Mapping the extent of the literature and psychometric properties for the Physical Activity Scale for the Elderly (PASE) in community-dwelling older adults: a scoping review.

BACKGROUND: Identifying valid and accessible tools for monitoring and improving physical activity levels is essential for promoting functional ability and healthy aging. The Physical Activity Scale for the Elderly (PASE) is a commonly used and recommended self-report measure of physical activity in older adults. The objective of this scoping review was to map the nature and extent to which the PASE has been used in the literature on community-dwelling older adults, including the evidence for its psychometric properties. METHODS: Seven electronic databases (MEDLINE (Ovid), Embase (Ovid), AMED (Ovid), Emcare (Ovid), CINAHL (EBSCO), Ageline (EBSCO)) were searched from inception to January 25, 2023. Studies were included if physical activity was part of the aim(s) and measured using the PASE, participants had a mean age of 60 years or older and lived in the community, and papers were peer-reviewed journal articles published in English. Pairs of independent reviewers screened abstracts, full-texts, and extracted data. Where possible, weighted mean PASE scores were calculated for different subgroups based on age, sex, and clinical population. RESULTS: From 4,124 studies screened, 232 articles from 35 countries met the inclusion criteria. Most studies were cross-sectional (60.78%), completed in high-income countries (86.4%) and in North America (49.57%). A variety of clinical conditions were included (n = 21), with the most common populations being osteoarthritis (n = 13), Parkinson's disease (n = 11), and cognitive impairment (n = 7). Psychometric properties of ten versions of the PASE were found. All versions demonstrated acceptable test-retest reliability. Evidence for construct validity showed moderate correlations with self-reported physical activity, fair to moderate with accelerometry derived activity and fair relationships with physical function and self-reported health. Pooled means were reported in graphs and forest plots for males, females, age groups, and several clinical populations. CONCLUSION: The PASE was widely used in a variety of clinical populations and geographical locations. The PASE has been culturally adapted to several populations and evaluated for its reliability and convergent validity; however, further research is required to examine responsiveness and predictive validity. Researchers can use the weighted mean PASE scores presented in this study to help interpret PASE scores in similar populations. OSF REGISTRATION: osf.io/7bvhx.

Pulmonary rehabilitation with balance training for fall reduction in chronic obstructive pulmonary disease: a randomized controlled trial.

BACKGROUND AND OBJECTIVES: Available evidence suggests that adults with chronic obstructive pulmonary disease (COPD) performed substantially worse than healthy controls on many balance measures and balance training can improve the balance measures in this population. We conducted this study to determine the effects of incorporating balance training into pulmonary rehabilitation (PR) on the incidence of falls at 12 months follow-up in high fall risk adults with COPD. METHODS: We conducted a prospective international multi-center randomized controlled trial. Eligible participants were adults with COPD at a high risk of future falls and were randomly assigned (1:1) to the intervention or control group. The intervention included personalized balance training for a targeted total of 90 min per week. Both the intervention and control groups received usual PR (2-3 times per week for 8-12 weeks). The primary outcome was the incidence of falls at 12-month follow-up using monthly fall diary calendars. Negative binomial regression or recurrent events models were used to examine the effects of the intervention on fall events. Multiple imputations were performed to deal with missing values. RESULTS: Of 258 participants who were enrolled in the trial, 178 provided falls information (intervention group = 91, control group = 87) and were included in the main analysis. Forty-one participants (45%) experienced at least one fall event in the intervention group and 33 (38%) in the control group (p = 0.34). The mean incidence of falls at 12 months was similar between the two groups (128 versus 128 per 100 person-years; mean difference: 0.30, 95% CI: -0.76 to 1.36 per 100 person-years). The results are robust after multiple imputations for missing data (n = 67). CONCLUSIONS: PR incorporating balance training compared to PR alone did not reduce the incidence of falls over the 12-month period in high fall risk adults with COPD. TRIAL REGISTRATION: The study was registered with ClinicalTrials.gov (NCT02995681) on 14/12/2016.

Reflections on the challenges of conducting an international multicentre randomized controlled trial of balance training in addition to pulmonary rehabilitation and its impact on fall incidence in people with COPD.

