Activities Of Daily Living Motor Research Articles

Patient Perspectives on Upper-Limb Daily Function in Parkinson's Disease.

Dexterity impairments are common among people with Parkinson's disease (PWP), yet little is understood about the effect of upper-limb (UL) dysfunction on daily activity performance. The aims were to (1) map the dexterity activities most affected and meaningful to PWP; (2) explore the associations between perceived dexterity function and disease severity, cognitive and motor UL impairments, dexterity ability, self-reported activities of daily living (ADL) function, and quality of life (QOL); (3) investigate variables explaining perceived dexterity function; and (4) examine the differences in perceived dexterity function based on dominance affectedness. A total of 43 PWP (mean age = 70.00 years, standard deviation [SD] = 6.75) were assessed for perceived dexterity function (36-item Dexterity Questionnaire [DextQ-36]), dexterity ability (Coin Rotation Task), disease severity (modified Hoen and Yahr Scale), self-reported ADL function and motor UL impairments (Movement Disorder Society-Unified Parkinson's Disease Rating Scale), cognition (Montreal Cognitive Assessment), and QOL (Parkinson's Disease Questionnaire-39). The leading dexterity activities participants reported as difficult and meaningful included using a touchscreen, pulling on socks, and dialing a phone. Perceived dexterity significantly correlated with self-reported ADL function (r = 0.716), QOL (r = 0.691), disease severity (r = 0.470), and dominant-hand dexterity (r = 0.432). Dexterity ability and disease severity explained 30% of perceived dexterity variance. No differences in perceived dexterity function based on dominance affectedness were found. PWP encounter challenges in complex dexterity tasks that impact their independence. Before interventions focused on UL function are initiated, assessments of PWP should include inquiries about the meaningfulness of challenging dexterity activities.

Association between the executive dysfunction and balance function in patients with stroke.

A previous study has shown an association between executive dysfunction (ED) and balance function in patients with stroke. However, it is unclear what factors mediate the association between ED and balance function. Therefore, the aim of this study was to investigate the association between ED and balance function and to identify mediating factors using mediation analysis. This study had a cross-sectional design. The study included 107 patients with stroke. This study was divided into two groups (ED and non-ED) using trail making test (TMT) part B. Two groups were compared for balance function (timed up and go test [TUGT] and Berg balance scale [BBS]) and other variables using paired test. In addition, partial correlation analysis with age, cognitive function as a control factor, and mediation analysis were also performed. The ED group (N=55) had significantly lower TUGT and BBS scores than the non-ED group (N=52). TMT part B correlated with TUGT (ρ=0.41), BBS (ρ=-0.33), and Brunnstrom recovery stage (BRS) lower limb (ρ=-0.22). The TUGT model of mediation analysis showed a significant indirect effect as a result of mediation of the BRS lower limb between TMT part B and TUGT. The BBS model showed a significant indirect effect as a result of mediation of the activities of daily living (ADL) motor function between TMT part B and BBS. ED and balance function were associated, and the degree of paralysis and ADL motor function were associated with them in patients with stroke.

Effectiveness of an individualised occupational therapy intervention programme (ABLE) using adaptational strategies on activities of daily living among persons with chronic conditions: A randomised controlled trial (RCT).

