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Koponen S, Nykänen I, Savela RM, Välimäki T, Suominen AL, Schwab U. Family caregivers' better nutritional status is associated with care recipients' better nutritional status. Clin Nutr ESPEN 2024; 62:199-205. [PMID: 38901942 DOI: 10.1016/j.clnesp.2024.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 05/14/2024] [Accepted: 05/21/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND AND AIMS A high proportion of older care recipients (CRs) face malnutrition and risk of malnutrition, affecting their functional abilities and posing challenges for caregiving. The aim of this study was to assess the risk for malnutrition among older CRs and the associated characteristics of both CRs and family caregivers (FCs) with nutritional status of CRs. METHODS A cross-sectional study consisted of 120 CRs (≥65 years) and their 118 FCs (≥60 years). Nutritional status was assessed with the Mini Nutritional Assessment (MNA). RESULTS The majority (63%) of the CRs had a risk of malnutrition (MNA score 17-23.5), and 7% had malnutrition (MNA score <17). The CRs had significantly lower MNA scores compared to their FCs (p < 0.001). The multivariate linear regression analysis showed that CRs' higher number of comorbidities (B = -0.37, p = 0.013) and higher P-hs-CRP (B = -0.10, p = 0.047) were associated with their decreased MNA scores. There was a positive association between CRs' hand grip strength (B = 0.11, p = 0.004) and FCs' MNA scores (B = 0.41, p = 0.004) with MNA scores of the CRs. CONCLUSION Malnutrition and risk of malnutrition are common concerns in older CRs, especially those with a higher number of comorbidities and low-grade inflammation. Regular assessment of the nutritional status of both older CRs and FCs is justified, as FCs' better nutritional status is associated with better nutritional status of CR. CLINICAL TRIAL REGISTRATION NUMBER ClinicalTrials.gov NCT04003493.
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Affiliation(s)
- Sohvi Koponen
- Institute of Public Health and Clinical Nutrition, School of Medicine, University of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland.
| | - Irma Nykänen
- Institute of Public Health and Clinical Nutrition, School of Medicine, University of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland
| | - Roosa-Maria Savela
- Department of Nursing Science, University of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland; INVEST Research Flagship Centre, University of Turku, Turku, Finland
| | - Tarja Välimäki
- Department of Nursing Science, University of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland
| | - Anna Liisa Suominen
- Institute of Dentistry, School of Medicine, University of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland; Oral and Maxillofacial Diseases Teaching Unit, Kuopio University Hospital, P.O. Box 1711, FI-70211 Kuopio, Finland
| | - Ursula Schwab
- Institute of Public Health and Clinical Nutrition, School of Medicine, University of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland; Department of Medicine, Endocrinology and Clinical Nutrition, Kuopio University Hospital, P.O. Box 100, FI-70029 KYS, Finland
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Beneciuk JM, Michener LA, Sigman E, Harrison T, Buzzanca-Fried KE, Lu X, Shan G, Hill JC. Validation of the Keele STarT MSK Tool for Patients With Musculoskeletal Pain in United States-based Outpatient Physical Therapy Settings. THE JOURNAL OF PAIN 2024; 25:104475. [PMID: 38242334 DOI: 10.1016/j.jpain.2024.01.340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 01/05/2024] [Accepted: 01/10/2024] [Indexed: 01/21/2024]
Abstract
The STarT MSK tool was developed to enable risk stratification of patients with common musculoskeletal (MSK) pain conditions and help identify individuals who may require more targeted interventions or closer monitoring in primary care settings, however, its validity in U.S.-based outpatient physical therapy settings has not been investigated. The 10-item Keele STarT MSK risk stratification tool was tested for construct (convergent and discriminant) and predictive validity using a multicenter, prospective cohort study design. Participants (n = 141) receiving physical therapy for MSK pain of the back, neck, shoulder, hip, knee, or multisite regions completed intake questionnaires including the Keele STarT MSK tool, Functional Comorbidity Index (FCI), Optimal Screening for Prediction of Referral and Outcome Review-of-Systems and Optimal Screening for Prediction of Referral and Outcome Yellow Flag tools. Pain intensity, pain interference, and health-related quality of life (Medical Outcomes Study 8-item Short-Form Health Survey (SF-8) physical [PCS] and mental [MCS] component summary scores) were measured at 2- and 6-month follow-up. Participants were classified as STarT MSK tool low (44%), medium (39%), and high (17%) risk. Follow-up rates were 70.2% (2 months) and 49.6% (6 months). For convergent validity, fair relationships were observed between the STarT MSK tool and FCI and SF-8 MCS (r = .35-.37) while moderate-to-good relationships (r = .51-.72) were observed for 7 other clinical measures. For discriminant validity, STarT MSK tool risk-dependent relationships were observed for Optimal Screening for Prediction of Referral and Outcome Review-of-Systems, Optimal Screening for Prediction of Referral and Outcome Yellow Flag, pain interference, and SF-8 PCS (low < medium < high; P < .01) and FCI, pain intensity, and SF-8 MCS (low < medium-or-high; P < .01). For predictive validity, intake STarT MSK tool scores explained additional variability in pain intensity (11.2%, 20.0%), pain interference (7.5%, 14.1%), and SF-8 PCS (8.2%, 12.8%) scores at 2 and 6 months, respectively. This study contributes to the existing literature by providing additional evidence of STarT MSK tool cross-sectional construct validity and longitudinal predictive validity. PERSPECTIVE: This study presents STarT MSK risk stratification tool validity findings from a U.S. outpatient physical therapy sample. The STarT MSK tool has the potential to help physical therapists identify individuals presenting with the most common MSK pain conditions who may require more targeted interventions or closer monitoring.
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Affiliation(s)
- Jason M Beneciuk
- Department of Physical Therapy, College of Public Health & Health Professions, University of Florida, Gainesville, Florida; Clinical Research Center, Brooks Rehabilitation, Jacksonville, Florida
| | - Lori A Michener
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California
| | - Erica Sigman
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California
| | - Trent Harrison
- Brooks Institute of Higher Learning, Brooks Rehabilitation, Jacksonville, Florida
| | - Katherine E Buzzanca-Fried
- Clinical Research Center, Brooks Rehabilitation, Jacksonville, Florida; Rehabilitation Science Doctoral Program, College of Public Health & Health Professions, University of Florida, Gainesville, Florida
| | - Xinlin Lu
- Department of Biostatistics, University of Florida, Gainesville, Florida
| | - Guogen Shan
- Department of Biostatistics, University of Florida, Gainesville, Florida
| | - Jonathan C Hill
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Staffordshire, UK
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Kadam E, Javaid M, Sen P, Saha S, Ziade N, Day J, Wincup C, Andreoli L, Parodis I, Tan AL, Shinjo SK, Dey D, Cavagna L, Chatterjee T, Knitza J, Wang G, Dalbeth N, Velikova T, Battista S, Cheng K, Boyd P, Kobert L, Gracia-Ramos AE, Mittal S, Makol A, Gutiérrez CET, Uribe CVC, Kuwana M, Burmester GR, Guillemin F, Nikiphorou E, Chinoy H, Aggarwal V, Gupta L. Collating the voice of people with autoimmune diseases: Methodology for the Third Phase of the COVAD Studies. Rheumatol Int 2024; 44:1233-1244. [PMID: 38609655 PMCID: PMC11178609 DOI: 10.1007/s00296-024-05562-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 02/21/2024] [Indexed: 04/14/2024]
Abstract
INTRODUCTION The growing recognition of holistic patient care highlights the various factors shaping the quality of life of individuals with autoimmune and rheumatic diseases (AIRDs). Beyond the traditional disease measures, there is an emerging acknowledgment of the less-explored aspects, including subjective well-being, social determinants of health, comorbidities, mental health, and medication adherence. Moreover, digital health services have empowered patients to engage actively in decision-making alongside clinicians. To explore these domains within the context of AIRDs, the "Collating the Voice of People with Autoimmune Diseases" COVAD survey was conceived, a successor of the previous two COVAD surveys. In this document, we present the study protocol in comprehensive detail. METHODS The COVAD-3 survey is a cross-sectional patient self-reported e-survey incorporating multiple widely accepted scales/scores to assess various aspects of patients' lifestyles objectively. To ensure the survey's accuracy and usability across diverse regions, it will be translated into multiple languages and subjected to rigorous vetting and pilot testing. It will be distributed by collaborators via online platforms and data will be collected from patients with AIRDs, and healthy individuals over eight months. Data analysis will focus on outcome measures related to various social, demographic, economic, and psychological factors. CONCLUSION With the increasing awareness to adopt a holistic treatment approach encompassing all avenues of life, the COVAD-3 survey aims to gain valuable insights into the impact of social, demographic, economic, and psychological determinants of health on the subjective well-being in patients with AIRDs, which will contribute to a better understanding of their overall health and well-being.
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Affiliation(s)
- Esha Kadam
- Seth Gordhandhas Sunderdas Medical College and King Edwards Memorial Hospital, Mumbai, Maharashtra, India
| | | | - Parikshit Sen
- Maulana Azad Medical College, 2-Bahadurshah Zafar Marg, New Delhi, Delhi, 110002, India
| | - Sreoshy Saha
- Mymensingh Medical College, Mymensingh, Bangladesh
| | - Nelly Ziade
- Rheumatology Department, Saint-Joseph University, Beirut, Lebanon
- Rheumatology Department, Hotel-Dieu de France Hospital, Beirut, Lebanon
| | - Jessica Day
- Department of Rheumatology, Royal Melbourne Hospital, Parkville, VIC, 3050, Australia
- Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia
- Department of Medical Biology, University of Melbourne, Parkville, VIC, 3052, Australia
| | - Chris Wincup
- Department of Rheumatology, King's College Hospital, London, UK
| | - Laura Andreoli
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili and University of Brescia, 25123, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, 25123, Brescia, Italy
| | - Ioannis Parodis
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
- Department of Rheumatology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Ai Lyn Tan
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, Leeds, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Samuel Katsuyuki Shinjo
- Division of Rheumatology, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Dzifa Dey
- Department of Medicine and Therapeutics, School of Medicine and Dentistry, University of Ghana, College of Health Sciences, Korle-Bu, Accra, Ghana
| | - Lorenzo Cavagna
- Rheumatology Unit, Dipartimento di Medicine Interna e Terapia Medica, Università degli Studi di Pavia, Pavia, Lombardy, Italy
| | - Tulika Chatterjee
- Department of Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL, USA
| | - Johannes Knitza
- Medizinische Klinik 3, Rheumatologie Und Immunologie, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Ulmenweg 18, 91054, Erlangen, Deutschland
| | - Guochun Wang
- Department of Rheumatology, China-Japan Friendship Hospital, Yinghua East Road, Chaoyang District, Beijing, 100029, China
| | - Nicola Dalbeth
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Tsvetelina Velikova
- Medical Faculty, Sofia University, St. Kliment Ohridski, 1 Kozyak Str., 1407, Sofia, Bulgaria
| | - Simone Battista
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Campus of Savona, University of Genova, Savona, Italy
| | - Karen Cheng
- Patient Research Partner/Volunteer, Myositis Support and Understanding, Lincoln, USA
| | - Peter Boyd
- Services Support Officer, Arthritis Ireland, Dublin, Ireland
- Chair, EULAR PARE Committee, Kilchberg, Switzerland
| | - Linda Kobert
- Research and Communications Specialist, The Myositis Association, Lincoln, USA
| | - Abraham Edgar Gracia-Ramos
- Department of Internal Medicine, National Medical Center "La Raza", Instituto Mexicano del Seguro Social, General Hospital, Av. Jacaranda S/N, Col. La Raza, Del. Azcapotzalco, C.P. 02990, Mexico City, Mexico
| | - Srijan Mittal
- Maulana Azad Medical College, 2-Bahadurshah Zafar Marg, New Delhi, Delhi, 110002, India
| | - Ashima Makol
- Division of Rheumatology, Mayo Clinic, Rochester, MN, USA
| | - Carlos Enrique Toro Gutiérrez
- Reference Center for Osteoporosis, Rheumatology and Dermatology, Pontificia Universidad Javeriana Cali, Columbia, USA
| | | | - Masataka Kuwana
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8602, Japan
| | - Gerd-Rüdiger Burmester
- Department of Rheumatology and Clinical Immunology, Charité, University Medicine Berlin, Free University and Humboldt University Berlin, Berlin, Germany
| | - Francis Guillemin
- EA 4360 Apemac, Université de Lorraine, Nancy, France
- Inserm, CHRU Nancy, CIC-1433 Epidémiologie Clinique, Université de Lorraine, Nancy, France
| | - Elena Nikiphorou
- Centre for Rheumatic Diseases, King's College London, London, UK
- Rheumatology Department, King's College Hospital, London, UK
| | - Hector Chinoy
- Division of Musculoskeletal and Dermatological Sciences, Centre for Musculoskeletal Research, School of Biological Sciences, The University of Manchester, Manchester, UK
- National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, The University of Manchester, Manchester, UK
- Department of Rheumatology, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, UK
| | - Vikas Aggarwal
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Latika Gupta
- Division of Musculoskeletal and Dermatological Sciences, Centre for Musculoskeletal Research, School of Biological Sciences, The University of Manchester, Manchester, UK.
- Department of Rheumatology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK.
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Kho ME, Berney S, Pastva AM, Kelly L, Reid JC, Burns KEA, Seely AJ, D'Aragon F, Rochwerg B, Ball I, Fox-Robichaud AE, Karachi T, Lamontagne F, Archambault PM, Tsang JL, Duan EH, Muscedere J, Verceles AC, Serri K, English SW, Reeve BK, Mehta S, Rudkowski JC, Heels-Ansdell D, O'Grady HK, Strong G, Obrovac K, Ajami D, Camposilvan L, Tarride JE, Thabane L, Herridge MS, Cook DJ. Early In-Bed Cycle Ergometry in Mechanically Ventilated Patients. NEJM EVIDENCE 2024:EVIDoa2400137. [PMID: 38865147 DOI: 10.1056/evidoa2400137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
BACKGROUND Critical illness requiring invasive mechanical ventilation can precipitate important functional disability, contributing to multidimensional morbidity following admission to an intensive care unit (ICU). Early in-bed cycle ergometry added to usual physiotherapy may mitigate ICU-acquired physical function impairment. METHODS We randomly assigned 360 adult ICU patients undergoing invasive mechanical ventilation to receive 30 minutes of early in-bed Cycling + Usual physiotherapy (n=178) or Usual physiotherapy alone (n=182). The primary outcome was the Physical Function ICU Test-scored (PFIT-s) at 3 days after discharge from the ICU (the score ranges from 0 to 10, with higher scores indicating better function). RESULTS Cycling began within a median (interquartile range) of 2 (1 to 3) days of starting mechanical ventilation; patients received 3 (2 to 5) cycling sessions for a mean (±standard deviation) of 27.2 ± 6.6 minutes. In both groups, patients started Usual physiotherapy within 2 (2 to 4) days of mechanical ventilation and received 4 (2 to 7) Usual physiotherapy sessions. The duration of Usual physiotherapy was 23.7 ± 15.1 minutes in the Cycling + Usual physiotherapy group and 29.1 ± 13.2 minutes in the Usual physiotherapy group. No serious adverse events occurred in either group. Among survivors, the PFIT-s at 3 days after discharge from the ICU was 7.7 ± 1.7 in the Cycling + Usual physiotherapy group and 7.5 ± 1.7 in the Usual physiotherapy group (absolute difference, 0.23 points; 95% confidence interval, -0.19 to 0.65; P=0.29). CONCLUSIONS Among adults receiving mechanical ventilation in the ICU, adding early in-bed Cycling to usual physiotherapy did not improve physical function at 3 days after discharge from the ICU compared with Usual physiotherapy alone. Cycling did not cause any serious adverse events. (Funded by the Canadian Institutes of Health Research and others; ClinicalTrials.gov numbers, NCT03471247 [full randomized clinical trial] and NCT02377830 [CYCLE Vanguard 46-patient internal pilot].).
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Affiliation(s)
- Michelle E Kho
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Physiotherapy Department, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Susan Berney
- Physiotherapy Department, Division of Allied Health, Austin Health, Heidelberg, VIC, Australia
- Department of Physiotherapy, The University of Melbourne, Melbourne, VIC, Australia
| | - Amy M Pastva
- Department of Orthopedic Surgery, Physical Therapy Division, Duke University School of Medicine, Durham, NC
| | - Laurel Kelly
- Physiotherapy Department, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Julie C Reid
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Karen E A Burns
- Interdepartmental Division of Critical Care, University of Toronto, Toronto
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, Unity Health Toronto-St. Michael's Hospital, Toronto
| | - Andrew J Seely
- Department of Surgery, University of Ottawa, Ottawa
- Critical Care Medicine, Ottawa Hospital Research Institute, Ottawa
| | - Frédérick D'Aragon
- Department of Anesthesiology, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Bram Rochwerg
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact (HEI), Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Ian Ball
- Department of Medicine, Western University, London, ON, Canada
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - Alison E Fox-Robichaud
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Department of Critical Care, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Tim Karachi
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Francois Lamontagne
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
- Département de Médecine, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Patrick M Archambault
- Centre de Recherche Intégrée pour un Système Apprenant en Santé et Services Sociaux, Centre Intégré de Santé et Services Sociaux de Chaudière-Appalaches, Lévis, QC, Canada
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec, QC, Canada
| | - Jennifer L Tsang
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Niagara Health Knowledge Institute, Niagara Health, St. Catharines, ON, Canada
| | - Erick H Duan
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - John Muscedere
- Queen's University, Kingston, ON, Canada
- Department of Critical Care Medicine, Kingston, ON, Canada
| | - Avelino C Verceles
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Maryland, Baltimore
| | - Karim Serri
- Critical Care Division, Department of Medicine, Centre de Recherche de l'Hôpital du Sacré-Cœur de Montréal, Hôpital Sacré-Coeur de Montréal, Faculté de Médecine, Université de Montréal, Montreal
| | - Shane W English
- Department of Medicine (Critical Care), University of Ottawa, Ottawa
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa
| | - Brenda K Reeve
- Department of Medicine, Brantford General Hospital, Brantford, ON, Canada
| | - Sangeeta Mehta
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto
- Department of Medicine, Sinai Health System, Toronto
| | - Jill C Rudkowski
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Diane Heels-Ansdell
- Department of Health Research Methods, Evidence, and Impact (HEI), Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Heather K O'Grady
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Geoff Strong
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Kristy Obrovac
- Physiotherapy Department, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Daana Ajami
- Physiotherapy Department, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Laura Camposilvan
- Physiotherapy Department, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Jean-Eric Tarride
- Department of Health Research Methods, Evidence, and Impact (HEI), Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Center for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, ON, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact (HEI), Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Research Institute of St. Joe's, Hamilton, ON, Canada
| | - Margaret S Herridge
- Department of Medicine, Interdepartmental Division of Critical Care Medicine, Toronto General Research Institute, Institute of Medical Science, University Health Network, University of Toronto, Toronto
| | - Deborah J Cook
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact (HEI), Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
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Stutzbach JA, Hare KS, Gustavson AM, Derlein DL, Kellogg AL, Stevens-Lapsley JE. A Novel Behavioral Intervention to Enhance Physical Activity for Older Veterans in a Skilled Nursing Facility. J Aging Phys Act 2024:1-12. [PMID: 38862110 DOI: 10.1123/japa.2022-0412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 03/19/2024] [Accepted: 04/14/2024] [Indexed: 06/13/2024]
Abstract
Physical activity levels during skilled nursing facility (SNF) rehabilitation fall far below what is needed for successful community living and to prevent adverse events. This feasibility study's purpose was to evaluate the feasibility, acceptability, and preliminary effectiveness of an intervention designed to improve physical activity in patients admitted to SNFs for short-term rehabilitation. High-Intensity Rehabilitation plus Mobility combined a high-intensity (i.e., high weight, low repetition), progressive (increasing in difficulty over time), and functional resistance rehabilitation intervention with a behavioral economics-based physical activity program. The behavioral economics component included five mobility sessions/week with structured goal setting, gamification, and loss aversion (the idea that people are more likely to change a behavior in response to a potential loss over a potential gain). SNF physical therapists, occupational therapists, and a mobility coach implemented the High-Intensity Rehabilitation plus Mobility protocol with older Veterans (n = 18) from a single SNF. Participants demonstrated high adherence to the mobility protocol and were highly satisfied with their rehabilitation. Treatment fidelity scores for clinicians were ≥95%. We did not observe a hypothesized 40% improvement in step counts or time spent upright. However, High-Intensity Rehabilitation plus Mobility participants made clinically important improvements in short physical performance battery scores and gait speed from admission to discharge that were qualitatively similar to or slightly higher than historical cohorts from the same SNF that had received usual care or high-intensity rehabilitation alone. These results suggest a structured physical activity program can be feasibly combined with high-intensity rehabilitation for SNF residents following a hospital stay.
