BI). Cognitive status was measured with the Mini-Mental-State Examination (MMSE) classifying three patient subgroups according to cognitive status. Results: Patients with more severe CI received least total therapy hours (TTH) (MMSE < 17, 13.67±6.58 versus MMSE 17–26...
AimTo evaluate the effectiveness and user satisfaction with the sit‐to‐stand (STS) assistance sys... more AimTo evaluate the effectiveness and user satisfaction with the sit‐to‐stand (STS) assistance system of a smart walker (SW), and to identify factors associated with them in potential users.MethodsA total of 33 older adults (29 women, aged ≥65 years) with motor impairments (habitual rollator use) and no severe cognitive impairment (Mini‐Mental State Examination ≥17 points) carried out a Five‐Chair Stand Test without assistance and five STS transfers with the STS assistance system. Based on the number of successfully completed STS transfers, success rates were calculated for the Five‐Chair Stand Test and the SW‐assisted STS transfers, and compared using the Wilcoxon signed‐rank test. User satisfaction was assessed using the Tele‐healthcare Satisfaction Questionnaire‐Wearable Technology (0–80 points, higher score = higher satisfaction). Bivariate correlations and multiple linear regression analyses were used to identify participant characteristics associated with the success rate and u...
Objective: To comprehensively validate an assessment tailored to an exergaming training program w... more Objective: To comprehensively validate an assessment tailored to an exergaming training program with motor-cognitive challenges. Materials and Methods: Fifty-eight cognitively intact, multimorbid, independently living older adults (mean age [standard deviation]: 78.3 [6.5] years) with moderate functional limitations participated in the study. For construct validity, Spearman's rank correlations (rs) between game parameters and established cognitive (Number-Connection-Test [Zahlen-Verbindungs-Test], Simple Response Time Task, Simon Task) and motor (Short Physical Performance Battery, Physiomat® balance tests) measures were calculated. Test-retest reliability was documented by intraclass correlation coefficients (ICCs), sensitivity to change by effect sizes using partial eta squared (ηp2), and feasibility by mean completion time and completion rates. Results: Good construct validity of the assessment was observed, with on average moderate-to-high correlations between game parameters and cognitive tests, measures of lower extremity function and dynamic balance (range of rs including extreme outliers = 0.00-0.70, P < 0.001-0.998). Test-retest reliability was good, with ICCs mostly ranging from moderate to high (ICCs = 0.37-0.93, P < 0.001-0.130), and sensitivity to change was excellent (ηp2 = 0.16-0.81, P < 0.001-0.044). Completion rates for the initial challenge levels were 100%, mean completion time 36.3 minutes, and no clinical events or safety problems were observed. Conclusion: Study results documented on average good validity, test-retest reliability and feasibility, with an extraordinary high responsiveness of the presented game-based assessment in older adults with moderate functional limitations. The innovative, data-based assessment validated in this study may serve as a blueprint for future, tailored assessments for exergaming.
Objective: To assess the concurrent validity of a smart walker–integrated gait analysis system wi... more Objective: To assess the concurrent validity of a smart walker–integrated gait analysis system with the GAITRite® system for measuring spatiotemporal gait parameters in potential users of the smart walker. Design: Criterion standard validation study. Setting: Research laboratory in a geriatric hospital. Participants: Twenty-five older adults (⩾65 years) with gait impairments (habitual rollator use and/or gait speed <0.6 m/s) and no severe cognitive impairment (Mini-Mental State Examination ⩾17). Main measures: Stride, swing and stance time; stride length; and gait speed were simultaneously recorded using the smart walker–integrated gait analysis system and the GAITRite system while participants walked along a 7.8-m walkway with the smart walker. Concurrent criterion-related validity was assessed using the Bland–Altman method, percentage errors (acceptable if <30%), and intraclass correlation coefficients for consistency (ICC3,1) and absolute agreement (ICC2,1). Results: Bias f...
