Activity Limitations In Adults Research Articles

Danish translation, cultural adaptation and psychometric testing of the Brachial Assessment Tool (BrAT), designed to assess activity limitation in adults with traumatic brachial plexus injuries

Purpose To translate and cross-culturally adapt The Brachial Assessment Tool (BrAT) into Danish and assess its content validity and reproducibility in adults with traumatic brachial plexus injury (BPI). Material and methods Translation followed international guidelines. BrAT(DK) were cognitive tested with 19 adults with traumatic BPI to evaluate cross-cultural understanding, relevance, comprehensiveness and comprehensibility. Content validity and reproducibility were evaluated following the COnsensus-based Standards for the selection of health Measurement INstruments guideline. Participants were recruited from an outpatient hand clinic. Test-retest reliability was assessed using intra-class-correlation coefficient (ICC) and the smallest detectable change (SDC). Internal consistency was evaluated using Cronbach’s alpha. Results Minor cultural differences were observed in the content validity analysis of BrAT(DK). Cognitive testing revealing no significant issues. All participants found the items relevant and important. 63 participants with traumatic BPI were recruited; 49 completed the retest. ICC values for the sub-scales and the total score ranged from 0.91 to 0.95 (95% CI 0.85 to 0.97). Internal consistency ranged from 0.87 to 0.98. SDC ranged from 4.16 to 9.63 for subscales and 16.01 for the total score. Conclusion BrAT(DK) appeared to be content valid and reliabel as a measure of activity limitation in adults with traumatic BPI.

The role of targeting glucose metabolism in chondrocytes in the pathogenesis and therapeutic mechanisms of osteoarthritis: a narrative review.

Osteoarthritis (OA) is a common degenerative joint disease that can affect almost any joint, mainly resulting in joint dysfunction and pain. Worldwide, OA affects more than 240 million people and is one of the leading causes of activity limitation in adults. However, the pathogenesis of OA remains elusive, resulting in the lack of well-established clinical treatment strategies. Recently, energy metabolism alterations have provided new insights into the pathogenesis of OA. Accumulating evidence indicates that glucose metabolism plays a key role in maintaining cartilage homeostasis. Disorders of glucose metabolism can lead to chondrocyte hypertrophy and extracellular matrix degradation, and promote the occurrence and development of OA. This article systematically summarizes the regulatory effects of different enzymes and factors related to glucose metabolism in OA, as well as the mechanism and potential of various substances in the treatment of OA by affecting glucose metabolism. This provides a theoretical basis for a better understanding of the mechanism of OA progression and the development of optimal prevention and treatment strategies.

The patterns and predictors of knee osteoarthritis pain flares

Osteoarthritis is the commonest joint disease in the world and is the main reason for activity limitation in adults. Notably, knee osteoarthritis (KOA) accounts for most of the global osteoarthritis burden and is especially prevalent in Asia, including Sri Lanka. Although KOA is now much better understood, it is still a disease without a cure and patients suffer profoundly from KOA pain. While it is generally accepted that intermittent KOA pain or knee osteoarthritis pain flares (KOAF) is symptomatic of early KOA, this phenomenon remains poorly understood. Therefore, more insights about the intermittent nature of knee pain can help to develop more effective methods to manage both the pain and progress of the disease.Knee osteoarthritis pain flares, its associated risk factors, and progression are the focus of the research presented in this oration. This research investigated the multiple risk factors and potential predictors of KOAF using data from two cohorts, one in Australia and another in Sri Lanka. Thereafter, a multivariable model was estimated to predict KOAF in the following 30 days. Subsequently, short-term pain evolution in persons with KOA pain fluctuations was examined to identify distinct and disparate pain trajectories, to better understand the evolution of pain in early KOA.This new information helps identify those at high risk of KOAF and has the potential to enhance patient education and resource allocation. Research findings about short-term pain trajectories, in particular, will ensure that patients at the highest risk of pain progression are targeted and treated in a timely manner.

Discordance between joint pain and imagery severity in the ankle joint and contributors of lower limb activity limitations in adults with haemophilia: A cross-sectional study.

