Home-based gait speed and the association with sociodemographic and anthropometric variables: A national study (ELSI-Brazil).

OBJECTIVES: To investigate home-based gait speed performance for men and women stratified by age group and its associations with sociodemographic and anthropometric variables. METHODS: Data from the 2nd wave of the Brazilian Longitudinal Study of Aging (ELSI-Brazil, 2019-2021) were used. Gait speed was tested twice at home over 3.0 meters at usual pace. Associations of sociodemographic and anthropometric variables with gait speed were evaluated using gamma regression. RESULTS: Median gait speed value reduced with increasing age in both sexes [men: 0.70 m/s (50-59 years) to 0.53 m/s (≥80 years); women: 0.68 m/s (50-59 years) to 0.48 m/s (≥80 years)] and was significantly lower in women than men in the age groups of 60-69 and 70-79 years. Age group and education among men and age group, education, and waist circumference among women were significantly associated with gait speed. CONCLUSIONS: Our findings may be helpful as reference values to identify mobility limitation among older Brazilians.

Do Older Brazilian Women Who Participate in a Regular Physical Exercise Program Have Higher Habitual Physical Activity Levels? A Cross-Sectional Study Based on Accelerometer Data.

A cross-sectional study was conducted to compare the habitual physical activity level, measured by accelerometry, gait performance, assessed by the GAITRite® system, handgrip strength, and static balance between older Brazilian women who participate (n = 50; 70.7 ± 5.5 years) and do not participate (n = 50; 70.1 ± 5.6 years) in a regular physical exercise program, and to investigate whether participation in a regular exercise program ensures compliance with physical activity recommendations. Older women who participated in a regular physical exercise program had significantly shorter sedentary activity time (effect size [ES] = 0.54), longer moderate activity time (ES = 0.85), and higher energy expenditure (ES = 0.64), number of steps (ES = 0.82), gait speed (ES = 0.49), and step length (ES = 0.45). However, regular participation in an exercise program did not guarantee compliance with physical activity recommendations. Behavioral changes to increase physical activity levels among older women who do and do not participate in a regular exercise program are necessary.

Cross-cultural validity of the Animated Activity Questionnaire for patients with hip and knee osteoarthritis: a comparison between the Netherlands and Brazil.

BACKGROUND: The Animated Activity Questionnaire (AAQ) was developed in the Netherlands to assess activity limitations in individuals with hip/knee osteoarthritis (HKOA). The AAQ is easy to implement and minimizes the disadvantages of questionnaires and performance-based tests by closely mimicking real-life situations. The AAQ has already been cross-culturally validated in six other countries. OBJECTIVE: To assess the cross-cultural validity, the construct validity, the reliability of the AAQ in a Brazilian sample of individuals with HKOA, and the influence of formal education on the construct validity of the AAQ. METHODS: The Brazilian sample (N = 200), mean age 64.4 years, completed the AAQ and the Western Ontario and McMaster Universities Index (WOMAC). A subgroup of participants performed physical function tests and completed the AAQ twice with a one-week interval. The Dutch sample (N = 279) was included to examine Differential Item Functioning (DIF) between the scores obtained in the Netherlands and Brazil. For this purpose, ordinal regression analyses were used to evaluate whether individuals with the same level of activity limitations from the two countries (the Dutch as the reference group) scored similarly in each AAQ item. To evaluate the construct validity, correlation coefficients were calculated between the AAQ, the WOMAC domains, and the performance-based tests. To evaluate reliability, the Cronbach's alpha coefficient, the intraclass correlation coefficient, and the standard error of measurement (SEM) were calculated. RESULTS: The AAQ showed significant correlations with all the WOMAC domains and performance-based tests (rho=0.46-0.77). The AAQ showed high internal consistency (Cronbach's alpha=0.94), excellent test-retest reliability (ICC2,1 = 0.98), and small SEM (2.25). Comparing to the scores from the Netherlands, the AAQ showed DIF in two items, however, they did not impact on the total AAQ score (rho=0.99). CONCLUSION: Overall, the AAQ showed adequate cross-cultural validity, construct validity, and reliability, which enables its use in Brazil and international/multicenter studies.

