Publications by authors named "Kimberley S van Schooten"

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

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

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

Health Promot Int 2021 Oct;36(5):1482-1497

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
October 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

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

Magnitude, symmetry and attenuation of upper body accelerations during walking in women: The role of age, fall history and walking surface.

Maturitas 2020 Sep 3;139:49-56. Epub 2020 Jun 3.

Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran.

Objectives: The present experiment examined the role of age and fall history in upper body accelerations when walking on an even and on an uneven surface.

Study Design: An observational cross-sectional study.

Main Outcome Measures: The magnitude (root mean square [RMS]), symmetry (harmonic ratio) and attenuation (attenuation coefficient) of upper body accelerations were quantified as primary outcomes; gait spatiotemporal parameters were measured as secondary outcomes.

Methods: Twenty young adults (mean ± SD age: 29.00 ± 4.51 yrs), 20 older non-fallers (66.60 ± 5.43 yrs) and 20 older fallers (68.55 ± 4.86 yrs) walked on an even and on an uneven surface, while wearing four accelerometers attached to the forehead, pelvis, right and left shanks.

Results: Older fallers exhibited increased RMS acceleration in the mediolateral direction at the pelvis level compared with young adults when walking on the even surface (0.18 ± 0.04 vs. 0.14 ± 0.02, respectively), whereas walking on an uneven surface was associated with reduced magnitude of acceleration in older fallers (0.19 ± 0.04) compared with non-fallers (0.23 ± 0.04) and young adults (0.22 ± 0.03). Among other changes, walking on the uneven surface diminished pelvis-to-head attenuation in the mediolateral direction in older fallers (38.07 ± 14.51) compared with non-fallers (50.96 ± 11.03) and young adults (62.62 ± 8.21; all ps<0.05).

Conclusions: Reduced mediolateral accelerations in older fallers when walking on the uneven surface can be interpreted as a compensatory mechanism to preserve stability through increased body stiffness. Reduced postural flexibility in the frontal plane compromises the central role of the trunk in minimizing the impact of gait-related oscillations to the head, as evidenced by reduced mediolateral attenuation in older fallers.
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http://dx.doi.org/10.1016/j.maturitas.2020.05.016DOI Listing
September 2020

Recreational Therapy to Promote Mobility in Long-Term Care: A Scoping Review.

J Aging Phys Act 2020 07 28;29(1):142-161. Epub 2020 Jul 28.

The objective of this study was to explore and synthesize evidence on the effectiveness and implementation of recreational therapy programs to enhance mobility outcomes (e.g., balance, functional performance, fall incidence) for older adults in long-term care. The authors conducted a scoping review of 66 studies following the PRISMA guidelines. Two independent reviewers evaluated each article, and a third reviewer resolved discrepancies. Randomized controlled studies provided strong to moderate evidence that tai chi programs, walking, dancing, and ball games improve flexibility, functional mobility, and balance. Studies assessing program implementation highlighted that program delivery was facilitated by clear instruction, encouragement, attendance documentation, and minimal equipment. This review elucidated the benefit of recreational therapy programs on mobility. It also identified the need for customized programs based on individuals' interests and their physical and mental abilities. These findings and recommendations will assist practitioners in designing effective and feasible recreational therapy programs for long-term care.
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http://dx.doi.org/10.1123/japa.2019-0345DOI Listing
July 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

Quality of Daily-Life Gait: Novel Outcome for Trials that Focus on Balance, Mobility, and Falls.

Sensors (Basel) 2019 Oct 11;19(20). Epub 2019 Oct 11.

