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Background Mobility, cognitive processing, and balance confidence impairments can negatively affect functional mobility in people with Parkinson’s disease (PD). This study aimed to examine the effects of a cognitive dual-task on functional mobility during Timed Up and Go (TUG) sub-phases involving transitions and turns. A secondary aim was to explore whether balance confidence was associated with dual-task interference (DTI) on TUG total duration and sub-phases. Methods A cross-sectional design was employed. Participants completed TUG and TUG-COG (serial three subtractions) and inertial sensors recorded spatiotemporal data on transitions and turns. Paired samples t-tests and corresponding effect sizes (Cohen’s d) were used to compare TUG conditions. Multivariate linear regression assessed the association between balance confidence and DTI on total duration and sub-phases, controlling for gait speed and executive function. Results People with mild-to-moderate PD (N = 94, mean age: 68.7 years) completed TUG-COG 2.7 s slower than TUG (p < 0.001, d = 0.5, DTI = 22.9%). The cognitive task led to reduced performance across TUG sub-phases, with generally stronger effects observed in turning outcomes (d = 0.25–0.45) and comparatively smaller effects observed in postural transitions ( d = 0.02–0.38 ). Balance confidence explained variance in DTI for sit-to-stand duration (B = -−3.560, 95% CI [−5.499, −1.622], p < 0.001), whereas no effect was observed for other sub-phases. Conclusion Dual-tasking impaired nearly all components of the TUG, prolonging total duration and altering spatiotemporal characteristics of transitions and turns. Turning was more strongly impacted by dual-tasking than postural transitions, which has relevance for fall-prevention strategies. Together, the results of this study indicate that clinicians should prioritize turning during dual-task gait training and incorporate assessment of balance confidence to better capture functional capacity in transitional movements such as sit-to-stand.

Background: Lower limb spasticity after stroke is common that can affect the balance, increase the risk of falling, and reduces the quality of life. Objective: First, evaluate the effects of spasticity severity of ankle plantar flexors on balance of patients after stroke. Second, to determine the relationship between the spasticity severity with ankle proprioception, passive ankle dorsiflexion range of motion (ROM), and balance confidence. Methods: Twenty-eight patients with stroke based on the Modified Modified Ashworth Scale (MMAS) were divided into two groups: High Spasticity Group (HSG) (MMAS > 2) ( n = 14) or a Low Spasticity Group (LSG) (MMAS ≤ 2) ( n = 14). The MMAS scores, Activities-Specific Balance Confidence Questionnaire, postural sway of both affected and non-affected limbs under the eyes open and eyes closed conditions, timed up and go (TUG) test, passive ankle dorsiflexion ROM, and ankle joint proprioception were measured. Results: The ankle joint proprioception was significantly better in the LSG compared to the HSG ( p = 0.01). No significant differences were found between the LSG and HSG on all other outcome measures. There were no significant relationships between the spasticity severity and passive ankle dorsiflexion ROM, and balance confidence. Conclusion: The severity of ankle plantar flexor spasticity had no effects on balance of patients with stroke. However, the ankle joint proprioception was better in patients with low spasticity. Our findings suggest that the balance is affected regardless of the severity of the ankle plantar flexor spasticity in this group of participants with stroke.

