Barthel Index Values Research Articles

Investigation of the effect of task-oriented occupational therapy on daily living activity performance in chronic stroke patients.

Task-oriented therapy (TOT) is used to increase the effectiveness of upper extremity (UE) in activity daily living (ADL). This study aimed to investigate the effect of TOT on the participation and ADLs of stroke patients. Between October 2018 and February 2019, 28 chronic stroke patients were included in the study treated in Kocaeli University Hospital, Department of Physical Medicine and Rehabilitation, Turkey. The performance areas and participation status of the patients in which they experienced limitations were evaluated with the Canadian Occupational Performance Scale (COPM), and their level of independence in ADLs was evaluated with the Modified Frenchay Activity Index (mFAI) and Barthel Index (BI). All patients were included in the occupational therapy (OT) program five days a week for three weeks at Kocaeli University Hospital. Three ADLs in which they had difficulties were studied with 28 patients. Each of the activities was designed specifically for the patient. All assessments were repeated after three weeks of treatment. A total of 28 patients, 12 females and 16 males, diagnosed with stroke, were included in the study. A statistically significant increase was found in the COPM performance and satisfaction value compared to the pre-treatment value (p<0.001). A statistically significant difference was found between pre- and post-treatment mFAI and BI values (p<0.001). Adding task-oriented therapy to the rehabilitation programs of stroke patients will contribute to the improvement of ADL.

CHRONIC ALCOHOL-INDUCED ENCEPHALOPATHY: PREDICTORS OF COGNITIVE IMPAIRMENT AND FUNCTIONAL DISABILITY

Introduction: Predicting the risk of cognitive dysfunction and disability in everyday life among chronic alcohol-induced encephalopathy (CAIE) patients allows timely treatment to prevent dementia.&#x0D; The aim: to develop a mathematical model for predicting the risk of developing cognitive disorders and functional disability in patients with CAIE based on the analysis of polymorphic variants of the genes ACE, AT2R1, eNOS, PON1, IL-1β, IL-10, TNF-α, as well as cofactors (gender, age group, the disease duration, and presence/absence of somatic comorbidity).&#x0D; Materials and methods: We examined the 102 patients with CAIE who were undergoing inpatient treatment in the communal non-profit enterprise «Ternopil Regional Clinical Psychoneurological Hospital» during 2021-2022 and were included in the retrospective analysis. The molecular-genetic testing was performed for 26 patients of the general group. The molecular-genetic differentiation of the studied polymorphic variants of genes was carried out in the molecular-genetic laboratory of the state institution «Reference Centre for Molecular Diagnostics of the Ministry of Health of Ukraine», Kyiv. Cognitive functions were assessed using the Montreal Cognitive Test (MoCA); activities of daily living were assessed using the Barthel index. A logistic regression analysis was performed to determine the risk of cognitive impairment and functional disability developing in patients with CAIE.&#x0D; Results: Analyzing polymorphic variants of the ACE, AT2R1, eNOS, PON1, IL-1β, IL-10, TNF-α genes, as well as such cofactors as gender, age group, history and presence/absence of somatic comorbidity in the context of the development of cognitive disorders in patients with CAIE it has been established that the C108T polymorphism of the PON1 gene has the most significant prognostic value (in the presence of the T/T genotype, the probability of cognitive impairment is 39.84 %). At the same time, carriage of both the T allele and the C allele of the PON1 gene is associated with a significant decrease in the MoCA score. Regarding the development of functional disability in patients with CAIE, the C108T polymorphism of the PON1 gene also has the most significant prognostic value (in the presence of the T/T genotype, the probability of functional disability is 48.08 %, respectively, C/C – 30.96 % and CT – 39.22 %, however, no statistically significant differences in the Barthel index values were found in carriers of the above genotypes).&#x0D; Conclusions: It was established that the C108T polymorphism of the PON1 gene is significantly associated with the development of cognitive impairment and functional disability in patients with CAIE, which indicates the feasibility of further studies involving a larger sample of patients.

