Mobility is a key predictor of change in well being among older adults who experience falls evidence from the vancouver falls prevention clinic cohort

Accepted Manuscript Mobility is a key predictor of changes in wellbeing among older fallers: Evidence from the Vancouver Falls Prevention Cohort Jennifer C Davis, John R Best, Stirling Bryan, Linda C Li, Chun Liang Hsu, Caitlin Gomez, Kelly Vertes, Teresa Liu-Ambrose PII: S0003-9993(15)00292-0 DOI: 10.1016/j.apmr.2015.02.033 Reference: YAPMR 56157 To appear in: ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION Received Date: 12 January 2015 Accepted Date: 24 February 2015 Please cite this article as: Davis JC, Best JR, Bryan S, Li LC, Hsu CL, Gomez C, Vertes K, Liu-Ambrose T, Mobility is a key predictor of changes in wellbeing among older fallers: Evidence from the Vancouver Falls Prevention Cohort, ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION (2015), doi: 10.1016/j.apmr.2015.02.033 This is a PDF file of an unedited manuscript that has been accepted for publication As a service to our customers we are providing this early version of the manuscript The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain ACCEPTED MANUSCRIPT Mobility is a key predictor of changes in wellbeing among older fallers: Evidence from the Vancouver Falls Prevention Cohort Jennifer C Davis* a,d, John R Best* d,e,f,g, Stirling Bryan a, Linda C Li b,c, Chun Liang Hsu d,e,f, Caitlin Gomez * Jennifer a Centre Kelly Vertes e,g, Teresa Liu-Ambrose d,e,f,g C Davis* a,d, John R Best* d,e,f,g sharing first-authorship RI PT e,g, for Clinical Epidemiology and Evaluation, 828 West 10th Avenue, University of British Columbia & b Department SC Vancouver Coastal Health Research Institute (VCHRI), Vancouver, British Columbia, V6T 2B5, Canada of Physical Therapy, 2177 Wesbrook Mall, University of British Columbia, Vancouver, British c Arthritis M AN U Columbia, V6T 2B5, Canada Research Centre of Canada, 5591 No Road, Richmond BC, British Columbia, V6X 2C7, Canada d Aging, Mobility, and Cognitive Neuroscience Lab, 2211 Wesbrook Mall, University of British Columbia, e Department of Physical Therapy, 2177 Wesbrook Mall, University of British Columbia, Vancouver, British Columbia, V6T 2B5, Canada Research Center, 2211 Wesbrook Mall, University of British Columbia, Vancouver, British Columbia, V6T 2B5, Canada Center for Hip Health and Mobility, 311-2647 Willow Street, Vancouver, British Columbia, V5Z 1M9, AC C g EP f Brain TE D Vancouver, British Columbia, V6T 2B5, Canada Canada Funding: The Canadian Institute for Health Research Emerging Team Grant (CIHR, MOB-93373 to Karim Khan, TLA, LL) provided funding for this study *Corresponding Author: Teresa Liu-Ambrose, PhD, PT, Tel: 1-604-875-4111 ext 69059, Fax: 1-604-875-4762, Email: tlambrose@exchange.ubc.ca ACCEPTED MANUSCRIPT Acknowledgement We thank the Vancouver Falls Prevention Cohort study participants The Canadian Institute for Health Research Emerging Team Grant (CIHR, MOB-93373 to Karim Khan, TLA, LL) provided funding for this RI PT study TLA is a Canada Research Chair in Physical Activity, Mobility, and Cognitive Neuroscience, a Michael Smith Foundation for Health Research (MSFHR) Scholar, a Canadian Institutes of Health Research (CIHR) New Investigator, and a Heart and Stroke Foundation of Canada’s Henry JM SC Barnett’s Scholarship recipient JCD and JB are funded by a CIHR and MSFHR Postdoctoral Fellowship LL is a MSFHR Scholar and a Canada Research Chair CLS is a CIHR Doctoral Trainee M AN U These funding agencies did not play a role in study design We obtained approval for the Vancouver Falls Prevention Clinic Cohort study from UBC Clinical Ethics Review Board Conflict of Interest TE D Jennifer C Davis, Stirling Bryan, John R Best, Linda C Li, Chun Liang Hsu, Caitlin Gomez, Kelly Vertes and Teresa Liu-Ambrose declare that they have no competing interests EP Author’s Contributions TLA was principal investigator for the Vancouver Falls Prevention Clinic Cohort study TLA and JCD AC C were responsible for study concept and design, acquisition of data, data analysis and interpretation, writing and reviewing of the manuscript JCD and JB were responsible for data analysis JCD, TLA, JB, SB, CLH, LL, CG, and KV drafted and revised the manuscript JCD, JB, TLA and SB acquired and interpreted the data ACCEPTED MANUSCRIPT Mobility predicts wellbeing among older fallers Mobility is a key predictor of changes in wellbeing among older fallers: Evidence from the Vancouver Falls Prevention Cohort ABSTRACT Objective: To determine the factors that predict change in wellbeing, over time among older men and women presenting to the Vancouver Falls Prevention Clinic Design: 12-month prospective cohort study Setting: Vancouver Falls Prevention Clinic Participants: The study sample consisted of between 244 - 255 (depending on the analysis) community- dwelling