Publications by authors named "Kim Delbaere"

146 Publications

Disentangling interventions to reduce fear of falling in community-dwelling older people: a systematic review and meta-analysis of intervention components.

Disabil Rehabil 2021 Sep 11:1-11. Epub 2021 Sep 11.

Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.

Purpose: Fear of falling (FoF) is a common and debilitating problem for older people. Most multicomponent interventions show only moderate effects. Exploring the effective components may help in the optimization of treatments for FoF.

Materials And Methods: In a systematic review of five scientific literature databases, we identified randomized controlled trials with older community-dwelling people that included FoF as an outcome. There was no restriction on types of interventions. Two reviewers extracted information about outcomes and content of interventions. Intervention content was coded with a coding scheme of 68 intervention components. We compared all studies with a component to those without using univariate meta-regressions.

Results: Sixty-six studies, reporting on 85 interventions, were included in the systematic review. In the meta-regressions ( = 49), few components were associated with intervention effects at the first available follow up after the intervention, but interventions with meditation, holistic exercises (such as Tai Chi or Pilates) or body awareness were significantly more effective than interventions without these components. Interventions with self-monitoring, balance exercises, or tailoring were less effective compared to those without these components.

Conclusions: The identified components may be important for the design and optimization of treatments to reduce FoF.Implications for rehabilitationFear of falling (FoF) is a common and debilitating issue among older people and multicomponent interventions usually show only small to moderate effects on FoF.This review and meta-analysis investigated 68 intervention components and their relation to intervention effects on FoF.Interventions with meditation, holistic exercises (such as Tai Chi), or body awareness are more effective than interventions without these components.Clinicians aiming to reduce FoF may recommend selected interventions to older people taking into account the current knowledge of intervention components.
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http://dx.doi.org/10.1080/09638288.2021.1969452DOI Listing
September 2021

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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http://dx.doi.org/10.1123/japa.2020-0516DOI Listing
August 2021

Rapid Inhibition Accuracy and Leg Strength Are Required for Community-Dwelling Older People to Recover Balance From Induced Trips and Slips: An Experimental Prospective Study.

J Geriatr Phys Ther 2021 Jul 26. Epub 2021 Jul 26.

Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia. UNSW Medicine, Sydney, New South Wales, Australia. Department of Human Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands. Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor.

Background And Purpose: Falls can result in bone fractures and disability, presenting a serious threat to quality of life and independence in older adults. The majority of falls in community-living older adults occur while walking and are often caused by trips and slips. The study aimed to identify the specific sensorimotor and psychological factors required for older adults to recover balance from trips and slips.

Methods: Forty-one older adults aged 65 to 87 years were assessed on sensorimotor (knee extension strength, proprioception, postural sway, and edge contrast sensitivity), reaction (simple reaction time, stepping, and catching reaction inhibition), and psychological (general anxiety and concern about falling) measures. Using a harness system, participants walked at 90% of their usual pace on a 10-m walkway that could induce trips and slips in concealed and changeable locations. Post-perturbation responses resulting in more than 30% of body weight being recorded by the harness system were defined as falls. Poisson regressions were used to test associations between the sensorimotor, reaction, and psychological measures and number of falls.

Results: Fifty-one falls occurred in 25 of 41 participants. Poisson regression revealed body mass index, lower-limb proprioception, knee extension strength, rapid inhibition accuracy, concern about falling, and anxiety were significantly associated with the rate of falls. Other measures including postural sway were not statistically significant. Using stepwise Poisson regression analyses, normalized knee extension strength (rate ratio [RR]: 0.68, 95% confidence interval [CI]: 0.47-0.98), and rapid inhibition accuracy (RR: 0.64, 95% CI: 0.46-0.87) were independently associated with falls.

Conclusion: Our findings suggest rapid inhibition accuracy and adequate leg strength are required for older adults to recover balance from trips and slips. The mechanisms for balance recovery during daily life activities are likely different from those for static balance, suggesting the need for task-specific assessments and interventions for fall prevention in older adults.
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http://dx.doi.org/10.1519/JPT.0000000000000312DOI Listing
July 2021

Implementation of the programme to prevent falls in older people: a process evaluation protocol.

BMJ Open 2021 07 26;11(7):e048395. Epub 2021 Jul 26.

Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Randwick, New South Wales, Australia

Introduction: One in three people aged 65 years and over fall each year. The health, economic and personal impact of falls will grow substantially in the coming years due to population ageing. Developing and implementing cost-effective strategies to prevent falls and mobility problems among older people is therefore an urgent public health challenge. is a low-cost, unsupervised, home-based balance exercise programme delivered through a computer or tablet. has a simple user-interface that incorporates physical and behavioural elements designed to promote compliance. A large randomised controlled trial in 503 community-dwelling older people has shown that is safe, has high adherence rates and is effective in improving balance and reducing falls. The current project targets a major need for older people and will address the final steps needed to scale this innovative technology for widespread use by older people across Australia and internationally.

Methods And Analysis: This project will endeavour to recruit 300 participants across three sites in Australia and 100 participants in the UK. The aim of the study is to evaluate the implementation of into the community and health service settings in Australia and the UK. The nested process evaluation will use both quantitative and qualitative methods to explore uptake and acceptability of the programme and associated resources. The primary outcome is participant adherence to the programme over 6 months.

Ethics And Dissemination: Ethical approval has been obtained from the South East Sydney Local Health District Human Research Ethics Committee (HREC reference 18/288) in Australia and the North West- Greater Manchester South Research Ethics Committee (IRAS ID: 268954) in the UK. Dissemination will be via publications, conferences, newsletter articles, social media, talks to clinicians and consumers and meetings with health departments/managers.

