Functional Ability In People Research Articles

Efficacy of Aromatherapy Against Behavioral and Psychological Disturbances in People With Dementia: A Meta-Analysis of Randomized Controlled Trials

ObjectivesBehavioral and psychological symptoms of dementia (BPSD) are common in people with dementia. Aromatherapy may reduce the frequency and severity of BPSD. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the efficacy of aromatherapy in relieving BPSD and improving functional ability in people with dementia. DesignSystematic review and meta-analysis. Setting and ParticipantsPatients with dementia receiving aromatherapy. MethodsA literature search was conducted using PubMed, Embase, and Cochrane Library for RCTs published before March 2024 comparing aromatherapy with control treatments in patients with dementia. ResultsThere were 15 trials involving 821 patients. Overall, significant reduction in BPSD was observed after 1 month of aromatherapy treatment. Among 15 trials, 9 reported the Cohen-Mansfield Agitation Inventory (CMAI) score, and 7 evaluated the Neuropsychiatric Inventory (NPI) score. The meta-analysis showed significant improvement in CMAI score [weighted mean difference (WMD) −6.31, 95% CI −9.52 to −3.11] and NPI score (WMD −8.07, 95% CI −13.53 to −2.61) in patients receiving 3 to 4 weeks of aromatherapy compared with the control group. Four of the 15 trials reported improvement in depressive mood and 3 trials reported no significant improvement in functional ability. Conclusions and ImplicationsIn conclusion, aromatherapy is a safe and viable nonpharmacologic treatment to improve BPSD in people with dementia and its combination with massage showed higher efficacy.

Trajectories of cognition and functional ability in people with dementia: Two‐year longitudinal results from the IDEAL programme

AbstractBackgroundImpairment in both cognition and instrumental activities of daily living (iADL) are key diagnostic features of dementia. Few studies have compared trajectories of cognition and iADL. By comparing trajectories of cognitive decline with both self‐rated and informant rated iADL, the study determines whether these aspects are related or decline in parallel and where there is a difference between perceptions of change.MethodData from the Improving the experience of Dementia and Enhancing Active Life (IDEAL) study were used. The study comprises 1537, 1183, and 851 people with dementia, and 1277, 977, and 749 carers at baseline (T1), 12 months later (Time 2, T2), and 24 months later (Time 3, T3), respectively. Cognition was assessed with the Addenbrooke’s Cognitive Examination‐III (ACE‐III), higher scores indicate fewer cognitive difficulties. iADL was assessed using the Functional Activities Questionnaire (FAQ), higher scores indicate more iADL difficulties. Both self‐ratings (FAQ‐S) and informant ratings (FAQ‐I) were collected. Because of the differences in the scale and distribution of FAQ and ACE‐III, scores were converted to ranks to enable comparison of trajectories between the two measures; deciles were calculated at T1 and imposed on T2 and T3 scores.ResultAs ACE‐III decreased both FAQ‐S and FAQ‐I increased suggesting that people with dementia with more cognitive difficulties were rated as having greater iADL difficulties by both people with dementia themselves and their carers. FAQ‐S declined on average by ‐0.10 (‐0.26, 0.06) decile points per timepoint more than ACE‐III. As confidence intervals overlapped zero this suggests that FAQ‐S and ACE‐III ratings declined at a similar rate. FAQ‐I declined on average by ‐0.31 (‐0.43, ‐0.19) decile points per timepoint more than ACE‐III. The trajectory over the two years suggests that FAQ‐I ratings declined at a significantly greater rate than ACE‐III scores.ConclusionBoth cognition and iADL, whether self‐ or informant‐rated declined over two years. Trajectory analysis suggests that self‐rated iADL was generally concordant with cognitive decline, whereas informant‐rated iADL reflected more perceived decline than cognition. Therefore, either cognition and perceived iADL decline at different rates or informants overestimate increasing iADL difficulties compared to both cognition and self‐ratings.

Repetitive peripheral magnetic stimulation for impairment and disability in people after stroke.

