Physiotherapy can play a vital role in the pathway of care of people after fragility fracture and includes interventions of early mobilisation and prescription of structured exercise programmes for ...maximising functional recovery and reducing the risk of falls and further fractures. Although the optimal nature of physiotherapist interventions after hip and vertebral fracture requires further investigation in large-scale trials, evidence supports the prescription of high-intensity and extended exercise interventions. This article will overview interventions in the acute and chronic phases after hip fractures, interventions after vertebral fracture and the role of physiotherapy in the prevention of further fractures.
Objectives:
To determine whether 12-week home-based exergame step training can improve stepping performance, gait and complementary physical and neuropsychological measures associated with falls in ...Parkinson’s disease.
Design:
A single-blinded randomised controlled trial.
Setting:
Community (experimental intervention), university laboratory (outcome measures).
Subjects:
Sixty community-dwelling people with Parkinson’s disease.
Interventions:
Home-based step training using videogame technology.
Main measures:
The primary outcomes were the choice stepping reaction time test and Functional Gait Assessment. Secondary outcomes included physical and neuropsychological measures associated with falls in Parkinson’s disease, number of falls over six months and self-reported mobility and balance.
Results:
Post intervention, there were no differences between the intervention (n = 28) and control (n = 25) groups in the primary or secondary outcomes except for the Timed Up and Go test, where there was a significant difference in favour of the control group (P = 0.02). Intervention participants reported mobility improvement, whereas control participants reported mobility deterioration—between-group difference on an 11-point scale = 0.9 (95% confidence interval: −1.8 to −0.1, P = 0.03). Interaction effects between intervention and disease severity on physical function measures were observed (P = 0.01 to P = 0.08) with seemingly positive effects for the low-severity group and potentially negative effects for the high-severity group.
Conclusion:
Overall, home-based exergame step training was not effective in improving the outcomes assessed. However, the improved physical function in the lower disease severity intervention participants as well as the self-reported improved mobility in the intervention group suggest home-based exergame step training may have benefits for some people with Parkinson’s disease.
The International Consortium for Health Outcomes Measurement (ICHOM) was founded in 2012 to propose consensus-based measurement tools and documentation for different conditions and populations.This ...article describes how the ICHOM Older Person Working Group followed a consensus-driven modified Delphi technique to develop multiple global outcome measures in older persons. The standard set of outcome measures developed by this group will support the ability of healthcare systems to improve their care pathways and quality of care. An additional benefit will be the opportunity to compare variations in outcomes which encourages and supports learning between different health care systems that drives quality improvement. These outcome measures were not developed for use in research. They are aimed at non researchers in healthcare provision and those who pay for these services.
A modified Delphi technique utilising a value based healthcare framework was applied by an international panel to arrive at consensus decisions.To inform the panel meetings, information was sought from literature reviews, longitudinal ageing surveys and a focus group.
The outcome measures developed and recommended were participation in decision making, autonomy and control, mood and emotional health, loneliness and isolation, pain, activities of daily living, frailty, time spent in hospital, overall survival, carer burden, polypharmacy, falls and place of death mapped to a three tier value based healthcare framework.
The first global health standard set of outcome measures in older persons has been developed to enable health care systems improve the quality of care provided to older persons.
Dog ownership may be associated with reduced risk for cardiovascular disease. However, data are scant on the relationship between dog ownership and all-cause and cause-specific mortality risk.
Data ...from six separate cohorts (1995–1997, 2001–2002, 2004) of the Health Survey for England were pooled and analyzed in 2017. Participants were 59,352 adults (mean age 46.5, SD=17.9 years) who consented to be linked to the National Death Registry. Living in a household with a dog was reported at baseline. Outcomes included all-cause and cardiovascular disease mortality (determined using ICD-9 codes 390–459, ICD-10 codes I01–I99). Multilevel Weibull survival analysis was used to examine the associations between dog ownership and mortality, adjusted for various sociodemographic and lifestyle variables. Potential effect modifiers, including age, sex, education, living circumstances, longstanding illness, and prior diagnosis of cardiovascular disease, were also examined.
During 679,441 person-years of follow-up (mean 11.5, SD=3.8 years), 8,169 participants died from all causes and 2,451 from cardiovascular disease. In the fully adjusted models, there was no statistically significant association between dog ownership and mortality outcomes (hazard ratio=1.03, 95% CI=0.98, 1.09, for all-cause mortality; and hazard ratio=1.07, 95% CI=0.96, 1.18, for cardiovascular disease mortality) and no significant effect modification.
There is no evidence for an association between living in a household with a dog and all-cause or cardiovascular disease mortality in this large sample. These results should be interpreted in light of limitations in the measurement of dog ownership and its complexity in potential long-term health implications. Future studies should measure specific aspects of ownership, such as caring responsibilities and temporality.
Issue Addressed: Despite strong evidence of physical and mental health benefits from physical activity, participation is low. Physical activity promotion by health professionals can effectively ...increase physical activity participation. This study aimed to explore the frequency of physical activity promotion by health professionals in public hospitals with a focus on community-based structured exercise; and facilitators and barriers to such promotion.
Methods: We surveyed health professionals (n equivalent 100) from physiotherapy, rheumatology and rehabilitation departments at six public hospitals in Sydney, Australia.
Results: Most common respondent characteristics were physiotherapist (84%), female (68%), aged 25-34 years (45%) and treating older adults (45%). Almost all health professionals (94%) considered themselves physical activity role-models. Half (53%) reported promoting physical activity frequently/often to their clients. Those working with children with a physical disability (23%) were more likely to promote physical activity (Relative Risk 1.69, 95% CI 1.13-2.51, p equivalent.03), than those working with adults or older adults. Half the physiotherapists (52%) reported providing tailored advice about increasing physical activity frequently/often, but only 20% provided advice about structured physical activity. Barriers reported by physiotherapists were lack of time (51%) and client's access to transport (61%).