Chronic heart failure (CHF) is a complex clinical syndrome, associated with frailty, higher fall rates, and frequent hospitalizations. Heart Failure (HF) and preserved ejection fraction (HFpEF) is defined as a condition where a patient with HF have a diagnosis of left ventricular ejection fraction (LVEF) of ≥ 50%. The risk of HFpEF increases with age and is related to higher non-cardiovascular mortality. The aim of this study was to evaluate static balance and examine the effect of task difficulty on the discriminating power of balance control between patients with HFpEF (Patients with HFpEF) and their healthy controls. Moreover, the associations between static balance parameters, balance confidence, falls, lean muscle mass, and strength were assessed. Seventy two patients with HFpEF (mean age: 66.0 ± 11.6 years) and seventy two age- and gender-matched healthy individuals (mean age: 65.3 ± 9.5 years) participated in this study. Participants underwent a 30 s bilateral stance (BS) test and a 20 s Tandem-Romberg stance (TRS) on a force platform, evaluating the Range and Standard Deviation of Center of Pressure (COP) displacement parameters in both axes. Balance confidence was evaluated by the Activities-Specific Balance Confidence (ABC) Scale, and the number of falls during the last year was recorded. Lower limb strength was measured using an isokinetic dynamometer, isometric leg strength, and a Sit-to-Stand test. Bioelectrical impedance analysis was conducted to assess lean fat mass, lean fat mass index, and lean%. Patients with HFpEF presented with lower static balance in BS and TRS compared to healthy controls (p < 0.05), lower balance confidence by 21.5% (p < 0.05), and a higher incidence of falls by 72.9% (p < 0.05). BS was a better descriptor of the between-group difference. Furthermore, static balance, assessed in controlled lab conditions, was found to have little if no relationship to falls, strength, lean muscle mass, and balance confidence. Although no correlation was noted between the static balance parameters and falls, the fall rate was related to balance confidence, age, muscle strength, and lean fat.

Background: Type 2 diabetes mellitus (DM) accounts for the majority (>85%) of all DM cases; these patients have a higher risk of complications and a greater chance of acquiring chronic microvascular diseases, including diabetic neuropathy. It negatively affects the nerve function, leading to altered balance and posture, which demands a protocol to help improve both. Objectives: To study the effect of BEEP on balance, balance confidence, Nerve conduction velocity (NCV) and quality of life using limits of stability (LOS), the modified Clinical Test on Sensory Interaction of Balance (m-CTSIB), Activities-Specific Balance Confidence (ABC) Scale, Nerve conduction study (NCS) and the Short Form-36 (SF-36) questionnaire, respectively. Materials and Methods: The randomized controlled trial was approved by the institutional ethics committee, and informed consent was taken from all the subjects. Eighty-three individuals with diabetes, aged 40-65 years, were screened for diabetic peripheral neuropathy (DPN) using the Michigan Neuropathy Screening Instrument Questionnaire (MNSIQ) and for the risk of falling using the Berg Balance Scale (BBS), and 52 were included. They were randomly allocated by the chit method, and both groups received 3 weeks of intervention. Group A received the BEEP and conventional treatment, and group B received conventional treatment. The outcome measures taken pre- and post-intervention were the LOS, m-CTSIB, ABC scale, NCS, and SF-36 questionnaire. Results: We evaluated 53.84% females and 46.15% males with a mean age of 53 years. Paired t-test and independent t-test were applied for within-group and between-group analysis, respectively. There was a statistically significant difference seen within group A with P < 0.05 for LOS, CTSIB, ABC, NCS, and SF-36. A similar finding was seen in group B, except for NCS (P > 0.05). The between-group comparison showed a significant difference of P < 0.05, which indicated better improvement in group A in all the outcome measures. Conclusion: BEEP has a significant effect on balance, balance confidence, and nerve conduction velocity in patients with DPN. Hence, it can be implemented in the treatment of DPN.

Obesity affects physical functions in numerous ways. We aimed to evaluate the association between obesity and falls, physical performance, and balance confidence in community-dwelling older adults. Using first-year baseline data from the Korean Frailty and Aging Cohort Study, 979 older adults were included. General obesity was defined based on the body mass index and body fat percentage, whereas central obesity was classified based on the waist circumference and waist-to-height ratio. Data regarding fall history and balance confidence were acquired using self-questionnaires, and a timed up-and-go test was performed to measure balance-related physical performance. Overall, 17.3% of participants experienced falls in the previous year. Central obesity, as determined by waist circumference (odds ratio, 1.461; 95% confidence interval, 1.024–2.086; p-value, 0.037) and by waist-to-height ratio (odds ratio, 1.808; 95% confidence interval, 1.015–3.221; p-value, 0.044) was significantly associated with falls. Interestingly, general obesity, measured by body fat percentage, was protective against fall-related fractures (odds ratio, 0.211; 95% confidence interval, 0.072–0.615; p-value, 0.004). Participants with central obesity had poorer physical performances in the timed up-and-go test (odds ratio, 2.162; 95% confidence interval, 1.203–3.889; p-value, 0.010) and lower balance confidence according to the Activities-specific Balance Confidence scale (odds ratio, 1.681; 95% confidence interval, 1.153–2.341; p-value 0.007). In conclusion, assessment of central obesity, particularly waist circumference, should be considered as a screening strategy for falls, and older adults with a high waist circumference should receive advice on fall prevention.