Trial Registration Number: ACTRN12619001329156.
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http://dx.doi.org/10.1136/bmjopen-2020-048395DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8314746PMC
July 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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http://dx.doi.org/10.1519/JPT.0000000000000321DOI Listing
July 2021

A novel cognitive-motor exercise program delivered via a tablet to improve mobility in older people with cognitive impairment - StandingTall Cognition and Mobility.

Exp Gerontol 2021 09 8;152:111434. Epub 2021 Jun 8.

Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Barker Street, Randwick, New South Wales, Australia; School of Population Health, University of New South Wales, Kensington, New South Wales, Australia.

Background: Evidence-based interventions to improve mobility in older people include balance, strength and cognitive training. Digital technologies provide the opportunity to deliver tailored and progressive programs at home. However, it is unknown if they are effective in older people, especially in those with cognitive impairment.

Objective: The aim of this study was to examine the efficacy of a novel tablet-delivered cognitive-motor program on mobility in older people with cognitive impairment.

Methods: This was a 6-month single-blind randomised controlled trial of older people living in the community with subjective and/or objective cognitive impairment. Participants randomised to the intervention were asked to follow a 120 min per week balance, strength and cognitive training program delivered via an app on an iPad. Both the intervention and control group received monthly phone calls and health fact sheets. The primary outcome measure was gait speed. Secondary measures included dual-task gait speed, balance (step test, FISCIT-4), 5 sit to stand test, cognition (executive function, memory, attention), mood and balance confidence. Adherence, safety, usability and feedback were also measured.

Results: The planned sample size of 110 was not reached due to COVID-19 restrictions. A total of 93 (mean age 72.8 SD 7.0 years) participants were randomised to the two groups. Of these 77 participants returned to the follow-up clinic. In intention-to-treat analysis for gait speed, there was a non-significant improvement favouring the intervention group (β 0.04 m/s 95% CI -0.01, 0.08). There were no significant findings for secondary outcomes. Adherence was excellent (84.5%), usability of the app high (76.7% SD 15.3) and no serious adverse events were reported. Feedback on the app was positive and included suggestions for future updates.

Conclusion: Due to COVID-19 the trial was under powered to detect significant results. Despite this, there was a trend towards improvement in the primary outcome measure. The excellent adherence and positive feedback about the app suggest a fully powered trial is warranted.
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http://dx.doi.org/10.1016/j.exger.2021.111434DOI Listing
September 2021

The association between white matter hyperintensity volume and gait performance under single and dual task conditions in older people with dementia: A cross-sectional study.

Arch Gerontol Geriatr 2021 Jul-Aug;95:104427. Epub 2021 May 4.

Falls, Balance and Injury Research Centre, Neuroscience Research Australia, UNSW, Sydney, NSW, Australia; Prince of Wales Clinical School, Medicine, UNSW, Sydney, NSW, Australia. Electronic address:

Background: Understanding the relationship between white matter hyperintensities (WMHs) and gait may assist in understanding the central control of gait and determining treatment modalities. These relationships are yet to be realized in older people with dementia.

Objective: To examine the association between WMH volume and gait under single-task and dual task (DT) conditions in people with dementia.

Methods: Twenty-eight community-dwelling older people with dementia (median age=83 years; [IQR=77-86]; 36% female) had timed gait speed assessed at usual pace. Gait (speed, stride length, cadence) was assessed using the GAITRite® mat under three conditions (n = 18/28): a) single-task, b) functional DT: carrying a glass of water and c) cognitive DT: counting backwards from 30. WMH volumes were quantified using a fully automated segmentation toolbox.

Results: Total, temporal and parietal WMH volumes were negatively correlated with timed and functional DT gait speed, and with stride length under single-task, functional DT and cognitive DT conditions. Frontal WMH volumes were negatively correlated with timed gait speed and stride length under single-task and functional DT conditions. Participants with higher total WMH burden had significantly slower timed and functional DT gait speed and reduced stride length under single-task, functional DT and cognitive DT conditions compared to participants with lower WMH burden.

Conclusions: WMH volume was associated with slower gait speed and reduced stride length, but not cadence, under single-task and DT conditions in people with dementia. Further research is needed to confirm these findings and determine whether vascular risk management can improve gait in older people with dementia.
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http://dx.doi.org/10.1016/j.archger.2021.104427DOI Listing
June 2021

Predictors of development and persistence of musculoskeletal pain in community-dwelling older people: A two-year longitudinal study.

Geriatr Gerontol Int 2021 Jun 23;21(6):519-524. Epub 2021 Apr 23.

Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia.

Aim: The aim of this prospective cohort study was to identify the predictors of the development and persistence of musculoskeletal pain (MSKP) in older people.

Methods: Participants comprised 431 community-dwelling older people aged 70+ years. Demographic, anthropometric, balance, mobility, cognitive function, psychological status and physical activity level measures were obtained at baseline. Participants were asked about the presence of MSKP in the neck/back, hip, knee/leg and/or feet at baseline and two-year follow-up. Logistic regression analyses were performed to identify predictors of the development and persistence of MSKP at two-year follow-up.

Results: Of 179 participants who reported no MSKP at baseline, 84 (46.9%) reported MSKP at two-year follow-up, which was associated with a higher body mass index (odds ratio (OR) 1.10, 95% confidence interval (CI) 1.02-1.18), more reported depressive symptoms (OR 1.30, 95% CI 1.05-1.61) and lower physical activity levels (OR 0.92, 95% CI 0.84-1.00) at baseline. Of 252 participants who reported MSKP at baseline, 202 (80.2%) reported MSKP at follow-up, which was associated with a slower 6-m walking time (OR 1.27, 95% CI 1.08-1.49) and more reported depressive symptoms (OR 1.39, 95% CI 1.09-1.78). These associations remained significant after adjusting for age, sex, comorbidities and medication use.

