Activities Of Daily Living Index Research Articles

Effects of the Robot-Assisted Gait Training Device Plus Physiotherapy in Improving Ambulatory Functions in Patients With Subacute Stroke With Hemiplegia: An Assessor-Blinded, Randomized Controlled Trial

ObjectiveTo investigate the effects of the robot-assisted gait training (RAGT) device plus physiotherapy vs physiotherapy alone in improving ambulatory functions in patients with subacute stroke with hemiplegia. DesignA prospective, assessor-blinded, randomized controlled trial. SettingPatients with subacute stroke with hemiplegia admitted at the Rehabilitation Center. ParticipantsTwenty-six patients with subacute stroke with hemiplegia (N=26). InterventionAll patients received 30 training sessions (5 d/wk for 6 wk), which included conventional physiotherapy training (60 minutes) and ambulation training (60 minutes). In the ambulation training session, the RAGT device group received robotic training (40 minutes) and ground ambulation training (20 minutes). The control group received only ground ambulation training (60 minutes). The outcomes were assessed at the initial session and at the end of the 15th and 30th sessions. Comparisons within groups and between groups were conducted. Main Outcome MeasuresPrimary outcome variables were the FIM-walk score and the efficacy of FIM-walk. ResultsThe RAGT device group showed greater improvements from baseline than control in (1) the FIM-walk score at the end of the 15th session (P=.012), (2) the efficacy of FIM-walk at the end of the 15th session (P=.008), (3) walking distance in the 6-minute walk test at the end of the 15th session (P=.018), (4) the Barthel Index for Activities of Daily Living (ADL) at the end of the 30th session (P<.001), and (5) gait symmetry ratio at the end of the 30th session (P=.044). Other gait parameters showed tendencies of improvement in the RAGT device group, but there were no significant differences. ConclusionsRAGT devices plus physiotherapy showed early improvements in walking ability and Barthel ADL index compared with the ground level training plus physiotherapy in patients with subacute stroke with hemiplegia.

Sociodemographic Determinants, Health Conditions, and Mental Status as Predictors of the Functional Status of Older Saudi People

The increasing population of Saudi elderly demands adequate assessment of their functional health status and mental status to improve their health and quality of life. This study aimed to determine the functional status of older Saudi people in performing basic activities of daily living (ADLs) and instrumental activities of daily living (IADLs) and its influencing factors. This quantitative, descriptive-correlational study surveyed a total of 203 participants using the Mini-Mental State Examination, Katz Index of ADL, and Lawton IADL. Overall, the participants had moderate cognitive impairment and were able to perform basic ADLs and IADLs independently, but they needed assistance in doing housework. Functional status was sensitive to their sociodemographic characteristics, presence of health problems, and mental status. Mental status, education, employment, marital status, and source of support were significantly associated with their ability to perform basic ADLs and IADLs. This study suggests that more efforts are needed to understand the sociodemographic characteristics, presence of health problems, and mental status that support the development of evidence-based public health policy on the functional status among older Saudi people. The findings can be utilized by hospital and nursing administrators to initiate educational and training programs for healthcare professionals including nurses and to create healthcare policies so that the health concerns and functional difficulties of older patients are adequately addressed.

Geography matters to disability: regional disparity of bathing difficulty among older adults in China

Bathing is a major type of disability among older adults. While studies on bathing difficulties have recently started to go beyond the limitations of the human body to examine bathroom amenities; researchers have rarely considered the environment beyond the bathroom. This study explored the regional disparities in bathing disability among older adults in China. Using data from the Chinese Longitudinal Healthy Longevity Survey from 1998 to 2018, random-effects logistic regressions were performed to examine how bathing difficulties differed across regions among older adults in China. We found that older adults residing in the northern regions were significantly more likely to experience bathing disability compared to those from the South after controlling for confounding variables. Women and the oldest-old were also the most likely to experience bathing disabilities. Within the Northern regions itself, individuals from the Northeast stood out for having the highest likelihood of experiencing bathing disability. Interestingly, this regional disparity only existed for bathing disability and not the other Activities of Daily Living (ADL) items. It is concluded that the large regional disparity could be due to both climate differences and uneven economic development across the different regions in China. As bathing is a highly environment-dependent activity, this study highlights the potential for policy interventions to reduce the prevalence of bathing disability among older adults through improving the bathing environment. Additionally, we aim to put forth the notion that disability research should move towards analyses of specific disability items rather than an undifferentiated ADL index.

