Changes In Functional Performance Research Articles

Velocity-Based Training Affects Function, Strength, and Power in Persons with Parkinson's Disease.

Calaway, CC, Martinez, KJ, Calzada Bichili, AR, Caplan, JH, Milgrim, WP, Mann, JB, Haq, I, and Signorile, JF. Velocity-based training affects function, strength, and power in persons with Parkinson's disease. J Strength Cond Res XX(X): 000-000, 2024-Velocity-based training (VBT) is commonly associated with high-level athletes. No study has examined the effects of VBT on performance in persons with Parkinson's disease (PD). The objective of the study was to compare the effects of 10 and 30% velocity-loss threshold protocols on changes in functional performance, strength, and power in persons with PD after 12 weeks of supervised VBT, 3 days per week. Twenty-one subjects with PD (72.9 ± 5.9 y) were randomly assigned to the 10% or 30% velocity-loss threshold group and performed the 6-m walk test at habitual and maximal gait speed (6MWTMax), the 5 time sit-to-stand test (5 × STS), 1 repetition maximum (1RM), and peak power (PP) testing for the chest press (CP) and leg press (LP) exercise. A mixed ANOVA with significance was set a priori at 0.05 revealed that significant time effects were seen for the 6MWT at maximal speed (MDiff ± SD = 0.22 ± 0.04 m·s-1, p < 0.001), 5-time sit-to-stand time (-1.48 ± 0.45 seconds, p = 0.005) and power (75.5 ± 22.7 W, p = 0.005), 1RM for CP (5.1 ± 1.1 kg, p < 0.001) and LP (12.6 ± 3.7 kg, p = 0.005), and LP-PP (43.6 ± 13.2 W, p = 0.006). Secondary analyses revealed time effects for the load at which PP was achieved for the CP exercise. A Wilcoxon signed-rank test revealed no significant differences in the percentage of 1RM at which PP was achieved for either condition. Results indicate that VBT is an effective training modality for improving functional capacity, strength, and power in persons with PD; however, shifts in force-velocity relationships were not evidenced.

Efficacy of accommodating variable-resistance training on muscle architecture, peak torque, and functional performance in patients with juvenile idiopathic arthritis: A randomized controlled trial

PurposeThis study sought to find out if a 6-week accommodating variable-resistance (AcVR) training might enhance muscle architecture, peak torque, and functional performance in patients with juvenile idiopathic arthritis (Juv-IA). MethodsFifty-eight patients with polyarticular Juv-IA (aged 12–18 years) were involved in a randomized controlled trial. They were allocated into two groups: the AcVR group (n = 29; underwent AcVR training, and the control group (n = 29; received the usual exercise regimen). Interventions were applied three times a week over six consecutive weeks. Measurements were done at baseline and after the intervention. The primary outcome measures were muscle architecture and peak torque, with functional capacity being the secondary measure. ResultsCompared to the control group, the AcVR group showed favorable pre-to-post changes in muscle architecture [fascicle length (P = 0.0007, η2p = .18), pennation angle (P = 0.0004, η2p = .20), and muscle thickness (P = 0.001, η2p = .17)]. Further, the AcVR group revealed a greater increase in peak concentric torque of knee extensors at angular speeds of 120°/sec [right side (P = 0.0032, η2p = .08); left side (P = 0.039, η2p = .07)] and 180°/sec [right side (P = 0.01, η2p = .11); left side (P = 0.014, η2p = .10)]. Furthermore, The AcVR group achieved more conducive changes in functional performance [6-min walk test (P = 0.003, η2p = .15), timed up and down stair test (P = 0.009, η2p = .12), and 4 × 10 m shuttle run test (P = 0.036, η2p = .08)]. ConclusionA 6-week AcVR training is potentially effective for improving muscle architectural qualities, enhancing peak muscle torque, and boosting functional performance in patients with Juv-IA without experiencing any detrimental side effects.