Each year, over 25% of adults aged sixty-five years old or older suffer a fall, and three million are treated for fall-related injuries due to lack of balance. Here, we aimed to investigate how virtual reality (VR)-based training affects balance performance and confidence in older adults. To accomplish this goal, we studied 21 healthy, older individuals between 60 and 85 years old, both pre- and post-training (6 weeks of training, twice per week (or 12 sessions)). The VR group donned an Oculus VR headset and consisted of nine participants (aged 75.9 ± 3.7 years old), while the control group (aged 75.1 ± 6.7 years old) performed training without a headset and consisted of eight participants that completed our study. To assess balance ability, we utilized the Balance Error Scoring System (BESS) and the Timed Up and Go (TUG) test. To assess balance confidence, we implemented the Activities-Specific Balance Confidence (ABC) Scale and, to assess fear of falling, the Tinetti Falls Efficacy Scale (FES). Further, we assessed depression (via the Geriatric Depression Scale (GDS)) and cognitive ability (via the Mini-Mental State Examination (MMSE)). The post-training results showed improvements in balance ability for both the VR and control groups, as well as changes in the relationship between balance confidence and balance ability for the VR group only. Further, improvements in cognitive ability were seen in the control group. This study is an indication that older individuals’ balance ability may benefit from several weeks of targeted training.

Falls are a major public health issue, largely driven by age-related declines in hip and lower limb muscle strength. Hip muscle strength plays a critical role in postural stability and falls prevention. Lower balance confidence increases fall risk by restricting activity participation, which may contribute to muscle weakness over time. This study examined the association between hip abductor and flexor strength and the incidence of injurious falls in older adults and investigated whether hip abductor and flexor strength mediate the relationship between balance confidence and incident injurious falls. Participants (n = 952; aged ≥ 65 years) were drawn from the Geelong Osteoporosis Study (GOS). The outcome was the time to first emergency department presentation for an incident injurious fall. Hip abductor and flexor strength were assessed using a handheld dynamometer to measure hip abduction and flexion force, with strength values adjusted for leg lean mass measured by dual-energy X-ray absorptiometry. Balance confidence was assessed using the 14-item Modified Falls Efficacy Scale (MFES). Associations between hip muscle strength and incident injurious falls were evaluated using a competing risk regression model, which accounted for death as a competing event. The results are expressed as adjusted sub-distribution hazard ratios (aSHR) and 95% confidence intervals. Mediation analysis was conducted to assess whether hip abductor and flexor strength mediated the relationship between balance confidence and the incidence of injurious falls. Among the 952 participants, 38% were women (mean age 76.1 ± 7.3 years), and 62% were men (mean age 76.9 ± 7.0 years). The median follow-up time was 11.5 years (IQR 5.9-19.0). During follow-up, 219 participants (23.0%) experienced at least one injurious fall, corresponding to an incidence rate of 19.3 per 1000 person-years (95% CI: 16.9-22.0). Greater hip abductor strength was associated with a lower risk of incident injurious falls (aSHR = 0.835, 95% CI: 0.724-0.963; p = 0.013), with each 1-N/kg increase in hip abductor strength reducing the sub-distribution hazard by 16.5%. Hip flexor strength was not significantly associated with incident injurious falls. Hip abductor strength accounted for 23.7% of the association between balance confidence and incident injurious falls. Greater hip abductor strength is protective against incident injurious falls in older adults and partially mediates the relationship between balance confidence and injurious falls. Fall prevention strategies should integrate hip abductor strengthening with interventions targeting cognitive and psychological factors, such as improving balance confidence.