People with haemophilia (PwH) suffer from knee and ankle joint pain, but the association with structural damage remains underexplored. They report activity limitations but it is unclear which factors contribute to lower limb activity limitations (LL-AL). This study aimed (i) to analyse the association between ankle joint pain and structure and (ii) explore the contribution of haemophilia-related, individual and psychological factors to LL-AL in PwH. This study included 104 moderate/severe PwH. Ankle pain intensity was assessed with a numeric rating scale and pain sensitivity with algometry (pressure pain threshold (PPTA )). Ankle structure was assessed with MRI (IPSG-MRI) and ultrasound (HEAD-US), joint health with the Haemophilia Joint Health Score (HJHS). The HAL-LOWCOM subscore evaluated LL-AL. A Spearman correlation analysed the correlation between ankle pain and structure. The contribution of haemophilia-related factors (joint health, overall pain (Brief Pain Inventory-Pain Severity (BPI-PS)), functional status (2-Minute-Walking-Distance, Timed Up and Go); individual factors (age, BMI) and psychological factors (fear and avoidance beliefs over physical activity (FABQ-PA) and work (FABQ-Work), anxiety and depression) to LL-AL was explored using a regression analysis. Only low correlations were found between ankle pain intensity and structure (IPSG-MRI, HEAD-US). PPTA was unrelated to structure. Altogether, HJHS, overall pain (BPI-PS), FABQ-Work and age explained 69% of HAL-LOWCOM variance, with 65% explained by the combination of HJHS and BPI-PS. No meaningful associations were found between ankle pain and structural damage, suggesting that other factors may contribute to PwH's ankle pain. In contrast, mainly haemophilia-related factors explained LL-AL variance.

Effectiveness of ergonomic interventions on work activity limitations in adults with rheumatoid arthritis: A systematic review.

Rheumatoid arthritis (RA) is one of the leading causes of work disability in the United States. Ergonomic interventions offer an individualized treatment approach, and when used in conjunction with pharmacological treatment interventions, may improve work outcomes and improve the overall quality of life for individuals with RA. To identify the current body of evidence regarding the effectiveness of ergonomic interventions in reducing work activity limitations in adults with RA. A systematic review was conducted to identify articles of ergonomic interventions targeting working adults with RA. The CONsolidated Standards of Reporting Trials (CONSORT) checklist and Non-Pharmacological Treatment (NPT) Extension evaluated the reporting quality of each randomized controlled trial (RCT), and the Grading of Recommendation Assessment, Development, and Evaluation (GRADE) evaluated the quality of the evidence. Six studies were identified and reviewed for the quality of their reporting on evidence related to work activity limitations. Sixty-six percent of the items on the CONSORT checklist were fully reported by all studies and analysis through the GRADE framework demonstrated moderate confidence that the reported effects of ergonomic interventions on work activity limitations in the studies are accurate. This review revealed varied results for the effectiveness of ergonomic interventions on work activity limitations and at-work productivity. The results of this review indicate a need for further investigation. Future studies should focus on reviewing specific ergonomic interventions to determine the dosage needed to see results in reducing work activity limitations for working adults with RA.

Pharmacokinetics, safety and efficacy of intra-articular non-steroidal anti-inflammatory drug injections for the treatment of osteoarthritis: A narrative review.