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

Technological advances in inertial sensors allow for monitoring of daily-life gait characteristics as a proxy for fall risk. The quality of daily-life gait could serve as a valuable outcome for intervention trials, but the uptake of these measures relies on their power to detect relevant changes in fall risk. We collected daily-life gait characteristics in 163 older people (aged 77.5 ± 7.5, 107♀) over two measurement weeks that were two weeks apart. We present variance estimates of daily-life gait characteristics that are sensitive to fall risk and estimate the number of participants required to obtain sufficient statistical power for repeated comparisons. The provided data allows for power analyses for studies using daily-life gait quality as outcome. Our results show that the number of participants required (i.e., 8 to 343 depending on the anticipated effect size and between-measurements correlation) is similar to that generally used in fall prevention trials. We propose that the quality of daily-life gait is a promising outcome for intervention studies that focus on improving balance and mobility and reducing falls.
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http://dx.doi.org/10.3390/s19204388DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6832726PMC
October 2019

Older People with Dementia Have Reduced Daily-Life Activity and Impaired Daily-Life Gait When Compared to Age-Sex Matched Controls.

J Alzheimers Dis 2019 ;71(s1):S125-S135

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

Understanding the characteristics of physical activity and daily-life gait in older people with dementia may help identify those at risk of negative health outcomes and inform targeted interventions. Questionnaires are often used to assess physical activity but may be more affected by recall bias in people with dementia and provide little information about daily-life gait characteristics. The aim of the study was to assess differences in daily-life activity levels and gait characteristics between community-dwelling older people with mild to moderate dementia (n = 45; mean age 81±6 years, 42% female) and age-sex matched (1:2) cognitively-healthy controls (n = 90). Participants wore a tri-axial accelerometer (DynaPort MoveMonitor, McRoberts) on their lower back for 7 days and were assessed on neuropsychological and physical performance. Compared to age-sex matched controls, participants with dementia demonstrated reduced daily-life activity (fewer steps per day, fewer and shorter walking bouts, and lower daily walk time) and walking intensity (reduced speed, stride length and cadence). Participants with dementia also had significantly increased within-walk variability (stride time) and less regular gait (higher sample entropy). Within the group of participants with dementia, higher daily-life activity levels were associated with greater self-reported physical activity and better executive function. Fallers (1+ falls past year) with dementia had significantly reduced daily-life activity and walking speed when compared to non-fallers with dementia. In conclusion, people with dementia are less active in daily-life and present with significant impairments across multiple gait domains when compared to age-sex matched controls. These findings highlight opportunities for targeted interventions and support further research to examine interventions aimed at addressing these deficits.
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http://dx.doi.org/10.3233/JAD-181174DOI Listing
October 2020

Concern About Falling Is Associated With Gait Speed, Independently From Physical and Cognitive Function.

Phys Ther 2019 08;99(8):989-997

Neuroscience Research Australia, Margarete Ainsworth Building, University of New South Wales, Barker Street, Randwick NSW 2031, Australia.

Background: Higher levels of concern about falling in older people have been associated with slower walking speed and an increased risk of falls. However, it is unclear whether this relationship is independent or confounded by other fall risk factors, such as physical and cognitive function.

Objective: The aim of this study was to examine the effects of concern about falling on gait speed, adjusted for physiological fall risk and cognitive function.

Design: This was an observational, cross-sectional study.

Methods: A total of 204 community-dwelling older people aged 70 years or older were recruited from 2 sites (Germany, n = 94; Australia, n = 110). Walking speed was measured over 6 m under 4 conditions: preferred speed, fast speed, speed while carrying a tray (functional dual task), and speed while answering a question (cognitive dual task). The Falls Efficacy Scale-International was used to assess concern about falling, the Physiological Profile Assessment was used to assess physiological fall risk, and the Digit Symbol Substitution Test and Trail Making Test were used to assess attention and executive function.

Results: Higher levels of concern about falling were associated with slower gait speed. Following adjustment for age, history of falls, and female sex, and further adjustment for physical and cognitive function, the association between concern about falling and walking speed remained significant, with a considerable effect size (standardized β = 0.18 ± 0.08; P = .037).

Limitations: The use of walking speed as a sole measure of gait was a limitation of this study.

Conclusions: Gait speed, especially under dual-task conditions, was affected by concern about falling. Concern about falling was the strongest predictor of gait speed under all 4 conditions and should be included in routine geriatric assessments.
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http://dx.doi.org/10.1093/ptj/pzz032DOI Listing
August 2019

Gait speed assessed by a 4-m walk test is not representative of daily-life gait speed in community-dwelling adults.