Conclusions: This study suggests that higher body mass index, more depressive symptoms and less physical activity are predictors of developing MSKP, whereas slow gait speed and depressive symptoms are predictors of the persistence of MSKP among older people. The results highlight the importance of weight control, strategies to improve mental wellbeing and an active lifestyle for pain management among older people. Geriatr Gerontol Int 2021; 21: 519-524.
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http://dx.doi.org/10.1111/ggi.14172DOI Listing
June 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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http://dx.doi.org/10.1136/bmjopen-2021-051085DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8055147PMC
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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http://dx.doi.org/10.1136/bmj.n740DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8022322PMC
April 2021

Validation of Walking Speed Estimation from Trunk Mounted Accelerometers for a Range of Walking Speeds.

Sensors (Basel) 2021 Mar 6;21(5). Epub 2021 Mar 6.

Philips Research, Patient Care & Monitoring Department, High Tech Campus 34, 5656 AE Eindhoven, The Netherlands.

Walking speed is a strong indicator of the health status of older people and patients. Using algorithms, the walking speed can be estimated from wearable accelerometers, which enables minimally obtrusive (longitudinal) monitoring. We evaluated the performance of two algorithms, the inverted pendulum (IP) algorithm, and a novel adaptation correcting for lateral step movement, which aimed to improve accuracy during slow walking. To evaluate robustness, we gathered data from different groups (healthy adults, elderly, and elderly patients) of volunteers (n = 159) walking under various conditions (over ground, treadmill, using walking aids) at a broad range of speeds (0.11-1.93 m/s). Both of the algorithms showed good agreement with the reference values and similar root-mean-square errors (RMSEs) for walking speeds ≥0.5 m/s, which ranged from 0.09-0.16 m/s for the different positions, in line with the results from others. However, for slower walking, RMSEs were significantly better for the new method (0.06-0.09 m/s versus 0.15-0.19 m/s). Pearson correlation improved for speeds <0.5 m/s (from 0.67-0.72 to 0.73-0.82) as well as higher speeds (0.87-0.97 to 0.90-0.98) with the new method. Overall, we found that IP(-based) walking speed estimation proved to be applicable for a variety of wearing positions, conditions and speeds, indicating its potential value for health assessment applications.
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http://dx.doi.org/10.3390/s21051854DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7961724PMC
March 2021

Depression, childhood trauma, and physical activity in older Indigenous Australians.

Int Psychogeriatr 2021 Mar 15:1-11. Epub 2021 Mar 15.

Neuroscience Research Australia, Australia.

Objectives: Indigenous Australians experience higher levels of psychological distress compared to the general population. Physical activity is a culturally acceptable approach, associated with reduction of depressive symptoms. The protective properties of physical activity for depressive symptoms are yet to be evaluated in older Indigenous Australians.

Design: A two-phase study design comprised of a qualitative thematic analysis following a quantitative regression and moderation analysis.

Participants: Firstly, a total of 336 Indigenous Australians aged 60 years and over from five NSW areas participated in assessments on mental health, physical activity participation, and childhood trauma. Secondly, a focus group of seven Indigenous Australians was conducted to evaluate barriers and facilitators to physical activity.

Measurements: Regression and moderation analyses examined links between depression, childhood trauma, and physical activity. Thematic analysis was conducted exploring facilitators and barriers to physical activity following the focus group.

Results: Childhood trauma severity and intensity of physical activity predicted depressive symptoms. Physical activity did not affect the strength of the relationship between childhood trauma and depression. Family support and low impact activities facilitated commitment to physical activity. In contrast, poor mental health, trauma, and illness acted as barriers.

Conclusion: Physical activity is an appropriate approach for reducing depressive symptoms and integral in maintaining health and quality of life. While situational factors, health problems and trauma impact physical activity, accessing low-impact group activities with social support was identified to help navigate these barriers.
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http://dx.doi.org/10.1017/S1041610221000132DOI Listing
March 2021

Ngarraanga Giinganay ('thinking peacefully'): Co-design and pilot study of a culturally-grounded mindfulness-based stress reduction program with older First Nations Australians.

Eval Program Plann 2021 Aug 3;87:101929. Epub 2021 Mar 3.

Neuroscience Research Australia, Sydney, NSW, Australia; Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; UNSW Ageing Futures Institute, Sydney, NSW, Australia.

First Nations 'survivors' are ageing in increasing numbers. Life-course stress and depression are of concern for older First Nations Australians, yet there are limited psychosocial interventions. This study aimed to co-design a culturally-grounded mindfulness-based program ('Ngarraanga Giinganay') and evaluate acceptability/feasibility with an Aboriginal community on Gumbaynggirr Country. An expert Working Group guided program development, with Aboriginal and non-Aboriginal clinicians/consultants. A workshop, collaborative yarning group with older Aboriginal people (n = 9), and further consultation contributed to the design/refinement of the 8-session group-based program, ensuring content aligned with therapeutic principles of mindfulness and cultural understandings of the Gumbaynggirr community. A single-group pilot study was conducted (n = 7, 62-81 years), co-facilitated by an Aboriginal clinician and Elder. Outcomes were qualitative (understandings of mindfulness, program acceptability, benefits to health/wellbeing). Pilot results demonstrated feasibility, acceptability and preliminary effectiveness. The program enhanced understandings of mindfulness and participants highlighted benefits such as helping anxiety, relaxation, focusing on the moment and connection to Country/land. Trends were seen for reducing depression, anxiety and stress symptoms, and blood pressure. This study provides insight into partnering with underrepresented populations through ageing research, highlighting the effectiveness of this co-design approach. Ngarraanga Giinganay has considerable potential for supporting health and wellbeing of First Nations peoples.
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http://dx.doi.org/10.1016/j.evalprogplan.2021.101929DOI Listing
August 2021

Multifaceted needs of individuals living with peripheral arterial disease: A qualitative study.

