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BACKGROUND Older adults are at increased risk of developing health disorders and functional decline. A comprehen-sive geriatric assessment (CGA) to identify early signs of negative trajectories has enormous potential for patients, society and health care system. However, due to time constraints and considerable effort physicians rarely conduct the CGA. If designed properly, digital technologies could identify health risks already at a pre-clinical stage and thereby facilitate preventive efforts and a targeted intervention. For this purpose, a LiSA (Life-integrated Self-Assessment) tablet system will be developed in a structured co-creation process. OBJECTIVE The aim of the present study was to investigate older adults’ perceptions of (1) different self-assessment domains, (2) components affecting user experience, (3) risks and benefits associated with LiSA, (4) characteristics of potential LiSA users, and (5) the LiSA concept in general. METHODS Ten community-dwelling older adults aged ≥70 years were recruited. Six co-creation workshops were held and started with an expert input followed by semi-structured discussion rounds. Participants per-formed “hands-on” activities with a tablet, including testing of pre-installed self-assessment apps. All workshops were audio-recorded and additionally documented by the researchers using flipcharts, notes, and photos. Qualitative content analysis was used to analyze data following a deductive-inductive approach, guided by the Optimized Honeycomb model for user experience (UX). RESULTS The group (mean age 77.8 ± 5.1 years) was heterogeneous in terms of prior technology experience and health status. The mean workshop duration was two hours and an average of eight participants attend-ed each workshop. Eleven thematic categories were identified, covering results on all research ques-tions. Participants emphasized a strong interest in conducting a digital self-assessment of physical activ-ity and function, sensory and cognitive functions, and requested additional features such as recom-mendations for actions or reminders. LiSA was perceived as an empowerment and a motivator to en-gage in active health care planning as well as to enable shared and informed decision making. Concerns and barriers were lack of technical competence, feelings of frustration and fear of being left alone with negative assessment results. In essence, participants expressed a positive attitude towards using LiSA repeatedly and identified it as an option to increase the chances for maintaining independence when growing old. CONCLUSIONS The co-creation participants supported the LiSA approach and were interested in performing regular self-assessments on a long-term basis. In their opinion LiSA should include relevant assessments captur-ing physical activity and function, sensory and cognitive functions as well as recommendations for ac-tions. It should be customizable to individual needs. These results will form the basis for a prototype. Iterative development and validation will aim to make LiSA accessible in the public domain as a reliable tablet-based system for self-assessment.

Digital health apps have a large potential for autonomous screening and monitoring of older people with respect to maintaining their independence. Due to demographic change and the shortage of specialized personnel in medicine, these premedical self-assessment apps could be of great value in the future.This narrative review enables the assessment of whether a digital geriatric self-assessment for older people ≥ 70 years is feasible using currently available apps.A search was carried out for apps that enable a self-assessment in the following domains: physical capacity, cognition, emotion, nutrition, sensory perception and context factors. Based on predefined criteria apps were selected and presented.Self-assessment apps could be identified in four of the six domains: physical capacity, cognition, emotion and sensory perception. In total five apps are presented as examples. No apps were identified regarding nutrition and context factors. Numerous self-assessment apps were identified for the field of physical activity.The presented results indicate that digital self-assessment can currently be realized for certain domains of the comprehensive geriatric assessment. New promising apps are currently under development. More research is needed to verify test quality criteria and usability of available apps. Furthermore, there is a need for a platform that integrates individual assessment apps to provide users with an overview of the results and recommendations.HINTERGRUND: Digitale Gesundheits-Apps haben ein großes Potenzial für das selbstständige Screening sowie das Monitoring älterer Menschen hinsichtlich der Aufrechterhaltung ihrer Selbstständigkeit. Aufgrund des demografischen Wandels und des Fachkräftemangels in der Medizin könnten diese prämedizinischen Self-Assessment-Apps in Zukunft einen großen Stellenwert einnehmen.Dieses narrative Review soll die Einschätzung ermöglichen, ob ein digitales geriatrisches Self-Assessment für ältere Menschen ≥ 70 Jahren mithilfe aktuell verfügbarer Apps durchführbar ist.Es erfolgte die Recherche nach Apps, die ein Self-Assessment in den folgenden Domänen ermöglichen: physische Kapazität, Kognition, Emotion, Ernährung, Sensorik und Kontextfaktoren. Anhand definierter Kriterien werden Apps ausgewählt und vorgestellt.In 4 der 6 Domänen konnten Self-Assessment-Apps identifiziert werden: physische Kapazität, Kognition, Emotion, Sensorik. Insgesamt 5 Apps werden exemplarisch vorgestellt. Für Ernährung und Kontextfaktoren wurden keine Apps identifiziert. Zahlreiche Self-Assessment-Apps wurden für den Bereich physische Aktivität identifiziert.Zum aktuellen Zeitpunkt ist ein Self-Assessment für einige Domänen des umfassenden geriatrischen Assessments möglich. Weitere vielversprechende Apps befinden sich in der Entwicklungsphase. Insgesamt bedarf es der wissenschaftlichen Überprüfungen der App-Testgütekriterien und App Usability. Darüber hinaus wird eine Plattform benötigt, die die einzelnen Assessment-Apps integriert, um Nutzer*innen einen Überblick über die Ergebnisse zu geben und Empfehlungen abzuleiten.