Maturitas 2019 Mar 7;121:28-34. Epub 2018 Dec 7.

Department of Human Movement Sciences, @AgeAmsterdam, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, the Netherlands. Electronic address:

Objectives: Standardized tests of gait speed are regarded as being of clinical value, but they are typically performed under optimal conditions, and may not reflect daily-life gait behavior. The aim of this study was to compare 4-m gait speed to the distribution of daily-life gait speed.

Study Design: The cross-sectional Grey Power cohort included 254 community-dwelling participants aged 18 years or more.

Main Outcome Measures: Pearson's correlations were used to compare gait speed assessed using a timed 4-m walk test at preferred pace, and daily-life gait speed obtained from tri-axial lower-back accelerometer data over seven consecutive days.

Results: Participants (median age 66.7 years [IQR 59.4-72.5], 65.7% female) had a mean 4-m gait speed of 1.43 m/s (SD 0.21), and a mean 50th percentile of daily-life gait speed of 0.90 m/s (SD 0.23). Ninety-six percent had a bimodal distribution of daily-life gait speed, with a mean 1st peak of 0.61 m/s (SD 0.15) and 2nd peak of 1.26 m/s (SD 0.23). The percentile of the daily-life distribution that corresponded best with the individual 4-m gait speed had a median value of 91.2 (IQR 75.4-98.6). The 4-m gait speed was very weakly correlated to the 1st and 2nd peak (r = 0.005, p = 0.936 and r=0.181, p = 0.004), and the daily-life gait speed percentiles (range: 1st percentile r = 0.076, p = 0.230 to 99th percentile r = 0.399, p < 0.001; 50th percentile r = 0.132, p = 0.036).

Conclusions: The 4-m gait speed is only weakly related to daily-life gait speed. Clinicians and researchers should consider that 4-m gait speed and daily-life gait speed represent two different constructs.
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http://dx.doi.org/10.1016/j.maturitas.2018.12.008DOI Listing
March 2019

Similarity of Repeated Falls in Older Long-Term Care Residents: Do the Circumstances of Past Falls Predict Those of Future Falls?

J Am Med Dir Assoc 2019 03 11;20(3):386-387. Epub 2018 Dec 11.

Injury Prevention and Mobility Laboratory, Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, Canada; Centre for Hip Health and Mobility, University of British Colombia, Vancouver, Canada; School of Engineering Science, Simon Fraser University, Burnaby, Canada.

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http://dx.doi.org/10.1016/j.jamda.2018.10.030DOI Listing
March 2019

Catch the ruler: concurrent validity and test-retest reliability of the ReacStick measures of reaction time and inhibitory executive function in older people.

Aging Clin Exp Res 2019 Aug 9;31(8):1147-1154. Epub 2018 Oct 9.

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

Background: Reduced cognitive function, particularly executive function (EF), is associated with an increased risk of falling in older people. We evaluated the utility of the ReacStick test, a clinical test of reaction time, and inhibitory EF developed, for young athletes, for fall-risk assessment in older people.

Aims: To evaluate the psychometric properties of ReacStick measures of reaction time and executive functioning in healthy community-dwelling older people.

Methods: 140 participants (aged 77 ± 5 years) underwent testing. Two test conditions-simple and inhibitory go/no-go-provided measures of reaction time, recognition load (difference in reaction time between conditions), and go/no-go accuracy. Concurrent validity was evaluated against the conventional tests of reaction time and EF (simple hand reaction time, trail-making test, and Stroop colour test). Discriminant ability was determined for fall-risk factors (age, gender, physiological profile assessment, and fall history). Test-retest reliability after 1 week was evaluated in 30 participants.

Results: ReacStick reaction time correlated with tests of reaction time and EF, recognition load correlated with inhibitory EF, and go accuracy correlated with reaction time and inhibitory EF. No-go accuracy was not significantly correlated with any of the reaction time and EF tests. Test-retest reliability was good-to-excellent (ICC > 0.6) for all the outcomes. ReacStick reaction time discriminated between groups based on age, recognition load between genders, and no-go accuracy between retrospective fallers and non-fallers.