BACKGROUND: Pulmonary rehabilitation (PR) is accepted as standard care for individuals with COPD. We conducted an international, multi-centred randomized controlled trial (RCT) to determine if adding balance training to PR would reduce the incidence of falls in people with COPD. While there have been many trials investigating the effectiveness of PR, few have involved international collaboration. Successful execution of rehabilitation trials requires a significant investment of time, staffing, and resources. With the recent completion of the Balance Training for Fall Reduction in COPD RCT, we report on the design, implementation, and execution of our trial using project management phases. We also highlight our lessons learned for consideration in future multi-centre rehabilitation trials. METHODS: This was a retrospective review of the planning, preparation, timelines, and personnel training involved in the execution of this study using four of the five project management phases described by Farrell et al. in 2010: (1) initiation, (2) planning, (3) execution, and (4) monitoring and controlling. We report descriptive statistics as percentages and counts and summarize our lessons learned. RESULTS: Ten outpatient PR programs in three continents participated. Thirty-one personnel worked on the trial across all sites. Enrolment began in January 2017 and was suspended in March 2020 due to the COVID-19 pandemic. Approximately 1275 patients were screened, 455 (36%) were eligible, 258 (57%) consented, 243 (53%) participated, and 130 (61%) completed the 12-month follow-up assessment. Lessons learned through our experience included (1) ensuring awareness of funder policies and considering the impact on collaborating sites; (2) preparing for the possibility of human resource and program disruptions; (3) anticipating site dropout and having a contingency plan in place; (4) planning and monitoring process measure data before, during, and after trial initiation; (5) ensuring frequent and consistent communication with and between collaborating sites; (6) maximizing features of database platform to ensure data set completeness and controlled data access; and (7) identifying strategies for increasing patient engagement in a high-demand study. CONCLUSIONS: We identify seven lessons learned through our experience conducting an international, multicentre rehabilitation-based RCT. These lessons can provide guidance to other trialists conducting studies with similar logistics and may assist with future trial planning and implementation.

Long-Term Functional Limitations and Predictors of Recovery After COVID-19: A Multicenter Prospective Cohort Study.

BACKGROUND: Limited data exist on post-severe COVID-19 functional trajectory, particularly considering premorbid status. We characterized 1-year functional recovery post-hospitalization for COVID-19, highlighting predictors of long-term recovery. METHODS: We enrolled adult patients with lab-confirmed SARS-CoV-2 infection and hospitalized for COVID-19 sequelae, from five major Ontario, Canada hospitals in a prospective cohort study. Assessments included telephone interviews on admission followed by telephone and in-person assessments at 3-, 6-, 9-, and 12-months post-discharge. The Activity-Measure for Post-Acute Care (AM-PAC) Mobility and Cognition scales were administered at baseline and every 3 months for 1 year. Secondary outcomes included symptoms, spirometry, physical performance, dyspnea, fatigue, distress, anxiety and depression, and quality of life. RESULTS: A total of 254 patients (57.1% male) with a mean age of 60.0 (±13.1) years and an average hospital stay of 14.3 (±19.7) days agreed to participate. At 12 months, 55.3% demonstrated clinically important deficits in mobility and 38.8% had cognitive deficits compared to premorbid levels. Fatigue was reported in 44.2%, followed by difficulty walking long distances in 35.8% and dyspnea in 33.0%. Almost 40% of patients had an FEV1(% Pred) < 80% at 12 months, 60.3% had impairments in physical performance, and 44.5% had problems with anxiety or depression. Predictors of better mobility at 12 months included higher premorbid mobility status, male sex, shorter hospital stay, fewer comorbidities, and higher FEV1 (% pred) at the 3-month follow-up. CONCLUSIONS: Our study provides compelling evidence of the long-term impact of COVID-19 on functional and cognitive status 1-year post-infection.

Acceptability, Reliability, and Validity of Virtually Administered Gait Speed Tests.

OBJECTIVES: To evaluate the acceptability, reliability (inter- and intrarater), and validity (convergent, known groups, and predictive) of virtually administered gait speed tests for community-dwelling older adults. DESIGN: A prospective cohort study was performed, tracking health outcomes for a year. SETTING AND PARTICIPANTS: The 3-m gait speed test at usual and fast pace was administered to community-dwelling older adults over Zoom. METHOD: To examine acceptability, participants completed questionnaires regarding telehealth usability and experience. Virtual gait speed tests were administered at baseline and 24 to 72 hours later to evaluate reliability. Self-report mobility measures were used to examine convergent and known-groups validity. Participants' health outcomes were tracked for a year to evaluate predictive validity. RESULTS: Sixty participants completed the baseline assessment and 52 completed the second assessment. Participants reported an overall positive experience with the test. Intraclass correlation coefficients for reliability ranged from 0.79 to 0.90. For convergent validity, correlations >0.30 were found predominantly for usual gait speed with self-report mobility measures. Both the usual- and fast-gait speed were able to discriminate between difficulty walking and gait aid use. Usual gait speed was able to predict specialist and family doctor visits and fast gait speed was able to predict rehabilitation specialist visits over 1 year. CONCLUSIONS AND IMPLICATIONS: Our findings demonstrate support for the acceptability, reliability, and validity of virtually administered gait speed tests for community-dwelling older adults. Although future studies are needed to examine the validity of virtual gait speed tests in larger and more diverse samples to improve generalizability of results, clinicians and researchers can virtually administer 3-m gait speed tests with confidence that scores are trustworthy and reflect older adults' mobility.

