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Study Design This is a cross-sectional observational study. Background Reference equations for describing hand-grip strength across the age span were derived from the 2011 NIH Toolbox norming study. Purpose The purpose of this study was to cross-validate reference equations by evaluating its predicting power on a separate, independent data set from the 2011-2014 National Health and Nutrition Examination Survey (NHANES) study Methods Observed hand-grip strength data from 13,676 noninstitutionalized participants were obtained from the NHANES study. Best values (best from 3 trials) and the mean values (averaged from 3 trials) were determined for each hand. Using the age (yr), height (m), and weight (kg), we computed predicted grip strength values for dominant and nondominant hands using the reference equations. For validation, three predictability measures: the correlation coefficient, residuals, and accuracy, were used along with the Bland-Altman plot. Results The predicted values highly correlated with observed values (r = 0.90, ICC = 0.89). In predicting best values, means (SD) of residuals were 1.41 (5.57) and 1.03 (5.44) kg for dominant and nondominant hands, respectively. In predicting mean values, means (SD) of residuals were −0.23 (5.42) and −0.54 (5.31) kg for dominant and nondominant hands, respectively. Root mean square error ranged from 4.10 (female's nondominant mean values) to 6.74 (male's dominant best values). About 5.56% fell outside of the 95% confidence interval of the prediction. Conclusions We acknowledged that the two studies' hand-grip protocols (NIH Toolbox, NHANES) were different. Results provided the preliminary predicting performance of the reference equations derived from the NIH Toolbox study.

Translating and implementing research exercise programs that fit into the context of community service provisions could become part of the effort to reduce late-life disability. The purpose of this study was to examine the feasibility of a staff-led 3-Step Workout for Life program by applying a logic model in a local senior living community. The academic investigator and community fitness staff worked together to modify and implement the program protocol following the logic model. The community staff recruited residents and delivered the program. Residents were eligible if they were sedentary, showed muscle weakness, and experienced difficulty in performing activities of daily living. Feasibility was evaluated with program completion and attendance rates, adverse events, physical performance, and activities of daily living. Seventeen residents (mean age = 80 years) enrolled and 13 completed the program with an average attendance rate of 95%. No severe adverse events were reported. After program completion, participants' muscle strength and gross motor coordination of the upper extremity, as well as performance and satisfaction of activities of daily living were improved. This study supported the feasibility of the staff-led 3-Step Workout for Life program to promote independence for residents at risk of late-life disability in a senior living community.

Older adults with reduced physical capacity are at greater risk of progression to care dependency. Progressive resistance strength exercise and multimodal exercise have been studied to restore reduced physical capacity. To summarize the best evidence of the two exercise regimes, this meta-analysis study appraised randomized-controlled trials from published systematic reviews. Medline, Embase, and the Cochrane Database of Systematic Review and Cochrane Central Register of Controlled Clinical Trials were searched for relevant systematic reviews. Two reviewers independently screened the relevant systematic reviews to identify eligible trials, assessed trial methodological quality, and extracted data. RevMan 5.3 software was used to analyze data on muscle strength, physical functioning, activities of daily living, and falls. Twenty-three eligible trials were identified from 22 systematic reviews. The mean age of the trial participants was 75 years or older. Almost all multimodal exercise trials included muscle strengthening exercise and balance exercise. Progressive resistance exercise is effective in improving muscle strength of the lower extremity and static standing balance. Multimodal exercise is effective in improving muscle strength of the lower extremity, dynamic standing balance, gait speed, and chair stand. In addition, multimodal exercise is effective in reducing falls. Neither type of exercise was effective in improving activities of daily living. For older adults with reduced physical capacity, multimodal exercise appears to have a broad effect on improving muscle strength, balance, and physical functioning of the lower extremity, and reducing falls relative to progressive resistance exercise alone.

