Changes In Functional Ability Research Articles

Clinical Study of Preoperative Prehabilitation Synchronized Neoadjuvant Chemotherapy for Gastric Cancer Patients

Background. To investigate the effectiveness of prehabilitation in improving physical and nutritional status in patients undergoing gastric cancer resection. Methods. A total of 136 locally advanced gastric cancer patients who planned to undergo neoadjuvant chemotherapy (NAC) plus transabdominal radical surgery were involved. All participants were divided into the prehabilitation group and the control group using the odd-even method, with 68 cases in each group. Intervention consisted of preoperative exercise and nutrition optimization. Participants were adults awaiting elective gastric resection for cancer. The primary outcomes were changes in functional ability and nutritional status, as measured by relative changes in 6 minute walking distance (6MWD) and scores on the albumin and prealbumin. Preoperative (end of the prehabilitation period) and postoperative (from 4 to 6 weeks after surgery) data were compared between the two groups. Results. All 136 patients were randomized in this study. Compared with the control group, the prehabilitation group exhibited improved functional capacity both before surgery (6MWD change) and after surgery. Furthermore, it demonstrated significantly higher levels of albumin and prealbumin before and after surgery than the control group. Conclusion. Prehabilitation in gastric cancer patients can improve preoperative functional capacity and nutritional status. Maintaining a patient’s physical function and nutritional status may have a significant impact on the continuity of cancer care.

Test-retest reliability and minimal detectable change of four functional tests in community-dwelling older adults with high risk of falls

Objectives: This study aimed to quantify test-retest reliability and minimal detectable change (MDC) of the four commonly used functional tests in older adults with a high risk of falling. Patients and methods: The cross-sectional study was conducted with 30 community-dwelling older adults (26 females, 4 males; mean age: 73.7±6.0 years; range, 65 to 88 years) with a high fall risk identified by the Thai falls risk assessment test between November 2018 and May 2019. Data from the 10-m walk test at a comfortable gait speed (CGS) and fast gait speed (FGS), timed up and go (TUG) test, five times sit to stand test (FTSST), and 6-min walk test (6MWT) were collected twice for each participant. The interval between test sessions was one week. Test-retest reliability was analyzed by the intraclass correlation coefficient (ICC). Standard error of measurement (SEM) and MDC at the 95% confidence interval (MDC95) were also calculated. Results: The four functional tests had ICC in the range of 0.92 to 0.97. The SEM values of the CGS, FGS, TUG, FTSST, and 6MWT were 0.06 m/sec, 0.04 m/sec, 1.10 sec, 1.30 sec, and 20.60 m, respectively. The MDC95 values of the CGS, FGS, TUG, FTSST, and 6MWT were 0.16 m/sec, 0.12 m/sec, 3.00 sec, 3.50 sec, and 57.20 m, respectively. Conclusion: All functional tests demonstrated excellent test-retest reliability. The SEM and MDC95 of all functional tests were established. These findings can help clinicians interpret the effectiveness of interventions and determine changes in functional ability over time in older adults at high risk of falls.

Impact of childhood and adult socioeconomic position on change in functional aging.

To examine life-course models by investigating the roles of childhood and adult socioeconomic position (SEP) in longitudinal changes in a functional aging index. Up to eight waves of testing, covering 25 years, were available from the Swedish Adoption/Twin Study of Aging: N = 654, intake age = 50-82. A two-slope latent growth curve model was applied to the data, and the impact of including childhood and adult SEP as covariates of the intercept (at age 70) and slopes (before and after age 70) was tested. Both childhood and adult SEP contributed to the best-fitting model. Childhood SEP was significantly associated with intercept and Slope 1 (before age 70) of the latent growth curve model (p < .05). Association of adult SEP with Slope 2 (after age 70) trended toward significance (p < .10). There was a significant interaction effect of childhood and adult SEP on the intercept (p < .05). As a result, intercept at age 70 was highest and change after age 70 was fastest for those whose SEP decreased from childhood to adulthood. Both childhood and adult SEP impact change in functional abilities with age, supporting both critical period and social mobility models. The social environment is modifiable by policies at local, national, and international levels, and these policies need to recognize that early social disadvantage can have long-lasting health impacts. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