Therapeutic goals for hemiplegic patients with neurological impairments are mainly focused on improving their independent lives. Based on the previously reported effectiveness of Wii Fit balance training, this study investigated the most influential outcomes after long-term intensive training (including balance and functional factors) on quality of life in hemiplegic patients. The intervention group (n = 21) received Nintendo Wii Fit balance training under supervision, and control group (n = 20) received conventional balance training by an occupational therapist. Two groups were matched based on age and onset duration. Both groups received a total of 15 treatments for 30 min per session, twice a week for 8 weeks. There were significant improvements not only in balance confidence and activities of daily living, but also in body composition, such as fat proportion and metabolic rate, in the intervention group compared to the control group (p < 0.05). In particular, balance confidence significantly affected EuroQoL Visual Analogue Scale according to stepwise multiple regression analyses in this study. These results demonstrated that Wii Fit balance training using virtual reality improved the quality of life of hemiplegic patients while overcoming the asymmetrical weight distribution of the affected side via the self-modulating biofeedback exercises.

Adherence and participation can be improved in health programs for older people with concerns about falling. While health literacy empowers older people to have greater control over their health, little is known about the extent to which health literacy influences health behaviours associated with concerns about falling in older people. This study aimed to synthesise current findings on health literacy, concerns about falling and falls to propose a multicomponent theoretical model on health literacy and concerns about falling. The model was developed based on a review of the literature, existing frameworks and models on health literacy and concerns about falling. Existing evidence on the relationship between health literacy and concerns about falling in older people is limited. Evidence from other research areas, however, shows that health literacy is closely related to many of the determinants of concerns about falling. More research is needed to clarify the impact of health literacy on intervention adherence and decision-making processes of older people with concerns about falling. Our model offers a novel perspective on the role of health literacy in health behaviours associated with concerns about falling, suggesting new research directions and providing insights for clinicians to consider health literacy when managing older patients with concerns about falling.

Four constructs are encompassed by the term “falls-related psychological concerns” (FrPC); “fear of falling” (FOF), “falls-related self-efficacy” (FSe), “balance confidence” (BC) and “outcome expectancy” (OE). FrPC are associated with negative consequences including physical, psychological, and social. Identifying factors associated with FrPC could inform interventions to reduce these concerns. Sixty-two empirical papers relating to psychological factors associated with FrPC in community-dwelling older people (CDOP) were reviewed. Four levels of evidence were used when evaluating the literature: good, moderate, tentative, and none. Evidence that anxiety predicted FOF, BC, and OE was tentative. Moderate evidence was found for anxiety predicting FSe. Good evidence was found for depression predicting FSe. Moderate evidence was found for depression predicting both FOF and BC. No evidence was found for depression predicting OE. Tentative evidence was found for FSe predicting depression. Good and moderate evidence was found for quality of life (QoL) being predicted by FOF and BC respectively. Tentative evidence was found for FSe predicting QoL. Moderate evidence was found for QoL predicting both FSe and BC. No evidence was found for QoL predicting FOF. Good and moderate evidence was found for activity avoidance/restriction (AA/AR) being predicted by FOF and FSe respectively. Tentative evidence was found for BC and OE predicting AA/AR, as well as for AA/AR predicting FOF. Moderate evidence for activity level (AL) predicting FOF was identified, however the evidence of this predicting FSe and BC was tentative. Evidence for FOF, FSe, and BC predicting AL was tentative as was evidence to suggest FOF predicted coping. Mixed evidence has been found for the association of psychological factors in association with FrPCs. Future research should employ theoretically grounded concepts, use multivariate analysis and longitudinal designs.