Functional Independence predicts patients with stroke more likely to be discharged to the community after inpatient rehabilitation.

BACKGROUND: Functional domain predictors of discharge destination following inpatient rehabilitation for stroke have not been thoroughly identified. OBJECTIVES: 1) Determine the relationships between intrinsic variables (demographic; comorbidities; functional independence at admission to and at discharge from an inpatient rehabilitation facility (IRF)) and discharge to home. 2) Determine cut scores for Functional Independence Measure® (FIM) subscales and domains that predict discharge to the community. METHODS: This study was a secondary analysis of a large, multi-IRF dataset from the Uniform Data System for Medical Rehabilitation. Participants were adults with stroke who were discharged from an IRF in 2019 (n = 92,153). RESULTS: Correlations with discharge to the community were strongest for discharge FIM scores (r = 0.330 to 0.580), followed by admission FIM scores (r = 0.245 to 0.411), which were stronger than the demographic and comorbidity variables (r = 0.005 to 0.110). Logistic regression analysis indicated 5 of 6 FIM domains (Social Cognition, Self-care, Sphincter, Transfer, and Locomotion) scored at admission and at discharge were predictive of discharge home. Receiver operating characteristic curve analyses determined the best cut point for each domain. For each FIM measure, the area under the curve was greater when the measure was obtained at discharge than it was at admission. CONCLUSIONS: Clinicians may consider the cut points presented for each domain at admission and at discharge when setting goals or making recommendations for patients with stroke who aspire to a discharge from an IRF to a community setting.

Normal gait speed varies by age and sex but not by geographical region: a systematic review.

QUESTIONS: What are comfortable gait speed values for apparently healthy adults? How do these differ by age group, sex and geographical region? DESIGN: Systematic review of observational studies with meta-analysis. PARTICIPANTS: Apparently healthy, community-dwelling adults who have undergone measurement of comfortable gait speed. SEARCH METHOD: Potentially relevant studies were identified in four databases. Extracted data from studies that satisfied the eligibility criteria were added to a database containing the same information from a meta-analysis published a decade ago. OUTCOME MEASURES: The weighted mean comfortable gait speed was calculated along with the 95% confidence interval for each stratum of age/sex using a random-effects model. Mean gait speeds were further stratified by the continent where the study took place. Tests of homogeneity included I2 and prediction intervals. RESULTS: Meta-analysis of data from 51,248 apparently healthy adults was stratified by age (in decades) and sex. Male gait speed slowed beyond age 50 years whereas female gait speed slowed beyond age 30 years. The weighted mean gait speed ranged from 97 cm/s (females aged ≥ 80 years) to 140 cm/s (males aged 40 to 49 years). The I2 values ranged from 0 to 34.07; prediction interval ranges varied from a low of 30 (125 to 155 cm/s; males aged 40 to 49 years) to a high of 77 (83 to 160 cm/s; females aged 60 to 69 years). There was considerable overlap in confidence intervals between continents for each sex/age group. CONCLUSIONS: Comfortable gait speed slowed through the adult years, but males maintained a faster walking speed than females. Further stratification of comfortable gait speed by geographical region is not warranted.

Magnitude, validity and responsiveness of dynamometer measured neck retraction strength in patients referred with neck pain to out-patient physical therapy.

[Purpose] The magnitude, validity, and reliability of dynamometer measures of neck retraction strength have been reported but not for individuals referred with neck complaints to physical therapy. The purpose of this study, therefore, was to describe neck retraction strength and its responsiveness and validity as a correlate of neck pain and disability among patients referred for physical therapy. [Participant and Methods] Twenty-six consecutive patients referred with neck pain participated. Their neck retraction strength was measured with a handheld dynamometer using a standardized procedure. Neck pain and disability were quantified using a numeric pain rating scale and the Neck Disability Index, respectively. [Results] Measurements of neck retraction strength increased significantly over the episode of care from 76.5 N to 119.5 N (standardized response mean=1.57 N). The correlation of retraction strength with neck pain was significant (rs=-0.550); however, the correlation between retraction strength and Neck Disability Index scores was not significant (rs=0.155). [Conclusion] Neck retraction strength measured with a hand-held dynamometer was informative and responsive for patients treated with neck pain. Retraction strength was correlated significantly with neck pain but not neck disability. This apparent inconsistency warrants further investigation.