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Affiliation(s)
- Julie A Stutzbach
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation,School of Medicine,University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- School of Physical Therapy, Regis University, Denver, CO, USA
| | - Kristine S Hare
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation,School of Medicine,University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Allison M Gustavson
- Veterans Affairs Health Services Research and Development, Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Danielle L Derlein
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation,School of Medicine,University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Andrea L Kellogg
- Select Rehab, Veteran's Community Living Center at Fitzsimons, Aurora, CO, USA
| | - Jennifer E Stevens-Lapsley
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation,School of Medicine,University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- VA Eastern Colorado Geriatric Research Education and Clinical Center (GRECC), Aurora, CO, USA
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6
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Honda H, Ashizawa R, Take K, Hirase T, Arizono S, Yoshimoto Y. Effect of chronic pain on the occurrence of falls in older adults with disabilities: a prospective cohort study. Physiother Theory Pract 2024; 40:1206-1214. [PMID: 36335438 DOI: 10.1080/09593985.2022.2141597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 10/11/2022] [Accepted: 10/13/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND The relationship between chronic pain and the occurrence of falls in healthy older adults has been clarified in previous studies, but its relationship in older adults with disabilities has not. OBJECTIVE This study aimed to determine whether chronic pain is related to the occurrence of falls in older adults with disabilities. METHODS The participants were 101 older adults above 65 years old who used long-term care insurance services in Japan. Of these, 30 were fallers and 71 were non-fallers. Chronic pain, defined as pain lasting more than three months, was assessed using questionnaires, and the falls' occurrence was followed up for six months using a fall calendar. Logistic regression analysis was used to analyze the data, with falls as the dependent variable, chronic pain as the independent variable, and age, sex, body mass index, number of drugs, sleep disorders, and depression as covariates. RESULTS After adjusting for covariates, chronic pain significantly influenced the occurrence of falls (odds ratio: 3.168, 95% confidence interval: 1.057-9.495, p = .04). CONCLUSION Chronic pain was related to the occurrence of falls in older adults with disabilities. There is a need to focus on chronic pain presence in falls' prevention among older adults with disabilities.
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Affiliation(s)
- Hiroya Honda
- Division of Rehabilitation Science, Seirei Christopher University Graduate School, Shizuoka, Japan
| | - Ryota Ashizawa
- Division of Rehabilitation Science, Seirei Christopher University Graduate School, Shizuoka, Japan
| | - Koki Take
- Visiting Nurse Station Sumiyoshi-daini, Shizuoka, Japan
| | - Tatsuya Hirase
- Division of Physical Therapy Science, Graduate Course of Health and Social Work, Kanagawa University of Human Services, Yokosuka-shi, Japan
| | - Shinichi Arizono
- School of Rehabilitation Science, Seirei Christopher University, Shizuoka, Japan
| | - Yoshinobu Yoshimoto
- School of Rehabilitation Science, Seirei Christopher University, Shizuoka, Japan
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Skiba MB, El-Gohary M, Horak F, Dieckmann NF, Guidarelli C, Meyers G, Hayes-Lattin B, Winters-Stone K. Assessment of Mobility Trajectories Using Wearable Inertial Sensors During Autologous Hematopoietic Cell Transplant. Arch Phys Med Rehabil 2024; 105:1106-1115. [PMID: 38354878 PMCID: PMC11144568 DOI: 10.1016/j.apmr.2024.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 01/24/2024] [Accepted: 01/25/2024] [Indexed: 02/16/2024]
Abstract
OBJECTIVE This study aimed to characterize mobility patterns using wearable inertial sensors and serial assessment across autologous hematopoietic cell transplant (autoHCT) and investigate the relation between mobility and perceived function in patients with hematologic cancer. DESIGN Prospective longitudinal study. SETTING Hospital adult transplant clinic followed by discharge. PARTICIPANTS 78 patients with hematological cancer receiving autoHCT. MAIN OUTCOME MEASURES Mobility was measured across 3 clinical phases (pretransplant, pre-engraftment, and post-engraftment) in using inertial sensors worn during prescribed performance tests in the hospital. Perceived function was assessed using validated provider-reported (Eastern Cooperative Oncology Group [ECOG] Performance Status Scale) and patient-reported [European Organization for Research and Treatment of Cancer Quality of Life Questionnaire [EORTC QLQ-C30]) measures. Trajectories of 5 selected mobility characteristics (turn duration, gait speed, stride time variability, double support time, and heel strike angle) across the clinical phases were also evaluated using piecewise linear mixed-effects models. RESULTS Using Principal Components Analysis, 4 mobility patterns were identified pretransplant: Gait Limitation, Sagittal Sway, Coronal Sway, and Balance Control. Gait Limitation measured pretransplant was significantly inversely associated with perceived function reported by the provider- (β = -0.11; 95% CI: -0.19, -0.02) and patient- (β = -4.85; 95% CI: -7.72, -1.99) post-engraftment in age-adjusted linear regression models. Mobility characteristics demonstrated immediate declines early pre-engraftment with stabilization by late pre-engraftment. CONCLUSION Patients with hematological cancer experiencing gait limitations pretransplant are likely to have worse perceived function post-engraftment. Mobility declines in early phases post-transplant and may not fully recover, indicating an opportunity for timely rehabilitation referrals. Wearable inertial sensors can be used to identify early mobility problems and patients who may be at risk for future functional decline who may be candidates for early physical rehabilitation.
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Affiliation(s)
- Meghan B Skiba
- Advanced Nursing Practice and Science Division, College of Nursing, University of Arizona, Tucson, AZ; University of Arizona Cancer Center, Tucson, AZ; Division of Oncological Sciences, Knight Cancer Institute, School of Medicine, Oregon Health & Science University, Portland OR
| | | | - Fay Horak
- APDM, a Clario Inc Company, Portland, OR; Department of Neurology, School of Medicine, Oregon Health & Science University, Portland OR
| | | | - Carolyn Guidarelli
- Division of Oncological Sciences, Knight Cancer Institute, School of Medicine, Oregon Health & Science University, Portland OR
| | - Gabrielle Meyers
- Division of Hematology and Medical Oncology, School of Medicine, Oregon Health & Science University, Portland, OR
| | - Brandon Hayes-Lattin
- Division of Hematology and Medical Oncology, School of Medicine, Oregon Health & Science University, Portland, OR
| | - Kerri Winters-Stone
- Division of Oncological Sciences, Knight Cancer Institute, School of Medicine, Oregon Health & Science University, Portland OR.
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Hoffman RM, Davis-Wilson HC, Hanlon S, Swink LA, Kline PW, Juarez-Colunga E, Melanson EL, Christiansen CL. Maximal daily stepping cadence partially explains functional capacity of individuals with end-stage knee osteoarthritis. PM R 2024; 16:532-542. [PMID: 37819260 PMCID: PMC11006829 DOI: 10.1002/pmrj.13082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 06/01/2023] [Accepted: 09/16/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Individuals with end-stage knee osteoarthritis (OA) walk at a lower intensity (ie, slower step cadence) contributing to worse physical function. Previous literature reports daily step counts and sedentary time, with little information regarding stepping bouts or cadence. Determining relationships between daily higher stepping cadence duration and clinical outcomes can move the field toward optimal daily stepping prescription. OBJECTIVE To quantify daily physical activity patterns of individuals with end-stage knee OA and determine the contribution of high stepping cadence to explain functional capacity variability. DESIGN Cross-sectional analysis. SETTING Veterans Administration medical center. PARTICIPANTS U.S. military veterans (n = 104; age: 67.1 years [7.2]; mean [SD]; male [89.3%]) with end-stage knee OA were enrolled. INTERVENTION Not applicable. MAIN OUTCOME MEASURE Functional capacity (6-Minute Walk Test [6MWT]). Physical activity (activPAL wearable sensor; cadence and time sitting, standing, and stepping), pain (Western Ontario and McMaster Universities Osteoarthritis Index-pain subscale) sociodemographic variables, and comorbidities (body mass index and Functional Comorbidity Index) are the main explanatory variables. RESULTS Participants' wake time was mainly sitting (11.0 h/day) in ≥60-minute bouts (29.7% ± 12.7 of sitting time). Standing (3.4 hours/day) and stepping (1.4 h/day) primarily occurred in 0-5 minute bouts (standing: 87.7% ± 14.4 of standing time, stepping: 98.7% ± 12.7 of stepping time) and stepping cadence was predominantly incidental (1-19 spm; 52.9% ± 9.6 of total stepping time). Backward elimination model results indicated shorter medium-to-brisk cadence bout duration, older age, and higher pain significantly explained shorter 6MWT distance (AdjR2=0.24, p < .01). CONCLUSIONS Individuals with knee OA spend most of their waking hours sitting, while standing and stepping occurs in short bouts at very low stepping cadence. Decreased time in high stepping cadence is associated with lower functional capacity. Future studies should explore if increasing the daily time spent in higher step cadence can improve functional capacity in this population.
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Affiliation(s)
- Rashelle M Hoffman
- Department of Physical Therapy, School of Pharmacy and Health Professions, Creighton University, Omaha, Nebraska, USA
| | - Hope C Davis-Wilson
- RTI International, Technology Advancement and Commercialization, Research Triangle Park, North Carolina, USA
| | - Shawn Hanlon
- Geriatric Research Education and Clinical Center, VA Eastern Colorado Healthcare System, Denver, Colorado, USA
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA
| | - Laura A Swink
- Geriatric Research Education and Clinical Center, VA Eastern Colorado Healthcare System, Denver, Colorado, USA
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA
| | - Paul W Kline
- Department of Physical Therapy, High Point University, High Point, North Carolina, USA
| | - Elizabeth Juarez-Colunga
- Geriatric Research Education and Clinical Center, VA Eastern Colorado Healthcare System, Denver, Colorado, USA
- Department of Biostatistics and Informatics, University of Colorado Anschutz Medical Campus, Denver, Colorado, USA
| | - Edward L Melanson
- Geriatric Research Education and Clinical Center, VA Eastern Colorado Healthcare System, Denver, Colorado, USA
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado, Aurora, Colorado, USA
- Division of Geriatric Medicine, Department of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Cory L Christiansen
- Geriatric Research Education and Clinical Center, VA Eastern Colorado Healthcare System, Denver, Colorado, USA
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA
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Kobara S, Yamamoto R, Rad MG, Grunwell JR, Hikota N, Uzawa Y, Hayashi Y, Coopersmith CM, Kamaleswaran R. Association between comorbidities at ICU admission and post-Sepsis physical impairment: A retrospective cohort study. J Crit Care 2024; 83:154833. [PMID: 38776846 DOI: 10.1016/j.jcrc.2024.154833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 04/27/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE Few studies have measured the association between pre-existing comorbidities and post-sepsis physical impairment. The study aimed to estimate the risk of physical impairment at hospital discharge among sepsis patients, adjusting for pre-existing physical impairment prior to ICU admission and in-hospital mortality. MATERIALS AND METHODS We analyzed all consecutive adult patients admitted to an ICU in a tertiary community hospital, Kameda Medical Center, with sepsis diagnosis from September 2014 to October 2020. Inverse probability attrition weighting using machine learning was employed to estimate the risk of physical impairment at hospital discharge for sepsis patients with and without pre-existing comorbidities at ICU admission. This estimation was adjusted for baseline covariates, pre-ICU physical impairment, and in-hospital mortality. RESULTS Of 889 sepsis patients analyzed, 668 [75.1%] had at least one comorbidity and 221 [24.9%] had no comorbidities at ICU admission. Upon adjusting for baseline covariates, pre-ICU physical impairment, and in-hospital mortality, pre-existing comorbidities were not associated with an elevated risk of physical impairment at hospital discharge (RR: 1.02, 95% CI: 0.92, 1.14). CONCLUSIONS Pre-existing comorbidities prior to ICU admission were not associated with an increased risk of physical impairment at hospital discharge among sepsis patients after adjusting for baseline covariates and in-hospital mortality.
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Affiliation(s)
- Seibi Kobara
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA, USA.
| | - Ryohei Yamamoto
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan; Department of Intensive Care, Kameda Medical Center, Chiba, Japan
| | - Milad G Rad
- Department of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Jocelyn R Grunwell
- Department of Pediatrics, Division of Critical Care, Emory University School of Medicine, Atlanta, GA, USA; Children's Healthcare of Atlanta, GA, USA
| | - Nao Hikota
- Department of Rehabilitation, Kameda Medical Center, Chiba, Japan
| | - Yoshihiro Uzawa
- Department of Rehabilitation, Kameda Medical Center, Chiba, Japan
| | - Yoshiro Hayashi
- Department of Intensive Care, Kameda Medical Center, Chiba, Japan
| | - Craig M Coopersmith
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA; Emory Critical Care Center, Emory University School of Medicine, Atlanta, GA, USA
| | - Rishikesan Kamaleswaran
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA, USA; Department of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, USA; Department of Pediatrics, Division of Critical Care, Emory University School of Medicine, Atlanta, GA, USA; Emory Critical Care Center, Emory University School of Medicine, Atlanta, GA, USA; Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, USA
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Little RB, Carter SJ, Motl RW, Hunter G, Cook A, Liu N, Krontiras H, Lefkowitz EJ, Turan B, Schleicher E, Rogers LQ. Role of Gut Microbe Composition in Psychosocial Symptom Response to Exercise Training in Breast Cancer Survivors (ROME) study: protocol for a randomised controlled trial. BMJ Open 2024; 14:e081660. [PMID: 38702085 PMCID: PMC11086582 DOI: 10.1136/bmjopen-2023-081660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 04/12/2024] [Indexed: 05/06/2024] Open
Abstract
INTRODUCTION Breast cancer survivors have an increased risk for chronic fatigue and altered gut microbiota composition, both with negative health and quality of life affects. Exercise modestly improves fatigue and is linked to gut microbial diversity and production of beneficial metabolites. Studies suggest that gut microbiota composition is a potential mechanism underlying fatigue response to exercise. Randomised controlled trials testing the effects of exercise on the gut microbiome are limited and there is a scarcity of findings specific to breast cancer survivors. The objective of this study is to determine if fitness-related modifications to gut microbiota occur and, if so, mediate the effects of aerobic exercise on fatigue response. METHODS AND ANALYSIS The research is a randomised controlled trial among breast cancer survivors aged 18-74 with fatigue. The primary aim is to determine the effects of aerobic exercise training compared with an attention control on gut microbiota composition. The secondary study aims are to test if exercise training (1) affects the gut microbiota composition directly and/or indirectly through inflammation (serum cytokines), autonomic nervous system (heart rate variability) or hypothalamic-pituitary-adrenal axis mediators (hair cortisol assays), and (2) effects on fatigue are direct and/or indirect through changes in the gut microbiota composition. All participants receive a standardised controlled diet. Assessments occur at baseline, 5 weeks, 10 weeks and 15 weeks (5 weeks post intervention completion). Faecal samples collect the gut microbiome and 16S gene sequencing will identify the microbiome. Fatigue is measured by a 13-item multidimensional fatigue scale. ETHICS AND DISSEMINATION The University of Alabama at Birmingham Institutional Review Board (IRB) approved this study on 15 May 2019, UAB IRB#30000320. A Data and Safety Monitoring Board convenes annually or more often if indicated. Findings will be disseminated in peer-reviewed journals and conference presentations. TRIAL REGISTRATION NUMBER ClinicalTrials.gov, NCT04088708.
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Affiliation(s)
- Rebecca B Little
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Stephen J Carter
- Department of Kinesiology, Indiana University Bloomington, Bloomington, Indiana, USA
| | - Robert W Motl
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Gary Hunter
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Abby Cook
- Baylor Scott & White Medical Center Temple, Temple, Texas, USA
| | - Nianjun Liu
- Department of Epidemiology and Biostatistics, Indiana University Bloomington, Bloomington, Indiana, USA
| | - Helen Krontiras
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Elliot J Lefkowitz
- Department of Computer Science, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Bulent Turan
- Department of Psychology, Koc University, Istanbul, Turkey
| | - Erica Schleicher
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Laura Q Rogers
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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11
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Rosenblatt NJ, Major MJ, Manesh B, Schneider K, Miller SA. Validating a fear-of-falling-related activity avoidance scale in lower limb prosthesis users. PM R 2024; 16:462-473. [PMID: 37632836 PMCID: PMC10895070 DOI: 10.1002/pmrj.13063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 07/05/2023] [Accepted: 08/04/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND Limited available data suggest that fear of falling (FoF) may be common among lower limb prosthesis users (LLPUs) and associated with negative rehabilitation outcomes. The impact of FoF on outcomes may be exacerbated when fear leads to self-imposed declines in activity. There is a need to identify the validity of fear-of-falling-related activity avoidance scales in LLPUs. OBJECTIVE To evaluate the convergent, discriminant, and known-group construct validity of the modified Survey of Activities and FoF in the Elderly (mSAFE) for LLPUs. Secondarily, we sought to determine if the mSAFE scale could be reduced without losing information regarding construct validity. DESIGN Online survey. SETTING Not applicable. PARTICIPANTS Fifty-nine persons with unilateral or bilateral amputation at the transtibial or transfemoral level, with ≥6 months experience using a definitive prosthesis for activities other than transfers. INTERVENTION Participants completed an online survey that consisted of the mSAFE and questions to assess FoF (yes/no), fear-of-falling-related activity avoidance (yes/no), as well as previously validated scales capturing related and unrelated constructs. T-tests were used to compare mSAFE score between yes/no respondents for known-group construct validity. Correlations between mSAFE and previously validated surveys assessed convergent and discriminant validity. Analyses were repeated on a reduced number of mSAFE items following a redundancy analysis. MAIN OUTCOME MEASURES Not applicable. RESULTS Significant correlation coefficients of |0.440-0.825| were found for convergent validity with evidence of known-group construct validity (p < .021 for all comparisons). There was evidence for discriminant validity, with non-significant associations for two-of-three correlations. Results from validity analyses for a shortened 6-item mSAFE were similar to that for the full scale. CONCLUSION This study provided initial evidence regarding validity of the mSAFE as a measure to assess fear-of-falling-related activity avoidance in LLPUs. A 6-item scale may be appropriate if the full scale would be taxing or time-consuming.
