BackgroundLow hand grip strength is a strong predictor for both long-term and short-term disability and mortality. The Nintendo Wii Balance Board (WBB) is an inexpensive, portable, wide-spread instrument with the potential for multiple purposes in assessing clinically relevant measures including muscle strength. The purpose of the study was to explore intrarater reliability and concurrent validity of the WBB by comparing it to the Jamar hand dynamometer.MethodIntra-rater test-retest cohort design with randomized validity testing on the first session. Using custom WBB software, thirty old adults (69.0 ± 4.2 years of age) were studied for reproducibility and concurrent validity compared to the Jamar hand dynamometer. Reproducibility was tested for dominant and non-dominant hands during the same time-of-day, one week apart. Intraclass correlation coefficient (ICC) and standard error of measurement (SEM) and limits of agreement (LOA) were calculated to describe relative and absolute reproducibility respectively. To describe concurrent validity, Pearson’s product–moment correlation and ICC was calculated.ResultsReproducibility was high with ICC values of >0.948 across all measures. Both SEM and LOA were low (0.2-0.5 kg and 2.7-4.2 kg, respectively) in both the dominant and non-dominant hand. For validity, Pearson correlations were high (0.80-0.88) and ICC values were fair to good (0.763-0.803).ConclusionReproducibility for WBB was high for relative measures and acceptable for absolute measures. In addition, concurrent validity between the Jamar hand dynamometer and the WBB was acceptable. Thus, the WBB may be a valid instrument to assess hand grip strength in older adults.
BackgroundFalls among older adults is one of the major public health challenges facing the rapidly changing demography. The valid assessment of reaction time (RT) and other well-documented risk factors for falls are mainly restricted to specialized clinics due to the equipment needed. The Nintendo Wii Balance Board has the potential to be a multi-modal test and intervention instrument for these risk factors, however, reference data are lacking.ObjectiveTo provide RT reference data and to characterize the age-related changes in RT measured by the Nintendo Wii Balance Board.MethodHealthy participants were recruited at various locations and their RT in hands and feet were tested by six assessors using the Nintendo Wii Balance Board. Reference data were analysed and presented in age-groups, while the age-related change in RT was tested and characterized with linear regression models.Results354 participants between 20 and 99 years of age were tested. For both hands and feet, mean RT and its variation increased with age. There was a statistically significant non-linear increase in RT with age. The averaged difference between male and female was significant, with males being faster than females for both hands and feet. The averaged difference between dominant and non-dominant side was non-significant.ConclusionThis study reported reference data with percentiles for a new promising method for reliably testing RT. The RT data were consistent with previously known effects of age and gender on RT.
BackgroundForce steadiness is a quantitative measure of the ability to control muscle tonus. It is an independent predictor of functional performance and has shown to correlate well with different degrees of motor impairment following stroke. Despite being clinically relevant, few studies have assessed the validity of measuring force steadiness. The aim of this study was to explore the reproducibility of handgrip force steadiness, and to assess age difference in steadiness.MethodIntrarater reproducibility (the degree to which a rating gives consistent result on separate occasions) was investigated in a test-retest design with seven days between sessions. Ten young and thirty older adults were recruited and handgrip steadiness was tested at 5%, 10% and 25% of maximum voluntary contraction (MVC) using Nintendo Wii Balance Board (WBB). Coefficients of variation were calculated from the mean force produced (CVM) and the target force (CVT). Area between the force curve and the target force line (Area) was also calculated. For the older adults we explored reliability using intraclass correlation coefficient (ICC) and agreement using standard error of measurement (SEM), limits of agreement (LOA) and smallest real difference (SRD).ResultsA systematic improvement in handgrip steadiness was found between sessions for all measures (CVM, CVT, Area). CVM and CVT at 5% of MVC showed good to high reliability, while Area had poor reliability for all percentages of MVC. Averaged ICC for CVM, CVT and Area was 0.815, 0.806 and 0.464, respectively. Averaged ICC on 5%, 10%, and 25% of MVC was 0.751, 0.667 and 0.668, respectively. Measures of agreement showed similar trends with better results for CVM and CVT than for Area. Young adults had better handgrip steadiness than older adults across all measures.ConclusionThe CVM and CVT measures demonstrated good reproducibility at lower percentages of MVC using the WBB, and could become relevant measures in the clinical setting. The Area measure had poor reproducibility. Young adults have better handgrip steadiness than old adults.
A high relative and an acceptable absolute reproducibility was seen when using the Nintendo Wii Balance Board for testing unilateral lower limb strength in community-dwelling older adults. The WBB correlated strongly with the SID.
er lege i spesialisering 1 ved Sykehuset Østfold. Forfatter har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. PIA ZADIGPia Zadig (f. 1988) er doktorgradsstipendiat og lege i spesialisering i radiologi ved Universitetssykehuset Nord-Norge. Forfatter har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter.Det finnes gode argumenter på begge sider av dødshjelpdebatten, men det blir misvisende og for lettvint å bruke den gamle hippokratiske eden som grunnlag for en avvisning av dødshjelp.I dødshjelpdebatten blir legeeden ofte presentert som en yrkesfaglig plikt til å vaere motstander av dødshjelp. I 2012 uttale davaerende leder for Rådet for legeetikk, Trond Markestad, at dødshjelp er «i strid med den gamle hippokratiske ed» og dermed med legeetikken (1). Leder og nestleder konstaterte noen år senere at den «hippokratiske legeed forplikter legen til å ikke gi aktiv dødshjelp» (2). På spørsmål om dødshjelp burde innføres i Norge, svarte lederen for Rådet i 2015, Svein Aarseth, at «legeetikken [har] vaert helt klar siden Hippokrates' tid -og det var jo fire hundre år før Kristus -at vi skal hjelpe, lindre, trøste og behandle, men aldri skade» (3). Historisk kontekstDen første dokumenterte bruken av den hippokratiske eden var i 1508, men den ble ikke brukt seremonielt før i 1804, da den ble innlemmet i Montpellier, Frankrike (4). I en undersøkelse, utført av Association of American Medical Colleges 120 år senere, fant man at bare 19 % av skolene brukte eden (5). Selv om bruken økte etter -eller snarere på grunn avden annen verdenskrig, var det sjelden den originale hippokratiske eden som ble brukt (6, 7). Den originale versjonen brukes ikke ved de norske universitetene, og i en undersøkelse fra Storbritannia i 2017 var det ingen av skolene som brukte den (7).Og det er ikke så rart. Den originale versjonen starter med at legene sverger troskap til Apollon, Asklepios, Hygieia, Panakeia og alle andre guder og gudinner, før eden så plikter legen til å aere sine laeremestere som egne foreldre, «gi ham del i mine midler» og «regne hans avkom som mine egne brødre» (8). Deretter finner vi nokså eksplisitt at «jeg skal ikke gi noe dødelig legemiddel til noen eller gi råd om noe slikt», men også «på samme måte skal jeg heller ikke gi noen kvinne fosterdrivende middel» og «jeg skal ikke operere, ikke engang dem som lider av stein, men overlate det til dem som utfører slike handlinger» (8).En normativ lesning, uten historisk kontekst, ville tilsi at leger -utover at de sverger troskap til gresk mytologi og hedrer sine laerere som egne foreldre -bør avstå fra dødshjelp, abort og operasjoner. Istedenfor å hevde at legeetikken forplikter kirurger til enten ikke å operere eller å slutte å kalle seg leger, er de fleste enige om at eden må tolkes i sin historiske
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