Repetitive peripheral magnetic stimulation (rPMS) is a non-invasive treatment method that can penetrate to deeper structures with painless stimulation to improve motor function in people with physical impairment due to brain or nerve disorders. rPMS for people after stroke has proved to be a feasible approach to improving activities of daily living and functional ability. However, the effectiveness and safety of this intervention for people after stroke remain uncertain. This is an update of the review published in 2019. To assess the effects of rPMS for improving activities of daily living and functional ability in people after stroke. We searched the Cochrane Stroke Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL), in the Cochrane Library; MEDLINE; Embase; the Cumulative Index to Nursing and Allied Health Literature (CINAHL); PsycINFO; the Allied and Complementary Medicine Database (AMED); OTseeker: Occupational Therapy Systematic Evaluation of Evidence; the Physiotherapy Evidence Database (PEDro); Ichushi-Web; and six ongoing trial registries on 5 October 2021. We screened reference lists and contacted experts in the field. We placed no restrictions on the language or date of publication when searching the electronic databases. We included randomised controlled trials (RCTs) conducted to assess the therapeutic effect of rPMS for people after stroke. The following comparisons were eligible for inclusion: 1) active rPMS only compared with 'sham' rPMS (a very weak form of stimulation or a sound only); 2) active rPMS only compared with no intervention; 3) active rPMS plus rehabilitation compared with sham rPMS plus rehabilitation; and 4) active rPMS plus rehabilitation compared with rehabilitation only. Two review authors independently assessed studies for inclusion in the review. The same review authors assessed methods and risk of bias, undertook data extraction, and evaluated the certainty of the evidence using the GRADE approach. We contacted trial authors to request unpublished information if necessary. Any disagreements were resolved through discussion. We included four trials (three parallel-group RCTs and one cross-over trial) involving a total of 139 participants. This result was unchanged from the review published in 2019. Blinding of participants and physicians was well reported in three trials, with no information on whether personnel were blinded in one trial. We judged the overall risk of bias across trials as low. Only two trials (with 63 and 18 participants, respectively) provided sufficient information to be included in the meta-analysis. We found no clear effect of rPMS on activities of daily living at the end of treatment (mean difference (MD) -3.00, 95% confidence interval (CI) -16.35 to 10.35; P = 0.66; 1 trial; 63 participants; low-certainty evidence) and at the end of follow-up (MD -2.00, 95% CI -14.86 to 10.86; P = 0.76; 1 trial; 63 participants; low-certainty evidence) when comparing rPMS plus rehabilitation versus sham rPMS plus rehabilitation. We found no statistical difference in improvement of upper limb function at the end of treatment (MD 2.00, 95% CI -4.91 to 8.91; P = 0.57; 1 trial; 63 participants; low-certainty evidence) and at the end of follow-up (MD 4.00, 95% CI -2.92 to 10.92; P = 0.26; 1 trial; 63 participants; low-certainty evidence) when comparing rPMS plus rehabilitation versus sham rPMS plus rehabilitation. We observed a decrease in spasticity of the elbow at the end of follow-up (MD -0.41, 95% CI -0.89 to 0.07; 1 trial; 63 participants; low-certainty evidence) when comparing rPMS plus rehabilitation versus sham rPMS plus rehabilitation. In terms of muscle strength, rPMS treatment was not associated with improved muscle strength of the ankle dorsiflexors at the end of treatment (MD 3.00, 95% CI -2.44 to 8.44; P = 0.28; 1 trial; 18 participants; low-certainty evidence) when compared with sham rPMS. No studies provided information on lower limb function or adverse events, including death. Based on the GRADE approach, we judged the certainty of evidence related to the primary outcome as low, owing to the small sample size of the studies. There is insufficient evidence to permit the drawing of any conclusions about routine use of rPMS for people after stroke. Additional trials with large sample sizes are needed to provide robust evidence for rPMS after stroke.

