Change In Physical Disability Research Articles

Predictors of post-stroke depression: Validation of established risk factors and introduction of a dynamic perspective in two longitudinal studies.

Cerebral insults lead in many cases not only to cognitive impairment but also to disturbed emotionality. After stroke, one in three survivors develops a depression which impacts quality of life and rehabilitation. Meta-analyses have identified five main predictors of post-stroke depression (PSD): history of mental disorder, stroke severity, physical disability, cognitive impairment, and social support. However, these five established variables have never been conjointly investigated in a sample of stroke survivors. Therefore, their independent predictive values remain unclear. Moreover, predictors are most often used as time-invariant factors (status scores), neglecting the intraindividual dynamics after stroke. Our study analyses the data of two prospective longitudinal studies, investigating stroke survivors from two rehabilitation hospitals (N 1 = 273) and one acute care hospital (N 2 = 226). Baseline assessments included the five established predictors and depressive symptoms. After 6 months, depressive symptoms were reassessed in both studies (n 1 = 176, n 2 = 183), and physical disability and social support were reassessed in study 2. The predictivity of the five predictors and the additional predictivity of intraindividual dynamics for PSD were examined in multiple linear regression analyses. History of mental disorder was a risk factor for depressive symptoms after stroke at all measurement times (B = 3.32 to 3.97; p < 0.01). Physical disability was a risk factor at all measurement times (B = -0.09 to -0.03; p < 0.05) except 6 months after rehabilitation. Social support was a protective factor (B = -2.69 to -1.91; p < 0.01) outside the acute phase (R 2 = 0.15-0.39). Intraindividual changes in physical disability and perceived social support were independent predictors of PSD 6 months after the acute phase (B = -0.08/-0.14; p < 0.01), in addition to status scores on established variables (ΔR 2 = 0.08, p < 0.001). History of mental disorder, physical disability, and social support are independent predictors of depressive symptoms in the first year post-stroke, also when considered conjointly. Future studies should control for these variables when investigating new predictors of PSD. In addition, intraindividual changes in known predictors after stroke play a relevant role in the pathogenesis of PSD and should be considered in clinical practice and future research.

TO INVESTIGATE THE ASSOCIATION OF DOSE-DEPENDENT VITAMIN D SUPPLEMENT ON CLINICAL OUTCOMES IN VETERANS WITH MULTIPLE SCLEROSIS

Objective: To investigate the association of daily dose-dependent Vitamin-D supplement on clinical outcomes including mortality in veterans with multiple sclerosis (MS) with low serum Vitamin-D (25[OH]D) levels. This Methods: observational, longitudinal study reports on data collected from 1/1/2000 to 12/31/2020 at the MS Regional Program. We reviewed the electronic records of 163 veterans with MS who were followed every four months in our MS clinic. The study sample was divided into three groups based on the daily Vitamin-D supplement doses: low (1000 IU/day), medium (2000 IU/day) and high (4000 IU/day). The clinical outcomes were changes in physical disability (Expanded Disability Severity Scale (EDSS)), function (Total Function Independence Measures (TFIM)), time-to-event EDSS score of 6 (progressive MS) and mortality. Results: There were 32 patients in the low, 46 in the medium, and 85 in the high-dose daily Vitamin-D supplement groups. The mean age of the entire study sample was 51 12 SD years (range 23 - 79 years). The mean duration of MS was 21.7 13 years. The mean initial EDSS and TFIM scores were 3.4 2.8 and 111 17 SD. At entry, mean serum 25[OH]D and calcium levels were 30 16 nmol/l and 9.3 0.4. The risk of MS-related progressive disability (time-to-event EDSS score 6) was lower and there were fewer deaths in the high- (compared to low- and medium-) dose groups. Conclusion: This study suggests that among veterans with MS and low 25[OH]D levels, those who received high-doses daily of supplemental Vitamin-D supplement were associated with a decreased risk of MS-related progressive disability and death than those who received a lower dose. No adverse clinical or biochemical events were noted.