Compare the effectiveness of a problem-solving, individualised, home-based occupational therapy intervention (ABLE 2.0), to usual occupational therapy, on activities of daily living (ADL) ability in persons with chronic conditions. A single-centre, double-blinded, randomised controlled trial with 10- and 26-week follow-up. A Danish municipality. Persons with chronic conditions experiencing problems performing ADL tasks (n = 80). ABLE 2.0 was compared with usual occupational therapy. Coprimary outcomes were self-reported ADL ability (ADL-Interview Performance) and observed ADL motor ability (Assessment of Motor and Process Skills) at Week 10. Secondary outcomes were self-reported ADL ability (ADL-Interview Performance) and observed ADL motor ability (Assessment of Motor and Process Skills) at Week 26, and perceived satisfaction with ADL ability (ADL-Interview Satisfaction) and observed ADL process ability (Assessment of Motor and Process Skills) at Weeks 10 and 26. In total, 78 persons were randomly assigned: 40 to usual occupational therapy and 38 to ABLE 2.0. No statistically significant nor clinically relevant difference between group mean changes in primary outcomes was identified from baseline to Week 10 (ADL-Interview Performance [-0.16; 95% CI: -0.38 to 0.06] and Assessment of Motor and Process Skills ADL motor ability [-0.1; 95% CI: -0.3 to 0.1]). At Week 26, a statistically significant and clinically relevant difference was found in Assessment of Motor and Process Skills ADL motor ability (LS mean change: -0.3; 95% CI: -0.5 to -0.1) between groups. ABLE 2.0 was effective in improving observed ADL motor ability at 26 weeks.

Predicting length of stay with assessment of motor and process skills in subjects with acquired brain injury

ABSTRACT Background The Functional Independence Measure (FIM) is a well-established predictor of length of stay (LOS) for rehabilitation. The Assessment of Motor and Process Skills (AMPS) is a more in-depth construct for measuring activities of daily living (ADL) and may therefore be a valuable adjunct when predicting LOS. This paper aimed to investigate AMPS as a candidate predictor of LOS in a statistical model including FIM. Methods A cohort study of 647 patients with acquired brain injuries admitted for rehabilitation. LOS was analyzed in a multiple regression model with the motor and process/cognitive domains of AMPS and FIM. Results Independence in ADL process ability and FIM cognition were associated with 31% (p < 0.001) and 38% (p < 0.001) shorter LOS, respectively, relative to patients needing total assistance. Independence in ADL motor ability was associated with a 26% (p = 0.002) shorter LOS, whereas FIM motor was not a predictor. Conclusions The AMPS predicts LOS for rehabilitation at a level that is at least as good as that of FIM. Conducting the AMPS early in the course of inpatient rehabilitation provides clinicians and managers with valuable information for planning LOS.

The efficiency of activities of daily living (ADLs) skills in late adulthood: A mediational approach

The term “Activities of Daily Living” (ADLs) refers to a set of fundamental tasks (i.e., toileting, bathing, personal care, eating, grooming, and getting dressed) considered necessary for living and being autonomous in everyday life. Although in the clinical setting ADLs efficiency is a marker to diagnose dementia, limited evidence on the mechanism implicating muscular function and cognitive alterations in ADLs skills in late adulthood exists. This study primarily intended to determine the extent to which executive functions mediate between muscular strength, as assessed through handgrip strength (HGS) measurement, and ADLs skills of older community-dwellers. A further goal was to explore the impact of gender and cognitive status on ADLs and HGS scores, using education as a covariate. Three hundred and thirty-four older participants, 199 females and 135 males (Mage = 77.5 years, SD = 5.6 years, age range = 63–93 years) completed a battery of tests assessing ADLs, HGS, and executive functions. The results showed that 34–56% of the variance in the ADLs condition was explained by HGS and executive functioning. Furthermore, cognitively healthy participants exhibited better ADLs skills, whereas cognitively impaired individuals, both males and females, exhibited poorer HGS efficiency. In conclusion, in clinical settings, the concurrent evaluation of ADLs skills, motor, and higher-order cognitive processes should be encouraged to detect individuals needing a person-tailored intervention to boost their quality of life.

Evaluating a complex intervention addressing ability to perform activities of daily living among persons with chronic conditions: study protocol for a randomised controlled trial (ABLE)

IntroductionThe need to develop and evaluate interventions, addressing problems performing activities of daily living (ADL) among persons with chronic conditions, is evident. Guided by the British Medical Research Council’s guidance...

Motor performance after treatment of pilocytic astrocytoma in the posterior fossa in childhood.