IMPROVING REHABILITATION OUTCOMES FOR PEOPLE AGING WITH LONG-TERM HAND IMPAIRMENTS

Abstract Despite the importance of hand and upper extremity function in ADL performance and successful aging-in-place, contextual and engaging in-home rehabilitation interventions that promote use, feedback of progress, and long-term monitoring of changes in functional ability among individuals with chronic upper limb deficits are lacking. This presentation will present the findings from three TechSAge pilot projects focused on the use of technology to support in-home rehabilitation for individuals aging with long-term upper extremity disabilities. DigiHand, is a smartphone-based application combined with sensor-embedded objects used in daily activities (e.g., coffee cup) that enables users to self-manage their own rehabilitation, obtain feedback on progress to refine movements, and allow remote monitoring by therapists. Similarly, KeyStroke is an in-home piano training mobile app that provides engaging music exercises to promote long-term rehabilitation and therapists’ monitoring of progress of stroke survivors. Finally, 3DP for AT is generating design requirements to support the development of an open-source software tool that would allow assistive technology service providers, who are novice users of 3D printers, to create and fabricate highly customized 3D-printed assistive devices that are more durable, aesthetic, and will better meet the unique needs of people aging with long-term hand impairments.

The Effects of Cognitive Ability, Mental Health, and Self-Quarantining on Functional Ability of Older Adults During the COVID-19 Pandemic: Results From the Canadian Longitudinal Study on Aging.

Determine whether levels of anxiety and depression, cognitive ability, and self-quarantining during and prior to the pandemic predict decreases in perceived functional ability. Longitudinal data collected from the Canadian Longitudinal Study on Aging (CLSA) COVID-19 Questionnaire Study (2020) and core CLSA study (Follow-Up 1; 2014-2018). 17541 CLSA participants. Self-quarantining behaviours from questionnaires administered at Baseline (April 2020), Monthly, and Exit (December 2020) time points of the CLSA COVID-19 Questionnaire Study, levels of anxiety and depression at Baseline, perceived change in functional ability at Exit, and performance on neuropsychological tests (Rey Auditory Verbal Learning Task, Mental Alternation Task, Animal Fluency Test) and functional ability (Older Americans Resources and Services [OARS] Multidimensional Assessment Questionnaire) from the core CLSA study. Greater cognitive ability pre-pandemic (B = -.003, P < .01), higher levels of anxiety (B = -.024, P < .01) and depressive symptoms (B = -.110, P < .01) at Baseline, and higher frequency of engaging in self-quarantining throughout the COVID-19 survey period (B = -.098, P < .01) were associated with perceived loss in functional ability at Exit. Self-quarantining behaviour was associated with perceived loss in functional ability only at average and high levels of depressive symptoms (B = -.013, P < .01). Older adults with higher cognitive and lower functional ability prior to the pandemic were at greater risk of decreased perceived functional ability during the first year of the pandemic, as were those who experienced greater levels of anxiety and depressive symptoms during the pandemic. Strategies/interventions to preserve functional ability in older adults with cognitive independence prior to future pandemics are warranted.

Conditional Minimal Detectable Change for the Cochlear Implant Quality of Life-35 Profile Associated With Improved Functional Abilities 12 Months After Cochlear Implantation