Real-life evidence of treatment with alemtuzumab in patients diagnosed with relapsing-remitting multiple sclerosis in Colombia

Physical disability, cognitive impairment, depression, and fatigue are poorly understood in Latin American patients with multiple sclerosis following alemtuzumab infusion. To describe Sustained changes in physical disability in an average 22-month follow-up period after alemtuzumab infusion, and which demographical or clinical variables modulate change in EDSS, and adverse events, changes in cognition, fatigue, and depressive symptoms after an average 15-month follow-up period. Retrospective cohort observational study. Following the review of medical records, 23 patients with Relapsing Remitting Multiple Sclerosis treated with alemtuzumab were identified; of these, 17 had a baseline neuropsychological assessment and 12 had at least one follow-up neuropsychological assessment. Most of the patients presented a low level of physical disability, depression, fatigue, and cognitive impairment, which was more pronounced in the processing speed and visuospatial memory at baseline. Fifteen of 23 (65.2%) of patients showed disability improvement, 7 (30.1%) patients remained stable, and 1 (4.3%) patient worsened, and change was not influenced by age or baseline disability score. Twenty (87%) patients remained free of clinical relapses. Performance improved on the BVMT-R visual memory test, 9 (75%) remained stable or improved on the BICAMS, and 66.6% perceived decreased fatigue on the d-FIS. Adverse events occurred in 7 (30.1%) of patients, the most common were opportunistic infections in 2 (8.6%) patients, and one 29-year-old patient presented papillary thyroid carcinoma after infusion of the second course of alemtuzumab. Results suggest that treatment with alemtuzumab has a beneficial impact on disability, cognitive impairment, and perception of fatigue. The percentage and type of adverse events observed in the cohort are similar to those reported for other real-life studies.

Disease-related disability burden: a comparison of seven chronic conditions in middle-aged and older adults

BackgroundAlthough previous studies have explored the effect of chronic conditions on physical disability, little is known about the levels and rates of change in physical disability after a chronic condition diagnosis in middle-aged and older adults in the Asian population. The aim of this study is to ascertain the average levels and rates of change in the development of disability after disease diagnosis, as well as to determine the influences of sociodemographic and health-related correlates in the development of disability.MethodsThis is a retrospective cohort study analyzing data of nationally representative participants aged 50 and over with a chronic condition or having developed one during follow-ups based on data from the 1996–2011 Taiwan Longitudinal Study on Aging (TLSA) (n = 5131). Seven chronic conditions were examined. Covariates included age at initial diagnosis, gender, education level, number of comorbidities, and depression status. Physical disability was measured by combining self-reported ADL, IADL, and strength and mobility activities with 17 total possible points, further analyzed with multilevel modeling.ResultsThe results showed that (1) physical disability was highest for stroke, followed by cancer and diabetes at the time of the initial disease diagnosis. (2) The linear rate of change was highest for stroke, followed by lung disease and heart disease, indicating that these diseases led to higher steady increases in physical disability after the disease diagnosis. (3) The quadratic rate of change was highest in diabetes, followed by cancer and hypertension, indicating that these diseases had led to higher increments of physical disability in later stage disease. After controlling for sociodemographic and comorbidity, depression status accounted for 39.9–73.6% and 37.9–100% of the variances in the physical disability intercept and change over time, respectively.ConclusionsDespite the fact that a comparison across conditions was not statistically tested, an accelerated increase in physical disabilities was found as chronic conditions progressed. While stroke and cancer lead to disability immediately, conditions such as diabetes, cancer, and hypertension give rise to higher increments of physical disability in later stage disease. Mitigating depressive symptoms may be beneficial in terms of preventing disability development in this population.

Long-term course and morphological MRI correlates of cognitive function in multiple sclerosis

Background: Cognitive impairment frequently occurs in patients with MS (pwMS). Magnetic resonance imaging (MRI) markers could help to identify patients at risk for decline. Objective: To characterize the long-term course and morphological MRI correlates of cognitive function in pwMS. Methods: We invited 116 pwMS who had undergone clinical, cognitive, and MRI evaluations between 2006 and 2012 (baseline, BL) to attend follow-up (FU) testing between 2016 and 2018. Disability (expanded disability status scale (EDSS)), cognition (brief repeatable battery of neuropsychological test (BRB-N)), global and regional T2-lesion load (T2-LL), brain volumes, and cortical thickness were assessed. Results: Sixty-three pwMS were willing to attend the FU (54%; median EDSS = 2, interquartile range (IQR) = 2) and did not differ from non-participating pwMS regarding BL characteristics. At BL, half of the participants showed cognitive deficits in at least one domain. Across the entire group, we observed no relevant changes in physical disability and cognition over 10 years. BL thalamic volume best predicted cognitive function at FU, in addition to age and BL cognition, explaining 67% of variance. Cognitive decliners (23.8%) were older, had longer disease duration, and a tendency for lower thalamic volume at BL. Conclusion: Thalamic volume predicted FU cognitive function and distinguished declining from stable pwMS, underlining the potential of MRI to define risk groups.

