Journal of Geriatric Physical Therapy最新文献

{"title":"Improvements in Physical Capacity via a Wearable Sensor May Not Indicate Reductions in Real-World Sedentary Activity: A Longitudinal Post-Total Hip Arthroplasty Study.","authors":"Rashelle M Hoffman, Lauren Hinrichs-Kinney A, Jeri E Forster, Michael Dayton, Douglas Dennis, Dana L Judd, Cory L Christiansen, Jennifer E Stevens-Lapsley","doi":"10.1519/JPT.0000000000000467","DOIUrl":"https://doi.org/10.1519/JPT.0000000000000467","url":null,"abstract":"<p><strong>Background and purpose: </strong>Patients with end-stage hip osteoarthritis typically elect total hip arthroplasty (THA) to improve life activity performance while clinical outcomes focus on physical capacity. However, it is unclear how improvements in life activity performance relate to improvements in physical capacity following THA. This study aimed to assess the longitudinal relationship between improvement in life activity performance (ie, decreases in sedentary time) and improvements in physical capacity (ie, increases in 6-Minute Walk [6MWT] distance) from before THA to a 6-month post-THA follow-up time point.</p><p><strong>Methods: </strong>This is a secondary analysis of a double-blind randomized controlled trial that enrolled individuals 50 to 85 years of age with unilateral hip osteoarthritis who underwent THA. Longitudinal variables of interest included the % of active wear time in sedentary activity using a hip-mounted wearable accelerometer-based monitor [ActiGraph wGT3X-BT] and 6MWT distance. The variables were modeled to extract predicted change scores, and simulations were used to determine if each participant had a change in sedentary time and 6MWT distance. Participants were classified on whether they improved sedentary activity time (P+: decrease in sedentary time or P-: no improvement in sedentary time) and/or 6MWT distance (C+: increased 6MWT distance or C-: no improvement in 6MWT distance). Independent sample t-tests (continuous variables) and Fisher exact tests (categorical variables) were used to compare characteristics between classification groups.</p><p><strong>Results and discussion: </strong>All 76 participants (age: 63.9 ± 7.0 years, 64.5% male) were classified as C+, as all improved physical capacity. A majority (n = 45; 59.2%) were C+/P+, while 31 participants (40.8%) were classified as C+/ P-, and no participants were classified as C-/P+ or C-/ P-.</p><p><strong>Conclusions: </strong>There is a noted disagreement between improvements in life activity performance versus physical capacity suggesting gains in the 6MWT are not always associated with reductions in sedentary time during recovery from THA. Improving physical capacity does not equate to decreased sedentary time. Thus, different rehabilitation targets (ie, behavior change interventions) may need to be identified and explored to enhance life activity performance following THA that may better align with patient performance goals.</p>","PeriodicalId":49035,"journal":{"name":"Journal of Geriatric Physical Therapy","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Roles and Tasks of Physiotherapists in Nursing Homes: A Survey.","authors":"Shanty Sterke, Ana Paula Nascimento da Cunha, Lennard Voogt, Marleen Goumans","doi":"10.1519/JPT.0000000000000462","DOIUrl":"https://doi.org/10.1519/JPT.0000000000000462","url":null,"abstract":"<p><strong>Background and purpose: </strong>Physiotherapists in nursing homes perform a diversity of roles and tasks. But the delivery of physiotherapy services varies widely between organizations and between individual physiotherapists. This depends on both organizational and personal factors. This study aims to investigate to what extent physiotherapists in Dutch nursing homes agree on the scope and content of their professional roles and tasks.</p><p><strong>Methods: </strong>We performed a cross-sectional survey study of a convenience sample of physiotherapists in nursing homes. The questions were divided into five themes: (1) care and functional problems (falls, incontinence, physical strain, decubitus, inactivity/immobility, pain, problems with lying and sitting, the use of physical restraints, malnutrition and sarcopenia, overweight, behavioral problems, oedema, joint contractures), (2) referrals and accessibility, (3) assessments and examinations, (4) interventions and actions, and (5) organizational matters. We asked the participants to answer the questions on a five-point Likert scale. We defined consensus when ≥75% of the participants rated the question with a Likert-score of 4 or 5 or with a Likert-score of 1 or 2.</p><p><strong>Results and discussion: </strong>Sixty-five physiotherapists returned the survey. They agreed that physiotherapists play an essential role in the management of prevention of falls, mobility problems, transfer problems, ergonomic advice, physical strain, pain, problems with sitting and lying, sarcopenia, and joint contractures. There was a discrepancy in consensus regarding what a physiotherapist should do in the specific cases versus what they actually do.