The heel-raise test for ankle plantarflexor strength: a scoping review and meta-analysis of studies providing norms.

[Purpose] The heel-raise test (HRT) is sometimes used to quantify ankle plantarflexion strength. However, descriptions of the test vary and normative values are limited. This paper, therefore was generated to summarize procedures and provide normative values for the HRT in a younger and older age group of adults. [Methods] Electronic and hand searches were conducted to identify relevant literature. Meta-analysis was used to provide norms. [Results] Among 439 nonduplicative articles identified, 13 qualifying articles were ultimately included. Procedures for the HRT described in the studies varied considerably. The mean number of HRT repetitions was 28.7 for adults with a mean age less than 40 years and 11.8 for adults with a mean age greater than 60 years. [Conclusion] This study provides information on HRT performance and norms derived with them for younger and older adults.

Forward flexed posture: reliability and determinants of tragus-to-wall measurement.

Introduction: Forward flexed posture is an impairment in body structure commonly seen among older adults and those with pathologies such as ankylosing spondylitis and osteoporosis. Accurate measurement of forward flexed posture is important as it is related to pain, mobility limitations, and falls. Our purpose was to examine the reliability and determinants of forward flexed posture as indicated by tragus-to-wall (TTW) distanceMethods: Twenty healthy younger and 20 healthy older adults were included in this secondary analysis of data from a neck strength study. Measurements included the linear distance of TTW standing naturally and with neck retraction, age, gender, body mass index (BMI), and neck retraction strength. Measurements were performed initially by 2 investigators and by the primary investigator 1 week later. Intraclass correlation coefficients (ICCs) (model 3,1) described relative reliability and Bland-Altman plots characterized absolute reliability. A mixed general linear model examined the determinants for TTW distanceResults: Good inter-rater (ICC = 0.811-0.878) and test-retest reliability (ICC = 0.853-0.862) were found in both positions. Bland-Altman plots showed that absolute limits of agreement ranged from - 1.9 to +3.8 cm for inter-rater reliability and -2.4 to +2.6 cm for test-retest reliability. Analysis of TTW determinants demonstrated significant differences between neck positions, dichotomous age groups, and BMI groups (p ≤ 0.001). There was no significant difference based on neck strength.Conclusions: Our results indicate that TTW distance, measured using a standardized procedure, is a reliable method of quantifying forward flexed posture. TTW distance is greater in relaxed standing, older individuals, and those with greater BMI.

Predicting the handgrip strength across the age span: Cross-validating reference equations from the 2011 NIH toolbox norming study.

STUDY DESIGN: This is a cross-sectional observational study. BACKGROUND: Reference equations for describing hand-grip strength across the age span were derived from the 2011 NIH Toolbox norming study. PURPOSE: The purpose of this study was to cross-validate reference equations by evaluating its predicting power on a separate, independent data set from the 2011-2014 National Health and Nutrition Examination Survey (NHANES) study METHODS: Observed hand-grip strength data from 13,676 noninstitutionalized participants were obtained from the NHANES study. Best values (best from 3 trials) and the mean values (averaged from 3 trials) were determined for each hand. Using the age (yr), height (m), and weight (kg), we computed predicted grip strength values for dominant and nondominant hands using the reference equations. For validation, three predictability measures: the correlation coefficient, residuals, and accuracy, were used along with the Bland-Altman plot. RESULTS: The predicted values highly correlated with observed values (r = 0.90, ICC = 0.89). In predicting best values, means (SD) of residuals were 1.41 (5.57) and 1.03 (5.44) kg for dominant and nondominant hands, respectively. In predicting mean values, means (SD) of residuals were -0.23 (5.42) and -0.54 (5.31) kg for dominant and nondominant hands, respectively. Root mean square error ranged from 4.10 (female's nondominant mean values) to 6.74 (male's dominant best values). About 5.56% fell outside of the 95% confidence interval of the prediction. CONCLUSIONS: We acknowledged that the two studies' hand-grip protocols (NIH Toolbox, NHANES) were different. Results provided the preliminary predicting performance of the reference equations derived from the NIH Toolbox study.