The effectiveness of shared decision-making followed by positive reinforcement on physical disability in the long-term follow-up of patients with nonspecific low back pain in primary care: a clustered randomised controlled trial

BackgroundAlthough the recovery of patients suffering from low back pain is highly context dependent, patient preferences about treatment options are seldom incorporated into the therapeutic plan. Shared decision-making (SDM) offers a tool to overcome this deficiency. The reinforcement by the general practitioner (GP) of a ‘shared’ chosen therapy might increase patients’ expectations of favourable outcomes and thus contribute to recovery.MethodsIn the Netherlands, a clustered randomised controlled trial was performed to assess the effectiveness of shared decision-making followed by positive reinforcement of the chosen therapy (SDM&PR) on patient-related clinical outcomes. Overall, 68 GPs included 226 patients visiting their GP for a new episode of non-chronic low back pain. GPs in the intervention group were trained in implementing SDM&PR using a structured training programme with a focus on patient preferences in reaching treatment decisions. GPs in the control group provided care as usual. The primary outcome was the change in physical disability measured with the Roland-Morris disability questionnaire (RMD) during the six-month follow-up after the first consultation. Physical disability (RMD), pain, adequate relief, absenteeism and healthcare consumption at 2, 6, 12 and 26 weeks were secondary outcomes. A multivariate analysis with a mixed model was used to estimate the differences in outcomes.ResultsOf the patients in the intervention and the control groups, 66 and 62%, respectively, completed the follow-up. Most patients (77%) recovered to no functional restrictions due to back pain within 26 weeks. No significant differences in the mean scores for any outcome were observed between intervention patients and controls during the follow-up, and in multivariate analysis, there was no significant difference in the main outcome during the six-month follow-up. Patients in the intervention group reported more involvement in decision-making.ConclusionThis study did not detect any improvement in clinical outcome or in health care consumption of patients with non-chronic low back pain after the training of GPs in SDM&PR. The implementation of SDM merely introduces task-oriented communication. The training of the GPs may have been more effective if it had focused more on patient-oriented communication techniques and on stressing the expectation of favourable outcomes.Trial registrationThe Netherlands National Trial Register (NTR) number: NTR1960. The trial was registered in the NTR on August 20, 2009.

The Relation of Volunteering and Subsequent Changes in Physical Disability in Older Adults.

To describe the association between initiating volunteering and changes in physical disability in older adults, and whether intensity and gender modify this relationship. Employing propensity score weighted regression adjustment, we calculate changes in disability using a sample of U.S. adults (n = 7,135) in the Health and Retirement Study (1996-2012) not volunteering at baseline but later initiating volunteering (1-99 hr/year or 100+ hours per year) or remaining a nonvolunteer. Relative to continuous nonvolunteers, low-intensity volunteering is related to 34% lower disability in the low-intensity group (average treatment effect [ATE] = -0.12) and 63% lower in the higher-intensity group (ATE = -0.23). For men, progression was lower only in the highest intensity group (ATE = +0.02), but women experienced similarly less progression of disability (38%-39%) at either level of new engagement (ATE = -0.17 and -0.18). Initiating a new volunteer role in later life is related to decreased progression of disability, at low or high levels for women and only at higher levels for men. This study suggests that volunteer intervention programs may represent a major public health strategy to delay the progression of physical disability for older adults.

Changes in physical activity measured by accelerometry following initiation of DMARD therapy in rheumatoid arthritis

The aim of this study was to assess changes in habitual physical activity levels in response to DMARD therapy in RA patients. Eighteen drug-naive RA patients were prospectively assessed at baseline and following 3 months of DMARD therapy for habitual physical activity by accelerometry, disease activity using the clinical disease activity index (CDAI) and functional disability using the modified HAQ (mHAQ). Baseline physical activity was also compared with an equal number of healthy control participants matched for age, sex and BMI. Following 3 months of DMARD therapy, in parallel with significant improvements in CDAI scores (P < 0.001) and HAQ scores (P < 0.001), accelerometry measures in the RA cohort showed that the average activity counts in sedentary thresholds decreased (P = 0.012), while average activity counts within higher-intensity thresholds increased (P = 0.039). Multiple regression analysis showed that the change in moderate activity was associated with a decrease in CRP (β = - 0.922, P = 0.026) while the decrease in sedentary activity and increase in moderate activity were associated with decreased morning stiffness of the joints (β = 0.694, P = 0.035 and β = -0.927, P = 0.024, respectively). At baseline, RA patients were less physically active than control participants in the morning (P = 0.048) and in the late afternoon (P = 0.016), but these diurnal differences were no longer significant after the DMARD intervention. These findings suggest that accelerometry may potentially be a viable objective method of assessing changes in physical disability in response to various disease-modifying drugs.