Safety of an inactivated SARS-CoV-2 vaccine in elderly persons

Introduction. Brazil has the 2nd highest number of COVID-19 deaths (more than 530,000) and the 3rd highest number of confirmed cases (more than 19 million) worldwide. COVID-19 vaccination is the most effective strategy to prevent new cases and illness, reducing hospitalizations and deaths. The 1st vaccine used in Brazil was the Sinovac/Instituto Butantan CoronaVac, an inactivated SARS-CoV-2 vaccine. Elderly persons (EP) were among the first groups eligible for immunization, after healthcare workers, indigenous people and quilombolas. Objective. To evaluate adverse events following immunization (AEFI) with CoronaVac in EP. Methods. This observational retrospective study was conducted at the Reference Center for Special Immunobiologicals (CRIE) of the Hospital das Clínicas (HC-FMUSP), a tertiary/quaternary hospital attached to the University of São Paulo Medical School (FMUSP), in São Paulo city, from February to April 2021. EP, who searched or were referred to CRIE to receive the COVID-19 vaccine were asked for authorization for follow-up calls to evaluate AEFI. The on phone follow up was made by healthcare workers who conducted AEFI forms on day 4 and day 8 after the first and second vaccine doses; a sociodemographic questionnaire; and a modified functionality scale for EP based on the Independence in Activities of Daily Living index (ADLi), Instrumental Activities of Daily Living scale (IADLs) and Study of Osteoporotic Fractures index (SOFi). Results. During the study period, CoronaVac was used; 159 EP received the first dose and 155 EP were fully vaccinated at CRIE; 152 participants were contacted after the first dose and 142 participants were contacted after the second dose. The participants’ age ranged from 53 to 101 years (mean, 84 years), 65.4% were females, and 73.7% were white. 148 (93.1%) participants have at least one comorbidity, the most common was hypertension (59.8%) followed by heart disease (30.2%) and dyslipidemia (25.2%). 70/152 (46.1%) participants were classified as independent in IADLs, 117/152 (77.0%) in ADLi and 66/152 (43.4%) according to SOFi. 47 participants (30.2%) reported at least one AEFI at first dose. The most common local AEFI was pain at the injection site (13, 8.6%) and the most common systemic AEFI was fatigue (8, 6.0%), followed by headache (6, 4.0%). Thirty participants (21.1%) reported at least one AEFI at the second dose. The most common local AEFI was pain at the injection site (6, 4.3%) and the most common systemic AEFI was myalgia (11, 7.9%), followed by fatigue (9, 6.5%). Most AEFI were mild and had no or little interference in daily activities. There were five severe AEFI: two deaths after the first dose (a sudden death and another following a hemorrhagic stroke) and three hospitalizations (one after the first dose and two after the second dose). None of them were considered related to the vaccine. Discussion and conclusion. This unique studied population was composed of EP with comorbidities and some level of dependency. The participants reported few and mild AEFI, suggesting CoronaVac is safe in EP.

Impact of the COVID-19 Lockdown and Confinement Measures on the Musculoskeletal Health of the Urban Geriatric Population

BackgroundOwing to the coronavirus disease 2019 (COVID-19) pandemic, a nationwide lockdown was imposed in India, with strict confinement measures imposed on the elderly. Because mobility and regular physical activity are considered to be the key determinants of musculoskeletal health, this study aimed to investigate the effect of lockdown and confinement measures on the musculoskeletal health and activities of daily living of the urban geriatric population.MethodologyA cross-sectional survey was conducted among the elderly aged ≥60 years. The survey instrument consisted of a questionnaire, a modified Nordic Musculoskeletal Questionnaire (mNMQ), and the Barthel activities of daily living (ADL) index. The net mNMQ score and Barthel ADL index were compared before and during the lockdown. Univariate and multivariate analyses were performed to determine which factors could result in the worsening of the net mNMQ score. In addition, floor and ceiling effects of the net mNMQ score were determined.ResultsIn this study, a total of 105 out of 150 eligible participants were enrolled. A significant decline in physical activity status was noted during the lockdown. Overall, 54.3% of the respondents reported that their medical services were impacted during the lockdown. The net mNMQ score showed a significant worsening during the lockdown (P < 0.0001). A statistically significant increase in the modified NMQ score was noted for the lower limb (P < 0.0001) and spine (P = 0.002), but not for the upper limb (P = 0.052). Elderly whose medical services were impacted during lockdown had significantly worse net mNMQ scores than those whose services were not impacted (odds ratio = 6.16; 95% confidence interval = 2.51-15.08; P = 0.0001). Age, gender, ambulatory status, increase in body weight, and indulgence in exercise before and during lockdown had no effect on the change in the net mNMQ score. A significant ceiling effect was noted in the mNMQ score; however, no floor effect was noted.ConclusionsLockdown and confinement measures resulted in a significant decline in physical activity as well as the overall musculoskeletal health of the urban geriatric population in the present study. Hence, policymakers should ensure uninterrupted medical care to the elderly during extended periods of confinement and develop optimal home-based physical activity programs to counter the problems associated with sedentarism.