Conclusion: Only half the health professionals surveyed offered tailored physical activity advice to clients, and advice on structured physical activity was less common.
So What?: Some promotion of physical activity by health professionals is occurring in hospital settings but more work is needed to embed this within clinical care.
Socioeconomic status (SES) has been suggested as a risk factor for falls but the few prospective studies to test this have had mixed results. We evaluated the prospective association between SES and ...falls in the Concord Health and Ageing in Men Project (CHAMP).
CHAMP is a population-based prospective cohort study of men aged ≥70 years in Sydney, Australia. Incident falls were ascertained by triannual telephone calls for up to 4 years. SES was assessed with 4 indicators (education, occupation, source of income, home ownership) and cumulative SES score. We tested for interaction between SES indicators and country of birth and conducted stratified analyses.
We evaluated 1624 men (mean age: 77.3 ± 5.4 years). During a mean ± SD follow-up of 42.6 ± 8.7 months, 766 (47%) participants reported ≥1 incident falls. In nonstratified analyses, there were no associations between SES indicators and falls. In stratified analyses, falls rates were higher among Australian-born men with less formal education (incidence rate ratio IRR 1.66, 95% confidence interval CI 1.16-2.37, compared with those with more education) and those with low occupational position (1.45; 1.09-1.93). However, among men born in non-main English-speaking countries the rate of falls was lower among those with low educational level and no associations were evident for occupational position.
Lower educational level and occupational position predicted a higher falls rate in Australian-born men; the opposite relationship was evident for educational level among migrants born in non-main English-speaking countries. Further studies should test these relationships in different populations and settings and evaluate targeted interventions.
What specific attributes of exercise programs influence the preferences of people with Parkinson's disease for additional exercise compared with their current practice? What trade-offs are ...participants willing to make between exercise program attributes?
Discrete choice experiment.
Five hundred and forty people with Parkinson's disease.
Participants decided whether they would adopt a hypothetical program in addition to their current exercise routine.
Exercise program attributes included: type, number of sessions/week, location, travel time/session, delivery mode, supervisor's expertise, extent of supervision, benefits for physical and psychological function and out-of-pocket cost/session.
Participants preferred additional exercise when programs: provided physical (OR 1.85, 95% CI 1.61 to 2.13) or psychological (OR 1.45, 95% CI 1.26 to 1.67) benefit, involved less travel time (ORs 1.50 to 2.02) and were supervised by qualified professionals with Parkinson's disease expertise (ORs 1.51 to 1.91). Participants were most willing to add multimodal exercise to their exercise routine (ORs 2.01 to 2.19). Participants were less likely to prefer higher cost programs (OR 0.65, 95% CI 0.60 to 0.71, per AU$10 cost increase) or group sessions compared to individual sessions (OR 0.72, 95% CI 0.54 to 0.96). Men preferred adding strengthening exercises (OR 2.00, 95% CI 1.23 to 3.26) and women had a preference against adding aerobic exercise (OR 0.33, 95% CI 0.15 to 0.73). Participants not currently exercising were more likely to prefer adding exercise compared with those already exercising 300 minutes weekly (OR 1.74, 95% CI 1.15 to 2.63).
People with Parkinson's disease were more willing to participate in exercise programs that cost less, involve less travel, provide physical or psychological benefits and are supervised by qualified professionals. To enable more people with Parkinson's disease to exercise, health services should provide programs addressing these factors and account for sex differences.
Volunteering positively affects overall health of both volunteers and recipients through social interaction, support and physical activity. Health professionals' volunteering has considerable ...potential to improve health outcomes in communities.
This study aimed to summarize published scientific literature regarding volunteering by health professionals.
Medine, Embase, Scopus, PsycINFO and CINAHLdatabases were searched to identify eligible studies published between 2010 and 2023. Data on study methods and findings were extracted and synthesized.
Of the 144 eligible studies, 80 (56%) used quantitative methods, 46 (32%) used qualitative, 18 (12%) used mixed methods and 8 (6%) were interventional. Doctors (74 studies, 51%) and nurses (
= 40, 28%) were the professions with most reports of volunteering. Half the studies were from USA (
= 77, 53%), followed by UK (
= 19, 13%), Canada (
= 12, 8%), and Australia/New Zealand (
= 11, 8%). International volunteering in low-to-middle-income countries was reported in 64 studies (44%). Providing service and training were the dominant types of activities (
= 90, 62.5%), with health promotion reported in only 4 studies (3%). Studies reported positive impact from volunteering, both professionally and personally. Time and family commitments were the main barriers. Enablers, barriers and impact were summarized in a socio-ecological map.
Health professionals volunteer in diverse activities and report multifaceted benefits. Studies of volunteering interventions could enable new, sustainable approaches to health promotion.
Healthy ageing has been unattainable for many of Australia’s First Nation people, driven by an earlier onset of chronic disease when compared to the general Australian population. Our objective was ...to examine the perspectives of Australian First Nation people about healthy ageing.
We used a conversational method to gather knowledge from older First Nation people from established communities in New South Wales, Australia. Discussions were audio recorded and transcribed and analysed using an Indigenous research standpoint methodology. Eight yarning circles were held in six locations with 76 participants aged 45 years and over.
Key issues around healthy ageing were identified; particularly, what the impact of chronic disease means to individuals. Study participants reported that healthy ageing is essential to continue to share knowledge of their history and culture.
This article highlights the need for culturally appropriate healthy ageing programs addressing issues related to chronic disease among First Nation communities.
Research into what constitutes healthy ageing for older First Nation people is necessary for the development of culturally appropriate chronic disease interventions.
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