Activities Of Daily Living Evaluation Research Articles

Knowledge-Based Remote E-Coaching Framework Using IoT Devices for In-Home ADL Rehabilitation Treatment of Degenerative Brain Disease Patients

The activities of daily living (ADL) ability level of an elderly patient is an important indicator in determining the patient’s degree of degenerative brain disease and is mainly evaluated through face-to-face interviews with doctors and patients in hospitals. It is impossible to determine the exact ADL ability of a patient through such a temporary interview, and the pursuit of accurate ADL ability evaluation technology is a very important research task worldwide. In this paper, in order to overcome the limitations of the existing ADL evaluation method mentioned above, first of all, a self-organized IoT architecture in which IoT devices autonomously and non-invasively measure a patient’s ADL ability within the context of the patient’s daily living place was designed and implemented. Second, a remote rehabilitation treatment concept for enhancing the patient’s ADL ability we call an “e-coaching framework”, in which a doctor remotely gives an instruction in a specific ADL scenario, and the patient’s ability to understand and perform the instruction can be measured on-line and in real time, was additionally developed on top of the self-organized IoT architecture. In order to verify the possibility of remote rehabilitation treatment through the proposed architecture, various remotely directed ADL scenarios were performed and the accuracy of the measurements was verified.

Research Progress on Responsiveness of Activities of Daily Living Scales of Patients with Stroke

Stroke is characterized with high morbidity, high disability rate and high mortality rate. Motor dysfunction after stroke often leads to decreased activities of daily living (ADL) and affects the quality of life of patients. It is of great significance to select a scale with good responsiveness in clinical and scientific work to reflect the changes of ADL abilities of patients sensitively. In this paper, we summarized the assessment items, characteristics and target population of the Barthel index (BI), functional independence measure (FIM) and modified Rankin scale (mRS), which were commonly used at home and abroad for ADL evaluation of stroke patients, and analyzed the responsiveness of these three scales in stroke patients at different stages of disease. For acute stroke patients, the responsiveness of BI and mRS scale was lower than that of FIM scale. For subacute stroke patients, BI, FIM and mRS Scales all showed good responsiveness, but due to the simple evaluation content, BI scale had a "ceiling" effect and its responsiveness was lower than mRS scale. For patients in chronic stage of stroke, their physical function recovery has almost reached a plateau, and their ADL ability recovery mainly focuses on family and social life, but BI, FIM and mRS scale lack evaluation items about family and social life, resulting in poor responsiveness. Frenchay activities index (FAI) and Longshi Scale (LS) have added IADL evaluation content to the commonly used ADL scales. However, the FAI and LS scales are not widely used, and there is still a lack of relevant studies on their responsiveness. In the future studies, the application of FAI and LS scales in patients with different stages after stroke will be strengthened, and the study on their responsiveness will be carried out, in order to provide a stronger basis for the development of rehabilitation training plan and evaluation of training effect for patients with stroke.

Comparing the effectiveness of bimanual and unimanual mirror therapy in unilateral neglect after stroke: A pilot study.

Unilateral neglect in stroke patients is a major obstacle to rehabilitation, which is a great challenge for therapists. This study aimed to compare the effectiveness of bimanual mirror therapy (BMT) and unimanual mirror therapy (UMT), the two protocols of mirror therapy, for the reduction of the symptoms of unilateral neglect in stroke patients. Twenty-eight individuals were randomly assigned to the BMT or UMT groups. Both groups received mirror therapy for 30 minutes per day, 5 days a week, for a period of 4 weeks. The Star Cancelation Test (SCT), Line Bisection Test (LBT), Picture Scanning Test (PST), and Korean Catherine Bergego Scale (K-CBS) were used to measure the change in unilateral neglect, and the Korean version of the Modified Barthel Index (K-MBI) was used to evaluate activities of daily living (ADL). The results of SCT, LBT, PST, and K-CBS showed significant decreases in unilateral neglect in both groups (p < 0.05). K-MBI improved significantly in both groups (p < 0.05). There were significant differences between the two groups in the unilateral neglect tests (p < 0.05), but no significant difference in ADL evaluation (p > 0.05). Mirror therapy protocols can be applied to treat unilateral neglect in stroke patients. However, BMT may be more beneficial for reducing the symptoms of unilateral neglect.

Automated Classification of Normal Control and Early-Stage Dementia Based on Activities of Daily Living (ADL) Data Acquired from Smart Home Environment.