Self-Reported and Performance-Based Evaluations of Functional Status in Older Women With Breast Cancer.

To evaluate self-reported and performance-based functional status (FS) in older women with breast cancer according to stage and time of visit during treatment. 72 women with breast cancer aged 78 years or older and receiving any type of treatment at a midwestern outpatient clinic. FS was evaluated using grip strength, the Index of Activities of Daily Living (ADLs), the instrumental ADLs (IADLs) scale, and the Timed Up and Go Test (TUGT). Mixed models were fit for grip strength and the TUGT, and generalized estimating equations were used to fit binary logistic regressions for the Index of ADLs and the IADLs scale. Continuous FS outcomes were evaluated using means and standard deviations. Cancer stage and time of visit did not affect self-reported or performance-based FS scores. Most participants were considered independent on the Index of ADLs, the IADLs scale, and the TUGT, which did not change significantly between visits. Self-reported measures revealed less impairment. Monitoring FS using self-reported and performance-based measures can ensure that older patients receive timely support.

Revisiting nutrition\u2013labor productivity link: new empirical evidence from farm households in Ethiopia

BackgroundAmong others, the productive use of surplus labor is a viable mechanism to transform the agricultural sector and thus the whole economy in low-income countries. It is critically important to understand the factors that condition labor productivity to design and deploy effective agricultural and labor market policies. A few studies confirm that, at low-income levels, improving nutrition can contribute to the labor productivity of households. These studies rely heavily on self-reported farm data, which are prone to systematic and random measurement errors. The empirical evidence on this topic remains inadequate and inconclusive for this reason. Here, we substantiate whether better nutritional status enhances the labor productivity of farm households using objective measures of plot-level data from a recent household survey in Ethiopia. We also employ alternative measures of nutrition status indicators known as, Food Consumption Score (FCS) and Household Dietary Diversity Score (HDDS), inter alia, to capture additional aspects of nutrition such as diet quality and diversity, which are overlooked by calorie intake data. To deal with possible endogeneity, we employ a panel fixed effect estimation technique with a rich set of household socioeconomic and plot characteristics.ResultsWe observe that the impact of current nutritional status, as measured by HDDS, on labor productivity varies considerably depending on the initial level of diet quality and diversity with a stronger and positive effect for low-consumption households. In an alternative specification, we also observe a positive farm labor productivity effect of current nutritional status as measured by FCS with a homogenous effect across households. However, the effect of the outcome of past nutritional status as evaluated by the Activity of Daily Living Index (ADLI) seems negligible.ConclusionOur findings indicate that improving nutrition can contribute to farm labor productivity at least for households with low current diet quality and diversity. Also, based on the findings, we conclude that there is a possibility of a low consumption–low productivity trap in Ethiopia.

Association of Lifetime Traumatic Brain Injury and Military Employment with Late-Life ADL Functioning: A Population-Based Prospective Cohort Study

