Functional Performance Status Research Articles

Exercise Training for Older Adults with Limitations in Physical Function

This study aimed to evaluate the effects of an 8-week supervised exercise program on physiological measurements during treadmill walking, muscle strength, functional performance, and health status in older adults limited in physical function. Twenty-four participants were randomly assigned to an exercise group (EG, N = 13) or a control group (CG, N = 11), and were evaluated before and after the exercise program (EG) or 8-week period (CG). Evaluations included a progressive treadmill lest, strength testing, the Physical Performance Test (PPT), and the SF-36 Health Survey. The exercise program consisted of 3 sessions per week of brisk walking and strengthening exercises. The EG demonstrated increases in cardiorespiratory fitness and increases in treadmill walking time. The EG also demonstrated increases in force production in 3 of the 6 muscle groups that were tested. Both the EG and CG demonstrated improvements in PPT scores and in 2 health concepts on the SF-36 Health Survey.

Cardiac valve surgery in octogenarians: improving quality of life and functional status.

Although cardiac valve procedures are being performed more frequently in the elderly, long-term functional outcomes have not been well characterized. To evaluate changes in quality of life and functional status in octogenarians after cardiac valve surgery. Retrospective medical record review and patient telephone interview. Median follow-up 30 months (range, 6-95 months). Tertiary care university hospital. Octogenarians undergoing cardiac valve surgery (N = 61; mean age, 83.5 years; range, 80-89 years). Forty-seven patients had aortic valve replacement, 14 had mitral valve replacement and/or repair, and 27 had a combined procedure with coronary artery bypass grafting. Actuarial survival, morbidity, length of hospital stay, and discharge disposition were evaluated. Functional status, using the New York Heart Association classification, and Karnofsky performance status were evaluated preoperatively and postoperatively at 1 and 3 months after hospital discharge. Operative (<30 days) mortality occurred in 7 (11.4%) of 61 patients. Preoperative intensive care unit stay (P < .001) and New York Heart Association class 4 (P < .02) were independent predictors of early death by multivariable analysis. Among hospital survivors, there were no major complications in 34 patients (63%), and this group had a mean (+/- SD) postoperative hospital stay of 12.2 +/- 5.5 days. Twenty patients (37%) incurred significant complications, the most common of which were bleeding, pneumonia, and renal insufficiency. The mean (+/- SD) postoperative hospital stay in this group was 25 +/- 17 days. Although significant complications were associated with an increased postoperative stay, this was not predictive of disposition to a skilled nursing facility or the final score on the postoperative Karnofsky performance scale. Actuarial survival was 85% at 1 year and 66% at 5 years. Patients with perioperative complications had significantly decreased actuarial survival by the Cox proportional hazards regression model (P < .001). Among hospital survivors, the score on the Karnofsky performance scale 1 month after discharge had improved 50% from a preoperative median score of 30% (severely disabled, requiring special care) to a postoperative median score of 80% (being able to perform normal activity with only moderate symptoms). The New York Heart Association classification improved a median of 2 classes in this group. These benefits were sustained at the 3-month follow-up. Although greater resource expenditure is required for the initial perioperative convalescence, octogenarians can be expected to have an excellent functional outcome and long-term performance status after cardiac valve surgery.

Results After Surgical Repair of Ebstein’s Anomaly

Background. Ebstein’s anomaly of the tricuspid valve is a complex malformation. Various operations have been undertaken with varying results. Because valve replacement yielded poor results, surgical treatment has focused on valvuloplasties.Methods. Between April 1974 and February 1995, 60 patients with Ebstein’s anomaly underwent surgical repair. Age ranged from 5 months to 54 years. In 56 patients (93.3%), tricuspid valvuloplasty was feasible, mainly by creating a monocusp valve with the single-stitch technique. The other 4 patients had valve replacement with a bioprosthesis. Six reoperations were necessary (10.0%): four valve replacements and two repeat valvuloplasties.Results. There were two hospital deaths (3.3%) and a late mortality rate of 10.0% (6 patients). Forty-nine (94.2%) of 52 survivors were followed for 5 months to 18.6 years (median follow-up, 5.0 years; mean follow-up, 6.9 years). The actuarial survival rate (Kaplan-Meier) was 96.5% ± 2.4% at 1 year and 83.3% ± 5.6% at 18 years. At follow-up evaluation, nearly all patients showed substantial improvement (93.9% were in functional class I or II) compared with their preoperative status. Doppler echocardiographic studies demonstrated good tricuspid valve function in most patients.Conclusions. Valvuloplasty using the single-stitch technique is a rewarding operation. It yields good long-term results with substantial improvement in functional performance and clinical status.(Ann Thorac Surg 1997;63:1650–6)