Cross-cultural adaptation and reliability of the Functional Gait Assessment in older Brazilian adults.

BACKGROUND: The Functional Gait Assessment (FGA) is a standardized instrument for assessing postural stability during various walking tasks. It was developed to increase the reliability and to decrease the potential ceiling effect observed with the Dynamic Gait Index (DGI). OBJECTIVE: To translate and cross-culturally adapt the FGA into Portuguese-Brazilian, and to evaluate its reliability in community-dwelling Brazilian older adults. METHODS: The process of translation and cross-cultural adaptation followed the recommendations of international guidelines. The pre-final version was applied to a sample of 55 older adults of both sexes living independently in the community. For the assessment of reliability (i.e. inter- and intra-rater reliability, standard error of measurement (SEM), and internal consistency), 70 older adults aged 60-87 years were evaluated. RESULTS: There was a conceptual equivalence between the original and the translated versions. All FGA items that used measurements in inches and feet were modified to use matching values in centimeters to reflect the measurement unit used in Brazil. The FGA-Brazil showed excellent inter- and intra-rater reliability (ICC2,1 > 0.90), low SEM (ranging from 1.03 to 1.52), and good internal consistency (Cronbach's alpha = 0.858). CONCLUSION: The FGA-Brazil is a semantically and linguistically valid and reliable instrument to assess walking balance among community-dwelling older adults.

Effectiveness of exercises by telerehabilitation on pain, physical function and quality of life in people with physical disabilities: a systematic review of randomised controlled trials with GRADE recommendations.

OBJECTIVE: Investigate whether exercise-based telerehabilitation improves pain, physical function and quality of life in adults with physical disabilities. DESIGN: Systematic review of randomised controlled trials. DATA SOURCES: Searches were performed in AMED, MEDLINE, CINAHL, SPORTDiscus, Embase, PEDro, Cochrane Library and PsycINFO. ELIGIBILITY CRITERIA: Trials were considered if they evaluated exercise by telerehabilitation. The population included adults with physical disability. Comparisons were control and other interventions. The outcomes were pain, physical function and quality of life. Study selection, data extraction and analysis followed the protocol registered in PROSPERO (CRD42019122824). GRADE determined the strength of evidence. RESULTS: Forty-eight trials were included in the quantitative analysis. When compared with other interventions, there was high-quality evidence that telerehabilitation was not different to other interventions for pain (95% CI: -0.4 to 0.1), physical function (95% CI: -0.2 to 0.2) and quality of life (95% CI: -0.1 to 0.5) at long-term. There was moderate-quality evidence that telerehabilitation was not different to other interventions for physical function (95% CI: -0.1 to 0.5) and quality of life (95% CI: -0.2 to 0.5) at short-term. However, due to the low-quality evidence and the small number of trials comparing exercise protocols offered by telerehabilitation with control groups, it is still not possible to state the efficacy of telerehabilitation on pain, function and quality of life at short-term and long-term. CONCLUSIONS: Exercise by telerehabilitation may be an alternative to treat pain, physical function and quality of life in adults with physical disabilities when compared with other intervention.

Construct and criterion validity of the functional gait assessment-Brazil in community-dwelling older adults.