The effects of co-designed physical activity interventions in older adults: A systematic review and meta-analysis.

BACKGROUND: Physical activity (PA) declines with age despite the knowledge that physical inactivity is a leading cause of disease, death, and disability worldwide. To better tailor PA interventions to older adults, researchers are turning to the collaborative principles of co-design. The purpose of this systematic review was to compare the effectiveness of co-designed PA interventions and standard care for increasing PA and other health outcomes (i.e., physical function, quality of life, mental health, functional independence, attendance and attrition rates) in older adults. METHODS: A search was conducted in MEDLINE, AgeLine, CINAHL, Embase, and SPORTDiscus. Records were screened by independent pairs of reviewers. Primary research studies conducted among community-dwelling older adults (age 60+) comparing co-designed PA interventions to standard care were considered for inclusion. Controls included wait-list control, usual care, sham interventions, PA interventions without the use of co-design, and no intervention. A random effects meta-analysis was conducted, and the standardized mean difference (SMD) was used to report effect estimates. Quality of evidence was rated using GRADE. RESULTS: Of 16,191 studies screened, eight (N = 16,733) were included in this review. Most studies reported results favouring the effect of co-design on physical activity; however, only two studies (N = 433) could be pooled for meta-analysis resulting in a SMD of 0.28, (95% CI = -0.13 to 0.69; p = 0.19; I2 = 56%) immediately post-intervention. The GRADE quality of evidence was very low. The quantitative analysis of three studies reported improved physical function. CONCLUSION: This review did not demonstrate that co-designed PA interventions are more effective than standard care for increasing PA in older adults; however, evidence was limited and of very low quality. Further well-designed trials are warranted to better understand the impacts of co-designed PA interventions and how to best implement them into practice. TRIAL REGISTRATION: PROSPERO registration number: CRD42022314217.

Balance measures for fall risk screening in community-dwelling older adults with COPD: A longitudinal analysis.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) increases fall risk, but consensus is lacking on suitable balance measures for fall risk screening in this group. We aimed to evaluate the reliability and validity of balance measures for fall risk screening in community-dwelling older adults with COPD. METHODS: In a secondary analysis of two studies, participants, aged ≥60 years with COPD and 12-month fall history or balance issues were tracked for 12-month prospective falls. Baseline balance measures - Brief Balance Evaluation Systems Test (Brief BESTest), single leg stance (SLS), Timed Up and Go (TUG), and TUG Dual-Task (TUG-DT) test - were assessed using intra-class correlation (ICC2,1) for reliability, Pearson/Spearman correlation with balance-related factors for convergent validity, t-tests/Wilcoxon rank-sum tests with fall-related and disease-related factors for known-groups validity, and area under the receiver operator characteristic curve (AUC) for predictive validity. RESULTS: Among 174 participants (73 ± 8 years; 86 females) with COPD, all balance measures showed excellent inter-rater and test-retest reliability (ICC2,1 = 0.88-0.97) and moderate convergent validity (r = 0.34-0.77) with related measures. Brief BESTest and SLS test had acceptable known-groups validity (p < 0.05) for 12-month fall history, self-reported balance problems, and gait aid use. TUG test and TUG-DT test discriminated between groups based on COPD severity, supplemental oxygen use, and gait aid use. All measures displayed insufficient predictive validity (AUC<0.70) for 12-month prospective falls. CONCLUSION: Though all four balance measures demonstrated excellent reliability, they lack accuracy in prospectively predicting falls in community-dwelling older adults with COPD. These measures are best utilized within multi-factorial fall risk assessments for this population.

Measurement properties of the usual and fast gait speed tests in community-dwelling older adults: a COSMIN-based systematic review.

