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Objective To investigate the impact of a 12-week exercise programme in addition to usual care for post-traumatic stress disorder ( PTSD). Method An assessor-blinded randomized controlled trial was conducted among 81 participants with a DSM- IV- TR diagnosis of primary PTSD. Participants were recruited after admission to an in-patient programme at a private hospital. Participants were randomized to receive either usual care ( n = 42), or exercise in addition to usual care ( n = 39). The exercise intervention involved three, 30-min resistance-training sessions/week and a pedometer-based walking programme. Usual care involved psychotherapy, pharmaceutical interventions, and group therapy. Primary outcome was PTSD symptoms assessed via the PTSD checklist-civilian version ( PCL-C). Secondary outcomes included symptoms of depression, anthropometry, physical activity, mobility, strength, and sleep quality. Results Participants had a mean ( SD) age of 47.8 years (12.1), 84% male. PTSD symptoms in the intervention group significantly reduced compared with the usual care group (mean difference = −5.4, 95% CI −10.5 to −0.3, P = 0.04, n = 58). There were significant between-group differences at follow-up for depressive symptoms, waist circumference, sleep quality, and sedentary time. Conclusion This study provides the first evidence that an exercise intervention is associated with reduced PTSD and depressive symptoms, reduced waist circumference, and improved sleep quality. [ABSTRACT FROM AUTHOR]

Objectives: this study aimed to investigate the construct validity and responsiveness of performance-based and self-reported measures of strength, mobility and balance after hip fracture.Design: secondary analysis of clinical trial data.Subjects: a total of 148 older people undergoing hip fracture rehabilitation.Methods: correlation coefficients assessed construct validity. Internal responsiveness was assessed by calculating effect sizes (ES) I and II. Area under the receiver operating characteristic curve (AUC) assessed external responsiveness with change in EuroQol as the reference.Results: correlations between performance-based and self-reported measures were small to medium (strength r = 0.17, mobility r = 0.45 and balance r = 0.37). The most responsive performance-based measures included walking speed (ESI 1.7, ESII 1.2), Physical Performance and Mobility Examination (ESI 1.3, ESII 1.0) and chair-rise test (ESI 1.1, ESII 0.8). Self-reported mobility (ESI 0.8, ESII 0.6) and strength (ESI 0.8, ESII 0.6) were more responsive than self-reported balance (ESI 0.3, ESII 0.2). External responsiveness (AUC) was greatest for walking speed (0.72) and lowest for the measures of body sway (0.53).Conclusion: self-reported and performance-based indices appear to assess different constructs and may provide complementary information about physical functioning in people after hip fracture. Measures of strength and mobility showed greater ability to detect change than measures of balance. [ABSTRACT FROM AUTHOR]

Objective This series of studies was conducted to develop and establish characteristics of exercise videogame play in older adults. The videogame was a modified version of the popular Dance Dance Revolution (DDR; Konomi). Methods Participants aged >=70 were asked to make simple step movements in response to vertically drifting arrows presented on a video screen. Step responses were detected by a modified USB DDR mat, and characteristics of stepping performance such as step timing, percentage of missed target steps and percentage of correct steps were recorded by purpose-built software. Drift speed and step rate of visual stimuli were modified to increase task difficulty. Results Significant linear relationships between stepping performance and stimulus characteristics were observed. Performance of older adults decreased as stimulus speed and step rate were increased. Optimal step performance occurred for a stimulus speed of 17° of visual angle per second and a step rate of one step every 2 s. At fast drift speeds (up to 35°/s), participants were more than 200 ms too slow in coordinating their steps with the visual stimulus. Younger adults were better able to perform the stepping task across a wider range of drift speeds than older adults. Conclusion The findings suggest that older adults are able to interact with video games based upon DDR but that stepping performance is determined by characteristics of game play such as arrow drift speed and step rate. These novel 'exergames' suggest a low-cost method by which older adults can be engaged in exercises that challenge balance and which can be conducted in their own homes. [ABSTRACT FROM AUTHOR]