BACKGROUND: The functional gait assessment (FGA) is a reliable instrument to evaluate walking balance in the Brazilian older population. However, other measurement properties need investigation. OBJECTIVE: To determine the construct and criterion validity of the FGA-Brazil and its ceiling and floor effects. METHODS: Sociodemographic, clinical, and anthropometric data were collected from 126 older adults. Participants completed the Mini-mental state examination followed by the FGA-Brazil, Berg balance scale (BBS), gait speed, and the Falls Efficacy Scale-International. Six months later, the participants were interviewed by telephone about their fall history. Exploratory factor analysis was used to determine the structural validity. We also determined the construct validity of the FGA-Brazil, using hypothesis testing, by investigating the differences between groups using the Mann-Whitney U test. Criterion validity was determined using the Spearman correlation between the FGA-Brazil and the other balance and gait measures, and using the Receiver Operator Characteristic curve. RESULTS: Participants' mean age was 69.3 ±â€¯7.4 years, and 84 (69.4%) were female. Factor analysis resulted in two factors explaining 53.3% of the total variance. Moderate and high significant correlations were found between the FGA-Brazil and gait speed (r = 0.65) and BBS (r = 0.80). A significant difference in the FGA-Brazil median score between older adults with low and high concern about falls was observed. The cutoff score recommended for predicting falls was 22 or less. No ceiling and floor effects were observed. CONCLUSION: We recommend the FGA-Brazil to determine the risk of falls in community-dwelling older adults.

Validity of balance and mobility screening tests for assessing fall risk in COPD.

People with chronic obstructive pulmonary disease (COPD) have balance impairments and an increased risk of falls. The psychometric properties of short balance tests to inform fall risk assessment in COPD are unknown. Our objective was to determine the validity (concurrent, convergent, and known-groups) of short balance and mobility tests for fall risk screening. Participants with COPD aged ≥ 60 years attended a single assessment. Correlation coefficients described the relationships between the Brief Balance Evaluation Systems Test (Brief BESTest), Single-Leg Stance (SLS), Timed Up and Go (TUG), and Timed Up and Go Dual-Task (TUG-DT) tests, with the comprehensive Berg Balance Scale (BBS), chair-stand test, and measures of exercise tolerance, functional limitation, disability, and prognosis. Independent t-tests or Mann-Whitney U tests were used to examine differences between groups with respect to fall risk. Receiver operating characteristic curves examined the ability of the screening tests to identify individuals with previous falls. A total of 86 patients with COPD completed the study (72.9 ± 6.8 years; forced expiratory volume in 1 second: 47.3 ± 20.3% predicted). The Brief BESTest identified individuals who reported a previous fall (area under the curve (AUC) = 0.715, p = 0.001), and the SLS showed borderline acceptable accuracy in identifying individuals with a fall history (AUC = 0.684, p = 0.004). The strongest correlations were found for the Brief BESTest and SLS with the BBS (r = 0.80 and r = 0.72, respectively) and between the TUG and TUG-DT with the chair-stands test (r = 0.73 and r = 0.70, respectively). The Brief BESTest and SLS show the most promise as balance screening tools for fall risk assessment in older adults with COPD. These tests should be further evaluated prospectively.

Pelvic floor muscle function in women with and without urinary incontinence: are strength and endurance the only relevant functions? a cross-sectional study.

OBJECTIVES: To investigate if pelvic floor muscle functions (PFMFs), besides strength and endurance, are associated with the occurrence of urinary incontinence (UI) in women, and to investigate which functions predict the occurrence of UI. DESIGN: Cross-sectional study. SETTING: Public health service and community. PARTICIPANTS: Two hundred and ten women (101 with UI and 109 without UI). MAIN OUTCOME MEASURES: PFMF was investigated by the Pelvic Floor Sensory and Muscle Function Exam (Exame das Funções Sensoriais e Musculares do Assoalho Pélvico), a valid and reliable instrument that measures the following functions: tone, reaction, control (contraction), control (relaxation), coordination, strength and endurance. The International Consultation on Incontinence Questionnaire-Short Form was used to document the occurrence and type of UI. Sociodemographic and clinical data were collected through the questionnaire. Chi-squared test, Student's t-test and Mann-Whitney test were used to evaluate the association of each function with UI. Two logistic regression models tested the predictive value of each function for UI: Model a included all of the above PFMFs and Model b included all of the above PFMFs except strength and endurance. RESULTS: Most sociodemographic and clinical risk factors differed between women with UI and women without UI. On univariate analysis, tone, reaction, control (contraction), coordination, strength and endurance were found to be significantly associated (P<0.05) with the occurrence of UI. On multivariate analysis, Model a explained 69% and Model b explained 61% of the likelihood of UI, respectively. CONCLUSIONS: Besides strength and endurance, pelvic floor muscle tone, reaction, control (contraction) and coordination were significantly associated with the occurrence of UI, and should be investigated further.

