Publications by authors named "K S van Schooten"

60 Publications

The Relationship Between Concerns About Falling and Daily Life Activity in Older Men and Women.

J Aging Phys Act 2021 Aug 18:1-8. Epub 2021 Aug 18.

Concerns about falling (CAF) affect daily life activities in older people; however, it is unclear whether gender moderates this relationship. The authors investigated the cross-sectional relationship between CAF and objectively measured physical activity (PA) and gait quality in 503 community-dwelling older men and women. About 448 people (age = 76.2 [SD 7.9] years, 296 females) contributed sufficient data on movement intensity, activity duration (bouts of walking, sitting, and standing), number of transitions between activities (sit-to-stand and sit-to-walk), number of steps and gait quality, quantified as walking speed, and sample entropy. Associations with the Iconographical Falls Efficacy Scale were tested. The authors found no significant moderation by gender. However, women participated in less PA than men and showed a more irregular walking pattern. Higher levels of CAF led to lower PA and poorer gait quality. Our findings suggest that prevention of CAF-related PA avoidance may be particularly important for women, who are less active and at higher risk of falls.
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August 2021

Evidence of slow and variable choice-stepping reaction time in cancer survivors with chemotherapy-induced peripheral neuropathy.

Gait Posture 2021 Sep 21;89:178-185. Epub 2021 Jul 21.

Prince of Wales Clinical School, University of New South Wales, Kensington, Australia; Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia.

Background: Chemotherapy-induced peripheral neuropathy (CIPN) is reported to affect up to 70 % of cancer survivors. Despite evidence that CIPN-related impairments often translate into balance and mobility deficits, the effects on stepping and quality of gait, well-documented risk factors for falls, are unclear.

Aims: (i) Establish choice-stepping reaction time (CSRT) performance in survivors with CIPN compared to young and older healthy controls and people with Parkinson's disease; (ii) document walking stability; (iii) investigate relationships between stepping and gait data to objective and patient-reported outcomes.

Methods: 41 cancer survivors with CIPN (mean (SD) age: 60.8 (9.7) years) who were ≥3months post chemotherapy, performed tests of simple and inhibitory CSRT. Walking stability measures were derived from 3-D accelerometry data during the 6-minute walk test. CIPN was assessed using neurological grading and patient-reported outcome measures (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire in CIPN Questionnaire scale EORTC CIPN20).

Results: In both stepping tests, CIPN participants performed at the level of adults aged 10 years older and people with mild to moderate Parkinson's disease. Mean (SD) total stepping response times in both CSRT (1160 (190) milliseconds) and inhibitory CSRT (1191 (164) milliseconds) tests were not associated with objective neurological grading but were correlated with increased difficulty feeling the ground. Participants with lower-limb vibration sensation deficit had slower and more variable CSRT times. There were no associations between walking stability and objective measures of CIPN, and limited correlations with the EORTC-CIPN20.

Conclusions: Cancer survivors with CIPN showed deficits in voluntary stepping responses and seemed to compensate for their sensory and motor deficits by walking slower to maintain stability. Objective and patient-reported outcomes of CIPN were correlated with slower and more variable stepping response times. Future studies should aim to identify the causes of the apparent premature decline in cognitive-motor function and develop remediating interventions.
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September 2021

Exploring Older Adults' Experiences of a Home-Based, Technology-Driven Balance Training Exercise Program Designed to Reduce Fall Risk: A Qualitative Research Study Within a Randomized Controlled Trial.

J Geriatr Phys Ther 2021 Jul 14. Epub 2021 Jul 14.

School of Health, Medicine and Applied Science, Appleton Institute, CQUniversity, Melbourne, Victoria Australia. Public Health, Health Faculty, Torrens University Australia, Adelaide, South Australia, Australia. Physical Activity, Lifestyle, Ageing and Wellbeing Faculty Research Group, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, Australia. Exercise Science Laboratory, School of Kinesiology, Faculty of Medicine, Universidad Finis Terrae, Santiago, Chile. School of Population Health, University of New South Wales, Sydney, Australia. Neuroscience Research Australia, Randwick, Australia. Prince of Wales Hospital Clinical School, University of New South Wales, Sydney, Australia. Centre for Excellence in Population Ageing Research, The University of Sydney, Sydney, Australia. Care and Public Health Research Institute, Department of Health Services Research, Maastricht University, the Netherlands. Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia. School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia. School of Health, Medicine and Applied Science, Appleton Institute, CQUniversity, Rockhampton North, Australia.

Background And Purpose: With an aging population, falls have become an increasing public health concern. While face-to-face exercise programs have demonstrated efficacy in reducing falls, their effectiveness is hampered by low participation and adherence. Digital technologies are a novel and potentially effective method for delivering tailored fall prevention exercise programs to older adults. In addition, they may increase the reach, uptake, and sustainability of fall prevention programs. Therefore, understanding older adults' experiences of using technology-driven methods is essential. This study explored the user experience of StandingTall, a home-based fall prevention program delivered through a tablet computer.

Methods: Fifty participants were recruited using purposive sampling, from a larger randomized controlled trial. Participants were selected to ensure maximum variability with respect to age, gender, experience with technology, and adherence to the program. Participants undertook a one-on-one structured interview. We followed an iterative approach to develop themes.