Chronic Illn 2021 Mar 5:1742395321999450. Epub 2021 Mar 5.

University of Technology Sydney, Faculty of Health, IMPACCT, Broadway, NSW, Australia.

Objectives: To ascertain a comprehensive perspective of the impact of peripheral arterial disease (PAD) on people including needs for access to disease specific information, education, services, and support.

Methods: Participants were recruited from outpatient clinics at a tertiary hospital in metropolitan Australia. Telephone and face-to-face semi-structured interviews were conducted with nine individuals living with PAD and analysed using qualitative content thematic analysis.

Results: The nine participants were on average 74.2 (SD 10.9) years and predominantly women (67%). Lack of understanding of PAD and inconsistent information resulted in confusion regarding self-management strategies. Effects of pain and mobility problems were amplified for participants who lived alone and did not have an informal carer.

Discussion: Poor quality of life in PAD reflects pain, social isolation and fear of falls. Multidisciplinary teams with case managers should consider older people's living situations and needs for additional support services and education to facilitate integrated care.
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http://dx.doi.org/10.1177/1742395321999450DOI Listing
March 2021

Association between health literacy and physical activity in older people: a systematic review and meta-analysis.

Health Promot Int 2020 Jan 15. Epub 2020 Jan 15.

Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Randwick, NSW 2031, Australia.

Physical inactivity is common in older people and contributes to morbidity and mortality. Health literacy might play a role in motivating people to become or stay physically active. However, little is known about the influence of health literacy on physical activity in older people. This review aims to determine the association between health literacy and physical activity in older people. A systematic search was conducted in CINAHL, MEDLINE, PsychINFO and CENTRAL. Inclusion criteria: (i) community-dwelling people with an average age of ≥55 and (ii) reported on the association between health literacy and physical activity. Exclusion criteria: (i) population with a health condition and (ii) case study or qualitative study. Data were extracted independently by two reviewers. Risk of bias was assessed using the Downs and Black checklist. A meta-analysis was conducted using random-effects models with inverse variance. Thirteen articles were included in the review and five articles were selected for the meta-analysis. Older people with inadequate health literacy were 38% less likely than older people with adequate health literacy to report engaging in physical activity on ≥5 days per week [odds ratio = 0.62, 95% confidence interval (CI) 0.55-0.77]. Only two articles used activity monitors; the mean number of steps taken per day was not significantly different between older people with adequate and inadequate health literacy (standardized mean difference = -0.15, 95% CI -0.30 to 0.01). Physical activity could potentially be fostered by increasing health literacy and empowering older people to make beneficial health decisions.
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http://dx.doi.org/10.1093/heapro/daaa072DOI Listing
January 2020

Understanding implementation factors and participant experiences of a cluster randomised controlled trial to prevent falls among older Aboriginal people: a process evaluation protocol.

Inj Prev 2021 Jan 5. Epub 2021 Jan 5.

Ngarruwan Ngadju First Peoples Health and Wellbeing Research Centre, Australian Health Services Research Institute, University of Wollongong, Wollongong, New South Wales, Australia.

Introduction: Process evaluations examining programme implementation are often conducted in conjunction with effectiveness studies. Their inclusion in studies with Aboriginal participants can give an understanding of programme delivery in Aboriginal community contexts. The programme was codesigned with Aboriginal communities and includes exercise and facilitated 'yarning' discussion about fall risk and prevention strategies. The programme pilot showed favourable outcomes and acceptability for Aboriginal people aged 45 years and over. The programme is now being compared with a '' programme in a cluster randomised controlled trial within Aboriginal health and community services. An embedded process evaluation aims to explore relationships between participation and programme outcomes and the quality of programme implementation.

Methods And Analysis: The process evaluation will use a mixed methods design, guided by Indigenous research methodology. It will evaluate quantitative data (number of completed sessions, site coaching checklist tool, participant and facilitator questionnaire data and a participant habit formation scale), as well as qualitative data (open-ended responses from project and site staff and semistructured interviews using yarning with study participants and site managers). A programme logic model was developed to explain the intended inputs, activities, outputs and outcomes, which guided this process evaluation design.

Conclusion: This process evaluation of a fall prevention programme for older Aboriginal people using a mixed methods design and data triangulation will allow for a comprehensive understanding of study findings. Multiple study sites allow for generalisability of findings and exploration of variation across sites.

Trial Registration Number: ACTRN12619000349145.
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http://dx.doi.org/10.1136/injuryprev-2020-043980DOI Listing
January 2021

Determinants of concern about falling in adults with age-related macular degeneration.

Ophthalmic Physiol Opt 2021 03 25;41(2):245-254. Epub 2020 Dec 25.

Centre for Vision and Eye Research, School of Optometry and Vision Science, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia.

Purpose: To investigate the prevalence and level of concern about falling (CF) among older people with vision impairment due to age-related macular degeneration (AMD) compared to a visually normal control group, and to identify determinants of CF for the AMD group.

Methods: Participants included 133 older people: 77 with AMD (mean age = 80.5 ± 6.2 years), and 56 controls (mean age = 75.4 ± 5.3 years). Binocular visual acuity, contrast sensitivity and visual fields were measured, and CF was assessed using the Falls Efficacy Scale - International (FES-I). Data were also collected for sensorimotor function (postural sway, sit-to-stand, knee extensions, walking speed, proprioception), and neuropsychological function (reaction time, symptoms of anxiety and depression) using validated tests and scales.

Results: Concern about falling scores were higher for AMD participants compared to control participants (mean ± S.D. 24.6 ± 8.0 vs 21.6 ± 5.7, p = 0.02, respectively), although these findings failed to reach significance when adjusted for age (p = 0.16). Among AMD participants, multivariable models showed that greater CF was associated with reduced contrast sensitivity (p = 0.02), slower sit-to-stand times (p < 0.001) and higher anxiety scores (p < 0.001); these factors explained 40% of the variance in CF (p < 0.01).