</p><p><strong>Conclusion: </strong>Physiotherapists in nursing homes agreed they have an important role in a variety of care and functional problems. However, there was a difference between what needs to be done versus what is actually done by the physiotherapists. Future research should focus on the underlying reasons for this inconsistency.</p>","PeriodicalId":49035,"journal":{"name":"Journal of Geriatric Physical Therapy","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Diagnostic Accuracy of Subjective Screening for Identifying Mobility Impairment in Older Adults.","authors":"Dalerie Lieberz, Molly Watkins, Emily J Johnson, Kylie Butterfield, Kellie Huschle, Madilyn Jankila, Mallery Johnson, Amy Leopold, Brayden Mogg","doi":"10.1519/JPT.0000000000000460","DOIUrl":"10.1519/JPT.0000000000000460","url":null,"abstract":"<p><strong>Background and purpose: </strong>Identifying preclinical mobility limitation (PCML) and mobility disability are critical for a preventative model of physical therapy. Subjective fall risk and mobility screening questions are used to determine the need for objective testing. This study aimed to determine the diagnostic accuracy of subjective screening for mobility impairment.</p><p><strong>Methods: </strong>Participants answered 8 evidence-based subjective fall risk and mobility screening questions followed by evaluation with the Short Physical Performance Battery (SPPB) and the grip strength test. Gait speed and the Five Times Sit to Stand Test time were calculated from the SPPB. Reference standards for the tests were used to binarize results as at/above or below standards. Relationships between binarized subjective screening and objective test results were analyzed with Phi (φ) correlation coefficients. Sensitivity and specificity were calculated for relationships with acceptable cutoff values ( P < .05, φ  > 0.3). Binomial regression was used to determine the sensitivity and specificity of asking multiple questions. Screening questions were considered useful predictors of the objective test result if combined sensitivity and specificity were ≥1.5.</p><p><strong>Results and discussion: </strong>Ambulatory adults (N = 83) aged 65 to 92 years ( M = 70) participated. One question-\"Do you have difficulty with balance?\"-met the diagnostic accuracy threshold for predicting the SPPB outcome with a sensitivity of 0.632 and a specificity of 0.871.</p><p><strong>Conclusions: </strong>Subjective screening does not adequately predict objective test results for identifying PCML. The findings indicate that improved screening tools or more referrals for objective testing are needed to detect early mobility loss with aging.</p>","PeriodicalId":49035,"journal":{"name":"Journal of Geriatric Physical Therapy","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Movement Framework for Older Adults: Application of the Geriatric 5Ms.","authors":"Susan J Leach, Marni Larkin, Laura Z Gras, Myla U Quiben, Kenneth L Miller, Michelle M Lusardi, Gregory W Hartley","doi":"10.1519/JPT.0000000000000473","DOIUrl":"10.1519/JPT.0000000000000473","url":null,"abstract":"<p><p>Physical therapy for older adults must evolve to address the increasingly complex needs of older adults, who are living longer and managing multiple chronic conditions within challenging psychosocial and environmental contexts. Foundational models, such as the International Classification of Functioning, Disability and Health and the Patient/Client Management model provide structural guidance but fail to fully integrate critical components necessary for comprehensive geriatric care. These models often emphasize immediate medical concerns rather than considering the broader, multifaceted influences on function and overall well-being. The prevailing focus remains on restorative approaches rather than proactive prevention and individualized management strategies, limiting their effectiveness in optimizing movement, function, and quality of life. The Movement Framework for Older Adults (MFOA) offers a paradigm shift in geriatric physical therapy by bridging these gaps and prioritizing a holistic, movement-centered approach. Rooted in the Geriatric 5Ms-Mind, Mobility, Medication, Multicomplexity, and what Matters Most-the MFOA provides a structured yet adaptable model by integrating movement with the physiological, cognitive, psychosocial, and pharmacological factors influencing mobility and function. This approach compels clinicians to assess and address the unique needs of each older adult, moving beyond impairment-based care toward a more comprehensive, person-centered strategy. Developed by the APTA Academy of Geriatrics' Geriatric Movement System Task Force, the MFOA builds upon existing frameworks by explicitly incorporating movement and the Geriatric 5Ms into the assessment and intervention process. It aligns with hypothesis-driven clinical reasoning, equipping physical therapists with a systematic method to analyze movement impairments and functional limitations. This paper introduces the MFOA as a critical advancement in geriatric physical therapy, strengthening the foundation of current practice and enhancing its relevance to the evolving landscape of aging and health care. By emphasizing movement as a fundamental determinant of function and well-being, the MFOA empowers physical therapists to deliver targeted, effective, and person-centered care that aligns with what Matters Most to older adults.