<h3>Research Objectives</h3> To determine associations of lifetime history of traumatic brain injury (TBI) with loss of consciousness (LOC) and military employment with activities of daily living (ADL) in late life. <h3>Design</h3> A population-based prospective cohort study of older adults with a baseline visit and up to 10-years of biennial follow-up visits. <h3>Setting</h3> Seattle-area integrated healthcare delivery system. <h3>Participants</h3> Male (n=2066) and female (n=2887) participants of the Adult Changes in Thought (ACT) study, aged 65+ and dementia-free. <h3>Interventions</h3> We fitted repeated-measures Poisson mixed effects regression models. Military employment and TBI with LOC variables were included as main effects. We included interaction terms with time to allow for different longitudinal trends in ADL difficulties within each exposure group of interest. <h3>Main Outcome Measures</h3> History of TBI with LOC was based on participant self-report during the baseline visit. History of military employment was ascertained based on items addressing the longest and second longest occupations for each participant. ADL functioning was assessed at baseline and biennial follow-up via participant self-reported function on the 6-item Katz ADL index. For analyses, we summed the number of ADLs with which a person reported at least some difficulty (range 0-6). <h3>Results</h3> TBI with LOC before age 40 was associated with greater ADL difficulty at baseline for females (RR=1.44, 95% CI: 1.08-1.93, p=0.01). For males, TBI with LOC at any age was associated with greater ADL difficulty at baseline (age < 40: RR=1.58, 95% CI: 1.20 - 2.08, p = 0.001; age 40+: RR=2.14, 95% CI: 1.24 - 3.68, p = 0.006). TBI with LOC was not associated with the rate of accumulation of ADL difficulties over time in males or females. There was no evidence of an association between military employment and either outcome, nor of an interaction between military employment and TBI with LOC. Findings were consistent across a variety of sensitivity analyses. <h3>Conclusions</h3> Future study of the implications of TBI and military employment on late-life physical functioning as measured by performance-based tools in more diverse cohorts is warranted. <h3>Author(s) Disclosures</h3> No conflicts of interest reported.

Baseline measure of activities of daily living (ADL) using Katz index of ADL on participants those who were recruited to a RCT form a tertiary care hospital in Sri Lanka

Official journal of the Postgraduate Institute of Medicine, University of Colombo, Sri Lanka.Interested in submitting to this journal? We recommend that you review the About the Journal page for the journal's section policies, as well as the Author Guidelines. Authors need to register with the journal prior to submitting or, if already registered, can simply log in and begin the five-step process.

Behavioural and psychological symptoms of dementia in patients with Alzheimer\u2019s disease and family caregiver burden: a path analysis

BackgroundStudies reported the relationship between behavioural and psychological symptoms of dementia (BPSD), cognitive function, caregiver burden, and therapeutic effects. However, the causal relationship between BPSD in community-dwelling patients with Alzheimer’s disease (AD) and caregiver burden is yet to be established. This study aimed to classify BPSD in patients with AD and identify the relationship between BPSD and the factors affecting family caregiver burden.MethodsPath analysis was conducted at a neurology outpatient clinic of a tertiary general hospital in South Korea. The medical records of 170 patients, aged ≥50 years, diagnosed with or suspected for AD were retrospectively reviewed. We investigated cognitive function (Korean version of the Mini-Mental-State Exam), dementia stages (Korean version of the Expanded Clinical Dementia Rating scale), depression (Short-form Geriatric Depression Scale-Korea), activities of daily living (ADL; Korean version of the Barthel Activities of Daily Living index), instrumental activities of daily living (IADL; Seoul-Instrumental Activities of Daily Living), and BPSD and caregiver burden (Korean Neuropsychiatric Inventory). Considering the characteristic features of BPSD with various symptoms, BPSD was classified using factor analysis. Factor extraction was performed using principal component analysis, followed by Varimax factor rotation.ResultsMean total BPSD score was 17.66 ± 20.67, and the mean score for family caregiver burden was 9.65 ± 11.12. Symptom cluster-1 (hyperactivity symptoms) included disinhibition, irritability, and agitation/aggression. Symptom cluster-2 (psychosis symptoms) included hallucinations, anxiety, elation/euphoria, delusions, and depression/dysphoria. Symptom cluster-3 (physical behaviour symptoms) included appetite and eating abnormalities, apathy/indifference, aberrant motor behaviour, sleep, and night-time behaviour disturbances. Dementia stages, ADL, and IADL had indirect effects on family caregiver burden through hyperactivity, psychosis, and physical behaviour symptoms, indicating that BPSD exerted a complete mediating effect.ConclusionsUnlike previous studies, we classified BPSD symptoms into similar symptom clusters to evaluate its effect on caregiver burden, rather than collectively investigating the 12 symptoms of BPSD. As the dementia stage worsens, symptom clusters in BPSD serve as a medium between ADL and IADL degradation and for the increase in caregivers’ burden. The development and implementation of therapeutic, nursing interventions, and policies focusing on dementia stages, ADL, and IADL, delaying and preventing BPSD can alleviate family caregivers’ burden.