High-velocity resistance training improves executive function in mobility-limited older adults

ObjectivesTo examine the effect of high-velocity resistance training (HVRT) on the executive function of middle-aged and older adults with and without mobility limitations. MethodsParticipants (n = 41, female: 48.9%) completed a supervised 12-week HVRT intervention (2 sessions/week; at 40–60% of one-repetition maximum). The sample included 17 middle-aged adults (40–55 years); 16 older adults (>60 years) and 8 mobility-limited older adults (LIM). Executive function was assessed before and after the intervention period and was reported as z-scores. Maximal dynamic strength, peak power, quadriceps muscle thickness, maximal isometric voluntary contraction (MVIC), and functional performance were also measured pre and post intervention. Training-related adaptations in cognitive measures were calculated using a Generalized Estimating Equation model. ResultsHVRT improved executive function in LIM (adjusted marginal mean differences [AMMD]: 0.21; 95%CI: 0.04, 0.38; p = 0.040) although no effect on middle-aged (AMMD: 0.04; 95%CI: -0.09; 0.17; p = 0.533) and older (AMMD: -0.11; 95%CI: -0.25; 0.02; p = 0.107) participants was observed. Improvements in maximal dynamic strength, peak power, MVIC, quadriceps muscle thickness, and functional performance were all associated with changes in executive function, and changes in the first four also seem to mediate the association between changes in functional performance and executive function. ConclusionsHVRT-induced improvement in executive function of mobility-limited older adults were mediated by changes in lower-body muscle strength, power, and muscle thickness. Our findings reinforce the relevance of muscle-strengthening exercises to preserve cognition and mobility in older adults.

Efficacy and Cost over 12 Hospitalization Weeks of Postacute Care for Stroke.

Few studies have investigated changes in functional outcomes and economic burden in patients in the postacute care cerebrovascular disease (PAC-CVD) program. We, for the first time, retrospectively investigated changes in functional performance and the national health insurance (NHI) cost over 12 PAC-CVD hospitalization weeks and evaluated the therapeutic effects of the PAC-CVD program on the NHI cost. Specifically, the functional outcomes and NHI cost of 263 stroke patients in the PAC-CVD program were analyzed. The repeated measures t test was used to compare functional performance over 0-3 weeks, and a one-way repeated measures multivariate analysis of variance was used to compare functional performance and NHI costs during weeks 0-6 and 0-9. The Wilcoxon signed-rank test was used to compare functional performance over weeks 9-12. Hierarchical multiple regression was used to estimate the effects of functional performance on NHI costs during weeks 3, 6, and 9. Over weeks 0-12, all functional performance measures demonstrated significant improvements. Changes in NHI costs varied depending on whether hospitalization was extended. At any time point, functional performance did not have a significant impact on NHI cost. Therefore, the PAC-CVD program may aid patients with stroke in sustainably regaining functional performance and effectively controlling economic burden.

Muscle function and functional performance after pulmonary rehabilitation in patients with chronic obstructive pulmonary disease: a prospective observational study

This study aimed to measure changes in different properties of skeletal muscles and evaluate their contribution and relationship to changes in functional performance after pulmonary rehabilitation (PR) in patients with chronic obstructive pulmonary disease (COPD). COPD outpatients attending 5 weeks of conventional PR were recruited. Functional performance [5-repetitions sit-to-stand (5STS), and 4-m gait speed (4mGS)], and muscle function (maximal isometric strength, power, force control, and relative concentric and eccentric activation during 5STS) were assessed after PR and 3 months of follow-up. Twenty patients (71 years; 52% of predicted FEV1) completed the study. 4mGS and relative concentric activation during 5STS decreased respectively by 7.7% and 26% between the beginning of PR and follow-up. Quadriceps strength, power, and force control improved by 10.4%, 27.3%, and 15.2%, respectively, from the beginning of PR to follow-up the relative eccentric activation during 5STS explained 31% of the variance in 4mGS changes. In conclusion, functional performance appeared to decline after conventional PR, whereas several properties of skeletal muscles were maintained at follow-up in COPD outpatients. Of note, eccentric contractions might play a role in the improvement of functional performance. Therefore, future studies with interventional design should include eccentric training in PR programs during clinical COPD practice.

Progressive resistance training compared to neuromuscular exercise in patients with hip osteoarthritis and the additive effect of exercise booster sessions: protocol for a multicentre cluster randomised controlled trial (The Hip Booster Trial)

IntroductionThe primary aim of this randomised controlled trial is to investigate the effectiveness of 3 months of progressive resistance training (PRT) compared to neuromuscular exercise (NEMEX) on functional performance in...