Objective This series of studies was conducted to develop and establish characteristics of exercise videogame play in older adults. The videogame was a modified version of the popular Dance Dance Revolution (DDR; Konomi). Methods Participants aged ≥70 were asked to make simple step movements in response to vertically drifting arrows presented on a video screen. Step responses were detected by a modified USB DDR mat, and characteristics of stepping performance such as step timing, percentage of missed target steps and percentage of correct steps were recorded by purpose-built software. Drift speed and step rate of visual stimuli were modified to increase task difficulty. Results Significant linear relationships between stepping performance and stimulus characteristics were observed. Performance of older adults decreased as stimulus speed and step rate were increased. Optimal step performance occurred for a stimulus speed of 17° of visual angle per second and a step rate of one step every 2 s. At fast drift speeds (up to 35°/s), participants were more than 200 ms too slow in coordinating their steps with the visual stimulus. Younger adults were better able to perform the stepping task across a wider range of drift speeds than older adults. Conclusion The findings suggest that older adults are able to interact with video games based upon DDR but that stepping performance is determined by characteristics of game play such as arrow drift speed and step rate. These novel “exergames” suggest a low-cost method by which older adults can be engaged in exercises that challenge balance and which can be conducted in their own homes. [ABSTRACT FROM PUBLISHER]

Abstract: Purpose: Muscle strength (force) and power (force × velocity) are reduced in Parkinson''s disease (PD). Reduced muscle power is associated with slower walking velocity and falls in the older population, but these associations in people with PD have not previously been investigated. This study investigated the relationships between leg extensor muscle power and strength with walking speed and past falls in people with PD. Participants and Methods: Forty people with mild to moderate PD were assessed. Walking velocity was measured over 10 m and the number of falls the participant reported having in the past 12 months was recorded. Leg extensor muscle power and strength were measured using a Keiser leg press machine. Results: Muscle power explained more than half of the variance (R 2 = 0.54) in walking velocity and remained significantly (p < 0.05) associated with walking velocity in models which included Unified Parkinson''s Disease Rating Scale (UPDRS) motor scores. Participants with low muscle power were 6 times more likely to report multiple falls in the past year than those with high muscle power (OR = 6.0, 95% CI 1.1 to 33.3), though this association between falls and power was no longer significant in models which included UPDRS motor scores (p = 0.09). Conclusion: Muscle power is a significant determinant of walking velocity in PD even after adjusting for UPDRS motor score. Muscle power training warrants investigation in people with PD. [Copyright &y& Elsevier]

The article discusses the study on the importance of exercise programs in the reduction of falls in old people in the U.S. Findings show that intense exercises developed intentionally for the development of an individual, especially those focusing on the part of balance, are recommended to lessen the chances of falls. Moreover, it also specifically highlights the different types of physical activities complimented for the aid of such aim.

Objective: Falls in older adults are common and may result in serious injury. Inappropriate footwear has been suggested to be a contributing factor to many falls. However no studies have been undertaken to determine whether clinicians can reliably assess footwear variables thought to influence postural stability in older adults. The aim of this study was therefore to develop a simple clinical footwear assessment form and assess its reliability, both between examiners and with repeated assessments over time. Design: Two examiners assessed seven footwear variables (shoe type, heel height, heel counter stiffness, longitudinal sole rigidity, sole flexion point, tread pattern and sole hardness) in 12 different shoes, and repeated the measurements three weeks later. The examiners were blinded to each other’s and their own previous results. Results: Analysis using the kappa (κ) and percentage agreement statistics revealed the examiners’ footwear assessments to be generally highly reliable (κ = 0.47–1.00 for inter-tester comparisons, κ = 0.40–1.00 for intra-tester comparisons), with the exception of inter-tester assessment of sole hardness (κ = 0.03–0.48). Conclusion: The Footwear Assessment Form is a reliable clinical tool for the assessment of shoe type, heel height, heel counter stiffness, longitudinal sole rigidity and tread pattern; however, a more objective protocol may be required to improve the reliability of sole hardness evaluation. The Footwear Assessment Form can now be used with confidence in the clinical setting and in future investigations to determine the contribution of footwear characteristics to instability and falls in older adults. [ABSTRACT FROM AUTHOR]

