Investigating the Feasibility of Using Telemedicine to Deliver a Fall Prevention Program: A Pilot Study.

AIM: This pilot study was designed to examine the feasibility of using telemedicine to deliver a fall prevention program, a modified Otago exercise program, to low-income older adults living independently in affordable housing apartments. METHODS: A mixed-methods feasibility study. Participants were divided into two groups: one group participated in a 12-week modified Otago fall prevention program via telehealth, while the other group participated in the program with an on-site instructor. Performance-based measures of physical function and self-report measures for self-efficacy for exercise and social connectedness were collected pre- and post-intervention and 1 year later. RESULTS: All participants completed the 12-week intervention and expressed satisfaction with both the telehealth program and the on-site instructor-led program. There were no major differences in performance or self-report measures between the two groups, showing that telehealth-delivered applications can be effective. Participants in the on-site instructor-led group performed slightly better on performance-based measures, while those in the telehealth group scored higher on self-report measures of self-efficacy and social network scales. CONCLUSION: A telehealth-delivered exercise program that includes strength and balance exercises and walking was feasible to conduct with a small group of low-income older adults living in a community-based apartment complex. Recruitment and retention of participants for the study was successful, and participants expressed satisfaction with the intervention whether conducted in-person or via telehealth.

When More Than Exercise Is Needed to Increase Chances of Aging in Place: Qualitative Analysis of a Telehealth Physical Activity Program to Improve Mobility in Low-Income Older Adults.

BACKGROUND: A telehealth-delivered physical activity program was implemented within two low-income older adult housing properties utilizing the Otago exercise program, a physical therapy program endorsed by the Centers for Disease Control and Prevention to improve balance and strengthening in community dwelling older adults and by the National Council on Aging as the highest level of evidence for fall prevention programs. Participants were also given Fitbit activity monitors to help track their activity. OBJECTIVE: The goal of this project was to increase older adults' daily physical activity in hopes of decreasing chronic disease morbidity, disability, and falls, and decrease social isolation. METHODS: The Otago exercise program was conducted via telehealth twice weekly for 12 weeks. Participants also wore Fitbit activity trackers to encourage physical activity outside of the group classes. Postintervention qualitative interviews were conducted, recorded, transcribed, and analyzed using discourse analysis. RESULTS: Twenty-one older adult participants from two low-income properties in Charleston, SC, participated in the 12-week telehealth physical therapy program. Postintervention qualitative interviews revealed that the two sites were very different in their participation in the program and their main concerns surrounding aging in place. One site had a community-oriented outlook and enjoyed participating in physical activity together; whereas, the other site had very few participants and referenced depression and social isolation as main concerns. CONCLUSIONS: A telehealth physical therapy-led intervention to increase physical activity in low-income older adults aging in place was successfully implemented and attended; however, it became clear in postintervention qualitative interviews that social isolation and depression were prevalent and mental health needs to be addressed along with physical health to encourage successful aging in place.

It's All in the Wrist: Diagnosis and Management of Carpal Tunnel Syndrome.

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy accounting for 90% of similar disorders, occurring in 3.8% of the population, common in adults aged 40-60 years, and is associated with an average 32 lost days of work and lost productivity. In addition to occupational exposure, there are several common chronic disorders that can preclude CTS, obesity, diabetes mellitus, rheumatoid arthritis, pregnancy, metabolic syndrome, and thyroid disorder, to name a few. Therefore, it is important for the primary care provider to have knowledge in this syndrome. The purpose of the article is to inform the provider about the etiology, presentation, diagnosis, and treatment of CTS, as well as the implications for job-associated CTS.

Diagnosis and management of impetigo.

Impetigo, a bacterial skin infection that involves the superficial layers of the skin, is one of the most common skin infections in children ages 2 to 5 but can occur in individuals across the lifespan. This article discusses the diagnosis and management of impetigo in primary care.