Degree Of Activity Limitation Research Articles

A smartphone-based application for cough counting in patients with acute asthma exacerbation.

While tools exist for objective cough counting in clinical studies, there is no available tool for objective cough measurement in clinical practice. An artificial intelligence (AI)-based cough count system was recently developed that quantifies cough sounds collected through a smartphone application. In this prospective study, this AI-based cough algorithm was applied among real-world patients with an acute exacerbation of asthma. Patients with an acute asthma exacerbation recorded their cough sounds for 7 days (2 consecutive hours during awake time and 5 consecutive hours during sleep) using CoughyTM smartphone application. During the study period, subjects received systemic corticosteroids and bronchodilator to control asthma. Coughs collected by application were counted by both the AI algorithm and two human experts. Subjects also provided self-measured peak expiratory flow rate (PEFR) and completed other outcome assessments [e.g., cough symptom visual analogue scale (CS-VAS), awake frequency, salbutamol use] to investigate the correlation between cough and other parameters. A total of 1,417.6 h of cough recordings were obtained from 24 asthmatics (median age =39 years). Cough counts by AI were strongly correlated with manual cough counts during sleep time (rho =0.908, P<0.001) and awake time (rho =0.847, P<0.001). Sleep time cough counts were moderately to strongly correlated with CS-VAS (rho =0.339, P<0.001), the frequency of waking up (rho =0.462, P<0.001), and salbutamol use at night (rho =0.243, P<0.001). Weak-to-moderate correlations were found between awake time cough counts and CS-VAS (rho =0.313, P<0.001), the degree of activity limitation (rho =0.169, P=0.005), and salbutamol use at awake time (rho =0.276, P<0.001). Neither awake time nor sleep time cough counts were significantly correlated with PEFR. The strong correlation between cough counts using the AI-based algorithm and human experts, and other indicators of patient health status provides evidence of the validity of this AI algorithm for use in asthma patients experiencing an acute exacerbation. Study findings suggest that CoughyTM could be a novel solution for objectively monitoring cough in a clinical setting.

The physical characteristics underpinning performance of wheelchair fencing athletes: A Delphi study of Paralympic coaches

ABSTRACT Wheelchair fencing (WF) is a Paralympic sport which is practised by athletes with physical disabilities and is classified into three categories according to the degree of activity limitation the impairment causes in the sport. All Paralympic sports are requested to develop their own evidence-based classification system to enhance the confidence in the classification process; however, this is yet to be achieved in WF. Research within WF is scarce; therefore, the aim of this study was to reach expert consensus on the physical characteristics that underpin performance of athletes competing in the sport as this is known as one of the initial steps required to achieve an evidence-based classification system. Sixteen Paralympic WF coaches were invited to take part in a three-round Delphi study, with experts drawing consensus on qualities of speed, strength, power, flexibility and motor control of the trunk and fencing arm being associated with increased athletic success. The required qualities of the non-fencing arm led to diverging opinions across the expert panel. This study provides clear guidance of the physical qualities to be developed to maximize athletic performance while also providing the initial framework to guide future WF classification research.

Association between diabetes mellitus and depressive symptoms in the Brazilian population.

ABSTRACTOBJECTIVETo determine the prevalence of current depressive symptoms in people with diabetes mellitus and their association with the disease.METHODSData were collected from the Brazilian National Health Survey (Pesquisa Nacional de Saúde - PNS), a cross-sectional, population-based study conducted in 2013. Study participants were selected by simple random cluster sampling in three stages: census tracts, households, and residents aged ≥ 18 years. The presence of diabetes was self-reported, whereas the presence of current depressive symptoms was determined by the Patient Health Questionnaire-9 (PHQ-9) and mean scores of this questionnaire were calculated for the variables assessed. Tobit regression was used to evaluate variation in these individuals.RESULTSOf the 60,202 interviewees, 6.03% (n = 3,636) reported diabetes mellitus. The disease was more frequent in female, older, widowed, obese and with incomplete elementary education. Depression symptoms were mild-to-moderately severe in 22% of the diabetics. The severity of current depressive symptoms was higher in individuals that were female (PHQ-9 mean = 3.35), older adults (PHQ-9 mean = 3.01), indigenous (PHQ-9 mean = 3.46), separated/divorced (PHQ-9 mean = 3.13), widowed (PHQ-9 mean = 3.39), obese (PHQ-9 mean = 3.13) and with incomplete primary education (PHQ-9 mean = 3.21). Higher severity of depressive symptoms was associated with the use of insulin and with coma (PHQ-9 mean = 8.32), limb amputation (PHQ-9 mean = 7.55), circulatory problems (PHQ-9 mean = 6.94), infarction (PHQ-9 mean = 6.83), diabetic foot (PHQ-9 mean = 6.62), and kidney problems (PHQ-9 mean = 6.68). The severity of current depressive symptoms was associated with diabetes severity and degree of limitation in activities of daily living (PHQ-9 mean = 10.62).CONCLUSIONSInterventions to improve depressive symptoms should be prioritized in people with diabetes are female, older adults, indigenous, widowed, separated/divorced, obese and with incomplete elementary education.