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Affiliation(s)
- Noah J Rosenblatt
- Center for Lower Extremity Ambulatory Research (CLEAR) at the Dr. William M. Scholl College of Podiatric Medicine, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - Matthew J Major
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, Illinois, USA
- Department of Biomedical Engineering, Northwestern University, Evanston, Illinois, USA
- Jesse Brown VA Medical Center, Chicago, Illinois, USA
| | - Bobak Manesh
- Center for Lower Extremity Ambulatory Research (CLEAR) at the Dr. William M. Scholl College of Podiatric Medicine, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - Kristin Schneider
- Psychology Department, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - Steven A Miller
- Psychology Department, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
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12
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van Tol LS, Haaksma ML, Cesari M, Dockery F, Everink IHJ, Francis BN, Gordon AL, Grund S, Matchekhina L, Bazan LMP, Schols JMGA, Topinková E, Vassallo MA, Caljouw MAA, Achterberg WP. Post-COVID-19 patients in geriatric rehabilitation substantially recover in daily functioning and quality of life. Age Ageing 2024; 53:afae084. [PMID: 38725361 PMCID: PMC11082471 DOI: 10.1093/ageing/afae084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND After an acute infection, older persons may benefit from geriatric rehabilitation (GR). OBJECTIVES This study describes the recovery trajectories of post-COVID-19 patients undergoing GR and explores whether frailty is associated with recovery. DESIGN Multicentre prospective cohort study. SETTING 59 GR facilities in 10 European countries. PARTICIPANTS Post-COVID-19 patients admitted to GR between October 2020 and October 2021. METHODS Patients' characteristics, daily functioning (Barthel index; BI), quality of life (QoL; EQ-5D-5L) and frailty (Clinical Frailty Scale; CFS) were collected at admission, discharge, 6 weeks and 6 months after discharge. We used linear mixed models to examine the trajectories of daily functioning and QoL. RESULTS 723 participants were included with a mean age of 75 (SD: 9.91) years. Most participants were pre-frail to frail (median [interquartile range] CFS 6.0 [5.0-7.0]) at admission. After admission, the BI first steeply increased from 11.31 with 2.51 (SE 0.15, P < 0.001) points per month and stabilised around 17.0 (quadratic slope: -0.26, SE 0.02, P < 0.001). Similarly, EQ-5D-5L first steeply increased from 0.569 with 0.126 points per month (SE 0.008, P < 0.001) and stabilised around 0.8 (quadratic slope: -0.014, SE 0.001, P < 0.001). Functional recovery rates were independent of frailty level at admission. QoL was lower at admission for frailer participants, but increased faster, stabilising at almost equal QoL values for frail, pre-frail and fit patients. CONCLUSIONS Post-COVID-19 patients admitted to GR showed substantial recovery in daily functioning and QoL. Frailty at GR admission was not associated with recovery and should not be a reason to exclude patients from GR.
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Affiliation(s)
- Lisa S van Tol
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- Center for Medicine for Older People, Leiden University Medical Center, Leiden, The Netherlands
- University Network for the Care sector South-Holland, Leiden University Medical Center, Leiden, The Netherlands
| | - Miriam L Haaksma
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- Center for Medicine for Older People, Leiden University Medical Center, Leiden, The Netherlands
- University Network for the Care sector South-Holland, Leiden University Medical Center, Leiden, The Netherlands
| | - Matteo Cesari
- IRCCS Istituti Clinici Maugeri, University of Milan, Milan, Italy
| | - Frances Dockery
- Beaumont Hospital & Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Irma H J Everink
- Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
| | - Bahaa N Francis
- Fliman Geriatric Rehabilitation Hospital, Zalman Shneur Street, Haifa, 31021, Israel
- Geriatric Division, Holy Family Hospital, Bar Ilan University, Safad, Israel
| | - Adam L Gordon
- Academic Unit of Injury, Recovery and Inflammation Sciences (IRIS), School of Medicine, University of Nottingham, Medical School, Nottingham, NG7 2UH, UK
| | - Stefan Grund
- Center for Geriatric Medicine, Agaplesion Bethanien Hospital Heidelberg, Geriatric Center at the Heidelberg University, Heidelberg, Germany
| | - Luba Matchekhina
- Russian Gerontology Research and Clinical Centre, Pirogov Russian National Research Medical University, Moscow, Russia
| | - Laura Monica Perez Bazan
- RE-FiT Barcelona Research Group, Parc Sanitari Pere Virgili Hospital and Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Jos M G A Schols
- Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
| | - Eva Topinková
- Department of Geriatrics, First Faculty of Medicine, Charles University and General Faculty Hospital, Prague, Czech Republic
- Faculty of Health and Social Sciences, University of South Bohemia, Ceske Budejovice, Czech Republic
| | | | - Monique A A Caljouw
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- Center for Medicine for Older People, Leiden University Medical Center, Leiden, The Netherlands
- University Network for the Care sector South-Holland, Leiden University Medical Center, Leiden, The Netherlands
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- Center for Medicine for Older People, Leiden University Medical Center, Leiden, The Netherlands
- University Network for the Care sector South-Holland, Leiden University Medical Center, Leiden, The Netherlands
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13
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Minnema J, Polinder-Bos HA, Cesari M, Dockery F, Everink IHJ, Francis BN, Gordon AL, Grund S, Perez Bazan LM, Eruslanova K, Topinková E, Vassallo MA, Faes MC, van Tol LS, Caljouw MAA, Achterberg WP, Haaksma ML. The Impact of Delirium on Recovery in Geriatric Rehabilitation after Acute Infection. J Am Med Dir Assoc 2024:105002. [PMID: 38670170 DOI: 10.1016/j.jamda.2024.03.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 03/07/2024] [Accepted: 03/17/2024] [Indexed: 04/28/2024]
Abstract
OBJECTIVES Delirium is common during acute infection in older patients and is associated with functional decline. Geriatric rehabilitation (GR) can help older patients to return to their premorbid functional level. It is unknown whether delirium affects GR outcomes in patients with acute infection. We evaluated whether delirium affects trajectories of activities of daily living (ADL) and quality of life (QoL) recovery in GR after COVID-19 infection. DESIGN This study was part of the EU-COGER study, a multicenter cohort study conducted between October 2020 and October 2021. SETTING AND PARTICIPANTS Participants were recruited after COVID-19 infection from 59 GR centers in 10 European countries. METHODS Data were collected at GR admission, discharge, and at the 6-week and 6-month follow-ups. Trajectories of ADL [using the Barthel index (BI)] and QoL [using the EuroQol-5 Dimensions-5 Level (EQ-5D-5L)] recovery were examined using linear mixed models. RESULTS Of the 723 patients included (mean age 75.5 ± 9.9 years; 52.4% male), 28.9% had delirium before or during GR admission. Participants with delirium recovered in ADL at approximately the same rate as those without (linear slope effect = -0.13, SE 0.16, P = .427) up to an estimated BI score of 16.1 at 6 months. Similarly, participants with delirium recovered in QoL at approximately the same rate as those without (linear slope effect = -0.017, SE 0.015, P = .248), up to an estimated EQ-5D-5L score of 0.8 at 6 months. CONCLUSIONS AND IMPLICATIONS Presence of delirium during the acute phase of infection or subsequent GR did not influence the recovery trajectory of ADL functioning and QoL.
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Affiliation(s)
- J Minnema
- Section Geriatric Medicine, Department of Internal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
| | - H A Polinder-Bos
- Section Geriatric Medicine, Department of Internal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - M Cesari
- IRCCS Istituti Clinici Maugeri, University of Milan, Milan, Italy
| | - F Dockery
- Department of Geriatric Medicine, Beaumont Hospital, Dublin, Ireland
| | - I H J Everink
- Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
| | - B N Francis
- Fliman Geriatric Rehabilitation Centre, Haifa, Israel; Geriatric Division, Holy Family Hospital, Bar Ilan University, Safad, Israel
| | - A L Gordon
- Academic Unit of Injury, Recovery and Inflammation Sciences (IRIS), School of Medicine, University of Nottingham, United Kingdom
| | - S Grund
- Centre for Geriatric Medicine, Agaplesion Bethanien Hospital Heidelberg, Geriatric Centre at the Heidelberg University, Heidelberg, Germany
| | - L M Perez Bazan
- RE-FiT Barcelona Research Group, Parc Sanitari Pere Virgili Hospital and Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - K Eruslanova
- Russian Clinical and Research Centre of Gerontology, Moscow, Russia
| | - E Topinková
- Department of Geriatric Medicine, First Faculty of Medicine, Charles University and General Faculty Hospital, Prague, Czech Republic; Faculty of Health and Social Sciences, South Bohemian University, České Budějovice, Czech Republic
| | - M A Vassallo
- Geriatric Medicine Society of Malta & Telghet G'Mangia, Rehabilitation Hospital Karin Grech, Pietà, Malta
| | - M C Faes
- Department of Geriatrics, Amphia Hospital, Breda, the Netherlands
| | - L S van Tol
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands; University Network for the Care sector South-Holland, Leiden University Medical Center, Leiden, the Netherlands
| | - M A A Caljouw
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands; University Network for the Care sector South-Holland, Leiden University Medical Center, Leiden, the Netherlands
| | - W P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands; University Network for the Care sector South-Holland, Leiden University Medical Center, Leiden, the Netherlands; LUMC Center for Medicine for Older People, Leiden University Medical Center, Leiden, the Netherlands
| | - M L Haaksma
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands; University Network for the Care sector South-Holland, Leiden University Medical Center, Leiden, the Netherlands; LUMC Center for Medicine for Older People, Leiden University Medical Center, Leiden, the Netherlands
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14
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Jehu DA, Langston R, Sams R, Young L, Hamrick M, Zhu H, Dong Y. The Impact of Dual-Tasks and Disease Severity on Posture, Gait, and Functional Mobility among People Living with Dementia in Residential Care Facilities: A Pilot Study. SENSORS (BASEL, SWITZERLAND) 2024; 24:2691. [PMID: 38732796 PMCID: PMC11086138 DOI: 10.3390/s24092691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 04/14/2024] [Accepted: 04/19/2024] [Indexed: 05/13/2024]
Abstract
Gait speed and timed-up-and-go (TUG) predict cognitive decline, falls, and mortality. Dual-tasks may be useful in cognitive screening among people living with dementia (PWD), but more evidence is needed. This cross-sectional study aimed to compare single- and dual-task performance and determine the influence of dementia severity on dual-task performance and interference. Thirty PWD in two residential care facilities (Age: 81.3 ± 7.1 years; Montreal Cognitive Assessment: 10.4 ± 6.0 points) completed two trials of single- (feet apart) and dual-task posture (feet apart while counting backward), single- (walk 4 m) and dual-task gait (walk 4m while naming words), and single- (timed-up-and-go (TUG)), and dual-task functional mobility (TUG while completing a category task) with APDM inertial sensors. Dual-tasks resulted in greater sway frequency, jerk, and sway area; slower gait speed; greater double limb support; shorter stride length; reduced mid-swing elevation; longer TUG duration; reduced turn angle; and slower turn velocity than single-tasks (ps < 0.05). Dual-task performance was impacted (reduced double limb support, greater mid-swing elevation), and dual-task interference (greater jerk, faster gait speed) was related to moderate-to-severe compared to mild PWD. Moderate-to-severe PWD had poorer dynamic stability and a reduced ability to appropriately select a cautious gait during dual-tasks than those with mild PWD, indicating the usefulness of dual-tasks for cognitive screening.
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Affiliation(s)
- Deborah A Jehu
- Department of Community & Behavioral Health Sciences, Institute of Public and Preventative Health, Augusta University, Augusta, GA 30912, USA
| | - Ryan Langston
- Department of Community & Behavioral Health Sciences, Institute of Public and Preventative Health, Augusta University, Augusta, GA 30912, USA
| | - Richard Sams
- Georgia War Veterans Nursing Home, Augusta, GA 30901, USA;
| | - Lufei Young
- School of Nursing, University of North Carolina, Charlotte, NC 28081, USA;
| | - Mark Hamrick
- Department of Cellular Biology and Anatomy, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA;
| | - Haidong Zhu
- Georgia Prevention Institute, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| | - Yanbin Dong
- Georgia Prevention Institute, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
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15
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Pulling BW, Braithwaite FA, Mignone J, Butler DS, Caneiro JP, Lipp OV, Stanton TR. People with painful knee osteoarthritis hold negative implicit attitudes towards activity. Pain 2024:00006396-990000000-00579. [PMID: 38635466 DOI: 10.1097/j.pain.0000000000003210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 01/30/2024] [Indexed: 04/20/2024]
Abstract
ABSTRACT Negative attitudes/beliefs surrounding osteoarthritis, pain, and activity contribute to reduced physical activity in people with knee osteoarthritis (KOA). These attitudes/beliefs are assessed using self-report questionnaires, relying on information one is consciously aware of and willing to disclose. Automatic (ie, implicit) assessment of attitudes does not rely on conscious reflection and may identify features unique from self-report. We developed an implicit association test that explored associations between images of a person moving/twisting their knee (activity) or sitting/standing (rest), and perceived threat (safe vs dangerous). We hypothesised that people with KOA would have greater implicit threat-activity associations (vs pain-free and non-knee pain controls), with implicit attitudes only weakly correlating with self-reported measures (pain knowledge, osteoarthritis/pain/activity beliefs, fear of movement). Participants (n = 558) completed an online survey: 223 had painful KOA (n = 157 female, 64.5 ± 8.9 years); 207 were pain free (n = 157 female, 49.3 ± 15.3 years); and 99 had non-KOA lower limb pain (n = 74 female, 47.5 ± 15.04 years). An implicit association between "danger" and "activity" was present in those with and without limb pain (KOA: 0.36, 95% CI 0.28-0.44; pain free: 0.13, 95% CI 0.04-0.22; non-KOA lower limb pain 0.11, 95% CI -0.03 to 0.24) but was significantly greater in the KOA group than in the pain free (P < 0.001) and non-KOA lower limb pain (P = 0.004) groups. Correlations between implicit and self-reported measures were nonsignificant or weak (rho = -0.29 to 0.19, P < 0.001 to P = 0.767). People with painful KOA hold heightened implicit threat-activity associations, capturing information unique to that from self-report questionnaires. Evaluating links between implicit threat-activity associations and real-world behaviour, including physical activity levels, is warranted.
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Affiliation(s)
- Brian W Pulling
- Persistent Pain Research Group, Hopwood Centre for Neurobiology, Lifelong Health Theme, South Australia Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
- IIMPACT in Health, University of South Australia, Adelaide, South Australia, Australia
| | - Felicity A Braithwaite
- Persistent Pain Research Group, Hopwood Centre for Neurobiology, Lifelong Health Theme, South Australia Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
- IIMPACT in Health, University of South Australia, Adelaide, South Australia, Australia
| | - Joanne Mignone
- UniSA Creative, University of South Australia, Adelaide, South Australia, Australia
| | - David S Butler
- IIMPACT in Health, University of South Australia, Adelaide, South Australia, Australia
| | - J P Caneiro
- Body Logic Physiotherapy, Perth, Western Australia, Australia
- Curtin University, Perth, Western Australia, Australia
| | - Ottmar V Lipp
- Queensland University of Technology, Queensland, Australia
| | - Tasha R Stanton
- Persistent Pain Research Group, Hopwood Centre for Neurobiology, Lifelong Health Theme, South Australia Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
- IIMPACT in Health, University of South Australia, Adelaide, South Australia, Australia
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16
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Muñoz JM, Groskreutz M, Compher C, Andy UU. Diet Intake After Diet Modification Intervention in Women With Fecal Incontinence. UROGYNECOLOGY (PHILADELPHIA, PA.) 2024:02273501-990000000-00211. [PMID: 38621418 DOI: 10.1097/spv.0000000000001480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
IMPORTANCE Older women with fecal incontinence (FI) who underwent diet modification intervention (DMI) showed significant improvement in FI symptoms. It is unclear whether improvement in symptoms was associated with objective changes in dietary intake quality. OBJECTIVES The primary aim was to determine if improvement in overall dietary intake quality was associated with improvement in FI symptoms. Our secondary aim was to evaluate whether individual food group consumption changes were associated with changes in FI symptoms. STUDY DESIGN This was an ancillary analysis of a prospective cohort study of women aged 65 years and older with FI who underwent DMI. Seven-day diet-and-bowel diaries at baseline and 6 weeks after DMI were examined for how frequently participants consumed food categories and FI triggers. Adherence to recommended dietary guidelines was assessed between 2 and 4 weeks using a 24-hour diet recall. Baseline and postintervention consumption were compared using the Wilcoxon signed rank test. Spearman correlation was used to compare dietary intake changes with FI symptom changes. RESULTS Twenty-four women completed the 24-hour diet recalls, and 17 women completed the 7-day diet-and-bowel diaries at baseline and 6 weeks. More participants who were adherent had clinically significant improvement in symptoms compared with those who were not adherent (70% vs 30%, P=0.57). Decreased consumption of saturated fats (P=0.01) and fried foods (P<0.001) was associated with improvement in FI symptoms. CONCLUSIONS In this small population, overall dietary intake quality was not associated with change in FI symptom improvement. Decreased intake of saturated fat and fried food was associated with FI symptom improvement.