Introduction/Background Technology may enable a higher dose of exercise to improve rehabilitation outcomes. Aim To evaluate the effect of the addition of affordable technology to usual care on physical activity and mobility in people with mobility limitations admitted to inpatient aged and neurological rehabilitation compared to usual care alone. Material and method A pragmatic, assessor-blinded, parallel-group randomised trial of 300 consenting rehabilitation inpatients. The intervention group received technology-based exercise prescribed by a physiotherapist to target mobility and physical activity problems for 6 months. Technology included video and computer games/exercises, tablet applications and activity monitors. The control group received no additional intervention and both groups received usual rehabilitation care. The co-primary outcomes were objectively assessed physical activity (average minutes per day spent upright using activPAL) and mobility (Short Physical Performance Battery, SPPB, 0–3 continuous score) at 6 months after randomisation. Linear models assessed the effect of group allocation with baseline scores entered as covariates. Results Participants (mean age 74 (SD14); 50% female; 54% with neurological conditions limiting mobility) received on average 11 (SD11) inpatient sessions using 4 (SD1) different technologies and 15 physiotherapy contacts to support technology use in the post-hospital phase. At 6-months physical activity was similar between groups (mean between group difference (95% CI) uptime in minutes: −3.1 (−39.4 to 33.2; P = 0.87)) and mobility was significantly better in the intervention group compared to the control group (mean SPPB between group change score 6-month to baseline 0.2 points (95% CI 0.1 to 0.3, P < 0.01)). Secondary outcomes of mobility also favoured the intervention group as did other aspects of physical activity (e.g. self-reported physical activity), particularly for younger participants. Conclusion A tailored intervention using technology, targeting specific mobility limitations and promoting physical activity in addition to usual rehabilitation, improved mobility and some aspects of physical activity and appears to have greater impact in younger people. [ABSTRACT FROM AUTHOR]

Background: Vigorous Intermittent Lifestyle Physical Activity (VILPA) refers to brief bouts of vigorous intensity physical activity performed as part of daily living. VILPA has been proposed as a novel concept to expand physical activity options among the least active. As a nascent area of research, factors which impede or encourage VILPA in physically inactive adults are yet to be explored. Such information is pertinent in the design of future interventions. We examined the barriers and enablers of VILPA among physically inactive adults using the Capability, Opportunity, Motivation, Behavior (COM-B) model as a conceptual framework. Methods: We recruited a sample of self-identified physically inactive middle-aged and older adults (N = 78) based in Australia to take part in 19 online focus groups across three age groups: young-middle (age 35–44), middle (age 45–59) and old (age 60–76). We analyzed interviews using a critical realist approach to thematic analysis. Identified barriers and enablers were subsequently mapped onto the COM-B model components. Results: The data generated 6 barriers and 10 enablers of VILPA that corresponded to COM-B concepts. Barriers included physical limitations (physical capability), perceptions of aging, need for knowledge (psychological capability), environmental constraints (physical opportunity), perceptions of effort and energy, and fear (automatic motivation). Enablers included convenience, reframing physical activity as purposeful movement, use of prompts and reminders (physical opportunity), normalization of taking the active option, gamification (social opportunity), sense of achievement, health improvements, personally salient rewards (reflective motivation), identity fit, and changing from effortful deliberation to habitual action (automatic motivation). Conclusion: The barriers and enablers of VILPA span capability, opportunity, and motivation beliefs. Promoting the time-efficient nature and simplicity of VILPA requiring no equipment or special gym sessions, the use of prompts and reminders at opportune times, and habit formation strategies could capitalize on the enablers. Addressing the suitability of the small bouts, the development of specific guidelines, addressing safety concerns, and explicating the potential benefits of, and opportunities to do, VILPA could ameliorate some of the barriers identified. Future VILPA interventions may require limited age customization, speaking to the potential for such interventions to be delivered at scale. [ABSTRACT FROM AUTHOR]

