1. James, Wendy Powers PT

Article Content

An American moral and social philosopher, Eric Hoffer stated, "The best part of the art of living is to know how to grow old gracefully." As rehabilitation professionals, guiding our patients to grow old gracefully is our mission and calling. Although this Topics in Geriatric Rehabilitation issue is entitled "Off the Topic," it is our hope that you will glean helpful evidence-based research on the one topic of directing and teaching our patients to live their best lives while growing old gracefully.


We are pleased to feature a variety of diverse articles from Malaysia, Spain, Brazil, the Republic of Korea, Turkey, Japan, the United States, and the Islamic Republic of Iran. In this issue, we discuss a myriad of topics ranging from factors that affect falls in the elderly to dynamic balance training with a Wii console. We also discuss research related to topics including dual tasking, standing balance tests, aquatic cycling, the Brief Cognitive Status Examination, the Six-Spot Step Test (SSST), and shoes reducing varus instability of the knee. This issue also highlights a new pain and mobility outcome measure, the Pain and Mobility Index (PMI). Without further delay, let us take a peek at some of the highlights of this issue.


Maw Pin Tan, MD, et al conducted a study on fallers recruited from the Malaysian Elders Longitudinal Research (MELoR) study. The aim of the study was to compare and contrast fall characteristics between older adults with a body mass index (BMI) 25.0 kg/m2 or more and those with a BMI of less than 25.0 kg/m2. The results suggest that mechanisms of falls may differ in individuals with excess body weight, and these patients may benefit from a specifically designed fall prevention program.


Do you have a patient who enjoys video gaming but also has problems with his dynamic balance? Cristina Garcia-Bravo, MSc, et al analyzed the results of a physical exercise program for older adults with dynamic balance deficits using the Nintendo Wii console. Physiotherapy intervention using the exercise-based game software available with the Nintendo Wii is capable of improving dynamic balance, postural control, and quality of life in older adults.


Dual tasking during therapeutic intervention has been utilized during rehabilitation of balance and postural control problems for years. In this Brazilian study, Raynara Maritsa Cavalcante Pessoa, MSc, et al investigated the immediate effects of an intervention with dual tasks on balance in elderly individuals. This research supports the use of therapeutic exercises, which include dual motor-motor and cognitive-motor tasks to improve balance in older adults.


As rehabilitation professionals, we are all keenly aware of the potential devastating impact of falls on the elderly. The rehabilitation community has spent countless hours studying and analyzing how to predict falls and subsequently implement treatment and prevention strategies for our patients. Si-hyun Kim, PhD, et al compared the 1-leg standing time and Y balance test score between older adults residing in South Korea with and without a history of falls. The study also examined the association between 1-leg standing and the Y balance test score in these older adults.


The World Health Organization has published numerous reports and studies on the phenomenon of falls being a primary problem encountered by aging individuals. In this Turkish study, Cetin and Calik report the relationship between occupational performance using the Canadian Occupational Performance Measure and frequency of pain and falls for older individuals living at home. It is suggested that using rehabilitation programs to reduce pain and fall frequency could potentially improve occupational performance of these elderly individuals.


Aquatic exercise is an effective, safe treatment frequently used by rehabilitation professionals in the treatment of knee osteoarthritis. Sharif Najafi, MD, et al assessed the effects of aqua-cycling on pain, physical function, and muscle strength for elderly individuals with knee osteoarthritis. Functional outcome measures were assessed using the Knee Injury and Osteoarthritis Outcome Score. Patients who participated in aqua-cycling experienced decreased knee pain, increased strength of hamstring and quadriceps, and improved reported functional outcomes.


Knee osteoarthritis affects millions of individuals worldwide, with the medial compartment of the knee being most involved. This Japanese research study, by Hideki Nakano, PhD, et al investigated the effects of shoes reducing varus instability of the knee on gait parameters, knee pain, and health-related quality of life (HRQOL) in patients with medial knee osteoarthritis. It was concluded that shoes reducing varus instability of the knee can effectively improve gait parameters, knee pain, and HRQOL in these patients.


Functional testing of older adults is a significant part of the physical examination performed by the rehabilitation professional. Walking speed (WS) and lower extremity function strength (LEFS) are 2 such measures that are valid predictors of health conditions and mortality risks. In this US study, Emerson Sebastiao, PhD, et al examined the association between LEFS and WS and the extent to which LEFS significantly predicts WS in older adults living in a senior housing facility.


Cognitive assessment can be crucial in the accurate examination and management of rehabilitation patients in both inpatient and outpatient settings. In this study, Drew Parkhurst, DO, et al validated the use of a 2-minute cognitive screening instrument, the Brief Cognitive Status Examination, to identify patients who may require additional cognitive testing.


The SSST is an ambulation test originally developed for patients with multiple sclerosis. This test evaluates complex sensor-motor functions such as speed, coordination, and stability. Sebahat Yaprak Cetin, PhD, et al investigated the validity and reliability of the SSST in older adults. The SSST was found to be correlated with the Timed Up and Go Test (TUG), the Ten-Meter Walk Test (10MWT), the Four-Square Step Test (FSST), and the Tinetti Balance and Gait Test (TBGT). According to this study, the SSST can be considered suitable as an objective assessment tool in the community and in rehabilitation facilities to evaluate areas such as balance, postural stability, functional mobility, and cognitive skills.


One costly challenge facing the health care industry is rehospitalization following discharge from the hospital to home or a skilled nursing facility. Rehabilitation professionals in home health and skilled nursing facilities routinely use various functional tests to assess basic mobility improvement with the goal to improve function as well as reduce rehospitalization risk. Ronald Walser, DPT, et al conducted research to pilot the use of a new pain and mobility outcome measure, the Pain and Mobility Index (PMI), and to assess its convergent validity with the Short Physical Performance Battery. The PMI may be a tool that health care practitioners can use to get a more thorough look at basic functional mobility while also considering how pain affects a person's overall functional status.


Well, now that we took a sneak peek at the contents of this Topics in Geriatric Rehabilitation "Off the Topic" issue, I hope you are anxiously awaiting to soak up the plethora of scientific knowledge and evidence presented on the following pages. The research done by physical medicine and rehabilitation specialists from all over the world gives evidence to support our practice which, in turn, contributes to the health and quality of life of our patients. The need for rehabilitation research is out there, both now and in the future. Let's press on ... let's learn from research, let's conduct our own research ... and let's assist our patients to grow old gracefully.


-Wendy Powers James, PT


Managing Editor and Issue Editor


Topics in Geriatric Rehabilitation