With the global trend toward an aging population, the increasing number of dementia patients and elderly living alone has emerged as a serious social issue in South Korea. The assessment of activities of daily living (ADL) is essential for diagnosing dementia. However, since the assessment is based on the ADL questionnaire, it relies on subjective judgment and lacks objectivity. Seven healthy seniors and six with early-stage dementia participated in the study to obtain ADL data. The derived ADL features were generated by smart home sensors. Statistical methods and machine learning techniques were employed to develop a model for auto-classifying the normal controls and early-stage dementia patients. The proposed approach verified the developed model as an objective ADL evaluation tool for the diagnosis of dementia. A random forest algorithm was used to compare a personalized model and a non-personalized model. The comparison result verified that the accuracy (91.20%) of the personalized model was higher than that (84.54%) of the non-personalized model. This indicates that the cognitive ability-based personalization showed encouraging performance in the classification of normal control and early-stage dementia and it is expected that the findings of this study will serve as important basic data for the objective diagnosis of dementia.

Functional autonomy in dementia of the Alzheimer’s type, mild cognitive impairment, and healthy aging: a meta-analysis

Activities of daily living (ADL) are fundamental skills required to independently care for oneself and are categorized in basic (BADLs) and instrumental (IADLs) activities of daily living. ADL evaluation is of paramount importance in clinical practice to discriminate between healthy individuals (HC) and patients with mild cognitive impairment (MCI) or Alzheimer's disease (AD). However, it is unclear whether and to what extent BADL and IADL deficits occur in MCI, when compared with AD. Therefore, the present study aimed at comparing performance on both BADLs and IADLs in HC, MCI, and AD. Three electronic databases were consulted for studies comparing total BADLs/IADLs, and single BADLs/IADLs in AD, MCI, and HC (comparisons: AD versus MCI, AD versus HC, MCI versus HC). Ninety-six studies were included in the meta-analysis with random effect models (Hedges' g). Meta-regression was performed to evaluate the effect of clinical variables on ESs. AD group had more difficulties in BADLs and IADLs than HC and MCI groups; people with MCI showed more difficulties in both IADLs and BADLs than HC. The meta-regression analysis revealed that the percentage of males in the samples was a significant predictor of the ES in the meta-analysis comparing total BADL scores between MCI and HC; in the comparison between AD and HC, age at evaluation predicted the ES on some single IADLs: preparing food, handling medication, and finances. In MCI, it should be considered not only a decline of IADLs but also subtle decline of BADL abilities.

Feasibility of ABLE 1.0\u2014a program aiming at enhancing the ability to perform activities of daily living in persons with chronic conditions

BackgroundThe “A Better everyday LifE” (ABLE) intervention was developed to accommodate the need of a program addressing ability to perform activities of daily living (ADL) in persons with chronic conditions living at home. During intervention development, it is necessary to evaluate relevant aspects of the feasibility of a program. Thus, the aim was to evaluate the feasibility of content and delivery of ABLE version 1.0.MethodsA one group pre- and post-test design was applied. Thirty persons with chronic conditions, two occupational therapists (OTs), and five occupational therapy students (OTSs) participated. ABLE 1.0 is an 8-week program consisting of ADL evaluation (session 1); goal setting and reasons for ADL problems (session 2); intervention (sessions 3–7); and re-evaluation (final session), conducted in the clients’ home-setting and local area. Sessions 1–4 and the final session was mandatory.To evaluate the feasibility of content and delivery, the OTs, after each session, reported on applied intervention component(s), time-use, needed equipment, adjustments, meaningfulness, confidence, progress toward goal attainment, and side effects using registration forms. The clients reported on progress toward goal attainment, meaningfulness, and satisfaction. Clinically relevant improvements in ADL ability were identified using the ADL-Interview (ADL-I) and the Assessment of Motor and Process Skills (AMPS). Goal attainment was evaluated using the Goal Attainment Scaling (GAS).ResultsTwenty clients (67%) completed ABLE 1.0 and received four sessions (median = 4, range 4–7) each lasting between 30 and 94 min. Most frequently applied component was “Changing habits related to task performance”. Generally, OTs reported having the needed equipment. Deviations from the manual were made by omission of GAS and AMPS and less than mandatory number of sessions per client. The OTs reported confidence in delivering the program and the clients perceived the program as meaningful and satisfying, and experienced progress toward goal attainment. Goal attainment was found in 52% of the goals. Sixteen (80%) clients obtained clinically relevant improvements in self-reported or observed ADL ability.ConclusionsThe content and delivery of ABLE 1.0 was feasible. However, the study revealed a need to adjust the recruitment procedure and make minor changes in the intervention manual. A pilot randomized controlled trial (RCT) study is recommended.Trial registrationThe study was registered at ClinicalTrials.gov with registration no. NCT03335709 on November 8, 2017.