Conclusion: Levels of CF in older people with AMD were not found to be elevated by their disease status alone, but rather by the extent of vision loss. Levels of CF in those with AMD were associated with various visual, sensorimotor and neuropsychological factors. These findings will assist clinicians in identifying those at greatest risk of developing high CF and inform the design of future intervention programmes for this population.
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http://dx.doi.org/10.1111/opo.12777DOI Listing
March 2021

Deep Learning for Activity Recognition in Older People Using a Pocket-Worn Smartphone.

Sensors (Basel) 2020 Dec 15;20(24). Epub 2020 Dec 15.

Neuroscience Research Australia, University of New South Wales, Sydney 2031, Australia.

Activity recognition can provide useful information about an older individual's activity level and encourage older people to become more active to live longer in good health. This study aimed to develop an activity recognition algorithm for smartphone accelerometry data of older people. Deep learning algorithms, including convolutional neural network (CNN) and long short-term memory (LSTM), were evaluated in this study. Smartphone accelerometry data of free-living activities, performed by 53 older people (83.8 ± 3.8 years; 38 male) under standardized circumstances, were classified into lying, sitting, standing, transition, walking, walking upstairs, and walking downstairs. A 1D CNN, a multichannel CNN, a CNN-LSTM, and a multichannel CNN-LSTM model were tested. The models were compared on accuracy and computational efficiency. Results show that the multichannel CNN-LSTM model achieved the best classification results, with an 81.1% accuracy and an acceptable model and time complexity. Specifically, the accuracy was 67.0% for lying, 70.7% for sitting, 88.4% for standing, 78.2% for transitions, 88.7% for walking, 65.7% for walking downstairs, and 68.7% for walking upstairs. The findings indicated that the multichannel CNN-LSTM model was feasible for smartphone-based activity recognition in older people.
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http://dx.doi.org/10.3390/s20247195DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7765519PMC
December 2020

Sensorimotor, Cognitive, and Affective Functions Contribute to the Prediction of Falls in Old Age and Neurologic Disorders: An Observational Study.

Arch Phys Med Rehabil 2021 05 27;102(5):874-880. Epub 2020 Nov 27.

Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, Australia; School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia. Electronic address:

Objective: To determine whether impairments across cognitive and affective domains provide additional information to sensorimotor deficits for fall prediction among various populations.

Design: We pooled data from 5 studies for this observational analysis of prospective falls.

Setting: Community or low-level care facility.

Participants: Older people (N=1090; 74.0±9.4y; 579 female); 500 neurologically intact (NI) older people and 3 groups with neurologic disorders (cognitive impairment, n=174; multiple sclerosis (MS), n=111; Parkinson disease, n=305).

Interventions: None.

Main Outcome Measures: Sensorimotor function was assessed with the Physiological Profile Assessment, cognitive function with tests of executive function, affect with questionnaires of depression, and concern about falling with falls efficacy questionnaires. These variables were associated with fall incidence rates, obtained prospectively over 6-12 months.

Results: Poorer sensorimotor function was associated with falls (incidence rate ratio [95% CI], 1.46 [1.28-1.66]). Impaired executive function was the strongest predictor of falls overall (2.91 [2.27-3.73]), followed by depressive symptoms (2.07 [1.56-2.75]) and concern about falling (2.02 [1.61-2.55]). Associations were similar among groups, except for a weaker relationship with executive impairment in NI persons and a stronger relationship with concern about falling in persons with MS. Multivariable analyses showed that executive impairment, poorer sensorimotor performance, depressive symptoms, and concern about falling were independently associated with falls.

Conclusions: Deficits in cognition (executive function) and affect (depressive symptoms) and concern about falling are as important as sensorimotor function for fall prediction. These domains should be included in fall risk assessments for older people and clinical groups.
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http://dx.doi.org/10.1016/j.apmr.2020.10.134DOI Listing
May 2021

The Iconographical Falls Efficacy Scale (IconFES) in community-dwelling older people-a longitudinal validation study.

Age Ageing 2021 05;50(3):822-829

Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, Australia.

Background: This study aimed to develop cut-points for the 30-item and 10-item Iconographical Falls Efficacy Scale (IconFES) in community-dwelling older people and evaluate the psychometric properties, including construct and predictive validity with respect to falls and reduced physical activity over 1 year.

Methods: Eight hundred and one participants completed the IconFES and underwent physical, psychological and cognitive measures at baseline. Physical activity was recorded at baseline and 12 months using an activity monitor, and 1-year fall incidence was collected using monthly falls calendars.

Results: Using receiver-operating characteristic curves and the Youden's index for history of falls, physiological fall risk and depressive symptoms, cut-points were defined to differentiate between low and high concern about falling (30-item: <53; 10-item: <19). For the 30-item IconFES, we additionally defined cut-points for low (≤40), moderate (41-58) and high (≥59) concern about falling. Groups based on these cut-points differed significantly: low coordinated stability, executive function and amount of daily walking, and high level of disability (30-item version) and female gender (low/high 30-item version). Although there were some inconsistencies across IconFES classifications, high concern about falling predicted having had multiple falls or multiple/injurious falls, low amount of daily walking and low movement intensity at 12 months.

Conclusions: The developed IconFES cut-points were sensitive to variables associated with concern about falling and predicted fall incidence and physical activity restriction after 12 months. Applying these cut-points appears useful to identify older people with high concern about falling, who are at higher risk of falls and activity curtailment.
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http://dx.doi.org/10.1093/ageing/afaa213DOI Listing
May 2021

Older Aboriginal Australians' Health Concerns and Preferences for Healthy Ageing Programs.

Int J Environ Res Public Health 2020 10 10;17(20). Epub 2020 Oct 10.

