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Objective. The authors compared the effects of a standard strength and endurance intervention with a standard plus timing and coordination training intervention on community mobility measured using global positioning systems (GPS) among community-dwelling older adults in this secondary analysis of a randomized controlled trial. Methods. Participants were randomized to a standard or a standard plus timing and coordination training program. Community mobility was measured using the Life Space Assessment (LSA) and GPS indicators of community mobility at baseline, as well as at 12 (immediately after the intervention), 24, and 36 weeks. Linear mixed models were used for analysis. Results. There were 166 participants with GPS data at baseline, including 81 in the standard plus group and 85 in the standard group. The groups did not differ in participant characteristics or GPS measures at baseline. There were no significant within-group changes in GPS indicators of community mobility or LSA score over time, nor between-group differences of the same. Conclusion. There were no significant changes in community mobility with either intervention or between-intervention differences. These findings suggest that interventions targeting physical function alone may not be sufficient to improve community mobility or participation in older adults. Future research should focus on the development of multifaceted interventions targeted to improve real-world participation. Impact. The studied interventions did not significantly change community mobility measured using GPS-derived community mobility measures or self-report measures in older adults, suggesting that more comprehensive interventions may be needed to target improvements in community mobility. Keywords: Activity Monitoring, Mobility, Participation, Rehabilitation, Introduction Community mobility, or the ability to move outside the home to the neighborhood and regions beyond, is necessary for participation in many aspects of life, including physical activity, social, [...]

Objective. The purpose of this study was to determine the association between fear-avoidance beliefs and disability in 3 months in people with vestibular disorders while accounting for demographic and clinical characteristics. Methods. This prospective cohort study included people aged 18 to 100 years who reported dizziness. Participants were recruited from a balance disorders clinic and outpatient physical therapy clinics. All participants completed the Vestibular Activities Avoidance Instrument (VAAI) and the Hospital Anxiety and Depression Scale at baseline and the Vestibular Activities and Participation measure (VAP), dizziness Visual Analogue Scale (VAS), and 12-item Short Form Health Questionnaire at baseline and 3-month follow-up. A modified version of the VAAI included 9 items abstracted from the 81-item VAAI. The relationships between 9-item VAAI scores and follow-up measures of disability were assessed using Spearman correlation coefficients. Linear regression models were analyzed to determine the effect of fear-avoidance beliefs on follow-up VAP score while accounting for baseline outcome measures. Results. All participants (n = 404) completed the baseline assessment (mean age =54 years), and 286 (71%) completed the 3-month assessment. The mean 9-item VAAI score was 25 (SD = 14) at baseline and was significantly associated with VAP ([rho] =0.54), 12-item Short Form Health Questionnaire component scores ([rho] = -0.53; -0.44), and dizziness VAS at followup ([rho] = 0.37). Approximately 38% of the variation in VAP score at follow-up was predicted by age, number of medications, 9-item VAAI score, dizziness VAS, and Hospital Anxiety and Depression Scale-depression score when considered together ([R.sup.2] =0.38). Conclusion. Fear-avoidance beliefs are associated with measures of disability at 3 months and are predictive of activity limitations and participation restrictions at 3 months when controlling for age, medications, baseline dizziness, and depression symptom severity in people with vestibular disorders. Impact. Measurement of fear-avoidance beliefs may provide important prognostic information, suggesting that an assessment of fear-avoidance beliefs could be used by clinicians to identify individuals at greater risk of disability after a vestibular disorder. Lay Summary. Fear-avoidance beliefs in people who have vestibular disorders are associated with disability at 3 months and predict limitations in daily activities at 3 months. Keywords: Avoidance Behavior, Dizziness, Vertigo, Vestibular Rehabilitation, Introduction Fear avoidance is a behavioral response characterized by the avoidance of activities or movement due to fear. (1) Fear of bodily sensations has been associated with chronic dizziness among [...]

Background. Standardized instruments for measuring the intensity of balance exercises in clinical environments are lacking. Objective. The objective of this study was to develop a method for quantifying the perceived intensity of standing balance exercises. Design. A test-retest study design was used, with repeated evaluations within the same visit and between visits 1 week later. Methods. Sixty-two participants who were healthy and 18 to 85 years old (with a mean age of 55 years [SD = 20 years]; 50% women) were enrolled. On each of 2 visits, they performed 2 sets of 24 randomized static standing exercises consisting of combinations of the following factors: surface, vision, stance, and head movement. Postural sway was measured with an inertial measurement unit, and ratings of perceived difficulty (RPD) were recorded using numerical and qualitative scales. The RPD scales were validated against the quantitative sway measures using a general linear model approach. The test-retest reliability of the RPD scales was examined using a weighted kappa coefficient. Results. Both RPD scales were associated with postural sway measures with correlation coefficients > 0.6 for the whole sample. The test-retest reliability of the ratings varied considerably across the different balance exercises, and the highest weighted kappa values occurred for RPD scores on the numerical scale within the second visit, as moderate agreement was achieved in 18 of the 24 exercises. Limitations. The limitations are that the RPD scales need to be validated for other types of balance exercises and in individuals with balance disorders. Conclusions. The RPD scores correlated with the magnitude of postural sway, suggesting that they can be used as a proxy measure of perceived intensity of balance exercises., Targeted balance and vestibular rehabilitation exercises have been shown to improve balance in older adults and people with vestibular disorders. (1-4) Similarly, a number of studies that have investigated interventions [...]