Relationship status and quality moderate daily pain-related changes in physical disability, affect, and cognitions in women with chronic pain

The objectives of this study were to examine whether (1) daily pain-related changes in physical functioning differed between happily partnered, unhappily partnered, and unpartnered female chronic pain patients, and (2) affect and pain cognitions mediated the partner status effect on pain-related changes in physical functioning. Two hundred fifty-one women with chronic pain due to osteoarthritis and/or fibromyalgia completed 30 daily electronic diaries assessing pain, affect, pain-related cognitions, and physical functioning. Patients living with a romantic partner also completed a modified version of the Locke-Wallace Marital Adjustment Scale to assess relationship satisfaction. Multilevel modeling revealed that patients in satisfying unions showed more adaptive daily pain-related changes in physical functioning, pain coping difficulty, and catastrophizing compared to those in unsatisfying unions and those who were unpartnered. Both partnered groups also showed more adaptive pain-related changes in positive affect compared to the unpartnered group. The impact of relationship status on pain-related changes in physical functioning was partly mediated by the pain cognitions catastrophizing and coping difficulty. These results indicate that happily partnered pain patients show less pain-related physical disability and more adaptive affective and cognitive responses to daily pain changes than do unhappily partnered and unpartnered patients. Living in a happy union may bolster the capacity of patients to sustain a sense of pain coping efficacy during pain episodes, which in turn, minimizes pain-related physical activity limitations.

Prospective associations between cardiovascular reactions to acute psychological stress and change in physical disability in a large community sample

Exaggerated haemodynamic reactions to acute psychological stress have been implicated in cardiovascular disease outcomes, while lower reactions have been considered benign. This study examined, in a large cohort, the prospective associations between stress reactivity and physical disability. Blood pressure and pulse rate were measured at rest and in response to a stress task. Physical disability was assessed using the OPCS survey of disability at baseline and five years later. Heart rate reactivity was negatively associated with change in physical disability over time, such that those with lower heart rate reactivity were more likely to deteriorate over the following five years. These effects remained significant following adjustment for a number of confounding variables. These data give further support to the recent argument that for some health outcomes, lower or blunted cardiovascular stress reactivity is not necessarily protective.

Diabetes-related change in physical disability from midlife to older adulthood: Evidence from 1996–2003 Survey of Health and Living Status of the Elderly in Taiwan

One in five older adults in Taiwan have been diagnosed with diabetes. This study drew on disability data for 5121 nationally representative middle-aged and older adults from the 1996–2003 Survey of Health and Living Status of the Elderly in Taiwan (SHLSET). By employing cohort sequential design and multilevel models, it combined cross-sectional and longitudinal evidence to characterize the age trajectory of physical disability from midlife to older adulthood and to discern the extent to which diabetes contributes to the variation in that trajectory. The main effects of diabetes and diabetes×age interaction in the fully controlled model provide evidence that diabetes independently and consistently changes physical functioning over and above natural aging processes in Taiwanese adults. In addition, while adding diabetes in the age trajectory of physical disability explained 3.2% and 1.6% of the variance in levels of and linear changes in physical disability trajectory, respectively, further adding follow-up status, sociodemographic factors and comorbidities altogether explained 40.5% and 29.1% of the variance in levels of and linear changes in that trajectory. These results imply that preventing the incidence of diabetes-related comorbidities may reduce the deterioration in both levels of and rates of change in physical disability.

Patient dissatisfaction: insights into the rehabilitation process.

Most patients admitted for inpatient rehabilitation find it beneficial even when there is little change in physical disability. The aim of this study was to determine the characteristics of patients who felt that they had not benefited from inpatient rehabilitation and to delineate the underlying reasons for this perception. From a database of 331 patients admitted to a neurological rehabilitation unit over a three-year period, we ascertained those with a low score (< 5) on a self-rated visual analogue scale (VAS) regarding their perception of the benefit of rehabilitation. We investigated their disability outcomes, aspects of the rehabilitation process through analysis of integrated care pathways, and from inspection of the multidisciplinary record identified specific adverse factors which might contribute to dissatisfaction. Low VAS scores were detected in 6% of patients (n = 19). These did not correlate with baseline demographic factors or disability levels, but were associated with unresolved external problems regarding community care and accommodation, and conflicts between patients and therapists. We conclude that from the patients' perspective, successful inpatient rehabilitation depends on adequate attention given to community-based issues and health care professionals recognising patients' needs. When these two conditions are not fulfilled, patients are more likely to express a lack of satisfaction with their rehabilitation.