UNSW Medicine, University of New South Wales, Kensington, NSW 2052, Australia.

While there is strong evidence of the need for healthy ageing programs for older Aboriginal Australians, few are available. It is important to understand older Aboriginal Australians' perspectives on healthy ageing in order to co-design culturally-appropriate programs, including views on technology use in this context. Semi-structured interviews were conducted with 34 Aboriginal Australians aged 50 years and older from regional and urban communities to explore participants' health concerns, preferences for healthy ageing programs, and receptiveness to technology. Qualitative data were analyzed using a grounded theory approach. This study found that older Aboriginal Australians are concerned about chronic health conditions, social and emotional well-being, and difficulties accessing health services. A range of barriers and enablers to participation in current health programs were identified. From the perspective of older Aboriginal people, a successful healthy ageing program model includes physical and cognitive activities, social interaction, and health education. The program model also provides culturally safe care and transport for access as well as family, community, cultural identity, and empowerment regarding ageing well as central tenets. Technology could also be a viable approach for program delivery. These findings can be applied in the implementation and evaluation of culturally-appropriate, healthy ageing programs with older Aboriginal people.
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http://dx.doi.org/10.3390/ijerph17207390DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7600369PMC
October 2020

Association between Daily-Life Gait Quality Characteristics and Physiological Fall Risk in Older People.

Sensors (Basel) 2020 Sep 29;20(19). Epub 2020 Sep 29.

Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands.

Gait quality characteristics obtained from accelerometry during daily life are predictive of falls in older people but it is unclear how they relate to fall risk. Our aim was to test whether these gait quality characteristics are associated with the severity of fall risk. We collected one week of trunk accelerometry data from 279 older people (aged 65-95 years; 69.5% female). We used linear regression to investigate the association between six daily-life gait quality characteristics and categorized physiological fall risk (QuickScreen). Logarithmic rate of divergence in the vertical (VT) and anteroposterior (AP) direction were significantly associated with the level of fall risk after correction for walking speed (both < 0.01). Sample entropy in VT and the mediolateral direction and the gait quality composite were not significantly associated with the level of fall risk. We found significant differences between the high fall risk group and the very low- and low-risk groups, the moderate- and very low-risk and the moderate and low-risk groups for logarithmic rate of divergence in VT and AP (all ≤ 0.01). We conclude that logarithmic rate of divergence in VT and AP are associated with fall risk, making them feasible to assess the physiological fall risk in older people.
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http://dx.doi.org/10.3390/s20195580DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7582484PMC
September 2020

Use of tricyclic antidepressants and other anticholinergic medicines by older Aboriginal Australians: association with negative health outcomes.

Int Psychogeriatr 2020 Sep 28:1-8. Epub 2020 Sep 28.

Neuroscience Research Australia, Randwick, NSW, Australia.

Background: Aboriginal and Torres Strait Islander Australians have a relatively high prevalence of multimorbidity requiring treatment with medications. This study examines medication use and anticholinergic burden (ACB) among a cohort of older Aboriginal and Torres Strait Island people.

Method: This cross-sectional study involving five Aboriginal communities (two in metropolitan Sydney and three on the mid-north coast of New South Wales) used a structured interview process to assess cognition, depression, and activities of daily living for a cohort of older adults (aged 60 years and over). Participants also reported on their health status, medical history, and prescription medications during the interview. ACB was calculated, and its association with adverse health outcomes including cognitive impairment, falls, hospitalization, and depressive symptoms were examined.

Results: Most participants (95%) were taking at least one regular medication with polypharmacy (≥5 medications) observed in 43% of participants; 12.2% had a significant ACB (≥3) with antidepressants being a major contributor. Anticholinergic medication use was associated with cognitive impairment, recent hospitalization (past 12 months), and depressive symptoms. After controlling for age, sex, and comorbidity, only the presence of depressive symptoms remained significantly associated with the use of anticholinergic medication (odds ratio 2.86; 95% confidence interval 1.48-5.51).

Conclusions: Clinically significant ACB was common in older Aboriginal Australians and was largely attributable to inappropriate use of tricyclic antidepressants. Greater awareness of medication-related risk factors among both health care professionals and Aboriginal communities can play an important role in improving health and quality of life outcomes.
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http://dx.doi.org/10.1017/S104161022000174XDOI Listing
September 2020

Mild cognitive impairment in Aboriginal Australians.

Alzheimers Dement (N Y) 2020 24;6(1):e12054. Epub 2020 Aug 24.

Neuroscience Research Australia Sydney New South Wales Australia.

Introduction: Aboriginal Australians have among the highest rates of dementia worldwide, yet no study has investigated the subtypes, risk factors, or longer term outcomes of mild cognitive impairment (MCI) in this population.

Methods: A total of 336 community-dwelling Aboriginal Australians aged ≥60 years participated in a longitudinal study, completing a structured interview at baseline. MCI (amnestic subtype, aMCI; non-amnestic subtype, naMCI) and dementia were diagnosed via cognitive screening, medical assessment, and clinical consensus. Associations between life-course factors and baseline MCI subtypes were examined using logistic regression. Conversion to dementia was assessed at 6-year follow-up.

Results: Prevalent aMCI (= 24) was associated with older age (odds ratio [OR] = 1.68, 95% confidence interval [CI]: 1.12 to 2.53), head injury (OR = 3.19, 95% CI: 1.35 to 7.56), symptoms of depression (OR = 1.52, 95% CI: 1.04 to 2.24), and lower blood pressure (OR = 0.53, 95% CI: 0.33 to 0.86). Prevalent naMCI (= 29) was associated with low education (OR = 4.46, 95% CI: 1.53 to 13.05), unskilled work history (OR = 5.62, 95% CI: 2.07 to 13.90), higher body mass index (OR = 1.99, 95% CI: 1.30 to 3.04), and moderate to severe hearing loss (OR = 2.82, 95% CI: 1.06 to 7.55). A small proportion of MCI cases reverted to intact at follow-up (15%), but most remained stable (44%), developed dementia and/or died (41%).

