Volume 8, Issue 2, June 2023

Objectives

Vestibular rehabilitation clinical guidelines document the additional benefit offered by the Mixed Reality environments in the reduction of symptoms and the improvement of balance in peripheral vestibular hypofunction. The HOLOBalance platform offers vestibular rehabilitation exercises, in an Augmented Reality (AR) environment, projecting them using a low- cost Head Mounted Display. The effect of the AR equipment on the performance in three of the commonest vestibular rehabilitation exercises is investigated in this pilot study.

Methods

Twenty-five healthy adults (12/25 women) participated, executing the predetermined exercises with or without the use of the AR equipment.

Results

Statistically significant difference was obtained only in the frequency of head movements in the yaw plane during the execution of a vestibular adaptation exercise by healthy adults (0.97 Hz; 95% CI=(0.56, 1.39), p<0.001). In terms of difficulty in exercise execution, the use of the equipment led to statistically significant differences at the vestibular-oculomotor adaptation exercise in the pitch plane (OR=3.64, 95% CI (-0.22, 7.50), p=0.049), and in the standing exercise (OR=28.28. 95% CI (23.6, 32.96), p=0.0001).

Conclusion

Τhe use of AR equipment in vestibular rehabilitation protocols should be adapted to the clinicians’ needs.

Objectives

To identify which risk factors were associated with developing Coronavirus Disease-19 (COVID-19) infection, with symptoms, in institutionalized older people.

Methods

A 1-year longitudinal multi-center study was conducted in 5 nursing homes (NHs) over the period December 2019 to March 2021. Inclusion criteria included being a permanent resident in the NH, aged 65 years or older, and a positive diagnosis of COVID-19 objectively confirmed by a diagnostic test. A descriptive and bivariate analysis was performed, calculating relative risk (RR) with 95% confidence intervals and statistical significance at p<0.05.

Results

Of the total sample of 78 individuals who tested positive for COVID-19, the mean age was 84.6 years (SD=±7.8), 62 (79.5%) were female; 40 (51.3%) participants presented with COVID-19 symptoms. Living in a private NH (RR=3.6, 95% CI [1.2-11.0], p=0.023) and having suffered a stroke (RR=4.1, 95% CI [1.1-14.7], p=0.033) were positively associated with developing COVID-19 infection with symptoms.

Conclusions

Having suffered a stroke and living permanently in a private NH were positively associated with symptomatic COVID-19 in this sample of institutionalized older people. Clinical Trials ID: NCT04297904

Objectives

The concept of frailty has gained importance, especially in patients with liver disease. Our study systematically investigated the effect of frailty on post-procedural outcomes in patients undergoing transjugular intrahepatic portosystemic shunt (TIPS).

Methods

We used National Inpatient Sample(NIS) 2016-2019 data to identify patients who underwent TIPS. Hospital frailty risk score (HFRS) was used to classify patients as frail (HFRS≥5) and non-frail (HFRS<5). The relationship between frailty and outcomes such as death, post-procedural shock, non-home discharge, length of stay (LOS), post-procedural LOS, and total hospitalization charges (THC) was assessed.

Results

A total of 13,700 patients underwent TIPS during 2016-2019. Of them, 5,995 (43.76%) patients were frail, while 7,705 (56.24%) were non-frail. There were no significant differences between the two groups based on age, gender, race, insurance, and income. Frail patients had higher mortality (15.18% vs. 2.07%, p<0.001), a higher incidence of non-home discharge (53.38% vs. 19.08%, p<0.001), a longer overall LOS (12.5 days vs. 3.35,p<0.001), longer post-procedural stay (8.2 days vs. 3.4 days, p<0.001), and higher THC ($240,746.7 vs. $121,763.1, p<0.001) compared to the non-frail patients. On multivariate analysis, frail patients had a statistically significant higher risk of mortality (aOR-3.22, 95% CI-1.98- 5.00, p<0.001).

Conclusion

Frailty assessment can be beneficial in risk stratification in patients undergoing TIPS.