It is essential to measure an individual patient's baseline and follow-up abilities to demonstrate changes in clinical outcomes over time. Inherent in this strategy is interpreting whether the measured change is clinically significant and beyond measurement error. Conditional minimal detectable change (cMDC) values are widely used in many disciplines but have rarely been established for outcome measures in otolaryngology or hearing research, and never in cochlear implantation. To determine cMDC values for the Cochlear Implant Quality of Life-35 (CIQOL-35) Profile instrument to enhance our understanding of the initial and ongoing changes in functional abilities from cochlear implants (CIs). Item response theory analyses of responses from a multi-institutional cohort of 705 CI users at a tertiary CI center were used to derive standard error (SE) values for each possible CIQOL-35 domain score. Using an iterative approach, these SE values were used to calculate cMDC values for every possible pre-CI and post-CI domain score combination. We then compared pre-CI to 12-month post-CI CIQOL-35 domains scores in an independent cohort of 65 adult CI users to determine whether the measured change exceeded error to be clinically significant. The analysis took place on December 14, 2022. The CIQOL-35 Profile instrument and cochlear implantation. The cMDC values were smaller for the communication domain, and global measure and cMDC values for all domains were larger at the extremes of the measurement scale. Overall, 60 CI users (92.3%) demonstrated improvement beyond cMDC at 12 months post-CI for at least 1 CIQOL-35 domain, and no patients' scores declined beyond cMDC for any domain. The percentage of CI users demonstrating improvement beyond cMDC varied by domain, with communication (53 [81.5%]) showing the largest number of CI users improving, followed by global (42 [64.6%]) and entertainment (40 [60.9%]). In general, CI users who demonstrated improvement in CIQOL-35 domains had greater improvement in speech recognition scores than patients who did not, but the strength and significance of these associations greatly varied by domain and speech material. This multistep cohort study found that cMDC values for the CIQOL-35 Profile provided personalized thresholds for detecting real changes in patient self-reported functional abilities over time across multiple domains, which may inform clinical decision-making. Moreover, these longitudinal results reveal the domains with more or less improvement, which may aid in patient counseling.

A quasi-experimental study of group counselling effectiveness for patient functional ability and quality of counselling among patients with hip arthroplasty.

The aim of this study was to investigate effectiveness of group counselling for the patients with hip arthroplasty, self-assessed functional ability, and quality of counselling. A quasi-experimental study. The questionnaire included the Counselling Quality Instrument (CQI), Harris hip score and Oldwellactive self-rated wellness profile. A Mann-Whitney U- and chi-squared and t-tests were used. A Wilcoxon singed rank test were used to evaluate changes in functional ability. Patients and the public were not involved in the design, recruitment and implementation of this study. Fifty patients participated. Patients reported better results for limping (p = 0.000), walking distance (p = 0.000) and use of a walking aid (p = 0.001) in the follow-up time point and they pain decreased. Patients were satisfied with interactions during counselling; gender (p = 0.000) and use of a walking aid (p = 0.044) were found to significantly affect. A lack of goal-oriented counselling was in depressive symptoms (p = 0.016), worries (p = 0.010) and loneliness (p = 0.026).

SMARTBATHROOM 102: STUDYING BATHING TRANSFER PERFORMANCE

Abstract Age-related changes in functional ability, particularly among people aging with long-term disabilities, can impact safe performance of toilet and bathtub transfers and severely limit their ability to successfully age-in-place. The SmartBathroom is a state-of-the-art bathroom laboratory that features mechanically adjustable features and an array of sensors that can measure walking performance, location of feet and hands, and forces applied to the bathroom surfaces and fixtures. To complement the SmartToilet system, TechSAge recently developed the SmartBathing Transfer Testbed prototype that will enable us to study how different bathing environment configurations can impact transfer performance. The testbed consists of a height adjustable tub wall and three-wall, height and angle adjustable grab bars with integrated sensors to measure hand location and grip and load forces. This session will describe the SmartBathing Testbed and present results of studies with individuals both with and without ambulatory impairments performing simulated transfers within the testbed.