Effect of sleep-disordered breathing on recovery in patients with “wake-up” stroke

Background. Wake-up stroke (WUS) is often combined with sleep-disordered breathing and may potentially have a more unfavorable course.Objective — to evaluate the association between the time of stroke onset and the pattern of sleep-disordered breathing, as well as the effect of wake-up stroke on stroke recovery and stroke severity in patients with ischemic stroke.Design and methods. We included patients 18–85 years old with acute ischemic stroke admitted within 24 hours of symptom onset to the neurological resuscitation unit, and performed polygraphy within the first day of hospitalization to assess the parameters and severity of sleep-disordered breathing. In 2018–2023, 2122 patients were screened, polygraphy was performed in 639 patients, and data from 292 patients were included in the final analysis. Stroke severity was assessed using the NIHSS scale, stroke type was determined using the TOAST classification. WUS was considered when symptoms were detected upon awakening. Functional status was assessed by the Barthel index, and rehabilitation outcomes by the modified Rankin scale. The cumulative end point included death from any cause, new nonfatal myocardial infarction, new nonfatal stroke/transient ischemic attack, emergency revascularization, or emergency hospitalization due to exacerbation of cardiovascular disease.Results. WUS was detected in 101 patients (34,6 %). The WUS group had more frequent diabetes mellitus and higher NIHSS (p = 0,021) and Barthel index (p = 0,026) at discharge, less frequent thrombolytic therapy and emergency endovascular procedures (p = 0,007) which in most cases was associated with hospitalization in time beyond the therapeutic window (p &lt; 0,001). Endpoints were reached in 21,6 % with a median follow-up of 209 days. No significant differences were found in the main indices of sleep-disordered breathing in groups of different severity and pathogenetic type of stroke. The most significant factors related to Barthel index were stroke severity at discharge (p &lt; 0,001) and age (p &lt; 0,001). Stroke severity at discharge was most influenced by thrombolytic therapy (p = 0,006) and stroke severity on admission (p &lt; 0,001).Conclusions. Our study did not show the previously described higher incidence of sleep-disordered breathing in WUS. The best outcomes were in subjects who received reperfusion therapy. Patients with WUS should be hospitalized in a hospital where reperfusion therapy is available. Lower Barthel index values at discharge of patients with WUS may characterize their lower rehabilitation potential.

Comprehensive Geriatric Care in Older Adults: Walking Ability after an Acute Fracture

Background/Objectives: Comprehensive Geriatric Care (CGC) is a specific multimodal treatment for older patients. In the current study, we aimed to investigate walking performance after CGC in medically ill patients versus those with fractures. Methods: The timed up and go test (TuG), a 5-grade scale assessment (1 = no walking impairment to 5 = no walking ability at all) for evaluating individual walking ability was performed in all patients who underwent CGC prior to and after treatment. Factors associated with improvement in walking ability were analyzed in the subgroup of patients with fractures. Results: Out of 1263 hospitalized patients, 1099 underwent CGC (median age: 83.1 years (IQR 79.0–87.8 years); 64.1% were female). Patients with fractures (n = 300) were older than those without (n = 799), (median 85.6 versus 82.4 years, p = 0.001). Improvement in TuG after CGC was found in 54.2% of the fracture patients compared to just 45.9% of those without fractures. In fracture group patients, TuG improved from median 5 on admission to median 3 on discharge (p = 0.001). In fracture patients, improvement in walking ability was associated with higher Barthel index values on admission (median 45 (IQR: 35–55) versus 35 (IQR: 20–50): p = 0.001) and Tinetti assessment scores (median 9 (IQR: 4–14.25) versus 5 (IQR: 0–13); p = 0.001) and was negatively associated with the diagnosis of dementia (21.4% versus 31.5%; p = 0.058). Conclusion: CGC improved walking ability in more than half of all patients examined. Older patients in particular might benefit from undergoing the procedure after an acute fracture. A better initial functional status favors a positive result following the treatment.

