Publications by authors named "Clemens Becker"

167 Publications

Change of physical activity parameters of hip and pelvic fracture patients during inpatient rehabilitation and after discharge: analysis of global and in-depth parameters.

Eur Rev Aging Phys Act 2021 Jun 12;18(1). Epub 2021 Jun 12.

Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr. 110, 70376, Stuttgart, Germany.

Background: A growing number of older adults suffer hip and pelvic fractures leading to hospital admission. They often result in reduced physical activity (PA) and impaired mobility. PA can be objectively measured with body-worn sensors. Usually, global cumulative PA parameters are analysed, such as walking duration, upright-time and number of steps. These traditional parameters mix different domains of PA, such as physical capacity (PC), behaviour and living environment. We examined the change of global cumulative PA measures during rehabilitation and after discharge in patients with hip or pelvic fracture and whether more 'in-depth' PA parameters, such as walking interval length, variability of interval length and sit-to-stand transitions and their changes during rehabilitation and 3 months after discharge might better reflect the above mentioned three clinically relevant domains of PA.

Methods: This study is a secondary data analysis of a randomised controlled trial to improve PA and fall-related self-efficacy in hip or pelvic fracture patients (≥60 years) with concerns about falling. Changes of accelerometer-measured global cumulative and in-depth PA parameters (activPAL3) were analysed in an observational design before and after discharge combining both groups. For comparison, the same analyses were applied to the traditional PC measures gait speed and 5-chair-rise.

Results: Seventy-five percent of the 111 study participants were female (mean age: 82.5 (SD = 6.76) years. Daily walking duration, upright time and number of steps as aspects of global PA increased during inpatient rehabilitation as well as afterwards. The in-depth PA parameters showed differing patterns. While the total number of walking bouts increased similarly, the number of longer walking bouts decreased by 50% after discharge. This pattern was also seen for the average walking interval length, which increased by 2.34 s (95% confidence interval (CI): 0.68; 4.00) during inpatient rehabilitation and decreased afterwards below baseline level (- 4.19 s (95% CI: - 5.56; - 2.82)). The traditional PC measures showed similar patterns to the in-depth PA parameters with improvements during rehabilitation, but not at home.

Conclusion: Our findings suggest that the in-depth PA parameters add further information to the global cumulative PA parameters. Whereas global cumulative PA parameters improved significantly during inpatient rehabilitation and after discharge, in-depth PA parameters as well as PC did not continuously improve at home. In contrast to global cumulative PA parameters the in-depth parameters seem to reflect contextual factors such as the build environment and aspects of PC, which are traditionally assessed by clinical PC measures. These in combination with digital mobility measures can help clinicians to assess the health status of fragility fracture patients, individually tailor therapy measures and monitor the rehabilitation process.
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http://dx.doi.org/10.1186/s11556-021-00261-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8199557PMC
June 2021

The course of gait speed during a 400m walk test of mobility limitations in community-dwelling older adults.

Z Gerontol Geriatr 2021 Jun 11. Epub 2021 Jun 11.

Institute for Biomedicine of Aging (IBA), Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), Nuremberg, Germany.

Background: The 400‑m walk test (400MWT) of usual gait speed is an assessment of mobility limitations in geriatric medicine and sarcopenic research.

Objective: The aim of this study was to describe the course of gait speed during a 400MWT in community-dwelling older adults in terms of physical, psychological and general health-related outcomes. Possible plateau phases during the 400MWT could enable integrated measurements of short distance walk tests.

Methods: In this study 148 community-dwelling older adults (mean age 80.4 ± 4.4 years, 61% women) performed a 400MWT at comfortable gait speed. Additionally, an 8m walk test was carried out and history of falling, sex, comorbidities, fear of falling, executive function and gait variability were determined as covariates.

Results: Gait speed was higher in the beginning and the end of the 400MWT compared to the middle part with respect to all analyzed covariates. Mean gait speed of the 8 m walk test was significantly faster than mean gait speed of the 400MWT (t (df = 147) = 0.07, p = 0.001).

Conclusion: The course of gait speed during a 400MWT performed by community-dwelling older adults was not affected by sex, gait variability, comorbidity, history of falling, fear of falling or executive function. Gait speed measurements of the 400MWT do not fully represent assessment of supervised short distance gait speed in community-dwelling adults.
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http://dx.doi.org/10.1007/s00391-021-01908-5DOI Listing
June 2021

New horizons in falls prevention and management for older adults: a global initiative.

Age Ageing 2021 May 26. Epub 2021 May 26.

Centre for Innovation in Medical Engineering (CIME), Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia.

Background: falls and fall-related injuries are common in older adults, have negative effects both on quality of life and functional independence and are associated with increased morbidity, mortality and health care costs. Current clinical approaches and advice from falls guidelines vary substantially between countries and settings, warranting a standardised approach. At the first World Congress on Falls and Postural Instability in Kuala Lumpur, Malaysia, in December 2019, a worldwide task force of experts in falls in older adults, committed to achieving a global consensus on updating clinical practice guidelines for falls prevention and management by incorporating current and emerging evidence in falls research. Moreover, the importance of taking a person-centred approach and including perspectives from patients, caregivers and other stakeholders was recognised as important components of this endeavour. Finally, the need to specifically include recent developments in e-health was acknowledged, as well as the importance of addressing differences between settings and including developing countries.

Methods: a steering committee was assembled and 10 working Groups were created to provide preliminary evidence-based recommendations. A cross-cutting theme on patient's perspective was also created. In addition, a worldwide multidisciplinary group of experts and stakeholders, to review the proposed recommendations and to participate in a Delphi process to achieve consensus for the final recommendations, was brought together.

Conclusion: in this New Horizons article, the global challenges in falls prevention are depicted, the goals of the worldwide task force are summarised and the conceptual framework for development of a global falls prevention and management guideline is presented.
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http://dx.doi.org/10.1093/ageing/afab076DOI Listing
May 2021

Short distance analysis of the 400-meter walk test of mobility in community-dwelling older adults.

Gait Posture 2021 Jul 14;88:60-65. Epub 2021 May 14.

Institute for Biomedicine of Aging, Friedrich-Alexander-University of Erlangen-Nürnberg, Kobergerstr. 60, 90408, Nürnberg, Germany.

