Basic Activities Of Daily Research Articles

Impact of Cognitive Reserve and Premorbid IQ on Cognitive and Functional Status in Older Outpatients.

The study aimed to investigate cross-sectionally the associations of cognitive reserve (CR) and premorbid IQ with cognitive and functional status in a cohort of older outpatients. Additionally, we evaluated the association of CR and premorbid IQ with the worsening of patients’ cognitive status at one-year follow-up. We originally included 141 outpatients (mean age 80.31 years); a telephone-based cognitive follow-up was carried out after one year, including 104 subjects (mean age 80.26 years). CR (β = 0.418), premorbid IQ (β = 0.271) and handgrip strength (β = 0.287) were significantly associated with the MMSE score. The cognitive worsening at follow-up was associated with lower CR, lower MMSE score, reduced gait speed and frailty exhibited at baseline. Univariate linear regressions showed that CR was associated with handgrip strength (β = 0.346), gait speed (β = 0.185), autonomy in basic (β = 0.221) and instrumental (β = 0.272) daily activities, and frailty (β = −0.290); premorbid IQ was significantly associated with autonomy in instrumental daily activities (β = 0.211). These findings highlight the need for integrating CR and premorbid IQ with physical and motor measures when appraising predictors of cognitive decline in the elderly population. The study also newly extends the link of CR and premorbid IQ to the functional status in older adults.

Identifying Clinically Relevant Functional Strata to Direct Mobility Preservation Among Patients Hospitalized With Medical Conditions

ObjectiveTo develop a system to guide interpretation of scores generated from the newly developed item response theory (IRT)-based Functional Assessment in Acute Care Multidimensional Computerized Adaptive Test (FAMCAT), which assesses 3 important domains of function: Mobility, Daily Activities, and Applied Cognition. DesignCross-sectional data was used to inform a modified Delphi approach to establish FAMCAT cutpoints delineating various functional ability levels. SettingLarge midwestern academic teaching hospital. ParticipantsPatients hospitalized to an inpatient medical service (N=2049). InterventionsNot applicable. Main Outcome MeasuresFAMCAT Basic Mobility, Daily Activity, and Applied Cognition scores. ResultsIRT-based score estimation data was successfully integrated with expert clinical feedback using a modified Delphi process to arrive at consensus yielding 4 functional level strata (ranging from bed-based mobility to independent mobility) for both the FAMCAT Mobility and Daily Activity scales; 1 cutpoint was supported to delineate 2 functional strata for Applied Cognition. ConclusionsMeaningful cutpoints were established for each FAMCAT domain using a data-informed, modified Delphi process for achieving consensus. The resulting FAMCAT interpretation guide may be used to develop an ability-matched mobility preservation program and identify patients who may require a higher level of supervision based on the resulting FAMCAT scores.

The Effect of Polypharmacy on the Charlson Comorbidity Index and Katz Index in Aging People with and without Diabetes Mellitus.

The prevalence of diabetes mellitus is growing worldwide, as well as in the aging population, and its comorbidity and mortality rates are higher in aging people than they are in young people. It has been observed that the number of drugs used increases in aging patients, especially in diabetic patients. This study aimed to investigate the relationship between polypharmacy and modified Charlson Comorbidity Index (CCI) and Katz Index of Independence in Activities of Daily Living (Katz ADL) scores in aging diabetic and non-diabetic patients. This prospective study included 184 diabetic and 62 non-diabetic subjects who were ≥65 years old. Comorbidity was determined with CCI, and dependency on daily basic activities was assessed with Katz ADL. CCI and the number of drugs were significantly higher in diabetic groups (P = .001). In all subjects and in the diabetic group, there was a negative correlation between CCI and Katz ADL (r = -0.343, P = .001; r = -0.383, P = .001, respectively); there was a positive correlation between CCI and number of drugs (r = 0.430, P = .001; r = 0.248, P = .001, respectively). We found an increase in the number of drugs taken by the aging patients, positively correlated with the CCI score. The increase in the number of drugs used is closely related to the insufficiency in daily life activity and comorbidity, and this predicts 10-year survival. Patients should be directed to special centers or physicians who will be scheduled for multidisciplinary treatment for the prevention of polypharmacy, especially in the aging.

Can AM-PAC "6-Clicks" Inpatient Functional Assessment Scores Strengthen Hospital 30-Day Readmission Prevention Strategies?