The association of osteoporosis and geriatric syndromes in the elderly: data from the Russian epidemiological study EVKALIPT

SummaryOsteoporosis is associated with almost all geriatric syndromes (GSs), and the occurrence of osteoporosis in patients over 65 years of age increases by 1.2–2.5 times. Early diagnosis of osteoporosis and GSs is very important. Additional programs should be adopted by the state to introduce information about the possibilities of working with elderly patients.PurposeTo analyze associations of osteoporosis with geriatric syndromes in patients aged 65 years and older in the Russian Federation.MethodsA total of 4308 patients (30% men) aged 65–107 years were examined and distributed into 3 age groups (65–74 years, 75–84 years, and 85 years and older). All patients underwent a comprehensive geriatric assessment. In the “Falls and risk of falls” module, the number and circumstances of falls over the previous year were analyzed, as well as the history of fractures. The presence of osteoporosis was determined based on medical records. Physical examination included anthropometric measurements and standard enquiry, short physical performance battery (SPPB), dynamometry, measurement of gait velocity, Mini-Cog test, and orthostatic test.ResultsA total of 507 patients (11.8%) had evidence of osteoporosis; indications of low-energy fractures in history were recorded in 739 (17.3%) patients. Patients with osteoporosis were older, shorter, and predominantly women; had a lower body weight and a higher Charlson comorbidity index; and took more drugs. Patients with osteoporosis had lower gait velocity, hand grip strength, Barthel index value, and scores of the Lawton instrumental activities of daily living scale, the MNA (Mini Nutritional Assessment) short-form, and the SPPB. Osteoporosis is associated with almost all geriatric syndromes (GSs), and the occurrence of osteoporosis in patients over 65 years of age increases by 1.2–2.5 times.ConclusionsOsteoporosis is associated with almost all GSs. The association of osteoporosis with advanced GSs aggravates the condition of these patients. Early diagnosis of osteoporosis and GSs is very important. Additional programs should be adopted by the state to introduce information about the possibilities of working with elderly patients: early detection and correction of osteoporosis.

Analysis of Relationship among Bmi and Activity of Daily Living in Homecare Individuals

Objective: Obesity has been linked to a variety of chronic diseases. Numerous researchers have discovered that having a high BMI is connected with substantial morbidity and mortality in the aged. As a result, obesity or being overweight may have a negative effect on everyday life. The main aim of our current research remained to look at association among BMI and Action of Everyday Living in Homecare Individuals.&#x0D; Methods: The data for 2019 from Allied Hospital Faisalabad's homecare unit. During this time, 1125 students come to this clinic. Subjects who were unconscious or bedridden (hemiplegia, hemiparesis, and tetra paresis), as well as those with insufficient information, were eliminated from the research. As a result, the study was finished with 260 files including all of information required for our research. Age, ethnicity, BMI, and Barthel Index values have been entered into the statistical analysis software; p0.06 was deemed statistically substantial.&#x0D; Results: One hundred fifty-one (61.5%) comprised females, while 97 (38.7%) were males. Age and sex, weight, and Disease activity index scores had no strong correlations. Weight and Barthel index scores had a strong positive connection, as did BMI and Barthel index scores (r = 0.196; p = 0.004). The cases remained separated into two sets: Unit I (low weight for height and normal weight) in addition Class Ii (obese and obese) (overweight and obese). Group II had significantly greater capacity to execute Activities of Daily Living than Group I (p = 0.003).&#x0D; Conclusion: Many researches claim that overweightness protects in contradiction of activities of everyday living, whereas others claim reverse. Quality and outcomes of BMI and Activity of Daily Living abilities were found in our study, indicating protective benefits. The association among BMI and physical impairment has yet to be shown as linear.

The effect of telerehabilitation on early outcomes in patients undergoing primary total knee replacement: A prospective randomized study

Background/Aim: The continuity of rehabilitation is a problem after arthroplasty operations. There is a need for accessible rehabilitation programs for patients. The purpose of this study is to determine the difference in knee functions and patients' quality of life between patients doing home telerehabilitation and home rehabilitation after total knee arthroplasty (TKA). Methods: This prospective study was conducted on 90 patients, between June 2019 and January 2021. Patients are divided into three groups. Patients in group 1 are told to continue with the daily routine exercises which began in hospital. Group 2 patients got an information message to their mobile phones every day for the first month, reminding them of their postoperative exercises, whereas patients in group 3 are called by mobile phone for the same reminding. All patients participating in the study were evaluated by completing the Universities of Western Ontario and McMaster Osteoarthritis Index (WOMAC) scores, the Knee Society Clinical Evaluation System (KSS), the Barthel Index (BI) and the Quality of Life Scale Short Form 36 (SF-36) preoperatively and in the first and third months postoperatively, and the differences between the groups based on these scores were evaluated. Results: There was a statistically significant difference in WOMAC between the groups regarding first-month and third-month postoperatively (P=0.004 and P<0.001, respectively), as well as in KSS values between the same groups (P=0.048 and P=0.036, respectively). There was no statistically significant difference between the groups regarding postoperative first-month BI (P=0.826) and SF-36 values (P=0.264). There was a statistically significant difference between the groups regarding postoperative third-month BI and SF-36 values (P=0.035 and P<0.001, respectively). Conclusion: The telerehabilitation therapy appears to be more effective and successful than the control group, as shown by improvements in overall physical functions.

