Higher levels of physical activity is associated with better walking ability and fall-related fitness of older adults during COVID-19 in China

This study analyzed the relationship of physical activity levels with walking ability and fall-related fitness in older adults in the Henan Provence, China. Physical activity levels of 288 older adults were assessed using the short form of the International Physical Activity Questionnaire. The participants were divided into low (LPAG, n = 81), moderate (MPAG, n = 106), and high physical activity groups (HPAG, n = 101). The 10-m walking test (10MWT), 3-m backward walking (3MBW), and Berg Balance Scale (BBS) were used to evaluate walking ability. Thirty seconds Sit to Stand Test (30SST), Time up and Go Test (TUGT), and figure-of-8 walk test (8WT) were evaluated for fall-related fitness. One-way ANOVA was used to detect between group differences, whilst Pearson's correlation was used to evaluate the relationship between total physical activity level and the measured variables. Logistic regression analyses were used to compute the odds ratios (ORs) of LPAG and MPAG relative to HPAG. There were significant differences between the groups for walking ability, 10MWT (p < 0.01), 3MBW, and BBS (p < 0.01), and also for variables of fall-related fitness, TUGT (p < 0.01), and 8WT (p < 0.01). Total physical activity levels had significant correlations with all variables except 30SST. In the walking ability, OR for 10MWT was 2.42 and 2.53 times for the LPAG compared to that for HPAG by model 1 and model 2. OR for BBS was 3.24 and 3.54 times for the LPAG and 9.31 and 9.65 times for the MPAG compared to for the HPAG by model 1 and model 2. In the fall-related fitness, OR for 8WT was 14.09 and 16.76 times for the LPAG compared to that for HPAG. High levels of physical activity are positively correlated with good walking ability and fall-related fitness. Increasing physical activity levels can reduce the risks associated with impaired walking ability and fall-related fitness.Copyright ©2023 The Author(s). Published by MRE Press.

Effect of Tai Chi versus Aerobic Training on Improving Hand Grip Strength, Fatigue, and Functional Performance in Older Adults Post-COVID-19: a randomized controlled trial

Background: The recent pandemic of COVID-19 has left a wide range of after-effects on the health of older adults. The effects of the pandemic have been particularly felt in the areas of physical strength, fatigue, and functional performance. Material(s) and Method(s): Fifty-four participants were allocated into three groups: Tai Chi (TC) attended 4 sessions of 60-min TC training per week for consecutive 12 weeks, Aerobic Training (AT) attended 4 sessions of 60-min aerobic training per week for 12 weeks, and Control (CON) instructed to maintain a daily routine. Hand grip strength (HGS) and Fatigue Severity Scale (FSS) were used to evaluate the participants. Functional performance outcomes were determined The functional performance outcome was determined by The 30-second Chair Stand Test (CST), The 30-second Arm Curl Test (ACT), The 8-feet Up-and-Go test (TUG), and The 2 min steps. Pre-post comparisons of all outcomes in each group and comparisons between groups were analyzed using the ANOVA test with SPSS software. Result(s): After the intervention, TC and AT groups both experienced significant improvements in HGS, fatigue levels, CST, ACT, TUG, and 2-minute steps compared to baseline (all P < 0.001). The Tai Chi group also experienced significantly improved hand grip strength (p =0.0435, mean difference of-2.5), and ACT (p =0.0235, mean difference of 1) compared to the AT group. Conclusion(s): Tai Chi is an integrated rehabilitation program that had a positive effect on hand grip strength, fatigue levels, and functional performance compared to aerobic training in the elderly post-COVID-19.Copyright © 2023, Codon Publications. All rights reserved.