Measurement of trunk muscle strength after stroke: An integrative review.

BACKGROUND: Research examining the measurement of trunk muscle strength after stroke is limited and diverse. This review, therefore, was undertaken to summarize research addressing what is known about measurements of trunk muscle strength after stroke. METHODS: Potentially relevant research was identified via 3 electronic database searches and a hand search. The research was examined for information on patients, measurement procedures and study findings. Findings regarding measurement properties (ie, validity, reliability, and responsiveness) were of particular interest. RESULTS: Searches identified 260 potentially relevant articles of which 28 met inclusion and exclusion criteria. Research involving diverse populations and measurement procedures demonstrates that trunk muscle strength is impaired after stroke. Many studies show that measurements of trunk muscle strength have known-groups/conditions and convergent validity with balance and performance of functional activities. The literature also supports the reliability of measurements of trunk strength after stroke. Little is known regarding the responsiveness of the measurements. CONCLUSIONS: Trunk strength is commonly impaired after stroke. As weakness of the trunk muscles can affect balance and function, it may warrant routine measurement.

Neurologic and musculoskeletal effects of tilt-table standing on adults: a systematic review.

[Purpose] Tilt table use is associated, most often, with the assessment of syncope. However, it also has applications for patients with neurologic and orthopedic problems. These applications do not appear to be widely applied. The purpose of this review, therefore, was to summarize the research literature addressing the use of tilt tables for treating specific musculoskeletal and neurologic impairments in adults. [Methods] Relevant literature was identified by searches of the PubMed, CINAHL, and Scopus databases and hand searches (December 2018 and October 2020). The methodological quality of the identified research articles was assessed using the PEDro scale. [Results] Of 482 unique articles identified, 20 matched the eligibility criteria of the review and were included. The studies varied widely in the populations studied, procedures used, and responses reported. The studies provide limited support for tilt table standing as an intervention. [Conclusion] However, evidence that some patients with neurologic conditions may respond positively to tilt-table standing is available. Among such individuals are those with decreased ankle range of motion, positive neurologic signs in the lower limbs, and decreased levels of consciousness.

Measurement of finger tapping performance using a smartphone application: a pilot study.

[Purpose] Describe the measurement, reliability and validity of finger tapping repetitions recorded using a commercially available smartphone application (app). [Participants and Methods] We tested a convenience sample of 12 young right-handed participants who completed unilateral index finger tapping and peg board completion tasks with each hand. [Results] Measurement of finger tapping performance was practicable and was shown to be acceptably reliable and able to distinguish between performance of the dominant versus nondominant hand. Finger tapping was not correlated with pegboard performance. [Conclusion] A small sample of young adults showed that measures of finger tapping were easily obtained using a smartphone app. The measures demonstrated acceptable reliability and known groups validity. They, however, may not reflect performance at other measures of voluntary movement functions.

Performance and Clinimetric Properties of the Timed Up From Floor Test Completed by Apparently Healthy Community-Dwelling Older Women.