Background: The 400-meter walk test (400MWT) is used to assess cardiovascular and pulmonary fitness or to predict adverse outcomes such as mobility disability. Additionally, short tests of walking such as the 4- or 8-meter walk test are administered to predict mortality, falls and other events. It remains uncertain if and how an integrated measurement of a short distance during 400MWT can replace an additional short distance measurement which would be clinically useful.

Research Question: How do short distance (i.e. segment) measurements of gait speed and walk ratio during a 400MWT of mobility compare to those from an additional 8-meter walk test?

Methods: A 400MWT and a separate 8-meter walk test were performed by 148 community-dwelling older adults (mean age 80.4 ± 4.4 years) using an instrumented walkway.

Results: Gait speed and walk ratio (i.e. step length divided by step frequency) of single segments of the 400MWT were strongly associated with gait speed (r ≥ 0.91) and walk ratio (r ≥ 0.93) of an 8-meter walk test with best agreement in the middle part 20-meter walk during the 400MWT. Mean gait speed of all single walks on the instrumented walkway during the 400MWT was faster than the mean gait speed of the total 400MWT.

Significance: A single walk of the 6 to 10 20-meter walk during the 400MWT can be used as a substitute to an additional short distance trial. Furthermore, the awareness of being measured is higher on an instrumented walkway and possibly increases the motivation to overperform.
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http://dx.doi.org/10.1016/j.gaitpost.2021.05.002DOI Listing
July 2021

Sensitivity to Change and Responsiveness of the Original and the Shortened Version of the Community Balance & Mobility Scale for Young Seniors.

Arch Phys Med Rehabil 2021 Apr 28. Epub 2021 Apr 28.

Network Aging Research (NAR), Heidelberg University, Heidelberg, Germany. Electronic address:

Objective: To examine sensitivity to change and responsiveness of the Community Balance & Mobility Scale (CBM) and shortened CBM (s-CBM) DESIGN: Secondary analysis using data of a randomized controlled trial SETTING: General community PARTICIPANTS: Community-dwelling seniors aged 61-70 years INTERVENTION: Participants underwent 12 months of exercise intervention MAIN OUTCOME MEASURES: CBM and s-CBM. Sensitivity to change was assessed using standardized response mean (SRM), and paired t-tests as appropriate. Responsiveness was assessed using two minimal important difference (MID) estimates. Analyses were conducted for the full sample and for the subgroups 'high-balance' and 'low-balance', divided by median split.

Results: Young community-dwelling seniors (n=155, 66.2±2.5) were recruited. Inferential statistics revealed a significant CBM (p<0.001) and s-CBM (p<0.001) improvement within the full sample and the subgroups (high-balance: p=0.001, p=0.019; low-balance: p<0.001, p<0.001). CBM and s-CBM were moderately sensitive to change (SRM: 0.48 vs. 0.38) within the full sample. In the high-balance subgroup, moderate SRM values (0.70) were found for the CBM, small values for the s-CBM (0.29). In the low-balance subgroup, moderate SRM values were found for the CBM (0.67), high values for the s-CBM (0.80). For the full sample, CBM and s-CBM exceeded the lower, but not the higher MID value. In the high-balance subgroup, the CBM exceeded both MID values, the s-CBM only the lower. In the low-balance subgroup, CBM and s-CBM exceeded both MID values.

Conclusions: The CBM is a suitable tool to detect intervention-related changes of balance and mobility in young, high-performing seniors. Both versions of the CBM scale show good sensitivity to change and responsiveness, particularly in young seniors with low-balance.
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http://dx.doi.org/10.1016/j.apmr.2021.03.036DOI Listing
April 2021

Template-Based Recognition of Human Locomotion in IMU Sensor Data Using Dynamic Time Warping.

Sensors (Basel) 2021 Apr 7;21(8). Epub 2021 Apr 7.

Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr. 110, 70376 Stuttgart, Germany.

Increased levels of light, moderate and vigorous physical activity (PA) are positively associated with health benefits. Therefore, sensor-based human activity recognition can identify different types and levels of PA. In this paper, we propose a two-layer locomotion recognition method using dynamic time warping applied to inertial sensor data. Based on a video-validated dataset (ADAPT), which included inertial sensor data recorded at the lower back (L5 position) during an unsupervised task-based free-living protocol, the recognition algorithm was developed, validated and tested. As a first step, we focused on the identification of locomotion activities walking, ascending and descending stairs. These activities are difficult to differentiate due to a high similarity. The results showed that walking could be recognized with a sensitivity of 88% and a specificity of 89%. Specificity for stair climbing was higher compared to walking, but sensitivity was noticeably decreased. In most cases of misclassification, stair climbing was falsely detected as walking, with only 0.2-5% not assigned to any of the chosen types of locomotion. Our results demonstrate a promising approach to recognize and differentiate human locomotion within a variety of daily activities.
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http://dx.doi.org/10.3390/s21082601DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8067979PMC
April 2021

[Group-based exercise to prevent falls in community-dwelling older adults : Update of the 2009 recommendations of the German Federal Initiative to Prevent Falls].

Z Gerontol Geriatr 2021 May 7;54(3):229-239. Epub 2021 Apr 7.

Netzwerk Alternsforschung, Universität Heidelberg, Bergheimer Straße 20, 69115, Heidelberg, Deutschland.

This update of the 2009 recommendations of the German Federal Initiative to Prevent Falls in community-dwelling older persons includes current evidence on state-of-the-art fall prevention group programs and aims to foster their set-up including recommendations on the implementation process. A standardized pathway for identification of the target group as well as guidelines regarding program content and structure, quality assurance, financing, and trainer education are addressed. Established programs being available in Germany are compiled and described briefly.
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http://dx.doi.org/10.1007/s00391-021-01876-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8096731PMC
May 2021

Health-economic evaluation of collaborative orthogeriatric care for patients with a hip fracture in Germany: a retrospective cohort study using health and long-term care insurance claims data.

Eur J Health Econ 2021 Aug 4;22(6):873-885. Epub 2021 Apr 4.

Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.

Background: Evidence suggests benefits of orthogeriatric co-management (OGCM) for hip fracture patients. Yet, evidence on cost-effectiveness is limited and based on small datasets. The aim of our study was to conduct an economic evaluation of the German OGCM for geriatric hip fracture patients.