Comparison between in-person and remote assessment of four field tests for people with chronic lung diseases

Introduction: COVID-19 pandemic has driven an abrupt shift from centre-based pulmonary rehabilitation to home-based or telerehabilitation models in order to safely deliver this important treatment. However, functional capacity assessment is still carried out with in-person supervision. Aim(s): To compare remote and in-person assessment of four field tests for patients with chronic lung diseases. Method(s): People with chronic respiratory diseases underwent timed up and go test (TUG), 5-repetitions sit-to-stand test (5-repStS), 1-minute STS (1-minStS), and modified incremental step test (MIST). Tests were carried out at participants' home with in-person or remote (Skype or WhatsApp) assessment, in random order. During the remote assessment, the physiotherapist was at the pulmonary rehabilitation centre. The order of the tests was also randomized and was the same for in-person and remote supervision. Each test was performed twice and the test with best performance was used for comparison between remote and in-person supervision. A kit containing a finger pulse oximeter, tape measure, and a step was provided. Pair t -test expressed as mean difference (95% CI), intraclass correlation coefficient (ICC 2:1), and Bland-Altman method were used for analysis. Result(s): Forty-four participants (23 COPD, 18 bronchiectasis, three cystic fibrosis, FEV 1 47 +/- 19%, 56 +/- 15 years old) were assessed. There was no difference between in-person and remote supervision for all tests (TUG 0.04(-0.2-0.2) s, 5-repStS: 0.3(-0.1-0.7) s, 1-minStS: -0.9 (-1.9-0.1) repetitions, and MIST: -3.1 (-9.9-3.7) steps). High reproducibility was observed by ICC (95% CI) (TUG: 0.94 (0.89-0.97), 5-repStS: 0.96 (0.92-0.98), 1-minStS: 0.87 (0.77-0.93), and MIST: 0.94 (0.88-0.96). Limits of agreement were narrow for TUG (-0.8-1.7), 5-repStS (-2.3-2.9), and 1-minStS (-7.4-5.5), but wide for MIST (-46-40). Conclusion(s): Remote assessment provides similar results to in-person assessment for four field tests commonly used in people with chronic lung diseases.

Validity and test-retest reliability of field tests carried out by teleassessment of children and adolescents with cystic fibrosis

Background: The COVID-19 pandemic led to the rapid adoption of alternative evaluation methods for measuring functional capacity in people with cystic fibrosis, who are at high risk for severe COVID-19 outcomes. Teleassessment may be an alternative to conducting in-person field tests in this population. Objectives : To investigate the validity, reliability, and safety of field tests conducted by teleassessment in children and adolescents with cystic fibrosis. Method(s): Participants underwent three functional tests: 3-min step test (3-min ST), 1-min sit-to-stand test (1-min StS), and a timed up-and-go (TUG) test performed in their homes with in-person and remote assessment, in random order. During the remote assessment, the physiotherapist was at the pulmonary rehabilitation center. The order of the tests was randomized and the same in both assessments. For validity, main outcomes were compared between in-person and remote supervision by Wilcoxon test for 3-min ST and TUG, expressed as median (IQR), and pair t -test for 1-min StS, expressed as mean (SD). For test-retest reliability (test 1 vs. test 2) of the remote tests, intraclass correlation coefficient (ICC 2,1) and Bland-Altman analysis were used. Result(s): Thirty-two participants (15 boys, 11 +/- 3 years, FEV 1 73 +/- 17% of predicted) were included. No significant difference was observed between in-person and remote supervision (3-min ST: 88 [83.5-90] vs. 88 [82.5-90] steps;1-min StS: 33(7) vs. 32(8) repetitions;TUG: 6.5 [5.6-8.0] vs. 6.6 [5.7-7.9] s). Test-retest of remote supervision demonstrated very good to excellent reliability for all field tests (ICC (95%CI) 3-min ST: 0.88 [0.65-0.95], 1-min StS: 0.86 [0.67-0.94], and TUG: 0.76 [0.41-0.89]). Mean difference (lower-upper limits of agreement) were 3-min-ST: -3.6 (-13.9-6.7) steps, 1-min StS: -1.9 (-8.6-4.7) repetitions, and TUG: 0.8 (-1.4-2.9) s. No adverse events were reported. Conclusion(s): In children and adolescent with cystic fibrosis, 3-min ST, 1-min StS, and TUG are valid, reliable and safe when carried out by teleassessment.