Discussion: An unavoidable time pressure may result in complementary information to the traditional measures.

Conclusions: The ReacStick is a reliable test of reaction time and inhibitory EF in older people and could have value for fall-risk assessment.
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http://dx.doi.org/10.1007/s40520-018-1050-6DOI Listing
August 2019

The association between age and accelerometry-derived types of habitual daily activity: an observational study over the adult life span in the Netherlands.

BMC Public Health 2018 07 4;18(1):824. Epub 2018 Jul 4.

McRoberts BV, The Hague, The Netherlands.

Background: Advances in sensor technology allow for objective and high-resolution monitoring of physical activity and sedentary behaviour. Novel epidemiological data is required to provide feedback on an individual's habitual daily activity in comparison to peers and might eventually lead to refined physical activity guidelines.

Methods: We merged data of 762 people between 18 and 99 years of age, who all wore a DynaPort MoveMonitor accelerometer on their lower back during 1 week in daily-life, to provide insight into habitual types and durations of daily activities, and examine the association between age and physical activity and sedentary behaviour.

Results: We found associations between age and almost all activity outcomes. These associations suggested that physical activity declines and sedentary behaviour increases from the age of 50. We further describe an association with gender, with men walking more often in fewer but longer bouts and having fewer, longer bouts of sitting and standing.

Conclusions: These data provide a valuable reference and may call for more age- and gender-specific activity interventions.
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http://dx.doi.org/10.1186/s12889-018-5719-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6031182PMC
July 2018

eHealth interventions to promote objectively measured physical activity in community-dwelling older people.

Maturitas 2018 Jul 25;113:32-39. Epub 2018 Apr 25.

Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands. Electronic address:

eHealth solutions are increasingly being applied to deliver interventions for promoting an active lifestyle in the general population but also in older people. Objective assessment of daily physical activity (PA) is essential to accurately and reliably evaluate the effectiveness of such interventions. This review presents an overview of eHealth interventions that focus on promoting PA in community-dwelling older people, and discusses the methods used to objectively assess PA, and the effectiveness of the eHealth interventions in increasing PA. The twelve eHealth intervention studies that met our inclusion criteria used a variety of digital solutions, ranging from solely the use of an accelerometer or text messages, to interactive websites with access to (animated) coaches and peer support. Besides evaluating the effectiveness of an intervention on objectively assessed PA, all interventions also included continuous self-monitoring of PA as part of the intervention. Procedures for the collection and analysis of PA data varied across studies; five studies used pedometers to objectively assess PA and seven used tri-axial accelerometers. Main reported outcomes were daily step counts and minutes spent on PA. The current evidence seems to point to a positive short-term effect of increased PA (i.e. right after administering the intervention), but evidence for long-term effects is lacking. Many studies were underpowered to detect any intervention effects, and therefore larger studies with longer follow-up are needed to provide evidence on sustaining the PA increases that follow eHealth interventions in older people.
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http://dx.doi.org/10.1016/j.maturitas.2018.04.010DOI Listing
July 2018

Deep Learning to Predict Falls in Older Adults Based on Daily-Life Trunk Accelerometry.

Sensors (Basel) 2018 May 22;18(5). Epub 2018 May 22.

Department of Computer Science, Amsterdam University of Applied Sciences, 1091 GM Amsterdam, The Netherlands.

Early detection of high fall risk is an essential component of fall prevention in older adults. Wearable sensors can provide valuable insight into daily-life activities; biomechanical features extracted from such inertial data have been shown to be of added value for the assessment of fall risk. Body-worn sensors such as accelerometers can provide valuable insight into fall risk. Currently, biomechanical features derived from accelerometer data are used for the assessment of fall risk. Here, we studied whether deep learning methods from machine learning are suited to automatically derive features from raw accelerometer data that assess fall risk. We used an existing dataset of 296 older adults. We compared the performance of three deep learning model architectures (convolutional neural network (CNN), long short-term memory (LSTM) and a combination of these two (ConvLSTM)) to each other and to a baseline model with biomechanical features on the same dataset. The results show that the deep learning models in a single-task learning mode are strong in recognition of identity of the subject, but that these models only slightly outperform the baseline method on fall risk assessment. When using multi-task learning, with gender and age as auxiliary tasks, deep learning models perform better. We also found that preprocessing of the data resulted in the best performance (AUC = 0.75). We conclude that deep learning models, and in particular multi-task learning, effectively assess fall risk on the basis of wearable sensor data.
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http://dx.doi.org/10.3390/s18051654DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5981199PMC
May 2018

