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To describe admission and discharge characteristics of participants admitted to prosthetic rehabilitation following a lower limb amputation and determine changes in participant characteristics including if the population has gotten older over time at admission. A retrospective chart audit of consecutive admissions to an amputee rehabilitation program. Study criteria were transtibial level LLA and above and ≥ 18 years old. Admission characteristics included: age, Montreal Cognitive Assessment (MoCA), Functional Comorbidity Index (FCI) and days between amputation surgery and admission. Discharge characteristics included the L -Test of Functional Mobility (L-Test), 2-Minute Walk Test (2MWT), 6-Minute Walk Test (6MWT), and Activities-specific Balance Confidence (ABC) scale. Multivariable linear regression modelling quantified the association between participant characteristics and admission time. A total of 601 participants (62.3 ± 14.1 years) were included, 63 were (84.9 ± 3.7 years) aged 80 and over. FCI scores [β = 70.34, (95% CI: 20.93, 119.74), p = 0.005] and days between amputation surgery [β = −0.08, (95% CI: −0.13, −0.02), p = 0.011] were independently associated with admission time. People with an LLA are presenting with a higher number of comorbidities at admission over time while being admitted faster from amputation surgery. Future research should investigate the impact of these changing characteristics on rehabilitation outcomes to better assist this population. It is expected that the rate of inpatient prosthetic rehabilitation admissions due to lower limb amputations will increase amongst those over eighty. An analysis of participant characteristics of people admitted to inpatient prosthetic rehabilitation over time will inform modification and developments to future programs. Future prosthetic rehabilitation programs should consider an increased number of comorbidities when developing prognostic expectations for participants. A shortened interval between amputation surgery and admission should be considered when developing prosthetic rehabilitation programs. [ABSTRACT FROM AUTHOR]

Background: There has been a continuing trend toward decreasing the length of hospital stay for patients undergoing total hip arthroplasty (THA). We aimed to investigate the impact of timing of discharge on gait and patient-reported outcomes early after THA. Methods: In this prospective observational cohort study conducted from May 2014 to November 2015, we measured gait velocity, stride length, single-limb support and single-limb support symmetry in adults aged 18-75 years before direct anterior THA, at discharge from the hospital, and 2, 6 and 12 weeks postoperatively. All procedures were performed by a single surgeon. Patients were discharged on the same day as surgery (outpatient group) or stayed at least 1 night in hospital (inpatient group). Participants also completed the Timed Up and Go test (all postoperative time points) and a series of questionnaires (Western Ontario and McMaster Universities Osteoarthritis Index [6 and 12 wk], 12-Item Short Form Health Survey [2, 6 and 12 wk], Harris Hip Score [12 wk] and a pain visual analogue scale [all postoperative time points]). Results: Thirty-six participants were enrolled in the study, of whom 16 were outpatients and 20 were inpatients. The mean pain rating at the time of discharge was lower in the outpatient group than in the inpatient group (adjusted mean difference -1.5, 95% confidence interval-3.0 to 0.0). We found no other significant differences between the groups for any gait, patient-reported or surgical outcome. Conclusion: There were no statistically significant differences in gait or patient-reported outcomes after direct anterior THA between patients who stayed overnight and those who were discharged as outpatients. Patients discharged as outpatients were younger than those who stayed overnight. Our results suggest that discharging patients as an outpatient after direct anterior THA may have a similar impact on patient function and outcomes as a standard overnight stay in hospital. Contexte: La tendance a reduire la duree de l'hospitalisation des patients soumis a une intervention pour prothese totale de la hanche (PTH) se maintient. Nous avons voulu evaluer l'impact du moment du conge sur la demarche et sur les parametres rapportes par les patients peu de temps apres la PTH. Methodes: Au cours de cette etude de cohorte observationnelle prospective realisee entre mai 2014 et novembre 2015, nous avons mesure la vitesse de la deambulation, la longueur de la foulee, l'equilibre sur une jambe et sa symetrie chez des adultes de 18 a 75 ans avant une PTH anterieure directe, au moment du conge hospitalier et 2, 6 et 12 semaines apres l'intervention. Toutes les interventions ont ete effectuees par 1 seul chirurgien. Les patients recevaient leur conge le jour meme de l'operation (groupe de patients ambulatoires) ou sejournaient au moins 1 nuit a l'hopital (groupe de patients hospitalises). Les participants effectuaient aussi un test de lever-marcher chronometre (Timed Up and Go test) a toutes les evaluations postoperatoires, et on leur administrait une serie de questionnaires: score WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) a 6 et 12 semaines, SF-12 (12-Item Short Form Health Survey) a 2, 6 et 12 semaines, score de hanche de Harris a 12 semaines et echelle visuelle analogique d'intensite de la douleur a toutes les evaluations postoperatoires. Resultats: Trente-six participants ont ete inscrits a l'etude, dont 16 dans le groupe ambula-toire et 20 dans le groupe hospitalise. L'evaluation moyenne de la douleur au moment du conge etaient moindre dans le groupe de patients hospitalises (difference moyenne ajustee -1,5, intervalle de confiance de 95 %-3,0 a 0,0). Nous n'avons observe aucune autre difference significative entre les groupes pour la demarche et les parametres autorapportes ou operatoires. Conclusion: Nous n'avons observe aucune difference statistiquement significative entre les groupes aux plans de la demarche ou des parametres autorapportes apres la PTH anterieure directe selon que les patients avaient sejourne 1 nuit a l'hopital ou qu'ils avaient recu leur conge le jour meme. Les patients non hospitalises etaient plus jeunes que les patients hospitalises. Selon nos resultats, l'impact sur le fonctionnement et sur les parametres des patients pourrait etre le meme, que ces derniers recoivent leur conge hospitalier le jour meme ou le lendemain., Total hip arthroplasty (THA) is a successful procedure for the treatment of osteoarthritis. Length of stay after this procedure continues to decrease, and some institutions have started to perform THA [...]