Rehabilitation Characteristics of Acute-stage COVID-19 Survivors Managed with Extracorporeal Membrane Oxygenation in the Intensive Care Unit.

ABSTRACTObjectives:This study aimed to describe the rehabilitation characteristics of patients with acute stage coronavirus disease managed with extracorporeal membrane oxygenation (ECMO) in the intensive care unit.Methods:This retrospective study enrolled coronavirus disease patients who underwent rehabilitation following ECMO between April 21, 2020, and August 20, 2021. The following patient data were evaluated: age, sex, weaning, peak C-reactive protein, lowest albumin level, white blood cell count, use of steroids and muscle relaxants, duration of respiratory management, ECMO management and rehabilitation, Medical Research Council (MRC) score, and Barthel index after sedation and at discharge.Results:ECMO was performed in 20 patients, and 16 were weaned successfully. The median durations of ECMO and respiratory management in survivors were 14.5 and 38 days, respectively. The median MRC scores after sedation and after rehabilitation therapy were 18 and 45, respectively. The median rehabilitation duration after sedation was 14 days. The MRC score after sedation showed significant correlations with the durations of ECMO and intubation. The median Barthel index values after sedation and at discharge were 0 and 30, respectively.Conclusions:Rehabilitation was important for patients with severe coronavirus disease because muscle weakness advanced in proportion with the durations of ECMO and ventilation management in the intensive care unit.

The Impact of Isolation on Elderly Patients with Mild to Moderate COVID-19.

ABSTRACTObjectives:Patients with mild to moderate COVID-19 who require hospitalization are prone to physical inactivity. This study examined the impact of mild to moderate COVID-19 on the activities of daily living (ADLs) of patients who received rehabilitation therapy.Methods:Between February 1, 2020, and January 31, 2021, of 216 patients with mild to moderate COVID-19, 36 were selected for rehabilitation therapy. Of these, 28 received direct rehabilitation therapy, whereas 7 were discharged before rehabilitation therapy could start and 1 carried out indirect rehabilitation. The Barthel Index (BI) scores at the beginning and the end of therapy were compared in 18 patients (10 patients who did not undergo a final BI evaluation were excluded).Results:In total, 27 of the 28 patients receiving direct rehabilitation therapy were more than 65 years of age or had underlying diseases. The BI score decreased in 6 patients and was maintained or improved in 12 patients. However, the 6 patients with decreased BI scores after rehabilitation therapy had significantly higher BI values at the start of therapy (P=0.014).Conclusions:It was considered that the isolated environment of these COVID-19 patients likely resulted in a decrease in activity levels, leading to a decrease in ADLs. Older adults with mild to moderate COVID-19 need to reduce their isolation as much as possible to ensure adequate activity levels.

Clinical Outcomes of MLC601 (NeuroAiDTM) in Traumatic Brain Injury: A Pilot Study.

Background: MLC601 is a natural product formulation from Chinese medicine that is extensively studied in ischemic stroke. Traumatic brain injury (TBI) shares pathophysiological mechanisms with ischemic stroke, yet there are few studies on the use of MLC601 in treating TBI. This Indonesian pilot study aimed to investigate clinical outcomes of MLC601 for TBI. Methods: This randomized controlled trial included subjects with nonsurgical moderate TBI allocated into two groups: with and without MLC601 over three months in addition to standard TBI treatment. Clinical outcomes were measured by the Glasgow Outcome Scale (GOS) and Barthel Index (BI) observed upon discharge and at months (M) 3 and 6. Results: Thirty-two subjects were included. The MLC601 group (n = 16) had higher GOS than the control group (n = 16) at all observation timepoints, though these differences were not statistically significant (p = 0.151). The BI values indicated a significant improvement for the MLC601 group compared to the control group at M3 (47.5 vs. 35.0; p = 0.014) and at M6 (67.5 vs. 57.5; p = 0.055). No adverse effects were associated with MLC601 treatment. Conclusion: In this cohort of nonsurgical moderate TBI subjects, MLC601 showed potential for a positive effect on clinical outcome with no adverse effects.