41224 REDUCED FRONTOSTRIATAL FUNCTIONAL CONNECTIVITY IN 41- TO 70-YEAR-OLD ADULTS WITH HIV

ABSTRACT IMPACT: The knowledge acquired from my research can inform the development of early diagnostic methods for HIV-associated neurocognitive disorders. OBJECTIVES/GOALS: In the era of combination antiretroviral therapy (cART), the prevalence of HIV-associated neurocognitive disorders (HAND) remains high but the neural mechanisms are unclear. We examined whether older people with HIV (PWH) with minimal cognitive impairment have reduced functional connectivity in frontostriatal circuits compared to controls. METHODS/STUDY POPULATION: 99 PWH (mean age 56.6 years, 75% male, 62% Black, mean duration of HIV-infection 26.2 years ±9.3, 90% viral load &lt;50 copies, 98% on stable cART) and 38 demographically-comparable controls (mean age 54.5 years, 71% male, 58% Black) participated in a cross-sectional study. A 7-domain neuropsychological battery and an Activities of Daily Living index were used to determine HAND diagnoses: 32 PWH met criteria for asymptomatic to mild HAND. Motor skill was assessed using the Grooved Pegboard Test by measuring performance speed. Structural MRI and resting-state functional MRI were collected. Seed-to-voxel analyses were conducted using 4 distinct regions in the striatum as seed regions. We used a voxel threshold of p&lt;0.001 and cluster threshold of p&lt;0.05 (FDR-corrected) after controlling for demographic variables. RESULTS/ANTICIPATED RESULTS: Compared to controls, PWH had lower resting state functional connectivity between the default mode region of the striatum (i.e., medial caudate) and bilateral superior frontal gyrus, supplementary motor cortex and paracingulate gyrus (p&lt;0.05; cluster size: 567 voxels). Also, compared to controls, PWH had reduced resting state functional connectivity between the motor division of the striatum (i.e., posterior putamen) and anterior cingulate cortex and left supplementary motor cortex (p&lt;0.05, cluster size: 405 voxels). Performance speed on the Grooved Pegboard motor test negatively correlated with functional connectivity between the motor region of the striatum and supplementary motor frontal regions in all participants (Spearman’s rho=-0.18, p=0.04). DISCUSSION/SIGNIFICANCE OF FINDINGS: Our results support the hypothesis that frontostriatal abnormalities are widely present in PWH and might play a key role in HAND development. Our data suggest that dysfunction within the frontostriatal circuits may be involved in motor impairment in PWH, and ongoing inflammation may contribute to motor impairment and frontostriatal injury.

Impact of cardiac surgery-associated acute kidney injury on activities of daily living at discharge in elderly cardiac surgery patients.

Cardiac surgery-associated acute kidney injury (CSA-AKI) is a critical complication associated with mortality and morbidity. This study aimed to clarify the impact of CSA-AKI on activities of daily living (ADL) at discharge in elderly cardiac surgery patients. We included 122 cardiac patients who underwent coronary artery bypass surgery, valve surgery, or combined surgery by mid-line incision followed by postoperative cardiac rehabilitation (CR) from March 2015 to May 2020. CSA-AKI was based on KDIGO criteria. The index of ADL was the Functional Independence Measure (FIM). We compared background factors, clinical parameters, activity level before hospitalization, CR progress, and FIM in patients with or without CSA-AKI. Multiple regression analysis was performed with FIM at discharge as the dependent variable and items with p < 0.01 in bivariate correlation as independent variables. Ultimately, 122 patients were divided into the non-CSA-AKI group (n = 84) and CSA-AKI group (n = 38). CR progression in the CSA-AKI group was significantly slower and FIM was lower than that in the non-CSA-AKI group. Moreover, even after adjustment for confounding factors, CSA-AKI (β = -0.18), start day of walking (β = -0.34), postoperative atrial fibrillation (β = -0.15), and activity level before hospitalization (β = -0.37) were predictive factors of ADL decline at discharge (adjusted R2 = 0.52). CSA-AKI of elderly cardiac surgery patients was a predictive factor of ADL decline at discharge.