Pain beliefs and perceived physical disability of patients with chronic low back pain

Cognitive–behavioural therapy and maintenance of exercise have emerged as major tools in the treatment of patients with chronic low back pain. Patients' beliefs about their problem may influence their uptake of and responses to particular treatment modalities. In particular, we hypothesised that patients' beliefs about the cause and treatment of pain may mediate changes in physical disability following participation in a multidisciplinary pain management programme. A cohort of 84 patients was invited to respond to booklets of self-report questionnaires prior to, immediately after and 3 months following participation in multidisciplinary pain management programmes. Questionnaires addressed subjects' beliefs about the nature and treatment of pain (Pain Beliefs Questionnaire), and their disability (Likert-modified Roland and Morris Disability Questionnaire, Physical Functioning scale of the Short Form-36 Health Survey, and Oswestry Low Back Pain Disability Questionnaire). Patients with chronic low back pain who more strongly endorsed ‘organic’ concepts about the nature and treatment of pain reported higher levels of physical disability at baseline, and displayed greater reductions in disability following participation in the pain management programmes. Reductions in reported ‘organic’ pain beliefs were associated with improvements in reported disability. Endorsement of ‘psychological’ concepts about the nature and treatment of pain was not associated with disability. These findings support a view that patients' beliefs about the nature and treatment of their pain can change during participation in a multidisciplinary pain management programme based on cognitive–behavioural intervention. Modification of these beliefs may be associated with improvements in patients' perceptions of the level of their disability.

Relationship Between Private Religious Activity and Physical Functioning in Older Adults

This study sought to further understand the relationship between physical func tioning and use of private religious activity in older adults. Subjects were age 65 or older from urban and rural counties in North Carolina who participated in the Duke University Established Populations for Epidemiologie Studies of the Elderly (Duke/EPESE). A total of 3,851 subjects responded to a question that inquired about their use of prayer, meditation, or Bible reading in 1986. Their response was correlated to number of impairments in activities of daily living (ADLs) (n = 3,791). Subjects who indicated use of private religious activity either daily or never had the greatest number of impairments. Those who prayed or meditated one time per week had the least number of impairments. This cross-sectional finding is explained in terms of both changes in private religious activity in response to increasing physical disability and changes in physical disability in response to private religious activity. Previous research has found that prayer is often used as an effective coping mechanism with various sicknesses and chronic conditions. Further studies are needed to examine older individuals' health over time and evaluate their use of private religious activity to see its impact over time on physical disability.

Physical Disability in Older Runners: Prevalence, Risk Factors, and Progression With Age

Concern exists that certain types of exercise, particularly vigorous activity, may increase physical disability among older individuals. We investigated the prevalence of, and risk factors for, physical disability in active older persons (runners), and examined factors influencing the progression of physical disability with age. Physical disability, measured using the Health Assessment Questionnaire Disability Index, was assessed prospectively in 454 runners, age 50 or greater, over five to seven years by annual mailed questionnaires. Baseline sociodemographic, clinical, and life-style characteristics associated with the presence of any disability over the course of the study were determined and contrasted with those in 292 older non-runners who had been similarly followed. Two hundred twenty-two runners (49%) reported some physical disability during the study. The presence of arthritis symptoms at baseline was the most important risk factor for physical disability; older age, greater body mass index, strenuous work-related physical activity, and the use of more medications were also associated with a greater likelihood of physical disability. Among the non-runners, 224 (77%) reported some physical disability, and the presence of arthritis symptoms was also the most important risk factor for physical disability in this group. Age-related changes in physical disability differed between those with and without arthritis symptoms in both the runner and non-runner groups. The presence of arthritis symptoms was an important risk factor for physical disability among both older runners and non-runners, and also identified subgroups of individuals with different progressions of disability with age.

Musculoskeletal Impairments and Physical Disablement Among the Aged

This article summarizes the results of a longitudinal investigation of the progression of sight, hearing, and musculoskeletal impairments and their association with change in physical disability, in 10 ADLs among members of the Massachusetts Health Care Panel Study. The findings confirm widely held clinical beliefs that specific types of musculoskeletal decrement are an important cause of physical disability among older persons. Decrement in hand function is a significant musculoskeletal impairment influencing limitations in Basic ADL, and progression of Instrumental ADL dysfunction is influenced by progression of lower extremity impairments. Progression of sight and hearing impairments was not associated with change in physical disability. Musculoskeletal impairments, one of the most prevalent and symptomatic chronic complaints of middle and old age, deserve increased attention from epidemiologists, disability researchers, and clinicians seeking ways to prevent disablement among the aged.