BackgroundPrevention of unplanned hospital readmissions remains a priority in the US healthcare sector. Patient functional status has evolved as an important factor in identifying patients at risk for unplanned readmissions and poor predischarge functional performance has been shown to be predictive of increased readmission risk. Yet, patient functional status appears to be underutilized in readmission prediction models.MethodsTo examine the impact of inpatient functional status (mobility and activity performance) on unplanned 30-day hospital readmissions at two tertiary care hospitals, retrospective cohort analysis was performed on electronic health record data from adult inpatients (N = 26,298) having undergone completed functional assessments during their index hospitalization. Primary outcomes were functional assessment scores and unplanned all-cause patient readmission within 30 days following hospital discharge. Secondary analysis stratified the assessment by discharge destination. Functional assessment scores from the Activity Measure for Post-Acute Care (AM-PAC) “6-Clicks” Basic Mobility Short Form or Daily Activity Short Form were extracted along with patient demographics, admission diagnoses, comorbid conditions, and hospital readmission risk score. ResultsAdjusting for age, sex, and comorbidity, lower AM-PAC “6-Clicks” Basic Mobility and Daily Activity scores resulted in higher readmission rates when each score was considered separately. When both scores were considered, only Daily Activity scores were significant. ConclusionPatients with lower Basic Mobility and Daily Activity scores are at a higher risk for readmission. The relative importance of AM-PAC “6-Click” scores on short-term readmission depends on discharge destination. Timely identification of patient mobility and activity performance may lead to earlier intervention strategies to reduce readmissions.

Object recognition in performed basic daily activities with a handcrafted data glove prototype

Abstract In this paper, special attention is given to the hand. The literature provides solutions allowing the hand gestures recognition and/or object recognition for virtual reality, robotic applications, and so on. These solutions rely mainly on computer vision and data gloves. From this finding, we decided to develop our data glove prototype. The data glove is exploited to recognize common objects in the kitchen that the person can hold (e.g., hold a fork) while he/she performs basic daily activities such as drink a glass of water. The proposed approach is straightforward, cheap ( ∼ 260 $ in USD) and efficient ( ∼ 100%). Moreover, the designed data glove gives easy and direct access to the raw data provided by sensors. Besides, a comparison between classical machine learning algorithms (e.g., CART, Random Forest) and a deep neural network is given. Finally, the proposed prototype is described in a way that researchers can reproduce it for any applications involving the object recognition with the hand.

Activity Classification Using Backpropagation Neural Networks for the Daily Lives of the Elderly

Activity Analysis Systems or Activity Recognition Systems for the elderly is recently a part of the smart home systems design. This assisted system normally helps the senior people to live alone in a house, safely and improve a quality of life. Therefore, learning to recognize which activities are safe is necessary for classifying the activities of the elderly. This information will give the researchers in the assistive technology some insights to understand the basic daily lives of the elderly. Moreover, it is also help the caregivers to monitor activities of the senior people while they live alone in the house. In this paper, the novel method for detecting and recognizing the activities using Backpropagation Neural Networks has been proposed. The proposed model was tested on a set of basic daily activities (lie, stand, sit, walk and dine). The proposed model was trained to construct the Backpropagation Neural Networks model and used the trained model to classify basic daily activities of the elderly. The proposed model gives the results of 0.78, 0.72 and 0.74 of precision, recall and F1 score, respectively. The discussion and future extension are also given in this paper.

Clinical instruments for bedside functional assessment: Convergent validity among the AM-PAC '6-Clicks' and BMAT.