Blood Flow Restricted Walking in Elderly Individuals with Knee Osteoarthritis: A Feasibility Study.

ObjectiveTo investigate whether blood flow restricted walking exercise is feasible in patients with knee osteoarthritis, and to examine changes in functional performance and self-reported function.DesignFeasibility study.Patients and methodsFourteen elderly individuals diagnosed with knee osteoarthritis participated in 8–10 weeks of outdoor walking (4 km/h, 20 min/session, 4 times/week) with partial blood flow restriction applied to the affected leg. Adherence, drop-outs and adverse events were registered. Timed Up and Go test, 30-s sit-to-stand performance, 40-m fast-paced walk speed, stair-climbing and Knee Osteoarthritis Outcome Score were assessed pre- and post-training.ResultsNine participants completed the intervention, while 5 participants withdrew (4 due to intervention-related reasons). In non-completing participants baseline body mass index (BMI) (p = 0.05) and knee pain (p = 0.06) were higher, while gait performance (p = 0.04) was lower. Considering completed case data, the training-adherence rate was 93%, while mean knee pain in the affected leg was 0.7 on a numerical rating scale of 0–10. Functional performance improved, while self-reported function remained unchanged.ConclusionBlood flow restricted walking exercise appeared feasible in patients with knee osteoarthritis. Participants who completed the intervention protocol demonstrated improvements in functional performance, with no changes in self-reported function.LAY ABSTRACTPatients with knee osteoarthritis typically experience knee joint pain and functional disability. Consequently, it is beneficial for these patients to engage in tolerable exercise programmes to enhance their functional performance. This study examined the feasibility of 8–10 weeks of blood flow restricted (BFR) walking exercise in patients with long-term knee osteoarthritis. The exercise programme was feasible, did not exacerbate knee pain or provoke cuff discomfort, and produced improved functional performance in those participants (9/14) who completed the intervention protocol (93% adherence rate). Notably however, 4 patients withdrew from the study due to intervention-related reasons. In this study, feasibility and adherence to BFR-walking appeared to depend on individual factors, with high body mass index, high perceived knee pain, and low baseline levels of fast-paced walking, predisposing to low adherence to training. Thus, these individual characteristics must be taken into account when administering BFR-walking exercise in patients with knee osteoarthritis.

Assessment of Functional Performance in Children with Cerebral Palsy Receiving Treatment in a Day Care Facility: An Observational Study.

BackgroundThe study assessed changes in functional performance of children with cerebral palsy (CP), immediately following treatment and 2 months later, in addition to investigating the relationship between therapy effect and sex, age, or comorbidities.Material/MethodsFunctional performance of 32 children with spastic diplegia CP, aged 9–16 years, was assessed for: 1) manual function (Box and Block test), motor capacities (Gross Motor Function Measure), sensory capacities (Finger Identification [FI] and Localisation of Tactile Stimuli test [LTC]), and 2) activity and participation, ie, independence in essential and more complex daily activities (Barthel Index; Paediatric Evaluation of Disability Inventory). Measurements were conducted before the start (Month 0), immediately after 6-month rehabilitation program (Month 6), and following a 2-month period with no therapy, ie, 8 months after baseline measurement (Month 8).ResultsComparison of Month 0 and Month 6 scores showed significant differences (P<0.001) in all measures. However, Month 8 scores were significantly worse in all the measures, except for sensory capacities assessed using FI and LTC (P<0.001).ConclusionsFunctional performance of children with CP was positively affected by 6-month therapy, but 2 months later these effects significantly deteriorated, except for the sensory capacities. This suggests that therapy focusing on functional performance should be included as a permanent component of rehabilitation programs. These findings may be important for clinical practice as they show that therapy of children with CP should be continuous and systematic, and this should be taken into account by those designing therapeutic programs.

Is there a relationship between intensity of occupational therapy and functional outcomes in hospitalised older patients? A prospective cohort study.