Brazilian versions of the Measure of Processes of Care-20 and Measure of Processes of Care-Service Providers: translation, cross-cultural adaptation and reliability.

BACKGROUND: The Measure of Processes of Care (MPOC) questionnaires evaluate Family-Centered Practice (FCP) in services for children with developmental disorders. The MPOC-20 and MPOC-SP are completed by parents and by rehabilitation professionals, respectively, and are widely used in several countries. OBJECTIVES: To translate and cross-culturally adapt the MPOC-20 and MPOC-SP to Brazilian Portuguese and evaluate their reliability and internal consistency. METHODS: this study included translation, back-translation, cognitive interviews, testing of the pre-final versions, analysis of reliability and of internal consistency of the final versions. Respondents included parents and rehabilitation professionals from rehabilitation centers in four capital cities in Brazil. RESULTS: Translation and cultural-adaptation procedures ensured the Brazilian versions were understandable and semantically equivalent to the original MPOC-20 and MPOC-SP. Pre-final and final versions were analyzed and vetted by the original authors. The MPOC-20 internal consistency Cronbach's alpha varied between 0.61 and 0.91 (n=107), the test-retest reliability ICC varied between 0.44 and 0.83 and the standard error of measurement varied between 0.66 and 0.85 (n=50). The MPOC-SP internal consistency Cronbach's alpha varied between 0.52 and 0.83 (n=92), the test-retest reliability ICC between 0.83 and 0.90, and the standard error of measure between 0.34 and 0.46 (n=62). CONCLUSION: The Brazilian versions of the MPOC-20 and the MPOC-SP are in general stable and sufficiently reliable. They are relevant to the evaluation of FCP and provide information that can improve health services and ensure better care.

Reduced version of the Activity Measure for Post-Acute Care (AM-PAC) for inpatients, "6-clicks": Brazilian-Portuguese cross-cultural adaptation and measurement properties.

BACKGROUND: The "6-clicks" is the reduced version of the Activity Measure for Post-Acute Care for inpatients that assesses limitations in basic mobility, daily activity, and applied cognitive, simply and quickly. OBJECTIVE: Cross-culturally adapt the "6-clicks" into Brazilian-Portuguese and verify its measurement properties. METHODS: Cross-cultural adaptation followed recommendations from international guidelines. Reliability indices, standard error of measurement and minimum detectable difference were calculated. Participants included 13 professionals, 13 patients and 13 companions. Test of measurement properties involved 101 patients' of both sexes, hospitalized in the infirmary, under physical therapy care, able to understand and respond to commands and with no discharge expectation. Their 30 companions were also included. RESULTS: Minor changes implemented to the original version. The three domains showed adequate internal consistency (α>0.65). Inter-rater reliability (n=50) and test-retest reliability, when administer to patients (n=51) and to companions (n=30), showed good for basic mobility domain (ICC2.1=0.81, 0.83 and 0.82, respectively), good to moderate for daily activity (ICC2.1=0.78 and ICC3.1=0.71 and 0.82, respectively) and moderate to poor for applied cognitive (ICC2.1=0.64, 0.36 and ICC3.1=0.63), respectively. The highest agreements among patients/companions were also in basic mobility. Standard error of measurement ranged from 2.03 to 2.64 while the minimum detectable difference ranged from 5.63 to 7.32. CONCLUSION: Translated and adapted Brazilian version of the "6-clicks" showed acceptable measurement properties. The functional data provided by the instrument could be used to enhance care and help treatment follow-up.