To determine the level of convergent validity of the '6-Clicks' Basic Mobility and Daily Activity with the Bedside Mobility Assessment Tool (BMAT) in patients admitted to a tertiary care academic hospital. Accurately measuring a patient's ability to mobilise during hospitalisation is necessary but can be challenging. Two instruments, the Activity Measure for Post-Acute Care short-form '6-Clicks' and the BMAT, are commonly used to determine patients' mobility levels; however, these instruments have not been psychometrically evaluated together. Understanding the characteristics between these tools can support the process of shared decision making amongst healthcare providers. Retrospective Cohort adhering to the STROBE statement. Using 13,498 individual patient admissions from an electronic health record, the BMAT score measured closest in time to the '6-Clicks' Basic Mobility and Daily Activity evaluation was collected. Spearman rank correlations with 95% confidence intervals (CIs) were calculated to determine the level of convergent validity between the '6-Clicks' Basic Mobility and Daily Activity with the BMAT. Pairwise correlations were also calculated and stratified by admitting medical service. All correlations for the '6-Clicks' Basic Mobility or Daily Activity summative scores and the BMAT mobility levels were statistically significant and moderately correlated. The weakest correlations were seen within the Orthopaedic admitting service group. Most correlations stratified by admitting service [CVD/Pulmonary, Medicine/Hospitalist, Other Surgery and Solid Organ Transplant] were moderate. The strongest correlations were seen within the Neuro/Stroke admitting service. Moderate levels of convergent validity exist between the '6-Clicks' and the BMAT in this sample. These findings demonstrate that the construct of patient mobility is not being assessed similarly between the two instruments. These findings suggest the continued use of both instruments to allow interdisciplinary assessment of patient mobility status during a hospital stay.

Prevalence of SARS-CoV-2 in Household Members and Other Close Contacts of COVID-19 Cases: A Serologic Study in Canton of Vaud, Switzerland

BackgroundResearch on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission within households and other close settings using serological testing is scarce.MethodsWe invited coronavirus disease 2019 (COVID-19) cases diagnosed between February 27 and April 1, 2020, in Canton of Vaud, Switzerland, to participate, along with household members and other close contacts. Anti-SARS-CoV-2 immunoglobulin G antibodies were measured using a Luminex immunoassay. We estimated factors associated with serological status using generalized estimating equations.ResultsOverall, 219 cases, 302 household members, and 69 other close contacts participated between May 4 and June 27, 2020. More than half of household members (57.2%; 95% CI, 49.7%–64.3%) had developed a serologic response to SARS-CoV-2, while 19.0% (95% CI, 10.0%–33.2%) of other close contacts were seropositive. After adjusting for individual and household characteristics, infection risk was higher in household members aged ≥65 years than in younger adults (adjusted odds ratio [aOR], 3.63; 95% CI, 1.05–12.60) and in those not strictly adhering to simple hygiene rules like hand washing (aOR, 1.80; 95% CI, 1.02–3.17). The risk was lower when more than 5 people outside home were met during semiconfinement, compared with none (aOR, 0.35; 95% CI, 0.16–0.74). Individual risk of household members to be seropositive was lower in large households (22% less per each additional person).ConclusionsDuring semiconfinement, household members of a COVID-19 case were at very high risk of getting infected, 3 times more than close contacts outside home. This highlights the need to provide clear messages on protective measures applicable at home. For elderly couples, who were especially at risk, providing external support for daily basic activities is essential.

Long term results of lower limb posttraumatic acute bone defects treated with masquelet technique

IntroductionSeveral alternatives are now available when treating posttraumatic acute bone defects. Masquelet's technique represents a safe procedure to treat lower limb open fractures associated with significant bone defects and allows surgeons to try to reduce complications incidence. Material and MethodsRetrospective study based on patients´ record files and images (2015-2017). Twelve patients suffering acute bone defect, treated using Masquelet technique, were evaluated. A total of ten patients were finally included after exclusion criteria were applied. ResultsAverage time from injury to first stage surgery was 11 days. Free flaps were required in three cases (two latissimus dorsi and one anterolateral thigh flap). Time to second stage surgery was 115 days on average. As bone graft, reaming irrigation-aspiration system was associated to this technique. Consolidation was achieved in all patients but one after an average time of 8.4 months. There was only one case of limb shortening of 20 mm. There was no case of nonunion or infection, and patients could perform daily basic activities independently. VAS mean score was one point one year after final surgery. ConclusionsMasquelet's technique achieves encouraging results when treating lower limb acute bone defects. Using this technique, surgeons could decrease infection incidence in open fractures with severe bone loss. On the other hand, it is a two-stage surgery process, which makes the process longer.

Association of AM-PAC "6-Clicks" Basic Mobility and Daily Activity Scores With Discharge Destination.