What is known and ObjectiveOsteoarthritis (OA) is a common cause of joint disease and activity limitation in adults. Common therapies to treat OA‐related pain are oral and topical non‐steroidal anti‐inflammatory drugs (NSAIDs) and intra‐articular (IA) corticosteroids. However, prolonged courses of oral NSAIDs are associated with systemic adverse effects and repeat IA corticosteroid injections may cause cartilage degeneration. IA NSAIDs may be an alternative therapy possibly minimizing systemic side effects while maintaining efficacy. Therefore, we sought to summarize the pharmacokinetics, safety and efficacy of IA NSAIDs to help providers make a more informed decision on the use of IA NSAIDs.MethodsWe searched the National Library of Medicine Database with terms “intraarticular and nsaid”, yielding 1032 results. Only traditional formulations of NSAIDs were considered for inclusion. Animal studies were included if animals were healthy or if the method of arthritis induction was a reasonable model of osteoarthritis. Human studies were included if humans were healthy or if the primary disease studied was osteoarthritis of a large joint. Of 1032 results, 31 research articles met the inclusion criteria and were summarized in this review.Results and DiscussionWe found that single doses of IA NSAIDs provided far less total systemic and synovial exposure compared to a one week course of oral NSAIDs, but maximum concentrations to the synovium with IA administration were much higher. IA NSAIDs had an excellent safety profile in small animals, large animals and humans, although these injections were associated with non‐specific cartilage inflammation in healthy animals. In animal models, IA NSAIDs had similar efficacy to PO NSAIDs in treating OA‐related pain. In humans, IA NSAIDs had similar efficacy to PO NSAIDS and IA corticosteroids in treating OA‐related pain; however, many trials did not have a placebo control and outcome measures were heterogeneous.What is new and ConclusionOverall, single doses of IA NSAIDs appear safe and efficacious across animals and humans. The optimal use of IA NSAIDs is still to be determined and further research is needed. However IA NSAIDs may be an additional beneficial therapy to treat OA‐related pain. Potential uses may be to augment IA corticosteroids injections, to interrupt multiple IA corticosteroid injections or as an alternative in patients that are high risk for corticosteroid‐related adverse events.

Effectiveness of Ergonomic Interventions on Work Activity Limitations in Adults with Rheumatoid Arthritis: A Systematic Review

<h3>Research Objectives</h3> Rheumatoid arthritis (RA) is one of the leading causes of work disability in the United States. Ergonomic interventions offer an individualized treatment approach, and when used in conjunction with pharmacological treatment interventions, may improve work outcomes and improve the overall quality of life for individuals with RA. To identify the current body of evidence regarding the effectiveness of ergonomic interventions in reducing work activity limitations in adults with RA. <h3>Design</h3> A systematic review was conducted to identify articles of ergonomic interventions targeting working adults with RA. The CONsolidated Standards of Reporting Trials (CONSORT) checklist and Non-Pharmacological Treatment (NPT) Extension evaluated the reporting quality of each randomized controlled trial (RCT), and the Grading of Recommendation Assessment, Development, and Evaluation (GRADE) evaluated the quality of the evidence. <h3>Setting</h3> N/A. <h3>Participants</h3> N/A. <h3>Interventions</h3> N/A. <h3>Main Outcome Measures</h3> N/A. <h3>Results</h3> Six studies were identified and reviewed for the quality of their reporting on evidence related to work activity limitations. Sixty-six percent of the items on the CONSORT checklist were fully reported by all studies and analysis through the GRADE framework demonstrated moderate confidence that the reported effects of ergonomic interventions on work activity limitations in the studies are accurate. This review revealed varied results for the effectiveness of ergonomic interventions on work activity limitations and at-work productivity. <h3>Conclusions</h3> The results of this review indicate a need for further investigation. Future studies should focus on reviewing specific ergonomic interventions to determine the dosage needed to see results in reducing work activity limitations for working adults with RA.

Characterization of Respiratory Disability in the Adult Population of the Rostov Region