Multi-dimensional recording of long-term treatment of patients with schizophrenic disorders compared to patients with major depression measured with the ASSESS battery

BackgroundThe aim of the study was to validate the course and outcome of treatment in patients with schizophrenic disorders and to compare it with those of patients with depression using a multidimensional assessing approach measuring psychopathological, social and cognitive levels of functioning. MethodsWe recruited N = 86 chronically ill patients, n = 41 with schizophrenic disorders and n = 45 with depression and examined them by means of the ASSESS battery with 5 measuring points within one year. ResultsPsychopathological symptoms and cognitive functioning changed over time, but still remained. Furthermore, changes in functional ability in the psychosocial area were observed in the overall collective. The course of the patients with schizophrenic disorders differed especially from that of the patients with depression in relation to the domain personal relationships. In both groups, symptoms of the disease correlated negatively with cognition and psychosocial functioning. Cognitive deficits were associated with a reduced level of psychosocial functioning. DiscussionThe ASSESS battery proved to be a practicable measuring instrument for complex assessment of the course of the disease in patients with schizophrenic disorders as well as depression. The stable course of symptoms in both disorders as well as psychosocial differences would have to be further confirmed in long term studies to derive necessary treatment recommendations.

THE EFFECT OF STRENGTHENING EXERCISE ON THE QUADRICEPT AND HAMSTRING MUSCLES ON CHANGING FUNCTIONAL KNEES FOR PATIENTS WITH KNEE OSTEOARTHRITIS

Introduction Osteoarthritis is a failure to repair damage in the joints caused by excessive mechanical stress. This disease is chronic, degenerative, non-inflammatory, and slowly progressive, one of which is characterized by decreased function. Osteoarthritis is a form of osteoarthritis that affects people in old age or adulthood. The cause of osteoarthritis is not known with certainty, but age, gender, race, genetics, obesity, and physical activity are risk factors that lead to pathological changes and affect the decreased functional ability. This decrease in functional ability in osteoarthritis can be overcome by isometric exercise.Methods: The research design used was a pre-experimental design with an approach of pretest-posttest one group design. The sampling technique used was total sampling, with a total of 20 respondents aged 40–70 years. Exercise with a frequency of 2 times a week for 8 weeks at an intensity of 3 repetitions for 15 minutes. The measuring instrument in this study used WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index). Normality test using the Shapiro-Wilk test, hypothesis testing using the Wilcoxon Test.The results showed the level of functional ability before being given the intervention had an average value of 2.30 and after being given the intervention had an average value of 1.40. Statistical test results showed p-value = 0.000 (p 0.005). This shows that there is an effect of isometric exercise on changes in functional abilities of patients with Samarinda knee osteoarthritis at AW Sjahranie Hospital.Conclusion: Giving isometric exercise to the quadriceps and hamstrings has an effect on improving the functional ability of the knee in patients with osteoarthritis.

Effect of a structured aqua-plyometric exercise program on postural control and functional ability in children with hemiparetic cerebral palsy: A two-arm randomized controlled trial.

Individuals with hemiparetic cerebral palsy (h-CP) encounter postural control issues that largely interfere with activity and participation. So, there might be a need for improved, clearly effective rehabilitation protocols that target postural control dysfunction, which may, then, reduce activity limitations and participation restrictions. This trial was undertaken to examine the effect of a structured, 12-week aqua-plyometric (Aqua-PLYO) exercise program on postural control and functional ability in children with h-CP. Fifty-six children with h-CP took part in a two-arm, randomized single-blind controlled trial. They were randomly assigned to either receive the standard physical therapy (Control group; n = 28) or the Aqua-PLYO training program (Aqua-PLYO group; n = 28), three times/week over 12 consecutive weeks. The dynamic limit of stability [i.e., movement directional control (M-DC), reaction time (ReT), movement velocity (M-Vel), endpoint excursion (EP-Exc), and maximum excursion (M-Exc)] and functional ability [i.e., 30-second sit-to-stand test (30sec-STS), timed up and down stairs test (TUDS), and the dynamic gait index (DGI)] were assessed pre- and post-treatment. From the pre- to post-treatment occasion, the Aqua-PLYO group achieved greater improvement for the M-DC (P = 0.013), ReT (P = 0.004), M-Vel (P = 0.03), EP-Exc (P = 0.002), and M-Exc (P = 0.006), compared to controls. Besides, the Aqua-PLYO group showed more conducive changes in functional ability [as evidenced by the 30sec-STS (P = 0.005), TUDS (P = 0.002), and DGI (P = 0.004) scores]. Aqua-PLYO training is likely an effective training paradigm for enhancing postural control and functional ability in children with h-CP. Further studies are, however, recommended to substantiate the current evidence.