Analysis of symmetry between lower limbs during gait of older women with bilateral knee osteoarthritis.

BACKGROUND: Osteoarthritis (OA) is a common condition in older adults, with high epidemiological, clinical, and economic burden worldwide. In clinical practice, patients with knee OA often walk with abnormal gait patterns because of pain, stiffness and/or mobility dysfunctions. Therefore, assessing the symmetry of the lower limbs might improve the rehabilitation treatment and prescription of walking devices. AIMS: To compare the symmetry of step length and single support phase between lower limbs during gait of older women with bilateral knee OA and asymptomatic controls, and to verify if there is difference between these two groups in relation to velocity, cadence, step length and single support phase. METHODS: This cross-sectional study included a convenience sample of 66 community-dwelling older women aged ≥ 65 years with a medical diagnosis of symptomatic bilateral knee OA (n = 33) and asymptomatic controls (n = 33), matched by age and body mass index. All gait parameters were obtained using the GAITRite® system. RESULTS: Mean age of the sample was 72.6 ± 4.0 years. Participants with OA walked with lower velocity (p = 0.001), cadence (p = 0.009) and step length bilaterally (both p = 0.001). No significant difference was found between groups in the symmetry of step length between lower limbs, single support phase and symmetry of single support phase between lower limbs. CONCLUSION: Older women with bilateral knee OA walk with lower velocity, cadence and step length, but have the same symmetry in the step length and single support phase between lower limbs as asymptomatic older women.

Frailty Status and Gait Parameters of Older Women With Type 2 Diabetes.

OBJECTIVES: Gait decline in individuals with frailty status is associated with comorbidities, falls and reduced mobility, reflecting changes in gait. The prevalence of frailty in individuals with type 2 diabetes is higher compared to individuals without diabetes. However, the consequences of frailty status on gait in older women with diabetes are unclear. The objective of the study was to investigate gait changes in older women with diabetes who are classified as vulnerable, having 1 or more frailty conditions, or robust, having none of the conditions, according to the Fried phenotype. METHODS: Participants included 203 older women: 112 without diabetes and 91 with diabetes. The nondiabetes robust group included 59 older women: nondiabetes, vulnerable, 53; diabetes, robust, 26; and diabetes, vulnerable, 65. Gait parameters were obtained by using the GAITRite system and included velocity, cadence, step length, stance time and double-support time. Multivariate analysis was conducted followed by post hoc analysis. RESULTS: Older women with diabetes and vulnerable status used more drugs and had higher body mass indexes than the groups without diabetes who were vulnerable and robust; there was no difference between the diabetes, robust and diabetes, vulnerable groups. Falls history and fear of falling were similar in all groups. Vulnerable older women with diabetes walked with decreased velocity, cadence and step length and increased stance time compared to all groups and with increased double-support time compared to the nondiabetes robust and nondiabetes vulnerable groups. CONCLUSIONS: Gait decline in vulnerable older women with diabetes is worsened by their frailty status. Our study reinforces the importance of screening older women with diabetes for frailty status.

Gait parameters, functional mobility and fall risk in individuals with early to moderate primary open angle glaucoma: a cross-sectional study.

OBJECTIVE: This study investigated the influence of early to moderate primary open angle glaucoma on gait, functional mobility and fall risk. METHODS: Thirty-three participants in the early and moderate stages of primary open angle glaucoma and 34 asymptomatic controls participated in the study. Spatiotemporal gait data were obtained with the GAITRite system and included: velocity, cadence, step length, base of support, swing, stance and double support times. Functional measures included the Timed Up and Go test, the Five-Repetition Sit-To-Stand test and the Dynamic Gait Index. Fall risk was measured using the Physiological Profile Assessment. RESULTS: The variables contrast sensitivity, proprioception and the Timed Up and Go and Dynamic Gait Index tests were significantly different between groups. In addition, the glaucoma group presented significantly higher risk of falling compared to the control group. Individuals in the early and moderate stages of primary open glaucoma presented mobility and sensory deficits that increase the risk of falling. CONCLUSIONS: The results of this study suggest that adding the Timed Up and Go and Dynamic Gait Index tests to routine physical therapy assessment of individuals with early glaucoma could be useful. Rehabilitation programs should focus on maintaining and/or improving mobility and balance, and prevention of falls in this population.