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Affiliation(s)
- Jaclyn M Muñoz
- From the Division of Urogynecology, Department of OB/GYN, University of Pennsylvania School of Medicine
| | - Molly Groskreutz
- Department of Biobehavioral Health Science, University of Pennsylvania School of Nursing; Philadelphia, PA
| | - Charlene Compher
- Department of Biobehavioral Health Science, University of Pennsylvania School of Nursing; Philadelphia, PA
| | - Uduak U Andy
- From the Division of Urogynecology, Department of OB/GYN, University of Pennsylvania School of Medicine
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17
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Quek MS, Oei CW, Ong PL, Chung CLH, Kong PW, Zhang X, Leo KH. Prognosticating Prosthetic Ambulation Ability in People With Lower Limb Amputation in Early Post-Operative Phase. Arch Phys Med Rehabil 2024:S0003-9993(24)00904-3. [PMID: 38570179 DOI: 10.1016/j.apmr.2024.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 02/27/2024] [Accepted: 03/27/2024] [Indexed: 04/05/2024]
Abstract
OBJECTIVE To formulate a prognostication model in the early post-operation phase of lower limb amputation to predict patient's ability to ambulate with a prosthesis post rehabilitation. DESIGN Retrospective cohort study, using data collected from electronic medical records. Predictive factors and prosthetic ambulation outcomes post rehabilitation were used to develop prognostic models via machine learning techniques. SETTING Regional hospital's ambulatory rehabilitation clinic. PARTICIPANTS Patients with major lower limb amputation (N=329). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The outcome of prosthetic ambulation ability post rehabilitation collected was categorized in 3 groups: non-ambulant with prosthesis, homebound ambulant with prosthesis (AP), and community AP. RESULTS In a 2-class model of non-ambulant and AP (homebound and community), the model with highest accuracy of prediction included ethnicity, total Functional Comorbidity Index (FCI), level of amputation, being community ambulant prior to amputation, and age. The f1-score and area under receiver operator curve (AUROC) of the model is 0.78 and 0.82. In a 3-class model consisting of all 3 groups of outcomes, the model with highest accuracy of prediction required 10 factors. The additional factors from the 2-class model include presence of caregiver, history of congestive heart failure, diabetes, visual impairment, and stroke. The 3-class model has a moderate accuracy with a f1-score and AUROC of 0.60 and 0.79. CONCLUSION The 2-class prognostication model has a high accuracy which can be used early post-amputation to predict if patient would be ambulant with a prosthesis post rehabilitation. The 3-class prognostication model has moderate accuracy and is able to further differentiate the walking ability to either homebound or community ambulation with a prosthesis, which can assist in prosthetic prescription and setting realistic rehabilitation goals.
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Affiliation(s)
- Mei Sing Quek
- Physiotherapy Department, Tan Tock Seng Hospital, Singapore.
| | - Chien Wei Oei
- Office of Clinical Epidemiology, Analytics & kNowledge (OCEAN), Tan Tock Seng Hospital, Singapore
| | - Poo Lee Ong
- Rehabilitation Medicine, Tan Tock Seng Hospital, Singapore
| | | | - Pui Wah Kong
- National Institute of Education, Nanyang Technological University, Singapore
| | - Xiaojin Zhang
- Office of Clinical Epidemiology, Analytics & kNowledge (OCEAN), Tan Tock Seng Hospital, Singapore
| | - Kee Hao Leo
- Office of Clinical Epidemiology, Analytics & kNowledge (OCEAN), Tan Tock Seng Hospital, Singapore
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18
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Batista PP, Perracini MR, do Carmo Correia de Lima M, de Amorim JSC, Pereira DS, Pereira LSM. Risk of sarcopenia and mobility of older adults during the COVID-19 pandemic: the longitudinal data from the REMOBILIZE study. Aging Clin Exp Res 2024; 36:80. [PMID: 38546804 PMCID: PMC10978643 DOI: 10.1007/s40520-024-02720-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 02/01/2024] [Indexed: 04/01/2024]
Abstract
BACKGROUND We assessed whether clinical, functional and behavioral factors were associated with the decrease in mobility trajectories reported in older people at risk of sarcopenia (RS) and without risk of sarcopenia (NRS) during COVID-19 pandemic. METHODS We prospectively analyzed mobility trajectories reported in older adults with RS and NRS over 16-month follow-up (Remobilize study). The self-perceived risk of sarcopenia and mobility were assessed using the SARC-F and the Life-Space Assessment (LSA) tools, respectively. Gender, age, comorbidities, pain, functional limitation, physical activity (time spent in walking; min/week), and sitting time (ST; hours/day) were assessed. We used a multilevel model to determine changes in mobility between groups and over time. RESULTS Mobility was lower in RS than in NRS. Older people at RS, who were women, aged 70-79 years and 80 years or older, inactive, and with moderate to severe functional limitation experienced reduced mobility trajectories reported over the pandemic. For older people at NRS, trajectories with reduce mobility reported were experienced by women with comorbidities, for those with insufficient walking time and aged 70-79 years; aged 70-79 years and with ST between 5 and 7 hours/day; for those with insufficient walking time and increased ST; and for those with pain and increased ST. CONCLUSION Mobility trajectories reported in older people at risk of sarcopenia were negatively influenced by insufficient level of physical inactivity and pre-existing moderate to severe functional limitation. Health and social interventions should be target to avoid mobility limitation during and after the COVID-19 pandemic.
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Affiliation(s)
- Patricia Parreira Batista
- Postgraduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais (UFMG), Av. Pres. Antônio Carlos, 6.627. Pampulha, Belo Horizonte, MG, Brazil.
| | - Monica Rodrigues Perracini
- Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo, SP, Brazil
- Master's and Doctoral Programs in Gerontology, Faculty of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
| | - Maria do Carmo Correia de Lima
- Master's and Doctoral Programs in Gerontology, Faculty of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
| | | | - Daniele Sirineu Pereira
- Postgraduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais (UFMG), Av. Pres. Antônio Carlos, 6.627. Pampulha, Belo Horizonte, MG, Brazil
| | - Leani Souza Máximo Pereira
- Postgraduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais (UFMG), Av. Pres. Antônio Carlos, 6.627. Pampulha, Belo Horizonte, MG, Brazil
- Postgraduate Program in Health Sciences, Faculdade Ciências Médicas de Minas Gerais (FCMMG), Belo Horizonte, MG, Brazil
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19
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Wallimann M, Peleg S, Pauly T. Time-savoring moderates associations of solitude with depressive mood, loneliness, and somatic symptoms in older adults' daily life. Appl Psychol Health Well Being 2024. [PMID: 38520051 DOI: 10.1111/aphw.12538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 02/28/2024] [Indexed: 03/25/2024]
Abstract
Episodes of solitude (being alone and without social interaction) are common in older age and can relate to decreased well-being. Identifying everyday resources that help maintain older adults' well-being in states of solitude is thus important. We investigated associations of daily solitude with subjective and physical well-being under consideration of time-savoring (i.e., attending to positive experiences and upregulating positive emotions). 108 older adults aged 65-92 years (M = 73.11, SD = 5.93; 58% women; 85% born in Switzerland) took part in an app-based daily diary study in 2022. Over 14 consecutive days, participants reported daily solitude, time-savoring, depressive mood, loneliness, and somatic symptoms in an end-of-day diary. Multilevel models revealed that participants reported higher depressive mood and loneliness, but not higher somatic symptoms on days on which they spent more time in solitude than usual. Higher-than-usual daily time-savoring was associated with lower depressive mood, loneliness, and somatic symptoms. Associations of solitude with depressive mood, loneliness, and somatic symptoms were weaker on days on which higher time-savoring than usual was reported. Findings highlight the potential of everyday time-savoring as a resource in older adults in the context of increased solitude.
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Affiliation(s)
- Miriam Wallimann
- Department of Applied Social and Health Psychology, University of Zurich, Switzerland
| | - Shira Peleg
- Department of Gerontology, Simon Fraser University, Canada
| | - Theresa Pauly
- Department of Gerontology, Simon Fraser University, Canada
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20
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Honda H, Ashizawa R, Kameyama Y, Hirase T, Arizono S, Yoshimoto Y. Chronic pain in older adults with disabilities is associated with fall-related injuries: a prospective cohort study. Eur Geriatr Med 2024:10.1007/s41999-024-00965-4. [PMID: 38512605 DOI: 10.1007/s41999-024-00965-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 02/19/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE Previous studies have shown an association between chronic pain and the occurrence of falls in community-dwelling older adults; however, the association between chronic pain and fall-related injuries in older adults with disabilities is unclear. This study aimed to determine the association between chronic pain and fall-related injuries in older adults with disabilities. METHODS This 24-month prospective cohort study included older adults aged 65 years or older using Japanese long-term care insurance services. Chronic pain, defined as "pain that has persisted for more than three months to date," was assessed using a face-to-face questionnaire. Fall-related injuries, defined as "injuries requiring hospitalization or outpatient treatment due to a fall," were assessed using a fall calendar. Data were analyzed using a Cox proportional hazards model, with fall-related injury as the dependent variable, chronic pain as the independent variable, and confounders as covariates. RESULTS Among 133 included participants, 15 experienced fall-related injuries. After adjusting for age and sex as covariates, chronic pain was significantly associated with fall-related injuries (hazard ratio: 5.487, 95% confidence interval: 1.211-24.853, p = 0.027). CONCLUSIONS Chronic pain was associated with fall-related injuries in older adults with disabilities. In this population, a greater focus should be placed on treating chronic pain to reduce the occurrence of falls.
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Affiliation(s)
- Hiroya Honda
- Division of Rehabilitation Science, Seirei Christopher University Graduate School, 3453 Mikatahara-cho, Kita-ku, Hamamatsu-shi, Shizuoka, 433-8558, Japan.
| | - Ryota Ashizawa
- Department of Rehabilitation, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Yuto Kameyama
- Division of Rehabilitation Science, Seirei Christopher University Graduate School, 3453 Mikatahara-cho, Kita-ku, Hamamatsu-shi, Shizuoka, 433-8558, Japan
| | - Tatsuya Hirase
- Division of Physical Therapy Science, Graduate Course of Health and Social Work, Kanagawa University of Human Services, Yokosuka, Japan
| | - Shinichi Arizono
- School of Rehabilitation Science, Seirei Christopher University, Hamamtsu, Japan
| | - Yoshinobu Yoshimoto
- School of Rehabilitation Science, Seirei Christopher University, Hamamtsu, Japan
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21
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Park S, Tang A, Barclay R, Bayley M, Eng JJ, Mackay-Lyons M, Pollock C, Pooyania S, Teasell R, Yao J, Sakakibara BM. Investigating the Telerehabilitation With Aims to Improve Lower Extremity Recovery Poststroke Program: A Feasibility Study. Phys Ther 2024; 104:pzad165. [PMID: 38051660 DOI: 10.1093/ptj/pzad165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 06/19/2023] [Accepted: 09/15/2023] [Indexed: 12/07/2023]
Abstract
OBJECTIVE The purpose of this study was to examine the feasibility of a progressive virtual exercise and self-management intervention, the TeleRehabilitation with Aims to Improve Lower extremity recovery poststroke program (TRAIL), in individuals with stroke. METHODS A single group pre-post study design was used. Thirty-two participants were recruited who were aged 19 years or older, had a stroke within 18 months of the beginning of the study, had hemiparesis of the lower extremity, and were able to tolerate 50 minutes of activity. Participants completed TRAIL, a synchronous exercise and self-management program delivered via videoconferencing. Participants received 8 telerehabilitation sessions over 4 weeks that were 60 to 90 minutes, with a trained physical therapist in a ≤2 to 1 participant-to-therapist ratio. Feasibility indicators in the areas of process (recruitment and retention rates, perceived satisfaction), resources (treatment fidelity and adherence, participant and assessor burden, therapist burden), management (equipment, processing time), and scientific indicators (safety, treatment response, treatment effect) were collected throughout the study using a priori criteria for success. The treatment effect was examined on the Timed "Up & Go" test, the virtual Fugl-Meyer Lower Extremity Assessment, the 30-Second Sit-to-Stand Test, the Functional Reach, the Tandem Stand, the Activities-Specific Balance Confidence Scale, the Stroke Impact Scale, and the Goal Attainment Scale. RESULTS Forty-seven individuals were screened, of which 32 (78% male; median age of 64.5 years) were included for the study from 5 sites across Canada. Nine feasibility indicators met our study-specific threshold criteria for success: retention rate (0 dropouts), perceived satisfaction, treatment fidelity, adherence, therapist burden, equipment, and safety. In terms of treatment response and effect, improvements were observed in Timed "Up & Go" test (Cohen d = 0.57); Fugl-Meyer Lower Extremity Assessment (d = 0.76); 30-Second Sit-to-Stand Test (d = 0.89); and Goal Attainment Scale (d = 0.95). CONCLUSION The delivery of TRAIL, a lower extremity stroke rehabilitation program using videoconferencing technology, is feasible and appears to have positive influences on mobility, lower extremity impairment, strength, and goal attainment. IMPACT Community-based telerehabilitation programs, such as TRAIL, could extend the continuum of care during the transition back to community postdischarge or during global disruptions, such as Coronavirus Disease 2019 (COVID-19). Delivery of synchronous lower extremity rehabilitation via videoconferencing to community-dwelling stroke survivors is feasible.
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Affiliation(s)
- Sarah Park
- Graduate Program in Rehabilitation Sciences at UBC, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Chronic Disease Prevention & Management, Faculty of Medicine, University of British Columbia, Kelowna, British Columbia, Canada
| | - Ada Tang
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Ruth Barclay
- Department of Physical Therapy, College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mark Bayley
- Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Janice J Eng
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | | | - Courtney Pollock
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Sepideh Pooyania
- Section of Physical Medicine and Rehabilitation, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Robert Teasell
- Parkwood Institute, St Joseph's Health Care, London, Ontario, Canada
| | - Jennifer Yao
- GF Strong Rehabilitation Centre, Vancouver Coastal Health Authority. Vancouver, British Columbia, Canada
| | - Brodie M Sakakibara
- Graduate Program in Rehabilitation Sciences at UBC, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Chronic Disease Prevention & Management, Faculty of Medicine, University of British Columbia, Kelowna, British Columbia, Canada
- Department of Occupational Science & Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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22
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Kiljunen O, Välimäki T, Savela RM, Koponen S, Nykänen I, Suominen AL, Schwab U. Prevalence and risk factors of frailty among older family caregivers. Scand J Caring Sci 2024; 38:57-64. [PMID: 37341070 DOI: 10.1111/scs.13190] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 05/16/2023] [Accepted: 06/09/2023] [Indexed: 06/22/2023]
Abstract
AIM The aim of this study was to investigate the prevalence of frailty and identify the demographical and clinical factors associated with frailty among older family caregivers. METHOD The participants of this cross-sectional study were older family caregivers (n = 125) living in Eastern Finland. Data on functional and cognitive status, depressive symptoms, nutritional status, medication, chronic diseases, stroke, and oral health were obtained. The Mini Nutritional Assessment (MNA) was used to evaluate nutritional status. Frailty status was evaluated using the abbreviated comprehensive geriatric assessment (aCGA) scale. RESULTS Seventy-three percent of caregivers were identified as frail. According to multivariable logistic regression, cataract, glaucoma, or macular degeneration and the MNA score were predictors of frailty. After adjusting for age, gender, and number of own teeth, the MNA score remained a significant predictor of frailty (adjusted OR = 1.22, 95% CI = 1.06, 1.41). As the MNA scores decreased (meaning poorer nutritional status), the risk of frailty increased. CONCLUSIONS The present study showed that frailty is prevalent among older family caregivers. Recognising older family caregivers with frailty or at risk of frailty is vital. It is essential to acknowledge vision problems' role in frailty and to monitor and support the nutritional status of family caregivers regularly to prevent frailty development.
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Affiliation(s)
- Outi Kiljunen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - Tarja Välimäki
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - Roosa-Maria Savela
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - Sohvi Koponen
- School of Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Irma Nykänen
- School of Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Anna Liisa Suominen
- School of Medicine, Institute of Dentistry, University of Eastern Finland, Kuopio, Finland
- Oral Health Teaching Clinic, Kuopio University Hospital, Kuopio, Finland
| | - Ursula Schwab
- School of Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
- Department of Medicine, Endocrinology and Clinical Nutrition, Kuopio University Hospital, Kuopio, Finland
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23
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Hunter J, Soleymani F, Viktor H, Michalowski W, Poitras S, Beaulé PE. Using Unsupervised Machine Learning to Predict Quality of Life After Total Knee Arthroplasty. J Arthroplasty 2024; 39:677-682. [PMID: 37770008 DOI: 10.1016/j.arth.2023.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 09/08/2023] [Accepted: 09/16/2023] [Indexed: 10/03/2023] Open
Abstract
BACKGROUND Patient-reported outcome measures (PROMs) are an important metric to assess total knee arthroplasty (TKA) patients. The purpose of this study was to use a machine learning (ML) algorithm to identify patient features that impact PROMs after TKA. METHODS Data from 636 TKA patients enrolled in our patient database between 2018 and 2022, were retrospectively reviewed. Their mean age was 68 years (range, 39 to 92), 56.7% women, and mean body mass index of 31.17 (range, 16 to 58). Patient demographics and the Functional Comorbidity Index were collected alongside Patient-Reported Outcome Measures Information System Global Health v1.2 (PROMIS GH-P) physical component scores preoperatively, at 3 months, and 1 year after TKA. An unsupervised ML algorithm (spectral clustering) was used to identify patient features impacting PROMIS GH-P scores at the various time points. RESULTS The algorithm identified 5 patient clusters that varied by demographics, comorbidities, and pain scores. Each cluster was associated with predictable trends in PROMIS GH-P scores across the time points. Notably, patients who had the worst preoperative PROMIS GH-P scores (cluster 5) had the most improvement after TKA, whereas patients who had higher global health rating preoperatively had more modest improvement (clusters 1, 2, and 3). Two out of Five patient clusters (cluster 4 and 5) showed improvement in PROMIS GH-P scores that met a minimally clinically important difference at 1-year postoperative. CONCLUSIONS The unsupervised ML algorithm identified patient clusters that had predictable changes in PROMs after TKA. It is a positive step toward providing precision medical care for each of our arthroplasty patients.
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Affiliation(s)
- Jennifer Hunter
- Division of Orthopaedics, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Farzan Soleymani
- Faculty of Engineering, University of Ottawa, Ottawa, Ontario, Canada
| | - Herna Viktor
- Faculty of Engineering, University of Ottawa, Ottawa, Ontario, Canada
| | - Wojtek Michalowski
- Telfer School of Management, University of Ottawa, Ottawa, Ontario, Canada
| | - Stéphane Poitras
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Paul E Beaulé
- Division of Orthopaedics, The Ottawa Hospital, Ottawa, Ontario, Canada
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Ferguson CE, Lambell KJ, Ridley EJ, Goh GS, Hodgson CL, Holland AE, Harrold M, Chan T, Tipping CJ. Muscularity of older trauma patients at intensive care unit admission, association with functional outcomes, and relationship with frailty: A retrospective observational study. Aust Crit Care 2024; 37:205-211. [PMID: 37532620 DOI: 10.1016/j.aucc.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/06/2023] [Accepted: 06/21/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Older individuals are at an increased risk of delayed recovery following a traumatic injury. Measurement of muscularity and frailty at hospital admission may aid with prognostication and risk stratification. OBJECTIVE This study aimed to describe muscularity at intensive care unit (ICU) admission in patients admitted following trauma and assess the relationship between muscularity and clinical, long-term functional outcomes and frailty at ICU admission. METHODS This retrospective study utilised data from a prospective observational study investigating frailty in patients aged ≥50 years, admitted to the ICU following trauma. Patients were eligible if they had a Computed Tomography (CT) scan including the third lumbar vertebra at ICU admission. Specialist software was used to quantify CT-derived skeletal muscle cross-sectional area. Muscularity status was classified as normal or low using published sex-specific cut-points. Demographic data, frailty, clinical, and long-term functional outcomes (Glasgow Outcome Scale-Extended and EQ-5DL-5L Visual analogue scale and utility score) were extracted from the original study. RESULTS One hundred patients were screened; 71 patients had a CT scan on admission with 66 scans suitable for muscle assessment. Patients with low muscularity (n = 25, 38%) were older and had a higher Acute Physiology and Chronic Health Evaluation II score and lower body mass index than patients with normal muscularity. Low muscularity was associated with frailty at admission (32% vs 5%, p = 0.005) but not with long term outcomes at 6 or 12 months. As a continuous variable, lower muscle cross-sectional area was associated with a poorer outcome on the Glasgow Outcome Scale-Extended at 6 months (mean [standard deviation]: 150 [43] and 180 [44], respectively; p = 0.014), no association was observed after adjustment for age p = 0.43). CONCLUSION In a population of older adults hospitalised following trauma, low muscularity at ICU admission was prevalent. Low muscularity was associated with frailty but not long-term functional outcomes. Larger studies are warranted to better understand the relationship between muscularity and long-term functional outcomes.