Relationships of Sex Hormone Levels with Activity of Daily Living in Chinese Female Centenarians.

Activity of daily living declines in female elderly, which not only increases hospitalization and mortality rates, but also aggravates individual and societal burden. Large samples are needed to elucidate the relationships of plasma sex hormone levels with activity of daily living in Chinese female centenarians to better understand the effects of hormone-replacing therapy. As the first time in the world, the current study was designed to investigate the relationships of plasma sex hormone levels with activity of daily living in Chinese female centenarians. China Hainan Centenarian Cohort Study was carried out in 18 cities and counties of Hainan Province. Home interview, physical examination and blood analysis were carried out in 583 female centenarians following standard procedures. Barthel Index was used to assess the activity of daily living. Median age of all female centenarians was 102 years, with the range from 100 to 115 years. Median values of Barthel Index were 85(60-90). In multivariate linear regression analyses, Barthel Index values were inversely associated with plasma luteinizing hormone (LH), follicle-simulating hormone (FSH), testosterone, progesterone and estradiol levels (P<0.05 for all). Plasma sex hormone levels, including LH, FSH, testosterone, progesterone and estradiol, had significant relationships with activity of daily living in Chinese female centenarians.

Morphogenetic Variability as Potential Biomarker of Functional Outcome After Ischemic Stroke.

The aim of our study was to evaluate the role of morphogenetic variability in functional outcome of patients with ischemic stroke. The prospective study included 140 patients with acute ischemic stroke, all of whom were tested upon: admission; discharge; one month post-discharge; and three months post-discharge. The age was analyzed, as well. The Functional Independence Measure (FIM) test and the Barthel Index (BI) were used for the evaluation of functional outcomes for the eligible participants. We analyzed the presence of 19 homozygous recessive characteristics (HRC) in the studied individuals. There was a significant change in FIM values at discharge (p = 0.033) and in BI values upon admission (p = 0.012) with regards to the presence of different HRCs. Age significantly negatively correlated for the FIM score and BI values at discharge for the group with 5 HRCs (p < 0.05), while for BI only, negative significant correlation was noticed for the group with 5 HRCs at three months post-discharge (p < 0.05), and for the group with 3 HRCs at one month post-discharge (p < 0.05) and three months post-discharge (p < 0.05). Morphogenetic variability might be one among potentially numerous factors that could have an impact on the response to defined treatment protocols for neurologically-impaired individuals who suffered an ischemic stroke.

The use of Barthel index for the assessment of the functional recovery after osteoporotic hip fracture: One year follow-up.

The Barthel index evolution was analyzed in a sample of older people with osteoporotic hip fracture in order to verify the influence of comorbidities and cognitive impairment on the physical recovery of those patients, during the first year following the fracture. A prospective observational study was carried out between October 1, 2012 and March 31, 2013. A sample of 247 individuals was initially selected. After a primary revision, 39 participants were excluded (clearly not meeting inclusion criteria, lack of data, or not agree to participate in the study), and finally a total of 208 participants were included in the analysis, 166 women, with an average age of 84.59 years, and 42 men, with an average age of 82.05. 54.80% of all cases were older than 85 years. The mean Barthel index value prior to fracture was 76.63, decreasing to 64.91 at one-year follow-up. Only 22.12% of patients achieved a full recovery for activities of daily living. A statistical analysis was performed by comparing Barthel index recovery depending on the values of Charlson and Pfeiffer indexes, respectively. The mean differences in Barthel index drop between the one-year follow-up and the hospital admission values were found statistical significant (p<0.01). These findings indicate that Charlson and Pfeiffer indexes clearly influence the Barthel index recovery. Low values of Charlson and Pfeiffer indexes resulted in better Barthel index recovery. In conclusion, the Barthel index is a good tool to evaluate the physical recovery after osteoporotic hip fracture.