Results And Discussion: Eight themes were identified. These fall under 2 categories: user experience and program design. Participants found StandingTall enjoyable, and while its flexible delivery facilitated exercise, some participants found the technology challenging. Some participants expressed frustration with technological literacy, but most demonstrated an ability to overcome these challenges, and learn a new skill. Older adults who engaged in a technology-driven fall prevention program found it enjoyable, with the flexibility provided by the online delivery central to this experience. While the overall experience was positive, participants expressed mixed feelings about key design features. The embedded behavior change strategies were not considered motivating by most participants. Furthermore, some older adults associated the program characters with gender-based stereotypes and negative views of aging, which can impact on motivation and preventive behavior.

Conclusion: This study found digital technologies are an effective and enjoyable method for delivering a fall prevention program. This study highlights that older adults are interested in learning how to engage successfully with novel technologies.
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July 2021

Protocol of a 12-month multifactorial eHealth programme targeting balance, dual-tasking and mood to prevent falls in older people: the + randomised controlled trial.

BMJ Open 2021 04 15;11(4):e051085. Epub 2021 Apr 15.

Neuroscience Research Australia, Randwick, New South Wales, Australia

Introduction: Falls have a multifactorial aetiology, which may limit the effectiveness of the common approach of exercise as the sole intervention strategy. Multifactorial interventions could be more effective in people at high risk of falling; however, the focus of such interventions has traditionally been quite narrow. This paper describes the design of a randomised controlled trial that will evaluate the effectiveness of an eHealth programme, which addresses cumulative effects of key fall-risk factors across the triad of physical, affective and cognitive functions on falls in older people.

Methods And Analysis: 518 older people aged 65 years and over with high fall risk, defined as having a history of falls in the past 6 months, self-reported fear of falling or being aged 80 years or over, will be recruited via local advertisements, newsletters and presentations, and randomised to an intervention or health education control group. The intervention comprises balance exercise, cognitive-motor exercise and cognitive-behavioural therapy, with their dosage based on participant's baseline balance, executive function and mood. The primary outcome is the rate of falls in the 12 months after randomisation. Secondary outcomes at 6 and 12 months comprise programme adherence, healthcare use, physical activity, balance and mobility, cognitive function, psychological well-being, quality of life, health literacy and user experience and attitudes towards the programme. Data will be analysed following intention to treat to gauge real-world effectiveness. We will further determine complier averaged causal effects to correct for varying adherence and conduct economic analyses to gain insight into cost-effectiveness and cost-utility.

Ethics And Dissemination: Ethical approval was obtained from the University of New South Wales (UNSW) Human Research Ethics Committee in December 2017. Outcomes will be disseminated via peer-reviewed articles, conference presentations, community events and media releases.

Trial Registration Number: ACTRN12619000540112.
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April 2021

E-health StandingTall balance exercise for fall prevention in older people: results of a two year randomised controlled trial.

BMJ 2021 04 6;373:n740. Epub 2021 Apr 6.

Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Randwick, NSW, Australia.

Objective: To test whether StandingTall, a home based, e-health balance exercise programme delivered through an app, could provide an effective, self-managed fall prevention programme for community dwelling older people.

Design: Assessor blinded, randomised controlled trial.

Setting: Older people living independently in the community in Sydney, Australia.

Participants: 503 people aged 70 years and older who were independent in activities of daily living, without cognitive impairment, progressive neurological disease, or any other unstable or acute medical condition precluding exercise.

Interventions: Participants were block randomised to an intervention group (two hours of StandingTall per week and health education; n=254) or a control group (health education; n=249) for two years.

Main Outcome Measures: The primary outcomes were the rate of falls (number of falls per person year) and the proportion of people who had a fall over 12 months. Secondary outcomes were the number of people who had a fall and the number who had an injurious fall (resulting in any injury or requiring medical care), adherence, mood, health related quality of life, and activity levels over 24 months; and balance and mobility outcomes over 12 months.

Results: The fall rates were not statistically different in the two groups after the first 12 months (0.60 falls per year (standard deviation 1.05) in the intervention group; 0.76 (1.25) in the control group; incidence rate ratio 0.84, 95% confidence interval 0.62 to 1.13, P=0.071). Additionally, the proportion of people who fell was not statistically different at 12 months (34.6% in intervention group, 40.2% in control group; relative risk 0.90, 95% confidence interval 0.67 to 1.20, P=0.461). However, the intervention group had a 16% lower rate of falls over 24 months compared with the control group (incidence rate ratio 0.84, 95% confidence interval 0.72 to 0.98, P=0.027). Both groups had a similar proportion of people who fell over 24 months (relative risk 0.87, 95% confidence interval 0.68 to 1.10, P=0.239), but the proportion of people who had an injurious fall over 24 months was 20% lower in the intervention group compared with the control group (relative risk 0.80, 95% confidence interval 0.66 to 0.98, P=0.031). In the intervention group, 68.1% and 52.0% of participants exercised for a median of 114.0 min/week (interquartile range 53.5) after 12 months and 120.4 min/week (38.6) after 24 months, respectively. Groups remained similar in mood and activity levels. The intervention group had a 0.03 (95% confidence interval 0.01 to 0.06) improvement on the EQ-5D-5L (EuroQol five dimension five level) utility score at six months, and an improvement in standing balance of 11 s (95% confidence interval 2 to 19 s) at six months and 10 s (1 to 19 s) at 12 months. No serious training related adverse events occurred.

Conclusions: The StandingTall balance exercise programme did not significantly affect the primary outcomes of this study. However, the programme significantly reduced the rate of falls and the number of injurious falls over two years, with similar but not statistically significant effects at 12 months. E-health exercise programmes could provide promising scalable fall prevention strategies.

Trial Registration: ACTRN12615000138583.
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April 2021