Undertreated emotional distress in older adults with cancer.

165 Background: Depression and anxiety are common among older adults with cancer, and concern about the adequacy of emotional distress management is increasing. We examined receipt of prescription medication (Rx) by older adults with cancer relative to reported activity limitation associated with emotional distress. Methods: Using the 2007-2012 SEER-Medicare Health Outcomes Survey (MHOS) database with a unique linkage to Part D prescription claims, we selected MHOS participants with Part D coverage who were within 5 years of cancer diagnosis. We used claims to identify use of Rx for emotional distress management: anti-depressants, antipsychotics, anxiolytics, and/or sedatives during the 90 days post survey. Participants reported activity limitations (“accomplished less” or “worked less carefully”) within the past 30 days “due to emotional problems.” Limitations were quantified as severe (most/all of the time), moderate (some/little of the time), or none. We used multivariable logistic regression to determine associations of Rx use with degree of activity limitation, controlling for characteristics of cancer, demographics and health status. Results presented are predicted percentages. Results: Reported activity limitation in the study sample (N = 9,105) was 15% severe, 34% moderate, and 52% none. Rx were used by 28% overall, with higher rates for severe (39%) and moderate (33%) compared to no activity limitation (23%), p &lt; .001. Among respondents not using Rx, 13% [32%] reported severe [moderate] activity limitations. Among respondents using Rx, severe [moderate] activity limitation was reported by 20% [39%]. Rx use was lower for male sex, with increasing age, non-white race, with fewer comorbid conditions and without the Part D low-income subsidy. Conclusions: Undertreatment of emotional distress is highly prevalent among older adults with cancer. Many SEER-MHOS respondents reporting moderate or severe activity limitations due to emotional distress did not receive Rx for symptom management, and of those receiving Rx, many still report moderate to severe symptoms. Treatment disparities identified by race/ethnicity, age and sex suggest the need for enhanced emotional distress screening and interventions to reduce treatment barriers.

Effect of obesity on self-reported pain and functional disability in patients with knee osteoarthritis in Zaria, North Western Nigeria

Introduction: Osteoarthritis (OA) is the most common causes of arthritis in human, with the knee joint being the most commonly affected. Knee OA patients often present with knee pain and varying degree of functional limitation in activities of daily living. The incidence and prevalence of knee OA increases with age and is poised to increase even further in tandem with an expected increase in life expectancy, rise in population age, and increased prevalence of obesity. Obesity is associated with the occurrence and severity of knee OA, and it is perhaps the most amenable of all knee OA risk factors. The contribution of obesity to pain and functional limitation in Nigerian knee OA patients is not well elucidated. This study aims at ascertaining the burden of obesity in Nigerian knee OA patients with regards to its prevalence, effects on pain, and functional disability. Materials and Methods: Between January 2010 and February 2011, 140 consenting knee OA patients were recruited consecutively, as they presented to the Rheumatology Clinic of Ahmadu Bello University Teaching Hospital, Zaria. Knee OA was diagnosed in patients using American College of Rheumatology clinicoradiographic criteria. Information was collected from patient using a pretested interviewer-administered structured question. Pain, stiffness, and functional disability were determined using Likert version of Western Ontario McMaster Universities Osteoarthritis index (WOMAC). Patients were grouped based on body mass index (BMI) into obese (BMI > 30 kg/m2) and nonobese (BMI

Establishing the Diagnosis of Cerebral Palsy

Cerebral palsy (CP) is a diagnosis of considerable concern to obstetricians, but the diagnosis of CP can be challenging, and may need to be confirmed by an experienced practitioner, ideally a child neurologist or psychiatrist. It is important not to make the diagnosis too early in infancy, especially when the signs are not severe, as resolution of early neuromotor abnormalities does occur, particularly in premature infants. Exclusion of genetic/metabolic disorders presenting with CP-like findings is important. The degree of activity limitation should be characterized; labeling children as having CP on the basis of abnormal examination findings alone without evidence of activity limitation is not useful. Brain imaging can be helpful in pinpointing the location of the underlying brain abnormality and sometimes provides etiologically useful information.

Renewed prescription of hearing aids: A clinically based study

We explored whether or not perceived health, subjective well-being, everyday life consequences of hearing loss, and/or use of communication strategies in experienced hearing aid users were associated with the outcome of renewed counselling, i.e. a prescription of a new hearing aid(s) (HA(s))or keeping the existing HA(s). The study included 170 subjects (84 men and 86 women) who had previously undergone HA fitting and audiological rehabilitation and at study entry had indications for a renewed rehabilitation and HA prescription. Self-report inventories assessed general health, well-being, activity limitation, participation restriction, and use of communication strategies. The outcome was studied by logistic regression. Review of medical records 18 months after the renewed counselling showed that 147 (86.5%) subjects had been fitted with new hearing aids. Gender, duration of hearing loss and previous use of one versus two aids influenced the outcome under study. Reported high degree of activity limitation a...

