[Participant characteristics and intervention effects of a program to improve the physical function in community-dwelling frail elderly subjects].

AIM: To examine the intervention effects of a physical function improvement program for community-dwelling frail elderly subjects. METHODS: The subjects included 309 participants (108 males, 224 females) who took part in "Iki Iki Health Classes," an exercise training program for frail elderly individuals conducted over three years from April 2008 to March 2011. The average participant age was 75.4±5.8 years in the males and 74.6±5.6 years in the females. RESULTS: Many participants had bone and joint disease with hypertension. The proportion of those with a history of falls (49.0%) was high. Significant improvements from the program were seen in the motor function and in the total scores for the Kihon checklist, grip strength, standing on one leg, timed up-and-go test (TUG), 5-m walking time and 5-m walking maximum time, fear of falling (77.5→70.1%) and subjective health ("good/well good/usually," increased from 73.6% to 89.1%). A new care-needs certification was issued in 21.6% of the subjects during the period spanning to March 31, 2013. A logistic regression analysis revealed that the deterioration of subjective health was significantly related to the presence of risk factors for new care-needs certification (odds ratio and 95% confidence interval: 4.99 (1.04-23.9), p=0.04). CONCLUSIONS: These results suggest that the interventions used in the program to improve the physical function contributed to improving the subjects' mental and physical functions. We speculate that whether improvements in subjective health are linked to roles in normal life and/or social activity participation is important for care prevention.

Effects of physical exercise prescribed by a medical support team on elderly lower extremity osteoarthritis combined with metabolic syndrome and/or type 2 diabetes.

AIM: The aims of the present study were to investigate the effectiveness of exercise intervention provided by a medical support team specializing in lifestyle-related diseases in the treatment of elderly lower extremity osteoarthritis and to examine the influence of bodyweight decrease on changes in the evaluation indexes. METHODS: Participants were 61 patients (57 women and 4 men, aged 68.3 ± 9.6 years) with lower extremity osteoarthritis (109 total diseased joints) and either one or more of the following diseases: obesity, metabolic syndrome and type 2 diabetes. Indexes relating to metabolic diseases, orthopedic disorders, lifestyle activity level and health-related quality of life (HRQOL) were obtained before and after exercise intervention. RESULTS: The numbers of patients with obesity, metabolic syndrome, type 2 diabetes, gonarthrosis and coxarthrosis were 56, 49, 32, 56 and 9, respectively. The mean intervention period was 4.7 ± 1.6 months (2-10.8 months). Indexes relating to metabolic diseases and orthopedic disorders, activity level and HRQOL were all significantly improved after intervention (P < 0.05). Bodyweight decreased by 10.3% and showed a correlation with other evaluated items. Five explanatory variables were extracted through multiple regression analysis that bodyweight reduction rate was set as the criterion variable: changes of bodyweight, body mass index, percent body fat, glycated hemoglobin and total energy expenditure per bodyweight. CONCLUSION: The exercise intervention provided by our medical support team clearly improved indexes relating to metabolic diseases and orthopedic disorders. In addition, decreased bodyweight was related to improvements in metabolic factors, motor function and HRQOL.

Is latero-medial patellar mobility related to the range of motion of the knee joint after total knee arthroplasty?

Diminished range of motion (ROM) of the knee joint after total knee arthroplasty (TKA) is thought to be related to reduced patellar mobility. This has not been confirmed clinically due to a lack of quantitative methods adequate for measuring patellar mobility. We investigated the relationship between patellar mobility by a reported quantitative method and knee joint ROM after TKA. Forty-nine patients [osteoarthritis--OA: 29 knees; rheumatoid arthritis--RA: 20 knees] were examined after TKA. Respective medial and lateral patellar mobility was measured 1 and 6 months postoperatively using a patellofemoral arthrometer (PFA). Knee joint ROM was also measured in each of those 2 sessions. Although the flexion and extension of the knee joints improved significantly from 1 to 6 months after TKA, the medial and lateral patellar displacements (LPDs) failed to improve during that same period. Moreover, only the changes in knee flexion and medial patellar displacement (MPD) between the two sessions were positively correlated (r = 0.31, p < 0.05). However, our findings demonstrated that medial and lateral patellar mobility had no sufficient longitudinal relationship with knee ROM after TKA.