Prediction of functional consequences of cerebral ischemic stroke one year after its occurrence

The aim — investigation of independent prognostic factors of minimal dependence in everyday activities one year after ischemic stroke by developing a prognostic mathematical model.Materials and methods. The neurological and functional status of 150 patients (74 (49.3 %) women and 76 (50.7 %) men of mean age of (67.4 ± 0.7 years) with primary ischemic stroke and primary arterial hypertension in anamnesis was evaluated. Neurological deficit was evaluated by the NIHSS scale. The assessment of everyday life activity was provided by Bartel index (BI). The cognitive status was evaluated by MMSE scale. Diagnosis of hypertension was based on the results of clinical, instrumental examination and medical documentation. We applied daily blood pressure (BP) monitoring from the moment of admission every 4 hours for 6 days of acute period. The variability of SBP and DBP was determined by calculating the standard deviation for 6 days, as well as for the period from the first to the third and from the third to the sixth day.Results and discussion. A year after stroke, the median of the Barthel index values was 85, the minimum value was 45, the maximum — 100, the first quartile — 75, the third quartile — 95 points. Data on 105 patients with neurological deficit of moderate (82) and severe (23) degrees took part in the determination of the functional recovery prognostic predictors by BI. Of the 161 indicators that characterized the pathology and the results of an additional patient’s examination, 18 variables that had a reliable correlation with the BI score in a year were selected and involved in logistic regression analysis. According to the step­by­step analysis, (10 steps), the independent prognostic factors of minimal dependence in daily activities in a year were determined in patients with moderate and severe ischemic stroke: duration of hypertension (B coefficient = –0.11), thickness of the intima­media complex (B coefficient = –7.62), the MMSE score (B coefficient = 0.19), gender (B coefficient = –2.13), intake of sartans in combination with calcium antagonists or in monotherapy (B coefficient = –1.31), achievement of target BP in antihypertension therapy (its efficiency) (B coefficient = +2.95); constant — 7.43. The obtained model has a sensitivity of 95.3 %, a specificity of 88.9 % and a diagnostic accuracy of 93.4 %, an area under the ROC curve — 0.926 (95 % confidence interval: 0.881 — 0.972).Conclusions. The main tasks at the stage of rehabilitation of patients for achievement of a minimum functional dependence in a year in the case of moderate to severe ischemic stroke is to prevent the progression of the atherosclerotic process, improve cognitive functions and achieve the primary hypertension treatment effectiveness.

Prognostic model of the minimal limitation in everyday life in patients with primary arterial hypertension in acute period of ischemic stroke

Objective — investigation of independent prognostic factors of minimal dependence in everyday activities at the end of an acute period of ischemic stroke in patients with primary hypertension by developing of the prognostic mathematical model.Methods and subjects. The neurological and functional status of 150 patients with primary ischemic stroke and primary arterial hypertension in anamnesis was evaluated: 74 (49.3 %) women and 76 (50.7 %) men with mean age of 67.4 ± 0.7 years. Neurological deficit was evaluated by the NIHSS scale. The assessment of everyday life activity was provided by Bartel index. The cognitive status was evaluated by MMSE scale. Diagnosis of hypertension was based on the results of clinical, instrumental examination and medical documentation. We applied daily blood pressure monitoring from the moment of admission every 4 hours for 6 days of acute period. The mean value of SBP, DBP, the maximum values of SBP and DBP and the variability of BP were calculated by using of standard deviation (SD) evaluated for SBP and DBP. Statistical processing of the results was provided by the statistical analysis program of IBM SPSS Statistics 22.Results. On the 21st day the median of the Barthel index values was 75, the minimum value was 20, the maximum — 95, the first quartile — 55, the third quartile — 85 points, only 124 patients with moderate (86) and severe (38) neurological deficit degrees took part in the functional recovery prognostic predictors determining by BI. Of the 159 indicators that characterized the pathology and the results of an additional patient’s examination, 19 variables had a reliable correlation with the BI score on discharge and were selected and involved in logistic regression analysis. According to the step‑by‑step analysis, (13 steps), six independent prognostic factors were determined: the duration of hypertension (B coefficient = 0.22), the variability of systolic blood pressure (SD SBP) during first three days (B = –0.30), viability of diastolic blood pressure (SD DBP) during first three days (В = 0.48), sex (В = –2.46), ММSE in acute period (В = 0.44), higher education (В = 2.11). Constant — 6.76. The obtained model has sensitivity — 93.9 %, specificity — 86.5 % and a diagnostic accuracy of 90.1 %, an area under the ROC curve 0.95 (95 % CI: 0.94 — 0.99). The prognostic factors of minimal dependence in everyday activity at the end of acute period of moderate to severe and severe ischemic stroke were: duration of hypertension, systolic blood pressure and diastolic blood pressure variability during first three days of stroke, MMSE score and higher education.Conclusions. The main direction of therapeutic measures aimed at achieving the minimal functional dependence in the acute period of moderate and severe stroke should be to reduce the variability of both systolic and diastolic blood pressure, especially during first three days, accompanied with measures to improve cognitive status.