Methods: This retrospective cohort study was based on German health and long-term care insurance data. Individuals were 80 years and older, sustained a hip fracture in 2014, and were treated in hospitals providing OGCM (OGCM group) or standard care (control group). Health care costs from payer and societal perspective, life years gained (LYG) and cost-effectiveness were investigated within 1 year. We applied weighted gamma and two-part models, and entropy balancing to account for the lack of randomisation. We calculated incremental cost-effectiveness ratios (ICER) and employed the net-benefit approach to construct cost-effectiveness acceptability curves.

Results: 14,005 patients were treated in OGCM, and 10,512 in standard care hospitals. Total average health care costs per patient were higher in the OGCM group: €1181.53 (p < 0.001) from payer perspective, and €1408.21 (p < 0.001) from societal perspective. The ICER equalled €52,378.12/ LYG from payer and €75,703.44/ LYG from societal perspective. The probability for cost-effectiveness would be 95% if the willingness-to-pay was higher than €82,000/ LYG from payer, and €95,000/ LYG from societal perspective.

Conclusion: Survival improved in hospitals providing OGCM. Costs were found to increase, driven by inpatient and long-term care. The cost-effectiveness depends on the willingness-to-pay. The ICER is likely to improve with a longer follow-up.
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http://dx.doi.org/10.1007/s10198-021-01295-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8275532PMC
August 2021

Estimate of gait speed by using persons' walk ratio or step-frequency in older adults.

Aging Clin Exp Res 2021 Mar 28. Epub 2021 Mar 28.

Department of Clinical Gerontology and Rehabilitation, Clinic for Geriatric Rehabilitation, Robert-Bosch-Hospital, Stuttgart, Germany.

Background And Aims: Gait speed estimation using wearable inertial sensors during daily activities suffers from high complexity and inaccuracies in distance estimation when integrating acceleration signals. The aim of the study was to investigate the agreement between the methods of gait speed estimation using the persons' walk ratio (step-length/step-frequency relation) or step-frequency (number of steps per minute) and a "gold standard".

Methods: For this cross-sectional validation study, 20 healthy community-dwelling older persons (mean age 72.1 years; 70% women) walked at slow, normal, and fast speed over an instrumented walkway (reference measure). Gait speed was calculated using the person's pre-assessed walk ratio. Furthermore, the duration of walking and number of steps were used for calculation.

Results: The agreement between gait speed calculation using the walk ratio or step-frequency (adjusted to body height) and reference was r = 0.98 and r = 0.93, respectively. Absolute and relative mean errors of calculated gait speed using pre-assessed walk ratio ranged between 0.03-0.07 m/s and 1.97-4.17%, respectively.

Discussion And Conclusions: After confirmation in larger cohorts of healthy community-dwelling older adults, the mean gait speed of single walking bouts during activity monitoring can be estimated using the person's pre-assessed walk ratio. Furthermore, the mean gait speed can be calculated using the step-frequency and body height and can be an additional parameter in stand-alone activity monitoring.
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http://dx.doi.org/10.1007/s40520-021-01832-zDOI Listing
March 2021

Robustness of In-Laboratory and Daily-Life Gait Speed Measures over One Year in High Functioning 61- to 70-Year-Old Adults.

Gerontology 2021 Mar 22:1-10. Epub 2021 Mar 22.

Department of Human Movement Sciences, @AgeAmsterdam, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands,

Introduction: Gait speed is a simple and safe measure with strong predictive value for negative health outcomes in clinical practice, yet in-laboratory gait speed seems not representative for daily-life gait speed. This study aimed to investigate the interrelation between and robustness of in-laboratory and daily-life gait speed measures over 12 months in 61- to 70-year-old adults.

Methods: Gait speed was assessed in laboratory through standardized stopwatch tests and in daily life by 7 days of trunk accelerometry in the PreventIT cohort, at baseline, and after 6 and 12 months. The interrelation was investigated using Pearson's correlations between gait speed measures at each time point. For robustness, changes over time and variance components were assessed by ANOVA and measurement agreement over time by Bland-Altman analyses.

Results: Included were 189 participants (median age 67 years [interquartile range: 64-68], 52.2% females). In-laboratory and daily-life gait speed measures showed low correlations (Pearson's r = 0.045-0.455) at each time point. Moreover, both in-laboratory and daily-life gait speed measures appeared robust over time, with comparable and smaller within-subject than between-subject variance (range 0.001-0.095 m/s and 0.032-0.397 m/s, respectively) and minimal differences between measurements over time (Bland-Altman) with wide limits of agreement (standard deviation of mean difference range: 0.12-0.34 m/s).

Discussion/conclusion: In-laboratory and daily-life gait speed measures show robust assessments of gait speed over 12 months and are distinct constructs in this population of high-functioning adults. This suggests that (a combination of) both measures may have added value in predicting health outcomes.
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http://dx.doi.org/10.1159/000514150DOI Listing
March 2021

Association between everyday walking activity, objective and perceived risk of falling in older adults.

Age Ageing 2021 Mar 12. Epub 2021 Mar 12.

Network Aging Research, Heidelberg University, Heidelberg, Germany.

Background: older persons can be grouped according to their objective risk of falling (ORF) and perceived risk of falling (PRF) into 'vigorous' (low ORF/PRF), 'anxious' (low ORF/high PRF), 'stoic' (high ORF/low PRF) and 'aware' (high ORF/PRF). Sensor-assessed daily walking activity of these four groups has not been investigated, yet.

Objective: we examined everyday walking activity in those four groups and its association with ORF and PRF.

Design: cross-sectional.

Setting: community.

Subjects: N = 294 participants aged 70 years and older.

Methods: ORF was determined based on multiple independent risk factors; PRF was determined based on the Short Falls Efficacy Scale-International. Subjects were allocated to the four groups accordingly. Linear regression was used to quantify the associations of these groups with the mean number of accelerometer-assessed steps per day over 1 week as the dependent variable. 'Vigorous' was used as the reference group.

Results: average number of steps per day in the four groups were 6,339 ('vigorous'), 5,781 ('anxious'), 4,555 ('stoic') and 4,528 ('aware'). Compared with the 'vigorous', 'stoic' (-1,482; confidence interval (CI): -2,473; -491) and 'aware' (-1,481; CI: -2,504; -458) participants took significantly less steps, but not the 'anxious' (-580 steps; CI: -1,440; 280).