Physical Therapy Management of Postacute Sequelae of COVID-19 in Outpatient Settings: A Scoping Review

Purpose:The devasting effects of the coronavirus disease 2019 (COVID-19) pandemic have warranted the rapid development of evidence surrounding the physical therapy (PT) management of the disease within inpatient settings. However, the medical community is still working to define the long-term effects of COVID-19, referred to as Postacute Sequalae of SARS-CoV-2 (PASC), and ways for physical therapists to manage them in outpatient settings. The primary objective of this review was to summarize the available evidence related to the PT management of PASC in outpatient settings. Method(s):A systematic search in PubMed, Cumulative Index to Nursing and Allied Health Literature, Cochrane CENTRAL, Academic Search Complete, and MedLine yielded systematic and scoping reviews and randomized controlled trials, among others. Data extraction was performed independently by 2 reviewers with 8 studies included. Result(s):Only 3 publications were specific to the outpatient setting area, with 5 more studies that focused on outpatient practice as part of a multisetting study, or the postacute setting. Although the limited number and quality of publications creates challenges applying the interventions provided across a population, each were specific to PASC. Conclusion(s):This review supports the need for further research focused on the PT management of patients who are experiencing PASC in outpatient settings.Copyright © Cardiovascular and Pulmonary Section, APTA.

Falls Prevention: Community Exercise Programme, Reducing Risk of Falls, Deconditioning and Loneliness in Frail Elderly Patients

Introduction Covid has had a devastating effect on the Elderly, resulting in deconditioning, increased falls and loneliness. Tailored exercises can reduce falls in people aged over 65 by 54% and participation in physical activity reduces the risk of hip fractures by 50%, currently costing the NHS 1.7 billion per year in England. This 8-week intervention delivered by trained volunteers in patient's homes, aims to reduce deconditioning, loneliness and the risk, incidence and fear of falling (FOF) amongst frail patients post-discharge from hospital. Method A gap in service was identified in Frail patients discharged from hospital, at risk of falling and awaiting community physiotherapy. A steering group was set up including acute and community therapists, volunteers and carers to design a collaborative intervention to bridge the gap. At risk patients were identified and referred by ward therapists supported by the hospital volunteering team. Volunteers were trained to deliver an 8 weeks programme of progressive exercises in patients' homes with additional signposting to appropriate statutory and voluntary services. Qualitative and quantitative outcome measures were taken at week 1 and week 8 of the intervention Results 91.5% total health outcomes improved or maintained by average: - FOF reduced by 22.5% - 180 degree turn improved by 43% - 60 sec Sit to Stand improved by 14.75% - Timed Up And Go improved by 15.5% - Confidence to cope at home improved by 15% - Pain / discomfort (self-reported) improved by 18.75% - Overall health (self-reported) improved by 8.5% Conclusion(s) Targeted exercise at home with skilled volunteers can improve functional fitness and health outcomes in a frail elderly population at risk of falls when discharged home from hospital. The programme increases patients' connectivity to local voluntary and community sector services. Volunteers' mental health improves by engaging in meaningful service.

Short-term impact of COVID-19 on health-related physical fitness in hospitalized and home-treated patients

Assessment of health-related physical fitness (PF) and body composition (BC) may yield relevant information on body function in patients who have been affected by Coronavirus disease-2019 (COVID-19). Aim of our study was to evaluate the short-term effects of COVID-19 on physical fitness in a real-life cohort of outpatients including hospitalized and home-treated patients. Sixty-four patients (M=36;mean age 56+/-13.5 yrs) previously affected by COVID-19 (25 hospitalized vs. 39 hometreated) in the 3-6 months preceding the study measurements were enrolled. PF was evaluated with the following tests: handgrip strength (HGS), gait speed (GAIT), sit-to-stand (STS), timed up and go (TUG) and Short physical performance battery (SPPB). Phase angle (PhA) was measured by bioelectrical impedance analysis (BIA) as a proxy marker of fat-free mass composition in terms of body cell mass and cell integrity. Poor PF performance was observed in 38% of subjects for HGS, 55% for GAIT, 30% for STS, 38% for TUG, and 70% for SPPB, while low values of PA were observed in 42% of the study sample in comparison with international cut-offs. The presence of 3-5 impaired values out of five was observed in 38% of patients. All PF tests (and even more the number of abnormal PF tests) consistently correlated with PhA. No differences were reported between hospitalized and home-treated patients. In the short-run, COVID-19 causes a worsening of physical fitness regardless of baseline disease severity. More research is required to systematically measure the extent of functional impairments in COVID-19 and to address whether and how rehabilitation can promote post-infection recovery.