BACKGROUND AND PURPOSE: Standing up from the floor is a demanding mobility activity with important implications. The purpose of this study was to describe performance and the clinimetric properties of the Timed Up From Floor (TUFF) test completed by apparently healthy community-dwelling older women. METHODS: In this observational and methodological quality study, 52 community-dwelling women, 55 years and older, were examined. Convergent and discriminant validities were examined by analyzing the correlations of TUFF test times with other mobility variables and emotional status, respectively. Validity was further examined by comparing TUFF times between age groups and fall risk groups. Interrater reliability of the TUFF test was established by comparing the times obtained by 3 raters observing the same videotaped performances. Test-retest reliability was determined by having the same 3 raters observe videos of the same participants performing the TUFF test during a second session 1 week later. RESULTS: The grand mean (SD) TUFF time measured by all testers on the first day was 5.8 (2.9) seconds. Convergent validity was demonstrated by significant negative (P < .001) Spearman correlations between the TUFF test and the Physical Functioning Scale of the 36-Item Short Form Health Survey (SF-36) (-0.69), usual gait speed (-0.48), fast gait speed (-0.74), and the 30-second sit-to-stand test (-0.46). Discriminant validity was indicated by a low and nonsignificant correlation (0.17) between the TUFF test and the SF-36 Emotional Well-being Scale. Known-groups validity was supported by a significant difference in the TUFF test times of 2 age groups (P = .02) and 2 fall risk groups (P < .001). The TUFF test was determined to have excellent relative interrater reliability (intraclass correlation coefficient [ICC] of 0.99) and absolute reliability (minimal detectable change [MDC95%] of 0.8 seconds). Relative test-retest reliability was excellent with ICCs of 0.88 to 0.92. Corresponding MDC95% values were large (2.4-2.8 seconds and 40.7%-45.9%). CONCLUSIONS: The TUFF test is an informative, reliable, and valid tool suitable for documenting mobility limitations in independent community-dwelling older women. More information regarding responsiveness is required.

Kinematics of shoulder, trunk, pelvis, and hip while reaching forward to progressively distant targets.

INTRODUCTION: Information on the normal contribution of various body regions to forward reaching provides a basis for assessing the maneuver. The purpose of this study was to describe the kinematics of the shoulder, trunk, pelvis, and hip of healthy young males while they stood and reached toward a target at arm's length and 5%, 10%, 15%, and 20% of body height beyond. METHOD: Twelve healthy adult males were marked with 22 spherical reflective markers. Two trials of unilateral forward reaching were performed towards a target placed at five target distances. Motion was captured via reflective markers and an infrared camera system. RESULTS: Sagittal and transverse plane motions demonstrated high reliability between trials at each target distance (ICC = 0.716 trunk flexion to 0.977 shoulder flexion). Shoulder flexion and horizontal abduction were major contributors to forward reaching with components of trunk flexion and left trunk rotation at all target distances. Hip flexion, pelvic tilt, left pelvis rotation, and hip external rotation made notable contributions at the furthest targets. All motions became more pronounced as target distance increased (P ≤ .001). CONCLUSION: Kinematic analysis demonstrated that right forward reaching requires composite movements at the shoulder, trunk, pelvis, and hip. The contribution of each body region to forward reaching became more pronounced as the target became more distant. These findings may be helpful when identifying localized movement impairments contributing to limited forward reach in a clinical population, although clinical validation is needed.

Feasibility and informativeness of the Patient-Specific Functional Scale with patients with Parkinson's disease.

Introduction: The primary purpose of this study was to examine the feasibility and informativeness of the Patient-Specific Functional Scale (PSFS) for identifying activities that persons with Parkinson disease (PD) self-identified as difficult.Method: Informativeness was investigated by cross-referencing the identified activities with the International Classification of Functioning, Disability, and Health (ICF), the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS), and Parkinson's Disease Questionnaire (PDQ-39). Twenty-eight individuals with PD (Hoehn & Yahr stage 1-4) completed the PSFS. Activities identified by the participants were classified according to the ICF and then cross-referenced across the MDS-UPDRS and PDQ-39.Results: Participants identified 98 specific (60 different) activities that they were unable to do or were having difficulty with as a result of PD. Activities most frequently listed as difficult included some aspect of fine hand use, dressing, eating, or changing position (e.g. transferring). All activities could be classified using the ICF, but many were not addressed specifically by the MDS-UPDRS or PDQ-39.Conclusion: We conclude that the PSFS can be used for identifying activities that persons with PD personally find difficult and may be useful as a compliment to the MDS-UPDRS and PDQ-39.

Validity and Reliability of Jump Height Measurements Obtained From Nonathletic Populations With the VERT Device.