Conclusion: we have integrated a digital mobility outcome into a fall risk categorisation based on ORF and PRF. Steps per day in this sample of community-dwelling older persons were in accordance with their ORF rather than their PRF. Whether this grouping approach can be used for the specification of participants' needs when taking part in programmes to prevent falls and simultaneously promote physical activity remains to be answered in intervention studies.
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http://dx.doi.org/10.1093/ageing/afab037DOI Listing
March 2021

Immune-related Gene Expression Predicts Response to Neoadjuvant Chemotherapy but not Additional Benefit from PD-L1 Inhibition in Women with Early Triple-negative Breast Cancer.

Clin Cancer Res 2021 May 16;27(9):2584-2591. Epub 2021 Feb 16.

Department of Pathology, Philipps-University Marburg and University Hospital Marburg (UKGM), Marburg, Germany.

Purpose: We evaluated mRNA signatures to predict response to neoadjuvant PD-L1 inhibition in combination with chemotherapy in early triple-negative breast cancer.

Experimental Design: Targeted mRNA sequencing of 2,559 transcripts was performed in formalin-fixed, paraffin-embedded samples from 162 patients of the GeparNuevo trial. We focused on validation of four predefined gene signatures and differential gene expression analyses for new predictive markers.

Results: Two signatures [GeparSixto signature (G6-Sig) and IFN signature (IFN-Sig)] were predictive for treatment response in a multivariate model including treatment arm [G6-Sig: OR, 1.558; 95% confidence interval (CI), 1.130-2.182; = 0.008 and IFN-Sig: OR, 1.695; 95% CI, 1.234-2.376; = 0.002), while the CYT metric predicted pathologic complete response (pCR) in the durvalumab arm, and the proliferation-associated gene signature in the placebo arm. Expression of PD-L1 mRNA was associated with better response in both arms, indicating that increased levels of PD-L1 are a general predictor of neoadjuvant therapy response. In an exploratory analysis, we identified seven genes that were higher expressed in responders in the durvalumab arm, but not the placebo arm: , and . These genes were associated with cellular antigen processing and presentation and IFN signaling.

Conclusions: Immune-associated signatures are associated with pCR after chemotherapy, but might be of limited use for the prediction of response to additional immune checkpoint blockade. Gene expressions related to antigen presentation and IFN signaling might be interesting candidates for further evaluation.
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http://dx.doi.org/10.1158/1078-0432.CCR-20-3113DOI Listing
May 2021

Applying Social Cognition Models to Explain Walking Duration in Older Adults: The Role of Intrinsic Motivation.

J Aging Phys Act 2021 Feb 8:1-9. Epub 2021 Feb 8.

This study examined the applicability of the health action process approach (HAPA) to walking duration in older adults and the added value of extending the HAPA by intrinsic motivation. Self-reports from older adults (N = 309; Mage = 78.7, 70-95 years) regarding activity-related intrinsic motivation and HAPA variables were collected at the baseline of a fall prevention intervention study. Walking duration at ≥3 metabolic equivalents of task was measured for 7 days via body-worn accelerometers. Two structural equation models with walking duration as a manifest outcome were specified. In both models, the model fit was acceptable, but intention and planning were not associated with walking duration. Intrinsic motivation was significantly related to most HAPA variables and walking duration. Variance explained for walking duration was R2 = .14 in the HAPA and R2 = .17 in the extended model. For explaining older adults' walking duration, intrinsic motivation, but not HAPA-based intention and planning, seemed to be important.
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http://dx.doi.org/10.1123/japa.2020-0296DOI Listing
February 2021

Group or individual lifestyle-integrated functional exercise (LiFE)? A qualitative analysis of acceptability.

BMC Geriatr 2021 02 1;21(1):93. Epub 2021 Feb 1.

Network Aging Research (NAR), Heidelberg University, Heidelberg, Germany.

Background: The Lifestyle-integrated Functional Exercise (LiFE) program is an effective but resource-intensive fall prevention program delivered one-to-one in participants' homes. A recently developed group-based LiFE (gLiFE) could enhance large-scale implementability and decrease resource intensity. The aim of this qualitative focus group study is to compare participants' experiences regarding acceptability of gLiFE vs LiFE.

Methods: Programs were delivered in seven group sessions (gLiFE) or seven individual home visits (LiFE) within a multi-center, randomized non-inferiority trial. Four structured focus group discussions (90-100 min duration; one per format and study site) on content, structure, and subjective effects of gLiFE and LiFE were conducted. Qualitative content analysis using the method of inductive category formation by Mayring was applied for data analysis. Coding was managed using NVivo.

Results: In both formats, participants (N = 30, 22 women, n = 15, n = 15, mean age 78.8 ± 6.6 years) were positive about content, structure, and support received by trainers. Participants reflected on advantages of both formats: the social aspects of learning the program in a peer group (gLiFE), and benefits of learning the program at home (LiFE). In gLiFE, some difficulties with the implementation of activities were reported. In both formats, the majority of participants reported positive outcomes and successful implementation of new movement habits.

Conclusion: This is the first study to examine participants' views on and experiences with gLiFE and LiFE, revealing strengths and limitations of both formats that can be used for program refinement. Both formats were highly acceptable to participants, suggesting that gLiFE may have similar potential to be adopted by adults aged 70 years and older compared to LiFE.

Trial Registration: ClinicalTrials.gov , NCT03462654 . Registered on March 12, 2018.
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http://dx.doi.org/10.1186/s12877-020-01991-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7852079PMC
February 2021

Reply to the letter : "Psychometric properties of the German version of the Fear of Falling Questionnaire-revised (FFQ-R) in a sample of older adults after hip or pelvic fracture".

Aging Clin Exp Res 2021 Mar 25;33(3):675-676. Epub 2021 Jan 25.

Department of Clinical Gerontology and Geriatric Rehabilitation, Robert-Bosch-Hospital, Stuttgart, Germany.

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http://dx.doi.org/10.1007/s40520-021-01789-zDOI Listing
March 2021

A Roadmap to Inform Development, Validation and Approval of Digital Mobility Outcomes: The Mobilise-D Approach.

Digit Biomark 2020 26;4(Suppl 1):13-27. Epub 2020 Nov 26.

Translational Medicine, Novartis Institutes for Biomedical Research, Basel, Switzerland.