Diagnosis of Chronic Fatigue Syndrome in Children and Adolescents:

It has been a common occurrence that children with chronic, unexplained fatigue receive no specific diagnosis because of difficulties posed by the 1988 research criteria for chronic fatigue syndrome (CFS). The lack of a specific diagnosis creates medical uncertainty and may lead to increased psychosocial and educational disruption. With the recent publication of new research criteria these problems may be improved as the new criteria are less restrictive. In the process of developing new research criteria, data was collected for children who presented for evaluation of chronic unexplained fatigue over a two year period. Diagnosis of CFS was based upon the 1988 CDC criteria or clinical criteria based upon activity limitation and the associated symptom complex. Comparison of these two groups showed differences in symptom severity and degree of activity limitation, while demographics, psychosocial variables, and symptom pattern were similar. These results would suggest that chronic fatigue syndrome exists in a continuum of severity and that definition based solely upon severity of fatigue is arbitrary. While severe and debilitating fatigue should remain the basis of any research definition, clinical criteria based upon the symptom pattern of CFS may improve long term management by providing a working clinical diagnosis.

Effect of a Home Exercise Training Program in Patients With Cystic Fibrosis

Physical training in patients with pulmonary diseases, including cystic fibrosis (CF), may improve exercise tolerance in these patients. Most training programs are performed in a clinical setting. Little information is available concerning the effect of home exercise training programs in CF patients. The purpose of this study was to investigate the effect of a home exercise training program in CF patients. Ten adolescent patients (seven male and three female) with CF, mean (SD) age 20.6 (6.5) years, participated in a home exercise training program for 3 months. Pretraining condition was assessed during a control period of 2 months in which patients were asked to continue their normal daily activities. Home exercise training consisted of cycle training of 15 min at a submaximal workload once a day and was supervised by a physiotherapist two times a week. A follow-up period of 1 month, in which the patients were advised to continue cycling at home without supervision, was included after the training program. Pulmonary function, bicycle exercise test performance, and the degree of limitation in activities of daily living (ADL) were measured. No significant differences were found between the two pretraining assessments. After the training period we found significant improvement in maximal exercise capacity (Wmax) (mean [SEM]: 126 [10] W before and 146 [11] W after; p = 0.004), maximal oxygen uptake (VO2max) (mean [SEM]: 31.4 [2.1] ml.kg-1.min-1 before and 36.5 [2.5] ml.kg-1.min-1 after; p = 0.008), oxygen pulse (VO2/HR) (mean [SEM]: 10.9 [0.66] ml before and 11.9 [0.74] ml after; p = 0.047), and degree of limitation in ADL (mean [SEM]: 2.4 [0.43] before and 1.5 [0.48] after; p = 0.019) as compared with the initial values. Since no significant differences were found between the posttraining values and the results at the end of the follow-up period, the patients were apparently able to maintain the training effects during the follow-up period. We conclude that in CF patients, a home exercise training program, after clinical assessment of exercise tolerance, is an effective and relatively simple treatment to improve physical performance and decrease limitation in ADL and should be included in the maintenance treatment in these patients.

Physical Medicine and Rehabilitation

Physiatry has continued to evolve with changing patterns of illness and disability. The Institute of Medicine estimates that 35 million Americans (approximately one in seven) have disabling conditions. 1 More than 9 million are unable to work, study, or live independently. The average American will live almost 13 years with some sort of limitation. A 1988 National Health Interview Study showed that the incidence of disability increases dramatically with age. 2 About 5% of those under the age of 18 years have some degree of activity limitation, increasing to almost 40% in those 65 and over. Chronic illnesses, arthritis, strokes, trauma, and pain syndromes account for a significant proportion of functional limitations. As specialists in the pathogenesis, prevention, and remediation of disability, physiatrists are in a position to assist a variety of practitioners in maximizing function and quality of life. In particular, there have been exciting advances in the treatment

The role of new health practitioners in a prepaid group practice: provider differences in process and outcomes of medical care.

Practice patterns and patient-reported outcomes of care are compared in detail for ten physicians and 12 new health practitioners delivering ambulatory care in two departments of a prepaid group practice, the Columbia Medical Plan (CMP). All providers completed questionnaires for a 50 per cent random sample of patients seen during a two-week period. Patients completed questionnaires prior to receiving care and were interviewed one week and one month after their clinic visits. New health practitioners deliver approximately 75 per cent of well-person care, 56 per cent of problem-oriented care in adult medicine, and 29 per cent of problem care in pediatrics. They have become increasingly involved over time in the treatment of acute conditions and injuries while physicians have retained their predominant role in treating patients with chronic conditions. Thirty-two per cent of visits with new healh providers involved a physician in one or more of the following: decision-making, direct supervision, consultation, or seeing the patient as a second provider of care. Degree of autonomy varied by type of task performed, category of problem treated, and specialty. The following outcomes of care were examined by type of provider: patient-reported change in problem status,including frequency and intensity of pain or discomfort, level of anxiety, and degree of activity limitation; the degree to which physician-specified criteria for the most commonly occurring conditions were met with respect to change in problem status; and patient satisfaction with a number of dimensions of the clinic visit. The analysis suggests that the new health practitioners at the CMP are providing care, within their areas of responsibility, of comparable quality to that delivered by physicians.