Common Cause Of Functional Disability Research Articles

Efficacy of standard operating procedures for fall protection in hospitalized patients with schizophrenia

Fall-related injury is the most common cause of functional disability and mortality in the older population. Falls in patients with schizophrenia are one of the major concerns in psychiatric hospitals. This study aimed to examine the impact of standardized operating procedures (SOP) on falls in veterans with schizophrenia. Veterans with schizophrenia were allocated to the control group (n = 345) and to the fall protection standardized operating procedures (FP-SOP) group (n = 342). Patients in the control group were given routine nursing for falls, and patients in the FP-SOP group were intervened with FP-SOP plus routine nursing. All patients were observed for one year. The study methods comply with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist. We found a fall rate of 1.5% in the FP-SOP group and 4.6% in the control group, with a significant difference in the fall rate between the two groups. In addition, the difference in patient satisfaction between the two groups was statistically significant. Our findings suggest that FP-SOP is an effective strategy for fall prevention in psychiatric hospitals.

CAUDAL BLOCK AS A TREATMENT MODALITY TO AVOID LUMBAR SPINE SURGERY IN PATIENTS WITH CHRONIC BACK PAIN

Introduction: Chronic Lower back pain is the most common cause of functional disability in an adult due to prolonged sitting, ageing society, obesity & sedentary lifestyle, the number of Chronic Lower back pain patients can be expected to increase in the coming decades. Caudal Pain Block is one of the procedures to avoid lumbar spine surgery in patients with chronic low back pain. Main aim of this study is to analyse weather the effect of caudal pain block can avoid lumbar spinal surgery in patients with chronic low back pain. Aims And Objectives: To find out that weather the effect of caudal pain block can avoid lumbar spinal surgery in patients with chronic low back pain.To review the literature. Material and Methods: A prospective study was done on 55 patients with chronic low back pain who were given caudal pain block and followed up at 1,2, 3, and 6 months and outcomes measured using visual analogue scale and The Roland–Morris Disability Questionnaire. Observations: Caudal pain block was given in 55 patients, 51 patients got relieved of their pain and were able to avoid spine surgery and 4 out of 55 patients went for the spine surgery despite given caudal pain block. Results:According to VAS score 12 patients had excellent results, 21 had good results, 18 had fair and 4 had poor results. According to Roland–Morris Disability Questionnaire - 10 patients had excellent results, 20 patients had good results, 21 had fair results and 4 had poor results. Conclusion:Chronic low back pain managed with Caudal pain block is a good treatment modality with excellent results and good alternative to avoid operative procedures.

Feet Don’t Fail Me Anymore! Single-Centre Results Using Low-Dose Radiation Therapy for Feet Inflammatory Disorders and Review of Current Evidence

Background: Plantar fasciitis- and tendinopathy-related foot pain are common cause of functional disability. Low-Dose Radiation Therapy (LDRT) has proven to be effective in the symptomatic relief of these disorders. Material and methods: Between February 2016 and December 2021, 31 patients were included in this prospective register. Seventeen patients suffered from calcaneodynia, 11 from tendonitis and 3 from osteoarthritis. 6 Gy (1 Gy/fraction) or 3 Gy (0,5 Gy/fraction) were delivered and repeated after 12 weeks if no adequate relief. Response was evaluated at the end of the planned courses, after 3 months and subsequently every 6 months using Visual Analogic Score (VAS), the Von Pannewitz Score (VPS) and daily analgesic drug needs. Results: Overall, 87% of the patients experienced pain relief. Patients with a VAS score above 5 dropped from 35.5% at the end of LDRT to 32%, 13% and 6% after 3, 6 and 12 months, respectively. According to the VPS, 74% showed improvement and 26% remained stable. Lastly, 39% of patients stopped or reduced analgesic intake. Nine patients have been followed up for more than 12 months. The median pre-treatment VAS score in this group was 9 (range 7-10), whereas median VAS scores after 3, 6 and 12 months stood at 5 (range 1-7), 3 (range 0-6) and 1 (range 0-6), respectively (Fig. 2). An improvement in functionality was reported by 7 out of 9 individuals (77.7%). No acute or late complications were observed. Conclusion: LDRT appears to be useful for symptomatic treatment of inflammatory and degenerative disorders of the foot.

A retrospective study assessing different techniques for Suprascapular Nerve Block for chronic shoulder pain

Shoulder pain is a common complaint associated with significant pain and disability. Chronic shoulder pain is common cause of functional disability in the community. A supra scapular nerve block is a safe and effective technique for treatment of both acute and chronic shoulder pain, resulting from inflammatory and degenerative disorders. It can be done using a number of different techniques including but not limited to landmark technique, USG guided, X-ray guided and CT guided and PRF. Methods: We did a retrospective study looking at efficacy of supra-scapular nerve block done in our centre over the last 2 years using different techniques. We audited a total of 80 procedures over two years. We looked at effective pain relief and any potential complications over 3- 6 months. Result and conclusion: This was a retrospective study looking at a number of patients over 2 years having had multiple procedures. Because of the nature and the limitations of an audit, it was not possible to suggest that any particular technique is superior over the other. We need to do at prospective study with better randomization, follow up and more specific disability and pain scoring tools like shoulder pain and disability index (SPADI) and VAS scoring systems.