Background: the smallest worthwhile effect (SWE) of an intervention is the smallest treatment effect that justifies the costs, risks and inconveniences associated with that health intervention. Objective: to estimate the SWE of exercise programs designed to prevent falls among older people and to compare estimates derived by two methodological approaches. Study design and setting: discrete choice experiment (n = 220) and benefit--harm trade-off (subsample n = 66) methods were used. Participants: community-dwelling older people who reported a past fall or a mobility limitation answered online or face-to-face questionnaires. Results: a substantial proportion of participants (82% in the discrete choice experiment and 50% in the benefit--harm trade-off study) did not consider that participation in the proposed exercise programs would be worthwhile, even if it reduced their risk of falling to 0%. Among remaining participants, the average SWE of participation in an exercise program was an absolute reduction in the risk of falling of 35% (standard deviation [SD] = 13) in the discrete choice experiment and 16% (SD = 11) in the benefit-harm trade-off study. Conclusions: many participants did not consider the hypothetical falls' risk reduction of the proposed exercise programs to be worth the associated costs and inconveniences. Greater community awareness of the fall prevention effects of exercise for older people is required. [ABSTRACT FROM AUTHOR]

Objective: To establish the psychometric properties of a simple ‘low-tech’ choice stepping reaction time test (CSRT-M) by investigating its validity and test–retest reliability. Design: Cross-sectional. Setting: Community. Subjects: A total of 169 older people from the control arm of a clinical trial and a convenience sample of 30 older people. Main measures: Demographic, physical, cognitive and prospective falls data were collected in addition to CSRT-M. The CSRT-M time was taken as the total time to complete 20 steps onto four targets printed on a portable rubber mat. Assessment of the original electronic version (CSRT-E) and re-administration of the CSRT-M the next day was done in 30 participants. Results: Multivariate regression analysis showed that the CSRT-M time was best explained by leaning balance control, quadriceps strength and cognitive functioning (R2 = 0.44). Performance on the CSRT-M was worse in older participants and participants with a presence of fall risk factors, supporting good discriminant validity. The odds of suffering multiple future falls increased by 74% (odds ratio (OR) = 1.74, 95% CI (confidence interval) = 1.14–2.65, p = 0.010) for each standard deviation increase in CSRT-M, supporting good predictive validity. Criterion validity was confirmed by a strong bivariate correlation between CSRT-M and CSRT-E (0.81, p < 0.001). Test–retest reliability for the CSRT-M was good (intraclass correlation coefficient = 0.74, 95% CI = 0.45–0.88, p < 0.001). Conclusions: A simple test of unplanned volitional stepping (CSRT-M) has excellent predictive validity for future falls, good inter-day test–retest reliability and excellent criterion validity with respect to the well-validated CSRT-E. The CSRT-M, therefore, may be a useful fall risk screening tool for older people. [ABSTRACT FROM AUTHOR]

Background: People with Parkinson's disease are twice as likely to be recurrent fallers compared to other older people. As these falls have devastating consequences, there is an urgent need to identify and test innovative interventions with the potential to reduce falls in people with Parkinson's disease. The main objective of this randomised controlled trial is to determine whether fall rates can be reduced in people with Parkinson's disease using exercise targeting three potentially remediable risk factors for falls (reduced balance, reduced leg muscle strength and freezing of gait). In addition we will establish the cost effectiveness of the exercise program from the health provider's perspective.Methods/design: 230 community-dwelling participants with idiopathic Parkinson's disease will be recruited. Eligible participants will also have a history of falls or be identified as being at risk of falls on assessment. Participants will be randomly allocated to a usual-care control group or an intervention group which will undertake weight-bearing balance and strengthening exercises and use cueing strategies to address freezing of gait. The intervention group will choose between the home-based or support group-based mode of the program. Participants in both groups will receive standardized falls prevention advice. The primary outcome measure will be fall rates. Participants will record falls and medical interventions in a diary for the duration of the 6-month intervention period. Secondary measures include the Parkinson's Disease Falls Risk Score, maximal leg muscle strength, standing balance, the Short Physical Performance Battery, freezing of gait, health and well being, habitual physical activity and positive and negative affect schedule.Discussion: No adequately powered studies have investigated exercise interventions aimed at reducing falls in people with Parkinson's disease. This trial will determine the effectiveness of the exercise intervention in reducing falls and its cost effectiveness. This pragmatic program, if found to be effective, has the potential to be implemented within existing community services.Trial Registration: The protocol for this study is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12608000303347). [ABSTRACT FROM AUTHOR]

Editorial. Focuses on iron as cofactor in chronic hepatitis C virus (HCV) infection. Indications of the importance of iron in the pathogenesis of HCV infection; Association between elevated iron indices and increased liver damage from HCV; Distante and colleagues' study of the association between iron indices and outcome of combination therapy with IFN and ribavirin.

