Welcome back for another installment of Research Bites! For all of you who missed my research posts on my Instagram (@science_of_falling), you came to the right place. Every few weeks I will be posting a new set of five quick and dirty research reviews with the main findings, how it was performed, and my quick take on it.

The trick is, I only have the space of an Instagram caption (2200 characters) to dive in and extract main points. It makes for a fun challenge! If you want to see these posts sooner, head on over to Instagram and hit that follow button.

Enjoy that tasty research!

Study Details

🔸Cross-sectional study done in primary care centers and social centers in Valencia, Spain in 2016
🔸229 adults; 70.3% women/29.7% men; mean age 77.8 yo
🔸All participants met at least one frailty criteria on the Fried Frailty phenotype (FFP)
↪Criteria include: weakness, slowness, exhaustion, low physical activity (PA), and unintentional weight loss
🔸Participant information and data collection performed by 4 nurses with background in at least 2 PA related fall prevention programs
🔸Participants reported # of falls in last 12 months; health care providers also scoured medical records for relevant data
🔸A number of measures used to collect whole picture data including: FFP, strength testing, walk testing, Falls Efficacy Scale (FES), Barthel Index, Lawton Instrumental Activities of Daily Living, Tinetti Index, Short Physical Performance Battery, Mini-Mental State Examination, Short Form Geriatric Depression Scale, Baecke Index

Study Findings

🔹Based on FFP the participants consisted of 59% frail and 41% prefrail individuals
🔹FES showed: 48.9% low fear of falling, 38.9% moderate fear, 12.2% high fear
🔹Prevalence of falls reported was 54.9% in last 12 months; 38.8% had at least one fall in medical history
🔹Higher FES scores (more fear), to varying degrees, correlated with being a female, living alone, being in the frail category, having a history of falls, reporting self slowness and exhaustion, depression, low PA levels, cognitive impairments, and lower quality of life

My take 🤔

I think this study makes a few obvious assumptions into data backed facts. This study looked at a tremendous # of aspects, but they found the highest correlations with FoF to be being a female, having depression, and a history of falling. I feel as though the depression and history of falling make sense. "Being a female" and higher FoF may correlate with low PA and thus a lower muscle mass when older. Biologically women will retain less muscle mass than men, and thus less strength to maneuver if falling. Leading to a ⬆ FoF.

Study Details

🔸51 total participants; 17 participants with lower limb OA (mean age 66.9 yo), 17 participants with lower limb RA (mean age 66.3), 17 healthy controls (mean age 66.3 yo)
🔸Each participant aged-matched (+/- 3 years) with one participant from the other two groups; 17 total matched groups
🔸A battery of assessments administered to gauge full fall and balance picture for each participant including: Falls Risk for Older People-Community Setting (FROP-Com), Step Test, Functional Reach Test, Clinical Test of Sensory Interaction on Balance, NeuroCom Balance Master Testing (force platform measures, sit-to-stand, gait), gait velocity, Timed Up and Go, Modified Falls Efficacy Scale, Western Ontario and McMaster Universities Osteoarthritis Index, Visual Analog Scale (VAS) for pain

Study Findings

🔹Most severely affected joint in the arthritis groups was the knee, although 41% of RA said it was their feet
🔹11 OA participants and 11 RA participants reported falling at least once in the last 12 months, compared to 2 of the controls
🔹FROP-Com scores in OA and RA groups demonstrated mild-to-moderate level of fall risk; Control's scores showed low fall risk
🔹Healthy control participants preformed significantly better on all performance measures than both arthritis groups
🔹RA group tended to perform worse than OA group on all measures but not to a statistically significant degree
🔹Pain levels via VAS did not seem to correlate with the OA or RA fall risk levels
🔹RA group tended to have higher foot and ankle issues (94.1%) compared to the OA group (58.8%)

My Take 🤔

This was a fairly small study, but despite that fact, a trend that those with arthritis fair worse in terms of balance and falling was clear. In my mind this may be due to the increased stiffness and potentially increased deconditioning of those with these diseases. That being said, one thing this study sheds light on is the importance of incorporating balance programming in anyone with arthritis of any kind.

Study Details

🔸Cross sectional study with analyzation of community-based data from the World Health Organization Study on Global Ageing and Adult Health (SAGE); data spans from 2007-2010
🔸This is the first study conducted on this topic
🔸13,623 subjects; mean age 72.3yo +/- 10.9 years; 54.4% female, 45.6% male
🔸MCI classification based on recommendations from the National Institute on Ageing-Alzheimer's Association
🔸From this sample subjects compared based on age, sex, years of education, wealth quintiles based on income, living arrangement, physical activity, alcohol use in past 30 days, hand grip strength, obesity, arthritis, stroke, diabetes, angina, and depression
🔸LMICs and their respective subjects included were China (5094), Ghana (1904), India (2211), Mexico (1179), Russia (1820), South Africa (1415)