Health care has had to adapt rapidly to COVID-19, and this in turn has highlighted a pressing need for tools to facilitate remote visits and monitoring. Digital health technology, including body-worn devices, offers a solution using digital outcomes to measure and monitor disease status and provide outcomes meaningful to both patients and health care professionals. Remote monitoring of physical mobility is a prime example, because mobility is among the most advanced modalities that can be assessed digitally and remotely. Loss of mobility is also an important feature of many health conditions, providing a read-out of health as well as a target for intervention. Real-world, continuous digital measures of mobility (digital mobility outcomes or DMOs) provide an opportunity for novel insights into health care conditions complementing existing mobility measures. Accepted and approved DMOs are not yet widely available. The need for large collaborative efforts to tackle the critical steps to adoption is widely recognised. Mobilise-D is an example. It is a multidisciplinary consortium of 34 institutions from academia and industry funded through the European Innovative Medicines Initiative 2 Joint Undertaking. Members of Mobilise-D are collaborating to address the critical steps for DMOs to be adopted in clinical trials and ultimately health care. To achieve this, the consortium has developed a roadmap to inform the development, validation and approval of DMOs in Parkinson's disease, multiple sclerosis, chronic obstructive pulmonary disease and recovery from proximal femoral fracture. Here we aim to describe the proposed approach and provide a high-level view of the ongoing and planned work of the Mobilise-D consortium. Ultimately, Mobilise-D aims to stimulate widespread adoption of DMOs through the provision of device agnostic software, standards and robust validation in order to bring digital outcomes from concept to use in clinical trials and health care.
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http://dx.doi.org/10.1159/000512513DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7768123PMC
November 2020

Accelerometer-Based Fall Detection Using Machine Learning: Training and Testing on Real-World Falls.

Sensors (Basel) 2020 Nov 13;20(22). Epub 2020 Nov 13.

Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, 40136 Bologna, Italy.

Falling is a significant health problem. Fall detection, to alert for medical attention, has been gaining increasing attention. Still, most of the existing studies use falls simulated in a laboratory environment to test the obtained performance. We analyzed the acceleration signals recorded by an inertial sensor on the lower back during 143 real-world falls (the most extensive collection to date) from the FARSEEING repository. Such data were obtained from continuous real-world monitoring of subjects with a moderate-to-high risk of falling. We designed and tested fall detection algorithms using features inspired by a multiphase fall model and a machine learning approach. The obtained results suggest that algorithms can learn effectively from features extracted from a multiphase fall model, consistently overperforming more conventional features. The most promising method (support vector machines and features from the multiphase fall model) obtained a sensitivity higher than 80%, a false alarm rate per hour of 0.56, and an F-measure of 64.6%. The reported results and methodologies represent an advancement of knowledge on real-world fall detection and suggest useful metrics for characterizing fall detection systems for real-world use.
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http://dx.doi.org/10.3390/s20226479DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7697900PMC
November 2020

Toward a Regulatory Qualification of Real-World Mobility Performance Biomarkers in Parkinson's Patients Using Digital Mobility Outcomes.

Sensors (Basel) 2020 Oct 20;20(20). Epub 2020 Oct 20.

Institute of Translational and Clinical Research, Newcastle University, Newcastle NE1 7RU, UK.

Wearable inertial sensors can be used to monitor mobility in real-world settings over extended periods. Although these technologies are widely used in human movement research, they have not yet been qualified by drug regulatory agencies for their use in regulatory drug trials. This is because the first generation of these sensors was unreliable when used on slow-walking subjects. However, intense research in this area is now offering a new generation of algorithms to quantify Digital Mobility Outcomes so accurate they may be considered as biomarkers in regulatory drug trials. This perspective paper summarises the work in the Mobilise-D consortium around the regulatory qualification of the use of wearable sensors to quantify real-world mobility performance in patients affected by Parkinson's Disease. The paper describes the qualification strategy and both the technical and clinical validation plans, which have recently received highly supportive qualification advice from the European Medicines Agency. The scope is to provide detailed guidance for the preparation of similar qualification submissions to broaden the use of real-world mobility assessment in regulatory drug trials.
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http://dx.doi.org/10.3390/s20205920DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7589106PMC
October 2020

Mediating factors on the association between fear of falling and health-related quality of life in community-dwelling German older people: a cross-sectional study.

BMC Geriatr 2020 10 14;20(1):401. Epub 2020 Oct 14.

Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics, Martinistraße 52, 20246, Hamburg, Germany.

Background: Previous research has shown that not only falls, but also fear of falling (FoF) influences health-related quality of life (HrQoL) negatively. The EQ-5D (consisting of an index and a visual analogue scale [EQ-VAS]) is a frequently used instrument to determine HrQoL in clinical studies and economic evaluations, but no previous study compared the association between FoF and the EQ-5D index with the association between FoF and the EQ-VAS. Moreover, factors that influence the association between FoF and HrQoL are rarely examined. Thus, this study aimed to examine the association between FoF and HrQoL and to examine factors that mediate the association.

Methods: FoF (Short Falls Efficacy Scale International) and HrQoL (EQ-5D descriptive system, EQ-5D index, and EQ-VAS) were assessed in a sample of community-dwelling older persons (≥70 years) participating in the baseline assessment of a randomized controlled trial (N = 309). Linear and logistic regression analyses were performed, adjusting for sociodemographic variables, frequency of falls, number of chronic conditions, functional mobility (Timed up-and-go test), and subjective functional capacity (LLFDI function and disability scales). Multiple regression models were used to test the mediating effects.

Results: Moderate or high FoF was prevalent in 66% of the sample. After adjusting for covariates, FoF was negatively associated with the EQ-5D index, but not with the descriptive system or the EQ-VAS. Subjective functional capacity partly mediated the association between FoF and the EQ-5D index and completely mediated the association between FoF and the EQ-VAS.

Conclusion: FoF was negatively associated with the EQ-5D index. As subjective functional capacity mediated the association between FoF and HrQoL, future interventions should account for subjective functional capacity in their design.
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http://dx.doi.org/10.1186/s12877-020-01802-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7556961PMC
October 2020

Robot-assisted training after proximal humeral fracture: A randomised controlled multicentre intervention trial.

Clin Rehabil 2021 Feb 5;35(2):242-252. Epub 2020 Oct 5.