This article discusses the relationship between mild cognitive impairment (MCI) and falls in older adults. MCI is a transitional state between normal cognitive changes associated with aging and dementia. The prevalence of MCI increases with age but is unaffected by sex. People with MCI have an increased risk of falls compared to cognitively healthy individuals, with at least 40% falling once each year. The study found that cognitive decline was associated with falls in cognitively normal individuals, while physical decline was associated with falls in the overall sample. The findings suggest that fall prevention interventions should be offered to all older adults, regardless of cognitive status, and should target improving and maintaining mobility. Rehabilitation professionals should be aware of the trajectory of changes in both cognitive and physical domains to provide appropriate interventions. [Extracted from the article]

Purpose: To determine gait aid use and decision-making related to usage in people with dementia, and examine factors influencing (1) gait aid use or not; and (2) falls in past year. Materials and methods: A survey of informal carers of older people with dementia in the community. Closed questions on gait aid use, falls, timing and sources of gait aid acquisition, and advice received to support use were used. Chi-squared tests (Fisher's Exact) compared: (1) gait aid users vs non-users and carers' report of (i) unsteadiness in walking/turning, (ii) dementia severity, (iii) falls in past year, and (2) fallers vs non-fallers and (i) timing of gait aid commencement relative to dementia diagnosis, (ii) whether health professional advice was received regarding use, and iii) regularity of use. Results: Forty-seven completed surveys, 63.8% of care recipients used a gait aid; 56.9% had >2 falls in past year; 66.7% commenced use after dementia diagnosis; 25% acquired their aids from non-health professionals; and 37% did not receive advice regarding use. Gait aid users and non-users differed on carer ratings of unsteadiness in walking/turning (p=0.02). Conclusion: Carers reported important aspects regarding gait aid acquisition, safe gait aid use and benefits which warrant further investigation. [ABSTRACT FROM AUTHOR]

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Introduction: More than 52.4% of people with a lower extremity amputation (PLEA) will fall at least once each year. Previously established standardized scales that evaluate a concern for falling (CFF) were developed primarily among community‐dwelling older adults. The reliability of commonly used scales to evaluate a CFF among PLEA is needed. Objective: To evaluate test‐retest relative and absolute reliability, and agreement of the Modified Survey of Activities and Fear of Falling in the Elderly (mSAFFE), Falls Efficacy Scale ‐ International (FES‐I), Consequences of Falling (COF) Scale, Perceived Control Over Falling (PCOF) Scale, and Perceived Ability to Manage Falls (PAMF) Scale among PLEA. Design: Web‐based cross‐sectional repeated‐measures study. Setting: Rehabilitation hospital. Participants: Adults with a transtibial or transfemoral level amputation, who had completed a prosthetic rehabilitation program, and at minimum of 1 year using a prosthesis for ambulation were recruited after regularly scheduled appointments (N = 22, mean age ± SD, 63.5 ± 12.9 years). Interventions: Not applicable. Main Outcome Measure(s): Initial and re‐test scores on the mSAFFE, FES‐I, COF, PCOF, and PAMF. Results: Intraclass correlation coefficients (ICCs) demonstrated excellent relative reliability of the mSAFFE (ICC = 0.92, 95% confidence interval [CI]: 0.82‐0.97), good relative reliability of the FES‐I (ICC = 0.87, 95% CI: 0.70‐0.94), and fair relative reliability of the COF (ICC = 0.78, 95% CI: 0.53‐0.90) and PAMF (ICC = 0.73, 95% CI: 0.46‐0.88) scales. The ICC value of the PCOF scale could not be validly calculated and was not further analyzed. Calculated standard error of measurement values for the mSAFFE, FES‐I, COF, and PAMF scales were small in magnitude, and Bland‐Altman graphs demonstrated good agreement of initial and re‐test scores for all scales. Conclusion: This study provides initial evidence on the suitability and reliable use of the mSAFFE, FES‐I, COF, and PAMF scales within this population. Further evaluation of the validity of these scales is needed. [ABSTRACT FROM AUTHOR]

Background: The prevalence of falls and related injuries is double in older adults with cognitive impairment compared with cognitively healthy older adults. A growing body of literature shows that falls prevention interventions in the cognitively impaired are difficult to implement and that the feasibility and adherence to interventions depend on a number of factors including informal caregiver involvement. However, no systematic review exists on the topic. Objective: Our objective is to determine whether involvement of informal caregivers can reduce falls in older adults with cognitive impairment. Methods: Rapid review following Cochrane collaboration guidelines. Results: Seven randomized controlled trials were identified involving 2,202 participants. We identified the following areas where informal caregiving may have an important role in fall prevention in older adults with cognitive impairment: 1) enhancing adherence to the exercise program; 2) identifying and recording falls incidents and circumstances; 3) identifying and modifying possible environmental falls risk factors inside patient's home; and 4) playing an active role in modifying lifestyle in terms of diet/nutrition, limiting antipsychotics, and avoiding movements risking falls. However, informal caregiver involvement was identified as an incidental finding in these studies and the level of evidence ranged from low to moderate. Conclusion: Informal caregiver involvement in planning and delivering interventions to reduce falls has been found to increase the adherence of individuals with cognitive impairment in falls prevention programs. Future research should address whether involvement of informal caregivers may improve efficacy of prevention programs by reducing the number of falls as a primary outcome. [ABSTRACT FROM AUTHOR]