The objective was to use the Activity Measure for Post-Acute Care "6-Clicks" scores at initial physical therapist and/or occupational therapist evaluation to assess (1) predictive ability for community versus institutional discharge, and (2) association with discharge destination (home/self-care [HOME], home health [HHA], skilled nursing facility [SNF], and inpatient rehabilitation facility [IRF]). In this retrospective cohort study, initial "6-Clicks" Basic Mobility and/or Daily Activity t scores and discharge destination were obtained from electronic health records of 17,546 inpatient admissions receiving physical therapy/occupational therapy at an academic hospital between October 1, 2015 and August 31, 2018. For objective (1), postacute discharge destination was dichotomized to community (HOME and HHA) and institution (SNF and IRF). Receiver operator characteristic curves determined the most predictive Basic Mobility and Daily Activity scores for discharge destination. For objective (2), adjusted odds ratios (OR) from multinomial logistic regression assessed association between discharge destination (HOME, HHA, SNF, IRF) and cut-point scores for Basic Mobility (≤40.78 vs >40.78) and Daily Activity (≤40.22 vs >40.22), accounting for patient and clinical characteristics. Area under the curve for Basic Mobility was 0.80 (95% CI=0.80-0.81) and Daily Activity was 0.81 (95% CI=0.80-0.82). The best cut-point for Basic Mobility was 40.78 (raw score=16; sensitivity=0.71 and specificity=0.74) and for Daily Activity was 40.22 (raw score=19; sensitivity=0.68 and specificity=0.79). Basic Mobility and Daily Activity were significantly associated with discharge destination, with those above the cut-point resulting in increased odds of discharge HOME. The Basic Mobility scores ≤40.78 had higher odds of discharge to HHA (OR=1.7 [95% CI=1.5-1.9]), SNF (OR=7.8 [95% CI=6.8-8.9]), and IRF (OR=7.5 [95% CI=6.3-9.1]), and the Daily Activity scores ≤40.22 had higher odds of discharge to HHA (OR=1.8 [95% CI=1.7-2.0]), SNF (OR=8.9 [95% CI=7.9-10.0]), and IRF (OR=11.4 [95% CI=9.7-13.5]). 6-Clicks at physical therapist/occupational therapist initial evaluation demonstrated good prediction for discharge decisions. Higher scores were associated with discharge to HOME; lower scores reflected discharge to settings with increased support levels. Initial Basic Mobility and Daily Activity scores are valuable clinical tools in the determination of discharge destination.

Analysis children with disabilities self-care problems based on selected data mining techniques

Children’s disabilities is a very important task. Lack of appropriate diagnosis and care increases children’s difficulties in adjusting to disability. Children with physical and motor disabilities have many problems in their lives related to basic daily activities. Therefore, it is very important to properly classify self-care problems. Such classification requires appropriately trained people and time. Data mining techniques can be helpful to support such diagnosis. Classification and selection of appropriate features can significantly support the work of diagnosticians and therapists. In this paper we attempted to build classification models based on all available instances as well as on instances obtained by feature selection. The most accurate model obtained, correctly classifies more than 85% of children with self-care problems, using only 19 characteristic features.

Progression of Motor and Non-Motor Symptoms in Multiple System Atrophy: A Prospective Study from the Catalan-MSA Registry.

Multiple system atrophy (MSA) is a highly debilitating, rare neurodegenerative disorder with two clinical motor variants (parkinsonian or MSA-P and cerebellar or MSA-C). There is a wide span of motor and non-motor symptoms (NMS) that progress over time. We studied the cohort from the Catalan Multiple System Atrophy Registry (CMSAR) to determine which symptoms are most likely to progress throughout a 2-year follow-up. We analyzed baseline, 12-month, and 24-month follow-up evaluations from the 80 cases recruited by the CMSAR. Evaluations included the UMSARS assessment, cognitive and neuropsychiatric evaluations, and a non-motor scale (NMSS-PD). Statistical analysis was done using a Generalized Estimated Equations (GEE) model. Both UMSARS I and II sub-scores significantly increased at 12- and 24-month follow-ups (p < 0.001), with a median total score increase of 11 and 12.5 points, respectively. Items on UMSARS I that significantly worsened were mostly motor affecting daily activities. NMS, including urinary and sexual dysfunction, as well as sleep difficulties showed a significant progression on the NMSS-PD; however, other NMS such as postural hypotension, gastrointestinal, and mood dysfunction, although prevalent, did not show a clear progression on clinical scales. Within 24 months and as early as 12 months, MSA cases may experience significant motor worsening, affecting basic daily activities. NMS are prevalent; however, not all clinical scales register a clear progression of symptoms, perhaps suggesting that they are not sensitive enough for non-motor evaluation.