BackgroundPilocytic astrocytoma is the most common brain tumour type in childhood located in the posterior fossa, and treated mainly with surgery. These tumours have low mortality, but knowledge concerning its long‐term outcome is sparse.AimsThe aim was to investigate if patients treated for pilocytic astrocytoma in the posterior fossa had motor complications, including balance, motor and process skills.Methods and ResultsThis descriptive single‐centre study includes eight children and 12 adults, treated for pilocytic astrocytoma as children. Motor performance was investigated with Bruininks–Oseretsky Test of Motor Proficiency, Second Edition, and dynamic balance with the mini‐balance evaluation systems test. Physiological cost index, six‐minute walk test, hand grip strength and assessment of motor and process skills were also evaluated. Ten patients reported motor difficulties, mainly from the upper limbs. The motor performance test showed results within normal limits except for manual dexterity, which was significantly below mean (p = .008). In the dynamic balance test patients had significantly lower results compared with controls (p = .036). Physiological cost index, six‐minute walk tests and hand grip strength showed results within normal limits. In the Assessment of Motor and Process Skills, patients over 16 years had significantly lower results compared with test norms for motor activities of daily living (ADL) and 30% of all patients scored below the cut‐off level for difficulties with motor skills.ConclusionsMotor performance for patients treated for pilocytic astrocytoma in the posterior fossa in childhood is satisfactory but some patients display difficulties with balance, manual dexterity and ADL motor skills. Thus, it is important to identify those in need of motor follow‐up and training.

Agreement between self-reported and observed functioning in patients with rheumatoid arthritis, osteoarthritis, and fibromyalgia, and the influence of pain and fatigue: a cross-sectional study

Objective To evaluate the relationship between self-reported and performance-based measures of functioning in rheumatoid arthritis (RA), knee osteoarthritis (OA), and fibromyalgia (FM), and the influence of pain and fatigue. Method Self-reported functioning was assessed by the Stanford Health Assessment Questionnaire, Fibromyalgia Impact Questionnaire, and Knee injury and Osteoarthritis Outcome Score. Performance-based measures of task-related physical activity included grip strength and Six-Minute Walk Test (6MWT). Assessment of Motor and Process Skills (AMPS) was used to obtain performance-based measures of activities of daily living (ADL) ability. Pain and fatigue were assessed by 100 mm visual analogue scales. Spearman’s rho correlation and regression modelling were applied. Results Correlations between self-reported functioning and performance-based measures of ADL ability were weak to moderate, and strongest in OA (r = 0.57, p = 0.002), and AMPS ADL ability measures did not enter regression models as explanatory factors for self-reported functioning. Correlations between AMPS ADL ability measures and measures of task-related physical activity were weak, except for a strong correlation between AMPS ADL motor ability and 6MWT in OA (r = 0.63, p = 0.000). The 6MWT was the only performance-based test explaining variance in AMPS motor ability (OA = 42%; FM = 11%). Pain explained variance in self-reported ability and contributed to variance in AMPS ADL motor ability measures in OA. Conclusion Self-reported and observed measures of functioning assess partly different aspects of functioning, and both approaches may therefore be relevant in a structured assessment of patients with musculoskeletal disorders.

The Effects of Partial Immersion Aquatic Intervention on Perceived Physical Competence and Quality of Life in Children With Severe Cerebral Palsy

