Peer reviewed article authored by (Kirk-Sanchez NJ, McGough EL). Read article or submit your manuscript for publishing.

APTA-Geriatrics, an Academy of the American Physical Therapy Association, appointed a guideline development group (GDG) to develop a clinical practice guideline (CPG) synthesizing the evidence for physical therapy management of fall risk in community-dwelling older adults. The GDG consisted of five physical therapists with clinical expertise in the management of fall risk in older adults and methodological expertise in evidence-based document development. The CPG includes a systematic review of existing literature, and stringent methodology developed by the American Physical Therapy Association to form the evidence-based recommendations. The CPG content, including methodology, recommendations and algorithm were externally reviewed by clinical providers and academicians with expertise in fall risk management for older adults. These recommendations are intended to assist physical therapists and physical therapist assistants who are engaged in fall risk management for community-dwelling older adults.

Background: Over a million people live with lower limb amputation (LLA) in the United States, and many of them will experience a fall in the next year. The aim of this study was to use existing theoretical frameworks in an attempt to organize the complex interactions of reported fall history and prosthetic mobility in community-ambulating people with LLA. Methods: Self-reported fall rate and fall circumstances were recorded in a cross-section of people with unilateral LLA due to nondysvascular causes. Self-report and performance-based standardized outcome measures assessed prosthetic mobility and balance confidence. All variables were considered and appropriately placed within a proposed International Classification of Functioning, Disability, and Health framework while using a fall-type classification framework to classify fall circumstances. Results: Information from 69 participants was analyzed. The reported fall rate was at 46%, with those with transfemoral amputation reporting significantly more falls than those with transtibial amputation (P = 0.001). Tripping over an object was the most common cause (62.5%), and fallers reported significantly lower perceived prosthetic mobility than nonfallers (P = 0.001). Despite reporting high levels of balance confidence, results indicate that all groups of fallers and nonfallers are at increased fall risk according to performance-based prosthetic mobility score cutoffs. Conclusions: Community-dwelling people with nondysvascular LLA are at increased fall risk. Classifying fall-related variables using theoretical frameworks provides a means to structure more informative fall risk surveys for people with LLA in an attempt to identify those at greater risk for falling and its potential detrimental effects.

Gait recovery after stroke is a primary goal of rehabilitation, therefore it is imperative to develop technologies that accurately identify gait impairments after stroke. Markerless motion capture (MMC) is an emerging technology that has been validated in healthy individuals. Our study aims to evaluate the validity of MMC against an instrumented walkway system (IWS) commonly used to evaluate gait in stroke survivors. Nineteen participants performed three comfortable speed (CS) and three fastest speed (FS) walking trials simultaneously recorded with IWS and MMC system, KinaTrax (HumanVersion 8.2, KinaTrax Inc., Boca Raton, FL, USA). Pearson’s correlation coefficient and intraclass correlation coefficient (ICC (3,1), 95%CI) were used to evaluate the agreement and consistency between systems. Furthermore, Bland–Altman plots were used to estimate bias and Limits of Agreement (LoA). For both CS and FS, agreements between MMC and IWS were good to excellent in all parameters except for non-paretic single-limb support time (SLS), which revealed moderate agreement during CS. Additionally, stride width and paretic SLS showed poor agreement in both conditions. Biases eliminated systematic errors, with variable LoAs in all parameters during both conditions. Findings indicated high validity of MMC in measuring spatiotemporal gait parameters in stroke survivors. Further validity work is warranted.

Limited research has examined inspiratory muscle performance (IMP) and functional performance (FP) of patients after valve replacement surgery (VRS). The purpose of this study was to examine IMP as well as several measures of FP in patients post-VRS. The study results of 27 patients revealed that patients undergoing transcatheter VRS were significantly (p = 0.01) older than patients undergoing minimally invasive or median sternotomy VRS with the median sternotomy VRS group performing significantly (p < 0.05) better than the transcatheter VRS group in the 6-min walk test, 5x sit-to-stand test, and sustained maximal inspiratory pressure. The 6-min walk test and IMP measures in all groups were significantly (p < 0.001) lower than predicted values. Significant (p < 0.05) relationships were found between IMP and FP with greater IMP being associated with greater FP. Pre-operative and early post-operative rehabilitation may improve IMP and FP post-VRS.