BACKGROUND AND PURPOSE: Vertical jump (VJ) is commonly used to assess lower extremity power in athletic populations. A portable device called the VERT has been validated for this population, but not in nonathletic populations. We sought in this study to assess the clinimetric properties of VJ height measurements obtained with the VERT from older and younger nonathletes. METHODS: Twenty-eight participants (14 older, 14 younger, evenly split between male and female) completed 2 submaximal and 3 maximal VJ trials wearing the VERT during 2 sessions separated by 5 to 9 days. During the first session, their VJ heights were also monitored using motion capture video. RESULTS: Analysis revealed concurrent validity of the VERT against motion capture (intraclass correlation coefficient [ICC3,1] = 0.826-0.950) and known-groups validity of the VERT based on age and gender (P < .001). Strong parallel reliability against a second VERT device (ICC = 0.992) was demonstrated as was strong test-retest reliability (ICC = 0.968). CONCLUSIONS: The VERT device provides valid and reliable measures of VJ height in nonathletic populations, including older adults. However, the VERT may not be suitable for recording the low jump heights of some older adults.

Effects of Intensive Versus Standard Ambulatory Blood Pressure Control on Cerebrovascular Outcomes in Older People (INFINITY).

BACKGROUND: Subcortical microvascular disease represented by brain white matter hyperintensity on magnetic resonance imaging is associated with functional decline in older people with hypertension. The effects of 2 levels of 24-hour average systolic blood pressure (BP) on mobility, white matter disease progression, and cognitive function over 3 years were studied. METHODS: This trial was a prospective, randomized, blinded end-points study in patients ≥75 years of age with systolic hypertension and magnetic resonance imaging evidence of white matter hyperintensity lesions. Patients were randomized to a 24-hour mean systolic BP of ≤130 mm Hg (intensive treatment) versus ≤145 mm Hg (standard treatment) with antihypertensive therapies. Primary study outcomes were changes in mobility (gait speed) and accrual of white matter hyperintensity volume after 3 years. Changes in cognitive function (executive processing) and adverse events were also evaluated. RESULTS: In 199 randomized patients, the mean age of the cohort was 80.5 years, and 54% were women; the average 24-hour systolic BP was 149 mm Hg. Goal BPs were achieved after a median treatment period of 3 to 4 months; at that time, the mean 24-hour systolic BP was 127.7 mm Hg in the intensive treatment group and 144.0 mm Hg in the standard treatment group for an average difference of 16.3 mm Hg. Changes in gait speed were not different between treatment groups (0.40±2.0 versus 0.42±2.7 s in the intensive treatment and standard treatment groups, respectively; P=0.91), whereas changes from baseline in white matter hyperintensity volumes were smaller (0.29%) in the intensive treatment group compared with the standard treatment group (0.48%; P=0.03). Cognitive outcomes also were not different between the treatment groups. Major adverse cardiovascular events were higher in the standard treatment group compared with the intensive treatment group (17 versus 4 patients; P=0.01). Falls, with or without injury, and syncope were comparable in the treatment groups. CONCLUSIONS: Intensive lowering of ambulatory BP reduction in older patients with hypertension did not result in differences in mobility outcomes but was associated with a reduction in accrual of subcortical white matter disease. Over periods >3 years, a reduction in the accumulation of white matter disease may be a factor in conserving function. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01650402.

Grip Strength: An Indispensable Biomarker For Older Adults.

Grip strength has been proposed as a biomarker. Supporting this proposition, evidence is provided herein that shows grip strength is largely consistent as an explanator of concurrent overall strength, upper limb function, bone mineral density, fractures, falls, malnutrition, cognitive impairment, depression, sleep problems, diabetes, multimorbidity, and quality of life. Evidence is also provided for a predictive link between grip strength and all-cause and disease-specific mortality, future function, bone mineral density, fractures, cognition and depression, and problems associated with hospitalization. Consequently, the routine use of grip strength can be recommended as a stand-alone measurement or as a component of a small battery of measurements for identifying older adults at risk of poor health status.

Relationships between grip strength, dexterity, and fine hand use are attenuated by age in children 3 to 13†years-of-age.