Clinical application of the experimental ADL test for patients with cognitive impairment: pilot study

We employed a hospital-based Internet of Things (IoT) platform to validate the role of real-time activities of daily living (ADL) measurement as a digital biomarker for cognitive impairment in a hospital setting. Observational study. 12 patients with dementia, 11 patients with mild cognitive impairment (MCI), and 15 cognitively normal older adults. The results of 13 experimental ADL tasks were categorized into success or fail. The total number of successful task and the average success proportion of each group was calculated. Time to complete the total tasks was also measured. Patients with dementia, patients with MCI, and cognitively normal older adults performed 13 experimental ADL tasks in a hospital setting. Significant differences in the average success rate of 13 tasks were found among groups. Dementia group showed the lowest success proportion (49.3%) compared with MCI group (78.3%) and normal group (97.4%). Correlation between classical ADL scales and the number of completed ADL tasks was statistically significant. In particular, instrumental ADL (I-ADL) had stronger relationship with the number of completed ADL tasks than Barthel’s ADL (B-ADL). Dementia group required more time to accomplish the tasks when compared to MCI and normal groups. This study demonstrated that there is a clear relationship between the performance of experimental ADL tasks and the severity of cognitive impairment. The evaluation of ADLs involving the IoTs platform in an ecological setting allows accurate assessment and quantification of the patient’s functional level.

Main Risk Factors Related to Activities of Daily Living in Non-Dialysis Patients with Chronic Kidney Disease Stage 3-5: A Case-Control Study.

IntroductionElderly people are at increased risk of falls, disability and death due to reduced functional reserve, decline in multiple systems functions, which affects their activities of daily living (ADL) and eventually develop into frailty. The ADL assessment is conducive to early detection to avoid further serious situations. Previous studies on patients’ activities of daily living with chronic kidney disease (CKD) are mainly focused on dialysis patients. Little information is available on non-dialysis patients.Patients and MethodsA total of 303 elderly patients with CKD stage 3–5 who were admitted to our hospital were selected. ADL evaluation was performed on patients at admission, with Barthel index (BI) as the evaluation tool. They were divided into two groups based on BI (≥60 and <60). Demographic information, lifestyle and clinical profile were collected. The risk factors related to ADL were analyzed by univariate and multivariate models.ResultsThe data of 303 patients enrolled in this study were analyzed. The average age of patients was 84.48± 7.14 years and 62.05% were male. There were 88 patients (29.04%) in BI <60 group and 215 patients (70.96%) in the BI ≥60 group. The average age of subjects in the two groups was 87.47 ± 5.85 years and 83.26± 7.28 years, respectively. On univariate analysis, ADL impairment was associated with many factors, such as age, body mass index, blood lipid, heart rate, smoking history, Charlson comorbidity index (CCI), hemoglobin, serum albumin, BNP, eGFR, etc. Multivariate logistic regression showed that age (OR 1.08, 95% CI 1.00–1.17, P=0.0390), Charlson comorbidity index (OR 4.75, 95% CI 1.17–19.30, P=0.0295), and serum albumin (OR 0.80, 95% CI 0.70–0.92, P=0.0012) were the independent risk factors of ADL impairment.ConclusionDecline of ADL in CKD patients was independently correlated with age, Charlson comorbidity index and serum albumin. ADL and its influential factors in the elderly CKD patients deserve further attention.

NQPC-06 FUNCTIONAL OUTCOMES OF INITIAL TREATMENTS FOR PATIENTS WITH PRIMARY CENTRAL NERVOUS SYSTEM LYMPHOMA ASSESSED BY ADL AND NEUROCOGNITIVE FUNCTION