Institute for Biomechanics, Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Germany.

Objective: To examine whether robotic-assisted training as a supplement to usual therapy is safe, acceptable and improves function and patient reported outcome after proximal humeral fractures (PHF).

Design: Multicentre, assessor-blinded, randomised controlled prospective trial.

Setting: Three different rehabilitation hospitals in Germany.

Subjects: In total 928 PHF patients between 35 and 70 years were screened. Forty-eight participants were included in the study (intervention group  = 23; control group  = 25).

Intervention: The control group received usual occupational and physiotherapy over three weeks, and the intervention group received additional 12 robot-assisted training sessions at the ARMEO-Spring.

Main Measures: Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH), the Wolf Motor Function Test-Orthopaedic, active range of motion and grip strength were determined before and after intervention period. The DASH was additionally obtained postal 6 and 13 months following surgery.

Results: The mean age of participants was 55 ± 10 years and was similar in both groups ( > 0.05). The change in DASH as the primary endpoint in the intervention group after intervention was -15 (CI = 8-22), at follow-up six month -7 (CI = -2 to 16) at follow up 13 month -9 (CI = 1-16); in control group -14 (CI = 11-18), at follow-up six month -13 (CI = 7-19) at follow up 13 month -6 (CI = -3 to 14). No difference in the change was found between groups ( > 0.05). None of the follow-up time points demonstrated an additional benefit of the robotic therapy.

Conclusion: The additional robot-assisted therapy was safe, acceptable but showed no improvement in functional shoulder outcome compared to usual therapy only.
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http://dx.doi.org/10.1177/0269215520961654DOI Listing
February 2021

The effect of different test protocols and walking distances on gait speed in older persons.

Aging Clin Exp Res 2021 Jan 15;33(1):141-146. Epub 2020 Sep 15.

Institute for Biomedicine of Aging, Friedrich-Alexander-University of Erlangen-Nürnberg, Kobergerstr. 60, 90408, Nuremberg, Germany.

Background And Aims: Walking is the core physical activity of older persons. The assessment of walking capacity is increasingly important for clinical purposes and clinical research. Differences between assessment tools and protocols for short walks to obtain gait characteristics can be responsible for changes, e.g., in gait speed from 0.1 to 0.2 m/s. The purpose of this study was to generate further knowledge for the harmonization and/or standardization of short walk-test protocols for assessing gait characteristics under supervised conditions.

Methods: For this cross-sectional study, 150 community-dwelling older adults (mean age 80.5 ± 4.5 years) were recruited. Participants performed eight walks differing in the distance (8-versus 4-m), static versus dynamic trials and comparing different test speed instructions (usual versus maximal) on an electronic walkway.

Results: A meaningful significant difference in mean usual gait speed was documented comparing the 4-m dynamic and static test protocol (0.12 m/s; p = 0.001). For the same comparison over an 8-m distance (dynamic versus static) and for the comparison between usual gait speed over 4-and 8-m, the differences in gait speed were smaller, but still statistically significant (p = 0.001).

Conclusions: Gait speed was faster, if the test protocol did not include a static start or stop. The differences were greater for a shorter walking distance. This aspect should be considered for the comparison of study results and is particularly relevant for systematic reviews and meta-analyses.
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http://dx.doi.org/10.1007/s40520-020-01703-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7897617PMC
January 2021

Predicting Advanced Balance Ability and Mobility with an Instrumented Timed Up and Go Test.

Sensors (Basel) 2020 Sep 3;20(17). Epub 2020 Sep 3.

Department for Clinical Gerontology, Robert-Bosch-Hospital, 70376 Stuttgart, Germany.

Extensive test batteries are often needed to obtain a comprehensive picture of a person's functional status. Many test batteries are not suitable for active and healthy adults due to ceiling effects, or require a lot of space, time, and training. The Community Balance and Mobility Scale (CBMS) is considered a gold standard for this population, but the test is complex, as well as time- and resource intensive. There is a strong need for a faster, yet sensitive and robust test of physical function in seniors. We sought to investigate whether an instrumented Timed Up and Go (iTUG) could predict the CBMS score in 60 outpatients and healthy community-dwelling seniors, where features of the iTUG were predictive, and how the prediction of CBMS with the iTUG compared to standard clinical tests. A partial least squares regression analysis was used to identify latent components explaining variation in CBMS total score. The model with iTUG features was able to predict the CBMS total score with an accuracy of 85.2% (84.9-85.5%), while standard clinical tests predicted 82.5% (82.2-82.8%) of the score. These findings suggest that a fast and easily administered iTUG could be used to predict CBMS score, providing a valuable tool for research and clinical care.
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http://dx.doi.org/10.3390/s20174987DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7506906PMC
September 2020

Effects of an intervention to reduce fear of falling and increase physical activity during hip and pelvic fracture rehabilitation.

Age Ageing 2020 08;49(5):771-778

Department of Clinical Gerontology and Rehabilitation, Robert-Bosch-Hospital, Stuttgart, Germany.

Background: fear of falling and reduced fall-related self-efficacy are frequent consequences of falls and associated with poorer rehabilitation outcomes. To address these psychological consequences, geriatric inpatient rehabilitation was augmented with a cognitive behavioural intervention ("Step by Step") and evaluated in a RCT.

Methods: one hundred fifteen hip and pelvic fracture patients (age = 82.5 years, 70% female) admitted to geriatric inpatient rehabilitation were randomly allocated to the intervention or control group. The intervention consisted of eight additional individual sessions during inpatient rehabilitation, one home visit and four telephone calls delivered over 2 months after discharge. Both groups received geriatric inpatient rehabilitation. Primary outcomes were fall-related self-efficacy (short falls efficacy scale-international) and physical activity as measured by daily walking duration (activPAL3™ sensor) after admission to rehabilitation, before discharge and 1-month post-intervention.

Results: in covariance analyses, patients in the intervention group showed a significant improvement in fall-related self-efficacy (P = 0.025, d = -0.42), but no difference in total daily walking duration (P = 0.688, d = 0.07) 1-month post-intervention compared to the control condition. Further significant effects in favour of the intervention group were found in the secondary outcomes "perceived ability to manage falls" (P = 0.031, d = 0.41), "physical performance" (short physical performance battery) (P = 0.002, d = 0.58) and a lower "number of falls" (P = 0.029, d = -0.45).

