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Biomedical subjects

Keith Hill

Publications and source records attributed to Keith Hill.

14 recordsLinked to original sources
PubMed2006

Exploring the feasibility of a community-based strength training program for older people with depressive symptoms and its impact on depressive symptoms.

BACKGROUND: Depression is a disabling, prevalent condition. Physical activity programs may assist depression management in older people, ameliorate co-morbid conditions and reduce the need for antidepressants. The UPLIFT pilot study assessed the feasibility of older depressed people attending a community-based progressive resistance training (PRT) program. The study also aimed to determine whether PRT improves depressive status in older depressed patients. METHODS: A randomised controlled trial was conducted. People aged > or = 65 years with depressive symptoms were recruited via general practices. Following baseline assessment, subjects were randomly allocated to attend a local PRT program three times per week for 10 weeks or a brief advice control group. Follow-up assessment of depressive status, physical and psychological health, functional and quality of life status occurred post intervention and at six months. RESULTS: Three hundred and forty six people responded to the study invitation, of whom 22% had depressive symptoms (Geriatric Depression Scale, GDS-30 score > or = 11). Thirty two people entered the trial. There were no significant group differences on the GDS at follow-up. At six months there was a trend for the PRT intervention group to have lower GDS scores than the comparison group, but this finding did not reach significance (p = 0.08). More of the PRT group (57%) had a reduction in depressive symptoms post program, compared to 44% of the control group. It was not possible to discern which specific components of the program influenced its impact, but in post hoc analyses, improvement in depressive status appeared to be associated with the number of exercise sessions completed (r = -0.8, p < 0.01). CONCLUSION: The UPLIFT pilot study confirmed that older people with depression can be successfully recruited to a community based PRT program. The program can be offered by existing community-based facilities, enabling its ongoing implementation for the potential benefit of other older people.

Aged↗
PubMed2005

A pilot study of falls risk and vestibular dysfunction in older fallers presenting to hospital emergency departments.

PURPOSE: To compare falls risk in older fallers and non-fallers, with an emphasis on dizziness and signs of vestibular dysfunction. METHOD: The fallers had presented to the Emergency Department of the Royal Melbourne Hospital, Australia following a fall and were discharged directly home (n = 20) (75% female, mean age 78 years). The non-fallers were an age and gender matched group, who had not fallen in the past 12 months (n = 20). All clients received a home-based assessment, which involved a comprehensive assessment of falls risk. RESULTS: Over three-quarters of the fallers took four or more medications, had balance impairments, and used a gait aid in the community. The fallers had a significantly higher falls risk score (P < 0.001), demonstrated significantly poorer balance (P < 0.001) and walked significantly more slowly (P < 0.001) than the non-fallers. There was no significant difference between the groups in their reports of dizziness (P = 0.68), although static balance testing (CTSIB condition 5) suggested a greater degree of underlying vestibular dysfunction in the group of fallers (P < 0.001). CONCLUSION: Older people discharged home from the ED following a fall are at high risk of falling in the future and have a greater level of vestibular dysfunction based on simple clinical testing. Additional clinically applicable tests of vestibular function are required to further investigate the relationship between vestibular dysfunction and falling in older people.

Accidental Falls↗
PubMed2005

Falls incidence and factors associated with falling in older, community-dwelling, chronic stroke survivors (> 1 year after stroke) and matched controls.

BACKGROUND AND AIMS: Using data from the Australian Longitudinal Study of Ageing, this study aimed at: 1) investigating differences in the incidence of falls between chronic Stroke subjects (n = 181) and matched Non-stroke subjects (n = 181) who were 65 years or older and community dwellers, and 2) establishing factors associated with falling within chronic Stroke subjects. METHODS: Subjects reporting a history of stroke 12 or more months ago, and age- and gender-matched Non-stroke subjects were extracted from the first wave of the Australian Longitudinal Study of Ageing database. Falls incidence and factors associated with falling were examined. Falls data were collected based on recall of the number of falls in the past year, including falls that did not result in injury. RESULTS: Significantly more Stroke subjects reported falling in the previous twelve months than Non-stroke subjects (36 vs 24%, p < 0.05). When comparing Stroke Fallers to Stroke Non-fallers within the Stroke group, Stroke Fallers were significantly more likely to report (i) difficulty in stooping or kneeling, (ii) getting up in the night to urinate more than once, and (iii) having a greater number of Instrumental Activities of Daily Living problems (p < 0.05). Self-reported difficulty in stooping or kneeling was the most significant factor associated with falling in the Stroke group (OR 2.44, 95% CI 1.30-4.58). CONCLUSIONS: Falls are a problem for community dwelling older people with chronic stroke and are associated with physical function difficulties. Factors identified in this and other similar studies should form the basis for targeted falls prevention programs in this high falls risk clinical group.

Accidental Falls↗
PubMed2005

The role of cyclooxygenase-2 inhibition in foot and ankle arthrodesis.