Delivering high-intensity occupational therapy can improve functional outcomes for patients and reduce length of stay. However, there is little published evidence of this in the aged rehabilitation setting. This study aims to explore the association between intensity of occupational therapy interventions and functional outcomes in geriatric rehabilitation inpatients. A prospective cohort study was conducted with adult inpatients admitted to a geriatric rehabilitation program. The intervention was the intensity of occupational therapy measured as high (≥30 minutes per day) versus low (&lt;30 minutes per day). The primary outcome measured was change in functional performance, defined as a minimum of half a point improvement in the Katz Index of Activities of Daily Living (ADL) and/or the Lawton and Brody Scale of Instrumental ADL (IADL) at admission to rehabilitation, discharge and 3months post-discharge. A total of 693 patients were included in the analysis. The mean age was 82.2years (standard deviation [SD] = 7.9), 57% were females, and 64% had cognitive impairment. Patients (n = 210) who received greater than or equal to 30 minutes of occupational therapy daily were more likely to have clinically relevant functional improvements.; for both ADL (odds ratio [OR] = 1.87, 95% confidence interval [CI]: 1.24-2.83) and IADL (OR = 3.00, 95% CI: 1.96-4.61), after adjusting for age, sex, severity of function (ADL ≤ 2) at admission, frailty and cognitive impairment. Improvements in ADL and IADL were maintained for at least 3months following discharge. This study found that geriatric rehabilitation inpatients who received higher intensity of occupational therapy interventions were more likely to functionally improve than those who received lower intensity. Further research is required to determine if other factors, such as therapy type, influence functional outcomes.

Feasibility and reliability of the Functional Movement Screen battery in adults with intellectual disability.

BackgroundThe feasibility and reliability of the Functional Movement Screen (FMS) battery for predicting injury risk have been widely studied in athletic, military, public service and healthy populations. However, scant research has been carried out in people with disabilities. This study aimed at identifying the feasibility and reliability of the FMS battery when administered to adults with intellectual disability (ID).MethodsAdults from a residential and day care centre over 18 years of age, diagnosed with ID and able to follow simple instructions, were included in the study. All participants with behavioural or health problems that prevented the completion of the FMS battery were excluded. All exercises were video recorded to assure proper scoring. Three assessors (one trained and two novices) scored each of the FMS subtests performed separately from the videos. Feasibility was based on completion rates. Reliability of the composite test scores was analysed using intraclass correlation coefficients (ICCs).ResultsA total of 30 people with ID (mean age: 35.5 ± 7.12 years; 33.3% women) completed all assessments. The battery showed to be feasible, although difficulties when performing two of the subtests were observed among those with moderate and severe ID. Mean total scores from the three assessors ranged from 7.83 to 8.90. An inverse trend was observed indicating that the higher the ID level, the lower the total FMS score. Test–retest reliability was good for the trained assessor (ICC = 0.89) and mostly moderate for both novice assessors (ICC range: 0.60 to 0.76). Moderate to good inter‐rater reliability was observed (ICC range: 0.65 to 0.80).ConclusionThe FMS battery is a reliable tool that can be performed by people with ID, albeit with certain difficulties, especially in those with moderate to severe impairment. The battery does not seem to be useful for identifying people with ID at risk of suffering a sport injury. Adequately powered, well‐designed studies are required to determine if the FMS battery is appropriate for identifying changes in functional performance in this population.

Effects of range of motion on resistance training adaptations: A systematic review and meta-analysis.

Nowadays, there is a lack of consensus and high controversy about the most effective range of motion (ROM) to minimize the risk of injury and maximize the resistance training adaptations. To conduct a systematic review and meta-analysis of the scientific evidence examining the effects of full and partial ROM resistance training interventions on neuromuscular, functional, and structural adaptations. The original protocol (CRD42020160976) was prospectively registered in the PROSPERO database. Medline, Scopus, and Web of Science databases were searched to identify relevant articles from the earliest record up to and including March 2021. The RoB 2 and GRADE tools were used to judge the level of bias and quality of evidence. Meta-analyses were performed using robust variance estimation with small-sample corrections. Sixteen studies were finally included in the systematic review and meta-analyses. Full ROM training produced significantly greater adaptations than partial ROM on muscle strength (ES=0.56, p=0.004) and lower-limb hypertrophy (ES=0.88, p=0.027). Furthermore, although not statistically significant, changes in functional performance were maximized by the full ROM training (ES=0.44, p=0.186). Finally, no significant superiority of either ROM was found to produce changes in muscle thickness, pennation angle, and fascicle length (ES=0.28, p=0.226). Full ROM resistance training is more effective than partial ROM to maximize muscle strength and lower-limb muscle hypertrophy. Likewise, functional performance appears to be favored by the use of full ROM exercises. On the contrary, there are no large differences between the full and partial ROM interventions to generate changes in muscle architecture.