Background and Purpose: The efficiency of free sitting on function and reaching is restricted in those skills during activities of daily living (ADL) for children with severe cerebral palsy (CP). No longitudinal study so far has examined the stability of perceived competence (PC) and quality-of-life (QOL) domains for this population following water and land intervention environments more than 12 months of follow-up. Case Description: A mixed-methods multiple case design was employed. Five children with severe bilateral spastic CP subtypes (male: n = 4; female: n = 1) aged 10 to 15.4 years (mean = 11.7 years old, SD = 2.1), Gross Motor Function Classification System level IV, participated in the study. Intervention: The innovative “partial immersion approach” (PIA) uses Archimedes' principle to create a restorative therapeutic chair. This therapeutic chair enhances learned functional skills during sitting adaptation in an aquatic environment. It enables the adjustment of weight-bearing by 30 mm, which is transferred to a land environment for practice. Outcomes: All participants experienced adaptation improvement in ADL skills and task movement during free sitting on land and demonstrated quantitative psychological enhancement of PC, with a total increase of 70.60% (161 points) for all participants and a mean increase of 17.65% (40.25 points). Childrenʼs subjective qualitative responses were reinforced by comparing them with proxy objective reports. Each qualitative category that emerged was verified by quantitative data and matched positively and corresponded with major domains across data of QOL instruments. Discussion: Generalization from the findings is limited. The PIA regulates the percentage of weight-bearing from unloading-water toward loading-land and modified the environment for each childʼs needs. This customized environment improved the psychological enhancement of PC and QOL of the participants with severe CP. The successes were retained at the follow-up assessment 12 months after intervention, as participants still exhibited ADL motor acquisition of sitting skills.

New Insights into Activities of Daily Living Performance in Chronic Obstructive Pulmonary Disease.

PurposeThere have been calls for more knowledge of activities of daily living (ADL) performance in order to address interventions in pulmonary rehabilitation effectively. Everyday technology (ET) has become an integrated dimension of ADL, impacting the ways in which ADL is performed. To improve everyday functioning and quality of life, the use of ADL and ET use needs to be evaluated and addressed effectively in interventions. Therefore, the aim of this study was twofold: 1) to explore the quality of ADL performance, and 2) to investigate the relationship between observation and self-reported ADL performance and ability to use everyday technologies in people living with COPD.MethodsThis cross-sectional study involved 84 participants aged 46–87 years. Participants were recruited through healthcare centres in the Northern Region of Denmark using a convenience sampling procedure. Data were collected using standardized assessments that investigated different ADL perspectives: self-reported ADL tasks and ET use, observed motor and process ability, and need for assistance. Data were analysed and presented using descriptive statistics and Pearson’s correlation coefficient.ResultsThe most affected ADL tasks were mobility within or outside the home, lower dressing, bathing, pedicuring, cooking, shopping, cleaning and washing clothes. New insights into the quality of ADL performance in people living with COPD were presented in terms of detailed ADL motor skills and ADL process skills, as well as the predicted need for support to function in the community. Moreover, new insights into the relationship between observation and self-reported ADL performance (r=0.546, p<0.01; r=0.297, p<0.01) and between ADL performance and self-perceived ability to use ET (r=0.524, p<0.01; r=0.273, p<0.05; r=0.044, p=0.692) were presented.ConclusionOverall, the knowledge from the present study is valuable for focusing interventions that address challenging ADL performance and ET use through relevant and realistic activities. The ability to use ET is important to evaluate and target pulmonary rehabilitation.

Association Between Everyday Technology Use, Activities of Daily Living and Health-Related Quality of Life in Chronic Obstructive Pulmonary Disease.

PurposeA decline in the ability to perform activities of daily living (ADL) and ability to use everyday technology can pose threats to independent living, healthcare management and quality of life (QOL) of patients suffering from chronic obstructive pulmonary disease (COPD). Evidence of the relationship between these variables remains limited. The dual aim of this study was, first, to investigate if health-related QOL (HRQOL) was associated with quality in ADL performance and everyday technology use; second, to examine whether lung function, years with COPD diagnosis, living status or educational level affected physical and mental domains of HRQOL.MethodsThis cross-sectional study included (N=80) participants aged 46–87 years recruited at healthcare centres in the Northern Region of Denmark using a convenience sampling procedure. Data were gathered through standardized assessments and analysed using multiple regression analysis.ResultsThe regression model explained 50.6% (R2=0.506) of the variation in HRQOL–physical. The following four variables were statistically significantly associated with HRQOL – physical: years since COPD diagnosis (p=0.023), ability to use everyday technology (p=0.006), amount of relevant everyday technologies (p=0.015) and ADL motor ability (p<0.01). The regression model explained 22.80% (R2=0.228) of HRQOL – mental. Only the variable ability to use everyday technology was statistically significantly associated with HRQOL – mental (p=0.009).ConclusionQuality of ADL performance and everyday technology use seem to be associated with HRQOL in people living with COPD. The only demographic variable associated with HRQOL was years with COPD. This indicates that healthcare professionals should enhance their attention also to ADL-performance and everyday technology use when striving to increase the HRQOL of persons living with COPD.