BACKGROUNDSPrimary central nervous system lymphoma (PCNSL) frequently causes severe damage of activities of daily living (ADL) and neurocognitive function (NCF) due to extensive brain infiltration, necessitating their appropriate assessment and measures even in clinical practice. Since few studies have focused on the changes in the level of ADL and NCF in the course of PCNSL treatment, we retrospectively analyzed the effect of initial treatment of PCNSL in view of ADL and NCF.METHODSAmong 55 patients (13 male/9 female) with newly-diagnosed PCNSL treated in our institution from January 2014 to June 2019, 22 were evaluated with both ADL and NCF. Remission induction therapies consisted of high-dose methotrexate alone (two patients), R-MPV (rituximab, methotrexate, procarbazine, and vincristine)(17 patients), and R-MPV+radiaotherapy (three patients), according to the patients’ conditions. Rehabilitation staffs intervened from the beginning, providing specific exercises and periodically evaluating scores of Karnofsky Performance Status (KPS) and Mini Mental State Examination (MMSE).RESULTSMean age was 68.4 yo (range 34 to 85). After induction therapies, there were 11 complete responses (CRs), eight partial responses (PRs), and three progressive diseases (PDs). Both KPS and MMSE scores improved after induction therapy, from median 70 (40–90) to 80 (50–90), and from 24 (0–30) to 27(0–30), respectively. Among three patients who underwent RT, MMSE declined in two (one CR/one PR).CONCLUSIONSCase-adjusted induction therapies resulted in significant radiographical responses, and the longitudinal evaluation of ADL and NCF by rehabilitation staffs could validate their maintenance or improvement over time through effective treatments and early rehabilitation intervention. However, three was difficulty in assessing patients with higher brain dysfunction such as aphasia and social adjustment disorder. Further study is needed to include more patients and to explore more appropriate evaluation batteries and timings during and after completion of induction therapy for PCNSL.

Effectiveness of a tele-rehabilitation intervention to improve performance and reduce morbidity for people post hip fracture - study protocol for a randomized controlled trial

BackgroundMost surviving hip-fracture patients experience reduced mobility and lose some of their functional ability, which increases the risk of complications and rehospitalization. Post-discharge transitional programs to reduce readmissions and disabilities have shown some success. Telerehabilitation refers to the use of technologies to provide rehabilitation services to people in their homes. Considering the need for long-term follow-up care for people with hip fracture, in-home telerehabilitation could increase independence, decrease hospital stays and reduce the burden for caregivers. The objective of this study is to investigate the effectiveness of an intervention program based on telerehabilitation on activities of daily living (ADL), quality of life (QOL), depression and burden on caregivers compared to face-to-face home visits and usual care of community-dwelling older adults after hip fracture.Methods/designThis will be a three-armed randomized control trial (RCT) including pre/post intervention and follow-up. The trial will include 90 older people with hip fractures who will be randomly assigned to a telerehabilitation group (N = 30), face-to-face visits (N = 30) and a control group. The aim of the intervention is to improve the transition from rehabilitation units to community dwelling. It will include 10 videoconferencing/ face-to-face sessions from an occupational therapist in the presence of the primary caregiver. Each session will be utilized to guide the participants to achieve their self-identified goals, focusing on problem-solving for daily life situations and on the ability to implement the discussed strategies for a variety of activities. Outcome measures include Functional Independence Measure (FIM) for evaluation of ADL, SF-12 for evaluation of Health-related QOL, The Geriatric Depression Scale (GDS) and The Zarit Caregiver Burden Scale. Data will be analyzed using Repeated measures MANOVA.DiscussionThe current study will enable the cost-effectiveness examination of a suggested rehabilitation service based on available technology. The proposed intervention will increase accessibility of in-home rehabilitation services, improve function and health, and reduce economic burden.Trial registrationNCT03376750 (12/15/2017).

The relationship between basic, instrumental, and advanced activities of daily living and executive functioning in geriatric patients with neurocognitive disorders.

Although many studies explored the relationship between executive functions (EF) and activities of daily living (ADLs) in cognitive disorders, previous studies used measurements without well-defined levels of ADLs. This study explored the relationship between EF and the threefold classification of everyday functioning (basic or b-, instrumental or i-, and advanced or a-ADLs) and examined how EF account for the variance in this triad of everyday functioning. A sample of 44 cognitively healthy persons, 41 persons with mild cognitive impairment, and 35 persons with Alzheimer disease were assessed with comprehensive measures of EF and the b-, i-, and a-ADL tools. Correlations demonstrated that subjects with higher executive dysfunctions have more limitations in b-, i-, and a-ADLs. The highest significant correlations with measures of EF were seen in i- and a-ADLs (ranging from r=-0.193 to r=-0.559, P<0.05). However, correlations with a-ADLs were not stronger than with i-ADLs. The multivariate analyses revealed Trail Making Test A (TMT-A) as a significant contributor of everyday functioning in b-ADLs, as well as i- and a-ADLs, and Clock Drawing Test (CDT) and Animal Fluency Test (AFT) seemed to contribute significantly to variance in i- and a-ADLs. EF are less related to b-ADLs than i- and a-ADLs and contribute to the same amount of variance to limitations in both i- and a-ADLs. This study recommends using the TMT-A, CDT, and AFT as screening tools to indicate the need for profound evaluation of ADLs in older persons with neurocognitive disorders.