Exercise in patients with hip osteoarthritis – effects on muscle and functional performance: A randomized trial

ABSTRACT Background: It is believed that clinical management of osteoarthritis should address muscle weakness to improve physical function and prevent disability and frailty.Objectives: This sub-study investigated the effects of supervised progressive resistance training (RT), supervised Nordic Walking (NW), and unsupervised home-based exercise (HBE) on muscle and functional performance; and associations between these exercise-induced changes in persons with hip osteoarthritis. Methods: Forty-two patients with hip osteoarthritis were recruited from a larger RCT (NCT01387867). All the groups (RT, n = 15; NW, n = 12; HBE, n = 15) exercised 1 h 3 times/week for 4 months. Quadriceps cross-sectional area (QCSA, MRI-determined); quadriceps strength (QMVC); leg extensor power (LEP); functional performance (chair stands (30sCS); stair climbs (TSC); and 6-minute walk (6MWT)) were assessed at baseline and 4 months. Results: Per protocol analyses (one-way ANOVA and Bonferroni test) showed significant between-group differences for improvements in QCSA in the most symptomatic leg favoring RT versus NW (2.3 cm2, 95% CI [0.6, 3.9]) and HBE (2.3 cm2 [0.8, 3.9]); and 30sCS (1.8 repetitions [0.2–3.3]), and 6MWT (35.1 m [3.5–66.7]) favoring NW versus HBE. Associations existed between exercise-induced changes in QCSA and QMVC (r = 0.366, p = .019) for the most symptomatic leg and between changes in 6MWT and QMVC (r = 0.320, p = .04) and LEP (r = 0.381, p = .01), respectively, for the least symptomatic leg. Conclusions: Resistance training appeared effective for improving muscle mass, but less effective for improving muscle strength, power, and functional performance. Only exercise-induced changes in muscle strength and power of the least symptomatic leg, not the most symptomatic leg, were related to changes in functional performance.

Effect of clinical factors on trajectory of functional performance in patients undergoing hemodialysis

Purpose This study aimed to investigate the association between clinical factors and temporary changes in functional performance in patients undergoing hemodialysis. Methods This was a retrospective, longitudinal observational study conducted from 2015 to 2017. Eight-two patients undergoing hemodialysis in the outpatient clinic were enrolled. Functional performance was measured using the Karnofsky Performance Status (KPS) scale. Collected data for analysis included demographics, laboratory parameters, and KPS scale scores. All participants were grouped into a high KPS cluster and a low KPS cluster based on dynamic changes in KPS scales from 2015 to 2017. Results Participants in the high KPS cluster demonstrated an approximate trend, and those in the low KPS cluster demonstrated a low pattern. By stepwise selection model analysis, age (OR 1.12, 95% CI 1.03–1.23, p = 0.011), serum BUN (OR 1.08, 95% CI 1.02–1.16, p = 0.015), calcium levels (OR 3.24, 95% CI 1.2–8.73, p = 0.02), and beta-2-microglobulin (OR > 1.0, CI >1.00-<1.01, p = 0.031) showed risk for the low KPS cluster. Male sex (OR 0.20, 95% CI 0.04–0.96, p = 0.045) and albumin level (OR 0.02, 95% CI 0–0.4, p = 0.009) showed a low risk for the low KPS cluster. Conclusions A different trajectory pattern was observed between the high and low KPS clusters in a 3-year period. Risk factors for the low KPS cluster were age, serum BUN, calcium, and beta-2-microglobulin levels. Male sex and serum albumin levels reduced the risk for the low KPS cluster.