Impact of pain, fatigue and dyspnoea on occupational performance in people with advanced cancer: A longitudinal study

Background: Pain, fatigue and dyspnoea are symptoms commonly experienced by people with advanced cancer, which may impact on their occupational performance. It is not known whether these symptoms impact their occupational performance over time.Objective: To examine correlation between pain, fatigue and dyspnoea and occupational performance and the impact of such symptoms on occupational performance over time in people with advanced cancer.Material and Methods: A longitudinal study was conducted including 242 participants assessed at baseline and after six and 12 weeks. Spearman’s rank-order test and mixed linear models were performed.Results: The correlation between pain, fatigue and dyspnoea and occupational performance at baseline spanned from trivial to moderate (Spearman’s rho: −0.004 to 0.34). Only pain had a statistically significant impact on activities of daily living (ADL) motor ability over time (p = 0.01). Participants with no pain problems had the largest decrease in ADL motor ability (−0.24 logits (95%-CI: −0.37 to −0.12)), but the observed decrease was not clinically relevant (≥−0.30).Conclusion: Pain, fatigue and dyspnoea did not seem to highly correlate with occupational performance or impact occupational performance over time of people with advanced cancer.

Hand exercise for women with rheumatoid arthritis and decreased hand function: an exploratory randomized controlled trial

BackgroundPeople with hand-related rheumatoid arthritis (RA) experience problems performing activities of daily living (ADL). Compensatory strategies to improve ADL ability have shown effective. Similarly, hand exercise has shown effect on pain, grip strength, and self-reported ability. A combination has shown positive effects based on self-report, but self-report and observation provide distinct information about ADL. The purpose of this study was to examine whether hand exercise as add on to compensatory intervention (CIP) will improve observed ADL ability in RA.MethodsWomen (n = 55) with hand-related RA were randomized to CIPEXERCISE (intervention) or CIP only (control). CIP is focused on joint protection, assistive devices, and alternative ways of performing AD. The hand-exercise program addressed range of motion and muscle strength.Primary outcome was change in observed ADL motor ability measured by the Assessment of Motor and Process Skills (AMPS). Baseline measures were repeated after 8 weeks.ResultsImprovements in ADL motor ability in CIPEXERCISE (mean change = 0.24 logits; 95% CI = 0.09 to 0.39) and CIPCONTROL (mean change =0.20 logits; 95% CI = 0.05 to 0.35) were statistically significant, with no differences between groups (mean difference = 0.04 logits; 95% CI = − 0.16 to 0.25). Thirteen (46.4%) participants in the CIPEXERCISE and 12 (44.4%) in the CIPCONTROL obtained clinically relevant improvements (≥ 0.30 logits) in ADL motor ability; this group difference was not significant (z = 0.15; p = 0.88).ConclusionAdding hand exercise to a compensatory intervention did not yield additional benefits in women with hand-related RA.The study was approved by the ethics committee 14th of April 2014 (H-3-2014-025) and registered at ClinicalTrials.gov 16th of May 2014 (NCT02140866).