Abstract: Background: Reduced muscle power (speed × strength) is associated with increased fall risk and reduced walking speed in people with Parkinson''s disease (PD) as well as in the general older population. This study aimed to determine the relative contribution of motor impairments (bradykinesia, tremor, rigidity and weakness) to reduced leg muscle power in people with PD. Methods: Eighty-two people with PD were tested while “on” medication. Leg extensor muscle strength and muscle power were measured using pneumatic variable resistance equipment. Lower limb bradykinesia, rigidity and tremor were measured using the Movement Disorders Society-sponsored Unified Parkinson''s Disease Rating Scale. Associations between motor impairments and leg muscle power were examined using linear regression. Results: Univariate models revealed that muscle strength (R 2 = 0.84), bradykinesia (R 2 = 0.05) and rigidity (R 2 = 0.05) were significantly associated with leg muscle power, while tremor was not. A multivariate model including bradykinesia, tremor, rigidity, muscle strength, age and gender explained 89% of the variance in leg muscle power. This model revealed reduced muscle strength to be the major determinant of reduced muscle power (β = 0.7), while bradykinesia was a minor contributor to reduced muscle power (β = −0.1), even when accounting for age and gender. Conclusions: The findings that reduced strength and bradykinesia contribute to reduced muscle power in people with PD tested “on” medication suggest that these impairments are potential targets for physical interventions. [Copyright &y& Elsevier]

Background: Many people who suffer a hip fracture do not achieve full functional recovery. Simple tests of physical function such as quadriceps strength and postural sway may provide insight into why this population is at increased risk of experiencing further falls and fractures and assist in developing rehabilitation strategies for preventing falls.Objective: To determine whether impairments in a range of physiological measures and specific medical conditions are more prevalent in people who have suffered a fall-related hip fracture than in a matched sample of community-dwelling people without a history of falls.Methods: This case-control study involved 88 older people. The hip fracture group comprised 44 persons aged 64-94 years, assessed on average 7 months following a fall-related hip fracture. An age- and sex-matched control group (older persons who had not fallen in a 12-month period before recruitment) was drawn randomly from community samples.Results: Compared with the control group, the hip fracture group had markedly reduced quadriceps strength and increased body sway when tested on firm and compliant (foam rubber) surfaces. Patients in the hip fracture group also had higher prevalence rates of poor vision, arthritis and stroke, were taking more medications, were less physically active and perceived themselves to be at greater risk of falling than the control group. No significant differences were apparent for cardiovascular conditions, subjective health status and psychoactive medication use between the groups. Multivariate analyses identified quadriceps strength and body sway on the compliant surface as the most important variables for distinguishing between the hip fracture and no hip fracture groups. These two variables correctly classified 92% of the cases, with equal sensitivity and specificity.Conclusion: The findings identify an increased prevalence of certain physical fall risk factors among older persons who have suffered a hip fracture. Decreased quadriceps strength and increased postural sway are potentially modifiable. Intervention programs designed to improve performance on these variables among this population require investigation. [ABSTRACT FROM AUTHOR]

Summary: This study examined hip fracture hospitalisation trends and predictors of access to rehabilitation for adults aged ≥ 65 years living with and without dementia. The hospitalisation rate was 2.5 times higher for adults living with dementia and adults who lived in aged care were between 4.8 and 9.3 times less likely to receive rehabilitation. Introduction: To examine hip fracture hospitalisation temporal trends, health outcomes, and predictors of access to in-hospital rehabilitation for older adults living with and without dementia. Methods: A population-based retrospective cohort study of adults aged ≥ 65 years hospitalised with a hip fracture during 2007–2017 in New South Wales, Australia. Results: Of the 69,370 hip fracture hospitalisations, 27.1% were adults living with dementia. The hip fracture hospitalisation rate was 2.5 times higher for adults living with dementia compared with adults with no dementia (1186.6 vs 492.9 per 100,000 population). The rate declined by 6.1% per year (95%CI − 6.6 to − 5.5) for adults living with dementia and increased by 1.0% per year (95%CI 0.5–1.5) for adults with no dementia. Multivariable associations identified that adults living with dementia who experienced high frailty and increasing age were between 1.6 and 1.8 times less likely to receive in-hospital rehabilitation. Adults who were living in long-term aged care facilities were between 4.8 and 9.3 times less likely to receive in-hospital rehabilitation which varied by the presence of dementia or delirium. Conclusion: Consistent criteria should be applied to determine rehabilitation access, and rehabilitation services designed for older adults living with dementia or in aged care are needed. Highlights: • Adults living with dementia were able to make functional gains following hip fracture rehabilitation. • Need to determine consistent criteria to determine access to hip fracture rehabilitation. • Rehabilitation services specifically designed for adults living with dementia or in aged care are needed. [ABSTRACT FROM AUTHOR]