Functional status among community‐dwelling older adults is determined by cognitive status

AbstractBackgroundSince 2008, the number of older adults has increased by 34% and is expected to nearly double by 2060. Among US older adults over 70 years of age, 22‐30% report difficulty performing at least one activity of daily living (ADL). ADL performance is associated with functional fitness parameters. Negative longitudinal changes in functional performance among older adults are associated with cognitive decline and may be able to predict future cognitive impairment. Thus, it is imperative to understand the influence of cognition on functional fitness among older adults.Method84 older adults (80.9+5.4 years) consented to have their functional fitness and cognition assessed. Functional fitness parameters included the following assessments: Short Physical Performance Battery (SPPB), 10‐meter walk (habitual and fast), dual‐task (habitual and fast), power chair stand assessment (average and peak power and velocity). Cognition was assessed using the Montreal Cognitive Assessment (MoCA) and a digital Visual Paired Comparison (VPC) task. Categories of low and high cognitive function were determined using the VPC results. A one‐way ANOVA was conducted to determine differences between cognitive groups.ResultParticipants with high cognitive performance scored significantly better on the SPPB, 10‐meter fast walk, dual‐task fast condition, and average velocity during the power chair stand assessment. SPPB scores were 10.2% lower among older adults with low cognitive performance (p = .04). The high cognition group walked 16.5% (0.16 m/s) faster when compared to the low cognitive group (p = .04). Dual‐task (fast) performance was 13.2% slower among the low cognition group (p = .03). Additionally, low cognitive older adults moved 16.7% slower when rising from a seated position during the power chair stand task (p = .01). MoCA was 2.76 points lower among the low cognition group (p &lt; .001).ConclusionBased on the current results, a relationship exists between functional fitness and cognitive performance in older adults. However, it remains unknown whether functional fitness can influence cognition or vice versa and how these impact ADL performance. Future research is warranted to determine if and how the relationship between cognitive function and functional fitness changes over time in older adults.

Association of care workers’ job satisfaction and global happiness with change of functional performance of severely disabled elderly residents in nursing homes: a cohort and questionnaire study in Japan

ObjectivesThere is growing concern regarding quality of work life (QWL) among care staff in nursing homes. However, little is known about the impact of QWL on nursing home residents’ functional...

Limb symmetry index on a functional test battery improves between one and five years after anterior cruciate ligament reconstruction, primarily due to worsening contralateral limb function

ObjectiveEvaluate change in functional performance from 1- to 5-years after anterior cruciate ligament reconstruction (ACLR). Methods59 participants (38 men) aged 29 ± 16 years completed three hops and one-leg rise 1- and 5-years following ACLR. Linear mixed-effects models evaluated differences in change between the ACLR and contralateral limbs. Participants were classified with stable, improving or worsening function relative to previously published minimal detectable change thresholds. Healthy controls completed the three hops (n = 41) and one-leg rise (n = 31) as reference data. ResultsThe contralateral limb had a significantly greater decrease in functional performance between 1- and 5-years for the three hops, compared to the ACLR limb. Worsening was more common in the contralateral limb than the ACLR limb; resulting in significant improvements in the LSI for the single hop (mean 87% at 1-year to 95% at 5-years), side hop (77%to 86%) and one-leg rise (76% to85%). Performance of both ACLR and contralateral limbs and the LSI remained below the healthy controls. ConclusionFunctional performance changes differ between limbs between 1- and 5-years post-ACLR. The LSI should not be used in isolation to evaluate functional performance changes after ACLR, as it may overestimate functional improvement, due to worsening contralateral limb function.