Using Functional Performance Measures to Assess Clinical Response in Patients with Sclerotic Chronic Graft Versus Host Disease: An Exploratory Study

Introduction In allogeneic hematopoietic stem cell transplant survivors, sclerotic chronic graft-versus-host disease (ScGVHD) is associated with poor quality of life (QOL) and range of motion restrictions. The latter can limit patients' ability to perform important activities of daily living (ADLs). The NIH Consensus Development Project established a standard set of measures to monitor chronic GVHD (cGVHD) progression. This includes indicators of patient-reported QOL and symptom burden, which is defined as the subjective severity and impact of physiological symptoms. Adding measures of functional performance may allow clinicians to more fully characterize the impact of ScGVHD on daily life. Objective To determine whether change in functional capacity and QOL relate to changes in symptom burden and clinician-rated cGVHD severity. Methods Between December 2008 and February 2011, patients with ScGVHD enrolled in a single-arm prospective clinical trial assessing the efficacy of imatinib mesylate. At baseline and 6 months, patients completed measures of functioning [Disabilities of the Arm, Shoulder, and Hand (DASH); Human Activity Profile (HAP); Manual Ability Measure (MAM-36)] and QOL [Short Form 36 version 2 (SF 36); Lee Symptom Scale (Lee)]. Clinicians rated patients' ADL ability [Assessment of Motor and Process Skills version 7 (AMPS)] and cGVHD symptom severity [Provider Global Score (PGS)]. Spearman's rank correlation tests evaluated the association among measures. The alpha level was set to 0.01. Results Twenty patients with ScGVHD enrolled in the trial; 13 patients were assessable for primary endpoint analysis. At study entry, patients were a median of 53 years old, a median of 53 months post-transplant, and had a median of 5 cGVHD-affected organs. Change in PGS was not correlated with change of any measures. Reduced symptom burden (Lee) correlated with improved SF 36 physical component scores (r = -0.72, p = 0.008), AMPS ADL motor skill scores (r = -0.84, p Conclusion Our results suggest the value of supplementing the Lee scale and the SF 36 with functional measures to assess clinical response to ScGVHD treatment. The association between changes in symptom burden and changes in ADL ability (AMPS and DASH scores) indicate the potential utility of these measures in this clinical population. Such scales may allow for a better understanding of patients' functional limitations, thereby promoting individualized clinical care and rehabilitative efforts. Clinician-reported cGVHD severity may not have been related to functional changes due to insufficient sensitivity of the measure or the small size of this sample. Our findings highlight the potential relevance of the AMPS and DASH in patients with cGVHD, though further exploration in larger and more diverse samples is necessary.

Focused ultrasound thalamotomy in Parkinson disease: Nonmotor outcomes and quality of life.

To examine nonmotor outcomes and correlates of quality of life (QoL) 3 and 12 months after unilateral focused ultrasound thalamotomy in tremor-dominant Parkinson disease (TDPD). Twenty-seven patients with TDPD in a double-blind, sham-controlled, randomized clinical trial underwent comprehensive neuropsychological evaluations. These included assessment of mood, behavior, and QoL at baseline, 3 months, 3 months post crossover in the sham group, and 12 months after active treatment. We used Mann-Whitney U tests to assess differences between the active (n = 20) and sham (n = 7) groups at 3 months and Friedman tests to assess within-group changes after active treatment. We assessed correlations between disease variables and postoperative QoL using Kendall tau-b tests. There were no differences in cognition, mood, or behavior between the active and sham groups at 3-month blinded assessment. After active treatment, there were no differences in mood or behavior. Only declines in Stroop Color Naming and phonemic fluency were observed. Patients experienced postoperative improvements in QoL and activities of daily living (ADL). Mood and behavioral symptoms, aspects of cognitive functioning, ADL, and overall motor symptom severity, but not tremor severity specifically, were associated with QoL. In TDPD, unilateral focused ultrasound thalamotomy appears safe from a cognitive, mood, and behavioral perspective. QoL and ADL significantly improved following surgery. Nonmotor symptoms and ADL were more closely associated with QoL than tremor severity. This study provides Class II evidence that for patients with TDPD, unilateral focused ultrasound thalamotomy did not adversely change cognition, mood, or behavior at 3 months.