The Relationship between Restrictions on Going Out and Motor Imagery among Medical University Students in Japan-Research with Small Samples.

Motor imagery is often used as a training method to improve physical performance. Previous studies have often reported that reduced motor imagery is more likely to occur in older adults and stroke patients. However, it has also been reported that it is difficult to imagine exercises that cannot be performed. Therefore, we hypothesized that this may also have occurred in young people who were physically able to exercise but who were restricted by COVID-19 lockdowns, however, we could find no studies that investigated the impact of restricting outings. In this study, 83 healthy young people were measured for physical performance (maximum walking speed, grasp strength, Timed Up and Go test, imagined Timed Up and Go test, functional reach test, and five chair stand test). It was found that, while restricting outings did not influence physical performance in the subjects, it did influence motor imagery. Therefore, it should be borne in mind that training with motor imagery may not generate adequate actual motor imagery when restrictions are imposed on activities.

The PACE-DM1 tool: An Adapted Home-Based Physical Activity Program for DM1 to Counter Physical Deficiencies

Introduction: Myotonic dystrophy type 1 (DM1) is related to muscle weakness, impaired balance, and a high risk of falls resulting in decreased quality of life and social participation. Indeed, DM1 is considered as a model of premature aging. However, the Covid-19 pandemic has exacerbated these health problems by decreasing the access to rehabilitation services and significantly decrease volunteer total weekly physical activity (PA) level. A pragmatic tool: PACE (Promoting Autonomy through exer-CisE), which has been developed to allow safe and adapted physical activity (APA) practice in older adults at home, could be a solution to counter physical deficiencies and lockdown restrictions in DM1 population. Objectives: 1. To adapt the PACE tool (decisional tree related to 35 APA programs) for the DM1 population (Pace-DM1 tool);2. To evaluate if assessing functional and muscular capacity in remote mode is feasible and valid in the DM1 population compared to in person modality;3. To evaluate the acceptability, feasibility and usability of implementing the PACE-DM1 tool for the health professionals and the patients. Methods: O-1: Two patient-partners, 3 participants who will experience the PACE-DM1 APA program, 2 health professionals from the Neuromuscular Disease Clinic of Jonquière (NMC), 1 NMC manager and 3 researchers were recruited to adapt the PACE tools using a co-creation design. O-2: Participants are assessing functional and muscular capacity [Time Up and Go, 30sec. chair stand test, 5 reps of sit-to-stand, 4-meter gait speed, balance and functional reach test] per and post-intervention (12 weeks) in remote (zoom) and in-person methods. O-3: After co-creation meetings, health professional were asked to evaluate the acceptability (satisfaction assessed via Likert scales;semi-opened questions), usability (System Usability Scale questionnaire) and feasibility (adherence, recruitment rate, etc.) of the PACE-DM1 tool. Results: First, co-creation meetings allowed us to adapt PACE tool (e.g. decisional tree cut points) for DM1 participants. Health professionals found PACE-DM1 tool exercises safe and adapted to the physical deficiencies of the DM1 population. Our preliminary data (n=2) using the adapted decisional tree showed similar results between inperson and remote assessment. More precisely, both assessment modality identified the same physical deficiencies (lower limb cardio-muscular, trunk mobility and stability, and balance) and prescribed the same program difficulty (out of a possible 5 levels). In the pre-intervention phase, implementing the PACE-DM1 tool was considered acceptable, usable and feasible for health professionals. Conclusion: Preliminary results demonstrate that an APA pragmatic, easy-to-use and adapted tool is implementable to prevent care trajectory of people with DM1. Nevertheless, these promising results need to be confirmed and validated with a larger sample.