[Purpose] The purpose of this secondary analysis of data from the validation phase of National Institutes of Health Toolbox study was to describe the relationship between grip strength, dexterity, fine hand use, and age. [Participants and Methods] Children 3 to 13 years (n=132) contributed data. Grip strength was measured bilaterally with a Jamar dynamometer. Dexterity was measured bilaterally with the Nine-hole Peg Test. Fine hand use was characterized using 5 items of the Bruininks Oseretsky Test of Motor Proficiency. [Results] All grip strength and dexterity and fine hand use measures were correlated moderately to highly with one another and with age. The Cronbach's alpha for all measures was 0.88. Factor analysis suggested that all measures loaded strongly on a single component with the first factor explaining 75.6% of the total variance. Nevertheless, correlations between grip strength and dexterity and fine hand use measures were mostly negligible after controlling for age. [Conclusion] As moderate to strong relationships between grip strength and dexterity and fine hand use are attenuated by age in children of 3 to 13 years, we cannot recommend the use of any one measure over others to characterize motor function of the hand.

Between-side differences in hand-grip strength across the age span: Findings from 2011-2014 NHANES and 2011 NIH Toolbox studies.

This project was undertaken to describe percentage differences in the grip strength between the dominant and nondominant-sides of left- and right-handed males and females across the age span. Data used in the project were from population-based samples of participants: 13,653 from the 2011-2014 National Health and Nutrition Examination Survey (NHANES) and 3,571 from the 2011 normative phase of the National Institutes of Health (NIH) Toolbox project. Depending on how percentage differences were calculated, the overall grip strength was a mean 5.0-5.6% greater on the dominant than nondominant side. The percentage differences were significantly greater for individuals who were right-hand dominant rather than left-hand dominant. The differences also varied according to gender. We present summary data for percentage differences stratified by study, handedness, and gender. The values can be used to determine whether grip strength on one side is limited relative to the other.

Handgrip Strength: A Comparison of Values Obtained From the NHANES and NIH Toolbox Studies.

IMPORTANCE: Handgrip dynamometry is probably the most commonly used method to characterize overall human muscle strength. OBJECTIVE: To compare and summarize grip strength measurements obtained from two population-based studies. DESIGN: Secondary data analysis. SETTING AND PARTICIPANTS: Data from (1) the 2011-2014 National Health and Nutrition Examination Survey (NHANES) with 13,918 participants and (2) the 2011 normative phase of the National Institutes of Health (NIH) Toolbox project with 3,594 participants. OUTCOMES AND MEASURES: The NHANES values used were the mean and best of three trials; the NIH Toolbox value used was the one maximum trial after a practice trial. RESULTS: General linear model analysis revealed that values obtained from the NIH Toolbox differed from NHANES best values but not from NHANES mean values. The analysis also indicated, regardless of the values used, that grip strength differed significantly between dominant and nondominant sides, males and females, and age groups. We provide updated reference values for handgrip strength. CONCLUSIONS AND RELEVANCE: On the basis of these analyses, we summarize grip strength measures obtained from the NHANES and NIH Toolbox for side, gender, and age group strata. Reference values are essential to assist in the interpretation of testing results and clinical decision making.

Minimal clinically important difference for grip strength: a systematic review.

[Purpose] The minimal clinically important difference (MCID) in grip strength is critical to interpreting changes in hand strength over time. This review was undertaken to summarize extant descriptions of the MCID for grip strength. [Methods] A search of 3 bibliographic databases as well as a hand search were completed to identify articles reporting the MCID for grip forces obtained by dynamometry. [Results] Of 38 unique articles identified as potentially relevant, 4 met the inclusion and exclusion criteria of this review. The MCIDs ranged from 0.04 kg to 6.5 kg. However, only a single study used receiver operating characteristic curve analysis and had an associated area under the curve exceeding 0.70. That study reported an MCID of 6.5 kg, which was similar to the MCIDs of another included study and minimal detectable changes reported elsewhere. [Conclusion] Additional, more rigorous, studies are needed to identify MCIDs for grip strength. In the meantime changes of 5.0 to 6.5 kg may be reasonable estimates of meaningful changes in grip strength.