Study Findings

🔹Overall presence of MCI and fall-related injury in target population was 18.5% and 4.5% respectively
🔹Those with MCI more likely to suffer fall-related injury were female, had lower education, lived with others, had low hand-grip strength, and had a stroke or depression
🔹Those with MCI had 6.3% chance of a fall-related injury; those without MCI had a 4.1% chance of a fall-related injury
🔹MCI was associated with a 1.6x higher odds for a fall-related injury; adjusting for having other health factors this dropped to a 1.53x higher odds

My Take 🤔

It makes sense that having MCI would increase the odds of a fall-related injury. This makes even more sense when you add in the factor of having low income which would result in less quality health care, less food, less opportunity to exercise intentionally, and increased stress. All of these factors would make a person a much less capable mover to various degrees. I don't have a solution to this problem but it does make one think a bit.

Study Details

🔸Cross-sectional population based study focusing on the effect of sleep deprivation on the risk of falla and the role of weekend catch-up sleep in reducing that risk in Korean adolescents
🔸Used data from 2013 Korea Youth Risk Behavior Web-based Survey (KYRBWS)
↪Uses a self administered anonymous survey which has been conducted annually since 2005
↪125 ?s assessing sociodemographic characteristics and 15 categories of health related behaviors
↪Target population: 12-18 yo Korean school children
🔸Total of 57,225 total adolescent data sets included in statistical analysis based off of full survey completion
🔸Two groups
↪Fall Group (FG): 7,346 subjects; each reported a falling event in previous 12 months; mean age 14.7 +/- 1.7 years; 4,198 female/3,148 male
↪Non-Fall Group (NFG): 49,879 subjects; no falls; mean age 15.0 +/- 1.8 years; 24,495 female/25,384 male
🔸Self-reported wake time and bedtime assessed for both weekdays and weekends
↪Average sleep time calculated as well as weekend catch-up sleep time

Study Findings

🔹Compared to NFG, fallers tended to be more likely female, living without parents, current smokers, alcohol drinkers, substance abusers, have higher family income, higher academic achievements, more perceived stress/poorer health status/unhappiness/depression
🔹FG reported higher proportion of sleep <5 hours, late weekday/weekend bedtimes, shorter avg sleep duration
🔹FG reported less sleep satisfaction
🔹Adjusted for other variables sleep less than 5 and 6 hours lead to increased risk of falling (1.24x and 1.12x respectively)
🔹Sleep of 9+ hours and longer weekend catch-up sleep (2 hours longer of sleep on weekends) decreased risk of falling (.9x and .94x respectively)

My Take 🤔

Get your sleep! So many factors are involved in less sleep for both adults and kids alike. Prioritizing sleep is paramount to reducing fall risk among other benefits. Although these were Korean adolescents, I truly believe the correlation of sleep and falling is universally true.

Study Details

🔸Participants: female;18-30 years of age; recreationally active for atleast 1.5 h per week; all having prior lateral ankle sprain
🔸Two groups: Chronic Ankle Instability (CAI) and Copers
↪Participants with CAI were required to have at least one ankle sprain sustained 12 months or more prior to study with residual disability classified as ≤90 on the Foot and Ankle Ability Measure (FAAM) - Activities of Daily Living (ADL), and ≤85 on the FAAM-Sport subscale
↪Copers were classified as having one ankle sprain at least 12 months prior to study collection without disability
🔸Treadmill with imbedded force plates used for walking trials
🔸GMED ultrasound images (USI) and video clip data collected during treadmill trials
↪Ultrasound (US) placed on ipsilateral hip of reported ankle sprain limb
🔸Three quiet bipedal standing images taken as reference for gluteal muscle thickness prior to walking
🔸For walking collection, treadmill speed was gradually increased until participants indicated a preferred walking pace for a 5-min warm-up prior to collection
🔸Following warm-up, 120% of preferred (fast), and 1.35 m/s (standard) walking speed trials were performed using block-randomization scheme
🔸Data collected during multiple 10s walking trials

Study Findings

🔹Copers presented w/ significantly Increased GMED mean functional activity ratios (FARs) [FARs = muscle thickness during activity / muscle thickness quiet] compared to the CAI group for all walking speeds. Increased FARs correlates with increased muscle activation
🔹CAI FARs remained below 1 across entire gait cycle; Coper's FARs was above 1 from early stance to late swing
🔹GMED inhibition in CAI compared to copers was highest during stance phase of gait

My Take 🤔

When broken down this study simply shows that CAI leads to an overall inhibition of the GMED. The GMED is vital in balance and stability. Thus, if CAI is present GMED training should be performed to reestablish hip and ankle stability.

Thanks for reading the fifth volume of Research Bites! I hope you learned a tidbit or two. Be sure to follow my Instagram account to see these research bites right away, and comment below on what you think about the findings above.

Happy Falling!