[Influence of high fall-related self-efficacy on falls due to dissociation with ADL among elderly women in nursing homes].

AIM: We examined the influence of high fall-related self-efficacy on falls due to dissociation with activities of daily living (ADL) among elderly women in nursing homes. METHODS: We enrolled 72 female nursing home residents who were 70 years old or over and who scored 18 or higher on the Mini-Mental State Examination (MMSE). Subjects were classified into three groups based on the relationship between ADL and fall-related self-efficacy derived from a scattergram of the Functional Independence Measure (FIM) motor items and Falls Efficacy Scale (FES). The three groups were: group I which had low ADL and high fall-related self-efficacy (n=25); group II which had high ADL and low fall-related self-efficacy (n=30); and group III which had a correlation of ADL and fall-related self-efficacy in the 95% confidence interval (n=17). Then, we investigated the incidence of falls and the number of falls after 6 months in the three groups. The risk factor of falls was also investigated using multiple logistic regression analysis. RESULTS: The incidence and number of falls were significantly different in the three groups after 6 months. Moreover, the incidence of those falling was significantly different between group I and group III. The occurrence of falls was also significantly related with a past history of falls, FES, and group I which had low ADL and high fall-related self-efficacy. CONCLUSION: These findings suggest that the risk of falling increases in the presence of excessive fall-related self-efficacy dissociated from ADL.

Relation of falls efficacy scale (FES) to quality of life among nursing home female residents with comparatively intact cognitive function in Japan.

The purpose of this study was to investigate the relation of the Falls Efficacy Scale (FES) to quality of life (QOL) among nursing home residents. The subjects were 133 institutionalized women aged 70 years or older. They had comparatively intact cognitive function, with a Mini-Mental State Examination (MMSE) score of 15 or more, and could provide sufficient informed consent for a questionnaire survey. We evaluated their age, height, weight, body-mass index, history of hip fracture, history of fall(s) within the past year, complicating conditions, MMSE, Medical Outcomes Study 8-Item Short-Form Health Survey (SF-8), FES, and their subscores for Functional Independence Measure (FIM) motor items (self care, sphincter control, transfer, locomotion). There was a significant relationship between the Physical Component Summary (PCS) of SF-8 and FES. In each subscale, FES showed significant relations that were especially close in physical functioning (PF) and role physical (RP), with those relations proving stronger than those of the subscores of transfer and locomotion. In conclusion, the present results suggested that taking account of mental confidence is important for physical QOL, and that falls self-efficacy, including not only physical activity per se but also mental confidence, should be given prominence in the physical QOL of the institutionalized elderly.

Comparison of patellar mobility in female adults with and without patellofemoral pain.

STUDY DESIGN: Case control study. OBJECTIVE: To compare the patellar mobility of female adult subjects with and without patellofemoral pain (PFP). BACKGROUND: Although abnormal patellar mobility is believed to be one of the causes of PFP, there is currently no published evidence to support this contention. In part, this lack of evidence is because a reliable clinical measurement method to measure patellar mobility and objective criteria to define abnormal patellar mobility have not been established. METHODS AND MEASURES: The study sample was comprised of 22 females with PFP (PFP group) and 22 females who had no knee pain (control group), matched by age, height, and body mass index to the subjects with PFP. Patellar mobility was measured objectively using a specially designed apparatus. Measurements of lateral and medial patellar displacement, patellar mobility balance (lateral minus medial patellar displacement), lateral patellar mobility index (lateral patellar displacement divided by patellar width), and medial patellar mobility index (medial patellar displacement divided by patellar width) were used. RESULTS: Lateral and medial patellar mobility values were not significantly different between the individuals in the PFP and control groups. When normal patellar mobility was arbitrarily defined as the average mobility +/- 2 SDs, based on the data from the control group, normal lateral patellar displacement was within a range of 7.2 to 17.6 mm and normal medial patellar displacement was within a range of 6.8 to 14.0 mm. The intraclass correlation coefficient for intratester and intertester reliability of lateral and medial patellar displacement measurements varied from 0.80 to 0.97. CONCLUSION: Although there were no significant differences in patellar mobility between females with and without PFP, these measurements give reference information about normal patellar mobility for this group. LEVEL OF EVIDENCE: Diagnosis, level 5.