</p>","PeriodicalId":49035,"journal":{"name":"Journal of Geriatric Physical Therapy","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144080931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Building Seamless Care Transitions: Connecting Physical Therapy to Community Resources for Older Adults With Arthritis.","authors":"Julia Chevan, Joy D Doll, Trina Radske-Suchan, Elizabeth Erck, Heather Murphy","doi":"10.1519/JPT.0000000000000459","DOIUrl":"10.1519/JPT.0000000000000459","url":null,"abstract":"","PeriodicalId":49035,"journal":{"name":"Journal of Geriatric Physical Therapy","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144080940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrating the Geriatric 5Ms: Enhancing Physical Therapy Care of Older Adults.","authors":"Myla U Quiben, Michelle M Lusardi, Marni Larkin, Susan J Leach, Kenneth L Miller, Laura Z Gras, Gregory W Hartley","doi":"10.1519/JPT.0000000000000472","DOIUrl":"10.1519/JPT.0000000000000472","url":null,"abstract":"<p><p>The Geriatric 5Ms framework offers a comprehensive, person-centered approach to addressing the complex needs of older adults. Initially developed in geriatric medicine, the 4Ms strategy- Medications, Mind, Mobility , and what Matters Most to the patient-challenges clinicians to consider these dimensions in guiding care decisions. The Geriatric 5Ms builds on this framework and adds Multicomplexity , which emphasizes the management of multiple co-existing acute and chronic conditions, along with social and environmental factors and access to resources. The Geriatric Movement System Task Force recognizes the relevance of the 5Ms framework for addressing the functional movement needs of older adults with complex medical conditions. As movement experts, physical therapists are uniquely positioned to assess, monitor, and address Mobility issues while considering the impact of Medications, Mind, and Multicomplexity on movement and function. Engaging in meaningful conversations with older adults and their families about what Matters Most further ensures that care aligns with the individual's values and goals, forming the groundwork for successful outcomes. This article highlights the significance of the Geriatric 5Ms framework and advocates for its integration into physical therapy practice. By adopting this model, physical therapists can enhance examination, intervention planning, and rehabilitation outcomes, ultimately optimizing care for older adults.</p>","PeriodicalId":49035,"journal":{"name":"Journal of Geriatric Physical Therapy","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Item Response Theory of the English Version of the Falls Efficacy Scale-International Tool Among Community-Dwelling Older Adults From Four Different Sites.","authors":"Owis Eilayyan, Saionara Câmara, Carmen-Lucia Curcio, Cristiano Dos Santos Gomes, Fernando Gomez, Ricardo Guerra, Tamer Ahmed, Mohammad Auais","doi":"10.1519/JPT.0000000000000445","DOIUrl":"https://doi.org/10.1519/JPT.0000000000000445","url":null,"abstract":"<p><strong>Background and purpose: </strong>The Falls Efficacy Scale-International (FES-I) is widely used in clinical practice, but it is unclear how each item can discriminate different levels of fall concern. This study applied item response theory (IRT) to evaluate the psychometric properties of each item in the original English version of FES-I among older adults, and compared those properties across genders and with translations in French, Portuguese, and Spanish.</p><p><strong>Methods: </strong>This cross-sectional study used data from the International Mobility in Aging Study, which recruited community-dwelling older adults. Modified graded IRT was used to assess the psychometric properties of the FES-I items, specifically estimating difficulty and discrimination (ie, ability to differentiate levels of fall concern) parameters. Item reliability across the different levels of fall concern was estimated and differential item functioning (DIF) was tested for each item to assess if participants perceived the items similarly regardless of gender and language.</p><p><strong>Results and discussion: </strong>The study included 1608 community-dwelling older adults, of which 395 had completed the English version of the FES-I. Generally, the IRT results showed that the English version was a reliable tool, especially for older adults with high fall concerns, but did not distinguish between low and moderate levels of concern. Factor analysis supported the construct validity of the FES-I. In the DIF analysis, 2 items were perceived differently by gender in the English version, and 9 items were perceived differently between the English and the translated versions (French, Spanish, and Portuguese). The presence of DIF indicates that the psychometric properties of these items are different across genders and languages, and they might relate to cultural factors, the surrounding environment, the wording, the biological differences between men and women, and the item's task itself.