Assessment of the neuropathic component in a chronic low back pain syndrome

Background/Aim. Chronic low back pain syndrome (CLBPS) is the most common cause of functional disability and loss of working ability in developed countries. Some research shows that neuropathic pain (NP) is present in almost 50% of patients with CLPBS. The aim of this study was to determine the characteristics of NP and its impact on quality of life (QoL) in patients with CLBPS. Methods. Patients were tested using three questionnaires for NP: Pain Detect Questionnaire, Leeds Assessment of Neuropathic Symptoms and Signs, and Douleur Neuropathique 4 questions. Thirty-two patients diagnosed with NP based on current clinical criteria and with positive results for NP on all three NP questionnaires formed an experimental group. A control group consisted of 32 patients with CLBPS who did not fulfill clinical criteria for NP and were negative for NP on all three questionnaires. Hamilton depression and anxiety rating scales (Ham-D and Ham-A, respectively) and Short Form (SF)-36 questionnaire were also applied. Results. According to magnetic resonance imaging (MRI), disc herniation was typically detected in the experimental group, while degenerative changes were commonly found in the control group. Patients from the experimental group had significantly greater intensity of pain, pain radiation in the legs, and the pain was usually presented as episodes of sudden attacks with mild pain between them. The most distinctive features of NP were allodynia, electric shock sensation, and hypoesthesia to prick. Patients from the experimental group also had significantly higher depression and anxiety scores, as well as worse QoL compared to the control group, especially in mental domains. Predictors of worse QoL in the patients with CLBPS were a higher level of anxiety and depression. Conclusion. The presence of allodynia, electric shock-like sensations, and hypoesthesia to prick in patients with CLBPS suggest NP. CLBPS patients with NP had worse scores in mental domains of QoL compared to CLPBS patients without NP.

T189. FREE THYROXIN CONCENTRATIONS MODERATE THE RESPONSE TO A COGNITIVE REMEDIATION THERAPY IN PEOPLE WITH EARLY PSYCHOSIS: PRELIMINARY FINDINGS

BackgroundCognitive deficits are a common cause of functional disability in people with psychotic disorders. Cognitive remediation produces moderate improvements in cognitive performance in people with schizophrenia, although there is variability in the responses between patients. As previous longitudinal studies suggest that free thyroxin (FT4) levels influence attention cognitive tasks in patients with early psychosis, we aimed to conduct a pilot study to explore whether thyroid hormones might predict the response to cognitive remediation therapy (CRT) in patients with first-episode psychosis.Methods27 patients (8 women; 19 men) with first-episode psychosis aged between 18 and 35 years old were randomized to receive a computerized CRT for three months (2 sessions/week) (N=14) or treatment as usual (TAU) (N=13). A full cognitive battery (CANTAB Schizophrenia) was administered at baseline and follow-up (3 months later, after the CRT/TAU period). Plasma levels of thyroid-stimulating hormone (TSH) and FT4 were measured. Data were analyzed on an intention-to-treat basis. Correlation analyses were conducted to explore the association between TSH and FT4 levels and cognitive changes over time. An ANOVA for repeated measures was used to compare longitudinal changes over time by the experimental group while adjusting for TSH and FT4 levels. Significance was defined as p<0.05.ResultsTSH concentrations were not associated with cognitive changes over time. FT4 concentrations were associated with cognitive worsening over time in cognitive tasks dealing with reaction time (simple median movement time [r= 0.60, p= 0.003]; simple median reaction time [r= 0.44, p= 0.039]), sustained attention (signal detection for the rapid visual processing task [r= -0.46, p= 0.028]) and verbal memory (immediate recognition [r= -0.54, p= 0.008]; delayed recognition [r= -0.48, p= 0.019]). The ANOVA for repeated measures did not show time by group effects although a time by FT4 significant effect was found for cognitive tasks dealing with these cognitive domains (p<0.05 for all).DiscussionAlthough a direct effect of the CRT on cognitive improvement was not found, baseline FT4 concentrations appeared to predict the response to CRT in people with early psychosis. Significant associations were found for cognitive domains dealing with attention processes, which are in accordance with previous studies exploring the association between thyroid function and cognitive functioning in early psychotic patients. Our preliminary findings suggest that the determination of thyroid function status might be important for establishing which patients could show cognitive improvements over time. If these results are replicated in larger studies, the determination of thyroid status might help identify those individuals more prone for showing cognitive improvements, and allowing the implementation of a personalized medicine approach in the field of cognitive rehabilitation in psychosis.