OBJECTIVE: The gait speed test is one of the most widely used mobility assessments for older adults. We conducted a systematic review to evaluate and compare the measurement properties of the usual and fast gait speed tests in community-dwelling older adults. METHODS: Three databases were searched: MEDLINE, EMBASE and CINAHL. Peer-reviewed articles evaluating the gait speed test's measurement properties or interpretability in community-dwelling older adults were included. The Consensus-based Standards for the selection of health Measurement Instruments guidelines were followed for data synthesis and quality assessment. RESULTS: Ninety-five articles met our inclusion criteria, with 79 evaluating a measurement property and 16 reporting on interpretability. There was sufficient reliability for both tests, with intraclass correlation coefficients (ICC) generally ranging from 0.72 to 0.98, but overall quality of evidence was low. For convergent/discriminant validity, an overall sufficient rating with moderate quality of evidence was found for both tests. Concurrent validity of the usual gait speed test was sufficient (ICCs = 0.79-0.93 with longer distances) with moderate quality of evidence; however, there were insufficient results for the fast gait speed test (e.g. low agreement with longer distances) supported by high-quality studies. Responsiveness was only evaluated in three articles, with low quality of evidence. CONCLUSION: Findings from this review demonstrated evidence in support of the reliability and validity of the usual and fast gait speed tests in community-dwelling older adults. However, future validation studies should employ rigorous methodology and evaluate the tests' responsiveness.

Therapeutic Quality Affects Physical Fitness Benefits of Home Exercise Interventions in Older Adults: A Systematic Review, Meta-Analysis, and Meta-Regression.

BACKGROUND AND PURPOSE: The international Consensus on Therapeutic Exercise aNd Training (i-CONTENT) tool is a new instrument developed to evaluate the therapeutic quality of exercise interventions. Home-based exercise has been shown to improve physical fitness in older adults, but its effects may be influenced by therapeutic quality. The purpose of this systematic review was to describe the therapeutic quality of home-based exercise interventions for community-dwelling older adults and examine the relationship between therapeutic quality and changes in physical fitness. METHODS: Six electronic databases and 2 clinical trial registries were searched for randomized controlled trials investigating the effects of home-based exercise on physical fitness in community-dwelling older adults (≥60 years). Therapeutic quality was evaluated using the i-CONTENT tool for items of patient selection, type of exercise, safety, type/timing of outcomes, exercise dose, and adherence. International Consensus on Therapeutic Exercise aNd Training items were used to explain heterogeneity in meta-regression analyses. Risk of bias, certainty of evidence and credibility of analyses were assessed. RESULTS: Thirty-six trials (n = 6157 participants) were identified. Most studies (≥66.7%) had high or probably high therapeutic quality for i-CONTENT items, except exercise dose (47.2%) and adherence (16.7%). Interventions improved upper- (N = 20 trials; standardized mean difference [SMD] = 0.39; 95% CI, 0.13-0.64; low certainty of evidence) and lower-body strength (N = 28; SMD = 0.42; 95% CI, 0.08-0.77; very low certainty), and aerobic fitness (N = 8; SMD = 0.42; 95% CI, 0.08-0.77; very low certainty). For exercise dose, low- or probably low-quality studies negatively influenced effects on upper- (estimated ß = -.48; P = .049; moderate credibility) and lower-body strength (estimated ß = -.77; P = .048; moderate credibility). For adherence, low- or probably low-quality studies negatively influenced effects on aerobic fitness (estimated ß = -.97; P = .02; low credibility). CONCLUSIONS: Home-based exercise may improve upper- and lower-body strength, as well as aerobic fitness in older adults. However, the effectiveness of interventions is affected by inadequate dosing of exercise programs and adherence issues. Physical therapists should have the best available evidence to support their clinical decision making, especially when designing and monitoring home programs.

Mapping sex and gender differences in falls among older adults: A scoping review.

BACKGROUND: There is growing recognition of the importance of sex and gender differences within falls literature, but the characterization of such literature is uncertain. The aim of this scoping review was to (1) map the nature and extent of falls literature examining sex or gender differences among older adults, and (2) identify gaps and opportunities for further research and practice. METHODS: We used a scoping review methodology. Eligible studies included participants with a mean age of ≥ 60 years and study aims specifying falls and either sex or gender concepts. MEDLINE, Embase, CINAHL, Ageline, and Psychinfo databases were searched from inception to March 2, 2022. Records were screened and charted by six independent reviewers. Descriptive and narrative reports were generated. RESULTS: A total of 15,266 records were screened and 74 studies were included. Most studies reported on sex and gender differences in fall risk factors (n = 52, 70%), incidence/prevalence (n = 26, 35%), fall consequences (n = 22, 30%), and fall characteristics (n = 15, 20%). The majority of studies (n = 70, 95%) found significant sex or gender differences in relation to falls, with 39 (53%) identifying significant sex differences and 31 (42%) identifying significant gender differences. However, only three (4%) studies defined sex or gender concepts and only nine (12%) studies used sex or gender terms appropriately. Fifty-six (76%) studies had more female participants than males. Four (5%) were intervention studies. Studies did not report falls in line with guidelines nor use common fall definitions. CONCLUSION: Sex and gender differences are commonly reported in falls literature. It is critical for future research to use sex and gender terms appropriately and include similar sample sizes across all genders and sexes. In addition, there is a need to examine more gender-diverse populations and to develop interventions to prevent falls that address sex and gender differences among older adults.