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Affiliation(s)
- Clare E Ferguson
- Dietetics and Nutrition Department, The Alfred Hospital, Melbourne, Victoria, Australia; Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne 3004, Australia.
| | - Kate J Lambell
- Dietetics and Nutrition Department, The Alfred Hospital, Melbourne, Victoria, Australia.
| | - Emma J Ridley
- Dietetics and Nutrition Department, The Alfred Hospital, Melbourne, Victoria, Australia; Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne 3004, Australia.
| | - Gerard S Goh
- Department of Radiology, The Alfred, Melbourne, Victoria, Australia; Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia; National Trauma Research Institute, Melbourne, Australia.
| | - Carol L Hodgson
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne 3004, Australia; Division of Clinical Trial and Cohort Studies, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Critical Care, University of Melbourne, Melbourne, Victoria, Australia; The George Institute for Global Health; Department of Physiotherapy, The Alfred Hospital, Melbourne, Victoria, Australia.
| | - Anne E Holland
- Department of Physiotherapy, The Alfred Hospital, Melbourne, Victoria, Australia; Respiratory Research @ Alfred, Department of Immunology & Pathology, The Central Clinical School, Monash University, Australia.
| | - Meg Harrold
- Curtin School of Allied Health, Curtin University, Perth, WA, Australia.
| | - Terry Chan
- Department of Physiotherapy, The Alfred Hospital, Melbourne, Victoria, Australia.
| | - Claire J Tipping
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne 3004, Australia; Department of Physiotherapy, The Alfred Hospital, Melbourne, Victoria, Australia.
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Mehrabi F, Béland F. The role of frailty in the relationships between social relationships and health outcomes: a longitudinal study. BMC Public Health 2024; 24:602. [PMID: 38402184 PMCID: PMC10894481 DOI: 10.1186/s12889-024-18111-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 02/14/2024] [Indexed: 02/26/2024] Open
Abstract
BACKGROUND Socially isolated older adults incur increased risks of adverse health outcomes, though the strength of this association is unclear. We examined whether changes in physical frailty moderated the associations between changes in social relationships and changes in health outcomes among older adults. METHODS This longitudinal study is based on three waves of the FRéLE study among 1643 Canadian community-dwelling older adults aged 65 years and older over 2 years. We performed latent growth curve modelling (LGMs) to assess changes with the assumption of missing not at random, adjusting for time-invariant covariates. We used the latent moderated structural equations (LMS) to test the interactions in LGMs. Social relationships were measured by social participation, social networks, and social support from different social ties. Frailty was assessed using the five components of the phenotype of frailty. RESULTS The results revealed that changes in frailty moderated changes in social participation (β = 3.229, 95% CI: 2.212, 4.245), social contact with friends (β = 4.980, 95% CI: 3.285, 6.675), and social support from friends (β = 2.406, 95% CI: 1.894, 2.917), children (β = 2.957, 95% CI: 1.932, 3.982), partner (β = 4.170, 95% CI: 3.036, 5.305) and extended family (β = 6.619, 95% CI: 2.309, 10.923) with changes in cognitive function and depressive symptoms, but not with chronic diseases. These results highlight the beneficial role of social relationships in declining depressive symptoms and improving cognitive health among older adults experiencing increases in frailty. CONCLUSIONS The findings suggest that changes in social support have a protective and compensatory role in decreasing depressive symptoms and enhancing cognitive health among older adults with increasing frailty. Public health policy and strategies should consider the impact of social support on multiple health outcomes among older adults with increasing frailty. Further experimental studies and interventions are warranted to extend findings on the relationships between social relationships and health outcomes, targeting frail older adults. Future studies may also consider other health-related risk factors that may impact the associations between social relationships and health outcomes among older adults.
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Affiliation(s)
- Fereshteh Mehrabi
- School of Public Health, Université de Montréal, Montréal, Québec, Canada.
- Department of Psychology, Concordia University, Montréal, Québec, Canada.
| | - François Béland
- School of Public Health, Université de Montréal, Montréal, Québec, Canada
- Centre de recherche en santé publique (CReSP), Université de Montréal et CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, Québec, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
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26
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Gill AS, Tullis B, Mace JC, Massey C, Pandrangi VC, Gutierrez JA, Ramakrishnan VR, Beswick DM, Soler ZM, Smith TL, Alt JA. Health care disparities and chronic rhinosinusitis: Does neighborhood disadvantage impact outcomes in sinonasal disease? Int Forum Allergy Rhinol 2024. [PMID: 38367249 DOI: 10.1002/alr.23337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 01/04/2024] [Accepted: 01/30/2024] [Indexed: 02/19/2024]
Abstract
OBJECTIVE Socioeconomic status (SES) is linked to health outcomes but has not been well studied in patients with chronic rhinosinusitis (CRS). The area deprivation index (ADI) is a comprehensive measure of geographic SES that ranks neighborhood disadvantage. This investigation used ADI to understand the impact of neighborhood disadvantage on CRS treatment outcomes. METHODS A total of 642 study participants with CRS were prospectively enrolled and self-selected endoscopic sinus surgery (ESS) or continued appropriate medical therapy as treatment. The 22-item SinoNasal Outcome Test (SNOT-22) and Medical Outcomes Study Questionnaire Short-Form 6-D (SF-6D) health utility value scores were recorded pre- and post-treatment. Using residence zip codes, national ADI scores were retrospectively assigned to patients. Spearman's correlation coefficients (Rs) and Cramer's V effect size (φc ) with 95% confidence interval (CI) were calculated. RESULTS A history of ESS was associated with significantly worse ADI scores compared to no history of ESS (φc = 0.18; 95% CI: 0.10, 0.25; p < 0.001). Baseline total SNOT-22 (Rs = 0.14; 95% CI: 0.06, 0.22; p < 0.001) and SF-6D values (Rs = -0.20; 95% CI: -0.27, -0.12; p < 0.001) were significantly negatively correlated with national ADI rank. No significant correlations between ADI and within-subject improvement, or achievement of >1 minimal clinically important difference, in SNOT-22 or SF-6D scores after treatment were found. CONCLUSIONS Geographic socioeconomic deprivation was associated with worse baseline disease severity and history of prior surgical intervention. However, ADI did not correlate with improvement in disease-specific outcomes. The impact of socioeconomic deprivation on outcomes in CRS requires further investigation.
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Affiliation(s)
- Amarbir S Gill
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Benton Tullis
- Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Jess C Mace
- Division of Rhinology and Sinus Surgery/Oregon Sinus Center, Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University (OHSU), Portland, Oregon, USA
| | - Conner Massey
- Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Vivek C Pandrangi
- Division of Rhinology and Sinus Surgery/Oregon Sinus Center, Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University (OHSU), Portland, Oregon, USA
| | - Jorge A Gutierrez
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Vijay R Ramakrishnan
- Department of Otolaryngology-Head and Neck Surgery, University of Indiana, Indianapolis, Indiana, USA
| | - Daniel M Beswick
- Department of Otolaryngology-Head and Neck Surgery, University of California, Los Angeles, California, USA
| | - Zachary M Soler
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Timothy L Smith
- Division of Rhinology and Sinus Surgery/Oregon Sinus Center, Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University (OHSU), Portland, Oregon, USA
| | - Jeremiah A Alt
- Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
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Canter BE, Goebel R, Kulkarni V, Mak W, Falvey J, Boockvar K. Associations Between Eating, Mobility, and Toileting Functional Dependence and COVID-19 Symptoms. J Am Med Dir Assoc 2024; 25:342-347.e4. [PMID: 38141663 DOI: 10.1016/j.jamda.2023.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 11/05/2023] [Accepted: 11/08/2023] [Indexed: 12/25/2023]
Abstract
OBJECTIVES The first goal of this study was to explore associations between functional dependence levels during activities of daily living (eg, functional mobility, eating, and toileting) before COVID-19 and presence of COVID-19 symptoms (eg, fever, dehydration, lethargy, and shortness of breath) during illness. The second goal of this study was to explore associations between presence of specific COVID-19 symptoms and level of functional decline from before to after illness. DESIGN Retrospective cohort study. SETTING AND PARTICIPANTS A total of 375 residents at a single skilled nursing facility in New York City. METHODS Data were extracted from the Minimum Data Set 3.0 and chart reviews. Multiple linear regressions analyzed relationships between baseline functional dependence in eating, functional mobility, and toileting and presence of dehydration, lethargy, shortness of breath, and fever. Ordinal linear regressions analyzed associations between COVID-19 symptom presence and changes in functional dependence from before to after illness. RESULTS Pre-COVID-19 eating dependence was significantly associated with dehydration during COVID-19. Dehydration during COVID-19 was significantly associated with greater functional declines in functional mobility from before to after illness. Shortness of breath was significantly associated with increased functional declines in eating and functional mobility. CONCLUSIONS AND IMPLICATIONS Patients with COVID-19 should be monitored for shortness of breath and dehydration, as these symptoms are associated with functional decline. Individuals experiencing functional decline before COVID-19 onset are especially vulnerable to these symptoms. Future research should further explore the relationship between functional status and COVID-19 symptoms.
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Affiliation(s)
- Benjamin E Canter
- Department of Occupational Therapy, Boston University College of Rehabilitation: Sargent College, Boston, MA, USA.
| | - Russell Goebel
- Department of Mathematics and Statistics, Boston University College of Arts and Sciences, Boston, MA, USA
| | - Varsha Kulkarni
- Department of Mathematics and Statistics, Boston University College of Arts and Sciences, Boston, MA, USA
| | - Wingyun Mak
- The Research Institute on Aging, The New Jewish Home, New York, NY, USA; Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jason Falvey
- Department of Physical Therapy and Rehabilitation Science, University of Maryland, Baltimore, MD, USA; Department of Epidemiology & Public Health, University of Maryland, Baltimore, MD, USA
| | - Kenneth Boockvar
- The Research Institute on Aging, The New Jewish Home, New York, NY, USA; Division of Gerontology Geriatrics and Palliative Care, University of Alabama, Birmingham, Birmingham, AL, USA
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Sears JM, Rundell SD, Fulton-Kehoe D, Hogg-Johnson S, Franklin GM. Using the Functional Comorbidity Index with administrative workers' compensation data: Utility, validity, and caveats. Am J Ind Med 2024; 67:99-109. [PMID: 37982343 PMCID: PMC10824282 DOI: 10.1002/ajim.23550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/30/2023] [Accepted: 11/06/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Chronic health conditions impact worker outcomes but are challenging to measure using administrative workers' compensation (WC) data. The Functional Comorbidity Index (FCI) was developed to predict functional outcomes in community-based adult populations, but has not been validated for WC settings. We assessed a WC-based FCI (additive index of 18 conditions) for identifying chronic conditions and predicting work outcomes. METHODS WC data were linked to a prospective survey in Ohio (N = 512) and Washington (N = 2,839). Workers were interviewed 6 weeks and 6 months after work-related injury. Observed prevalence and concordance were calculated; survey data provided the reference standard for WC data. Predictive validity and utility for control of confounding were assessed using 6-month work-related outcomes. RESULTS The WC-based FCI had high specificity but low sensitivity and was weakly associated with work-related outcomes. The survey-based FCI suggested more comorbidity in the Ohio sample (Ohio mean = 1.38; Washington mean = 1.14), whereas the WC-based FCI suggested more comorbidity in the Washington sample (Ohio mean = 0.10; Washington mean = 0.33). In the confounding assessment, adding the survey-based FCI to the base model moved the state effect estimates slightly toward null (<1% change). However, substituting the WC-based FCI moved the estimate away from null (8.95% change). CONCLUSIONS The WC-based FCI may be useful for identifying specific subsets of workers with chronic conditions, but less useful for chronic condition prevalence. Using the WC-based FCI cross-state appeared to introduce substantial confounding. We strongly advise caution-including state-specific analyses with a reliable reference standard-before using a WC-based FCI in studies involving multiple states.
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Affiliation(s)
- Jeanne M. Sears
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
- Harborview Injury Prevention and Research Center, Seattle, WA, USA
| | - Sean D. Rundell
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
- The Clinical Learning, Evidence And Research (CLEAR) Center for Musculoskeletal Disorders; University of Washington, Seattle, WA, USA
| | - Deborah Fulton-Kehoe
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | - Sheilah Hogg-Johnson
- Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Gary M. Franklin
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
- Department of Neurology, University of Washington, Seattle, WA, USA
- Washington State Department of Labor and Industries, Tumwater, WA, USA
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Haylett R, Grant J, Williams MA, Gustafson O. Does the level of mobility on ICU discharge impact post-ICU outcomes? A retrospective analysis. Disabil Rehabil 2024:1-6. [PMID: 38293804 DOI: 10.1080/09638288.2024.2310186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 01/19/2024] [Indexed: 02/01/2024]
Abstract
PURPOSE Mobilisation is a common intervention in Intensive Care (ICU). However, few studies have explored the relationship between mobility levels and outcomes. This study assessed the association of the level of mobility on ICU discharge with discharge destination from the hospital and hospital length of stay. MATERIALS AND METHODS A retrospective analysis of data from 522 patients admitted to a single UK general ICU who were ventilated for ≥5 days was performed. The level of mobility was assessed using the Manchester Mobility Score (MMS). Multivariable regression analysed demographic and clinical variables for the independence of association with discharge destination and hospital length of stay. RESULTS MMS ≥5 on ICU discharge was independently associated with discharge destination and hospital LOS (p < 0.001). Patients achieving MMS ≥5 on ICU discharge were more likely to be discharged home (OR 3.86 95% CI 2.1 to 6.9, p < 0.001), and had an 11.8 day shorter hospital LOS (95% CI -17.6 to -6.1, p < 0.001). CONCLUSIONS The ability to step transfer to a chair (MMS ≥5) before ICU discharge was independently associated with discharge to usual residence and hospital LOS, irrespective of preadmission morbidity. Increasing the level of patient mobility at ICU discharge should be a key focus of rehabilitation interventions.
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Affiliation(s)
- Rebekah Haylett
- Oxford Allied Health Professions Research and Innovation Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Jonathan Grant
- Oxford Allied Health Professions Research and Innovation Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Mark A Williams
- Oxford Allied Health Professions Research and Innovation Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Centre for Movement, Occupational and Rehabilitation Sciences (MOReS), Oxford Institute of Applied Health Research (OxINAHR), Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Owen Gustafson
- Oxford Allied Health Professions Research and Innovation Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Centre for Movement, Occupational and Rehabilitation Sciences (MOReS), Oxford Institute of Applied Health Research (OxINAHR), Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
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Tan M, Xiao Y, Jing F, Xie Y, Lu S, Xiang M, Ren H. Evaluating machine learning-enabled and multimodal data-driven exercise prescriptions for mental health: a randomized controlled trial protocol. Front Psychiatry 2024; 15:1352420. [PMID: 38287940 PMCID: PMC10822920 DOI: 10.3389/fpsyt.2024.1352420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 01/02/2024] [Indexed: 01/31/2024] Open
Abstract
Background Mental illnesses represent a significant global health challenge, affecting millions with far-reaching social and economic impacts. Traditional exercise prescriptions for mental health often adopt a one-size-fits-all approach, which overlooks individual variations in mental and physical health. Recent advancements in artificial intelligence (AI) offer an opportunity to tailor these interventions more effectively. Objective This study aims to develop and evaluate a multimodal data-driven AI system for personalized exercise prescriptions, targeting individuals with mental illnesses. By leveraging AI, the study seeks to overcome the limitations of conventional exercise regimens and improve adherence and mental health outcomes. Methods The study is conducted in two phases. Initially, 1,000 participants will be recruited for AI model training and testing, with 800 forming the training set, augmented by 9,200 simulated samples generated by ChatGPT, and 200 as the testing set. Data annotation will be performed by experienced physicians from the Department of Mental Health at Guangdong Second Provincial General Hospital. Subsequently, a randomized controlled trial (RCT) with 40 participants will be conducted to compare the AI-driven exercise prescriptions against standard care. Assessments will be scheduled at 6, 12, and 18 months to evaluate cognitive, physical, and psychological outcomes. Expected outcomes The AI-driven system is expected to demonstrate greater effectiveness in improving mental health outcomes compared to standard exercise prescriptions. Personalized exercise regimens, informed by comprehensive data analysis, are anticipated to enhance participant adherence and overall mental well-being. These outcomes could signify a paradigm shift in exercise prescription for mental health, paving the way for more personalized and effective treatment modalities. Registration and ethical approval This is approved by Human Experimental Ethics Inspection of Guangzhou Sport University, and the registration is under review by ChiCTR.