Improved Prediction of Falls in Community-Dwelling Older Adults Through Phase-Dependent Entropy of Daily-Life Walking.

Front Aging Neurosci 2018 5;10:44. Epub 2018 Mar 5.

Burnaby and Centre for Hip Health and Mobility, University of British Columbia, Vancouver, BC, Canada.

Age and age-related diseases have been suggested to decrease entropy of human gait kinematics, which is thought to make older adults more susceptible to falls. In this study we introduce a new entropy measure, called phase-dependent generalized multiscale entropy (PGME), and test whether this measure improves fall-risk prediction in community-dwelling older adults. PGME can assess phase-dependent changes in the stability of gait dynamics that result from kinematic changes in events such as heel strike and toe-off. PGME was assessed for trunk acceleration of 30 s walking epochs in a re-analysis of 1 week of daily-life activity data from the FARAO study, originally described by van Schooten et al. (2016). The re-analyzed data set contained inertial sensor data from 52 single- and 46 multiple-time prospective fallers in a 6 months follow-up period, and an equal number of non-falling controls matched by age, weight, height, gender, and the use of walking aids. The predictive ability of PGME for falls was assessed using a partial least squares regression. PGME had a superior predictive ability of falls among single-time prospective fallers when compared to the other gait features. The single-time fallers had a higher PGME ( < 0.0001) of their trunk acceleration at 60% of their step cycle when compared with non-fallers. No significant differences were found between PGME of multiple-time fallers and non-fallers, but PGME was found to improve the prediction model of multiple-time fallers when combined with other gait features. These findings suggest that taking into account phase-dependent changes in the stability of the gait dynamics has additional value for predicting falls in older people, especially for single-time prospective fallers.
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http://dx.doi.org/10.3389/fnagi.2018.00044DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5844982PMC
March 2018

The Association Between Fall Frequency, Injury Risk, and Characteristics of Falls in Older Residents of Long-Term Care: Do Recurrent Fallers Fall More Safely?

J Gerontol A Biol Sci Med Sci 2018 05;73(6):786-791

Injury Prevention and Mobility Laboratory, Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, Canada.

Background: Although a fall is a necessary prerequisite to a fall-related injury, previous studies suggest that frequent fallers are at lower injury risk for a given fall. We tested the hypotheses that differences in protective responses or the circumstances of falls underlie differences in injury risk with fall frequency.

Methods: We analyzed video footage of 897 falls experienced by 220 long-term care residents (mean age 82 ± 9 years) to identify the cause of imbalance, activity leading to falling, direction of fall initiation, balance recovery and fall protective responses, and occurrence of impact to the head or hip. We further obtained injury information from the facilities' fall registration. We used generalized estimating equation models to examine the association between quartiles of fall frequency, injury risk, and fall characteristics.

Results: Residents with the highest fall frequency group (Q4; ≥5.6 falls/year) were less likely to sustain an injury per fall. They were less likely to fall during walking and more likely to fall during stand-to-sit transfers. Residents in the lowest fall frequency group (Q1; <1.15 falls/year) were more likely to fall during walking, and walking was associated with an increased risk for injury.

Conclusion: When compared to less frequent fallers, more frequent fallers had a lower risk for injury per fall. This appeared to be explained by differences in the circumstances of falls, and not by protective responses. Injury prevention strategies in long-term care should target both frequent and infrequent fallers, as the latter are more mobile and apt to sustain injury.
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http://dx.doi.org/10.1093/gerona/glx196DOI Listing
May 2018

Sex Differences in the Circumstances Leading to Falls: Evidence From Real-Life Falls Captured on Video in Long-Term Care.