Optimal resistance exercise training parameters for stroke recovery: A protocol for a systematic review.

BACKGROUND: Stroke impacts nearly 14 million people annually. Muscle strength and physical function are often affected by stroke and important determinants of stroke recovery. Resistance exercise training (RT) has been shown to improve muscle strength, but RT prescriptions may be suboptimal for other aspects of stroke recovery. Parameters such as frequency, intensity, type, and duration may influence the effectiveness of RT interventions but have not been systematically evaluated. OBJECTIVES: 1) To determine the effects of RT on stroke recovery, and 2) to examine the influence of RT parameters on intervention effects. ELIGIBILITY CRITERIA: Randomized controlled trials examining the effects of RT will be eligible for this systematic review if they: 1) included only adults with stroke or transient ischemic attack, 2) compared RT to no exercise or usual care, and 3) did not apply a co-intervention. STUDY SELECTION: Eight databases (MEDLINE, EMBASE, EMCARE, AMED, PsychINFO, CINAHL, SPORTDiscus, and Web of Science) and 2 clinical trials registries (ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform) will be searched from inception. Two independent pairs of authors will compare titles, abstracts, and full-text reports against the eligibility criteria. Conflicts will be resolved by consensus or third author. MAIN OUTCOME MEASURES: The construct of interest is stroke recovery. An advisory group of clinicians, researchers, and partners with lived experience of stroke will be consulted to determine specific outcome measures of interest, and to rank their relative importance. We expect to include measures of physical function, strength, cognition, and quality of life. Random-effects meta-analyses will be used to pool results for each outcome across studies, and RT parameters (frequency, intensity, type, and duration) will be used as covariates in meta-regression analyses. CONCLUSION: The results of this review will inform the optimal RT prescription parameters for promoting stroke recovery.

Monitoring mobility in older adults using a Global Positioning System (GPS) smartwatch and accelerometer: A validation study.

There is growing interest in identifying valid and reliable methods for detecting early mobility limitations in aging populations. A multi-sensor approach that combines accelerometry with Global Positioning System (GPS) devices could provide valuable insights into late-life mobility decline; however, this innovative approach requires more investigation. We conducted a series of two experiments with 25 older participants (66.2±8.5 years) to determine the validity of a GPS enabled smartwatch (TicWatch S2 and Pro 3 Ultra GPS) and separate accelerometer (ActiGraph wGT3X-BT) to collect movement, navigation and body posture data relevant to mobility. In experiment 1, participants wore the TicWatchS2 and ActiGraph simultaneously on the wrist for 3 days. In experiment 2, participants wore the TicWatch Pro 2 Ultra GPS on the wrist and ActiGraph on the thigh for 3 days. In both experiments participants also carried a Qstarz data logger for trips outside the home. The TicWatch Pro 3 Ultra GPS performed better than the S2 model and was similar to the Qstarz in all tested trip-related measures, and it was able to estimate both passive and active trip modes. Both models showed similar results to the gold standard Qstarz in life-space-related measures. The TicWatch S2 demonstrated good to excellent overall agreement with the ActiGraph algorithms for the time spent in sedentary and non-sedentary activities, with 84% and 87% agreement rates, respectively. Under controlled conditions, the TicWatch Pro 3 Ultra GPS consistently measured step count in line with the participants' self-reported data, with a bias of 0.4 steps. The thigh-worn ActiGraph algorithm accurately classified sitting and lying postures (97%) and standing postures (90%). Our multi-sensor approach to monitoring mobility has the potential to capture both accelerometer-derived movement data and trip/life-space data only available through GPS. In this study, we found that the TicWatch models were valid devices for capturing GPS and raw accelerometer data, making them useful tools for assessing real-life mobility in older adults.

Determinants of physical activity in community-dwelling older adults: an umbrella review.