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Affiliation(s)
| | - Yanning Xiao
- China Swimming College, Beijing Sport University, Beijing, China
- China’s National Artistic Swimming Team, Beijing, China
- Institute of Physical Education, Sichuan University, Chengdu, China
| | - Fengshi Jing
- Faculty of Data Science, City University of Macau, Taipa, Macao SAR, China
- Project-China, School of Medicine, The University of North Carolina, Chapel Hill, NC, United States
- College of Business, City University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Yewei Xie
- Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Sanmei Lu
- South China Agricultural University, Guangzhou, China
| | | | - Hao Ren
- Institute for Healthcare Artificial Intelligence Application, Guangdong Second Provincial General Hospital, Guangzhou, China
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Fisher SR, Villasante-Tezanos A, Allen LM, Pappadis MR, Kilic G. Comparative effectiveness of pelvic floor muscle training, mirabegron, and trospium among older women with urgency urinary incontinence and high fall risk: a feasibility randomized clinical study. Pilot Feasibility Stud 2024; 10:1. [PMID: 38178267 PMCID: PMC10765875 DOI: 10.1186/s40814-023-01440-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 12/21/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Untreated, urgency urinary incontinence (UUI) and overactive bladder (OAB) can precipitate a vicious cycle of decreasing physical activity, social isolation, fear of falling, and falls. Structured behavioral interventions and medications are common initial treatment options, but they elicit their effects through very different mechanisms of action that may influence fall-related outcomes differently. This study will determine the feasibility of conducting a comparative effectiveness, three-arm, mixed methods, randomized clinical trial of a behaviorally based pelvic floor muscle training (PFMT) intervention versus two recent drug options in older women with UUI or OAB who are also at increased risk of falling. METHODS Forty-eight women 60 years and older with UUI or OAB who screen positive for increased fall risk will be recruited through the urogynacology and pelvic health clinics of our university health system. Participants will be randomly assigned to one of three 12-week treatment arms: (1) a course of behavioral and pelvic floor muscle training (PFMT) provided by physical therapists; (2) the beta-3 agonist, mirabegron; and (3) the antimuscarinic, trospium chloride. Study feasibility will be established through objective metrics of evaluability, adherence to the interventions, and attrition. We will also assess relevant measures of OAB symptom severity, quality of life, physical activity, incident falls, and concern about falling. DISCUSSION The proposed research seeks to ultimately determine if linkages between reduction in UI symptoms through treatment also reduce the risk of falling in this patient population. TRIAL REGISTRATION NCT05880862. Registered on 30 May 2023.
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Affiliation(s)
- Steve R Fisher
- Department of Physical Therapy, University of Texas Medical Branch at Galveston, Galveston, USA.
| | | | - Lindsay M Allen
- Department of Physical Therapy, University of Texas Medical Branch at Galveston, Galveston, USA
| | - Monique R Pappadis
- Department of Population Health and Health Disparities, University of Texas Medical Branch at Galveston, Galveston, USA
| | - Gokhan Kilic
- Department of Obstetrics and Gynecology, University of Texas Medical Branch at Galveston, Galveston, USA
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Lemes ÍR, Morelhão PK, Verhagen A, Gobbi C, Oliveira CB, Silva NS, Lustosa LP, Franco MR, Pinto RZ. Does the Number of Comorbidities Predict Pain and Disability in Older Adults With Chronic Low Back Pain? A Longitudinal Study With 6- and 12-Month Follow-ups. J Geriatr Phys Ther 2024; 47:21-27. [PMID: 37937986 DOI: 10.1519/jpt.0000000000000400] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
BACKGROUND AND PURPOSE People who live longer often live with multimorbidity. Nevertheless, whether the presence of multimorbidity affects pain and disability in older adults with chronic low back pain (LBP) remains unclear. The aim of this study was to investigate whether multimorbidity predicts pain intensity and disability at 6- and 12-month follow-ups in older adults with chronic LBP. METHODS This was a prospective, longitudinal study with 6- and 12-month follow-ups. Participants with chronic LBP (age ≥ 60 years) were recruited and interviewed at baseline, 6 months, and 12 months. Self-reported measures included the number of comorbidities, assessed through the Self-Administered Comorbidity Questionnaire, pain intensity, assessed with the 11-point Numerical Rating Scale, and disability, assessed with the Roland-Morris Disability Questionnaire. Data were analyzed using univariate and multivariate regression models. RESULTS AND DISCUSSION A total of 220 participants were included. The number of comorbidities predicted pain intensity at 6-month (β= 0.31 [95% CI: 0.12 to 0.50]) and 12-month (β= 0.29 [95% CI: 0.08 to 0.50]) follow-ups. The number of comorbidities predicted disability at 6-month (β= 0.55 [95% CI: 0.20 to 0.90]) and 12-month (β= 0.40 [95% CI: 0.03 to 0.77]) follow-ups. CONCLUSION The number of comorbidities at baseline predicted pain and disability at 6-month and 12-month follow-ups in older adults with chronic LBP. These results highlight the role of comorbidities as a predictive factor of pain and disability in patients with chronic LBP, emphasizing the need for timely and continuous interventions in older adults with multimorbidity to mitigate LBP-related pain and disability.
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Affiliation(s)
- Ítalo R Lemes
- Department of Physical Therapy, Universidade Estadual Paulista (UNESP), Presidente Prudente, Brazil
- Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Priscila K Morelhão
- Department of Physical Therapy, Universidade Estadual Paulista (UNESP), Presidente Prudente, Brazil
- Department of Psychobiology, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Arianne Verhagen
- Discpline of Physiotherapy, Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - Cynthia Gobbi
- Department of Physical Therapy, Universidade UniCesumar, Maringá, Brazil
| | - Crystian B Oliveira
- Faculty of Medicine, University of Western São Paulo (UNOESTE), Presidente Prudente, Brazil
| | - Nayara S Silva
- Department of Physical Therapy, Universidade Estadual Paulista (UNESP), Presidente Prudente, Brazil
| | - Lygia P Lustosa
- Department of Physical Therapy, Universidade Estadual Paulista (UNESP), Presidente Prudente, Brazil
- Deceased on September 17, 2020
| | - Márcia R Franco
- Department of Physical Therapy, Centro Universitário UNA, Belo Horizonte, Brazil
| | - Rafael Z Pinto
- Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
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Badawoud AM, Salgado TM, Lu J, Peron EP, Parsons P, Slattum PW. Medication self-management capacity among older adults living in low-income housing communities. J Am Pharm Assoc (2003) 2024; 64:88-95. [PMID: 38453663 DOI: 10.1016/j.japh.2023.10.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 09/06/2023] [Accepted: 10/24/2023] [Indexed: 03/09/2024]
Abstract
BACKGROUND Medication self-management capacity (MMC) is essential to safe and independent living. There is a need to understand the challenges low-income older adults face during the routine use of medications to promote safe medication use and healthy aging in place. OBJECTIVE To assess the cognitive and physical deficiencies in MMC and the impact of using pharmaceutical aids/services on MMC among low-income older adults. METHODS This was a cross-sectional study of 107 older residents of 5 low-income housing buildings in Richmond, VA. The Medication Management Instrument for Deficiencies in the Elderly was used to measure MMC during individual in-person interviews. Participants were asked whether they used any medication aids, including medication lists, organizers, or reminders, or pharmacy services such as specialized medication packaging, medication synchronization, prescription home delivery, or mail order services. Multiple regression modeling was used to assess the relationship between MMC and the use of pharmaceutical aids/services. RESULTS Eighty-nine percent of participants were African American with a mean (standard deviation [±SD]) age of 68.5 (7.2) years. The mean deficit in MMC was 3 (±2.0). The most challenging skill was naming all the medications (69.2%), followed by stating their indications (46.7%) and knowing how or when all of the medications should be taken (38.3%). Seventy-nine percent used at least 1 pharmaceutical aid/service; using 1 pharmaceutical aid/service was significantly associated with better MMC (P = .0285). Low educational level and health literacy were associated with deficits in MMC (P < .05). CONCLUSION Many older adults residing in low-income housing had impaired capacity to manage their medications independently. Inadequate medication knowledge affected their cognitive ability to manage medications. Using a pharmaceutical aid/service was associated with better MMC. Greater attention to developing medication self-management skills for older adults with low health literacy and adverse social determinants of health is needed.
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Butera KA, Gustavson AM, Forster JE, Malone D, Stevens-Lapsley JE. Admission Cognition and Function Predict Change in Physical Function Following Skilled Nursing Rehabilitation. J Am Med Dir Assoc 2024; 25:17-23. [PMID: 37863110 PMCID: PMC10872438 DOI: 10.1016/j.jamda.2023.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 07/04/2023] [Accepted: 09/12/2023] [Indexed: 10/22/2023]
Abstract
OBJECTIVES Many older adults are discharged from skilled nursing facilities (SNFs) at functional levels below those needed for safe, independent home and community mobility. There is limited evidence explaining this insufficient recovery. The purpose of this secondary analysis was to determine predictors of physical function change following SNF rehabilitation. DESIGN Secondary analysis of a prospective observational cohort study. SETTING AND PARTICIPANTS Across 4 SNFs, data were collected from 698 adults admitted for physical rehabilitation following an acute hospitalization. METHODS Physical function recovery was evaluated as change from admission to discharge in Short Physical Performance Battery (SPPB) scores (N = 698) and gait speed (n = 444). Demographic and clinical characteristics collected at admission served as potential predictors of physical function change. Following imputation, a standardized model selection estimator was calculated for predictors per physical function outcome. Predictor estimates and 95% CIs were calculated for each outcome model. RESULTS Higher cognitive scores [standardized β (βSTD) = 0.11, 95% CI: 0.0004, 0.20] and higher activities of daily living (ADL) independence at admission (βSTD = 0.22, 95% CI: 0.05, 0.34) predicted greater SPPB change; higher SPPB scores at admission (βSTD = -0.26, 95% CI: -0.35, -0.14) predicted smaller SPPB change. Higher ADL independence at admission (βSTD = 0.17, 95% CI: 0.01, 0.37) predicted greater gait speed change; faster gait speed at admission (βSTD = -0.30, 95% CI: -0.44, -0.15) predicted smaller gait speed change. CONCLUSIONS AND IMPLICATIONS Admission cognition, ADL independence, and physical function predicted physical function change following post-hospitalization rehabilitation. Inverse findings for admission physical function and ADL independence predictors suggest independence with ADL is not necessarily aligned with mobility-related function. Findings highlight that functional recovery is multifactorial and requires comprehensive assessment throughout SNF rehabilitation.
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Affiliation(s)
- Katie A Butera
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, USA; Department of Physical Therapy, University of Delaware, Newark, DE, USA
| | - Allison M Gustavson
- Center for Care Delivery and Outcome Delivery Center for Care Delivery & Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA; Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Jeri E Forster
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, USA; VA Rocky Mountain Mental Illness Research Education and Clinical Center, Aurora, CO, USA
| | - Daniel Malone
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, USA
| | - Jennifer E Stevens-Lapsley
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, USA; VA Eastern Colorado Geriatric Research, Education, and Clinical Center (GRECC), VA Eastern Colorado Health Care System, Aurora, CO, USA.
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Nawab A, Acosta A, Levine CG, Hoffer ME, Casiano R, Liu XZ. Chemosensory function recovery in COVID-19 patients: A cross-sectional study. Am J Otolaryngol 2024; 45:104047. [PMID: 37738881 DOI: 10.1016/j.amjoto.2023.104047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/12/2023] [Indexed: 09/24/2023]
Abstract
OBJECTIVE To determine whether subjects who have recovered from COVID-19 smell and taste disturbance perform similarly to their COVID-naïve baseline, on gold-standard smell and taste tests. STUDY DESIGN Prospective cross-sectional study. SETTING University of Miami Department of Otolaryngology in Miami, FL between September 2021, and August 2022. METHODS Those previously COVID-19 positive composed the experimental group, those who reported being COVID-naïve composed the control group. Mean total score for the UPSIT Smell Test, and the Burghart Taste Strip test were the primary outcome measures. RESULTS 70 adult subjects (35 former COVID-positive, 35 COVID-naïve) were enrolled, with 21 females and 14 males in each group. 87 % of all subjects were white and were almost distributed evenly between Hispanic and non-Hispanic. Mean UPSIT total score for the experimental group was 30.6 (95 % CI 28.9-32.3), mean UPSIT total score for the control group was 31.2 (95 % CI 29.7-32.8). Mean Burghart total score for the experimental group was 11.3 (95 % CI 10.6-12.0), mean Burghart total score for the control group was 10.7 (95 % CI 9.7-11.8). These showed a significant overlap of the 95 % CI of the mean total score between the control group and the experimental group, suggesting no significant difference between the two groups. CONCLUSION These results suggest that COVID-19 patients who experience smell and taste disturbance and recover, regain sensory ability similar to their pre-COVID ability. Further study is needed to validate these findings, but the results are promising in the long-term recovery of COVID-19.
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Affiliation(s)
- Aria Nawab
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Aura Acosta
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Corinna G Levine
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Michael E Hoffer
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL, United States of America; Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Roy Casiano
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Xue Zhong Liu
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL, United States of America.
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Zhang Y, Chen YC, Wang JSH. Long-term Care Insurance and Health and Perceived Satisfaction of Older Chinese: Comparisons Between Urban/Rural Areas, Chronic Conditions, and Their Intersectionality. Int J Health Policy Manag 2023; 12:7938. [PMID: 38618772 PMCID: PMC10843175 DOI: 10.34172/ijhpm.2023.7938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 11/21/2023] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Evidence of the impact of long-term care insurance (LTCI) on health and well-being has predominantly come from developed countries. China officially launched its city-level LTCI policy in 2016. Recent evidence in China has shown that having an LTCI program contributes to positive health. However, it is unclear whether such positive policy effects were attributed to policy announcement or implementation effects, and whether the policy effects vary by locality, chronic conditions, and their intersectionality. This study examines whether there are longitudinal health benefits for older Chinese who are participating in LTCI, particularly considering their city location (urban/rural), whether they have chronic conditions, and the intersectionality. METHODS Following the Andersen Behavioral Model, health and satisfaction outcomes of 9253 adults aged 60+ years were extracted from the 2015 and 2018 waves of the China Health and Retirement Longitudinal Study (CHARLS). Individual data were linked to census socioeconomic data with city-level characteristics and LTCI policy variable. Multilevel lagged regression models investigated the impact of LTCI policy on health and satisfaction with health services, after controlling for baseline individual- and city-level covariates. RESULTS Of 125 cities in the dataset, 21 (16.8%) had adopted LTCI. These city inhabitants had significantly better self-rated health and higher satisfaction relative to cities without LTCI policies when environmental- and personal-level characteristics were modeled. Health benefits of LTCI were stronger after policy announcement and were particularly observed among rural older adults and those with chronic conditions. Results also suggest that LTCI's positive effects on satisfaction spill over to middle-aged adults. CONCLUSION Expanding coverage and eligibility to LTCI for all older Chinese could improve health and well-being.
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Affiliation(s)
- Yinkai Zhang
- Department of Social Work & Social Administration, The University of Hong Kong, Hong Kong SAR, China
| | - Yu-Chih Chen
- Department of Social Work & Social Administration, The University of Hong Kong, Hong Kong SAR, China
- Social Policy Institute, Washington University in St. Louis, St. Louis, MO, USA
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Murrell J, Khadabadi NA, Moores T, Hossain F. Identifying Preoperative Predictors for 24-Hour Discharge After Elective Hip and Knee Arthroplasties. Cureus 2023; 15:e50989. [PMID: 38143727 PMCID: PMC10748218 DOI: 10.7759/cureus.50989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2023] [Indexed: 12/26/2023] Open
Abstract
Introduction The resumption of elective medical services post-pandemic has brought to the forefront the importance of outpatient arthroplasty services in promoting efficiency and mitigating hospital-acquired infections. This study aimed to identify preoperative factors that predict the success of outpatient lower limb arthroplasty surgeries. Methods Our investigation involved a retrospective review of 606 patients who underwent elective hip and knee arthroplasty. We documented variables such as the hospital length of stay, patient demographics (age and gender), Oxford Joint Scores, body mass index, socioeconomic status, American Society of Anaesthesiologists' (ASA) physical status classification, comorbid conditions, the Functional Comorbidity Index (FCI), preoperative blood test results, implant types, scheduling details of the surgery, and rates of readmission within 30 days post-surgery. A two-step analysis using univariate and multivariate regression models was performed to pinpoint preoperative indicators that could predict same-day discharge following arthroplasty. Results Forty-five patients (7.4%) were discharged within 24 hours of surgery. Early discharge did not correlate with higher rates of readmission within 30 days (p>0.05). Neither weekend nor afternoon surgeries significantly extended the length of stay beyond 24 hours (p>0.05). No significant differences in the prevalence of comorbidities, FCI scores, socioeconomic status, or preoperative blood test results were found when comparing patients discharged within 24 hours to those who stayed longer. Multivariate analysis revealed that patients younger than 65 years (relative risk (RR) 2.41; 95% confidence interval (CI) 1.02-5.74) and those receiving partial knee arthroplasty (RR 8.91; 95% CI 3.05-26.04) were more likely to be discharged within 24 hours. Conclusions Outpatient arthroplasty is a viable option, especially for individuals younger than 65 years undergoing partial knee arthroplasty, independent of other patient-related factors, comorbidities, and specifics of the hospital episode.
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Affiliation(s)
- James Murrell
- Trauma and Orthopaedics, Walsall Manor Hospital, Walsall, GBR
| | | | - Thomas Moores
- Trauma and Orthopaedics, Walsall Manor Hospital, Walsall, GBR
| | - Fahad Hossain
- Trauma and Orthopaedics, Walsall Manor Hospital, Walsall, GBR
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Benhenneda R, Brouard T, Charousset C, Berhouet J. Can artificial intelligence help decision-making in arthroscopy? Part 2: The IA-RTRHO model - a decision-making aid for long head of the biceps diagnoses in small rotator cuff tears. Orthop Traumatol Surg Res 2023; 109:103652. [PMID: 37380127 DOI: 10.1016/j.otsr.2023.103652] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 05/09/2023] [Accepted: 05/17/2023] [Indexed: 06/30/2023]
Abstract
INTRODUCTION The possible applications of artificial intelligence (AI) in orthopedic surgery are promising. Deep learning can be utilized in arthroscopic surgery due to the video signal used by computer vision. The intraoperative management of the long head of biceps (LHB) tendon is the subject of a long-standing controversy. The main objective of this study was to model a diagnostic AI capable of determining the healthy or pathological state of the LHB on arthroscopic images. The secondary objective was to create a second diagnostic AI model based on arthroscopic images and the medical, clinical and imaging data of each patient, to determine the healthy or pathological state of the LHB. HYPOTHESIS The hypothesis of this study was that it was possible to construct an AI model from operative arthroscopic images to aid in the diagnosis of the healthy or pathological state of the LHB, and its analysis would be superior to a human analysis. MATERIALS AND METHODS Prospective clinical and imaging data from 199 patients were collected and associated with images from a validated protocoled arthroscopic video analysis, called "ground truth", made by the operating surgeon. A model based on a convolutional neural network (CNN) modeled via transfer learning on the Inception V3 model was built for the analysis of arthroscopic images. This model was then coupled to MultiLayer Perceptron (MLP), integrating clinical and imaging data. Each model was trained and tested using supervised learning. RESULTS The accuracy of the CNN in diagnosing the healthy or pathological state of the LHB was 93.7% in learning and 80.66% in generalization. Coupled with the clinical data of each patient, the accuracy of the model assembling the CNN and MLP were respectively 77% and 58% in learning and in generalization. CONCLUSION The AI model built from a CNN manages to determine the healthy or pathological state of the LHB with an accuracy rate of 80.66%. An increase in input data to limit overfitting, and the automation of the detection phase by a Mask-R-CNN are ways of improving the model. This study is the first to assess the ability of an AI to analyze arthroscopic images, and its results need to be confirmed by further studies on this subject. LEVEL OF EVIDENCE III Diagnostic study.