Study Design This is a cross-sectional, observational study. Introduction The disability of the arm, shoulder and hand (DASH) questionnaire is an upper-extremity specific outcome measure commonly used in routine clinical care and clinical trials. Purpose of the Study Our purposes were to: (1) examine the psychometric properties of the DASH questionnaire using factor analysis, one- and two-parameter item response theory models, and (2) develop a functional staging map illustrating the relationships between the item difficulty hierarchy of the DASH items and the patient's DASH total score. Methods Data from 2724 patients with orthopedic shoulder impairments seeking outpatient physical therapy in 79 clinics in the US were analyzed. Results Factor analysis supported a general factor, explaining 62.2% of the total variance. The coverage of DASH items was suitable for patients with shoulder impairments with no ceiling or floor effect. Endorsed items representing the most difficult items were related to feeling less capable, executing recreational activities with force or impact, and performing recreational activities in which you move your arm freely. Items with higher discriminating abilities were those related to do heavy household chores, garden/yard work, and change a light bulb overhead. With a separation index equaled to 4.94, the DASH can differentiate persons into at least 6 statistically distinct person strata. None of the DASH items exhibited differential item functioning by gender or symptom acuity, except two items by age group. Discussion Besides a total (summed) final score obtained from a specific measure, the keyform and functional staging plots/maps can be used to assist clinicians in clinical interpretation of the scores. Conclusions Results supported the clinical usage of the DASH questionnaire in patients with orthopedic shoulder impairments seeking outpatient rehabilitation.

The purpose of this feasibility study was to evaluate the 3-Step Workout for Life program, a 10-week exercise program that included moderate-intensity muscle strength training followed by task-oriented training. Fourteen participants completed the program (mean age = 73 years; SD = 6.83). The Box and Block test (Z = −2.24, p = .03) and the 30-s chair stand test (Z = − 2.21, p = .03) indicate improved physical functioning of the upper and lower extremities. More importantly, results of the function component from the Late-Life Function and Disability Instrument (Z = –2.04, p = .04) and motor skills scale from the Assessment of Motor and Process Skills (Z = −2.97, p = .003) indicate subjective and objective improvements on performing activities of daily living. Supplementing moderate-intensity muscle strength exercise with task-oriented training components is feasible. Preliminary data support the effectiveness of 3-Step Workout for Life in reducing late-life disability.

Date Presented 03/26/20 The study examined Medicare quality-measure data to determine the amount of rehabilitation services needed (e.g., therapy intensity and the length of stay) to maximize the improvement in self-care skills for older adults with an orthopedic hip condition in skilled-nursing facilities. Findings of the study can serve as a reference for OTs to plan intervention and justify the resources necessary to increase clients’ independence. Primary Author and Speaker: Chiung-ju (CJ) Liu Additional Authors and Speakers: Christine Kroll Contributing Authors: Courtney Hayden, Craig Wright, Erin Ingram, Lauren Barr, Niki Pierson, Ashley Suda

The challenge of using exergames to promote physical activity among cancer survivors lies in the selection of the exergames that match their fitness level. There is a need for a standardized grading scheme by which to judge an exergame’s capacity to address specific physical fitness attributes with different levels of physical engagement. The study aimed to develop an Exergame Grading Scheme and preliminarily evaluate its psychometric properties. Fourteen (14) items were created from the human movement and exergame literature. The content validity index (CVI) was rated by content experts with two consecutive rounds (N=5 and N=3 independently). The interrater reliability (IRR) was determined by two raters who used the Exergame Grading Scheme to determine the grading score of the five exergames performed by two cancer survivors (N=10). Each item had a score of 1 for item-level CVI and 1 for k. For IRR, 9 items had rho values of 1, 1 item had 0.93, and 4 items had between 0.80 and 0.89. This valid and reliable Exergame Grading Scheme makes it possible to develop a personalized physical activity program using any type of exergame or fitness mobile application in rehabilitation practice to meet the needs of cancer survivors.

Aims: To describe and determine factors predicting utilization of occupational and physical therapy (PT) services in postacute rehabilitation systems over a 1-year period in Medicare beneficiaries. Methods: Data from 1,667 respondents in the 2006 Health and Retirement Study and linked Medicare claims were analyzed. Results: The average length of inpatient rehabilitation stay ranged between 11 and 17 days. Therapeutic procedures were the most commonly claimed Current Procedural Terminology (CPT) codes in outpatient rehabilitation. Very-high level was the mostly claimed resource utilization group (RUG) in skilled nursing facilities. Additionally, the average number of therapy home visit ranged between 31 and 34. Logistic regression analysis showed that greater age and more comorbidities were associated with using therapy services from two or more postacute care (PAC) systems. Conclusion: The study results increase the understanding of the utilization of rehabilitation therapy services across PAC sys...

The purpose of this study is to understand current practice of patient education by occupational therapy practitioners who work with the geriatric population. A 30-item survey was sent to 97 practitioners in the Indianapolis area. Seventy-eight (80.4%) returned the survey. Respondents reported that activities of daily living and safety were two topics taught most frequently. Verbal instructions and demonstrations were two main strategies of patient education. Clients’ cognitive function was the biggest factor considered when providing written information. Most respondents used written materials developed by their facilities. Over half of the respondents perceived that clients sometimes had difficulty understanding educational content. Time constraints and limited resources of educational materials were two main barriers to patient education. The majority of practitioners reported that they needed education materials that cover the topic of safety. Further research on developing effective and effic...