J Am Med Dir Assoc 2018 02 28;19(2):130-135.e1. Epub 2017 Sep 28.

Center for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada; Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada; School of Engineering Science, Simon Fraser University, Burnaby, British Columbia, Canada.

Objectives: Falls are a major health concern for older adults. Understanding sex differences in fall circumstances may guide the design of fall management plans specifically to men and women. In this study, analyzed real-life falls captured on video to compare scenarios leading to falls between men and women in 2 long-term care (LTC) facilities.

Design: Prospective cohort study.

Participants/setting: A total of 529 participants residing in 2 LTC facilities in British Columbia, Canada.

Measurements: Between 2008 and 2016, we video-captured 1738 falls experienced by 231 men and 298 women (mean age = 83 ± 9 years). Each video was analyzed to determine the causes of imbalance and the activities at time of falling. Using generalized estimating equation models, we examined how fall circumstances associated with age, sex, and health status.

Results: Men were more likely than women to fall from loss of support with an external object (odds ratio 1.37; 95% confidence interval 1.08-1.73) and less likely to fall from tripping (0.72; 0.54-0.96). Men were more likely to fall while seated (1.42; 1.07-1.87) or while rising (1.49; 1.11-1.99), and less likely to fall while walking (0.61; 0.50-0.75). After adjusting for age and health status, sex remained significantly associated with loss of support and walking. Furthermore, regardless of sex, falls from loss of support were more common among individuals who were less independent in activities of daily living, who used more medications, and who used diuretic. Individuals with independent activities of daily living and intact cognition were more likely to fall while walking, but less likely to fall while seated or while rising.

Conclusions: Our results elucidate differences between older men and women in the scenarios that lead to falls, to inform sex-specific fall prevention strategies in the LTC setting.
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http://dx.doi.org/10.1016/j.jamda.2017.08.011DOI Listing
February 2018

Association between Sedentary Behaviour and Physical, Cognitive, and Psychosocial Status among Older Adults in Assisted Living.

Biomed Res Int 2017 24;2017:9160504. Epub 2017 Aug 24.

Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada V5A 1S6.

Objective: Identification of the factors that influence sedentary behaviour in older adults is important for the design of appropriate intervention strategies. In this study, we determined the prevalence of sedentary behaviour and its association with physical, cognitive, and psychosocial status among older adults residing in Assisted Living (AL).

Methods: Participants ( = 114, mean age = 86.7) from AL sites in British Columbia wore waist-mounted activity monitors for 7 consecutive days, after being assessed with the Timed Up and Go (TUG), Montreal Cognitive Assessment (MoCA), Short Geriatric Depression Scale (GDS), and Modified Fall Efficacy Scale (MFES).

Results: On average, participants spent 87% of their waking hours in sedentary behaviour, which accumulated in 52 bouts per day with each bout lasting an average of 13 minutes. Increased sedentary behaviour associated significantly with scores on the TUG ( = 0.373, < 0.001) and MFES ( = -0.261, = 0.005), but not with the MoCA or GDS. Sedentary behaviour also associated with male gender, use of mobility aid, and multiple regression with increased age.

Conclusion: We found that sedentary behaviour among older adults in AL associated with TUG scores and falls-related self-efficacy, which are modifiable targets for interventions to decrease sedentary behaviour in this population.
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http://dx.doi.org/10.1155/2017/9160504DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5587924PMC
May 2018

Fractional Stability of Trunk Acceleration Dynamics of Daily-Life Walking: Toward a Unified Concept of Gait Stability.

Front Physiol 2017 29;8:516. Epub 2017 Aug 29.

Department of Human Movement Sciences, MOVE Research Institute Amsterdam, Vrije Universiteit AmsterdamAmsterdam, Netherlands.