Introduction: Disability resulting from diseases of the respiratory system is a complex problem for the health care and social security systems. The prevalence of chronic lung diseases keeps growing. Our objective was to analyze the rates of initial and recurrent respiratory disability in the adult population of the Rostov Region in 2014–2018 and to compare them with those registered in the Southern Federal District and the Russian Federation. Material and methods: We used information about initial and recurrent respiratory disability in adults from the electronic database of the unified information and analytical system of medical and social expertise of the Rostov Region and digests of the Federal Bureau of Medical and Social Expert Examination of the Ministry of Labor and Social Protection of the Russian Federation for 2014–2018. We applied methods of data copying, descriptive statistics (estimation of extensive and intensive indicators, significance tests (p)), analytical and comparative analysis. Results: The analysis of adult respiratory disability in the Rostov Region in 2014–2018 showed a decrease in the number of adults with initial and recurrent disability. The proportion of initial cases tended to decrease and was similar to the Russian average rate but exceeded that in the Southern Federal District while the proportion of recurrent disability cases increased. The rates of initial respiratory disability in the adult population of the Rostov Region and the Russian Federation were comparable. The regional proportion of young people with respiratory disability was 42.2 % in contrast to the Southern Federal District and the Russian Federation where elderly cases prevailed (42.0 % and 48.7 %, respectively). In terms of severity of disability, grade II disability cases prevailed (50.4 %) in the Rostov Region as opposed to the Southern Federal District and the Russian Federation with higher proportions of persons with disability grade III (62.3 % and 72.0 %, respectively). The recurrent disability rate showed a rising trend and was higher than the intensive indicator in the Southern Federal District but lower than that in the Russian Federation. The majority of regional cases with recurrent respiratory disability were young and middle-aged (40.5 % and 40.2 %, respectively); the proportion of young cases tended to increase while that of the middle-aged showed a downward trend. In the Southern Federal District and the Russian Federation, most recurrent cases were middle-aged or elderly (37.8 % and 35.3 %) and elderly or middle-aged (39.0 % and 35.1 %), respectively. The rate of recurrent respiratory disability among young people in the Rostov Region was twice as high as in the Southern Federal District and the Russian Federation. In terms of severity of recurrent respiratory disability, grade III disability was most prevalent in all territories but in the Rostov Region its proportion was lower than in the areas of comparison. The proportion of people with grade II disability tended to decrease but was still higher than in the Southern Federal District and the Russian Federation. Conclusions: Our findings will allow a more accurate assessment of severity of impairments and vital activity limitations in adults with respiratory disability and help plan appropriate age and sex-specific rehabilitation measures contributing to effective rehabilitation and habilitation actions and successful social integration of a disabled person.

Effects of Therapy in Patients Suffering from Chronic Back Pain Treated with Spinal Cord Stimulation

Pain in the lumbosacral part of the spine in the course of degenerative disease is the most common cause of physical activity limitation in adults. Treatment includes pharmacotherapy, physiotherapy, psychotherapy, health promotion, and sometimes surgery. Surgical treatment is not always successful, and the various clinical and psychosomatic symptoms that result from surgical treatment failure are known as failed back surgery syndrome. For some patients with this condition, spinal cord stimulation can provide relief. The aim of the work was to define subjective and objective spinal cord stimulation effects by assessing chosen disability and physical activity limitation ratios. Pain intensity, level of disability, and presence of neurological symptoms were assessed. The examination was performed twice: before the stimulator implantation and at least 6 months postimplantation. The study was conducted at the Department of Neurosurgery and Paediatric Neurosurgery in Lublin. Thirty-six patients suffering from failed back surgery syndrome were recruited for this study. The Visual Analog Scale, modified Laitinen's pain questionnaire, and Oswestry Disability Index were used in this work. The study showed that spinal cord stimulation was effective in treating spinal and lower limb pain in 64% of patients, similar to results obtained in other departments. Although back pain and neuropathic pain radiating to the lower limbs decreased, moderate physical activity impairment was still observed according to the Oswestry Disability Index scale. The decrease in neuropathic pain radiating to the lower limbs had the most significant influence on reducing physical activity impairment.

Should patients with asthma be routinely screened for depression?

Evidence-Based Answer The practice might be worth considering. Rates of depression are about 2 times higher among adults and adolescents with asthma than the general population. Depression is associated with activity limitation in adults with moderate to severe persistent asthma. It is unknown if treatment of depression without other intervention improves asthma control (SOR: C, cross-sectional and meta-analysis of case-controlled studies).

Specific treatment of problems of the spine (STOPS): design of a randomised controlled trial comparing specific physiotherapy versus advice for people with subacute low back disorders