Age-related decline in muscle strength affects both upper and lower extremities. This decline is associated with late-life onset of physical disability. Although progressive resistance strength training (PRT) has shown promising results in lower-extremity-related physical function, such as walking speed, little is known about the effect on upper-extremity-related physical function. This study reviewed 28 randomized controlled trials published before 2008. Outcomes of upper-extremity muscle strength, hand-grip strength, eye–hand coordination, and physical function were appraised. It is hard to conclude whether or not upper-extremity PRT is beneficial for upper-extremity-related physical function in older adults because the specific effect of upper extremities was often unmeasured, poorly measured with timed tests, or buried in mixed results of upper and lower extremities. Additional research that focuses on examining the effect of upper-extremity PRT is recommended to support the need for a compreh...

The decline of muscle strength is associated with physical disability in late adulthood. Progressive resistance strength training has been demonstrated to be an effective intervention to increase muscle strength, however, its effect on reducing physical disability in older adults is unclear. The purpose of this study is to examine the effect of progressive resistance strength training on physical disability via meta-analysis.Two reviewers independently searched for qualified trials, assessed trial quality and extracted data. Trial inclusion criteria are: (1) Randomised controlled trials, (2) Mean age of participant sample is ≥ 60 years, (3) Progressive resistance strength training as the primary intervention and (4) the trial included outcome measures of physical disability (i.e. physical function domain of the Short-Form 36).Thirty-three trials were analysed. Although the effect size is small, the intervention groups showed reduced physical disability when compared to the control groups (SMD = 0.14, 95% CI = 0.05 to 0.22).Progressive resistance strength training appears to be an effective intervention to reduce physical disability in older adults. To maximise the effect, we suggest therapists use responsive outcome measures and multi-component intervention approach.

Objective Knowledge of treatment assignment and failing to analyze results by randomized treatment groups--an intention-to-treat analysis--may cause bias in the treatment effect estimate in randomized controlled trials. This study was undertaken to determine the difference in lower limb muscle strength measured by blinded vs. by unblinded outcome assessors in 73 progressive resistance strength training trials conducted in older adults. Design Retrospective analysis of randomized controlled trials published before 2007. Results Meta-regression analyses showed that trials that used blinded assessors (n = 18) tend to report smaller effect sizes than do those that used unblinded assessors (n = 55), with a difference of -0.80 (95% confidence interval, -1.35 to -0.25). This result still holds even after adjusting for the use of an intention-to-treat analysis, with an adjusted difference of -0.65 (95% confidence interval, -1.26 to -0.04). The reported effects were exaggerated in trials that used unblinded assessors. Conclusions This study suggests that assessor blinding is important and is a safeguard to the internal validity of exercise trials in older adults.

Liu C, Latham N. Adverse events reported in progressive resistance strength training trials in older adults: 2 sides of a coin. Objectives To summarize adverse events reported in randomized controlled trials that applied progressive resistance strength training in older adults and to examine factors that might be associated with these events. Design After systematic searches of databases, 2 reviewers independently screened and extracted adverse event–related information from identified trials. Setting Not applicable. Participants Older adults 60 years of age and above (N = 6700). Intervention Muscle strength training exercise that increases load gradually. Main Outcome Measures Adverse events and reasons for dropout. Adverse events include any undesirable outcomes that may be directly related or unrelated to the intervention. Results Among 121 trials identified, 53 trials provided no comments about adverse events, 25 trials reported no adverse events occurred, and 43 trials reported some types of adverse events. Most adverse events reported were musculoskeletal problems such as muscle strain or joint pain. Adverse events were reported more often in trials that recruited participants with certain health conditions, functional limitations, or sedentary lifestyle; in trials that applied high intensity; and in trials that were published after the 2001 Consolidated Standards of Reporting Trials statement had been published. Reasons reported for dropout in 58 trials might be related to adverse events. The most frequent reasons for dropout were illness or medical problems. Conclusions Adverse events may be underreported because there is no consensus on the definition. Reporting adverse events associated with progressive resistance strength training in older adults is informative for practitioners to translate clinical research to clinical practice by knowing both the benefits and risks. Future trials should clearly define adverse events and report them in the published article.