Effects of Pre-Existing Comorbidities on Outcomes in Patients with Chronic Subdural Hematoma

The number of patients with chronic subdural hematoma (CSDH) showing comorbidities and/or impaired activities of daily living (ADL) before the onset of CSDH has increased with the recent aging of society. The purposes of this study were to evaluate ADL worsening by comparing premorbid ADL and ADL at discharge and to investigate the effects of pre-existing comorbidity-related clinical factors on the outcomes. A total of 570 patients with CSDH admitted from 2006 to 2016 were studied retrospectively. Clinical factors, including pre-existing comorbidities, related to outcomes were identified by multivariate analysis. A variation of the modified Rankin Scale (mRS) using 5 united categories of mRS scores 0/1, 2, 3/4, 5, and dead was used for evaluation of ADL. Of 570 patients, 390 (68.4%) had pre-existing comorbidities and 120 (21.1%) showed premorbid impaired ADL (mRS scores 2 and worse). Considering pre-existing impaired ADL, ADL deteriorated after CSDH in 92 patients (16.1%), whereas ADL impairment at discharge was found in 173 patients (30.4%). Comorbidities related to ADL deterioration on multivariate analysis were hemodialysis and chronic heart failure. Antithrombotic use for cardiovascular diseases was a predictor of acute-on-chronic subdural hematoma, which was the sole common predictor for ADL deterioration and the occurrence of surgical complications. In patients with CSDH, pre-existing comorbidity-linked factors related to outcomes were hemodialysis, chronic heart failure, and antithrombotic use. Patients with acute-on-chronic subdural hematoma with these factors should be regarded as a high-risk group.

Evaluating activities of daily living using an infrared depth sensor: KINECTTM

Purpose: With a growing proportion of elderly people in the population, the maintenance of activities of daily living (ADLs) in elderly people is crucial to keep medical costs down. We investigated the ADL measurement accuracy of KINECTTM and Kinect Studio. To eliminate the subjectivity of conventional methods, we numerically assessed motions with computer analysis.Methods: Eighteen actions that repeated “move” and “stationary” phases, including movement of arms, legs, head and torso were measured using KINECTTM. Errors and standard deviations of joint coordinates at the stationary points outputted from KINECT Studio were evaluated. Simultaneous measurements were performed with KINECTTM using conventional high-performance motion capture, and the output was treated as a true value for comparison.Results: In most motions, errors of the joint coordinates were within 100 mm; however, there were two cases where errors due to the skeleton-model estimation by KINECT Studio increased. Firstly, when a part of the body unexpectedly moved out of the infrared measurable area, and secondly, when parts of the body overlapped each other on the KINECTTM image.Conclusions: KINECTTM and Kinect Studio are effective for ADL assessment when positions that cause large errors are excluded. Since KINECTTM has sufficient precision, it should also be possible to develop a more appropriate ADL evaluation system with a new algorithm of skeleton-model estimation that does not depend on KINECT Studio.Implications for RehabilitationThe KINECTTM and Kinect Studio are effective for ADL assessment when positions that cause large errors are excludedWith an increasing proportion of elderly people in the population, the maintenance of activities of daily living (ADLs) in elderly people is crucial to keep medical costs downSystems such as the KINECTTM can support these goals

Atividade de vida diária e sintomas depressivos em pacientes com doença pulmonar obstrutiva crônica

Objetivo: avaliar a presena de sintomas depressivos e as atividades de vida diria em pacientes com doena pulmonar obstrutiva crnica (DPOC). Mtodos: Participaram 114 pacientes com DPOC classificados de acordo com Global Strategy for the Diagnosis, Manegement and Prevention in COPD nos estgios 2, 3 e 4. Foram avaliados a presena de sintomas depressivos (Inventrio de Depresso de Beck) e as limitaes nas atividades de vida diria (AVDs) (London Chest Activity of Daily Living Scale - LCADL). Resultados: A prevalncia de sintomas depressivos foi 41,2%. Os pacientes com sintomas depressivos apresentaram comprometimento em todos os domnios do LCADL (Cuidado pessoal, p0,001; Atividades domsticas, p=0,004; Atividade Fsica, p=0,002; Lazer, p0,001 e Escore total, p0,001). Concluso: os pacientes com DPOC e com sintomas depressivos apresentaram limitaes na capacidade de desempenhar as AVDs, sendo necessrio no s o rastreamento desses sintomas como tambm a avaliao das AVDs na prtica clnica.