Deterioro funcional asociado al deterioro cognitivo en el anciano hospitalizado

IntroductionThe aim of this study was to analyse the effect of cognitive impairment on functional decline in hospitalised patients aged ≥60 years. MethodsMeasurements at admission included demographic data, Charlson's comorbidity index, and cognitive impairment (according to education level).Data were also collected on hospital length of stay, depression, and delirium developed during hospitalisation. The outcome, Barthel Index (BI), was measured at admission, discharge, and 1-month post-discharge. Patients with BI≤75 at admission (n=54) or with a missing BI value were excluded (n=1). Multivariate logistic regression analyses were conducted to explore predictive factors with functional decline (BI≤75) from admission to discharge, and 1-month later. ResultsOf the 133 patients included, 24.8% and 19.6% had a BI≤75 at discharge and at 1-month, respectively. Compared with men, women had more than double risk for functional decline at discharge and 1-month (P<.05). Compared with those without delirium and without cognitive impairment, those with delirium and cognitive impairment had an increased risk for functional decline (BI≤75) at discharge (OR 5.15, 95% CI; 1.94-13.67), and at 1-month (OR 6.26, 95% CI; 2.30-17.03). Similarly, those with comorbidity (≥2) had increased functional decline at discharge (OR 2.36, 95% CI; 1.14-4.87), and at 1-month after discharge (OR 2.71, 95% CI; 1.25-5.89). ConclusionDelirium during hospitalisation, together with cognitive impairment on admission, was a strong predictor of functional decline.

A Randomized Controlled Study: Effectiveness of Functional Electrical Stimulation on Wrist and Finger Flexor Spasticity in Hemiplegia

The objective of this study was to investigate the effectiveness of functional electrical stimulation (FES) applied to the wrist and finger extensors for wrist flexor spasticity in hemiplegic patients. Thirty stroke patients treated as inpatients were included in the study. Patients were randomly divided into study and control groups. FES was applied to the study group. Wrist range of movement, the Modified Ashworth Scale (MAS), Rivermead Motor Assessment (RMA), Brunnstrom (BS) hand neurophysiological staging, Barthel Index (BI), and Upper Extremity Function Test (UEFT) are outcome measures. There was no significant difference regarding range of motion (ROM) and BI values on admission between the groups. A significant difference was found in favor of the study group for these values at discharge. In the assessment within groups, there was no significant difference between admission and discharge RMA, BS hand, and UEFT scores in the control group, but there was a significant difference between the admission and discharge values for these parameters in the study group. Both groups showed improvement in MAS values on internal assessment. It was determined that FES application is an effective method to reduce spasticity and to improve ROM, motor, and functional outcomes in hemiplegic wrist flexor spasticity.

The Activities of Daily Living after an Acute Exacerbation of Idiopathic Pulmonary Fibrosis.