The effect of adenotonsillectomy on the position of head, cervical and thoracic spine and scapular girdle of mouth breathing children.

The clinical decision for surgical treatment of children diagnosed with mouth breathing depends on the percentage of mechanical obstruction correlated with exacerbation of upper respiratory tract infections and systemic changes. The benefits of adenotonsillectomy include changes in the nasopharyngeal space, the mandibular plane and myofunctional alterations. Post-adenotonsilectomy postural benefits have not yet been described. OBJECTIVES: To investigate the kinematics of the shoulder girdle, cervical and thoracic spine in children with mouth breathing before and after adenotonsillectomy. METHODS: Forty-nine mouth breathing children (6.3 ±â€¯1.8 years) of both sexes participated in the study. The measures of thoracic kyphosis, forward head position, shoulders protrusion and abduction, elevation, anterior tilt and internal rotation of the scapula were evaluated before and after surgery. The kinematic data were obtained using the system Qualysis ProReflex®. RESULTS: There was a significant decrease in forward head position, shoulders protrusion, elevation and anterior tilt of the scapula after surgery compared to the pre-operative. CONCLUSION: One of adenotonsillectomy results is the improvement of the posture of the head and the shoulder girdle of mouth breathing children. Clinically these findings are important and will contribute to improving the quality of life of mouth breathing children.

Cross-cultural adaptation to Brazilian Portuguese of the Activity Measure for Post-Acute Care (AM-PAC) short forms for outpatients in rehabilitation.

BACKGROUND: The Activity Measure for Post-Acute Care was developed to evaluate the limitations of activities of adult individuals with different health conditions. OBJECTIVES: To translate and cultural adapt the Activity Measure for Post-Acute Care short forms for outpatients into Portuguese-Brazilian, to verify the comprehension of the items and categories of the responses by users of the rehabilitation services and to analyze the reliability indices of the instrument. METHODS: Translation and back-translation were conducted by two independent teams. Cognitive interviews (n=2) evaluated the comprehension of the translated version among patients. Item reliability and consistency was also investigated. RESULTS: There was conceptual equivalence between the translated and original versions. For some items, the information was modified in order to attend to the measurement units used in Brazil. Comparative analyses of the translated versions chose the most appropriate term to capture the English content. The few discrepancies identified in the back-translation were solved by consensus. The cognitive interviews detected few comprehension problems, which were solved by means of repetition of the item statement and use of examples to clarify the specificity of the information. The final translated short forms of the instrument showed excellent test-retest reliability and inter-examiner reliability indices, as well as high internal consistency. CONCLUSION: The Portuguese version of the Activity Measure for Post-Acute Care short forms will provide Brazilian clinicians and researchers with an up-to-date instrument for the evaluation of functioning of adults with various clinical conditions who attend outpatient rehabilitation settings.

Postural disorders in mouth breathing children: a systematic review.