Cyclooxygenase-2 (COX-2) inhibitors are an important adjunct in controlling postoperative pain. Concerns exist regarding the use of NSAIDs for postoperative pain management because of the possible deleterious impact on bone healing in patients undergoing hindfoot arthrodesis. Orthopedic surgeons are concerned with: (1) a multimodal approach for postoperative pain control, and (2) bone healing following arthrodesis, fracture repair with rigid internal fixation, and cementless implants. The use of COX-2 inhibitors has been shown to be an important component of a pain control strategy but questions about their effects on bone healing have inhibited their use. This article discusses the laboratory and clinical data available on the use of COX-2 inhibitors on bone healing and their effects on foot and ankle arthrodesis procedures.

Animals↗
PubMed2004

Predisposing factors for occasional and multiple falls in older Australians who live at home.

This study, which was part of a larger study on the Health Status of Older People conducted in Melbourne, Australia, aimed to identify factors that discriminate between multiple and occasional falls amongst older people living at home. It used a survey of 1000 Australians aged 65 years and over. Subjects were classified as multiple fallers (two or more falls in the past year), occasional fallers (one fall in the past year), or non-fallers. Twenty-nine percent of older people who lived at home reported falling once or more in the previous 12 months. Nearly 20% of older people fell once in the previous 12 months and just under 10% fell more than once. Occasional fallers were more likely to be women (OR 1.75, 95% CI 1.26 to 2.45), to have reported back pain (OR 1.54, 95% CI 1.10 to 2.16) and were nearly twice as likely to have more than three medical conditions compared to non-fallers (OR 1.88, 95% CI 1.22 to 2.90). Multiple fallers were also more likely to be women (OR 1.61, 95% CI 1.03 to 2.51). More multiple fallers (17%) than occasional fallers (9%) reported being very afraid of falling. Intervention strategies should take into account these differing predisposing factors for multiple and occasional falls.

Accidental Falls↗
PubMed2003

Falls prevention within the Australian general practice data model: methodology, information model, and terminology issues.

The iterative development of the Falls Risk Assessment and Management System (FRAMS) drew upon research evidence and early consumer and clinician input through focus groups, interviews, direct observations, and an online questionnaire. Clinical vignettes were used to validate the clinical model and program logic, input, and output. The information model was developed within the Australian General Practice Data Model (GPDM) framework. The online FRAMS implementation used available Internet (TCP/IP), messaging (HL7, XML), knowledge representation (Arden Syntax), and classification (ICD10-AM, ICPC2) standards. Although it could accommodate most of the falls prevention information elements, the GPDM required extension for prevention and prescribing risk management. Existing classifications could not classify all falls prevention concepts. The lack of explicit rules for terminology and data definitions allowed multiple concept representations across the terminology-architecture interface. Patients were more enthusiastic than clinicians. A usable standards-based online-distributed decision support system for falls prevention can be implemented within the GPDM, but a comprehensive terminology is required. The conceptual interface between terminology and architecture requires standardization, preferably within a reference information model. Developments in electronic decision support must be guided by evidence-based clinical and information models and knowledge ontologies. The safety and quality of knowledge-based decision support systems must be monitored. Further examination of falls and other clinical domains within the GPDM is needed.

Accidental Falls↗
PubMed2003

Retest reliability of dynamic balance during standing in older people after surgical treatment of hip fracture.

BACKGROUND AND PURPOSE: Computerized force platform systems are becoming more widely used in clinical practice to measure balance control; however, their retest reliability has not been documented in people with hip fracture. The present study examined the retest reliability of dynamic weight shift during standing in older people after surgical treatment of hip fractures. METHOD: This single group test-retest research design employed a computerized force platform system (the Neurocom Pro-Balance Master; PBM) to measure the amplitude and symmetry of weight shift in 14 patients with unilateral hip fracture on three test occasions held one hour and 24 hours apart. Subjects performed six trials of a forward-backward and side-to-side weight shift task at each test session. RESULTS: The results showed that reliability was, at best, moderate for forward-backward and side-to-side weight shift measures taken over an hour and over a day. CONCLUSIONS: Clinicians should be cautious when using the computerized balance assessment procedures investigated in this study to assess change in dynamic balance ability in older people during the early stages of rehabilitation after surgical treatment of hip fractures.

Aged↗
PubMed2003

Stage II flatfoot: what fails and why.

Stage II PTT dysfunction is a complex problem that has multiple treatment options. Whether it is treated nonoperatively or operatively, multiple factors affect the success of treatment. The orthopedic literature reports many factors that can lead to failure. Although it is virtually impossible to account for every possible scenario, adhering to sound principles and understanding what can go wrong and why, can help to avoid many of the pitfalls.

Arthrodesis↗
PubMed1997

Balance and mobility outcomes for stroke patients: a comprehensive audit.

This paper reports the in-patient rehabilitation admission and discharge scores on a comprehensive series of balance and mobility measures for 109 stroke patients (49.5 per cent female) with a mean (SD) age of 72.9 (10.4). The results reflect good outcomes regarding discharge destination (77 per cent discharged to own or families' home), and all balance and mobility measures improved significantly during rehabilitation (p<0.05). However, when performance at discharge was compared with values reported for healthy older people, the dynamic balance and mobility measures identified marked residual problems. Only 7 per cent of patients met all four criteria defined for independent community ambulation. These results are discussed in the context of modifying clinical practice to improve community ambulation outcomes for stroke patients.

Journal Article↗