INTRODUCTION: Physical activity (PA) is critical for disease prevention and maintaining functional ability with aging. Despite this, as many as 50% of older adults in populations worldwide are considered insufficiently active. There is a recognized need to mobilize policies targeted toward modifiable determinants of healthy aging like PA. This umbrella review aimed to summarize the evidence for determinants of PA in community-dwelling older adults. METHODS: A research librarian searched six databases. Systematic and scoping reviews were included if they investigated community-dwelling people with a mean age of 60 + years and examined a relationship between a determinant and any type of PA. Two independent reviewers screened and extracted data from all reviews. JBI methodology and Critical Appraisal Checklist for Systematic Reviews and Research Syntheses were followed and information on the quality of the evidence was extracted. RESULTS: From 17,277 records screened,11 reviews representing > 300 unique primary papers were ultimately included. Only 6% of studies included in all reviews had longitudinal designs. Included studies used a large variety of PA measures, with 76% using only self-report, 15% using only direct measures (e.g., accelerometry), 3% using both types, and 6% with no outcome measure reported. Only four reviews provided a definition of PA and there was substantial inconsistency in the way PA was categorised. Community level influences, which only included the physical environment, were the most commonly assessed (6/11) with more than 70% of the summarized relationships demonstrating null associations. Three out of four reviews reported a positive relationship between walkability and PA in general community-dwelling older adults. There was also evidence supporting relationships between presence of social support for PA, younger age, and men having higher PA from a single systematic review. None of the included reviews assessed the quality of evidence but over 60% performed a risk of bias assessment. CONCLUSIONS: Walkability, age, gender, and social support for PA were the most supported PA determinants identified. Further research should focus on interpersonal and intrapersonal influences and incorporate direct measures of PA with clear operational definitions. There is a need for longitudinal study designs to further understand determinants of PA behaviour trajectories.

Measures of perceived mobility ability in community-dwelling older adults: a systematic review of psychometric properties.

OBJECTIVES: The objective of this systematic review was to synthesise the psychometric properties of measures of perceived mobility ability and related frameworks used to define and operationalise mobility in community-dwelling older adults. METHODS: We registered the review protocol with PROSPERO (CRD42022306689) and included studies that examined the psychometric properties of perceived mobility measures in community-dwelling older adults. Five databases were searched to identify potentially relevant primary studies. We qualitatively summarised psychometric property estimates and related operational frameworks. We conducted risk of bias and overall quality assessments, and meta-analyses when at least three studies were included for a particular outcome. The synthesised results were compared against the Consensus-based Standards for the Selection of Health Measurement Instruments criteria for good measurement properties. RESULTS: A total of 36 studies and 17 measures were included in the review. The Late-Life Function and Disability Index: function component (LLFDI-FC), lower extremity functional scale (LEFS), Mobility Assessment Tool (MAT)-short form (MAT-SF) or MAT-Walking, and Perceived Driving Abilities (PDA) Scale were identified with three or more eligible studies. Most measures showed sufficient test-retest reliability (moderate or high), while the PDA scale showed insufficient reliability (low). Most measures had sufficient or inconsistent convergent validity (low or moderate) or known-groups validity (low or very low), but their predictive validity and responsiveness were insufficient or inconsistent (low or very low). Few studies used a conceptual model. CONCLUSION: The LLFDI-FC, LEFS, PDA and MAT-SF/Walking can be used in community-dwelling older adults by considering the summarised psychometric properties. No available comprehensive mobility measure was identified that covered all mobility domains.

A unified framework for the measurement of mobility in older persons.

Mobility is often referred to as a 'sixth vital sign' because of its ability to predict critical health outcomes in later adulthood. In the World Health Organization (WHO) World Report on Aging and Health, mobility is described as movement in all its forms whether powered by the body or a vehicle. As such, mobility encompasses basic physical actions such as getting up from a chair and walking, as well as activities such as exercising, driving and using public transportation. A plethora of measurement tools have been developed to assess various aspects of mobility; however, there is wide variability in the mobility constructs being measured which limits standardisation and meaningful comparison across studies. In this paper, we propose a comprehensive framework for measuring mobility that considers three distinct facets of mobility: perceived mobility ability ('what can you do'), actual mobility ability ('what you actually do') and locomotor capacity for mobility ('what could you do'). These three facets of mobility are rooted in the three components of healthy aging endorsed by the WHO: functional ability, intrinsic capacity and environments. By proposing a unified framework for measuring mobility based on theory and empirical evidence, we can advance the science of monitoring and managing mobility to ensure functional ability in older age.

Assessing the measurement properties of life-space mobility measures in community-dwelling older adults: a systematic review.

BACKGROUND: Preserving and enhancing mobility is an important part of healthy ageing. Life-space mobility is a construct that captures actual mobility within the home and the community. The objective of this systematic review was to synthesise the measurement properties and interpretability of scores produced by life-space mobility measures in community-dwelling older adults. METHODS: This systematic review followed Consensus-based Standards for the selection of health Measurement Instruments (COSMIN). Multiple databases were searched to identify potentially relevant articles. Data extraction and assessment of methodological quality was conducted by two independent reviewers. When possible, results were quantitatively pooled for each measurement property. If studies could not be combined quantitatively, then findings were summarised qualitatively using means and percentage of confirmed hypothesis. Synthesised results were assessed against the COSMIN criteria for good measurement properties. RESULTS: A total of 21 full text articles were included in the review. The University of Alabama at Birmingham Study of Aging Life-Space Assessment (LSA) was the most evaluated life-space mobility measure. The LSA demonstrated content validity, internal consistency (Cronbach's alpha 0.80-0.92), reliability [intra-class correlation value 0.89 (95% confidence interval (CI): 0.80, 0.94)] and convergent validity with measures of physical function in community-dwelling older adults. CONCLUSION: This systematic review summarised the measurement properties of life-space mobility measures in community-dwelling older adults following COSMIN guidelines. The LSA has been translated into multiple languages and has sufficient measurement properties for assessing life-space mobility among community-dwelling older adults.