P18.02 Prospective evaluation of quality of life in patients with recurrent high grade glioma treated with re-irradiation by tomotherapy based IMRT

Abstract Introduction: Prospective quality of life (QOL) evaluation in re-irradiation (reRT) for recurrent high grade glioma (HGG) is rare but an important endpoint. We report a prospective study of patient reported QOL and activities of daily living (ADL) as primary end point in patients treated with re-irradiation (reRT) for recurrent HGG. Materials and Methods: 34 patients of recurrent HGG with Karnofsky Performance Status (KPS) ≥60 planned for re-irradiation as per joint neuro-oncology meeting decision were included. Image guided intensity modulated radiotherapy (IG-IMRT) was delivered with helical tomotherapy at 1.8 Gy/fraction to 45-55 Gy. Serial QOL and ADL evaluation was done by a trained occupational therapist using validated Indian translations of EORTC QLQ30 + BN20 and Barthel’s ADL Index, before starting reRT and at 1,3,6,9 and 12 months follow up post reRT. Results: At recurrence, 56% HGG were grade 3 and 44% were grade 4 tumours. 65% patients had HGG transformed from a previous low grade glioma. Before reRT, 74% patients had undergone re-surgery and 59% had received salvage chemotherapy with either temozolomide or bevacizumab. Median interval from primary RT was 6.7 years. Planned reRT dose was completed by 91% patients, with 27% requiring treatment interruption. Concurrent chemotherapy was planned for 77% patients, of which 27% required early cessation due to poor tolerance. Concurrent corticosteroid support was required by 41% patients. QOL questionnaires were completed by patients themselves in 85% instances while 15% were filled in proxy by primary caregivers. Mean baseline global QOL score was 61/100, which remained stable up to 50.5/100 at 6 months post reRT. Global QOL was stable in 15/25 patients at 1 month, 13/20 at 3 months, 7/16 at 6 months and 4/10 patients at 1 year post RT. Mean physical and social function scores were stable till 6 months. Emotional, role and cognitive function scores remained stable till 9 months. Mean baseline ADL score was 16.5/20, declining to 14/20 at 9 months post reRT. Among symptom scores, appetite loss and seizures remained stable till 3 months while scores for fatigue, insomnia and weakness of legs were stable till 6 months. Scores for motor dysfunction, communication deficit, nausea and bladder control remained stable till 9 months. Remaining symptom scores showed no significant decline till 1 year post RT. Pseudo progression was seen in 9/34 patients. At the time of analysis, 17/34 patients are alive and on follow-up. Decline in QOL scores at 6 to 9 months coincided with a median progression free survival of 36.5 weeks. Median overall survival was 46.5 weeks. Serial QOL and ADL scores did not correlate significantly with age, sex, KPS, tumour location and grade. CONCLUSION: Clinical experience of re-irradiation in recurrent HGG with IG-IMRT has been encouraging in terms of tolerance and palliation, providing reasonably stable QOL till tumour progression.

Mild versus moderate stages of Alzheimer's disease: three-year outcomes in a routine clinical setting of cholinesterase inhibitor therapy

BackgroundThere is an increasing interest in cognitive and functional outcomes in the respective stages of Alzheimer’s disease (AD) and in novel therapies particularly for the milder phases of AD. Our aim was to describe and compare various aspects of disease progression in patients with mild versus moderate AD in routine clinical practice of cholinesterase inhibitor (ChEI) therapy.MethodsThis 3-year, prospective, observational, multicentre study included 1021 participants. Of these, 734 had mild AD (Mini-Mental State Examination (MMSE) score, 20–26) and 287 had moderate AD (MMSE score, 10–19) at the start of ChEI treatment. At baseline and every 6 months, patients were assessed using cognitive, global, instrumental and basic activities of daily living (ADL) scales. Potential predictors of deterioration in moderate AD were analysed using mixed-effects models.ResultsThe change from baseline between participants with mild and moderate stages of AD after 3 years of ChEI therapy differed significantly on the Alzheimer’s Disease Assessment Scale-cognitive subscale (ADAS-cog) and basic ADL, but not using the MMSE and instrumental ADL scales. Protective independent factors for better cognitive long-term outcome in the group with moderate AD were older age, higher instrumental ADL ability, no antipsychotics, usage of non-steroidal anti-inflammatory drugs/acetylsalicylic acid, living with family member, lower education and a higher mean dose of ChEI. Apolipoprotein E genotype did not influence the rates of disease progression or the longitudinal outcomes. Prediction models were provided for moderate AD.ConclusionsMore sensitive cognitive measures, such as the ADAS-cog scale, are required to detect a possibly faster deterioration among the participants with moderate AD. This study highlighted the clinical importance of instrumental ADL evaluations in patients at a mild stage of AD, and the importance of optimizing the ChEI dose even for individuals with moderate AD. Solitary living was a risk factor for faster cognitive decline, and probably expanded the need for formal care in the group with moderate AD. The patients with more advanced AD and presumably more pronounced neuroinflammation might have additional cognitive benefits from longer-term treatment with anti-inflammatory drugs.