The role of shoulder maximum external rotation during throwing for elbow injury prevention in baseball players.

The objective of the present study was to examine whether the passive range of shoulder external rotation (ER), the maximum shoulder external rotation angle (MER) during throwing, and the ratio of MER to ER are related to the incidence of the elbow injury. A mixed design with one between-factor (a history of the elbow injury) and two within-factors (ER and MER) was used to analyze the difference between baseball players with and without a history of medial elbow pain. Twenty high school baseball players who had experienced the medial elbow pain within the previous month but who were not experiencing the pain on the day of the experiment were recruited (elbow-injured group). Another twenty baseball players who had never experienced the medial elbow pain were also used for testing (control group). MER during throwing, ER, and the ratio of MER to ER were obtained in both of the group. A Mann-Whitney test was used for the group comparison (p < 0.05). The ratio of MER to ER was significantly greater in the elbow-injured group (1.52 ± 0.19) than that in the control group (1.33 ± 0.23) (p = 0.008). On the other hand, there was no statistical significance in MER and ER between two groups. The findings of the study indicate that MER/ER relation could be associated with the incidence of the elbow injury in baseball players. Key pointsIt is accepted that the greatest elbow valgus stress appears at the position of shoulder maximum external rotation (MER) in the acceleration phase of the throwing movement. As a consequence, shoulders with restricted range of motion of external rotation (ER) compensate with a valgus stress on their elbow joints.In this study, we evaluated the relation between MER and ER of shoulder in players with/without elbow injuries.The result of this study demonstrated that the elbow injured group showed significantly greater MER/ER relation than the control group.The current finding suggests that great MER combined with the ROM restriction may be one of the risk factors to cause medial elbow pain in baseball players.

Relationship between maximum shoulder external rotation angle during throwing and physical variables.

The amount of stress imposed on shoulder and elbow appears to be directly correlated with the degree of maximum shoulder external rotation (MER) during throwing motions. Therefore, identifying risk factors contributing to the increase of MER angle may help to decrease the throwing injuries occurrence in baseball players. The purpose of the present study was to demonstrate the correlation between MER and the kinematic variables at stride foot contact (SFC) during the early cocking phase, the passive range of motion (ROM), and the shoulder strength. The subjects were 40 high school baseball players. Each subject carried out five throwing tasks with his maximum effort. A three-dimensional analysis was performed to obtain the MER, and the shoulder angles of external rotation (ER), extension and abduction at SFC in the early cocking phase. The ROM and muscle strength of the shoulder ER and internal rotation (IR) were also measured. Significant moderate linear correlations were found between the MER and the ER (r = -0.32, p = 0.04) at SFC, extension angle ( r= 0.35, p = 0.03) at SFC, IR strength (r = -0.30, p = 0.04) and passive ROM of ER (r = 0.46, p = 0.01). The shoulder IR and extension angles at SFC may determine the degree of the MER angle. Furthermore, weak IR muscle strength and excessive ROM of ER might be risk factors for shoulder and elbow injuries. The finding will enable us to establish better prevention and rehabilitation strategies for throwing injuries in baseball players. Key pointsIt has been reported that the amount of stress imposed on shoulder and elbow joints is correlated with the degree of maximum shoulder external rotation angle (MER) during throwing. Therefore, controlling MER within a normal range plays a key role in the prevention for throwing-related injuries in baseball players.Physical and biomechanical factors related to the degree of MER must be addressed to advance the current prevention and rehabilitation strategies for the shoulder and elbow injuries.The current finding demonstrated that there was a significant moderate leaner correlation between shoulder internal rotation angle at the initial foot contact in the early cocking phase and MER.