Discussion: Sociodemographic and clinical factors both contributed to baseline MCI and were distinct for MCI subtypes, with similar patterns of conversion to dementia for amnestic and non-amnestic MCI.
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http://dx.doi.org/10.1002/trc2.12054DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7443744PMC
August 2020

Predicting Falls in Nursing Homes: A Prospective Multicenter Cohort Study Comparing Fall History, Staff Clinical Judgment, the Care Home Falls Screen, and the Fall Risk Classification Algorithm.

J Am Med Dir Assoc 2021 02 17;22(2):380-387. Epub 2020 Aug 17.

Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium; Centre of Expertise for Fall and Fracture Prevention Flanders, Leuven, Belgium; Division of Geriatric Medicine, University Hospitals, Leuven, Belgium. Electronic address:

Objectives: To evaluate and compare the predictive accuracy of fall history, staff clinical judgment, the Care Home Falls Screen (CaHFRiS), and the Fall Risk Classification Algorithm (FRiCA).

Design: Prospective multicenter cohort study with 6 months' follow-up.

Setting And Participants: A total of 420 residents from 15 nursing homes participated.

Methods: Fall history, clinical judgment of staff (ie, physiotherapists, nurses and nurses' aides), and the CaHFRiS and FRiCA were assessed at baseline, and falls were documented in the follow-up period. Predictive accuracy was calculated at 1, 3, and 6 months by means of sensitivity, specificity, positive and negative predictive value, positive and negative likelihood ratio, Youden Index, and overall accuracy.

Results: In total, 658 falls occurred and 50.2% of the residents had at least 1 fall with an average fall rate of 1.57 (SD 2.78, range 0-20) per resident. The overall accuracy for all screening methods at all measuring points ranged from 54.8% to 66.5%. Fall history, FRiCA, and a CaHFRiS score of ≥4 had better sensitivity, ranging from 64.4% to 80.8%, compared with the clinical judgment of all disciplines (sensitivity ranging from 47.4% to 71.2%). The negative predictive value (ranging from 92.9% at 1 month to 59.6% at 6 months) had higher scores for fall history, FRiCA, and a CaHFRiS score of ≥4. Specificity ranged from 50.3% at 1 month to 77.5% at 6 months, with better specificity for clinical judgment of physiotherapists and worse specificity for FRiCA. Positive predictive value ranged from 22.2% (clinical judgment of nurses' aides) at 1 month to 67.8% at 6 months (clinical judgment of physiotherapists).

Conclusions And Implications: No strong recommendations can be made for the use of any screening method. More research on identifying residents with the highest fall risk is crucial, as these residents benefit the most from multifactorial assessments and subsequent tailored interventions.
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http://dx.doi.org/10.1016/j.jamda.2020.06.037DOI Listing
February 2021

Evidence on technology-driven preoperative exercise interventions: are we there yet?

Br J Anaesth 2020 11 15;125(5):646-649. Epub 2020 Jul 15.

Department of Allied Health, Peter MacCallum Cancer Centre, Melbourne, Australia; Melbourne School of Health Sciences, Faculty of Medicine Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.

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http://dx.doi.org/10.1016/j.bja.2020.06.050DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7363435PMC
November 2020

The effects of cognitive-motor training interventions on executive functions in older people: a systematic review and meta-analysis.

Eur Rev Aging Phys Act 2020 2;17. Epub 2020 Jul 2.

Neuroscience Research Australia, Sydney, New South Wales Australia.

Background: Ageing is associated with physical and cognitive decline, affecting independence and quality of life in older people. Recent studies show that in particular executive functions are important for daily-life function and mobility. This systematic review investigated the effectiveness of cognitive-motor training including exergaming on executive function (EF, set-shifting, working memory, inhibitory control) in healthy older people.

Methods: An electronic database search for randomised controlled trials (RCT), controlled clinical trials (CCT) and parallel group trials was performed using MEDLINE, EMBASE, and PsychINFO following PRISMA guidelines. Inclusion criteria were: (1) community-dwelling participants > 60 years without a medical condition or medical treatment, (2) reporting at least one cognitive-motor intervention while standing or walking, (3) use of dual-task interventions using traditional methods or modern technology to deliver a cognitive-motor task, (4) inclusion of at least one cognitive outcome. The PEDro scale was used for quality assessment.

Results: A total of 1557 studies were retrieved, of which 25 studies were included in this review. Eleven studies used a technology-based dual-task intervention, while 14 trials conducted a general cognitive-motor training. The age range of the cohort was 69 to 87 years. The interventions demonstrated positive effects on global cognitive function [mean difference 0.6, 95% CI 0.29-0.90] and inhibitory control [mean difference 0.61, 95% CI 0.28-0.94]. Effects were heterogeneous (I range: 60-95) and did not remain after a sensitivity analysis. Processing speed and dual-task costs also improved, but meta-analysis was not possible.

Conclusion: Cognitive-motor and technology-based interventions had a positive impact on some cognitive functions. Dual-task interventions led to improvements of domains related global cognitive functions and inhibitory control. Likewise, technology-based exergame interventions improved functions related to processing speed, attentional and inhibitory control. Training interventions with a certain level of exercise load such as progression in difficulty and task specificity were more effective to gain task-related adaptations on cognitive functions.
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http://dx.doi.org/10.1186/s11556-020-00240-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7333372PMC
July 2020

Mobile Phone Technologies in the Management of Ischemic Heart Disease, Heart Failure, and Hypertension: Systematic Review and Meta-Analysis.

JMIR Mhealth Uhealth 2020 07 6;8(7):e16695. Epub 2020 Jul 6.