Subgroup effects of occupational therapy-based intervention for people with advanced cancer

Background: Many people with advanced cancer have decreased ability to perform activities of daily living (ADL). We recently performed a randomized, controlled trial (RCT) assessing the efficacy of an occupational therapy-based program, the ’Cancer Home-Life Intervention’ in people with advanced cancer (N = 242) and found no overall effects on ADL ability. However, heterogeneity of treatment effect may disguise subgroup differences.Objective: To investigate whether subgroups of people with advanced cancer gain positive effects from the ‘Cancer Home-Life Intervention’ on ADL ability.Material and method: An exploratory subgroup analysis including 191 participants from a RCT. The outcome was ADL motor ability measured by the Assessment of Motor and Process Skills (AMPS). Subgroups were defined by age, gender, years of education, type of primary tumor, functional level, and activity problems.Results: The ‘Cancer Home-Life Intervention’ had no statistically significant effect in the six subgroups. Modifying effects of age (0.30 [95% CI: −0.05 to 0.64]) and gender (0.23 [95% CI: −0.11 to 0.57]) were not found.Conclusion: There were no subgroup effects of the ‘Cancer Home-Life Intervention’on ADL motor ability. Some indications suggest greater effects for those aged below 69 years; however, this result should be interpreted with caution.

Abstract P355: Socioeconomic Factors and Race Negatively Impact Performance Based Motor Skills Following Stroke: Evidence From the Health and Retirement Study

Background: Evidence suggests that racial and ethnic minorities consistently have poorer post-stroke functional outcomes. Hypothesis: We hypothesized that race in addition to socioeconomic status (SES) would correlate with poorer measures of functional outcomes in stroke patients. Methods: Our aim was to identify factors that contribute to disparate functional outcomes among middle- and retirement-aged non-Hispanic whites (white) and non-Hispanic African Americans (AA). Through retrospective analysis of data from the Health and Retirement Study (HRS), we analyzed 2,831 respondents who reported incident stroke between 1999 and 2014. Respondents were asked to report perceived difficulty with gross and fine motor function and basic activities of daily living (ADL). Linear and logistic regression analysis determined independent predictors of post-stroke motor function and ADL. Results: The analysis included 2,314 (82%) whites and 517 (18%) AA adults with stroke. The AA median age was 71± 11.3 while the white median age was 76 ± 10.5 (p&lt;0.0001). Factors associated with more difficulty with ADL, fine motor function, and gross motor function included older age, female gender, AA race, and higher numbers of household residents. Surprisingly, the comorbidity score was only associated with difficulty in gross motor function. Moreover, the time since stroke did not associate with any performance measure. Increased difficulty with performance-based ADL, fine, and gross motor skills in AAs relative to whites, was associated with younger age, more residents in the home, and less household income. Although our analysis was limited due to the lack of long-term follow-up in the HRS study, these data can help direct future stroke recovery health disparity studies. Conclusions: Our findings highlight the importance of examining contributing factors to racial disparities in post stroke outcomes.

Ability to perform activities of daily living among patients with bipolar disorder in remission