The Association Between Level of Physical Activity and Body Mass Index, and Quality of Life Among Elderly Women.

The process of aging leads to changes in functional abilities, fitness levels, level of physical activity, and body mass index (BMI), all of which causes changes in the quality of life. The current study aims to determine the association between the level of physical activity (PA) and BMI, and quality of life (QoL) among elderly women. The total sample numbered 156 women, with an average age of 67.7 ± 5.6 years. To determine the level of physical activity, the self-reported International Physical Activity Questionnaire Long Form (IPAQ-LF), was used. To calculate the values of the BMI, the standard procedure recommended by the World Health Organization was used. Quality of life was evaluated using the short form of the WHOQOL-BREF questionnaire designed by the World Health Organization. All the data were processed using the statistical package for data analysis SPSS 20.0. Pearson’s correlation analysis shows statistically significant relations at the level of p < 0.01 between PA and Physical health in Housework = 0.36, Leisure time PA = 0.27, Walking = 0.24, Moderate PA 0.43, Total PA = 0.43, while the correlations between the variables at the significance level of p < 0.05 were determined in PA in transportation = 0.19 and High-intensity PA = 0.16. Multiple linear regression analysis of different levels of PA as independent variables on individual domains of QoL shows that there is an association of PA and Physical health (Sig = 0.000), more precisely, Total PA is statistically the most closely related to Physical health (Sig = 0.000), and then follows PA at work and Social relations (Sig = 0.036). Similar results were obtained when BMI is added to model A. In contrast to model A, model B shows a statistically significant association between PA and BMI with the environmental domain of QoL (Sig = 0.001). The results of the current study indicate that high- and moderate-intensity physical activity both have benefits for physical health, whereas moderate PA showed higher significance levels. Results also show that elderly women with higher BMI values achieve better results in the environmental domain of QoL.

Inspiratory muscle training in children and adolescents living with neuromuscular diseases: A pre-experimental study.

BackgroundChildren with neuromuscular diseases (NMD) are at risk of morbidity and mortality because of progressive respiratory muscle weakness and ineffective cough. Inspiratory muscle training (IMT) aims to preserve or improve respiratory muscle strength, thereby reducing morbidity and improving health-related quality of life (HRQoL).ObjectivesTo describe the safety and feasibility of a 6-week IMT programme using an electronic threshold device (Powerbreathe®). Any adverse events and changes in functional ability, spirometry, peak expiratory cough flow (PECF), inspiratory muscle strength and HRQoL (Pediatric Quality of Life [PedsQL]) were recorded.MethodsA convenience sample of eight participants (n = 4 boys; median [interquartile range {IQR}] age: 12.21 [9.63–16.05] years) with various NMD were included in a pre-experimental, observational pre-test post-test feasibility study. Training consisted of 30 breaths, twice daily, 5 days a week, for 6 weeks.ResultsThere were significant pre- to post-intervention improvements in upper limb function and coordination (p = 0.03) and inspiratory muscle strength: maximum inspiratory mouth pressure (Pimax) (p = 0.01); strength-index (p = 0.02); peak inspiratory flow (PIF) (p = 0.02), with no evidence of change in spirometry, PECF or HRQoL. No adverse events occurred and participant satisfaction and adherence levels were high.ConclusionInspiratory muscle training (at an intensity of 30% Pimax) appears safe, feasible and acceptable, in a small sample of children and adolescents with NMD and was associated with improved inspiratory muscle strength, PIF and upper limb function and coordination.Clinical implicationsLarger, longer-term randomised controlled trials are warranted to confirm the safety and efficacy of IMT as an adjunct respiratory management strategy in children with NMD.

