Assessing Upper Extremity Motion: An Innovative Method to Identify Frailty

Toosizadeh, Nima; Mohler, Jane; Najafi, Bijan

doi:10.1111/jgs.13451

Cited by 70 publications

(120 citation statements)

References 21 publications

(37 reference statements)

Supporting

Mentioning

110

Contrasting

Unclassified

Order By: Relevance

“…Weakness and exhaustion are also two important features of frailty, which are measured using hand grip strength and subjective questionnaires within the Fried index (9). Furthermore, previous studies demonstrated a smaller range of motion in upper extremities in frail and pre-frail compared to non-frail participants (34, 35). Accordingly, we observed less trunk sway of the trunk during walking, which may represent another frailty feature.…”

Section: Discussionmentioning

confidence: 76%

Gait and balance assessments as early indicators of frailty in patients with known peripheral artery disease

Thiede

Toosizadeh

Mills

et al. 2016

Clinical Biomechanics

Self Cite

View full text Add to dashboard Cite

Background Peripheral artery disease is associated with increased morbidity and mortality, and frailty syndrome may mediate the risk of these adverse health outcomes to predict intervention results. The aim of this study was to determine the association between motor performance impairments based on in-clinic gait and balance measurements with frailty at intermediate stages (pre-frailty) in peripheral artery disease patients. Methods Seventeen participants with peripheral artery disease (≥ 55 years) were recruited and frailty assessed using Fried criteria. Gait and balance were quantified using wearable sensor technologies in the clinical setting. Between-group differences in frailty were assessed using analysis of variance, and independent associations between gait and balance parameters with frailty were determined using logistic regression models. Findings Based on Fried index nine (53%) participants were pre-frail and eight (47%) were non-frail. Although no between group differences in demographics or clinical parameters was observed, gait parameters were worse among pre-frail compared to non-frail participants. The highest effect sizes for between group differences were observed in double support during habitual normal walking (effect size=1.86, p<0.01), speed variability during dual-task (effect size=1.26, p=0.03), and trunk sway during fast walking (effect size=1.43, p=0.02). No significant difference was observed in balance parameters (p > 0.07). The regression model using gait parameters demonstrated a high sensitivity and specificity in predicting pre-frailty. Interpretation A short 25-step sensor-based in-clinic overground gait test objectively identified pre-frailty independent of age. Double support was the most sensitive parameter in identifying pre-frail aging adults.

show abstract

Section: Discussionmentioning

confidence: 76%

Gait and balance assessments as early indicators of frailty in patients with known peripheral artery disease

Thiede

Toosizadeh

Mills

et al. 2016

Clinical Biomechanics

Self Cite

View full text Add to dashboard Cite

show abstract

“…Although we previously validated this model in community dwelling older adults (8), the test was not assessed in bed-bound and non-ambulatory older adults. In addition, several additional factors such as injury severity, injured area (head versus body), and medications including narcotics and sedatives might have influenced the accuracy of the UEF test in the trauma-related hospitalized patients, which were not addressed in the previous study.…”

Section: Discussionmentioning

confidence: 99%

“…Slowness was assessed by measuring speed, rise time, and flexion number; weakness was assessed by measuring power and moment; exhaustion was assessed by speed variability and speed reduction. (Readers are referred to (8) for more details regarding validation of UEF using a motion capture system, and for a detailed description of parameter calculations.) Of note, participants’ information and TSFI were not identified at the time of UEF outcome assessment.…”

Section: Methodsmentioning

confidence: 99%

“…As a secondary aim we explored the association between UEF parameters and the number of falls within one year prior to hospitalization in this sample of high fall risk older adults. In the previous study we determined high correlations between upper-extremity motion and gait speed (8), and since gait speed and fall risk are associated (9, 10), we, therefore, hypothesized significant associations would exist between UEF parameters and the number of retrospective falls.…”

Section: Introductionmentioning

confidence: 98%

“…We previously developed and validated (using the Fried index (4)) an upper-extremity frailty (UEF) assessment method among community dwelling older adults (8). The UEF assessment method integrates low cost sensors (as low as ~$200), the physical task is easily performed in under one minute, and the post-processing is performed in less than two minutes.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Assessing Upper-Extremity Motion: An Innovative, Objective Method to Identify Frailty in Older Bed-Bound Trauma Patients