</p><p><strong>Conclusions: </strong>The FES-I is a reliable and valid scale for identifying older adults with high fall concern, but it should include more difficult items. Additionally, differing perceptions of items across genders and languages necessitate caution in comparing results among diverse populations.</p>","PeriodicalId":49035,"journal":{"name":"Journal of Geriatric Physical Therapy","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144039377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Toward a Self-Report Cumulative Deficits Frailty Scale (Sr-CDFS): Development and Clinimetric Properties of a Novel Frailty Scale.","authors":"Meiry-Dashti Lian, Yaacov G Bachner, Achinoam Ben Akiva-Maliniak, Rabinovitz Sassoon Tzlil, Barak Sharon","doi":"10.1519/JPT.0000000000000441","DOIUrl":"https://doi.org/10.1519/JPT.0000000000000441","url":null,"abstract":"<p><strong>Background and purpose: </strong>Frailty, a multidimensional syndrome, is linked with heightened risk of adverse outcomes. Targeted physical therapy interventions for individuals with frailty have proven beneficial, underscoring the value of routine frailty assessment in both clinical and research settings. This study aimed to: (1) describe development of a simple self-report cumulative deficits frailty scale (Sr-CDFS); (2) establish the criterion validity of Sr-CDFS against the commonly used Fried's frailty scale and Study of Osteoporotic Fracture criteria (SOF); and (3) assess other concurrent validity and internal consistency of the new Sr-CDFS.</p><p><strong>Methods: </strong>The study included 230 older adults (M age = 79.27 ± 7.42 years), with 76.5% being women. Outcome measures were: (1) validated frailty scales, including Fried's frailty phenotype, SOF, and Sr-CDFS; and (2) a battery of tests for impairment, activity limitations, and health status. Data analysis involved calculating frailty prevalence using the validated frailty scales. The clinimetric properties of the Sr-CDFS were assessed against validated frailty scales. Convergent and discriminative validity of the Sr-CDFS were examined. Internal consistency and structure were evaluated using Cronbach's alpha and exploratory factor analysis.</p><p><strong>Results and discussion: </strong>No differences (P = .80) in frailty prevalence were found between Fried (26.1%) and SOF (25.2%) methods. The Sr-CDFS exhibited excellent internal consistency (Cronbach's alpha = .92), with reliability of questionnaire components (health, falls, physical, cognitive, socioemotional function) ranging from .73 (falls) to .90 (physical ability). Additionally, the Sr-CDFS demonstrated convergent and discriminative validity, with its total score and various parts correlating significantly with most outcomes (r = .25-.59, P < .05). Using K1-criterion and a scree plot, we identified a 5-factor solution that had a common variance of 63.9%.</p><p><strong>Conclusion: </strong>The newly developed Sr-CDFS exhibits robust clinimetric properties with good-to-excellent reliability and validity. The newly developed Sr-CDFS has the potential to increase the feasibility of assessing frailty in clinical settings or large-scale epidemiological studies.</p>","PeriodicalId":49035,"journal":{"name":"Journal of Geriatric Physical Therapy","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144023717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reduced Balance Confidence Significantly Mediates Fear of Falling Avoidance Behavior and Effectiveness of Balance Training in Older Adults With Type II Diabetes.","authors":"Szu-Ping Lee, Kian Habashi, Thomas Iida, Hui-Ting Shih, Lung-Chang Chien, Peter G Kaufman, Carolee J Winstein","doi":"10.1519/JPT.0000000000000433","DOIUrl":"https://doi.org/10.1519/JPT.0000000000000433","url":null,"abstract":"<p><strong>Background and purpose: </strong>Older adults with chronic diabetes have been shown to exhibit reduced balance function and increased fear of falling; however, the contextual inter-relationships between diabetes and its psychological consequences on physical functioning are not fully understood. This study examined the relationships between diabetes disease status, balance confidence, fear of falling avoidance behavior, and changes in performance and confidence after massed practice of a balance task in participants with and without diabetes (PWD and PWOD).