older adults referred to the clinic after suffering a fall M AN U SC RI PT Main Outcome Measure: The ICECAP-O, a measure of wellbeing/quality of life, was administered at 11 baseline, 6-months, and 12-months We constructed linear mixed models to determine whether baseline 12 predictor variables were related to baseline wellbeing and/or changes in wellbeing over time Additionally, 13 we included interactions with sex to investigate difference for males versus females Baseline predictors 14 included two measures of mobility (Short Performance Physical Battery (SPPB) and Timed Up and Go 15 (TUG)) and a measure of global cognitive function (Montreal Cognitive Assessment (MoCA)) 16 Results: All three predictors were associated with wellbeing at baseline (p[...]... our data suggest that a higher baseline level of mobility is related to 296 better maintenance of wellbeing in males In contract, baseline level of mobility in women is not significantly 297 related to changes in wellbeing in females In summary for the SPPB, although the trends for males and 298 females were different in explaining wellbeing over time, these trends were non-significant In contrast, the. .. regression Covariates included age, FCI, TUG, PPA and baseline ICECAP-O score, and the weight 213 and value of the missing variable in the preceding period The final imputed value was the mean value from 214 the five data sets created M AN U SC RI PT 204 217 Results 218 EP 216 TE D 215 Preliminary Analyses 220 Table 1 reports descriptive statistics of all available cases at baseline for our variables of interest... previous analyses, with 273 the exception that the SPPB X sex X time interaction was not significant 274 12 ACCEPTED MANUSCRIPT Mobility predicts wellbeing among older fallers Discussion 276 This is the first longitudinal study examining key factors that explain variation in wellbeing over time among 277 older fallers This is a critical research area to develop in order to appropriately tailor future intervention... longitudinal data that examines factors that explain variation in wellbeing among older 284 adults [12] Previously, cross-sectional data demonstrated that the ICECAP-O described between 285 measures of depression, instrumental activities of daily living and the presence or absence of social activity 286 limitations The ICECAP-O has also demonstrated discriminative ability between multi-morbid elderly and...ACCEPTED MANUSCRIPT Mobility predicts wellbeing among older fallers Physiological falls risk was assessed using the short form of the Physiological Profile Assessment (PPA) 156 The PPA is a valid and reliable [60] measure of falls risk Based on a participant’s performance in five 157 physiological domains – postural sway, reaction time, strength, proprioception, and vision – the PPA 158 computes a. .. low health related quality of life scores (measured using the EQ-5D) Mobility is affected 288 by all of the above items (depression, instrumental activities of daily living, mood, social activities and 289 health related quality of life) As such, our findings that mobility is a key factor accounting for variation in 290 wellbeing over time builds on existing literature in this field Interestingly, the. .. were also included If not statistically 193 significant, these terms involving an interaction with sex were dropped Additionally, in the examination of 194 SPPB and TUG as predictors, the use of armrest was included as a covariate, along with its interaction with 195 time (Note: the use of armrest did not interact with the main variables of interest the model, and therefore 196 these interaction terms... strategies targeting wellbeing among older fallers – a population at high risk of both functional and cognitive 279 decline We found that two valid and reliable measures of mobility interacted with sex to predict changes in 280 wellbeing overtime Interestingly, cognition and specifically executive function explained variation in 281 wellbeing at baseline only, not over time SC RI PT 275 282 There is. .. contrast, the 13 ACCEPTED MANUSCRIPT Mobility predicts wellbeing among older fallers TUG was significant for males and females in explaining variation in wellbeing over time This is a new 300 finding compared with previous cross-sectional research that did not demonstrate any significant 301 associations between ICECAP-O and sex [39] Because these analyses are exploratory, it is too early to 302 draw strong... summarized in Table 3 EP 266 Complete Case Analysis 268 The findings from the complete case analyses are consistent with the primary results described above; 269 indeed, the parameter estimates were generally equal to, or larger than, the estimates described above 270 AC C 267 271 Multiple Imputation Analysis 272 The findings from the multiple imputation analyses are generally consistent with the previous