Effects of neurofeedback and computer-assisted cognitive rehabilitation on relative brain wave ratios and activities of daily living of stroke patients: a randomized control trial.

[Purpose] This study investigated the effects of neurofeedback (NFB) and computer-assisted cognitive rehabilitation (CACR) on the relative brain wave ratios and activities of daily living (ADL) of stroke patients. [Subjects and Methods] Forty-four participants were randomly allocated to the NFB (n=14), CACR (n=14), or control (CON) (n=16) groups. Two expert therapists provided the NFB, CACR, and CON groups with traditional rehabilitation therapy in 30-minute sessions, 5 times a week, for 6 weeks. NFB training was provided only to the NFB group and CACR training was provided only to the CACR group. The CON group received traditional rehabilitation therapy only. Before and after 6 weeks of intervention, brain wave and ADL evaluations were performed, and the results were analyzed. [Results] The relative ratio of beta waves, only showed a significant increase in the frontal and parietal areas of the NFB group. Significant changes in ADL were shown by all three groups after the intervention. However, there were no significant differences between the NFB and CACR groups and the CON group. [Conclusion] Our results suggest that CACR and NFB are effective at improving cognitive function and ADL of stroke patients.

MP72-19 THE IMPACT OF HEALTH RELATED QUALITY OF LIFE ON CYSTECTOMY PATIENTS USING THE MEDICAL HEALTH OUTCOMES STUDY

You have accessJournal of UrologyBladder Cancer: Invasive V1 Apr 2015MP72-19 THE IMPACT OF HEALTH RELATED QUALITY OF LIFE ON CYSTECTOMY PATIENTS USING THE MEDICAL HEALTH OUTCOMES STUDY Brian Winters, George Schade, Sarah Holt, John Gore, Atreya Dash, Michael Porter, and Jonathan Wright Brian WintersBrian Winters More articles by this author , George SchadeGeorge Schade More articles by this author , Sarah HoltSarah Holt More articles by this author , John GoreJohn Gore More articles by this author , Atreya DashAtreya Dash More articles by this author , Michael PorterMichael Porter More articles by this author , and Jonathan WrightJonathan Wright More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2653AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The overall impact on health related quality life (HRQoL) for patients undergoing radical cystectomy (RC) for bladder cancer (BC) is not well quantified on a population-based level. We evaluated post-RC HRQoL in patients with BC undergoing RC compared with non-cancer controls using the SEER-Medical Health Outcomes Survey (MHOS) database. METHODS The SEER-MHOS database (1998-2011) was used to identify patients with a BC diagnosis and MHOS survey data. Each included patient was surveyed at intervals with the SF-36 or its short-form, the VR-12, from which the mental component summary (MCS) and physical component summary (PCS) scores were derived. 129 patients undergoing RC were identified with available MHOS results within 5 years of surgery. RC patients were propensity score matched 1:5 to non-cancer controls (n=645) on age, gender, race, marital status, education, smoking status and comorbidities (HTN, angina, CHF, MI, stoke, COPD, DM, sciatica, arthritis). Differences in MCS and PCS scores as well as self-reported activities of daily living (ADLs) between RC patients and non-cancer controls were evaluated with linear regression analysis and the Fisher's exact test where appropriate. RESULTS Overall, mean MCS (48.9 and 50.8, p = 0.01) and PCS (35.0 and 39.7, p < 0.001) scores were significantly lower for cases than matched controls, respectively. When stratified by length of time from RC (<6 mos, 6-12 mos, 12-18 mos, 18-24 mos, 24-60 mos), adjusted MCS scores were not significantly different between groups, with the exception of a decrease in MCS in post-RC patients in the 24-60 month group (p=0.04). PCS scores were significantly lower among RC patients at all time points except 18-24 months after RC. Evaluation of patient-reported ADLs revealed worse physical functioning among RC patients compared with controls including greater difficulty or inability to perform: bathing (24% vs. 13%, p=0.002), dressing (21% vs. 12%, p=0.009), eating (11% vs. 6%, p=0.047), and using the toilet (16% vs. 9%, p=0.02). There were no significant differences between groups with respect to walking or getting in/out of a chair. Overall, post RC patients rated their general health (p=0.0003) and health relative to peers of same age (p = 0.02) as significantly decreased compared to controls. CONCLUSIONS Patients undergoing RC for BC have worse physical HRQoL and greater difficulty performing ADLs compared with non-cancer controls. Further longitudinal study is needed to better quantify HRQoL in patients undergoing cystectomy for bladder cancer. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e928 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Brian Winters More articles by this author George Schade More articles by this author Sarah Holt More articles by this author John Gore More articles by this author Atreya Dash More articles by this author Michael Porter More articles by this author Jonathan Wright More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Participation in activities of daily living can reduce loneliness in older adults.