BACKGROUND: Mouth breathing syndrome can cause sleep disturbances that compromise the performance of children in school. It might also cause postural abnormalities involving the head and cervical spine; however, the association between postural abnormalities and mouth breathing in children is unclear. OBJECTIVE: To assess the methodological quality of studies and determine if there is an association between mouth breathing and postural disorders in children. METHODS: Databases comprised MEDLINE, CINAHL, PEDro, LILACS, EMBASE and Cochrane Central Registrar of Controlled Trials. Searches were until March 2016 and included studies that evaluated postural disorders in children diagnosed with mouth breathing. The Downs and Black checklist was used to evaluate the quality of the evidences. RESULTS: Ten studies were included totaling 417 children from 5 to 14 years. Two studies used the New York State Postural Rating Scale, seven used photography and one used motion capture to measure posture. The methods used to analyze the data included the Postural Analysis Software (SAPO), Fisiometer, ALCimagem and routines in MATLAB program. Quality assessment resulted in low scores (<14) for all the studies. The main areas of weakness were a clear description of the participants, of the methods used to access posture, of the principal confounders and lack of power analysis. External and internal validity were also threatened by the lack of a representative sample and blinding of the participants and assessors, respectively. CONCLUSIONS: The review provides low evidence that mouth-breathing pattern in children between the ages 5-14 years is associated with postural deviations.

Effects of aerobic exercise on functional capacity, anthropometric measurements and inflammatory markers in diabetic elderly women.

This study investigated the effects of an aerobic training program on functional capacity [Timed Up and Go test (TUG), timed 10-m walk test (10MWT), five-repetition sit-to-stand test (5-STS), handgrip strength test (HGS) and one-legged stance test (OLS)], anthropometric measurements [body mass, body mass index (BMI), waist and hip circumferences and waist-to-hip ratio] and plasma levels of inflammatory markers [soluble tumor necrosis factor receptors 1 and 2, and interleukins 6 and 10] in 43 elderly women with type 2 diabetes mellitus. After the training, a significant improvement was observed in the performance of the participants on the TUG, 10MWT, 5-STS and HGS and in the anthropometric measures of body mass, BMI and hip circumference. None of the inflammatory markers showed a significant difference between pre- and post-training. The aerobic exercise program improved the functional capacity of diabetic elderly women, but was ineffective to change the levels of the inflammatory markers evaluated.

Factors associated with fear of falling in community-dwelling older adults with and without diabetes mellitus: Findings from the Frailty in Brazilian Older People Study (FIBRA-BR).

PURPOSE: This study aimed to investigate the associated factors with fear of falling in community-dwelling older adults with and without diabetes mellitus. METHODS: Data from the Frailty in Brazilian Older People Study (FIBRA-BR), involving 4449 individuals aged 65years or older (19.2% with diabetes), were analyzed. The potential factors associated with fear of falling included sociodemographic data, chronic diseases, health-related variables and functional capacity measures. Logistic regression analysis was performed to identify the factors associated with fear of falling. RESULTS: Female gender, arthritis or rheumatism, negative health self-perception, frailty, lower Lawton Scale score and reduced gait speed were independently associated with fear of falling in both groups. Factors associated with fear of falling specific to non-diabetic older adults were depression, visual impairment, falls in the previous 12months, obesity, depressive symptoms, higher Katz Index score and decreased handgrip strength. Lower Mini-Mental State Examination score was an associated factor with fear of falling only in those with diabetes. CONCLUSION: The factors associated with fear of falling did differ between non-diabetic and diabetic older adults. Health care professionals should consider such differences when planning their therapeutic approaches for a successful management of fear of falling in these older populations.

Impact of Type-2 Diabetes Time Since Diagnosis on Elderly Women Gait and Functional Status.