The stroke transitional care intervention for older adults with stroke and multimorbidity: a multisite pragmatic randomized controlled trial.

BACKGROUND: This study aimed to test, in real-world clinical practice, the effectiveness of a Transitional Care Stroke Intervention (TCSI) compared to usual care on health outcomes, self-management, patient experience, and health and social service use costs in older adults (≥ 55 years) with stroke and multimorbidity (≥ 2 chronic conditions). METHODS: This pragmatic randomized controlled trial (RCT) included older adults discharged from hospital to community with stroke and multimorbidity using outpatient stroke rehabilitation services in two communities in Ontario, Canada. Participants were randomized 1:1 to usual care (control group) or usual care plus the 6-month TCSI (intervention group). The TCSI was delivered virtually by an interprofessional (IP) team, and included care coordination/system navigation support, phone/video visits, monthly IP team conferences, and an online resource to support system navigation. The primary outcome was risk of hospital readmission (all cause) after six-months. Secondary outcomes included physical and mental functioning, stroke self-management, patient experience, and health and social service use costs. The intention-to-treat principle was used to conduct the primary and secondary analyses. RESULTS: Ninety participants were enrolled (44 intervention, 46 control); 11 (12%) participants were lost to follow-up, leaving 79 (39 intervention, 40 control). No significant between-group differences were seen for baseline to six-month risk of hospital readmission. Differences favouring the intervention group were seen in the following secondary outcomes: physical functioning (SF-12 PCS mean difference: 5.10; 95% CI: 1.58-8.62, p = 0.005), stroke self-management (Southampton Stroke Self-Management Questionnaire mean difference: 6.00; 95% CI: 0.51-11.50, p = 0.03), and patient experience (Person-Centred Coordinated Care Experiences Questionnaire mean difference: 2.64, 95% CI: 0.81, 4.47, p = 0.005). No between-group differences were found in total healthcare costs or other secondary outcomes. CONCLUSIONS: Although participation in the TCSI did not impact hospital readmissions, there were improvements in physical functioning, stroke self-management and patient experience in older adults with stroke and multimorbidity without increasing total healthcare costs. Challenges associated with the COVID-19 pandemic, including the shift from in-person to virtual delivery, and re-deployment of interventionists could have influenced the results. A larger pragmatic RCT is needed to determine intervention effectiveness in diverse geographic settings and ethno-cultural populations and examine intervention scalability. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04278794 . Registered May 2, 2020.

Preconditioning program reduces the incidence of prolonged hospital stay after lung cancer surgery: Results from the Move For Surgery randomized clinical trial.

BACKGROUND: Lung cancer resection is associated with high rates of prolonged hospital stay. It is presumed that preconditioning with aerobic exercise can shorten the postoperative duration of hospital stay, but this has not yet been demonstrated in trials after lung cancer surgery. The aim of this study was to perform a RCT to determine whether Move For Surgery (MFS), a home-based and wearable technology-enhanced preconditioning program before lung cancer surgery, is associated with a lower incidence of prolonged hospital stay when compared to usual preoperative care. METHODS: Patients undergoing lung resection for early-stage non-small cell lung cancer were enrolled before surgery into this blinded, single-site RCT, and randomized to either the MFS or control group in a 1 : 1 ratio. Patients in the MFS group were given a wearable activity tracker, and education about deep breathing exercises, nutrition, sleep hygiene, and smoking cessation. Participants were motivated/encouraged to reach incrementally increasing fitness goals remotely. Patients in the control group received usual preoperative care. The primary outcome was the difference in proportion of patients with hospital stay lasting more than 5 days between the MFS and control groups. RESULTS: Of 117 patients screened, 102 (87.2 per cent) were eligible, enrolled, and randomized (51 per trial arm). The majority (95 of 102, 93.1 per cent) completed the trial. Mean(s.d.) age was 67.2(8.8) years and there were 55 women (58 per cent). Type of surgery and rates of thoracotomy were not different between arms. The proportion of patients with duration of hospital stay over 5 days was 3 of 45 (7 per cent) in the MFS arm compared to 12 of 50 (24 per cent) in the control arm (P = 0.021). CONCLUSION: MFS, a home-based and wearable technology-enhanced preconditioning program before lung cancer surgery, decreased the proportion of patients with a prolonged hospital stay. Registration number: NCT03689634 (http://www.clinicaltrials.gov).