Over the last decades, various measures have been introduced to assess stability during walking. All of these measures assume that gait stability may be equated with exponential stability, where dynamic stability is quantified by a Floquet multiplier or Lyapunov exponent. These specific constructs of dynamic stability assume that the gait dynamics are time independent and without phase transitions. In this case the temporal change in distance, (), between neighboring trajectories in state space is assumed to be an exponential function of time. However, results from walking models and empirical studies show that the assumptions of exponential stability break down in the vicinity of phase transitions that are present in each step cycle. Here we apply a general non-exponential construct of gait stability, called fractional stability, which can define dynamic stability in the presence of phase transitions. Fractional stability employs the fractional indices, α and β, of differential operator which allow modeling of singularities in () that cannot be captured by exponential stability. The fractional stability provided an improved fit of () compared to exponential stability when applied to trunk accelerations during daily-life walking in community-dwelling older adults. Moreover, using multivariate empirical mode decomposition surrogates, we found that the singularities in (), which were well modeled by fractional stability, are created by phase-dependent modulation of gait. The new construct of fractional stability may represent a physiologically more valid concept of stability in vicinity of phase transitions and may thus pave the way for a more unified concept of gait stability.
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http://dx.doi.org/10.3389/fphys.2017.00516DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5581839PMC
August 2017

Characteristics of daily life gait in fall and non fall-prone stroke survivors and controls.

J Neuroeng Rehabil 2016 07 27;13(1):67. Epub 2016 Jul 27.

Move Research Institute Amsterdam, Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.

Background: Falls in stroke survivors can lead to serious injuries and medical costs. Fall risk in older adults can be predicted based on gait characteristics measured in daily life. Given the different gait patterns that stroke survivors exhibit it is unclear whether a similar fall-prediction model could be used in this group. Therefore the main purpose of this study was to examine whether fall-prediction models that have been used in older adults can also be used in a population of stroke survivors, or if modifications are needed, either in the cut-off values of such models, or in the gait characteristics of interest.

Methods: This study investigated gait characteristics by assessing accelerations of the lower back measured during seven consecutive days in 31 non fall-prone stroke survivors, 25 fall-prone stroke survivors, 20 neurologically intact fall-prone older adults and 30 non fall-prone older adults. We created a binary logistic regression model to assess the ability of predicting falls for each gait characteristic. We included health status and the interaction between health status (stroke survivors versus older adults) and gait characteristic in the model.

Results: We found four significant interactions between gait characteristics and health status. Furthermore we found another four gait characteristics that had similar predictive capacity in both stroke survivors and older adults.

Conclusion: The interactions between gait characteristics and health status indicate that gait characteristics are differently associated with fall history between stroke survivors and older adults. Thus specific models are needed to predict fall risk in stroke survivors.
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http://dx.doi.org/10.1186/s12984-016-0176-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4962437PMC
July 2016

Daily-Life Gait Quality as Predictor of Falls in Older People: A 1-Year Prospective Cohort Study.

PLoS One 2016 7;11(7):e0158623. Epub 2016 Jul 7.

MOVE Research Institute Amsterdam, Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.

Falls can have devastating consequences for older people. We determined the relationship between the likelihood of fall incidents and daily-life behavior. We used wearable sensors to assess habitual physical activity and daily-life gait quality (in terms of e.g. stability, variability, smoothness and symmetry), and determined their predictive ability for time-to-first-and-second-falls. 319 older people wore a trunk accelerometer (Dynaport MoveMonitor, McRoberts) during one week. Participants further completed questionnaires and performed grip strength and trail making tests to identify risk factors for falls. Their prospective fall incidence was followed up for six to twelve months. We determined interrelations between commonly used gait characteristics to gain insight in their interpretation and determined their association with time-to-falls. For all data -including questionnaires and tests- we determined the corresponding principal components and studied their predictive ability for falls. We showed that gait characteristics of walking speed, stride length, stride frequency, intensity, variability, smoothness, symmetry and complexity were often moderately to highly correlated (r > 0.4). We further showed that these characteristics were predictive of falls. Principal components dominated by history of falls, alcohol consumption, gait quality and muscle strength proved predictive for time-to-fall. The cross-validated prediction models had adequate to high accuracy (time dependent AUC of 0.66-0.72 for time-to-first-fall and 0.69-0.76 for -second-fall). Daily-life gait quality obtained from a single accelerometer on the trunk is predictive for falls. These findings confirm that ambulant measurements of daily behavior contribute substantially to the identification of elderly at (high) risk of falling.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0158623PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4936679PMC
July 2017

Fall-related gait characteristics on the treadmill and in daily life.