Aims: Patients with bipolar disorder often experience disability in terms of cognitive impairments and activity limitations even in remission. However, knowledge is sparse concerning the ability to perform Activities of Daily Living (ADL) during remission. The aim of this study was to (1) investigate the observed and self-reported ability to perform ADL tasks and (2) examine the association between observed and self-reported ability to perform ADL in patients with bipolar disorder in remission. Methods: The observed ADL ability was assessed with the Assessment of Motor and Process Skills, a standardized assessment providing interpretation of ADL ability in relation to competence, independence, and normative age expectations. Self-reported ADL ability was assessed with the standardized ADL-Questionnaire. Results: Forty-three patients with bipolar disorder in remission (median age 35 years, range 19–58 years) were assessed and overall, they displayed decreased observed ADL motor and ADL process ability relative to normative age. They exhibited increased physical effort, clumsiness or fatigue and/or inefficiency, there was concern for safe task performance and one-third may need assistance to live in the community. While participants reported decreased ADL ability, especially within instrumental ADL, they had a tendency towards evaluating themselves as more competent than what was observed. No relationships between measures of observed and self-reported ADL ability were found. Conclusion: Overall, patients with bipolar disorder in remission showed decreased ability to perform ADL. Clinical practice and future studies are recommended to use both observation-based and self-reported assessments of the ability to perform ADL tasks to fully capture disability in bipolar disorder.

Ability to perform activities of daily living among patients with bipolar disorder in remission

Aims: Patients with bipolar disorder often experience disability in terms of cognitive impairments and activity limitations even in remission. However, knowledge is sparse concerning the ability to perform Activities of Daily Living (ADL) during remission. The aim of this study was to (1) investigate the observed and self-reported ability to perform ADL tasks and (2) examine the association between observed and self-reported ability to perform ADL in patients with bipolar disorder in remission. Methods: The observed ADL ability was assessed with the Assessment of Motor and Process Skills, a standardized assessment providing interpretation of ADL ability in relation to competence, independence, and normative age expectations. Self-reported ADL ability was assessed with the standardized ADL-Questionnaire. Results: Forty-three patients with bipolar disorder in remission (median age 35 years, range 19–58 years) were assessed and overall, they displayed decreased observed ADL motor and ADL process ability relative to normative age. They exhibited increased physical effort, clumsiness or fatigue and/or inefficiency, there was concern for safe task performance and one-third may need assistance to live in the community. While participants reported decreased ADL ability, especially within instrumental ADL, they had a tendency towards evaluating themselves as more competent than what was observed. No relationships between measures of observed and self-reported ADL ability were found. Conclusion: Overall, patients with bipolar disorder in remission showed decreased ability to perform ADL. Clinical practice and future studies are recommended to use both observation-based and self-reported assessments of the ability to perform ADL tasks to fully capture disability in bipolar disorder.

The Course of Activities in Daily Living: Who Is at Risk for Decline after First Ever Stroke?

Background: Stroke is not only an acute disease, but for the majority of patients, it also becomes a chronic condition. There is a major concern about the long-term follow-up with respect to activities of daily living (ADL) in stroke survivors. Some patients seem to be at risk for decline after a first-ever stroke. The purpose of this study was to determine the course of ADL from 3 months after the first-ever stroke and onward and identify factors associated with decline in ADL. Methods: A systematic literature search of 3 electronic databases through June 2015 was conducted. Longitudinal studies evaluating changes in ADL from 3 months post stroke onward were included. Cohorts including recurrent strokes and transient ischemic attacks were excluded. Regarding the course of ADL, a meta-analysis was performed using random-effects model. A best evidence synthesis was performed to identify factors associated with decline in ADL. Results: Out of 10,473 publications, 28 unique studies were included. A small but significant improvement in ADL was found from 3 to 12 months post stroke (standardized mean difference (SMD) 0.17 (0.04-0.30)), which mainly seemed to occur between 3 and 6 months post stroke (SMD 0.15 (0.05-0.26)). From 1 to 3 years post stroke, no significant change was found. Five studies found a decline in ADL status over time in 12-40% of patients. Nine factors were associated with ADL decline. There is moderate evidence for being dependent in ADL and impaired motor function of the leg. Limited evidence was found associated with insurance status, living alone, age ≥80, inactive state and having impaired cognitive function, depression and fatigue with decline in ADL. Conclusion: Although on an average patients do not seem to decline in ADL for up to 3 years, there is considerable variation within the population. Some modifiable factors associated with decline in ADL were identified. However, more research is needed before patients at risk of deterioration in ADL can be identified.