Background: Understanding the association between motor capacity (MC) (what people can do in a standardized environment), mobility performance (MP) (what people actually do in real-life) and falls is important for early detection of and counteracting on functional decline, particularly in the rapidly growing population of young seniors. Therefore, this study aims to 1) explore the association between MC and MP, and between MC and falls, and 2) investigate whether challenging MC measures are better associated with MP and falls than basic MC measures., Methods: Basic (habitual gait speed, Timed Up-and-Go) and challenging (fast gait speed, Community Balance & Mobility Scale) MC measures were performed in 169 young seniors (61-70 years). MP was assessed using one-week sensor-monitoring including time being sedentary, light active, and at least moderately active. Falls in the previous six months were reported. Associations and discriminative ability were calculated using correlation, regression and receiver operating curve analysis., Results: Mean age was 66.4 (SD 2.4) years (50.6 % women). Small to moderate associations (r = 0.06 - 0.31; p < .001-.461) were found between MC, MP and falls. Challenging MC measures showed closer associations with MP and falls (r = 0.10 - 0.31; p < .001-.461) compared to basic (r = 0.06 - 0.22; p = .012-.181), remained significant in three out of four regression models explaining 2.5-8.6 % of the variance, and showed highest discriminative ability (area under the curve = 0.59 - 0.70) in all analyses., Conclusions: Challenging MC measures are closer associated with mobility performance and falls as compared to basic MC measures in young seniors. This indicates the importance of applying challenging motor capacity assessments in young seniors. On the same note, small to moderate associations imply a need for an assessment of both MC and MP in order to capture the best possible MC and the actual daily-life MP in young seniors.

Background The Community Balance and Mobility Scale (CBM) has been shown to be reliable and valid for detecting subtle balance and mobility deficits in people who are 61 to 70 years of age. However, item redundancy and assessment time call for a shortened version. Objective The objective was to create and validate a shortened version of the CBM (s-CBM) without detectable loss of psychometric properties. Design This was a cross-sectional study. Methods Exploratory factor analysis with data from 189 young seniors (aged 61-70 years; mean [SD] age = 66.3 [2.5] years) was used to create the s-CBM. Sixty-one young seniors (aged 61–70 years; mean [SD] age = 66.5 [2.6] years) were recruited to assess construct validity (Pearson correlation coefficient) by comparing the CBM versions with Fullerton Advance Balance Scale, Timed Up-and-Go, habitual and fast gait speed, 8 Level Balance Scale, 3-m tandem walk, and 30-second chair stand test. Internal consistency (Cronbach α), ceiling effects, and discriminant validity (area under the curve [AUC]) between fallers and nonfallers, and self-reported high and low function (Late-Life Function and Disability Index) and balance confidence (Activities-Specific Balance Confidence Scale), respectively, were calculated. Results The s-CBM, consisting of 4 items, correlated excellently with the CBM (r = 0.97). Correlations between s-CBM and other assessments (r = 0.07-0.72), and CBM and other assessments (r = 0.06-0.80) were statistically comparable in 90% of the correlations. Cronbach α was .84 for the s-CBM, and .87 for the CBM. No CBM-version showed ceiling effects. Discriminative ability of the s-CBM was statistically comparable with the CBM (AUC = 0.66-0.75 vs AUC = 0.65-0.79). Limitations Longitudinal studies with larger samples should confirm the results and assess the responsiveness for detecting changes over time. Conclusions The psychometric properties of the s-CBM were similar to those of the CBM. The s-CBM can be recommended as a valid and quick balance and mobility assessment in young seniors.