Development of occupational therapy activities of daily living index to assess basic activities of daily living in an Indian context: A prospective quantitative study

Background: Activities of daily living (ADL) deficit is a common and significant problem after any condition. Many scales are more focused on assessing the patients' independence or dependence but are less understood on the different parameters such as importance and values of activity, satisfaction, ability to cope up, completion, and time taken for the activity. These parameters are not well defined in many ADL assessments. Objectives: The purpose of this index was to evaluate ADL not only based on independence but also to understand the patients' values, adequacy, safety, standard, and finally, acceptability. Study Design: A prospective quantitative study was conducted. Methods: We conducted prospective, quantitative study and developed a new scale. Items were generated from a review of literature, semi-structured interviews of adult as well as geriatric patients and discussions with experts were carried out. The new instrument was piloted among 290 patients with neurological and orthopedic conditions. Content validity, internal consistency, and test-retest reliability were evaluated. Results: The new scale has good internal consistency: Cronbach's alpha = 0.984 and KR20 value = 0.97. Test–retest reliability (intra-class correlation coefficient = 0.87) was found to be good. Conclusion: Our research analysis indicates that Occupational Therapy (OT) ADL index is reliable for rating the Basic ADL skills for functional deficits in neurological and orthopedic conditions in adults. The OT ADL index may facilitate an objective assessment in the OT domains of basic ADL.

A comparative study of MAKO robotic arm assisted total hip arthroplasty and traditional total hip arthroplasty through posterolateral approach

To investigate the efficacy of total hip arthroplasty (THA) assisted by the MAKO robotic arm via posterolateral approach. The clinical data of 70 patients treated with THA via posterolateral approach between March 2017 and March 2019 who met the selection criteria were retrospectively analyzed. According to different treatment methods, the patients were divided into two groups, 35 were treated with MAKO robotic arm assisted THA (MAKO group) and 35 with traditional THA (THA group). There was no significant difference in gender, age, body mass index, disease duration, etiology, perioperative time, preoperative activity of daily living (ADL) scale index, American Society of Anesthesiologists (ASA) classification, walking ability, comorbidities, hemoglobin, and other general data between the two groups ( P>0.05). The operation time, intraoperative blood loss, hospital stay, postoperative acetabular abduction and anteversion angles, postoperative length difference of bilateral lower limbs, and proportions of intraoperative blood transfusion, immediate postoperative loading, wound drainage time more than 2 days, and complications were recorded and compared between the two groups. According to the X-ray films at 6 months after operation, the reduction quality was judged. The forgotten joint score, Harris score, and proportions of independent walking and ADL index increased were used to evaluate the function recovery of patients. Patients in both groups were followed up 6-18 months, with an average of 8 months. There was no significant difference ( P>0.05) between the two groups in operation time, intraoperative blood loss, hospital stay, acetabular abduction and anteversion angles, and length difference of both lower limbs at 6 months after operation. There was no significant difference in the proportions of intraoperative blood transfusion, immediate postoperative loading, and wound drainage time more than 2 days between the two group ( P>0.05). X-ray reexamination at 6 months after operation showed that there was no significant difference in the reduction quality between the two groups ( Z=4.191, P=0.123). Postoperative complications occurred in 7 patients (20.0%) in the MAKO group and 10 patients (28.6%) in the THA group, showing no significant difference in the incidence of complications between the two groups ( χ 2=2.121, P=0.224). Two patients (5.7%) in the MAKO group and 4 patients (11.4%) in the THA group underwent revision within 6 months, showing no significant difference in the revision rate between the two groups ( χ 2=0.729, P=0.673). At 3 and 6 months after operation, the proportions of independent walking and ADL index increased showed no significant difference between the two groups ( P>0.05). Harris scores in both groups improved significantly when compared with preoperative scores ( P<0.05); there was no significant difference in the forgotten joint scores and Harris scores between the two groups ( P>0.05). Compared with traditional THA, MAKO robotic arm assisted THA has longer operation time and more intraoperative blood loss, but it has the advantages of accurate positioning and simple operation, and there is no significant difference in short-term postoperative function recovery.