BACKGROUND AND PURPOSE: The gait, mobility and lower-limb strength alterations of diabetic elderly women without symptoms of diabetic neuropathy in different periods of the chronic disease can contribute to an early functional diagnosis, allowing prevention of adverse outcomes like falls and disability. This could also contribute to the development of interventions, cures and physiotherapy practice for this population. The aim of this study was to verify the impact of type-2 diabetes mellitus time since diagnosis on gait and functional status of elderly women. METHODS: Eighty-two diabetic elderly women without neuropathic symptoms participated and divided in two groups: 1) 49 elderly (71.4 ± 4.8 years) with less than 10 years of type-2 diabetes mellitus diagnosis, and 2) 33 elderly (70 ± 4.5 years) with 10 or more years of type-2 diabetes mellitus diagnosis. Outcomes were spatiotemporal gait parameters (speed, cadence, step length, base of support, stance time, swing time, and double support time) assessed through GAITRite® system, and functional status assessed using the Timed Up and Go test and five times sit-to-stand test. To compare spatiotemporal gait variables and performance on functional tests between groups, multivariate analysis of variance and Mann-Whitney test were performed, respectively. RESULTS: The group with 10 or more years of diagnosis showed lower gait speed and smaller step length (112.3 cm/s; 59.2 cm) compared with the group with less than 10 years of diagnosis (122.9 cm/s; 62.4 cm). In relation to Timed Up and Go test and five times sit-to-stand test, there were no statistically significant differences between the groups. CONCLUSION: Type-2 diabetes mellitus time since diagnosis has a negative impact on gait speed and step length, but not on functional status of the elderly women. Copyright © 2015 John Wiley & Sons, Ltd.

Strategies to reduce joint load in the medial compartment of the knee during gait in individuals with osteoarthritis: a review of the literature / Estratégias redutoras da carga no compartimento medial do joelho durante a marcha em indivíduos com osteoartrite: uma revisão da literatura

Abstract Introduction: Increased joint load on the medial compartment of the knee during gait is a mechanical factor responsible for pain and progression of medial knee osteoarthritis. The knee external adductor moment of force is a kinetic parameter that correlates with the joint load in the medial compartment. Objective: The aim of this study was to conduct a narrative review of the biomechanics strategies during gait of individuals with medial knee osteoarthritis that reduce external adductor moment of force of the knee. Methods: The review of the literature was conducted in the databases MEDLINE, PUBMED and PEDro and included articles published between 2000 and 2011. It was selected transversal, theoretical, correlational and longitudinal studies as well as controlled clinical trials. Results: Decreased gait velocity, increased external rotation of the foot, increased internal abductor moment force of the hip and lateral trunk inclination to the side of the support limb are compensatory strategies used to reduce the external adductor moment of force of the knee during gait of individuals with medial knee osteoarthritis. The lateral trunk inclination may be beneficial in a short term, however it decreases the activity of the abductors muscles of the hip during the support phase of the gait favoring compensation that could result in the progression of medial knee osteoarthritis. Conclusion: Strengthening of the abductors muscles of the hip reduces pain, improves the function and prevents compensations that in a long term could possibly accelerate the progression of the medial knee osteoarthritis.

Resumo Introdução: O aumento da carga articular no compartimento medial do joelho durante a marcha é um fator mecânico responsável pela dor e progressão da osteoartrite medial do joelho. O momento de força externo adutor do joelho é o parâmetro cinético que correlaciona com a carga articular no compartimento medial do joelho. Objetivos: O objetivo deste estudo foi realizar uma revisão narrativa da literatura das estratégias biomecânicas durante a marcha em indivíduos com osteoartrite medial do joelho que reduzem o momento de força externo adutor do joelho. Métodos: A revisão da literatura foi realizada nas bases de dados MEDLINE, PUBMED e PEDro, incluindo artigos publicados entre 2000 e 2011. Foram selecionados artigos transversais, teóricos, de correlação e longitudinais, assim como ensaios clínicos controlados. Resultados: A diminuição da velocidade da marcha, aumento do ângulo de rotação externa do pé e do momento de força interno abdutor do quadril, inclinação lateral do tronco são estratégias compensatórias que reduzem o momento de força externo adutor do joelho durante a marcha em indivíduos com osteoartrite medial do joelho. A inclinação lateral do tronco pode ser benéfica em curto prazo, porém diminui a atividade dos músculos abdutores do quadril durante a fase de apoio da marcha favorecendo compensações que podem acarretar na progressão da osteoartrite medial do joelho. Conclusão: O fortalecimento dos músculos abdutores do quadril reduz a dor, melhora a função e previne compensações que em longo prazo poderiam acelerar a progressão da osteoartrite medial do joelho.