title: Neuromuscular Impairments Contributing to Persistently Poor and Declining Lower-Extremity Mobility Among Older Adults: New Findings Informing Geriatric Rehabilitation.
abstract: To identify neuromuscular impairments most predictive of unfavorable mobility outcomes in late life.
  
  
  
  Longitudinal cohort study.
  
  
  
  Research clinic.
  
  
  
  Community-dwelling primary care patients aged ≥65 years (N=391) with self-reported mobility modifications, randomly selected from a research registry.
  
  
  
  Not applicable.
  
  
  
  Categories of decline in and persistently poor mobility across baseline, 1 and 2 years of follow-up in the Lower-Extremity Function scales of the Late-Life Function and Disability Instrument. The following categories of impairment were assessed as potential predictors of mobility change: strength (leg strength), speed of movement (leg velocity, reaction time, rapid leg coordination), range of motion (ROM) (knee flexion/knee extension/ankle ROM), asymmetry (asymmetry of leg strength and knee flexion/extension ROM measures), and trunk stability (trunk extensor endurance, kyphosis).
  
  
  
  The largest effect sizes were found for baseline weaker leg strength (odds ratio [95% confidence interval]: 3.45 [1.72-6.95]), trunk extensor endurance (2.98 [1.56-5.70]), and slower leg velocity (2.35 [1.21-4.58]) predicting a greater likelihood of persistently poor function over 2 years. Baseline weaker leg strength, trunk extensor endurance, and restricted knee flexion motion also predicted a greater likelihood of decline in function (1.72 [1.10-2.70], 1.83 [1.13-2.95], and 2.03 [1.24-3.35], respectively).
  
  
  
  Older adults exhibiting poor mobility may be prime candidates for rehabilitation focused on improving these impairments. These findings lay the groundwork for developing interventions aimed at optimizing rehabilitative care and disability prevention, and highlight the importance of both well-recognized (leg strength) and novel impairments (leg velocity, trunk extensor muscle endurance).
authors.affiliation: New England Geriatric Research Education and Clinical Center, Boston Veterans Affairs Healthcare System, Boston, MA; Harvard Medical School, Boston, MA; Spaulding Rehabilitation Hospital, Cambridge, MA. Electronic address: reward@partners.org.
authors.forename: Rachel E
authors.initials: RE
authors.lastname: Ward
authors.affiliation: School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Marla K
authors.initials: MK
authors.lastname: Beauchamp
authors.affiliation: Health and Disability Research Institute, Boston University School of Public Health, Boston, MA.
authors.forename: Nancy K
authors.initials: NK
authors.lastname: Latham
authors.affiliation: Harvard Medical School, Boston, MA; College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA.
authors.forename: Suzanne G
authors.initials: SG
authors.lastname: Leveille
authors.affiliation: Harvard Medical School, Boston, MA; Massachusetts General Hospital, Boston, MA.
authors.forename: Sanja
authors.initials: S
authors.lastname: Percac-Lima
authors.affiliation: Harvard Medical School, Boston, MA; Spaulding Rehabilitation Hospital, Cambridge, MA.
authors.forename: Laura
authors.initials: L
authors.lastname: Kurlinski
authors.affiliation: Health and Disability Research Institute, Boston University School of Public Health, Boston, MA.
authors.forename: Pengsheng
authors.initials: P
authors.lastname: Ni
authors.affiliation: Harvard Medical School, Boston, MA; Spaulding Rehabilitation Hospital, Cambridge, MA.
authors.forename: Richard
authors.initials: R
authors.lastname: Goldstein
authors.affiliation: Health and Disability Research Institute, Boston University School of Public Health, Boston, MA.
authors.forename: Alan M
authors.initials: AM
authors.lastname: Jette
authors.affiliation: New England Geriatric Research Education and Clinical Center, Boston Veterans Affairs Healthcare System, Boston, MA; Harvard Medical School, Boston, MA; Spaulding Rehabilitation Hospital, Cambridge, MA.
authors.forename: Jonathan F
authors.initials: JF
authors.lastname: Bean
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D007717:Knee / Q000502:physiology; D008137:Longitudinal Studies; D035002:Lower Extremity / Q000502:physiology*; D008297:Male; D051346:Mobility Limitation; D009068:Movement / Q000502:physiology; D053580:Muscle Strength / Q000502:physiology; D018482:Muscle, Skeletal / Q000502:physiology; D009468:Neuromuscular Diseases / Q000503:physiopathology / Q000534:rehabilitation*; D026741:Physical Therapy Modalities; D004856:Postural Balance / Q000502:physiology; D016059:Range of Motion, Articular / Q000502:physiology; D060726:Torso / Q000502:physiology
keywords: Aged; Mobility limitation; Muscle strength; Range of motion, articular; Rehabilitation