117 AusTOMs An Outcome Measure to Determine the Impact of Environmental Adaptations on Functional Performance

Abstract Background Occupational Therapists routinely perform pre-discharge home assessment visits. The import of a supportive home environment to successful ageing has been established in the literature (Tanner, Tilse &amp; Desleigh de Jonge, 2008), with housing adaptations and aids recognised as a method of promoting independence within the home (Stark et al, 2009). In this hospital, home assessment visits review functional mobility, functional transfers and assess for environmental barriers within the home. The purpose of this study was to detect any change in functional performance following a pre-discharge home assessment visit and implementation of OT recommended aids/railings or both. The AusTOMs (Australian Therapy Outcome Measures) for Occupational Therapy scale was used as the outcome measurement tool. Methods The study was applied to a cohort of 20 consenting inpatients over 65 years of age. Convenience sampling was used for the purposes of the study. Inclusion criteria comprised of patients that attended a minimum of one pre-discharge OT home assessment visit. It was conducted over a ten week period in 2018. The study was conducted by two occupational therapists (OTs) on the general rehabilitation team. The scale was applied to review the following functional transfers within the home environment on initial home assessment visit and following the implementation of OT recommended aids/railings. 1. Access2. Stairs3. Bed4. Toilet5. Bath/Shower6. Seating Results The group Average AusTOMs Resultant score at initial home assessment was 3.05. The group average score following implementation of recommendations was 4.08. This indicates a change in performance from a Moderate Limitation experience to a Mild Limitation experience. This is reflected in Paired T test results. The two-tailed P value is less than 0.0001. Conclusion The AusTOMs Activity Limitation/Transfer scale indicated there is a positive correlation with the provision of OT recommended aids and equipment at improving functional transfer performance within the home context.

Walking time measures for evaluating OA of the knee

This study assessed the test-retest reliability and the sensitivity of self-paced walking time measurements for evaluating the functional performance of persons with knee osteoarthritis (OA). The 13 m timed walking tests were carried out on two separate occasions over a six-week period for 10 patients using a standardised protocol. The same measurements were recorded also for three additional patients before and after a six-week quadriceps strength training regimen. As indicated by an intraclass correlation coefficient of 0.83 with no significant intersession test differences for the group (P=0.98), the gait measurements were reliable. However, despite marked increase in knee extensor strength and significant subjective improvements in walking time for the three experimental subjects were smaller than the error of measurement. The findings suggest that regardless of reliability, measurements of self-paced level walking time might not be sufficiently sensitive for evaluating longitudinal changes in functional performance in this patient population.

Factors Associated with Change in Functional Performance among Wheelchair Users

Factors Associated with Change in Functional Performance among Wheelchair Users

Effectiveness of a multimodal intervention in functionally impaired older people with type 2 diabetes mellitus.

BackgroundType 2 diabetes, a highly prevalent chronic disease, is associated with increasing frailty and functional decline in older people. We aimed to evaluate the effectiveness of a multimodal intervention on functional performance in frail and pre‐frail participants aged ≥70 years with type 2 diabetes mellitus.MethodsThe MID‐Frail study was a cluster‐randomized multicenter clinical trial conducted in 74 trial sites across seven European countries. The trial recruited 964 participants who were aged >70 years [mean age in intervention group, 78.4 (SD 5.6) years, 49.2% male and 77.6 (SD 5.29) years, 52.4% male in usual care group], with type diabetes mellitus and determined to be frail or pre‐frail using Fried's frailty phenotype. Participants were allocated by trial site to follow either usual care (UCG) or intervention procedures (IG). Intervention group participants received a multimodal intervention composed of (i) an individualized and progressive resistance exercise programme for 16 weeks; (ii) a structured diabetes and nutritional educational programme over seven sessions; and (iii) Investigator‐linked training to ensure optimal diabetes care. Short Physical Performance Battery (SPPB) scores were used to assess change in functional performance at 12 months between the groups. An analysis of the cost‐effectiveness of the intervention was undertaken using the incremental cost‐effectiveness ratio (ICER). Secondary outcomes included mortality, hospitalization, institutionalization, quality of life, burden on caregivers, the frequency and severity of hypoglycaemia episodes, and the cost‐effectiveness of the intervention.ResultsAfter 12 months, IG participants had mean SPPB scores 0.85 points higher than those in the UCG (95% CI, 0.44 to 1.26, P < 0.0001). Dropouts were higher in frail participants and in the intervention group, but significant differences in SPPB between treatment groups remained consistent after sensitivity analysis. Estimates suggest a mean saving following intervention of 428.02 EUR (2016) per patient per year, with ICER analysis indicating a consistent benefit of the described health care intervention over usual care. No statistically significant differences between groups were detected in any of the other secondary outcomes.ConclusionsWe have demonstrated that a 12 month structured multimodal intervention programme across several clinical settings in different European countries leads to a clinically relevant and cost‐effective improvement in the functional status of older frail and pre‐frail participants with type 2 diabetes mellitus.