BackgroundLow back disorders are a common and costly cause of pain and activity limitation in adults. Few treatment options have demonstrated clinically meaningful benefits apart from advice which is recommended in all international guidelines. Clinical heterogeneity of participants in clinical trials is hypothesised as reducing the likelihood of demonstrating treatment effects, and sampling of more homogenous subgroups is recommended. We propose five subgroups that allow the delivery of specific physiotherapy treatment targeting the pathoanatomical, neurophysiological and psychosocial components of low back disorders. The aim of this article is to describe the methodology of a randomised controlled trial comparing specific physiotherapy treatment to advice for people classified into five subacute low back disorder subgroups.Methods/DesignA multi-centre parallel group randomised controlled trial is proposed. A minimum of 250 participants with subacute (6 weeks to 6 months) low back pain and/or referred leg pain will be classified into one of five subgroups and then randomly allocated to receive either physiotherapy advice (2 sessions over 10 weeks) or specific physiotherapy treatment (10 sessions over 10 weeks) tailored according to the subgroup of the participant. Outcomes will be assessed at 5 weeks, 10 weeks, 6 months and 12 months following randomisation. Primary outcomes will be activity limitation measured with a modified Oswestry Disability Index as well as leg and back pain intensity measured on separate 0-10 Numerical Rating Scales. Secondary outcomes will include a 7-point global rating of change scale, satisfaction with physiotherapy treatment, satisfaction with treatment results, the Sciatica Frequency and Bothersomeness Scale, quality of life (EuroQol-5D), interference with work, and psychosocial risk factors (Orebro Musculoskeletal Pain Questionnaire). Adverse events and co-interventions will also be measured. Data will be analysed according to intention to treat principles, using linear mixed models for continuous outcomes, Mann Whitney U tests for ordinal outcomes, and Chi-square, risk ratios and risk differences for dichotomous outcomes.DiscussionThis trial will determine the difference in outcomes between specific physiotherapy treatment tailored to each of the five subgroups versus advice which is recommended in guidelines as a suitable treatment for most people with a low back disorder.Trial registrationAustralia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12609000834257.

A Potential Role for Avocado- and Soybean-Based Nutritional Supplements in the Management of Osteoarthritis: A Review

Osteoarthritis (OA) is a common, painful, and debilitating condition that affects approximately 46.4 million individuals in the United States. By 2012, this number is expected to increase to 60 million. In addition, it is the leading cause of activity limitation in adults and represents a widely acknowledged economic burden. Although the ultimate goal is to slow or prevent OA progression, at present, medical management of OA is aimed primarily at controlling symptoms of pain and stiffness and maintaining joint mobility and quality of life. Because of the lack or perceived lack of response to many conventional therapies for OA as well as concerns regarding the long-term administration of drugs (eg, nonsteroidal anti-inflammatory drugs), oral joint health supplements (OJHSs) have become increasingly popular among patients with OA. This article briefly reviews pertinent molecular mechanisms involved in the development of OA and summarizes available in vitro and in vivo evidence supporting the use of avocado and soybean unsaponifiables (ASU) either alone or in combination with glucosamine and chondroitin sulfate in patients with OA. Basic scientific research studies and a systematic review and meta-analysis of the available high-quality randomized clinical trials indicate that 300 mg of ASU per day (with or without glucosamine and chondroitin sulfate) appears to be beneficial for patients with hip or knee OA. There is also some evidence that ASU or ASU/glucosamine/chondroitin sulfate combination products could be used prophylactically in even the earliest stages of OA. Considering concerns regarding inferior-quality OJHSs, consumers and physicians are encouraged to take an evidence-based approach when evaluating OJHSs to identify and recommend safe and effective products that meet label claims when tested independently, and are of the highest quality.

A Comparison Between Self-Reported and Observed Activity Limitations in Adults With Neuromuscular Disorders

Vandervelde L, Dispa D, Van den Bergh PY, Thonnard J-L. A comparison between self-reported and observed activity limitations in adults with neuromuscular disorders. Objective To investigate the agreement between the self-reported and examiner-reported difficulties of patients with neuromuscular disorders (NMDs) in performing daily activities at home. Design A comparison between 2 methods of administering a measurement instrument. Setting Neuromuscular reference center in a university hospital. Participants Adult patients (N=57) with diagnosed NMDs living at home. Interventions Not applicable. Main Outcome Measure The ACTIVLIM questionnaire. Results The intraclass correlation coefficient, model 2,1 (ICC 2,1), between the measures was very good (ICC 2,1=.87), indicating a good agreement between self-perceived and observed measures. Conclusions The use of ACTIVLIM as a self-reporting questionnaire is a valid method for assessing activity limitations in patients with NMD.