After lung cancer surgery, many patients are admitted to hospital for a prolonged amount of time. It is believed that exercises undertaken before surgery can shorten the stay in hospital, but this has not yet been studied. This study aimed to find out whether Move For Surgery (MFS), a home-based exercise (preconditioning) program using wearable technology before lung cancer surgery, can decrease the number of patients who are admitted to hospital for a prolonged amount of time. Patients with lung cancer were invited to enter this trial 3­4 weeks before surgery. They were randomly put into the MFS or control group. Patients in the MFS group were given a wearable activity tracker, and education about deep breathing exercises, nutrition, sleep hygiene, and quitting smoking. Participants were encouraged to reach increasing fitness goals each week. Patients in the control group underwent usual preoperative care. The difference between the MFS and control groups in the proportion of patients with duration of stay in hospital exceeding 5 days was studied. There were 102 participants in total, 51 in each group. The majority (95 of 102, 93.1 per cent) completed the trial. The average age of participants was 67 years, and 58 per cent were women. Type of surgery and number of open operations were no different between groups. The proportion of patients with duration of stay greater than 5 days was 3 of 45 (7 per cent) in the MFS group compared with 12 of 50 (24 per cent) in the control group. Therefore, MFS before lung cancer surgery was shown to decrease the number of patients admitted to hospital for a prolonged amount of time.

Assessing the Measurement Properties of the Self-Administered Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised (ALSFRS-R): A Rasch Analysis.

OBJECTIVE: The self-administered version of the Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised (ALSFRS-R) is used to monitor function and disease progression in individuals with amyotrophic lateral sclerosis (ALS). However, the performance of the self-administered ALSFRS-R has not been assessed using Rasch Measurement Theory. Therefore, the purpose of this study was to examine the psychometric properties of the self-administered ALSFRS-R using Rasch analysis. METHODS: Rasch analysis was performed on self-administered ALSFRS-R data from individuals with ALS across Canada. The following 6 aspects of Rasch analysis were examined using RUMM2030: fit via residuals and chi-square statistics, targeting via person-item threshold maps, dependency via item residual correlations, unidimensionality through principal components analysis of residuals, reliability via person separation index, and stability through differential item functioning analyses for sex, age, and language. RESULTS: Analysis was performed on 122 participants (mean age: 52.9 years; 62.8% men). The overall scale demonstrated good fit, reliability, and stability; however, multidimensionality was found. To address this issue, items were divided into 3 subscales (bulbar, motor, and respiratory function), and Rasch analysis was performed for each subscale. The subscales demonstrated good fit, reliability, stability, and unidimensionality. However, there were still issues with item dependency for all subscale and targeting for bulbar and respiratory subscales. CONCLUSIONS: The self-administered ALSFRS-R is reliable, internally valid, and stable across sex, age, and language subgroups; however, it is recommended that the ALSFRS-R be scored by subscale. Future studies can look at revising and/or adding items to tackle misfit, redundancy, and ceiling effects. IMPACT: Self-administered measures are simple to administer and inexpensive. The self-administered ALSFRS-R was found to be psychometrically sound and can be used as a tool to monitor disease progression and function in ALS.

Defining and Measuring Preclinical Mobility Limitation: An Expert Consensus Exercise Informed by a Scoping Review.

BACKGROUND: Early change in function in older adults has been termed preclinical disability (PCD). PCD has been understudied compared to other stages of disability because it is unlikely to receive comparative priority in clinical settings. It has major implications for prevention and population health as it may be the optimal time to intervene to prevent further decline. A standardized approach to research in PCD, including a common definition and measurement approaches, is needed to advance this work. METHODS: The process to establish how PCD should be defined and measured was undertaken in 2 stages: (1) a scoping review of the literature, which was used to inform (2) a web-enabled consensus meeting with content experts. RESULTS: The scoping review and the consensus meeting support the use of the term preclinical mobility limitation (PCML) and that it should be measured using both patient-reported and performance-based measures. It was agreed that the definition of PCML should include modification of frequency and/or method of task completion, without overt disability, and that requisite mobility tasks include walking (distance and speed), stairs, and transfers. CONCLUSIONS: Currently, there are few standardized assessments that can identify PCML. PCML is the term that most clearly describes the stage where people experience a change in routine mobility tasks, without a perception of disability. Further evaluation into the reliability, validity, and responsiveness of outcome measures is needed to advance research on PCML.