The article presents a study which determined the uptake of the 2014 hip fracture core outcome set recommendations of assessing the mortality, mobility, activities of daily living, pain, and health-related quality of life (HRQOL) in patient with hip fracture trials. Topics include the temporal trends in selecting outcome measures in the said trials, and the results showing limited uptake of the recommended domains in the conducted hip fracture trials.

Background and purpose Falls are common in people with Parkinson's disease ( PD) but few data exist on fall-related hospitalizations in this group. This population-based study compared fall-related hospital admissions, injury rates and consequences in people with and without PD, and determined whether PD was an independent predictor of fall-related hospital length of stay. Methods This was a retrospective study using probabilistic linkage of hospital data in people aged ≥65 years hospitalized for a fall between 1 July 2005 and 31 December 2013 in New South Wales, Australia. Rates of hospital admissions and injuries per person admitted over the study period were compared between people with and without PD using Poisson or negative binomial regression. Multilevel linear modelling was used to analyse length of stay by clustering individuals and adjusting for possible confounders. Results There were 342 265 fall-related hospital admissions in people aged ≥65 years during the study period, of which 8487 (2.5%) were for people with PD. Sixty-seven per cent of fall-related PD admissions were associated with injury and 35% were associated with fracture. People with PD had higher rate ratios for fall admissions (1.63, 95% confidence interval 1.59-1.67) and injury (1.47, 95% confidence interval 1.43-1.51) and longer median length of stay [9 (interquartile range 1-27) vs. 6 (interquartile range 1-20) days in people without PD; P < 0.001]. PD remained associated with increased length of stay after controlling for comorbidity, age, sex and injury ( P < 0.001). Conclusions This study provides important benchmark data for hospitalizations for falls and fall injuries for older people with PD, which may be used to monitor the effect of fall prevention programmes. [ABSTRACT FROM AUTHOR]

Summary: Despite the high burden of hip fracture in China, there is limited information on its management. This study investigated the management of hip fractures in a Beijing tertiary hospital and compared practice with that in 180 hospitals in the UK. The findings show a significant gap exists between the countries. Introduction: The purpose of this study was to determine if the management of older people with hip fractures in a Beijing tertiary hospital is comparable with the UK best practice guidelines for hip fracture management and the UK National Hip Fracture Database 2012, obtained from 180 hospitals. Methods: A retrospective audit was undertaken in a large tertiary care hospital in Beijing. Data were compared with the National Hip Fracture Database 2012 collected in 180 hospitals in the UK on the proportion of patients managed according to the UK Blue Book standards. Results: Sixty-six percent of patients were admitted to an orthopaedic ward within 24 h of fracture, while 100 % of patients in the UK were admitted to an orthopaedic ward within 24 h of arrival to an accident and emergency department. Only 8 % of patients received surgery within 48 h of admission compared with 83 % in the UK; 10 % received no surgery compared with 2.5 % in the UK; and 27 % received orthogeriatrician assessment compared with 70 % in the UK. New pressure ulcers developed in 2 % of patients compared with 3.7 % of those in the UK; whereas, 0.3 % of patients were assessed for osteoporosis treatment and 3.8 % received falls assessment, and comparable figures for the UK were 94 and 92 %, respectively. Conclusions: Significant gaps exist in hip fracture management in the Beijing hospital compared with the best practice achieved in 180 UK hospitals, highlighting the need to implement and evaluate proactive strategies to increase the uptake of best practice hip fracture care in China. [ABSTRACT FROM AUTHOR]