Objective: To examine sensitivity to change and responsiveness of the Community Balance and Mobility Scale (CBM) and shortened CBM (s-CBM). Design: Secondary analysis using data of a randomized controlled trial. Setting: General community. Participants: Young community-dwelling seniors aged 61-70 years (N=134; mean age, 66.2±2.5y). Interventions: Participants underwent 12 months of exercise intervention. Main Outcome Measures: CBM and s-CBM. Sensitivity to change was assessed using standardized response mean (SRM) and paired t tests as appropriate. Responsiveness was assessed using 2 minimal important difference (MID) estimates. Analyses were conducted for the full sample and for the subgroups “high-balance” and “low-balance,” divided by median split. Results: Inferential statistics revealed a significant CBM (P

Context Long-term adherence to physical activity (PA) interventions is challenging. The Lifestyle-integrated Functional Exercise programmes were adapted Lifestyle-integrated Functional Exercise (aLiFE) to include more challenging activities and a behavioural change framework, and then enhanced Lifestyle-integrated Functional Exercise (eLiFE) to be delivered using smartphones and smartwatches., Objectives To (1) compare adherence measures, (2) identify determinants of adherence and (3) assess the impact on outcome measures of a lifestyle-integrated programme., Design, setting and participants A multicentre, feasibility randomised controlled trial including participants aged 61-70 years conducted in three European cities., Interventions Six-month trainer-supported aLiFE or eLiFE compared with a control group, which received written PA advice., Outcome measures Self-reporting adherence per month using a single question and after 6-month intervention using the Exercise Adherence Rating Scale (EARS, score range 6-24). Treatment outcomes included function and disability scores (measured using the Late-Life Function and Disability Index) and sensor-derived physical behaviour complexity measure. Determinants of adherence (EARS score) were identified using linear multivariate analysis. Linear regression estimated the association of adherence on treatment outcome., Results We included 120 participants randomised to the intervention groups (aLiFE/eLiFE) (66.3 +/- 2.3 years, 53% women). The 106 participants reassessed after 6 months had a mean EARS score of 16.0 +/- 5.1. Better adherence was associated with lower number of medications taken, lower depression and lower risk of functional decline. We estimated adherence to significantly increase basic lower extremity function by 1.3 points (p, Conclusion PA adherence was associated with better lower extremity function and physical behavioural complexity. Barriers to adherence should be addressed preintervention to enhance intervention efficacy. Further research is needed to unravel the impact of behaviour change techniques embedded into technology-delivered activity interventions on adherence.

Gehen ist kein automatisierter Bewegungsablauf, sondern beansprucht kontinuierlich Aufmerksamkeitsressourcen. Beim Gehen mit zusatzlicher Aufmerksamkeitsanforderung („dual tasking“) treten Gangveranderungen auf, welche bei alteren Menschen mit Sturzen assoziiert sind. Die Beurteilung des Gangbilds unter Dual-task-Bedingungen erfolgt bislang in der Regel wahrend des Geradeausgehens (GG). Der Alltag erfordert jedoch auch komplexere Gangmanover, wie das Kurvengehen (KG). Moglicherweise werden fur solche Gangmanover hohere Aufmerksamkeitsressourcen benotigt und damit das Gangbild unter Dual-task-Bedingungen starker beeintrachtigt. Das Ziel war es, das Gangbild wahrend des GG und KG unter Dual-task-Bedingungen zu vergleichen. Bei 30 zu Hause lebenden alteren Menschen (71,6 ± 6,6 Jahre) wurden die Gangparameter Einbeinstandphase, Geschwindigkeit, Kadenz, Schrittlange und Spurbreite jeweils unter Single- und Dual-task-Bedingung fur das GG und KG uber elektronische Ganganalyse (GAITRite®, CIR Systems Inc., Franklin, New Jersey, USA) untersucht. Fur alle Gangparameter wurden die relativen Veranderungen von der Single- zur Dual-task-Aufgabe als Dual-task-Kosten (DTK) berechnet und uber gepaarte t‑Tests verglichen. Fur die Einbeinstandphase, Geschwindigkeit, Kadenz und Spurbreite zeigten sich deskriptiv hohere DTK wahrend des KG (2,08–23,74 %) im Vergleich zum GG (1,39–12,90 %). Fur Kadenz (DTK: GG: 6,81 ± 12,58 %, KG: 10,54 ± 13,46 %, p = 0,026) und Spurbreite (DTK: GG: −12,90 ± 18,01 %, KG: −23,74 ± 56,37 %, p = 0,004) waren die Unterschiede signifikant. Unter Dual-task-Bedingungen wird das Gangbild wahrend des KG starker beeintrachtigt als wahrend des GG. Diese Ergebnisse lassen darauf schliesen, dass KG hohere Aufmerksamkeitsressourcen erfordert als GG. Moglicherweise ist dadurch insbesondere beim KG unter Dual-task-Bedingungen das Sturzrisiko erhoht. Die vorliegenden Ergebnisse dienen der Entwicklung neuer, okologisch valider Assessment- und Trainingsansatze, welche komplexe Gangmanover miteinbeziehen.