To validate the “Life-Space Assessment in Persons with Cognitive Impairment” (LSA-CI) to assess m... more To validate the “Life-Space Assessment in Persons with Cognitive Impairment” (LSA-CI) to assess mobility within the environment including contextual factors in older persons without cognitive impairment. Excellent feasibility with 100% completion rate and average assessment duration of 4 min in 65 older persons. The LSA-CI composite score stood out with moderate to high construct validity, excellent test–retest reliability and moderate sensitivity to change. Analysis of sub-scores confirmed most of the composite score results. The LSA-CI represents a valid, reliable, responsive, and highly feasible assessment method in multi-morbid, older persons without cognitive impairment, and can be recommended for use in clinical practice and research. The “Life-Space Assessment in Persons with Cognitive Impairment” (LSA-CI) to assess mobility within the environment including frequency and independence in 1 week has been developed for and successfully validated in older persons with mild to moderate cognitive impairment. However, its psychometric properties in persons without cognitive impairment are unknown. This study aims to validate the LSA-CI in older persons without cognitive impairment. Comprehensive validation with construct validity, test–retest reliability and sensitivity to change of the LSA-CI including the main composite score and three sub-scores in community-dwelling older persons recruited during geriatric rehabilitation. Excellent feasibility with 100% completion rate and an average assessment duration of 4 min in 65 older, multimorbid persons (mean age: 81.4 ± 5.9 years; 72.3% female; average number of diagnoses: 11.1 ± 4.4). The LSA-CI composite score stood out with moderate to high construct validity (Spearman correlation coefficients |0.26|–|0.60|), excellent test–retest reliability (intraclass correlation coefficient 0.890) and moderate sensitivity to change (adjusted standardized response mean 0.70). Analysis of sub-scores confirmed most of the composite score results. The LSA-CI represents a valid, reliable, responsive, and highly feasible assessment method in multi-morbid, older persons without cognitive impairment, supporting the use of the LSA-CI in clinical practice and research.
Since muscle strength and coordination training in healthy elderly people has been effective in t... more Since muscle strength and coordination training in healthy elderly people has been effective in the primary prevention, a program for geriatric patients with falls is presented. Its aim is safer walking by an increase in muscular strength and improved coordination. The exclusion criteria and the size of the training program define a group of over 75 year old patients, who will be compared with a group with light physical exercise in a randomized fashion. The first results show a remarkable increase in strength and a low complication rate. The functional relevance of our program remains to be proven.
Background: Match or mismatch of objective physiological and subjectively perceived fall risk may... more Background: Match or mismatch of objective physiological and subjectively perceived fall risk may have serious consequences in patients with dementia (PwD) while research is lacking. Objective: To analyze mismatch of objective and subjective fall risk and associated factors in PwD. Method: Cohort study in a geriatric rehabilitation center. Objective and subjective risk of falling were operationalized by Tinetti’s Performance Oriented Mobility Assessment and the Falls Efficacy Scale-International. Four sub-groups according to objective and subjective fall risk were classified. Subgroups were compared for differences in clinical, cognitive, psychological, and behavioral variables. Results: In geriatric rehab patients with mild to moderate dementia (n = 173), two-thirds showed a mismatch of subjective versus objective risk of falling, independently associated with previous falls. Underestimation of objective fall risk (37.6%) was determined by lower activity avoidance (OR 0.39), less c...
Objective: The aim of the study is to assess the feasibility, sustainability, and effectiveness o... more Objective: The aim of the study is to assess the feasibility, sustainability, and effectiveness of task-specific memory exergame training on motor-cognitive performance in older adults. Materials and Methods: Fifty older adults (age: 78.8 ± 7.0 years) participated in a randomized controlled trial with a 10-week intervention and 3-month follow-up period. Both the intervention group (IG: n = 29) and control group (CG: n = 21) underwent a once-weekly exercise program, including strength and balance exercises, while the IG performed an additional exergame training, combining dynamic balance with visuospatial memory tasks. Outcome measures were completion time for distinct levels of memory exergame tasks without (condition 1) and with procedural support (condition 2) and (sub)-total game scores documented by a game-specific assessment strategy. Results: Significant improvements in the IG compared with the CG over the intervention period were found for completion times in most of the analyzed levels of condition 1 (P < 0.001-0.047; ηp2 = 0.238-0.335) and one level of condition 2 (P < 0.001, ηp2 = 0.267), for the subtotal game score of condition 1 (P = 0.002; ηp2 = 0.186), and for the total game score (P = 0.005; ηp2 = 0.162). Improvements were partially sustained 3 months after training cessation (P = 0.008-0.039, ηp2 = 0.095-0.174). Completion rates for initial levels were 86%-98%. No clinical events or safety issues were observed during the training. Conclusion: The study demonstrates that additional memory exergame training effectively, and sustainably, improves performance in complex motor-cognitive tasks involving dynamic balance and visuospatial memory in older adults.