Exercise is an important intervention to maintain bone health in women with osteopenia and osteoporosis. This systematic review aims to gain insight into the experiences or perceptions females have toward bone health interventions, to promote uptake and adherence. Four electronic databases were searched: MEDLINE, CINAHL, PubMed and PsycInfo. Inclusion Criteria: Qualitative studies examining perceptions or views of women to physical activity or exercise interventions aimed at improving bone health. 1,406 papers were identified. After screening, data were extracted from 2 studies considering experiences and 2 papers presenting perceptions of exercise for bone health. All studies scored >8 out of 10 on the CASP Quality Tool. Older women perceived barriers such as safety and advice, and facilitators of tangible results and feedback within supervised group sessions. Older womens' experiences of a digitally delivered exercise intervention included social interactions and voice reminders, with barriers of lack of feedback and knowledge. Younger women expressed enablers as feeling the benefits and physical literacy, and barriers of previous experience participating in tedious exercise. Supervised sessions, with different intensity levels and variety, offering feedback to promote confidence, are valuable to uptake and adherence in both younger and older females.

Therapeutic exercise is integral to the comprehensive rehabilitation of patients with cardiovascular disease and, as such, is recommended by the American Heart Association as a valuable and effective treatment method for such patients. The type of exercise applied to these patients is aerobic and resistance exercise with mild intensities and loads to avoid overloading the cardiovascular system. Blood flow restriction exercise is a novel exercise modality in clinical settings that has in many studies a similar effect on muscle hypertrophy, strength, and cardiovascular response to training at a 70% strength level without blood flow restriction. Since this exercise mode does not require high-intensity loads, it can be a safe method for improving muscle strength, cardiovascular endurance, and functionality in cardiovascular patients. Given that, the objective of this review is to assess and summarize existing evidence for the use of blood flow restriction in cardiovascular patients. A scoping review of existing clinical trials was conducted. Eleven studies were examined that suggested the use of blood flow restrictions in cardiovascular patients to achieve improvements in muscle strength, functionality, and cardiovascular parameters such as blood pressure decrease.

We performed a systematic review to evaluate whether an exercise-based intervention programme, for older people with a hip fracture, is effective in functional recovery and in preventing secondary fall-related injuries. This systematic review was conducted according to Cochrane review guidelines and based on the PRISMA statement. Six electronic databases (Medline, PubMed, Cochrane Library, CIHNAL, Embase, Google Scholar) from 2010 to 31 December 2021 were searched for randomised controlled trials (RCTs) of functional recovery or fall prevention exercises after a hip fracture surgery in older people (≥65 years). Thirty-four references were identified initially, however, only 8 studies (1617 patients) met the eligibility criteria. Despite the heterogeneity of the onset, duration and of the characteristics of exercise-based intervention, as well as the type of setting it was delivered in, there was evidence that an exercise-based rehabilitation programme improved physical function and gait ability. There was no evidence about preventing a secondary fall after a hip fracture. In conclusion, an exercise-based intervention programme can generally improve functional recovery after a hip fracture. It remains uncertain if it affects the prevention of a secondary fall over a 1-year follow-up period.

Community-dwelling older adults living with multiple long-term conditions (MLTC), frailty and a recent deterioration in health are underserved by research. This results in a limited evidence base for their care, including the potential benefits of lifestyle interventions such as structured exercise. The aims of the LiLL-OPM (Lifestyle in Later Life - Older People's Medicine) study are to determine if it is feasible to carry out a research project with these patients, describe their health and lifestyle, their attitudes to engaging in exercise and their experiences of taking part in the research. Older adults who are attending an Older People's Medicine Day Unit service in Newcastle, UK, and their informal carers will be invited to take part. The study will use mixed methods with semi-structured interviews and a health and lifestyle questionnaire, carried out in a way that is most convenient to participants, including in their own homes and with a flexible schedule of study visits. The findings from the feasibility study will provide invaluable data on how to design research, including the most suitable approaches to recruitment and data collection. This will improve the inclusion in research of older adults living with MLTC, frailty and a recent deterioration in health.