Department of Cardiology, Prince of Wales Hospital, Sydney, Australia.

Background: Cardiovascular disease (CVD) remains the leading cause of death worldwide. Mobile phones have become ubiquitous in most developed societies. Smartphone apps, telemonitoring, and clinician-driven SMS allow for novel opportunities and methods in managing chronic CVD, such as ischemic heart disease, heart failure, and hypertension, and in the conduct and support of cardiac rehabilitation.

Objective: A systematic review was conducted using seven electronic databases, identifying all relevant randomized control trials (RCTs) featuring a mobile phone intervention (MPI) used in the management of chronic CVD. Outcomes assessed included mortality, hospitalizations, blood pressure (BP), and BMI.

Methods: Electronic data searches were performed using seven databases from January 2000 to June 2019. Relevant articles were reviewed and analyzed. Meta-analysis was performed using standard techniques. The odds ratio (OR) was used as a summary statistic for dichotomous variables. A random effect model was used.

Results: A total of 26 RCTs including 6713 patients were identified and are described in this review, and 12 RCTs were included in the meta-analysis. In patients with heart failure, MPIs were associated with a significantly lower rate of hospitalizations (244/792, 30.8% vs 287/803, 35.7%; n=1595; OR 0.77, 95% CI 0.62 to 0.97; P=.03; I=0%). In patients with hypertension, patients exposed to MPIs had a significantly lower systolic BP (mean difference 4.3 mm Hg; 95% CI -7.8 to -0.78 mm Hg; n=2023; P=.02).

Conclusions: The available data suggest that MPIs may have a role as a valuable adjunct in the management of chronic CVD.
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http://dx.doi.org/10.2196/16695DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7381017PMC
July 2020

Intervention Characteristics Associated With a Reduction in Fear of Falling Among Community-Dwelling Older People: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Gerontologist 2021 08;61(6):e269-e282

Care and Public Health Research Institute, Department of Health Services Research, Maastricht University, Maastricht, the Netherlands.

Background And Objectives: Fear of falling (FoF) is associated with decreased physical functioning and an increased fall risk. Interventions generally demonstrate moderate effects and optimized interventions are needed. Intervention characteristics, such as setting or delivery method may vary. We investigated which overarching intervention characteristics are associated with a reduction in FoF in community-dwelling older people.

Research Design And Methods: A systematic review and meta-analysis of randomized controlled trials (RCTs) in community-dwelling older people without specific diseases was performed. Associations between intervention characteristics and standardized mean differences (SMD) were determined by univariate meta-regression. Sensitivity analyses were performed.

Results: Data on 62 RCTs were extracted, 50 intervention groups were included in the meta-analysis. Most intervention characteristics and intervention types were not associated with the intervention effect. Supervision by a tai chi instructor (SMD: -1.047, 95% confidence interval [CI]: -1.598; -0.496) and delivery in a community setting (SMD: -0.528, 95% CI: -0.894; -0.161) were-compared to interventions without these characteristics-associated with a greater reduction in FoF. Holistic exercise, such as Pilates or yoga (SMD: -0.823, 95% CI: -1.255; -0.392), was also associated with a greater reduction in FoF. Delivery at home (SMD: 0.384, 95% CI: 0.002; 0.766) or with written materials (SMD: 0.452, 95% CI: 0.088; 0.815) and tailoring were less effective in reducing FoF (SMD: 0.687, 95% CI: 0.364; 1.011).

Discussion And Implications: Holistic exercise, delivery with written materials, the setting and tailoring potentially represent characteristics to take into account when designing and improving interventions for FoF in community-dwelling older people. PROSPERO international prospective register of systematic reviews, registration ID CRD42018080483.
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http://dx.doi.org/10.1093/geront/gnaa021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8361503PMC
August 2021

The effect of eHealth-based falls prevention programmes on balance in people aged 65 years and over living in the community: protocol for a systematic review of randomised controlled trials.

BMJ Open 2020 01 15;10(1):e031200. Epub 2020 Jan 15.

School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Queensland, Australia.

Introduction: Between 20% and 28% of community-dwelling older people experience a fall each year. Falls can result in significant personal and socioeconomic costs, and are the leading cause of admission to hospital for an older person in Australia. Exercise interventions that target balance are the most effective for preventing falls in community-dwellers; however, greater accessibility of effective programmes is needed. As technology has become more accessible, its use as a tool for supporting and promoting health and well-being of individuals has been explored. Little is known about the effectiveness of eHealth technologies to deliver fall prevention interventions. This protocol describes a systematic review with meta-analysis that aims to evaluate the effect of eHealth fall prevention interventions compared with usual care control on balance in people aged 65 years and older living in the community.

Methods And Analysis: We will perform a systematic search of the following electronic databases: MEDLINE, CINAHL Complete, Embase and PsychINFO and citation search of Scopus, Web of Science, PubMed Central, Cochrane Database Central and PEDro for randomised controlled trials that use an eHealth technology to deliver a fall prevention intervention to community-dwellers aged ≥65 years, that are published in English, and include a balance outcome (primary outcome). The screening and selection of articles for review will be undertaken by two independent reviewers. The PEDro scale and Grading of Recommendations, Assessment, Development and Evaluations will be used to assess study quality. The results will be synthesised descriptively, and if sufficient data are available and the studies are not overly heterogeneous, a meta-analysis will be conducted using the random effects model.

Ethics And Dissemination: As this will be a systematic review, without involvement of human participants, there will be no requirement for ethical approval. The results of this systematic review will be disseminated through peer-reviewed publications, conference presentations and dissemination to policymakers and consumers to maximise health impact.

Prospero Registration Number: CRD42018115098.
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http://dx.doi.org/10.1136/bmjopen-2019-031200DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7044832PMC
January 2020
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