THE 2-YEAR IMPACT of COVID-19 PANDEMIC on MUSCLE STRENGTH and PHYSICAL PERFORMANCE in PATIENTS with SYSTEMIC SCLEROSIS: A COHORT STUDY

Background: Systemic sclerosis (SSc) patients are particularly prone to developing loss of muscle strength and worsening of physical performance due to decreased physical activity1. The lifestyle changes imposed by the SARS-CoV-2 outbreak have increased the incidence of sarcopenia in at-risk individuals2. However, the literature is scarce on the impacts of the COVID-19 pandemic on muscle strength and physical performance of SSc patients. Objectives: (1) To assess the impact of the COVID-19 pandemic on muscle strength and physical performance of SSc patients and (2) to verify the associations of muscle strength and physical performance with infammatory markers in a cohort study. Methods: SSc patients who met the ACR/EULAR 2013 classifcation criteria were included. Patients followed between 2019 and 2021. Muscle strength was measured by handgrip strength (kg) and sit and stand (SST, seconds) tests. Physical performance was measured by timed up and go (TUG, seconds) and short physical performance battery (SPPB, points). Infammatory markers were measured by C-reactive protein (CRP). T test for independent samples, Mann-Whitney U test of independent samples and Spearman's correlation coef-fcients were explored. The signifcance level was set at p ≤ 0.05 for all analyses. Results: Forty SSc patients concluded this study. At baseline, the mean age was 59 ± 11. 1 years old and the median disease duration was 13.1 (6.4-19.2) years. Patients had a median of 4.5 clinic visits (3.0-6.0) over the 2 years. The majority of patients were women (37, 92.5%). Te n patients (25%) had diffuse cutaneous disease, 30 patients (75%) non-diffuse cutaneous disease [25 patients (62.5%) had limited cutaneous disease, and 5 (12.5%) had sine scleroderma SSc]. The median of CRP was 2.9 (1.2-5.3). The median of handgrip strength was 20.0 (10.3-25.8) kg to the right hand and 19.0 (12.0-22.8) kg to the left hand. The median of SST was 14.4 (11.9-18.7) seconds. The median of TUG was 8.6 (7.7-9.5) seconds and the median of SPPB was 9.8 (9.0-11.0) points. The CRP was positively associated with SST (r=0.3, p=0.047) and TUG (r=0.3, p=0.029), and negatively with SPPB (r=-0.4, p=0.016). After 2 years of follow-up, the patients showed improvement in the left handgrip strength test (p=0.049) and SST (p=0.001). In physical performance, they showed improvement in the TUG test (p=0.005) and SPPB (p=0.001). The CRP was associated positively with TUG (r=0.4, p=0.033), no other associations were found. Conclusion: Despite the COVID-19 pandemic and the restrictions imposed, in this population of patients with SSc, we did not detect any worsening in muscle strength and physical performance. Some of these parameters of muscle strength and physical performance were associated with the infammatory marker CRP. More investigations are needed to assess the actual impact and possible associations.

Reliability of remote gait and balance assessment of people with Parkinson's disease

Parkinson's disease is a movement disorder that increases fall risk. Clinicians administer several validated gait and balance tests for people with Parkinson's disease in person. COVID-19 has reduced healthcare access, and this has disproportionately affected older populations. We tested the reliability of remote gait and balance assessments of people with Parkinson's disease using face-to-face as the comparator. Fifteen people with Parkinson's disease (aged 57-82, 11 males) performed 14 tests of gait and balance twice: (i) face-to-face, and (ii) remotely, via videoconference between 7 and 14 days after. A trained physiotherapist rated participant performance. The tests included items from the Berg Balance Scale, Functional Gait Assessment, and the Timed-Up- And-Go. These assessments have been validated face-to-face for people with Parkinson's disease. The videoconference assessment was recorded. We compared face-to-face and live videoconference performance to obtain assessment reliability. The physiotherapist rated the recording at least two weeks after the live videoconference to obtain intrarater reliability. A second rater assessed the recording, and we compared live and recorded telehealth assessments to obtain inter-rater reliability. Reliabil ity was measured using either intraclass correlation (ICC) two-way mixed with absolute agreement (continuous measures) or Fleiss multi-rater Kappa test (ordinal measures). Most tests showed moderate to very good assessment reliability between face-to-face and live telehealth (ICC=0.5-1), between face-to-face and recorded telehealth (ICC=0.5-1) and good to very good inter-rater reliability between the recorded telehealth assessments (ICC=0.63-1). Reliability appeared to be higher in tests involving quantitative, rather than qualitative, measures of performance. A ceiling effect was noted in some tests where all participants completed tests with maximum scores in both face-to-face and remote assessments. This study supports the feasibility of remote assessment in clinical practice for people with Parkinson's disease. Further research with a larger cohort and adjustment of the assessments to avoid ceiling effects is necessary.

