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Arai T1
1Faculty of Health Sciences, Mejiro University, Department of Physical Therapy, Saitama, Japan
Background: A new clinical assessment of maximum joint angular velocity (AV) during knee extension (KE) is strongly related to locomotive ability. Due to the superior utility of the gyroscope relative to an isokinetic device, we highly recommend the use of this assessment in community-based rehabilitation settings. Despite these prospects, there are no investigations into the relationship between the assessment and experiences of fall(s) and fear of falling in the community-dwelling frail elderly.
Purpose: This study aimed to investigate the relationship between AV during KE and falls and fear of falling in the community-dwelling frail elderly.
Methods: The study subjects were 204 community-dwelling frail elderly. Outcome measures included the experience of fall(s) and a modified fall efficacy scale (MFES) as dependent variables. AV during KE, isometric strength (IS) of KE, hand-grip strength (HS), 5-m maximum walk time (MWT), 5-m normal walk time (NWT), TUG, one leg standing time, and functional reach test were evaluated. To measure AV of the tibia against the thigh, a gyroscope was fixed on the distal end of the dominant limb. Subjects were asked to distally extend the knee of the dominant leg as quickly as possible. The paired t-test or Wilcoxon signed-rank test was used for examining the differences in average AV and other physical functions between fallers and non-fallers. The relationship between physical functionality and MFES were evaluated by the age-adjusted partial correlation coefficient. To extract the physical functions contributing to MFES, multiple linear regression analysis using the step-wise method was performed.
Results: Eighty-nine (46.3%) subjects had experienced at least one fall over the past year. Results of comparison of the average of physical functions revealed significant differences between fallers vs. non-fallers in MWT (fallers: 3.65 sec ± 1.4 vs. non-fallers: 3.22 ± 0.6 s (P 0.01)), NWT (5.17 ± 2.1 s vs. 4.52 ± 0.9 s (P 0.01)), and TUG was 7.87 ± 3.6 s vs. 6.78 ± 1.4 s (P 0.01). MFES was significantly correlated with MWT (r = −0.25, P 0.01), NWT (r = −0.25, P 0.01), and TUG（r = −0.23, P 0.01), but not with AV. Multiple linear regression analysis showed NWT as a contributing factor (R2 = 0.05, β = −0.221), but not AV.
Conclusion(s): Our study revealed that locomotive ability was strongly related with experience of fall(s) and fear of falling. Conversely, there was no significant relationship between AV or IS and fall(s) and fear of falling. Although AV is related with locomotive ability, it is difficult to understand the study results. Various factors, such as environment, are believed to be related to fall(s) among frail elderly, which could be a reason underlying the insignificant relationship between muscle function of lower extremities and fall(s). In future, prospective or intervention studies are required to accurately determine the relationship between muscle power of lower extremities and fall.
Implications: In geriatric field, assessing the AV of KE is essential. Our simplified methodology could easily be performed in clinical settings. The relationships between AV and fall(s) should be assessed by prospective studies.
Keywords: Muscle power, fall, fear of falling
Funding acknowledgements: This work was not funded by any foundation or company.
Purpose: This study aimed to investigate the relationship between AV during KE and falls and fear of falling in the community-dwelling frail elderly.
Methods: The study subjects were 204 community-dwelling frail elderly. Outcome measures included the experience of fall(s) and a modified fall efficacy scale (MFES) as dependent variables. AV during KE, isometric strength (IS) of KE, hand-grip strength (HS), 5-m maximum walk time (MWT), 5-m normal walk time (NWT), TUG, one leg standing time, and functional reach test were evaluated. To measure AV of the tibia against the thigh, a gyroscope was fixed on the distal end of the dominant limb. Subjects were asked to distally extend the knee of the dominant leg as quickly as possible. The paired t-test or Wilcoxon signed-rank test was used for examining the differences in average AV and other physical functions between fallers and non-fallers. The relationship between physical functionality and MFES were evaluated by the age-adjusted partial correlation coefficient. To extract the physical functions contributing to MFES, multiple linear regression analysis using the step-wise method was performed.
Results: Eighty-nine (46.3%) subjects had experienced at least one fall over the past year. Results of comparison of the average of physical functions revealed significant differences between fallers vs. non-fallers in MWT (fallers: 3.65 sec ± 1.4 vs. non-fallers: 3.22 ± 0.6 s (P 0.01)), NWT (5.17 ± 2.1 s vs. 4.52 ± 0.9 s (P 0.01)), and TUG was 7.87 ± 3.6 s vs. 6.78 ± 1.4 s (P 0.01). MFES was significantly correlated with MWT (r = −0.25, P 0.01), NWT (r = −0.25, P 0.01), and TUG（r = −0.23, P 0.01), but not with AV. Multiple linear regression analysis showed NWT as a contributing factor (R2 = 0.05, β = −0.221), but not AV.
Conclusion(s): Our study revealed that locomotive ability was strongly related with experience of fall(s) and fear of falling. Conversely, there was no significant relationship between AV or IS and fall(s) and fear of falling. Although AV is related with locomotive ability, it is difficult to understand the study results. Various factors, such as environment, are believed to be related to fall(s) among frail elderly, which could be a reason underlying the insignificant relationship between muscle function of lower extremities and fall(s). In future, prospective or intervention studies are required to accurately determine the relationship between muscle power of lower extremities and fall.
Implications: In geriatric field, assessing the AV of KE is essential. Our simplified methodology could easily be performed in clinical settings. The relationships between AV and fall(s) should be assessed by prospective studies.
Keywords: Muscle power, fall, fear of falling
Funding acknowledgements: This work was not funded by any foundation or company.
Topic: Outcome measurement; Older people; Musculoskeletal: lower limb
Ethics approval required: Yes
Institution: The Society of Physical Therapy Science
Ethics committee: Resarch Ethics Committe of The Society of Physical Therapy Science
Ethics number: SPTS2009008
All authors, affiliations and abstracts have been published as submitted.