Background: Cognitive impairment (CI) has been reported to negatively impact rehabilitation outco... more Background: Cognitive impairment (CI) has been reported to negatively impact rehabilitation outcomes. Knowledge about differences in rehabilitation received in dependence of CI as a potential mediating factor is limited. Objective: To analyze whether CI affects amount and frequency of rehabilitation received and if associations between CI and rehabilitation outcome are mediated by the provided amount of therapy. Methods: Observational cohort study in ward-based geriatric rehabilitation consecutively including 373 patients (mean age 82.0±6.69 years, mean MMSE 23.66±5.31). Outcome measures were amount, frequency, and type of multi-professional therapy sessions and rehabilitation outcome assessed with the Barthel Index (BI). Cognitive status was measured with the Mini-Mental-State Examination (MMSE) classifying three patient subgroups according to cognitive status. Results: Patients with more severe CI received least total therapy hours (TTH) (MMSE < 17, 13.67±6.58 versus MMSE 17–26...
AimTo evaluate the effectiveness and user satisfaction with the sit‐to‐stand (STS) assistance sys... more AimTo evaluate the effectiveness and user satisfaction with the sit‐to‐stand (STS) assistance system of a smart walker (SW), and to identify factors associated with them in potential users.MethodsA total of 33 older adults (29 women, aged ≥65 years) with motor impairments (habitual rollator use) and no severe cognitive impairment (Mini‐Mental State Examination ≥17 points) carried out a Five‐Chair Stand Test without assistance and five STS transfers with the STS assistance system. Based on the number of successfully completed STS transfers, success rates were calculated for the Five‐Chair Stand Test and the SW‐assisted STS transfers, and compared using the Wilcoxon signed‐rank test. User satisfaction was assessed using the Tele‐healthcare Satisfaction Questionnaire‐Wearable Technology (0–80 points, higher score = higher satisfaction). Bivariate correlations and multiple linear regression analyses were used to identify participant characteristics associated with the success rate and u...
Objective: To comprehensively validate an assessment tailored to an exergaming training program w... more Objective: To comprehensively validate an assessment tailored to an exergaming training program with motor-cognitive challenges. Materials and Methods: Fifty-eight cognitively intact, multimorbid, independently living older adults (mean age [standard deviation]: 78.3 [6.5] years) with moderate functional limitations participated in the study. For construct validity, Spearman's rank correlations (rs) between game parameters and established cognitive (Number-Connection-Test [Zahlen-Verbindungs-Test], Simple Response Time Task, Simon Task) and motor (Short Physical Performance Battery, Physiomat® balance tests) measures were calculated. Test-retest reliability was documented by intraclass correlation coefficients (ICCs), sensitivity to change by effect sizes using partial eta squared (ηp2), and feasibility by mean completion time and completion rates. Results: Good construct validity of the assessment was observed, with on average moderate-to-high correlations between game parameters and cognitive tests, measures of lower extremity function and dynamic balance (range of rs including extreme outliers = 0.00-0.70, P < 0.001-0.998). Test-retest reliability was good, with ICCs mostly ranging from moderate to high (ICCs = 0.37-0.93, P < 0.001-0.130), and sensitivity to change was excellent (ηp2 = 0.16-0.81, P < 0.001-0.044). Completion rates for the initial challenge levels were 100%, mean completion time 36.3 minutes, and no clinical events or safety problems were observed. Conclusion: Study results documented on average good validity, test-retest reliability and feasibility, with an extraordinary high responsiveness of the presented game-based assessment in older adults with moderate functional limitations. The innovative, data-based assessment validated in this study may serve as a blueprint for future, tailored assessments for exergaming.
Objective: To assess the concurrent validity of a smart walker–integrated gait analysis system wi... more Objective: To assess the concurrent validity of a smart walker–integrated gait analysis system with the GAITRite® system for measuring spatiotemporal gait parameters in potential users of the smart walker. Design: Criterion standard validation study. Setting: Research laboratory in a geriatric hospital. Participants: Twenty-five older adults (⩾65 years) with gait impairments (habitual rollator use and/or gait speed <0.6 m/s) and no severe cognitive impairment (Mini-Mental State Examination ⩾17). Main measures: Stride, swing and stance time; stride length; and gait speed were simultaneously recorded using the smart walker–integrated gait analysis system and the GAITRite system while participants walked along a 7.8-m walkway with the smart walker. Concurrent criterion-related validity was assessed using the Bland–Altman method, percentage errors (acceptable if <30%), and intraclass correlation coefficients for consistency (ICC3,1) and absolute agreement (ICC2,1). Results: Bias f...
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