Patients surviving of critical COVID-19 have impairments in dual-task performance related to post-intensive care syndrome

PURPOSE/HYPOTHESIS: Patients surviving critical COVID-19 are at risk of developing Post Intensive Care Syndrome (PICS), which may lead to deficits in concurrent multi-tasking or the ability to perform a motor and cognitive task simultaneously i.e., a dual-task (DT). To our knowledge no study has assessed DT in survivors of critical COVID-19. Thus, the primary aim of this study was to examine DT performance in patients recovering from critical COVID-19. Secondarily, we examined the psychometric properties of the Timed Up-and-Go (TUG) and DTTUG in patients recovering COVID-19. NUMBER OF SUBJECTS: Thirty-one survivors of COVID-19 requiring mechanical ventilation (COVID+MV) (Age: 55.6 (11.6);BMI: 36.2 (9.0);Sex:Female: 13 (43.3%)), 17 patients recovering from COVID-19 requiring supplemental oxygen with hospitalization (COVID+O2) (Age: 60.4 (9.8);BMI: 35.1 (7.0);Sex:Female:8 (57%)), and 24 patients with chronic lung disease (CLD) (Age: 65.5 (8.8);BMI: 31.1 (7.1);Sex:Female: 12 (50%)). MATERIALS AND METHODS: A prospective, cross-sectional study was conducted and performed 1- and 3-months after hospital discharge for patients post-COVID-19 or at initiation of outpatient physical therapy for patients with CLD. Patients completed the TUG and DT-TUG. A subset of 19 COVID+MV patients returned for follow up testing 8-weeks after the initial appointment and repeated TUG and DT-TUG tests. A physical therapist administered all tests. The minimal detectable change (MDC) was calculated for each TUG and DT-TUG times as well as DT Cost of TUG (DTC-TUG). An analysis of covariance was used to assess group differences in TUG, DT-TUG, and DTC-TUG. When necessary, pairwise comparisons, with Bonferroni adjustments for multiple comparisons were ran using estimated marginal means. Significance was set a-priori at P = 0.05. RESULTS: Twenty-four (n = 29, 83%) of COVID+MV and ten (n = 17, 59%) COVID+O2 patients demonstrated deficits indicative of a PICS diagnosis. The COVID+MV group was significantly worse at the DT-TUG compared to the CLD group (COVID+MV: 16.8 (7.3) s;CLD: 13.9 (4.8) s: F = 4.4, P = 0.03). DTC-TUG was also significantly worse in COVID+MV group (-21%) compared to CLD (-10%) and COVID+O2 (-13.1%;F = 4.1, P = 0.021). The MDC for TUG, DT-TUG, and DTC-TUG in COVID+MV patients was 3.8 s, 4.9 s, and 14.0% respectively. The MDC for TUG, DT-TUG, and DTC-TUG in post-ICU COVID1 O2 patients was 1.6 s, 1.9 s, and 7.8% respectively. CONCLUSIONS: These novel findings suggest a singular bout of critical illness results in worse DT performance during a clinical test of mobility. Survivors of COVID+MV exhibit a comparable pattern of DT deficits to those of advanced aged older-adults and neurologic disease. Additionally, the lack of single task deficits highlights the need for integrating DT mobility tests into clinical practice. CLINICAL RELEVANCE: These data suggest physical therapists need to integrate DT tests and measures into clinical practice for patients with PICS, particularly in patients who received MV. By providing MDC values, this study also provides data to use in clinical practice to monitor patient progress with rehabilitation.