The Relationship Between Demographic and Occupational Characteristics and Disability Severity in Patients With Knee Osteoarthritis

Purpose: Osteoarthritis is a progressive disease and the most common form of joint inflammation. Moreover, it is the most common cause of functional disability in the elderly. Among the multiple and predisposing factors influencing the disease are demographic indicators and occupational factors. The present study aimed to investigate the relationship between age, pain severity, Body Mass Index (BMI), occupation, and educational level, and the severity of functional disability in patients with Knee Osteoarthritis (KO). Methods: This descriptive study was performed on 97 KO patients referring to the Novin private physiotherapy clinic of Semnan University of Medical Sciences from April to March 2017. The study participants were selected through a simple nonprobability sampling technique. Literate individuals with the educational level of guidance school and above and diagnosed with KO were included in the study. Individuals with a history of inflammatory arthritis diseases, such as rheumatoid arthritis, soft tissue rheumatoid arthritis, fibromyalgia syndrome, bursitis, tendonitis, the neurological and vascular conditions of the lower extremity, mental problems, and malignancy were excluded from this research. The data related to the variables such as age, gender, occupation, history of osteoarthritis, pain intensity, involved side, educational level, and the Knee Injury and Osteoarthritis Outcome Score (KOOS) for knee disability were collected by a self-report questionnaire. This study was approved by the Research Ethics Committee of the University of Social Welfare and Rehabilitation Sciences. Using SPSS, Spearman’s correlation coefficients were calculated to examine the relationship between the study variables. Results: Spearman’s correlation coefficients revealed no significant correlation between the KOOS scores and age, occupation, and educational level. The obtained results suggested a poor significant association between KOOS and BMI; however, there was a strong significant correlation between KOOS and pain intensity Visual Analogue Scale (VAS) (P&lt;0.05). Conclusion: The severity of functional disability in patients with KO based on KOOS questionnaire scores, was well correlated with pain severity, but poorly associated with age and BMI. The obtained data indicated no significant relationship between disability and occupation and educational level.

Targeting Hormones for Improving Cognition in Major Mood Disorders and Schizophrenia: Thyroid Hormones and Prolactin.

Cognitive deficits are a core feature of serious mental illnesses such as major depression, bipolar disorder and schizophrenia and are a common cause of functional disability. However, the efficacy of pharmacological interventions for improving the cognitive deficits in these disorders is limited. As pro-cognitive pharmacological treatments are lacking, we aimed to review whether thyroid hormones or drugs that target prolactin may become potential candidates for 'repurposing' trials aiming to improve cognition. We conducted a narrative review focused on thyroid hormones and prolactin as potential targets for improving cognition in major mood disorders or schizophrenia. The role of thyroid hormones and prolactin on cognitive processes in non-psychiatric populations was also reviewed. Although clinical trials regarding these hormones are lacking, particularly in patients with schizophrenia, bipolar disorder or major depression, there is evidence from observational studies for the contribution of these hormones to cognitive processes. Patients with bipolar disorder and subclinical hypothyroidism show poorer cognitive function than euthyroid patients. In patients with early psychosis, lower free thyroxine concentrations have been associated with poorer attention whereas increased prolactin levels have been associated with poorer speed of processing. Only two small clinical trials tested the potential pro-cognitive effects of thyroid hormones, with positive findings for triiodothyronine (T3) treatment in patients receiving lithium or electroconvulsive therapy. In sum, thyroid hormones and prolactin might contribute to the cognitive performance of patients with major mood disorders and psychotic disorders. Thyroid hormones and prolactin-lowering drugs (e.g. cabergoline, aripiprazole) are candidate drugs to be tested in repurposing clinical trials aiming to improve the cognitive abilities of patients with major mood disorder and schizophrenia.

Medikamentöse Arthrosetherapie im Alter

Osteoarthritis (OA) is the most common cause of functional disability in the elderly. Pain and loss of motion induce a vicious circle, leading to instability, frailty and ultimately invalidity. Currently, there is no treatment to reverse or slow the disease progression to a clinically meaningful extent. Thus, the primary goal of OA treatment in the elderly is pain relief and preservation of joint function. For this, pharmacological, non-pharmacological and if necessary surgical treatment regimes must form an integrated concept. However, the real challenge is polymorbidity and other age-related or age-associated factors, which influence the course of disease and its therapy unfavorably. The changes in pharmacokinetics and -dynamics in the elderly can be compensated for the nonopioid and opioid-analgesics by the well known "start low, go slow" approach. More problematic are non-steroidal anti-inflammatory drugs (NSAIDs), which are most often used for symptomatic treatment of OA: Patients over 65 have an enhanced susceptibility to the gastrointestinal and renal side effects of NSAIDs; all NSAIDs, not only coxibs, increase the cardiovascular risk in patients with such a disease; number and severity of drug interactions is elevated due to age-associated polypharmacy. Thus, NSAIDs, including coxibs, should be used with great caution for treatment of OA in the elderly.