Conclusions: the intervention improved psychological and physical performance measures but did not increase daily walking duration. For the inpatient part of the intervention further research on the required minimum intensity needed to be effective is of interest. Duration and components used to improve physical activity after discharge should be reconsidered.
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http://dx.doi.org/10.1093/ageing/afaa050DOI Listing
August 2020

Psychometric properties of the German version of the Fear of Falling Questionnaire-revised (FFQ-R) in a sample of older adults after hip or pelvic fracture.

Aging Clin Exp Res 2021 Feb 23;33(2):329-337. Epub 2020 Jul 23.

Department of Clinical Gerontology and Geriatric Rehabilitation, Robert-Bosch-Hospital, Stuttgart, Germany.

Background: Identifying patients with maladaptive fear of falling (FOF) is important in the rehabilitation phase after serious fall. The 6-item Fear of Falling Questionnaire-revised (FFQ-R) was seen as promising measurement instrument as it evaluates FOF in a broader way than the one-item-question and independent of physical activities.

Aim: The purpose of the analysis was to evaluate the psychometric properties of the translated German FFQ-R.

Methods: Back-translation method was applied. Confirmatory factor analysis (CFA) with diagonally weighted least square estimation was used to verify the two-factor structure. Data were collected during inpatient rehabilitation from hip and pelvic fracture patients [age 84.3 ± 6.2, Mini-Mental State Examination (MMSE) scores > 23] participating in an RCT (N = 112) and a cross-sectional survey (N = 40).

Results: Internal consistency was 0.78 (Cronbach´s alpha). No floor or ceiling effects were found. Discriminatory power on item level was moderate to good (r = 0.43-0.65). CFA revealed a good model fit and confirmed the two-factor structure. The German FFQ-R was moderately correlated (r = 0.51) with the Short Falls Efficacy Scale-International (Short FES-I) used as a proxy measure for FOF. Missing rates up to 9% for specific items were because some individuals, independent of cognitive level or age, had problems to rate items with conditional statements on possible negative consequences of a fall.

Conclusions: Results demonstrated moderate to good psychometric properties similar to the original English version in a comparable sample of fracture patients.
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http://dx.doi.org/10.1007/s40520-020-01657-2DOI Listing
February 2021

Walking-related digital mobility outcomes as clinical trial endpoint measures: protocol for a scoping review.

BMJ Open 2020 07 19;10(7):e038704. Epub 2020 Jul 19.

Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.

Introduction: Advances in wearable sensor technology now enable frequent, objective monitoring of real-world walking. Walking-related digital mobility outcomes (DMOs), such as real-world walking speed, have the potential to be more sensitive to mobility changes than traditional clinical assessments. However, it is not yet clear which DMOs are most suitable for formal validation. In this review, we will explore the evidence on discriminant ability, construct validity, prognostic value and responsiveness of walking-related DMOs in four disease areas: Parkinson's disease, multiple sclerosis, chronic obstructive pulmonary disease and proximal femoral fracture.

Methods And Analysis: Arksey and O'Malley's methodological framework for scoping reviews will guide study conduct. We will search seven databases (Medline, CINAHL, Scopus, Web of Science, EMBASE, IEEE Digital Library and Cochrane Library) and grey literature for studies which (1) measure differences in DMOs between healthy and pathological walking, (2) assess relationships between DMOs and traditional clinical measures, (3) assess the prognostic value of DMOs and (4) use DMOs as endpoints in interventional clinical trials. Two reviewers will screen each abstract and full-text manuscript according to predefined eligibility criteria. We will then chart extracted data, map the literature, perform a narrative synthesis and identify gaps.

Ethics And Dissemination: As this review is limited to publicly available materials, it does not require ethical approval. This work is part of Mobilise-D, an Innovative Medicines Initiative Joint Undertaking which aims to deliver, validate and obtain regulatory approval for DMOs. Results will be shared with the scientific community and general public in cooperation with the Mobilise-D communication team.

Registration: Study materials and updates will be made available through the Center for Open Science's OSFRegistry (https://osf.io/k7395).
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http://dx.doi.org/10.1136/bmjopen-2020-038704DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7371223PMC
July 2020

Perturbation in public transport as a basic concept for perturbation-based balance training for fall prevention.

Z Gerontol Geriatr 2020 Jul 6. Epub 2020 Jul 6.

Department of Clinical Gerontology and Rehabilitation, Robert-Bosch-Hospital, Auerbachstr. 110, 70376, Stuttgart, Germany.

Introduction: The aim of the study was to collect real-world sensor data on acceleration and deceleration while riding a bus or tram. With respect to the risk of suffering fall-related injuries while using public transportation, our interest was to understand the amplitude of real-world perturbations to translate them to innovative reactive balance training programs.

Methods: Acceleration and deceleration data were collected during 12 days in buses and trams in a German city. A sensor, which was fixed to a vertical bar in the vehicle, measured the acceleration signals. Additionally, extreme values of deceleration during full braking were collected in a driving school bus.

Results: For the incident type acceleration from standing extreme values of acceleration and jerking were higher in buses compared to trams with a maximum acceleration of 3.37 m/s and 1.80 m/s, respectively, and extreme jerking of 13.30 m/s and -5.56 m/s, respectively. Similarly, for the incident type deceleration approaching a stop extreme values of deceleration and jerking were higher in buses compared to trams with maximum deceleration of -3.12 m/s and -2.31 m/s, respectively, and extreme jerking of -19.19 m/s and -10.83 m/s, respectively. Extreme values for maximum deceleration and extreme jerking as simulated at the driving school were not reached during real-world measurements. The duration of incidents in acceleration from standing and deceleration approaching a stop was shorter for buses than for trams.

Conclusion: Acceleration and jerking values were higher in buses compared to trams. Based on this study, laboratory simulation paradigms can be developed to study balance responses in older persons and to design fall prevention interventions which are ecologically valid.
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http://dx.doi.org/10.1007/s00391-020-01755-wDOI Listing
July 2020

German version of the outcome expectations for exercise scale-2 : Psychometric properties in geriatric patients after hip or pelvic fractures with fear of falling.

Z Gerontol Geriatr 2020 Jul 4. Epub 2020 Jul 4.

Department of Clinical Gerontology and Geriatric Rehabilitation, Robert-Bosch-Hospital, Stuttgart, Stuttgart, Germany.