Sir, We agreed with Tiwari that loneliness among older adults become significant public health issue.[1] In his guest editorial, Tiwari mention three types of loneliness situational, developmental and internal loneliness.[1] We believe the ability to perform activities of daily living (ADL) can help to reduce the chances of loneliness. For healthy ageing and to maintain older adults mobile ADL activities plays an essential role.[2] They focus more on ADL activities compare to any other work because it is a common activity people used to do throughout their lives to fulfill their time and give meaning of their life.[3] Activities that a person value encourage to participate and give help to look forward in daily life.[3] Valued life activities categorized as obligatory, committed and discretionary activities[3] among these obligatory and committed activity are purely ADL activities. Obligatory activities include activities necessary for survival basically known as personal ADL[34] or basic ADL[4] such as bathing, showering, bowel and bladder management, dressing, eating, feeding functional mobility, personal device care, personal hygiene and grooming, sexual activity, toilet hygiene.[34] Committed activities includes social role, family care and family responsibility known[4] as instrumental ADL such as care of others, care of pets, child rearing, communication management, community mobility, functional management, health management and maintenance, home establishment and management, meal preparation and clean-up, religious observance, safety and emergency maintenance, shopping.[4] When older persons able to perform all these ADL task independently with or without the help of assistive devices, surely it gives them satisfaction and felling of independence.[2] Which surely help them to reduced loneliness by providing the confidence and self-esteem. It also helps them to occupy their time by doing those activities in regular basis and help to integrate with social life. However, older adults showed age related decline with tasks even when those task are familiar, practiced and environmentally valid.[5] It is also applicable to their ADL activities also. Older adults should perform ADL as many as possible to maintain their activeness when they are not able to increase their activity level according to require guidelines within their abilities and depend upon health condition.[2] Ability to perform any ADL activity depends on client factors, performance skills, pattern of performance, and demand of that activity, context, and the environment.[4] Without detail evaluation of all aspect, it is a difficult task to address ADL related issues in elderly. Evaluation and implementation of the intervention is individualistic in nature, which makes this job a specialized one. We occupational therapist do ADL evaluation and intervention in our everyday practice because occupational therapy profession uses the term occupation to capture the breadth and meaning of everyday activity of an individual.[4] Though a multidisciplinary team approach is require to prevent loneliness where occupational therapist can play an important role to make older adults independent in their ADL activities by modifying the demand, context, environment and pattern of the activity. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Necessity to develop a tool to evaluate activity of daily living for electric powered indoor/outdoor chair users.

ObjectiveTo evaluate changes in activity of daily living before and after provision of electric-powered indoor/outdoor chair (EPIOC), discuss problems of current activities of daily living (ADL) evaluating tools for EPIOC users, and provide preliminary data to develop ADL evaluation tool for EPIOC user.MethodsA total of 70 users who were prescribed EPIOC and had been using for more than 1 year were recruited in this study. Before and after provision of EPIOC, MBI and FIM scores were measured and a questionnaire consisting of six categories (general socioeconomic states, currently using state, whether EPIOC was helpful for social participation and occupational chances, psychiatric influences, self-reported degrees of independency, and barriers of using EPIOC) was used.ResultsNo difference in MBI scores before and after provision of EPIOC was observed. However, the wheelchair ambulation category showed a significant difference. While motor FIM was not significantly different from MBI, FIM score were significantly (p<0.05) higher than MBI. For questions regarding social participation frequency, helpfulness of EPIOC on confidence, refreshing patients' emotions and self-reported degrees of independence, all of them showed positive responses. Especially, EPIOC users' self-reported degree of independency showed favorable results. There was discrepancy in MBI or FIM measured by physicians.ConclusionOur study showed that there was a gap between the existing ADL evaluation tool and the ADL level that EPIOC users were actually feeling. Thus, it is necessary to develop an evaluation tool specifically for EPIOC.