Development of a Clinical Global Impression of Change (CGI-C) and a Caregiver Global Impression of Change (CaGI-C) measure for ambulant individuals with Duchenne muscular dystrophy

BackgroundIn clinical trials for rare diseases, such as Duchenne muscular dystrophy, clinical outcome assessments (COA) used to assess treatment benefit are often generic and may not be sensitive enough to detect change in specific patient populations. Thus, there is a need for disease specific COAs that track meaningful change among individuals. When developing such measures, input from clinicians, caregivers and patients is critical for assessing clinically relevant concepts and ensuring validity of the measure.MethodThe aim of this study was to develop two Duchenne-specific global impression items for use in clinical trials. The development of the Duchenne Clinical Global Impression of Change (CGI-C) and Caregiver Global Impression of Change (CaGI-C) was informed by findings from concept elicitation (CE) interviews with clinicians, caregivers and individuals with Duchenne. Through cognitive debriefing (CD) interviews, clinicians and caregivers evaluated draft CGI-C and CaGI-C items to ensure relevance and understanding of the items and instructions. Suggestions made during the CD interviews were incorporated into the finalized CGI-C and CaGI-C measures.ResultsThe symptoms most frequently reported by clinicians, caregivers and individuals with Duchenne were muscle weakness, fatigue, cardiac difficulties and pain. Regarding physical functioning, all three populations noted that small changes in functional ability were meaningful, particularly when independence was impacted. Caregivers and clinicians reported that changes in speed, endurance and quality of movement were important, as was improvement in the ability of individuals to keep up with their peers. A change in the ability to complete everyday activities was also significant to families. These results were used to create two global impression of change items and instruction documents for use by clinicians (CGI-C) and caregivers (CaGI-C). Overall, both items were well understood by participants. The descriptions and examples developed from the CE interviews were reported to be relevant and appropriate for illustrating different levels of meaningful change in patients with Duchenne. Modifications were made based on caregiver and clinician CD feedback .ConclusionsAs part of a holistic measurement strategy, such COA can be incorporated into the clinical trial setting to assess global changes in relevant symptoms and functional impacts associated with Duchenne.

23. Functional Impact of Pelvic Floor Physical Therapy on Adolescents with Biopsy Confirmed Endometriosis at a Tertiary Children's Hospital: A Case Series

<h3>Background</h3> Chronic pelvic pain is a hallmark sign of endometriosis in adolescents and can persist in the form of musculoskeletal pain despite medical management. There is limited evidence to support that pelvic floor physical therapy (PT) is an effective intervention in treating chronic pelvic pain secondary to endometriosis in adolescents. The purpose of this case series is to describe the change in functional ability in adolescent females following pelvic floor PT management of chronic pelvic pain as part of a multidisciplinary approach. <h3>Case</h3> Participants included twenty adolescent females median age 16.5 years (IQR 3). Retrospectively, participants were included if they were referred to pelvic floor PT for chronic pelvic pain by Pediatric and Adolescent Gynecology between April 2018 and August 2019. All participants included had diagnostic laparoscopy performed with biopsy confirmed endometriosis. Fifteen participants had surgery before referral to PT and 5 participants had surgery after starting PT. The median duration of symptoms prior to referral to PT was 2 years (IQR 1.75). Pelvic floor PT included patient education, relaxation techniques to decrease pelvic floor muscle tone, manual therapy, breathing and postural retraining, and therapeutic exercise including pelvic floor muscle strengthening. Due to the adolescent age of the participants, all pelvic floor PT techniques were only performed externally. The Patient Specific Functional Scale (PSFS) assesses patient reported function and was utilized to determine functional improvements in participants referred to pelvic floor PT. The PSFS is a 0 to 10 point scale with 0 representing maximal disability and 10 representing no disability. Participants were able to self-report between one and three functional impairments with this outcome measure. In this case series, the PSFS score was represented as a percentage rather than a raw number to account for the variable number of impairments patients could report. Functional status was captured at initial evaluation and participants demonstrated a baseline score of 45.1% (IQR 16.66) on the PSFS. Functional status was captured throughout their course of PT care with the PSFS. Participants self-reported a clinically significant functional median improvement of 23.3% (IQR 41.66) over a median number of 12 visits (IQR 10.50) (p<0.001). <h3>Comments</h3> Participants in this case series reported significant functional improvement on the PSFS over the course of pelvic floor PT. This case series suggests that PT may be a helpful treatment option in the multidisciplinary approach to improve patient function in adolescents with endometriosis. Additional prospective controlled trials are warranted to assess the benefits of PT in this population.