Objective An acute exacerbation (AE) of idiopathic pulmonary disease (IPF) represents a life threatening condition. The activities of daily living (ADL) and quality of life of patients who survive an AE of IPF (AE-IPF) are often diminished. However, the association between AE-IPF and the ADL has yet to be evaluated. To evaluate the effect of AE-IPF on the ADL. Methods, Patients Patients treated for AE-IPF from 2010 to 2014 were identified. We retrospectively evaluated their ADL before and after AE-IPF using a modified Barthel index (BI) composed of 6 items. Results Twenty-eight of the 47 AE-IPF patients remained alive at 3 months after the onset of AE-IPF. The BI values of 22 survivors (79%) showed a full score (70 points) before the onset of AE-IPF. The evaluation of the BI scores at four weeks after the onset of AE-IPF revealed that the scores of 12 patients had decreased by >15 points and more than half of the survivors showed scores of <55. Logistic regression analyses showed that persistent hypeoxemia at 28 days after an AE, both at exertion (odds ratio, 24.20; 95% confidence interval, 2.42-242.31; p=0.009) and at rest (odds ratio, 21.00; 95% confidence interval, 2.05-215.18; p=0.010), was associated with a >15-point decrease in the BI score at 4 weeks after AE-IPF. Conclusion AE-IPF survivors with persistent hypoxemia showed diminished ADL after treatment.

Higher blood pressure as a risk factor for diseases other than stroke and ischemic heart disease.

Hypertension is an established risk factor for stroke, ischemic heart disease,1,2 and renal dysfunction.3 The management and prevention of hypertension are important to the prevention of these diseases. Recent evidence has suggested that hypertension also plays a central role in the underlying pathophysiological condition or at prodromal stages before the development of these diseases. Accumulating evidence also indicates that hypertension seems to be linked with common noncardiovascular diseases including dementia, cancer, oral health diseases (OHDs), and osteoporosis. In this brief review, we organize the reported results about the associations between hypertension and these diseases, discussing mainly epidemiological surveys, with the goal of clarifying the relationships between these diseases and hypertension. ### Atrial Fibrillation Atrial fibrillation (AF) is one of the most common types of chronic arrhythmia and is a risk factor for ischemic stroke.4 The Framingham Heart Study revealed that hypertension increases the risk of AF by factors of 1.5 for men and 1.4 for women.5 The Women’s Health Study and a cohort study of Norwegian men showed that high-normal blood pressure (BP) was associated with incident AF.6,7 All of these cohort studies were conducted in Westerners, and these associations were also confirmed in a recent Japanese cohort study.8 In that investigation, compared with normal BP and normal weight, systolic prehypertension with overweight was shown to be associated with an increased risk of incident AF ( P for interaction=0.04). Arterial stiffness, left ventricular hypertrophy, and increased left atrial size are important mediators of the relationship between BP and incident AF.9 Higher systolic BP (SBP) and overweight may mutually exacerbate left ventricular hypertrophy and hypertension, and consequently, they may synergistically increase the risk of AF. ### Chronic Kidney Disease and High BP Chronic kidney disease (CKD) is characterized by a progressive decline in an individual’s glomerular filtration rate over several decades, …

Perfil y pronóstico del paciente con anemia mayor de 85 años que vive en la comunidad. Estudio Octabaix

ObjectivesTo analyze the prevalence of anemia in a sample of patients over 85 years old. To explore possible differentiating features in the groups of people with and without anemia, and to evaluate the relationship of anemia with mortality after a follow-up of 3 years. Material and methodsAn observational multicenter study was conducted on a cohort of people born in 1924 and who lived in the community. Socio-demographic variables, comorbidity, functionality, cognitive status, social risk, perceived quality of life, nutritional status, drug consumption and laboratory parameters were collected. Multivariate logistic regression analysis was performed. ResultsA total of 328 inhabitants were included, of whom 61.6% were women. The prevalence of anemia was 24%. Statistically significant differences in the Charlson index were found, showing higher values in anemic patients (P=0001) and in the Barthel index (BI) and in the Lawton index (LI), with lower levels in anemic patients (P=002 for both). Patients with anemia had a poorer perception of their quality of life (P=015). The presence of anemia was associated with more dependence according the BI values (OR 0.985; 95% CI: 0973-0997) and with higher comorbidity according the Charlson index (OR 1.314; 95% CI: 1124-1536). Mortality was higher in the group of patients with anemia, reaching statistically significant differences in the third year P=005). ConclusionsIn our cohort anemia is a fairly prevalent feature in the population over 85 years old, and is associated with higher mortality at three years of follow up. Patients with anemia had worse physical functioning and greater comorbidity.