Four weeks of Mollii intervention on lower limb strength, gait speed, lower back pain, quality of life and fatigue in a female person with Multiple Sclerosis

Objective: Whole body electrical garment - Mollii suit delivers sensory input to improve sensorimotor organisation, balance muscle tone, facilitate muscle contraction and reduce pain experience. The aim of this study was to evaluate 4 weeks of Mollii intervention on lower limb strength, gait speed, lower back pain, quality of life and fatigue in a female person with Multiple Sclerosis (pwMS). Methods: Mollii was programmed by physiotherapist and subsequently worn at home for 60 minutes for 4 weeks every second day, by a female participant with primary progressive MS. Participant was walking with 2 elbow crutches. Stimulation parameters: pulse width 25-175 microseconds, constant current at 20 Hertz. Usability and perceived effects were monitored by a weekly phone call. Five time sit to stand (5xSTS) was used for functional lower limb strength, Timed Up and Go test (TUG) to evaluate gait speed, Visual analogue scale 0-10 (VAS) for the perceived back pain, Multiple Sclerosis Impact scale (MSIS29v2) for the quality-of-life and Modified Fatigue Impact scale (MFIS) for patient reported fatigue. Data was collected at baseline (T1) and 4 weeks (T2) later. Results: No adverse effects were reported. Compliance was 100% (14 sessions in 4 weeks). T1: 5xSTS was 20.73 seconds and T2: 12.76, change of 7.97sec., T1: TUG 29.09 sec. T2: 19.97, change of 9.12sec. VAS for pain T1: 6 points, T2: 0, change of 6 points: T1: MSIS29v2 total 86 points), T2: MSIS29v2 total 57 change of 29 points, T1: MFIS total 68 points, T2: 36 points, change of 32 points. Conclusion: This case study provides preliminary evidence of the effect of Mollii treatment for pwMS. High compliance and home usability are additional benefits in the Covid times. Larger studies that include muscle tone assessment will be particularly interesting as Mollii intervention might be an alternative approach to baclofen or surgical interventions.

Remote smartphone gait monitoring and fall prediction in Parkinson's disease during the COVID-19 lockdown.

BACKGROUND: Falls could be serious events in Parkinson's disease (PD). Patient remote monitoring strategies are on the raise and may be an additional aid in identifying patients who are at risk of falling. The aim of the study was to evaluate if balance and timed-up-and-go data obtained by a smartphone application during COVID-19 lockdown were able to predict falls in PD patients. METHODS: A cohort of PD patients were monitored for 4 weeks during the COVID-19 lockdown with an application measuring static balance and timed-up-and-go test. The main outcome was the occurrence of falls (UPDRS-II item 13) during the observation period. RESULTS: Thirty-three patients completed the study, and 4 (12%) reported falls in the observation period. The rate of falls was reduced with respect to patient previous falls history (24%). The stand-up time and the mediolateral sway, acquired through the application, differed between "fallers" and "non-fallers" and related to the occurrence of new falls (OR 1.7 and 1.6 respectively, p < 0.05), together with previous falling (OR 7.5, p < 0.01). In a multivariate model, the stand-up time and the history of falling independently related to the outcome (p < 0.01). CONCLUSIONS: Our study provides new data on falls in Parkinson's disease during the lockdown. The reduction of falling events and the relationship with the stand-up time might suggest that a different quality of falls occurs when patient is forced to stay home - hence, clinicians should point their attention also on monitoring patients' sit-to-stand body transition other than more acknowledged features based on step quality.

Individualised Responsible Artificial Intelligence for Home-Based Rehabilitation.

Socioeconomic reasons post-COVID-19 demand unsupervised home-based rehabilitation and, specifically, artificial ambient intelligence with individualisation to support engagement and motivation. Artificial intelligence must also comply with accountability, responsibility, and transparency (ART) requirements for wider acceptability. This paper presents such a patient-centric individualised home-based rehabilitation support system. To this end, the Timed Up and Go (TUG) and Five Time Sit To Stand (FTSTS) tests evaluate daily living activity performance in the presence or development of comorbidities. We present a method for generating synthetic datasets complementing experimental observations and mitigating bias. We present an incremental hybrid machine learning algorithm combining ensemble learning and hybrid stacking using extreme gradient boosted decision trees and k-nearest neighbours to meet individualisation, interpretability, and ART design requirements while maintaining low computation footprint. The model reaches up to 100% accuracy for both FTSTS and TUG in predicting associated patient medical condition, and 100% or 83.13%, respectively, in predicting area of difficulty in the segments of the test. Our results show an improvement of 5% and 15% for FTSTS and TUG tests, respectively, over previous approaches that use intrusive means of monitoring such as cameras.