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Affiliation(s)
- Rayane Benhenneda
- Service de chirurgie orthopédique, hôpital Trousseau, CHRU de Tours, faculté de médecine, université de Tours, Centre-Val-de-Loire, France.
| | - Thierry Brouard
- LIFAT (EA6300), école polytechnique universitaire de Tours, 64, avenue Jean-Portalis, 37200 Tours, France
| | | | - Julien Berhouet
- Service de chirurgie orthopédique, hôpital Trousseau, CHRU de Tours, faculté de médecine, université de Tours, Centre-Val-de-Loire, France; LIFAT (EA6300), école polytechnique universitaire de Tours, 64, avenue Jean-Portalis, 37200 Tours, France
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Chow IH, Miller T, Pang MY. Predictive factors for home discharge after femoral fracture surgery: a prospective cohort study. Eur J Phys Rehabil Med 2023; 59:743-753. [PMID: 37750861 DOI: 10.23736/s1973-9087.23.07900-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
BACKGROUND Femoral fractures require protracted hospitalization and often preclude return to pre-fracture levels of mobility, function and prior residential status following hospital discharge. Early prediction of rehabilitation and discharge potential in patients with femoral fracture would optimize discharge planning. AIM To identify predictive factors of discharge destination during the early phase of femoral fracture rehabilitation. DESIGN Prospective cohort design. SETTING Acute and postoperative rehabilitation hospital settings. POPULATION Data from 109 participants (65 women [59.6%]) admitted for unilateral femoral fracture were included. METHODS Sociodemographic information, hip pain severity during gait (Numeric Pain Rating Scale), mobility (Elderly Mobility Scale), activities of daily living (Modified Barthel Index), cognition (Mini-Mental State Examination [MMSE]), exercise self-efficacy (Self-Efficacy for Exercise Scale), amount of physiotherapy received, and caregiver availability were assessed pre- and/or postoperatively. Discharge destination was assessed via telephone interviews 6 weeks after discharge from acute care. Receiver operating characteristic curves were used to determine optimal cut-off scores for all outcomes based on discharge destination. Outcomes demonstrating a significant area under the curve were entered as dichotomous independent variables (i.e., above or below ROC-derived cut-off values) in subsequent logistic regression analyses to determine predictors of discharge destination. RESULTS SEE Score ≥53 (odds ratio [OR]=5.975, 95% confidence interval [CI]=1.674-21.333, P=0.006), female sex (OR=3.421, 95% CI=1.187-9.861, P=0.023), ≥8 physiotherapy sessions (OR=4.633, 95% CI=1.559-13.771, P=0.006), MMSE Score ≥17 (OR=3.374, 95% CI=1.047-10.873, P=0.042), and caregiver availability (OR=3.766, 95% CI=1.133-12.520, P=0.030) were identified as significant predictors of home discharge. CONCLUSIONS Exercise self-efficacy, female sex, more physiotherapy rehabilitation training, better pre-operative cognitive function, and caregiver availability emerged as important predictors of home discharge following femoral fracture. CLINICAL REHABILITATION IMPACT These findings are highly translational and may be useful for informing clinical guidelines and policy decisions regarding rehabilitation potential and discharge pathway selection during early hospitalization following femoral fracture surgery.
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Affiliation(s)
- Intonia H Chow
- Department of Physiotherapy, Queen Elizabeth Hospital, Kowloon, Hong Kong
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Tiev Miller
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Kowloon, Hong Kong
- International Collaboration on Repair Discoveries, Faculty of Medicine, University of British Columbia (UBC), Vancouver, Canada
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of British Columbia (UBC), Vancouver, Canada
| | - Marco Y Pang
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Kowloon, Hong Kong -
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Rice J, Li LC, Davis JC, Pahor M, Madden K, Wei N, Wong H, Skelton DA, McCormick S, Falck RS, Barha CK, Rhodes RE, Loomba S, Sadatsafavi M, Liu-Ambrose T. Supporting physical activity for mobility in older adults with mobility limitations (SuPA Mobility): study protocol for a randomized controlled trial. Trials 2023; 24:769. [PMID: 38017467 PMCID: PMC10685660 DOI: 10.1186/s13063-023-07798-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 11/09/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Limited mobility in older adults consistently predicts both morbidity and mortality. As individuals age, the rates of mobility disability increase from 1.0% in people aged 15-24 to 20.6% in adults over 65 years of age. Physical activity can effectively improve mobility in older adults, yet many older adults do not engage in sufficient physical activity. Evidence shows that increasing physical activity by 50 min of moderate intensity physical activity in sedentary older adults with mobility limitations can improve mobility and reduce the incidence of mobility disability. To maximize the healthy life span of older adults, it is necessary to find effective and efficient interventions that can be delivered widely to prevent mobility limitations, increase physical activity participation, and improve quality of life in older adults. We propose a randomized controlled trial to assess the effect of a physical activity health coaching intervention on mobility in older adults with mobility limitations. METHODS This randomized controlled trial among 290 (145 per group) community-dwelling older adults with mobility limitations, aged 70-89 years old, will compare the effect of a physical activity health coaching intervention versus a general healthy aging education program on mobility, as assessed with the Short Physical Performance Battery. The physical activity health coaching intervention will be delivered by exercise individuals who are trained in Brief Action Planning. The coaches will use evidence-based behavior change techniques including goal-setting, action planning, self-monitoring, and feedback to improve participation in physical activity by a known dose of 50 min per week. There will be a total of 9 health coaching or education sessions delivered over 26 weeks with a subsequent 26-week follow-up period, wherein both groups will receive the same duration and frequency of study visits and activities. DISCUSSION The consequences of limited mobility pose a significant burden on the quality of life of older adults. Our trial is novel in that it investigates implementing a dose of physical activity that is known to improve mobility in older adults utilizing a health coaching intervention. TRIAL REGISTRATION ClinicalTrials.gov Protocol Registration System: NCT05978336; registered on 28 July 2023.
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Affiliation(s)
- Jordyn Rice
- University of British Columbia, 2329 West Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Linda C Li
- University of British Columbia, 2329 West Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Jennifer C Davis
- University of British Columbia-Okanagan, 3333 University Way, Kelowna, BC, V1V 1V7, Canada
| | - Marco Pahor
- University of Florida, Gainesville, FL, 32611, USA
| | - Kenneth Madden
- University of British Columbia, 2329 West Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Nathan Wei
- University of British Columbia, 2329 West Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Hubert Wong
- University of British Columbia, 2329 West Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Dawn A Skelton
- Glasgow Caledonian University, Cowcaddens Rd, Glasgow, G4 0BA, UK
| | - Sioban McCormick
- University of British Columbia, 2329 West Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Ryan S Falck
- University of British Columbia, 2329 West Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Cindy K Barha
- University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
| | - Ryan E Rhodes
- University of Victoria, 3800 Finnerty Rd, Victoria, BC, V8P 5C2, Canada
| | - Sohail Loomba
- University of British Columbia, 2329 West Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Mohsen Sadatsafavi
- University of British Columbia, 2329 West Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Teresa Liu-Ambrose
- University of British Columbia, 2329 West Mall, Vancouver, BC, V6T 1Z4, Canada.
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Hooker ER, Chapa J, Vranas KC, Niederhausen M, Goodlin SJ, Slatore CG, Sullivan DR. Intersection of Palliative Care and Hospice Use Among Patients With Advanced Lung Cancer. J Palliat Med 2023; 26:1474-1481. [PMID: 37262128 PMCID: PMC10658737 DOI: 10.1089/jpm.2023.0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2023] [Indexed: 06/03/2023] Open
Abstract
Background: Hospice and palliative care (PC) are important components of lung cancer care and independently provide benefits to patients and their families. Objective: To better understand the relationship between hospice and PC and factors that influence this relationship. Methods: A retrospective cohort study of patients diagnosed with advanced lung cancer (stage IIIB/IV) within the U.S. Veterans Health Administration (VA) from 2007 to 2013 with follow-up through 2017 (n = 22,907). Mixed logistic regression models with a random effect for site, adjustment for patient variables, and propensity score weighting were used to examine whether the association between PC and hospice use varied by U.S. region and PC team characteristics. Results: Overall, 57% of patients with lung cancer received PC, 69% received hospice, and 16% received neither. Of those who received hospice, 60% were already enrolled in PC. Patients who received PC had higher odds of hospice enrollment than patients who did not receive PC (adjusted odds ratio = 3.25, 95% confidence interval: 2.43-4.36). There were regional differences among patients who received PC; the predicted probability of hospice enrollment was 85% and 73% in the Southeast and Northeast, respectively. PC team and facility characteristics influenced hospice use in addition to PC; teams with the shortest duration of existence, with formal team training, and at lower hospital complexity were more likely to use hospice (all p < 0.05). Conclusions: Among patients with advanced lung cancer, PC was associated with hospice enrollment. However, this relationship varied by geographic region, and PC team and facility characteristics. Our findings suggest that regional PC resource availability may contribute to substitution effects between PC and hospice for end-of-life care.
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Affiliation(s)
- Elizabeth R. Hooker
- Center to Improve Veteran Involvement in their Care (CIVIC), VA Portland Health Care System, Portland, Oregon, USA
| | - Joaquin Chapa
- Division of Pulmonary and Critical Care Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Kelly C. Vranas
- Center to Improve Veteran Involvement in their Care (CIVIC), VA Portland Health Care System, Portland, Oregon, USA
- Division of Pulmonary and Critical Care Medicine, Oregon Health and Science University, Portland, Oregon, USA
- Portland Veterans Affairs Medical Center, Divisions of Pulmonary Critical Care Medicine, Portland, Oregon, USA
| | - Meike Niederhausen
- Center to Improve Veteran Involvement in their Care (CIVIC), VA Portland Health Care System, Portland, Oregon, USA
- Oregon Health and Science University—Portland State University School of Public Health, Oregon Health and Science University, Portland, Oregon, USA
| | - Sarah J. Goodlin
- Geriatrics Section, Veterans Affairs Portland Health Care System, Portland, Oregon, USA
| | - Christopher G. Slatore
- Center to Improve Veteran Involvement in their Care (CIVIC), VA Portland Health Care System, Portland, Oregon, USA
- Division of Pulmonary and Critical Care Medicine, Oregon Health and Science University, Portland, Oregon, USA
- Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Donald R. Sullivan
- Center to Improve Veteran Involvement in their Care (CIVIC), VA Portland Health Care System, Portland, Oregon, USA
- Division of Pulmonary and Critical Care Medicine, Oregon Health and Science University, Portland, Oregon, USA
- Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon, USA
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Adjetey C, Davis JC, Falck RS, Best JR, Dao E, Bennett K, Tai D, McGuire K, Eng JJ, Hsiung GYR, Middleton LE, Hall PA, Hu M, Sakakibara BM, Liu-Ambrose T. Economic Evaluation of Exercise or Cognitive and Social Enrichment Activities for Improved Cognition After Stroke. JAMA Netw Open 2023; 6:e2345687. [PMID: 38032638 PMCID: PMC10690466 DOI: 10.1001/jamanetworkopen.2023.45687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 10/19/2023] [Indexed: 12/01/2023] Open
Abstract
Importance Cognitive impairment is prevalent in survivors of stroke, affecting approximately 30% of individuals. Physical exercise and cognitive and social enrichment activities can enhance cognitive function in patients with chronic stroke, but their cost-effectiveness compared with a balance and tone program is uncertain. Objective To conduct a cost-effectiveness and cost-utility analysis of multicomponent exercise or cognitive and social enrichment activities compared with a balance and tone program. Design, Setting, and Participants This economic evaluation used a Canadian health care systems perspective and the Vitality study, a randomized clinical trial aimed at improving cognition after stroke with a 6-month intervention and a subsequent 6-month follow-up (ie, 12 months). The economic evaluation covered the duration of the Vitality trial, between June 6, 2014, and February 26, 2019. Participants were community-dwelling adults aged 55 years and older who experienced a stroke at least 12 months prior to study enrollment in the Vancouver metropolitan area, British Columbia, Canada. Data were analyzed from June 1, 2022, to March 31, 2023. Interventions Participants were randomly assigned to twice-weekly classes for 1 of the 3 groups: multicomponent exercise program, cognitive and social enrichment activities program, or a balance and tone program (control). Main Outcomes and Measures The primary measures for the economic evaluation included cost-effectiveness (incremental costs per mean change in cognitive function, evaluated using the Alzheimer Disease Assessment Scale-Cognitive-Plus), cost-utility (incremental cost per quality-adjusted life-year gained), intervention costs, and health care costs. Since cognitive benefits 6 months after intervention cessation were not observed in the primary randomized clinical trial, an economic evaluation at 12 months was not performed. Results Among 120 participants (mean [SD] age, 71 [9] years; 74 [62%] male), 34 were randomized to the multicomponent exercise program, 34 were randomized to the social and cognitive enrichment activities program, and 52 were randomized to the balance and tone control program. At the end of the 6-month intervention, the cost per mean change in Alzheimer Disease Assessment Scale-Cognitive-Plus score demonstrated that exercise was more effective and costlier compared with the control group in terms of cognitive improvement with an incremental cost-effectiveness ratio of CAD -$8823. The cost per quality-adjusted life-year gained for both interventions was negligible, with exercise less costly (mean [SD] incremental cost, CAD -$32 [$258]) and cognitive and social enrichment more costly than the control group (mean [SD] incremental cost, CAD $1018 [$378]). The balance and tone program had the lowest delivery cost (CAD $777), and the exercise group had the lowest health care resource utilization (mean [SD] $1261 [$1188]) per person. Conclusions and Relevance The findings of this economic evaluation suggest that exercise demonstrated potential for cost-effectiveness to improve cognitive function in older adults with chronic stroke during a 6-month intervention.
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Affiliation(s)
- Cassandra Adjetey
- Faculty of Management, University of British Columbia, Kelowna, Canada
- Applied Health Economics Lab, University of British Columbia, Kelowna, Canada
| | - Jennifer C. Davis
- Faculty of Management, University of British Columbia, Kelowna, Canada
- Applied Health Economics Lab, University of British Columbia, Kelowna, Canada
- Centre for Aging SMART at Vancouver Coastal Health, Vancouver Coastal Health Research Institute, Vancouver, Canada
| | - Ryan S. Falck
- Centre for Aging SMART at Vancouver Coastal Health, Vancouver Coastal Health Research Institute, Vancouver, Canada
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada
| | - John R. Best
- Centre for Aging SMART at Vancouver Coastal Health, Vancouver Coastal Health Research Institute, Vancouver, Canada
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada
| | - Elizabeth Dao
- Centre for Aging SMART at Vancouver Coastal Health, Vancouver Coastal Health Research Institute, Vancouver, Canada
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
| | - Kim Bennett
- Centre for Aging SMART at Vancouver Coastal Health, Vancouver Coastal Health Research Institute, Vancouver, Canada
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada
| | - Daria Tai
- Centre for Aging SMART at Vancouver Coastal Health, Vancouver Coastal Health Research Institute, Vancouver, Canada
| | - Katherine McGuire
- Centre for Aging SMART at Vancouver Coastal Health, Vancouver Coastal Health Research Institute, Vancouver, Canada
| | - Janice J. Eng
- Centre for Aging SMART at Vancouver Coastal Health, Vancouver Coastal Health Research Institute, Vancouver, Canada
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
| | - Ging-Yuek Robin Hsiung
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada
| | - Laura E. Middleton
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, Canada
- Schlegel–UW Research Institute for Aging, Waterloo, Canada
| | - Peter A. Hall
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - Min Hu
- Department of Economics, Philosophy and Political Science, University of British Columbia, Kelowna, Canada
| | - Brodie M. Sakakibara
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, Canada
- Centre for Chronic Disease Prevention and Management, Southern Medical Program, The University of British Columbia, Kelowna, Canada
| | - Teresa Liu-Ambrose
- Centre for Aging SMART at Vancouver Coastal Health, Vancouver Coastal Health Research Institute, Vancouver, Canada
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada
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Savela RM, Nykänen I, Koponen S, Suominen AL, Schwab U, Välimäki T. Older family caregivers' diet-related disparities: Cross-sectional evidence from Finland. Int J Older People Nurs 2023; 18:e12570. [PMID: 37592405 DOI: 10.1111/opn.12570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 06/15/2023] [Accepted: 07/28/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND Some older family caregivers experience financial vulnerabilities due to their caregiving role, which may affect their ability to afford appropriate food. This study aimed to assess the extent to which there are diet-related disparities among older family caregivers in Eastern Finland. METHODS This study is based on the multidisciplinary LifEstyle, NutriTion and Oral health in caregivers (LENTO) study. In total, 125 family caregivers were included. Data were collected between June and December 2019. Participants were assessed on health, nutritional status and sociodemographic factors. The associations and predictors of diet-related disparities were assessed using the independent samples t-test, ANOVA-test, χ2 -tests and binary logistic regression. RESULTS The mean age of family caregivers was 74 years (SD = 8). Most were female (72%), 20% had malnutrition risk and 30% reported having 'moderately enough money' or less, which was identified as 'subjective poverty'. Family caregivers experiencing subjective poverty were less likely to consume two or more portions of fruit and vegetables daily and were more likely overweight. Study participants' diet-related disparities were further associated with several health inequalities, including comorbidity, depression, diabetes (Type I or II) and osteoporosis. CONCLUSIONS Older family caregivers have diet-related disparities, further associated with health inequalities. Family caregivers' diet-related disparities require increasing attention in healthcare. Addressing family caregivers' food insecurity risk would enhance their health equity. Lack of assessment of diet-related disparities will only deepen health inequalities.
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Affiliation(s)
- Roosa-Maria Savela
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - Irma Nykänen
- Institute of Public Health and Clinical Nutrition, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Sohvi Koponen
- Institute of Public Health and Clinical Nutrition, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Anna Liisa Suominen
- Institute of Dentistry, School of Medicine, University of Eastern Finland, Kuopio, Finland
- Department of Oral and Maxillofacial Diseases, Kuopio University Hospital, Kuopio, Finland
| | - Ursula Schwab
- Institute of Public Health and Clinical Nutrition, School of Medicine, University of Eastern Finland, Kuopio, Finland
- Department of Medicine, Endocrinology and Clinical Nutrition, Kuopio University Hospital, Kuopio, Finland
| | - Tarja Välimäki
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
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Webster-Dekker KE, Zhou W, Woo S, Son JY, Ploutz-Snyder R, Larson JL. Prolonged bouts of sedentary behavior in people with chronic obstructive pulmonary disease and associated factors. Heart Lung 2023; 62:129-134. [PMID: 37499548 DOI: 10.1016/j.hrtlng.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/22/2023] [Accepted: 07/15/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Increased sedentary behavior (SB), especially in prolonged bouts, is associated with adverse health outcomes, but little is known about patterns of SB in people with chronic obstructive pulmonary disease (COPD). OBJECTIVES The purpose of this study was to describe SB and patterns of SB and to examine factors associated with prolonged bouts of SB in inactive community-dwelling adults with COPD. METHODS This cross-sectional analysis used data from inactive adults with COPD who were enrolled in an exercise program but had not started exercising. Participants were ≥ 50 years old with a diagnosis of COPD, had a forced expiratory volume in one second < 80% predicted, and were inactive. Participants wore an activPAL device for seven days to measure their SB and completed surveys and physical measures. Data were analyzed with multiple regression. RESULTS The sample included 160 participants with a mean age (± SD) of 69 ± 8, and a mean total sedentary time of 742 ± 150 min/day, with 254 ± 146 min/day in SB bouts ≥ 60 min. DURATION Time spent in bouts of SB ≥ 60-min. was negatively associated with self-efficacy for overcoming barriers to light physical activity (P<0.05), balance (P<0.05), chair stand test (P<0.05), FEV1% predicted (P<0.05) and positively associated with BMI (P<0.001). CONCLUSIONS Inactive people with COPD engage in extensive SB, much of it in prolonged bouts. Self-efficacy, balance, and lower body strength are modifiable variables associated with SB and potential targets for future interventions to reduce time in prolonged sedentary behavior.