Background The incidence of proximal humeral fractures (PHF) increased by more than 30% over the last decade, which is accompanied by an increased number of operations. However, the evidence on operative vs. non-operative treatment and post-operative treatments is limited and mostly based on expert opinion. It is mandatory to objectively assess functional capacity to compare different treatments. Clinical tools should be valid, reliable and sensitive to change assessing functional capacity after PHFs. This study aimed to analyse inter-rater reliability of the videotaped Wolf-Motor-Function-Test-Orthopaedic (WMFT-O) and the association between the clinical WMFT-O and the Disability of the Arm, Shoulder and Hand (DASH) and to determine the sensitivity to change of the WMFT-O and the DASH to measure functional capacity before and after rehabilitation in PHF patients. Methods Fifty-six patients (61.7 ± 14.7 years) after surgical treatment of PHF were assessed using the WMFT-O at two different time points. To determine inter-rater reliability, the videotaped WMFT-O was evaluated through three blinded raters. Inter-rater agreement was determined by Fleiss’ Kappa statistics. Pearson correlation coefficients were calculated to assess the association between the clinical WMFT-O and the video rating as well as the DASH. Sensitivity to change and responsiveness were analysed for the WMFT-O and the DASH in a subsample of forty patients (53.8 ± 1.4 years) who were assessed before and after a three week robotic-assisted training intervention. Results Inter-rater agreement was indicated by Fleiss’ Kappa values ranging from 0.33–0.66 for functional capacity and from 0.27–0.54 for quality of movement. The correlation between the clinical WMFT-O and the video rating was higher than 0.77. The correlation between the clinical WMFT-O and the DASH was weak. Sensitivity to change was high for the WMFT-O and the DASH and responsiveness was given. In comparison to the DASH, the sensitivity to change of the WMFT-O was higher. Conclusion The overall results indicate that the WMFT-O is a reliable, sensitive and responsive instrument to measure more objectively functional change over time in rehabilitation after PHF. Furthermore, it has been shown that video assessment is eligible for studies to ensure a full blinding of raters. Trial registration Clinicaltrials.gov, NCT03100201. Registered on 28 March 2017. The trial was retrospectively registered. Electronic supplementary material The online version of this article (10.1186/s12891-019-2691-0) contains supplementary material, which is available to authorized users.

Walking is not an automatic movement task but requires continuous attention resources. While walking and undertaking an additional task (dual tasking), gait changes occur which are associated with falls in older adults. To date, the evaluation of gait characteristics under dual task conditions is typically performed during walking straight ahead (SW); however, everyday life also requires more complex walking maneuvers such as walking in a curve (CW). Complex walking maneuvers may require higher attentional resources and thus might have a greater impact on the gait under dual task conditions.The aim was to compare the gait characteristics under dual task conditions during SW and CW.In 30 community-dwelling older adults (mean age: 71.6 ± 6.6 years) gait parameters including single leg support phase, velocity, cadence, step length and width were measured by electronic gait analysis (GAITRite®, CIR Systems Inc., Franklin, New Jersey, USA) during SW and CW under single and dual task conditions. For each gait parameter the relative change from single to dual task condition was calculated as dual task costs (DTC) and compared using paired t‑tests.For the single leg support phase, velocity, cadence and step width, descriptive results showed increased DTC during CW (2.08-23.74%) as compared to SW (1.39-12.90%). For cadence (DTC: SW 6.81 ± 12.58%, CW 10.54 ± 13.46%, p = 0.026) and step width (DTC: SW -12.90 ± 18.01%, CW -23.74 ± 56.37%, p = 0.004) the differences were statistically significant.The relative decline in gait performance under dual task conditions is greater during CW than during SW. The results suggest that CW requires greater attentional resources as compared to SW. In turn, the risk of falling might be increased during CW under dual task conditions. The present findings may contribute to the development of new, ecologically valid assessment and training strategies taking complex walking maneuvers into account.