Intracerebral neutron brachytherapy for hemispheric glioblastoma multiforme. A pilot study.

The University of Kentucky Brain Tumor Study and Research Group has developed a new treatment protocol of interstitial brain brachytherapy using Californium-252 neutron source implantation in 1980. Only patients with malignant gliomas were eligible for this pilot study. Nine patients entered the Phase I trial of the protocol study between November 1980 and October 1981. According to the design of the protocol, all patients who had a verified histologic diagnosis of glioblastoma multiforme underwent postoperative intracerebral Cf-252 neutron source implantation, followed by 6 000 cGy of external photon beam irradiation. The purpose of this pilot study was to test the feasibility of interstitial Cf-252 neutron source implantation and only one implant afterloading applicator was used for brachytherapy. The implant applicator was placed in the center of tumor and the procedure was performed under CT guidance. In the assessment of the procedure, Karnofsky functional performance status, intellectual status, neurological examination, CT scans, and complications were used. All patients tolerated the procedure well and no serious complications were encountered. Despite the quality of these early treatments, there was some evidence of short-term benefit in duration of survival of the patients. We believe that further technical improvement to achieve an adequate isodose distribution to cover the tumor volume might result in longer duration improvement in survival.

The palliation of brain metastases: Final results of the first two studies by the radiation therapy oncology group

Five schedules of whole brain irradiation ranging from 4000 rad/4 weeks to 2000 rad/ 1 week have been evaluated in two sequential phase III randomized Radiation Therapy Oncology Group (RTOG I studies to determine palliative effectiveness in patients with metastatic brain disease. Improvement in neurologic function status and maintenance of improved or stable neurologic function were utilized as measures of response. All treatment schedules were comparable with respect to frequency of improvement, duration of improvement, time to progression, survival and palliative index. Important prognosticators of response included initial neurologic function and general performance status. Administration of steroids during irradiation favored more rapid improvement; for neurologic-function-3 patients, it increased the overall frequency of improvement. This result must be interpreted with caution since the administration of steroids was not controlled in either study. Patients whose disease is controlled at the primary site and in whom brain is the only site of metastases, constitute a prognostically favorable group; they may benefit from whole brain irradiation to higher doses. This population is currently under investigation in a third RTOG study.

Hemodynamic assessment of the new aortic Carpentier-Edwards bioprosthesis.

Although glutaraldehyde-preserved porcine aortic Hancock heterografts have lower thromboembolism incidence than mechanical aortic valves, Hancock xenografts provide less functional aortic outflow orifices and thereby greater transvalvular gradients than mechanical prostheses. The newly developed aortic Carpentier-Edwards porcine heterografts comprise a thin-walled Elgiloy flexible metal stent covered with Teflon which provides somewhat wider internal orifices than aortic Hancock valves of the same external annulus diameter. Since aortic Carpentier-Edwards xenografts have not been clinically evaluated previously, the present study assessed cardiac function and heterograft performance (1.7 months postoperation) and clinical status (4.2 months postoperation) of 19 patients with severe aortic stenosis and/or regurgitation prior to surgery. Left ventricular end-diastolic pressures decreased (17 to 9 mm Hg), cardiac index remained normal, and clinical symptomatology diminished markedly. Mean peak transxenograft systolic pressure was only 16 mm Hg (valve area 1.73 cm2), without meaningful regurgitation. Thus aortic Carpentier-Edwards bioprostheses provide generally excellent heterograft function which appears more favorable than previous reports of Hancock xenografts.