Toosizadeh

Joseph

Heusser

et al. 2016

Journal of the American College of Surgeons

Self Cite

View full text Add to dashboard Cite

Background Despite increasing evidence that assessing frailty facilitates medical decision-making, a quick and clinically simple frailty assessment tool is not available for trauma settings. Study Design This study examined accuracy and acceptability of a novel wearable technology (upper-extremity frailty: UEF) to objectively assess frailty status in older adults (≥65 years) admitted to the hospital due to traumatic ground-level falls. Frailty was measured using a validated modified Rockwood questionnaire, the Trauma-Specific Frailty Index (TSFI), as the gold standard. Participants performed a ~20-second trial of rapid elbow flexion with the dominant elbow in a supine posture while wearing the UEF system. Results We recruited 101 eligible older adults (Age: 79±9 years). UEF parameters indicative of slowness, weakness, and exhaustion during elbow flexion were independent predictors of the TSFI score, while adjusted for age, gender, and body mass index. A high agreement (r=0.72, p<.0001) was observed between TSFI score and UEF model; sensitivity and specificity for predicting the frailty status were 78% and 82%, respectively. Of recruited participants 57% were not able to walk at the time of measurements, suggesting a limitation for walking-based frailty assessments. Significant correlations were observed between UFE parameters and number of falls within a prior year, with highest correlation observed for elbow flexion slowness (r=−0.41). Conclusions The results suggest that a simple test of 20-second elbow flexion may be practical and sensitive to identify frailty among hospitalized older adults. The UEF test is independent of walking assessments, reflects several frailty markers, and it is practical for bed-bound patients.

show abstract

Association Between Wearable Device–Based Measures of Physical Frailty and Major Adverse Events Following Lower Extremity Revascularization

et al. 2020

Self Cite

View full text Add to dashboard Cite

IMPORTANCE Physical frailty is a key risk factor associated with higher rates of major adverse events (MAEs) after surgery. Assessing physical frailty is often challenging among patients with chronic limb-threatening ischemia (CLTI) who are often unable to perform gait-based assessments because of the presence of plantar wounds. OBJECTIVE To test a frailty meter (FM) that does not rely on gait to determine the risk of occurrence of MAEs after revascularization for patients with CLTI. DESIGN, SETTING, AND PARTICIPANTS This cohort study included 184 consecutively recruited patients with CLTI at 2 tertiary care centers. After 32 individuals were excluded, 152 participants were included in the study. Data collection was conducted between May 2018 and June 2019. EXPOSURES Physical frailty measurement within 1 week before limb revascularization and incidence of MAEs for as long as 1 month after surgery. MAIN OUTCOMES AND MEASURES The FM works by quantifying weakness, slowness, rigidity, and exhaustion during a 20-second repetitive elbow flexion-extension exercise using a wrist-worn sensor. The FM generates a frailty index (FI) ranging from 0 to 1; higher values indicate progressively greater severity of physical frailty. RESULTS Of 152 eligible participants (mean [SD] age, 67.0 [11.8] years; 59 [38.8%] women), 119 (78.2%) were unable to perform the gait test, while all could perform the FM test. Overall, 53 (34.9%), 58 (38.1%), and 41 (27.0%) were classified as robust (FI <0.20), prefrail (FI Ն0.20 to <0.35), or frail (FI Ն0.35), respectively. Within 30 days after surgery, 24 (15.7%) developed MAEs, either major adverse cardiovascular events (MACE; 8 [5.2%]) or major adverse limb events (MALE; 16 [10.5%]). Baseline demographic characteristics were not significantly different between frailty groups. In contrast, the FI was approximately 30% higher in the group that developed MAEs (mean [SD] score, 0.36 [0.14]) than those who were MAE free (mean [SD] score, 0.26 [0.13]; P = .001), with observed MAE rates of 4 patients (7.5%), 7 patients (12.1%), and 13 patients (31.7%) in the robust, prefrail and frail groups, respectively (P = .004). The FI distinguished individuals who developed MACE and MALE from those who were MAE free (MACE: mean [SD] FI score, 0.38 [0.16]; P = .03; MALE: mean [SD] FI score, 0.35 [0.13]; P = .004) after adjusting by body mass index. CONCLUSIONS AND RELEVANCE In this cohort study, measuring physical frailty using a wrist-worn sensor during a short upper extremity test was a practical method for stratifying the risk of MAEs following revascularization for CLTI when the administration of gait-based tests is often challenging.

show abstract

Assessing Upper Extremity Motion: An Innovative Method to Identify Frailty

Cited by 70 publications

References 21 publications

Gait and balance assessments as early indicators of frailty in patients with known peripheral artery disease

Gait and balance assessments as early indicators of frailty in patients with known peripheral artery disease

Assessing Upper-Extremity Motion: An Innovative, Objective Method to Identify Frailty in Older Bed-Bound Trauma Patients

Association Between Wearable Device–Based Measures of Physical Frailty and Major Adverse Events Following Lower Extremity Revascularization

Contact Info

Product

Resources

About