Background: Wearable sensors (WS) can accurately measure body motion and provide interactive feedback for supporting motor learning. Objective: This review aims to summarize current evidence for the effectiveness of WS training for improving balance, gait and functional performance. Methods: A systematic literature search was performed in PubMed, Cochrane, Web of Science, and CINAHL. Randomized controlled trials (RCTs) using a WS exercise program were included. Study quality was examined by the PEDro scale. Meta-analyses were conducted to estimate the effects of WS balance training on the most frequently reported outcome parameters. Results: Eight RCTs were included (Parkinson n = 2, stroke n = 1, Parkinson/stroke n = 1, peripheral neuropathy n = 2, frail older adults n = 1, healthy older adults n = 1). The sample size ranged from n = 20 to 40. Three types of training paradigms were used: (1) static steady-state balance training, (2) dynamic steady-state balance training, which includes gait training, and (3) proactive balance training. RCTs either used one type of training paradigm (type 2: n = 1, type 3: n = 3) or combined different types of training paradigms within their intervention (type 1 and 2: n = 2; all types: n = 2). The meta-analyses revealed significant overall effects of WS training on static steady-state balance outcomes including mediolateral (eyes open: Hedges' g = 0.82, CI: 0.43-1.21; eyes closed: g = 0.57, CI: 0.14-0.99) and anterior-posterior sway (eyes open: g = 0.55, CI: 0.01-1.10; eyes closed: g = 0.44, CI: 0.02-0.86). No effects on habitual gait speed were found in the meta-analysis (g = -0.19, CI: -0.68 to 0.29). Two RCTs reported significant improvements for selected gait variables including single support time, and fast gait speed. One study identified effects on proactive balance (Alternate Step Test), but no effects were found for the Timed Up and Go test and the Berg Balance Scale. Two studies reported positive results on feasibility and usability. Only one study was performed in an unsupervised setting. Conclusion: This review provides evidence for a positive effect of WS training on static steady-state balance in studies with usual care controls and studies with conventional balance training controls. Specific gait parameters and proactive balance measures may also be improved by WS training, yet limited evidence is available. Heterogeneous training paradigms, small sample sizes, and short intervention durations limit the validity of our findings. Larger studies are required for estimating the true potential of WS technology.

Aquatic exercises are widely used for rehabilitation or preventive therapies in order to enable mobilization and muscle strengthening while minimizing joint loading of the lower limb. The load reducing effect of water due to buoyancy is a main advantage compared to exercises on land. However, also drag forces have to be considered that act opposite to the relative motion of the body segments and require higher muscle activity. Due to these opposing effects on joint loading, the load-reducing effect during aquatic exercises remains unknown. The aim of this study was to quantify the joint loads during various aquatic exercises and to determine the load reducing effect of water. Instrumented knee and hip implants with telemetric data transfer were used to measure the resultant joint contact forces in 12 elderly subjects (6x hip, 6x knee) in vivo. Different dynamic, weight-bearing and non-weight-bearing activities were performed by the subjects on land and in chest-high water. Non-weight-bearing hip and knee flexion/extension was performed at different velocities and with additional Aquafins. Joint forces during aquatic exercises ranged between 32 and 396% body weight (BW). Highest forces occurred during dynamic activities, followed by weight-bearing and slow non-weight-bearing activities. Compared to the same activities on land, joint forces were reduced by 36–55% in water with absolute reductions being greater than 100%BW during weight-bearing and dynamic activities. During non-weight-bearing activities, high movement velocities and additional Aquafins increased the joint forces by up to 59% and resulted in joint forces of up to 301%BW. This study confirms the load reducing effect of water during weight-bearing and dynamic exercises. Nevertheless, high drag forces result in increased joint contact forces and indicate greater muscle activity. By the choice of activity, movement velocity and additional resistive devices joint forces can be modulated individually in the course of rehabilitation or preventive therapies.