Functional Decline Among Frail Patients After Vascular Surgery

Frailty is a clinical syndrome that has been associated with slow recovery and loss of independence after vascular surgery. However, the degree of functional impairment that frail patients experience after surgery is unclear. The objective of this study was to prospectively measure changes in functional status among frail patients undergoing both minor and major vascular procedures. We prospectively identified a sample of patients who had consented to undergo elective vascular surgery procedures at an academic medical center between May 2018 and March 2019. Before surgery, all patients underwent a provider assessment of frailty using the Clinical Frailty Scale as well as patient-reported functional status using the Lawton instrumental activities of daily living (iADLs) scale and the Katz activities of daily living (ADLs) index. After surgery, these same assessments were used to evaluate each patient’s functional status at 2-week and 1-month follow-up time points. Changes in iADL and ADL indices among frail and nonfrail patients were compared using paired t-tests and multivariate regression models. A total of 139 patients were assessed before and after minor (55%) and major (45%) surgical procedures; 35% of patients (48) were considered frail before surgery using the validated Clinical Frailty Scale. On average, frail patients were older (65 years frail vs 58 years nonfrail; P < .05) and more likely to have multiple medical comorbidities including chronic kidney disease, chronic obstructive pulmonary disease, and diabetes (P < .05). After surgery, frail patients were more likely to have complications (29.2% vs 14.4% nonfrail; P < .05) and experienced longer hospital stays (7.1 days vs 2.4 days; P < .001). Compared with nonfrail patients, frail patients had significantly lower functional status (iADL and ADL) scores at baseline before surgery and experienced a greater decline in ability to independently complete iADLs and ADLs at 2 weeks and 1 month after surgery (Fig 1 and Fig 2, respectively). In logistic regression models, frailty was associated with an increased likelihood of decline in iADLs (odds ratio, 5.7; 95% confidence interval, 2.1-15.6; P < .01) and ADLs (odds ratio, 8.2; 95% confidence interval, 1.9-35.1; P < .01) at 1 month after surgery after controlling for procedure type and medical comorbidities. Frail patients experience a significant decline in ability to perform ADLs and iADLs that persists at 1 month after surgery. These data highlight the importance of counseling frail patients and their caregivers about functional impairment that occurs after vascular surgery and employing strategies to help mitigate loss of independence.Fig 2Katz ADL function.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Early prognosis of stroke outcome by means of Katz Index of activities of daily living

The predictive validity of Katz' Index of ADL (Activities of Daily Living) regarding length of hospital stay, discharge to own home or death within one month, and its reproducibility in clinical practice was studied prospectively in S?dert?lje and in Enk?ping, Sweden. The S?dert?lje study included 124 consecutive patients, who were all assessed on days 5-7 after stroke by an occupational therapist. The Enk?ping study included 106 consecutive patients, who were assessed similarly by trained nurses. Ninety-six and 94%, respectively, of patients in grades A-C on days 5-7 after stroke were discharged to their own homes within one month. Ninety-six and 92%, respectively, of patients in grades D-G stayed in hospital longer than one month or died. Sixty-two and 68%, respectively, of patients in grade G died within one month. The instrument is now used as a valid tool for early prognosis of stroke outcome in order to facilitate the planning of care and rehabilitation in clinical practice

Effect of Danhong injection combined with edaravone in the treatment of patients with acute cerebral infarction and its influence on cytokines, cerebral hemodynamics and vascular endothelial function

Objective To investigate the effect of Danhong injection combined with edaravone in the treatment of patients with acute cerebral infarction, and its influence on cytokines, cerebral hemodynamics and vascular endothelial function. Methods From March 2018 to March 2019, 142 patients with acute cerebral infarction treated in the People's Hospital of Yuhuan were randomly divided into treatment group and control group according to the digital table, with 71 cases in each group.The treatment group was treated with Danhong injection combined with edaravone, while the control group was only treated with edaravone.Both two groups were treated for 2 weeks.The therapeutic effects, changes of cytokines, cerebral hemodynamics, vascular endothelial function, activity of daily living index(Barthel index) and neurological deficit score(NIHSS score) before and after treatment were compared between the two groups. Results The total effective rate of the treatment group was 90.14%(64/71), which was higher than 74.65%(53/71) of the control group, the difference was statistically significant(χ2=5.874, P<0.05). After treatment, the serum levels of CRP[(5.43±1.20)mg/L] and IL-6[(32.15±7.39)ng/L] in the treatment group were lower than those in the control group[(9.38±1.74)mg/L and (67.43±10.29)ng/L](t=15.747, 23.465, all P<0.05). After treatment, the Vp[(69.83±3.24)v·-1·s-1] and Vm[(35.24±2.10)v·-1·s-1] in the treatment group were higher than those in the control group[(63.81±2.68)v·-1·s-1 and (32.18±1.73)v·-1·s-1], while the PI in the treatment group[(0.72±0.04)] was lower than that in the control group[(0.83±0.07)], the differences were statistically significant(t=12.064, 9.477, 11.497, all P<0.05). After treatment, the serum level of ET-1[(60.17±5.46)mg/L] in the treatment group was lower than that in the control group[(73.21±6.78)mg/L], while the NO level in the treatment group[(72.15±7.39)ng/L] was higher than that in the control group[(61.43±10.29)ng/L], the differences were statistically significant(t=12.622, 7.130, all P<0.05). After treatment, the Barthel index score of the treatment group[(68.93±7.83)points] was higher than that of the control group[(54.57±7.38)points], while the NIHSS score of the treatment group[(9.34±1.97)points] was lower than that of the control group[(14.54±2.89)points], the differences were statistically significant(t=11.246, 12.528, all P<0.05). Conclusion Danhong injection combined with edaravone in the treatment of acute cerebral infarction is effective, which can alleviate inflammation and improve cerebral hemodynamics and vascular endothelial dysfunction. Key words: Infarction, middle cerebral artery; Cytokines; Hemodynamics; Endothelium, vascular; Quality of life; Danhong needle; Edaravone