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Affiliation(s)
- Katelyn E Webster-Dekker
- University of Michigan School of Nursing, Ann Arbor, 400 North Ingalls Building, Ann Arbor, MI 48109, USA; Indiana University School of Nursing, 600 Barnhill Dr, Indianapolis, IN 46202, USA.
| | - Weijiao Zhou
- University of Michigan School of Nursing, Ann Arbor, 400 North Ingalls Building, Ann Arbor, MI 48109, USA; Peking University School of Nursing, 38 Xueyuan Rd, Haidian District, Beijing 100191, China.
| | - Seoyoon Woo
- University of Michigan School of Nursing, Ann Arbor, 400 North Ingalls Building, Ann Arbor, MI 48109, USA; University of North Carolina Wilmington School of Nursing, McNeill Hall 3089, Wilmington, NC 28403, USA.
| | - Jung Yoen Son
- University of Michigan School of Nursing, Ann Arbor, 400 North Ingalls Building, Ann Arbor, MI 48109, USA.
| | - Robert Ploutz-Snyder
- University of Michigan School of Nursing, Ann Arbor, 400 North Ingalls Building, Ann Arbor, MI 48109, USA.
| | - Janet L Larson
- University of Michigan School of Nursing, Ann Arbor, 400 North Ingalls Building, Ann Arbor, MI 48109, USA.
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Radner H. Viewpoint: how to measure comorbidities in patients with rheumatoid arthritis - clinical and academic value. Rheumatology (Oxford) 2023; 62:SI282-SI285. [PMID: 37871917 PMCID: PMC10650270 DOI: 10.1093/rheumatology/kead436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 08/08/2023] [Indexed: 10/25/2023] Open
Abstract
Given the high prevalence and the enormous impact on key outcomes, comorbidities are important to consider, especially in patients with RA. Comorbidity indices are tools to quantify the impact of the overall burden of coexisting diseases on a specific outcome of interest. Until now, no gold standard exists on how to measure comorbidities. A large variety of indices have been developed using different settings and therefore leading to conceptual differences. Choosing the right tool clearly depends on the intention (clinical or research purpose) and the specific research question. The current article will address the purpose and challenge of measuring comorbidities in RA patients.
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Affiliation(s)
- Helga Radner
- Division of Rheumatology, Department of Internal Medicine III, Medical University Vienna, Vienna, Austria
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46
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Lawton R, Murray J, Baxter R, Richardson G, Cockayne S, Baird K, Mandefield L, Brealey S, O'Hara J, Foy R, Sheard L, Cracknell A, Breckin E, Hewitt C. Evaluating an intervention to improve the safety and experience of transitions from hospital to home for older people (Your Care Needs You): a protocol for a cluster randomised controlled trial and process evaluation. Trials 2023; 24:671. [PMID: 37838678 PMCID: PMC10576890 DOI: 10.1186/s13063-023-07716-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/07/2023] [Indexed: 10/16/2023] Open
Abstract
BACKGROUND Older patients often experience safety issues when transitioning from hospital to home. The 'Your Care Needs You' (YCNY) intervention aims to support older people to 'know more' and 'do more' whilst in hospital so that they are better prepared for managing at home. METHODS A multi-centre cluster randomised controlled trial (cRCT) will evaluate the effectiveness and cost-effectiveness of the YCNY intervention. Forty acute hospital wards (clusters) in England from varying medical specialities will be randomised to deliver YCNY or care-as-usual on a 1:1 basis. The primary outcome will be unplanned hospital readmission rates within 30 days of discharge. This will be extracted from routinely collected data of at least 5440 patients (aged 75 years and older) discharged to their own homes during the 4- to 5-month YCNY intervention period. A nested cohort of up to 1000 patients will be recruited to the study to collect secondary outcomes via follow-up questionnaires at 5-, 30- and 90-day post-discharge. These will include measures of patient experience of transitions, patient-reported safety events, quality of life and healthcare resource use. Unplanned hospital readmission rates at 60 and 90 days of discharge will be collected from routine data. A process evaluation (primarily interviews and observations with patients, carers and staff) will be conducted to understand the implementation of the intervention and the contextual factors that shape this, as well as the intervention's underlying mechanisms of action. Fidelity of intervention delivery will also be assessed across all intervention wards. DISCUSSION This study will establish the effectiveness and cost-effectiveness of the YCNY intervention which aims to improve patient safety and experience for older people during transitions of care. The process evaluation will generate insights about how the YCNY intervention was implemented, what elements of the intervention work and for whom, and how to optimise its implementation so that it can be delivered with high fidelity in routine service contexts. TRIAL REGISTRATION UK Clinical Research Network Portfolio: 44559; ISTCRN: ISRCTN17062524. Registered on 11/02/2020.
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Affiliation(s)
- Rebecca Lawton
- Yorkshire Quality and Safety Research group, Bradford Institute for Health Research, Bradford, UK.
- School of Psychology, University of Leeds, Leeds, UK.
| | - Jenni Murray
- Yorkshire Quality and Safety Research group, Bradford Institute for Health Research, Bradford, UK
| | - Ruth Baxter
- Yorkshire Quality and Safety Research group, Bradford Institute for Health Research, Bradford, UK
- School of Psychology, University of Leeds, Leeds, UK
| | | | | | | | | | | | - Jane O'Hara
- School of Healthcare, University of Leeds, Leeds, UK
| | - Robbie Foy
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Alison Cracknell
- Leeds Centre for Older People's Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Edmund Breckin
- Yorkshire Quality and Safety Research group, Bradford Institute for Health Research, Bradford, UK
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Scott H, Brown NI, Schleicher EA, Oster RA, McAuley E, Courneya KS, Anton P, Ehlers DK, Phillips SM, Rogers LQ. Associations between Symptoms and Exercise Barriers in Breast Cancer Survivors. J Clin Med 2023; 12:6531. [PMID: 37892669 PMCID: PMC10607025 DOI: 10.3390/jcm12206531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/30/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
Despite exercise benefits for cancer survivor health, most breast cancer survivors do not meet exercise recommendations. Few studies have examined associations between psychosocial symptoms and exercise barriers in this population. To improve physician exercise counseling by identifying survivors with high barriers in a clinical setting, associations between breast cancer symptoms (fatigue, mood, sleep quality) and exercise barriers were investigated. Physically inactive survivors (N = 320; average age 55 ± 8 years, 81% White, 77% cancer stage I or II) completed a baseline survey for a randomized physical activity trial and secondary analyses were performed. Potential covariates, exercise barriers interference score, Fatigue Symptom Inventory, Hospital Anxiety and Depression Scale (HADS), and Pittsburgh Sleep Quality Index were assessed. Based on multiple linear regression analyses, only HADS Global (B = 0.463, p < 0.001) and number of comorbidities (B = 0.992, p = 0.01) were independently associated with total exercise barriers interference score, explaining 8.8% of the variance (R2 = 0.088, F(2,317) = 15.286, p < 0.001). The most frequent barriers to exercise for survivors above the HADS clinically important cut point included procrastination, routine, and self-discipline. These results indicate greater anxiety levels, depression levels, and comorbidities may be independently associated with specific exercise barriers. Health professionals should consider mood and comorbidities when evaluating survivors for exercise barriers, and tailoring exercise counseling.
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Affiliation(s)
- Hunter Scott
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL 35233, USA
| | - Nashira I. Brown
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, AL 35233, USA
| | - Erica A. Schleicher
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, AL 35233, USA
| | - Robert A. Oster
- O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL 35233, USA
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35233, USA
| | - Edward McAuley
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL 61820, USA
- The Cancer Center at Illinois, Urbana, IL 60632, USA
| | - Kerry S. Courneya
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Philip Anton
- School of Human Sciences, Southern Illinois University Carbondale, Carbondale, IL 62910, USA
| | - Diane K. Ehlers
- Department of Quantitative Health Sciences, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Siobhan M. Phillips
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Laura Q. Rogers
- O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL 35233, USA
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35233, USA
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Zhu Y, Xu BY, Low SG, Low LL. Association of Social Support with Rehabilitation Outcome among Older Adults with Hip Fracture Surgery: A Prospective Cohort Study at Post-Acute Care Facility in Asia. J Am Med Dir Assoc 2023; 24:1490-1496. [PMID: 37156471 DOI: 10.1016/j.jamda.2023.03.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/14/2023] [Accepted: 03/23/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVES There is growing interest in the role of social support during the recovery after hip fractures. The research to date has been mainly focused on structural support, with few studies concerned with functional support. This study examined the effects of both functional and structural aspects of social support on rehabilitation outcomes among older adults with hip fracture surgery. DESIGN Prospective cohort study. SETTING AND PARTICIPANTS Consecutive older adults (≥60 years) with hip fracture surgery who underwent inpatient rehabilitation in a post-acute care facility in Singapore between January 11, 2021, and October 30, 2021 (n = 112). METHODS We administered the Medical Outcome Study-Social Support Survey (MOS-SSS) to assess perceived functional support of patients and used living arrangement as an indicator for structural support. Participants were followed up over the inpatient stay at the post-acute care facility until discharge; thereafter, rehabilitation efficiency (REy) and rehabilitation effectiveness (REs) were evaluated. Multiple linear regressions were performed to examine the associations of MOS-SSS score and living arrangement with REy and REs, respectively, adjusting for age, gender, ethnicity, comorbidity, body mass index, prefracture function, type of fracture, and length of stay. RESULTS Perceived functional support had positive associations with rehabilitation outcomes. A 1-unit increase in MOS-SSS total score was associated with 0.15 units (95% CI 0.03-0.3, P = .029) greater gain in physical function after a typical 1-month stay, and 0.21 units (95% CI 0.01-0.41, P = .040) higher achievement in potential functional improvement upon discharge. In contrast, no association was observed between structural support and rehabilitation outcomes. CONCLUSIONS AND IMPLICATIONS Perceived functional support may significantly impact the recovery of older adults with hip fracture during the inpatient rehabilitation process, independent of structural support. Our findings suggest the potential of incorporating interventions enhancing perceived functional support of patients into the post-acute care model for hip fracture.
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Affiliation(s)
- Yujin Zhu
- Department of Post-Acute and Continuity Care, Sengkang Community Hospital, SingHealth Community Hospitals, Singapore, Singapore; SingHealth Duke-NUS Family Medicine Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore.
| | - Bang Yu Xu
- Department of Post-Acute and Continuity Care, Sengkang Community Hospital, SingHealth Community Hospitals, Singapore, Singapore; SingHealth Duke-NUS Family Medicine Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Sher Guan Low
- Department of Post-Acute and Continuity Care, Sengkang Community Hospital, SingHealth Community Hospitals, Singapore, Singapore; SingHealth Duke-NUS Family Medicine Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Lian Leng Low
- SingHealth Duke-NUS Family Medicine Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore; Department of Post-Acute and Continuity Care, Outram Community Hospital, SingHealth Community Hospitals, Singapore, Singapore; Centre for Population Health Research and Implementation, SingHealth Regional Health System, Singapore, Singapore; Population Health and Integrated Care Office, Singapore General Hospital, Singapore, Singapore; Research and Translational Innovation Office, SingHealth Community Hospitals, Singapore, Singapore
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Jones JRA, Karahalios A, Puthucheary ZA, Berry MJ, Files DC, Griffith DM, McDonald LA, Morris PE, Moss M, Nordon-Craft A, Walsh T, Berney S, Denehy L. Responsiveness of Critically Ill Adults With Multimorbidity to Rehabilitation Interventions: A Patient-Level Meta-Analysis Using Individual Pooled Data From Four Randomized Trials. Crit Care Med 2023; 51:1373-1385. [PMID: 37246922 DOI: 10.1097/ccm.0000000000005936] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To explore if patient characteristics (pre-existing comorbidity, age, sex, and illness severity) modify the effect of physical rehabilitation (intervention vs control) for the coprimary outcomes health-related quality of life (HRQoL) and objective physical performance using pooled individual patient data from randomized controlled trials (RCTs). DATA SOURCES Data of individual patients from four critical care physical rehabilitation RCTs. STUDY SELECTION Eligible trials were identified from a published systematic review. DATA EXTRACTION Data sharing agreements were executed permitting transfer of anonymized data of individual patients from four trials to form one large, combined dataset. The pooled trial data were analyzed with linear mixed models fitted with fixed effects for treatment group, time, and trial. DATA SYNTHESIS Four trials contributed data resulting in a combined total of 810 patients (intervention n = 403, control n = 407). After receiving trial rehabilitation interventions, patients with two or more comorbidities had HRQoL scores that were significantly higher and exceeded the minimal important difference at 3 and 6 months compared with the similarly comorbid control group (based on the Physical Component Summary score (Wald test p = 0.041). Patients with one or no comorbidities who received intervention had no HRQoL outcome differences at 3 and 6 months when compared with similarly comorbid control patients. No patient characteristic modified the physical performance outcome in patients who received physical rehabilitation. CONCLUSIONS The identification of a target group with two or more comorbidities who derived benefits from the trial interventions is an important finding and provides direction for future investigations into the effect of rehabilitation. The multimorbid post-ICU population may be a select population for future prospective investigations into the effect of physical rehabilitation.
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Affiliation(s)
- Jennifer R A Jones
- Physiotherapy Department, The University of Melbourne, Parkville, Victoria, Australia
- Physiotherapy Department, Division of Allied Health, Austin Health, Heidelberg, Victoria, Australia
- Institute of Breathing and Sleep, Heidelberg, Victoria, Australia
| | - Amalia Karahalios
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Zudin A Puthucheary
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, England, United Kingdom
- Adult Critical Care Unit, Royal London Hospital, Barts Health NHS Trust, London, England, United Kingdom
| | - Michael J Berry
- Department of Health and Exercise Science, Wake Forest University, Winston Salem, NC
| | - D Clark Files
- Pulmonary, Critical Care, Allergy and Immunologic Disease, Wake Forest University, Winston-Salem, NC
- Wake Forest Critical Illness Injury and Recovery Research Center, Wake Forest University, Winston Salem, NC
| | - David M Griffith
- Deanery of Molecular, Genetic and Population Health Sciences, The University of Edinburgh, Edinburgh, United Kingdom
- Royal Infirmary of Edinburgh, NHS (National Health Service) Lothian, Edinburgh, Scotland, United Kingdom
| | - Luke A McDonald
- Physiotherapy Department, Division of Allied Health, Austin Health, Heidelberg, Victoria, Australia
| | - Peter E Morris
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Marc Moss
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Amy Nordon-Craft
- Physical Therapy Program, University of Colorado School of Medicine, Aurora, CO
| | - Timothy Walsh
- Deanery of Molecular, Genetic and Population Health Sciences, The University of Edinburgh, Edinburgh, United Kingdom
- Anaesthetics, Critical Care, and Pain Medicine, School of Clinical Sciences, Queens Medical Research Institute, University of Edinburgh, Edinburgh, Scotland, United Kingdom
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - Sue Berney
- Physiotherapy Department, The University of Melbourne, Parkville, Victoria, Australia
- Physiotherapy Department, Division of Allied Health, Austin Health, Heidelberg, Victoria, Australia
| | - Linda Denehy
- Physiotherapy Department, The University of Melbourne, Parkville, Victoria, Australia
- Melbourne School of Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
- Allied Health, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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50
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Koponen S, Nykänen I, Savela RM, Välimäki T, Suominen AL, Schwab U. Depressive symptoms, low-grade inflammation, and poor oral health prevents the success of nutritional guidance in older caregivers. Clin Nutr ESPEN 2023; 57:39-47. [PMID: 37739684 DOI: 10.1016/j.clnesp.2023.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/12/2023] [Accepted: 06/20/2023] [Indexed: 09/24/2023]
Abstract
PURPOSE The present study aimed to determine which factors prevents the success of nutritional interventions for older family caregivers (FCs), in the form of individually tailored nutritional guidance. METHODS The present study focuses on the intervention group of FCs (n = 63) of a randomized controlled trial. Older FCs (≥60 years of age) receiving a care allowance for a home-living care recipient (≥65 years of age) were included in the present study, which focused on nutritional interventions via individually tailored nutritional guidance provided by a clinical nutritionist. The associations between changes in protein intake (3-day food record), Mini Nutritional Assessment (MNA) scores, and plasma albumin and prealbumin concentrations, as well as associated factors, for the 6-month intervention period were analyzed using generalized estimating equations. RESULTS Intervention time, female sex, older age, higher net income, better hand grip strength, more teeth, and removable denture use were positively associated with an increase in protein intake. Fewer depressive symptoms were associated with a positive change in the MNA scores. Younger age, lower education level, lower body mass index (BMI), higher depressive symptoms, and fewer teeth were associated with an increase in plasma albumin concentration. Younger age, lower education, lower plasma concentration of high-sensitivity C-reactive protein at 6 months, lower Sense of Coherence (SOC) -13 score, fewer teeth, and absence of removable dentures were associated with an increase in plasma prealbumin concentration. CONCLUSION Older female FCs with a higher income, better hand grip strength, lower education, and lower SOC benefited most from individually tailored nutritional guidance. Depressive symptoms, oral health, and low-grade inflammation should be considered when providing nutritional guidance to older FCs. CLINICAL TRIAL REGISTRATION NUMBER ClinicalTrials.gov NCT04003493 (July 1, 2019).
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Affiliation(s)
- Sohvi Koponen
- Institute of Public Health and Clinical Nutrition, School of Medicine, University of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland.
| | - Irma Nykänen
- Institute of Public Health and Clinical Nutrition, School of Medicine, University of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland
| | - Roosa-Maria Savela
- Department of Nursing Science, University of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland
| | - Tarja Välimäki
- Department of Nursing Science, University of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland
| | - Anna Liisa Suominen
- Institute of Dentistry, School of Medicine, University of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland; Department of Oral and Maxillofacial Diseases, Kuopio University Hospital, P.O. Box 1711, FI-70211 Kuopio, Finland
| | - Ursula Schwab
- Institute of Public Health and Clinical Nutrition, School of Medicine, University of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland; Department of Medicine, Endocrinology and Clinical Nutrition, Kuopio University Hospital, P.O. Box 100, FI-70029 KYS, Finland
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