Screening of apathetic elderly adults using kinematic information in gait and sit-to-stand/stand-to-sit movements measured with Doppler radar.

This paper presents a Doppler radar apathy-screening technique applied to elderly people based on their basic daily activities of walking and movements of sit-to-stand and stand-to-sit (STS). Our Doppler radar system remotely measured the kinematic parameters of the movements of 78 community-dwelling elderly adults (27 apathetic participants and 51 non-apathetic ones). Subsequently, logistic regression models using the measured kinematic parameters of gait and sit-to-stand/stand-to-sit movements were constructed for screening. The experimental results verified that, although the model using gait parameters could screen an apathetic group with a sensitivity of 85.2% and a specificity of 58.8%, the model using the STS parameters achieved better screening accuracies with a sensitivity of 88.9% and a specificity of 76.5%. These results reveal that the kinematic information of STS movements is significantly more effective at detecting apathy than is the gait information, which is otherwise regarded to be effective in conventional epidemiological studies.

The economic and psychological impact of cancellations of elective spinal surgeries in the COVID-19 era

Background The adoption of health care restrictions due to the COVID-19 pandemic led to the cancellation of elective surgical care. However, the impact on patients is unknown. Objective To evaluate the psychological and economic impact of the cancellation of scheduled spinal operations. Methods We identified 50 patients with cancelled surgeries between 16 March 2020 and 24 April 2020. Forty-nine (98%) participants were contacted, with whom the modified WES-Pi questionnaire was filled in during a telephone interview. Results Of the 49 respondents, 28 (57.2%) were aged <65 years. The most often reported problem (85.7%) was an ongoing limitation in basic daily activities. At least moderate sadness was experienced by 65.3% and disappointment by 73.5% of the patients. More than 80% reported concerns about the continuation and 73.5% about the progression of their symptoms. Out of 27 employees (55.1%), 63% could not work due to severe pain or movement limitation (p < .001). The inability to work was associated with anger (p = .037). The work-related impact of the cancellation was associated with stress (p < .0001) and concerns about continuing the symptoms (p = .004). Two-third of patients would undergo immediate surgery despite the current epidemic situation. Conclusions The cancellations of elective spinal surgeries have a serious psychological impact on patients. This together with potential economic consequences is especially evident in employees unable to work due to pain or movement disability. The information is beneficial for health management. Every effort should be made to resume planned surgical treatment if the epidemiological situation allows it.

Functional Gait Assessment scale in the rehabilitation of patients after vestibular tumor surgery in an acute hospital.

BACKGROUNDPatients in the acute phase of rehabilitation after vestibular tumor surgery are dysfunctional in basic daily activities. Balance, gait impairments, and falls are prevalent with vestibular loss. AIMTo determine the degree of balance disorders after vestibular tumor surgery, the susceptibility to falls and to assess motor tasks using the Functional Gait Assessment (FGA) scale for functional gait, as part of the vestibular rehabilitation program during hospital stay. METHODSPatients who achieved a score higher than 25 points on the Mini-Mental State Examination and higher than 8 points on the Barthel index were included in the study. They were evaluated with the Berg Balance Scale the second day after surgery, during their hospital stay, at discharge, and three months after surgery. Throughout their hospitalization, patients took part in the vestibular rehabilitation program, focusing on multiple motor tasks included in the FGA. RESULTSAll patients progressed clinically and statistically significant differences in functional activities of daily living were observed during hospitalization, before discharge to the home environment (median = 11; P = 0.0059) and three months after vestibular tumor surgery (median = 8; P = 0.0058). After discharge from hospital, four patients were at risk of falls, and two patients were at risk at three months. CONCLUSIONOur study showed a positive effect of the use of FGA tasks as part of a rehabilitation program on functional activities of daily living in patients after vestibular tumor surgery. Nevertheless, we suggest further research to include a larger sample and a control group to overcome the deficiencies of our study.