Effects of Geriatric Interdisciplinary Home Rehabilitation on Independence in Activities of Daily Living in Older People With Hip Fracture: A Randomized Controlled Trial

ObjectiveTo evaluate the effects of early discharge followed by geriatric interdisciplinary home rehabilitation for older people with hip fracture on independence in activities of daily living (ADL) compared with inhospital geriatric care according to a multifactorial rehabilitation program. DesignPlanned analysis of a randomized controlled trial with 3- and 12-month follow-ups. SettingGeriatric ward, ordinary housing, and residential care facilities. ParticipantsOf 466 people screened for eligibility, participants (N=205) with acute hip fracture, aged 70 years or older, including those with cognitive impairment and those living in residential care facilities, were randomized to intervention or control groups. InterventionIndividually designed interdisciplinary home rehabilitation for a maximum of 10 weeks. The intervention aimed at early hospital discharge and focused on prevention of falls, independence in daily activities, and walking ability indoors and outdoors. Main Outcome MeasuresIndependence in ADL was measured using the Barthel ADL Index, and the ADL Staircase including the Katz ADL Index during hospital stay (prefracture performance) and at the follow-up visits in the participants’ homes. ResultsThere were no significant differences in ADL performance between the groups, and they recovered their prefracture level of independence in personal and instrumental ADL comparably. At 12 months, 33 (41.3%) in the intervention group vs 33 (41.8%) in the control group (P=.99) had regained or improved their prefracture ADL performance according to the Barthel ADL Index, and 27 (37.0%) vs 36 (48.6%) according to the ADL Staircase (P=.207). ConclusionsIn older people with hip fracture, early discharge followed by geriatric interdisciplinary home rehabilitation resulted in a comparable recovery of independence in ADL at 3 and 12 months as inhospital geriatric care and rehabilitation.

Disability and quality of life in individuals with muscular dystrophy

In the county of Orebro, Sweden, 32 individuals with myotonic disorders and 25 with other types of muscular dystrophy were examined. Disability was assessed with functional tests and standardized observations of muscle function (mainly based on those proposed by Dr. Brooke), a new self-administered questionnaire regarding the Activities of Daily Living (ADL) and the ADL staircase (based on Katz ADL index). The results of the different tests of disability were highly correlated. The Sickness Impact Profile and the Kaasa test were used for assessing the quality of life, and no significant differences were found between the groups of muscular dystrophy. In an explanatory factor analysis three main factors of disability were found. The factors walk and move" and "finger function" were fair to good associated with the quality of life. This study offers an approach for research on the consequences of muscular dystrophy using established as well as new methods."

A study on disability in terms of activities of daily living among elderly in Palam village of west Delhi

Background: Aging, an integral part of living, typically is accompanied by gradual but progressive physiological changes and an increased prevalence of acute and chronic illness. Although neither a disease nor disability per se, aging nonetheless is associated with a high incidence of physical impairment as well.The objective of the present study was to assess the prevalence of activities of daily living (ADL) disability in elderly living in Palam village of Delhi.Methods: A community based cross-sectional study was carried out to assess the prevalence of ADL disability in elderly living in Palam village of Delhi using Barthel ADL index. It uses ten variables describing ADL and mobility. The sample size was estimated to be 350 and systematic random sampling was used to choose the study subjects.Results: The prevalence of ADL disability was found to be 20.3% in the study population. This was found to be 16.3% in males and 23.9% in females.Conclusions: After obtaining adequate data on elderly having difficulty in performing their routine activities of daily living, appropriate steps needs to be taken to mitigate its ill effects which should also address their health care needs and help them to live a healthy and good quality life.