Increase of Consultants’ Work Efficiency Using ICT at the Lithuanian Agricultural Advisory Service

Information and communication technologies (ICT) allow increase of work efficiency of accounting data processing and business management. Traditional understanding of work efficiency most cases deals only with productivity of consultants, who are providing accounting data input, processing and preparation of reports for farmers. Less attention has be paid to changes of functional abilities of software, technical and communication equipment as well as behaviour of staff, providing consulting service. This article include results of theoretical analysis of factors, influencing understanding of consultants work efficiency in face with higher needs and expectations of consumers. For empirical investigation there were used the data received during questioning of consultants working at the Lithuanian Agricultural Advisory Service who are providing processing of farmers’ farms’ accounting data, preparing various reports for tax office and other official institutions, providing analysis of financial situation of the farms and taking recommendations on improvement of farms management. As the results of made research shown changes that have occurred at the Lithuanian Agricultural Advisory Service over the last two decades due to modernisation of data processing software and modern ICT use.

Anaemia and physical and mental health in the very old: An individual participant data meta-analysis of four longitudinal studies of ageing.

To determine the physical and mental health of very old people (aged 80+) with anaemia. Individual level meta-analysis from five cohorts of octogenarians (n = 2,392): LiLACS NZ Māori, LiLACS NZ non-Māori, Leiden 85-plus Study, Newcastle 85+ Study, and TOOTH. Mixed models of change in functional ability, cognitive function, depressive symptoms, and self-rated health over time were separately fitted for each cohort. We combined individual cohort estimates of differences according to the presence of anaemia at baseline, adjusting for age at entry, sex, and time elapsed. Combined estimates are presented as differences in standard deviation units (i.e. standardised mean differences-SMDs). The combined prevalence of anaemia was 30.2%. Throughout follow-up, participants with anaemia, on average, had: worse functional ability (SMD -0.42 of a standard deviation across cohorts; CI -0.59,-0.25); worse cognitive scores (SMD -0.27; CI -0.39,-0.15); worse depression scores (SMD -0.20; CI -0.31,-0.08); and lower ratings of their own health (SMD -0.36; CI -0.47,-0.25). Differential rates of change observed were: larger declines in functional ability for those with anaemia (SMD -0.12 over five years; CI -0.21,-0.03) and smaller mean difference in depression scores over time between those with and without anaemia (SMD 0.18 over five years; CI 0.05,0.30). Anaemia in the very old is a common condition associated with worse functional ability, cognitive function, depressive symptoms, and self-rated health, and a more rapid decline in functional ability over time. The question remains as to whether anaemia itself contributes to worse outcomes or is simply a marker of chronic diseases and nutrient deficiencies.

Potential associated factors of functional disability in Chinese older inpatients: a multicenter cross-sectional study

BackgroundThere is still controversy about the relationship between aging and changes in functional ability. This study aims to describe the level of basic activities of daily living (ADL) and higher-level instrumental activities of daily living (IADL) in different age groups and explore the factors associated with functional disability in Chinese older inpatients.MethodsThis cross-sectional study surveyed 9996 older inpatients aged 65 years and older from six tertiary hospitals in China from October 2018 to February 2019. The levels of ADL and IADL were measured by scores of the Barthel index and Instrumental Activities of Daily Living Scale. A mixed-effect generalized linear model was used to examine the association between functional disability and covariates.ResultsThe average ADL score was 89.51 ± 19.29 and the mean IADL score 6.76 ± 2.01 for all participants. There was a trend of decreasing scores along with aging, and significant differences between age groups were also observed (P < 0.001). The most affected ADL and IADL was stair climbing and shopping, respectively. Sociodemographic characteristics (such as age), physical health variables (frailty, emaciation, hearing dysfunction, urinary dysfunction, defecation dysfunction, falling accidents in the past 12 months), and mental health variables (cognitive dysfunction, depression) were associated with functional disability. Patients from the emergency department or transferred from other hospitals and former alcohol drinkers are at risk of ADL disability. Former smoking is a risk factor for IADL disability, whereas current drinking, higher-level education, and residing in a building without elevators were likely to maintain a better IADL performance.ConclusionsFunctional ability declines with aging, older inpatients are low dependency upon ADL and IADL. There are several associated factors among the participants derived from this investigation of a large-scale, multicenter, nationally representative Chinese older inpatient population. These findings potentially have major importance for the planning of hospital services, discharge planning, and post-discharge care.Trial registrationChinese Clinical Trial Registry, ChiCTR1800017682, registered August 9, 2018.