J Neuroeng Rehabil 2016 Feb 2;13:12. Epub 2016 Feb 2.

Department of Human Movement Sciences, MOVE Research Institute Amsterdam, Vrije Universiteit Amsterdam, van der Boechorststraat 9, Amsterdam, 1081 BT, The Netherlands.

Background: Body-worn sensors allow assessment of gait characteristics that are predictive of fall risk, both when measured during treadmill walking and in daily life. The present study aimed to assess differences as well as associations between fall-related gait characteristics measured on a treadmill and in daily life.

Methods: In a cross-sectional study, trunk accelerations of 18 older adults (72.3 ± 4.5 years) were recorded during walking on a treadmill (Dynaport Hybrid sensor) and during daily life (Dynaport MoveMonitor). A comprehensive set of 32 fall-risk-related gait characteristics was estimated and compared between both settings.

Results: For 25 gait characteristics, a systematic difference between treadmill and daily-life measurements was found. Gait was more variable, less symmetric, and less stable during daily life. Fourteen characteristics showed a significant correlation between treadmill and daily-life measurements, including stride time and regularity (0.48 < r < 0.73; p < 0.022). No correlation between treadmill and daily-life measurements was found for stride-time variability, acceleration range and sample entropy in vertical and mediolateral direction, gait symmetry in vertical direction, and stability estimated as the local divergence exponent by Rosenstein's method in mediolateral direction (r < 0.16; p > 0.25).

Conclusions: Gait characteristics revealed less stable, less symmetric, and more variable gait during daily life than on a treadmill, yet about half of the characteristics were significantly correlated between conditions. These results suggest that daily-life gait analysis is sensitive to static personal factors (i.e., physical and cognitive capacity) as well as dynamic situational factors (i.e., behavior and environment), which may both represent determinants of fall risk.
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http://dx.doi.org/10.1186/s12984-016-0118-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4736650PMC
February 2016

Ambulatory fall-risk assessment: amount and quality of daily-life gait predict falls in older adults.

J Gerontol A Biol Sci Med Sci 2015 May 7;70(5):608-15. Epub 2015 Jan 7.

MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, VU University Amsterdam, the Netherlands.

Background: Ambulatory measurements of trunk accelerations can provide valuable information on the amount and quality of daily-life activities and contribute to the identification of individuals at risk of falls. We compared associations between retrospective and prospective falls with potential risk factors as measured by daily-life accelerometry. In addition, we investigated predictive value of these parameters for 6-month prospective falls.

Methods: One week of trunk accelerometry (DynaPort MoveMonitor) was obtained in 169 older adults (mean age 75). The amount of daily activity and quality of gait were determined and validated questionnaires on fall-risk factors, grip strength, and trail making test were obtained. Six-month fall incidence was obtained retrospectively by recall and prospectively by fall diaries and monthly telephone contact.

Results: Among all participants, 35.5% had a history of ≥1 falls and 34.9% experienced ≥1 falls during 6-month follow-up. Logistic regressions showed that questionnaires, grip strength, and trail making test, as well as the amount and quality of gait, were significantly associated with falls. Significant associations differed between retrospective and prospective analyses although odds ratios indicated similar patterns. Predictive ability based on questionnaires, grip strength, and trail making test (area under the curve .68) improved substantially by accelerometry-derived parameters of the amount of gait (number of strides), gait quality (complexity, intensity, and smoothness), and their interactions (area under the curve .82).

Conclusions: Daily-life accelerometry contributes substantially to the identification of individuals at risk of falls, and can predict falls in 6 months with good accuracy.
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http://dx.doi.org/10.1093/gerona/glu225DOI Listing
May 2015
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