</p><p><strong>Methods: </strong>Older adult PWD and PWOD were recruited for the pre-post control group study (n = 27 PWD, n = 26 PWOD). Participants underwent practice of a novel stabilometer-based balance task over a 2-day period (40 practice trials in 8 blocks). Changes in balance task performance and balance confidence were assessed pre- and post-training. Balance confidence and activity avoidance behavior associated with fear of falling were assessed using the Activities-Specific Balance Confidence Scale and Fear of Falling Avoidance Behavior Questionnaire, respectively. Repeated measures analysis of variance and mediation analyses were conducted to examine the effects of diabetes and training on balance performance and confidence, as well as how baseline balance confidence affects the training outcomes.</p><p><strong>Results and discussion: </strong>Fifty-three participants (27 with type II diabetes, 29 men, 23 women, and 1 gender nonconforming, mean age = 63.8, range 50-89 years) were enrolled in the study. Of them, 48 (90.6%) successfully completed the balance training with significant balance task performance improvement of approximately 30% in both groups (PWD: 3.04 [95% confidence interval, 1.77-4.31], P < .001; PWOD: 4.39 [95% confidence interval, 3.04-5.74], P < .001). Activities-Specific Balance Confidence Scale score significantly mediated the effect of diabetes on balance confidence after training and fear of falling avoidance behavior.</p><p><strong>Conclusions: </strong>Despite the physical and psychological deficits associated with diabetes, individuals with chronic diabetes are capable of improving balance confidence and performance through targeted training. Balance confidence was identified as an important mediating factor, explaining the relationship between diabetes disease status and activity-related psycho-physical outcomes. Future research should focus on the potentially self-reinforcing effects of psycho-physical gains induced by exercise training.</p>","PeriodicalId":49035,"journal":{"name":"Journal of Geriatric Physical Therapy","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144036084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mild Cognitive Impairment Is Associated With Reduced Dynamic Balance Performance and Altered Lower-Extremity Kinematics During the Four Square Step Test.","authors":"Meghan E Kazanski, Clara E LaFollette, Meredith D Wells, Michael C Rosenberg, J Lucas McKay, Ihab Hajjar, Madeleine E Hackney","doi":"10.1519/JPT.0000000000000456","DOIUrl":"https://doi.org/10.1519/JPT.0000000000000456","url":null,"abstract":"<p><strong>Background purpose: </strong>Cognitive deficits associated with mild cognitive impairment (MCI) likely impact balance control, especially during dynamic tasks. The Four Square Step Test (FSST) presents concurrent obstacle step-over and multi-directional stepping tasks to clinically interrogate dynamic balance. The primary FSST outcome, completion time, delivers a coarse measure of dynamic balance control, but cannot reveal underlying kinematic strategies that may further characterize MCI-related balance deficits. The objective of this study was to use an augmented FSST to characterize aging and MCI effects on both dynamic balance performance and lower-extremity kinematic execution strategies.</p><p><strong>Methods: </strong>Younger adults (YA, mean age = 23.7y; n = 7), older adults (OA, mean age = 67.4y; n = 20), and individuals with MCI (MCI, mean age = 71.7y; n = 17) performed the FSST in an observational study. We compared overall group effects, then performed 2-way, post-hoc comparisons to identify age (YA vs OA) and cognitive (OA vs MCI) differences in: (1) FSST completion times indicating dynamic balance performance, and (2) lower-extremity peak joint angles during leading and trailing steps in anterior-posterior and lateral directions, indicating kinematic execution strategies.</p><p><strong>Results discussion: </strong>The FSST completion time was impaired in OA compared to YA (31% slower; p < .001) and in MCI compared to OA (18% slower, p = .008). Both YA and OA exhibited similar kinematics throughout. Individuals with MCI exhibited reduced knee flexion across steps compared to OA (p ≤ .002). Reduced knee flexion was associated with degraded FSST performance (Pearson's r < -0.44) and is generally less amenable to the obstacle step-over sub-task. While longer FSST completion times revealed aging-and MCI-related impacts on dynamic balance performance, kinematic analyses further revealed altered dynamic balance strategies only in individuals with MCI.</p><p><strong>Conclusions: </strong>Deficits associated with MCI impair FSST performance. Altered lower-extremity kinematics suggest that individuals with MCI may be especially challenged by the complexity of concurrent multi-directional stepping and obstacle step-over FSST sub-tasks. Clinicians should consider both impaired overall performance and underlying kinematic strategies when characterizing altered dynamic balance control during complex tasks (eg, FSST) in individuals with MCI.</p>","PeriodicalId":49035,"journal":{"name":"Journal of Geriatric Physical Therapy","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143994278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}