Cancer in Moroccan elderly: the first multicenter transverse study exploring the sociodemographic characteristics, clinical profile and quality of life of elderly Moroccan cancer patients

BackgroundMoroccan incidence of cancer is increasing with the lengthening of life expectancy. Data regarding elderly Moroccan cancer patients are lacking. In the context of our project aiming to develop an adapted version of the Comprehensive Geriatric Assessment CGA to the Moroccan population, we launched the first Moroccan multicenter transverse study to explore the characteristics of elderly Moroccan cancer patients.MethodsThe study was conducted in nine Moroccan medical oncology departments. Patients were enrolled over 4 months. Inclusion criteria were patients aged 65 years or over with verified solid cancer. The questionnaire included four sections: socio-demographic and economic data, clinical data, vulnerability and EORTC-QLQ C30. We explored the entire included population. Then, we compared the results according to age (65–70 years old and ≥ 71 years old) and sex. We also explored the correlation between G8 scores and the ability to practice religion as an indicator of fitness level.ResultsIn total, 164 patients were enrolled. The mean age was 73.18 ± 6.01 years. The majority of patients were married, lived with their children and received their financial income from them. Fifteen percent of families asked to hide the diagnosis from the patient. Breast (23%), colorectal (15.9%) and lung (14%) cancers were the most frequent, and 83.5% had an abnormal G8. The majority of the patients were independent for basic daily activities. Female patients had poorer social and economic conditions. Abnormal G8 was correlated with religious practice and quality of life scores.ConclusionThis is the first multicenter prospective study designed to collect data on the lifestyle and clinical profiles of elderly Moroccan cancer patients as an Arab and Muslim population. Our study shows that it is a well-cared-for population with strong social ties. However, there is deep economic vulnerability, especially among women, requiring urgent care. Religious practice is an important daily activity for our elderly patients and should be included in the Moroccan CGA.

Función sensorial y dependencia en adultos mayores con enfermedad crónica

Introducción: Con el envejecimiento se presentan cambios en los sentidos y en consecuencia, alteraciones en la función del gusto y olfato que influyen en la descompensación de enfermedades crónicas. Objetivo: conocer la función sensorial y su asociación con la dependencia para realizar Actividades básicas de la vida diaria e Instrumentales en adultos mayores con enfermedad crónica. Metodología: studio correlacional en una muestra de 96 participantes. Instrumentos utilizados: Carta Snellen, Audiómetro Manual, monofilamento de Semmes-Weinstein, prueba de aromas de Gustos Básicos e Índice de Barthel. El análisis estadístico implicó estadística descriptiva e inferencial, correlación de Spearman, U de Mann-Whitney. Resultados: El 71% de los participantes presentó alteración visual. 48% obtuvo audición normal en oído izquierdo y 43% oído derecho, 24% calificó con alteración táctil del pie izquierdo y 30% en pie derecho. Alteración de olfato y gusto en 77%. Presentaron dependencia en actividades Básicas (ABVD) 40%, 24 % en Instrumentadas (AIVD). Se identificó relación entre el tacto en ambos pies y agudeza auditiva con ABVD (p= &lt;.05). La edad y AIVD (p=&lt;.001) agudeza tacto pie izquierdo(p=&lt;.031), auditiva(p=&lt; .005), olfato (p=.018) y gusto (p= &lt;.047). La dependencia en ABVD no presentó diferencia en la prueba con anteojos (U=146.000; p= &lt;.754) y sin anteojos (U=127.500; p=.079); de igual manera en AIVD con anteojos (U=115.000; p= &lt;.079) y sin anteojos (U=160.000; p=.202). Conclusión. A mayor función en los sentidos de tacto y oído, menor dependencia para realizar las ABVD y a mayor función del tacto, oído, olfato y gusto menor dependencia en las AIVD.

Use of AM-PAC “6 Click” Scores to Predict Discharge Location Post-hospitalization in Adults With Cardiovascular Disease: A Retrospective Cohort Study