Objective: Physical exercise is associated with many health benefits. Especially for older adults it is challenging to achieve an appropriate adherence to exercise programs. The outcome expectations for exercise scale 2 (OEE-2) is a 13-item self-report questionnaire to assess negative and positive exercise outcome expectations in older adults. The aim of this study was to translate the OEE‑2 into German and to assess the psychometric properties of this version.

Methods: The OEE‑2 was translated from English into German including a forward and backward translation process. Psychometric properties were assessed in 115 patients with hip/pelvic fractures (76% female, mean age 82.5 years) and fear of falling during geriatric inpatient rehabilitation.

Results: Principal component analyses could confirm a two-factor solution (positive/negative OEE) that explained 58% of the total variance, with an overall internal reliability of α = 0.89. Cronbach's α for the 9‑item positive OEE subscale was 0.89, for the 4‑item negative OEE subscale 0.79. The two subscales were correlated with r = 0.49. Correlations of the OEE total score were highest with the perceived ability to manage falls, prefracture leisure time activities and prior training history (r = 0.35-0.41).

Conclusion: These results revealed good internal reliability and construct validity of the German version of the OEE‑2. The instrument is valid for measuring physical exercise outcome expectations in older, German-speaking patients with hip or pelvic fractures and fear of falling.
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http://dx.doi.org/10.1007/s00391-020-01753-yDOI Listing
July 2020

The association of basic and challenging motor capacity with mobility performance and falls in young seniors.

Arch Gerontol Geriatr 2020 Sep - Oct;90:104134. Epub 2020 Jun 6.

Network Aging Research, Heidelberg University, Bergheimer Str. 20, 69115, Heidelberg, Germany; Department of Clinical Gerontology and Rehabilitation, Robert Bosch Hospital Stuttgart, Auerbachstr. 110, 70376, Stuttgart, Germany; Institute of Sports and Sports Sciences, Heidelberg University, Im Neuenheimer Feld 700, 69120, Heidelberg, Germany. Electronic address:

Background: Understanding the association between motor capacity (MC) (what people can do in a standardized environment), mobility performance (MP) (what people actually do in real-life) and falls is important for early detection of and counteracting on functional decline, particularly in the rapidly growing population of young seniors. Therefore, this study aims to 1) explore the association between MC and MP, and between MC and falls, and 2) investigate whether challenging MC measures are better associated with MP and falls than basic MC measures.

Methods: Basic (habitual gait speed, Timed Up-and-Go) and challenging (fast gait speed, Community Balance & Mobility Scale) MC measures were performed in 169 young seniors (61-70 years). MP was assessed using one-week sensor-monitoring including time being sedentary, light active, and at least moderately active. Falls in the previous six months were reported. Associations and discriminative ability were calculated using correlation, regression and receiver operating curve analysis.

Results: Mean age was 66.4 (SD 2.4) years (50.6 % women). Small to moderate associations (r = 0.06-0.31; p < .001-.461) were found between MC, MP and falls. Challenging MC measures showed closer associations with MP and falls (r = 0.10-0.31; p < .001-.461) compared to basic (r = 0.06-0.22; p = .012-.181), remained significant in three out of four regression models explaining 2.5-8.6 % of the variance, and showed highest discriminative ability (area under the curve = 0.59-0.70) in all analyses.

Conclusions: Challenging MC measures are closer associated with mobility performance and falls as compared to basic MC measures in young seniors. This indicates the importance of applying challenging motor capacity assessments in young seniors. On the same note, small to moderate associations imply a need for an assessment of both MC and MP in order to capture the best possible MC and the actual daily-life MP in young seniors.
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http://dx.doi.org/10.1016/j.archger.2020.104134DOI Listing
December 2020

Neurogeriatrics-a vision for improved care and research for geriatric patients with predominating neurological disabilities.

Z Gerontol Geriatr 2020 Jul 19;53(4):340-346. Epub 2020 May 19.

Agaplesion Bethesda Clinic, Competence Centre of Geriatrics and Aging Research, University of Ulm, Ulm, Germany.

Geriatric medicine is a rapidly evolving field that addresses diagnostic, therapeutic and care aspects of older adults. Some disabilities and disorders affecting cognition (e.g. dementia), motor function (e.g. stroke, Parkinson's disease, neuropathies), mood (e.g. depression), behavior (e.g. delirium) and chronic pain disorders are particularly frequent in old subjects. As knowledge about these age-associated conditions and disabilities is steadily increasing, the integral implementation of neurogeriatric knowledge in geriatric medicine and specific neurogeriatric research is essential to develop the field. This article discusses how neurological know-how could be integrated in academic geriatric medicine to improve care of neurogeriatric patients, to foster neurogeriatric research and training concepts and to provide innovative care concepts for geriatric patients with predominant neurological conditions and disabilities.
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http://dx.doi.org/10.1007/s00391-020-01734-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7311516PMC
July 2020

Osteoporotic hip fracture prediction from risk factors available in administrative claims data - A machine learning approach.

PLoS One 2020 19;15(5):e0232969. Epub 2020 May 19.

Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical-Centre Hamburg-Eppendorf, Hamburg, Germany.

Objective: Hip fractures are among the most frequently occurring fragility fractures in older adults, associated with a loss of quality of life, high mortality, and high use of healthcare resources. The aim was to apply the superlearner method to predict osteoporotic hip fractures using administrative claims data and to compare its performance to established methods.

Methods: We devided claims data of 288,086 individuals aged 65 years and older without care level into a training (80%) and a validation set (20%). Subsequently, we trained a superlearner algorithm that considered both regression and machine learning algorithms (e.g., support vector machines, RUSBoost) on a large set of clinical risk factors. Mean squared error and measures of discrimination and calibration were employed to assess prediction performance.

Results: All algorithms used in the analysis showed similar performance with an AUC ranging from 0.66 to 0.72 in the training and 0.65 to 0.70 in the validation set. Superlearner showed good discrimination in the training set but poorer discrimination and calibration in the validation set.

Conclusions: The superlearner achieved similar predictive performance compared to the individual algorithms included. Nevertheless, in the presence of non-linearity and complex interactions, this method might be a flexible alternative to be considered for risk prediction in large datasets.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0232969PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7237034PMC
August 2020
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