Exploring the Predictive Ability of the Motor-Free Visual Perception Test (MVPT) and Trail Making Test (TMT) for On-Road Driving Performance.

Resuming driving after a change in functional ability is challenging for patients with a neurological condition. Although a combination of assessment tools has been suggested for use in driving evaluation, resources and availability of tools have been a problem. To examine the predictive ability of two commonly used tools, the Motor-Free Visual Perception Test (MVPT) and the Trail Making Test, Parts A and B (TMTA and TMTB), on on-road driving performance. Retrospective chart review of 82 patient charts between 2015 and 2016. Local rehabilitation hospital. Eighty-two patients with a primary neurological diagnosis (general neurological condition, n = 13; spinal cord injury, n = 11; stroke, n = 58). MVPT, TMTA, and TMTB. Among the patients, 36 passed and 46 failed the on-road evaluation. The TMTA and TMTB scores were significantly different between those who passed or failed the on-road evaluation. Logistic regression analyses revealed that the TMTB completion time was the only significant predictor of on-road driving performance (for the all-patient model, 66% prediction accuracy, -2 log-likelihood [LL] = 93.47, exp β = 0.98; for the stroke-only model, 76% prediction accuracy, -2LL = 59.61, exp β = 0.97). Our findings suggest that the TMTB is a better predictor of on-road driving performance for patients with a neurological condition than the MVPT. The findings shed light on the importance of selecting proper tools when assessing driving performance. Future prospective studies with a wider array of predictive variables are recommended to support the present findings. Occupational therapists should revisit the use of the MVPT in driving assessment and consider multiple assessment tools when evaluating and predicting driving performance.

Clinically Meaningful Changes In Mobility After An Exercise Program For Older Adults

Aging is associated with a progressive decline in muscle strength and mass, eventually leading to reduced functional ability and disability. Regular physical activity can slow this inevitable decline and promote physical wellbeing, improve physical function and reduce risk of chronic diseases in older adults. However, meaningful improvements in physical function for individuals in response to a training stimulus are often missed when only group effects are considered. PURPOSE: to examine interindividual variation in changes in functional ability in response to a 10-week exercise intervention designed to improve physical function in older adults. METHODS: 97 older adults (age= 72.7 yrs+7.9); BMI=32.3+7.2) completed the 10-week Physical Activity for Seniors for Life (PALS) group exercise and lifestyle behavior change program. 6MW (distance covered in 6 minutes), and UGS (meters/second (m/s) to walk 6 m distance) were measured before and after the exercise program. RESULTS: There was a significant (p<.05) improvement in 6mw and UGS for the group (m=60.2 meters and 0.1045 m/s respectively). For 6mw, 27% did not improve more than 20 meters (>20 meters is small meaningful change), 23% improved between 20 and 50 meters, and 50% improved more than 50 meters (>50 meters is substantial meaningful change). For UGS 38% showed less than 0.05 m/s improvement (0.05 m/s is small meaningful change), 12% improved between 0.05 and 0.1 m/s, and 47% improved more than 0.1 m/s (0.1 m/s is substantial meaningful change). CONCLUSIONS: Consideration of individual variability is important in establishing the clinical meaningfulness of improvements in physical function in response to exercise programs designed for older adults.