Purpose: Scores on the Activity Measure for Post-Acute Care (AMPAC) 6-Clicks are used in the hospital setting as functional measures to guide care and discharge recommendations. However, limited evidence exists regarding the accuracy of AMPAC 6-Clicks in predicting discharge location for those with cardiovascular disease (CVD). The purpose of this study was to determine the accuracy of AM-PAC 6-Clicks scores to predict discharge to home/self-care from an acute care hospital in adults with CVD. Methods: A retrospective review of medical record data comprised of AM-PAC 6-Clicks basic mobility or daily activity scores at physical or occupational therapy evaluation and discharge was completed. Logistic regression analyses were performed to determine if 6-Clicks scores could predict discharge to home/self-care while controlling for age, insurance type, and length of stay. Receiver operating characteristic curves were created to determine the 6-Clicks scores with the best sensitivity/specificity to determine discharge to home/self-care. Results: Logistic regression models indicated that the basic mobility score at discharge from physical therapy services accounted for 71% of the variance in predicting discharge to home/self-care after controlling for covariates. The best 6-Clicks non-converted cutoff value for accuracy of discharge to home/self-care was 20.50 for daily activity and 18.5 for basic mobility completed at discharge. Conclusions: Basic mobility scores at discharge are significant predictors of discharge to home/self-care in older adults with CVD. Further inpatient rehabilitation services should be considered for patients who score less than 18.5 (converted = 44.5) on the basic mobility or 20.50 (converted = 43.15) on the daily activity measures.

Lineamientos del Colegio Colombiano de Terapia Ocupacional para la atención hospitalaria aguda y subaguda de pacientes con COVID-19

El amplio espectro clínico de la enfermedad COVID-19 tiene importantes implicaciones funcionales para el cuidado hospitalario agudo y subagudo en unidades de cuidado intensivo. Ante la emergencia sanitaria desencadenada por esta enfermedad, el Colegio Colombiano de Terapia Ocupacional convocó a un grupo de profesionales expertas en el área para proveer lineamientos para terapeutas ocupacionales que participan en la rehabilitación temprana de pacientes con COVID-19 en Colombia. Se realizó una revisión de literatura sobre la clasificación y las manifestaciones clínicas de la enfermedad, la efectividad de la rehabilitación temprana adulta, pediátrica y neonatal, y el rol y la experiencia de profesionales en Terapia Ocupacional en el uso de guías de salud existentes. Un consenso de expertas determinó la aplicabilidad de los lineamientos al contexto colombiano. Terapia Ocupacional, como parte del equipo de rehabilitación temprana, juega un papel fundamental en la restauración y el mantenimiento de la independencia funcional; la adaptación del ambiente y el acondicionamiento holístico gradual de las funciones respiratorias, cardiovasculares, sensoriomotoras y cognitivas durante las actividades básicas cotidianas, y la prevención del deterioro físico, mental, espiritual y social de la persona hospitalizada y su familia. Estos lineamientos constituyen un recurso técnico y educativo relevante para la Terapia Ocupacional hospitalaria.

Developing an evidence-informed framework for safe and accessible urban mobility infrastructures for older adults in low- and middle-income countries: a protocol for realist synthesis

BackgroundMobility, one of the basic daily activities, helps in carrying out routine work, which contributes to people’s well-being. A lack of friendly and accessible infrastructure may act as a barrier, which limits older adults’ contributions and participation in society. Hence, it is important to have an enabling environment for older adults to carry out their activities independently at ease. There is ample research evidence about effective interventions on urban mobility infrastructures, but there is a lack of evidence regarding what works, for whom, and in what circumstances. Hence, there is a need to identify the contextual factors for different regions to design region-specific interventions. The aim of this realist synthesis is to develop an evidence-informed framework for safe and accessible urban mobility infrastructures for older adults in low- and middle-income countries.MethodsA realist review will be undertaken using the following process: (1) development of a program theory, (2) search strategy and information sources, (3) study selection and appraisal, (4) data extraction, and (5) data synthesis. In addition to searching grey literature and contacting authors, we will search (since inception) multiple electronic databases such as PubMed, EMBASE, Scopus, Web of Science, and Cochrane Library. Studies will be included based on their ability to provide data that evaluates some aspect of the program theory. Two independent reviewers will screen and extract data from all relevant sources. A realist logic of analysis will be used to identify all context-mechanism-outcome that explains how safe and accessible urban mobility infrastructures for older adults implemented in low- and middle-income countries translate to better health outcomes. The findings will be reported according to Realist and MEta-narrative Evidence Syntheses: Evolving Standards guidelines.DiscussionThis realist review will help to develop a framework for safe and accessible urban mobility infrastructures for older adults in low- and middle-income countries. The results of this study will support evidence-based decision-making on urban mobility systems and will be of interest to various stakeholders. Dissemination will be done through conference presentations, policy briefs, media, and peer-reviewed journals. Implications for future research will be discussed.Systematic review registrationPROSPERO CRD42020168020