Falls among people with intellectual disability (ID) occur at a younger age than the general population and are a significant cause of injury and hospitalisation. There is very limited research investigating risk factors for falls among people with ID and none with people living outside of formal care arrangements, either independently or with their family. We used a medical chart audit to identify the incidence and risk factors for falls among people with ID living in a variety of settings. We retrospectively identified 114 consecutive patients, aged 18 years and over who attended a clinic for people with developmental disabilities within a 15-month period. Fall information was measured by carer recall of falls in the past 12 months. Potential risk factors were extracted from medical reports and a patient information questionnaire. Potential predictors were identified using univariate analysis and entered into a multiple logistic regression. Of 114 participants, 39 (34%) reported a fall in the previous 12 months. The number of reported falls was similar for formal care and non-formal care arrangements. The vast majority of fallers (84%) reported sustaining an injury from a fall and many potential risk factors were identified. Multivariate analysis revealed having seizures in the past 5 years, a history of fracture and increasing age were risk factors for falls. Falls are a significant health concern for adults with ID of all ages as a result of their incidence and the resulting injuries. Falls appear to be equally an issue for people residing in formal and non-formal care accommodation. Further research is needed to develop screening tools and interventions for this population. [ABSTRACT FROM AUTHOR]

Objective: To evaluate whether clinical features associated with head injury in children can be correlated with an abnormal computed tomography (CT) scan.Methodology: Three hundred and eleven children aged 14 years or younger admitted with a diagnosis of acute head injury were studied retrospectively.Results: A Glasgow Coma Scale (GCS) score of 12 or lower and the presence of focal neurological deficits were significant predictors of an abnormal CT scan. Ninety-five per cent of those with abnormal CT scans and 100% of those with intracranial injury could be identified by the presence of one or more of the nine clinical findings, particularly by a GCS score of 12 or lower, and the presence of focal neurological deficits. Identification was also possible to a lesser degree by loss of consciousness, ataxia, amnesia, drowsiness, headache, seizure or vomiting.Conclusion: Use of CT scans can be limited to children with ongoing specific symptoms and/or focal neurological signs. The implementation of guidelines in the management of head injuries in children could have a substantial effect on clinical practice and health-care costs. [ABSTRACT FROM AUTHOR]

Introduction/Background The need for rehabilitation is growing although there are limited resources to meet this demand. Use of affordable technologies to enable health professionals to prescribe and monitor rehabilitation remotely may be one strategy to meet this demand. Aim: to describe physiotherapy support provided to participants using technology to improve mobility and physical activity in the post-hospital phase of the AMOUNT rehabilitation trial ( n = 300). Material and method Process evaluation including participants (mean age 70 (SD 18); 52% male; 54% with neurological conditions limiting mobility) randomised to the intervention group ( n = 149). Intervention was additional to standard rehabilitation, prescribed using a protocol which matched games/exercises from eight technologies to the participant's mobility limitations. Technologies included video and computer games/exercises, tablet applications and activity monitors. Participants were taught to use the technologies during inpatient rehabilitation and were then discharged home to use the technologies ≥ 5 days a week for the remainder of the 6-month trial. Trial protocol required the physiotherapist to provide support every 1–2 weeks using a health coaching approach. Intervention datasheets were audited to determine frequency, duration, mode and type of support provided. Results Participants used on average 2 (SD 1) technologies in the post-hospital phase, with 95% of participants using an activity monitor. Physiotherapists had contact with participants on average 15 (SD 5) times (approximately every 11 days), of which eight were phone calls (11 min duration), six home-visits (46 min duration) and one other. Contact primarily incorporated health coaching (68%) with 8% of contact specifically for technology support. Topics discussed during health coaching included discussing data from prescribed technologies (79%), physical activity and mobility status (70%), adherence (64%) and goal setting (47%). Conclusion A health coaching model to support technology-based rehabilitation post-hospitalisation is feasible. Some support can be provided remotely limiting the need for frequent home visits. [ABSTRACT FROM AUTHOR]