PENGARUH CLOSED KINETIC CHAIN EXERCISE DAN OPEN KINETIC CHAIN EXERCISE TERHADAP AKTIVITAS FUNGSIONAL PADA PASIEN OSTEOARTHRITIS KNEE DI RUMAH SAKIT GRANDMED LUBUK PAKAM TAHUN 2022

Osteoarthritis is the most common degenerative condition among the elderly. Functional disorders are caused by knee osteoarthritis. A person with osteoarthritis knee typically experiences pain, stiffness, and a decrease in functional activity as a result of limited function. The purpose of this study is to compare the effects of open kinetic chain exercise and closed kinetic chain exercise on increasing functional activity in patients with osteoarthritis of the knee. This is a quasi-experimental type of study. To compare two intervention groups, a two-group pre-test post-test research design was used. In addition, WOMAC is being used to assess functional ability. Exercises should be done twice a week for four weeks. Effect analysis using the paired T-test in treatment groups 1 and 2. The paired T-test on closed kinetic chain exercise and open kinetic chain exercise yielded the same result, P = 0.000 (p0.05), indicating that functional ability influences before and after treatment. Meanwhile, an independent t-test resulted in a value of p = 0.153 (p>0.05), indicating that there are differences in the influence of open kinetic chain and closed kinetic chain on increasing functional ability in patients with osteoarthritis knee. Open kinetic chain exercise and closed kinetic chain exercise have different effects on improving functional ability in people with osteoarthritis knee.

Factors predictive of adherence to a non-pharmacological intervention in nursing home research: a substudy of the LEDEN trial

Few older people participate in medical research, especially in the nursing home setting. The lack of evidence in this population may limit our ability to provide evidence-based treatments. This can partly be explained by difficulties in obtaining a satisfactory adherence to research in this population, especially when the practice of a physical activity is needed. In this study data from the LEDEN trial (Effects of a Long-term Exercise Program on Functional Ability in People with Dementia Living in Nursing Homes: A Cluster Randomized Controlled Trial) was used to determine the predictors of adherence to the study protocol. Retrospective cohort study based on the data from the cluster randomized, controlled LEDEN trial. The LEDEN trial aimed to compare the effects of an exercise intervention with a nonphysical intervention on the ability to perform activities of daily living. Predictors of adherence (being present at ≥ 75% of sessions of the LEDEN trial) were identified by multivariable logistic regression. By univariate analysis, the EVIBE scale (EValuation Immédiate du Bien-Être – evaluation of instantaneous well-being) measured at baseline was associated with study adherence, whereby higher scores were associated with higher adherence: 16.7% (1/6), 44.4% (4/9), 56.5% (13/23), 48.1% (13/27) and 75.0% (15/20) respectively for EVIBE scores from 1 to 5 (P = 0.02 for trend). By multi-variable analysis, an EVIBE scale score ≥ 4 did not predict clinical trial adherence (odds ratio [OR] 1.554, 95% confidence interval [CI] 0.619–3.942). Adherence was found to be lower among persons aged ≥ 95 years (OR: 0.121, 95%CI: 0.006–0.982). Older age (≥ 95 years) was associated with lower adherence to the study protocol. Further studies are needed to better understand and anticipate obstacles to adherence in research, while respecting consent procedures and patient autonomy.

Predictors of Awareness of Functional Ability in People with Dementia: The Contribution of Personality, Cognition, and Neuropsychiatric Symptoms – Findings from the IDEAL Program

Introduction: Discrepancy scores reflecting the difference between parallel ratings made by people living with dementia (PwD) in the mild-to-moderate stages and by their informants provide a way to investigate awareness of functional ability in relation to activities of daily living (ADL). Methods: Two measures of ADL (Functional Activities Questionnaire; Dependence Scale) were completed by 1,227 PwD and their informants in the IDEAL cohort study baseline assessment. Self-rated and informant-rated scores were used to calculate discrepancies, which were used as an indicator of awareness of functional ability. Smaller discrepancy scores were considered to reflect greater awareness on the part of PwD. PwD completed questionnaires on depression, personality, comorbidities, neuropsychiatric symptoms, and completed a measure of cognition. Informants provided ratings of stress. Univariable and multiple regressions were used to investigate factors related to ADL discrepancy. Results: A similar pattern of associations were found for both ADL discrepancy scores. Smaller discrepancy scores were associated with higher levels of depression, higher neuroticism, fewer neuropsychiatric symptoms, higher comorbidity, lower carer stress, and receipt of less than 1 hour of care per day from the informant. Discussion/Conclusion: There was a clear pattern of factors that were associated with greater awareness for both measures of functional ability. These factors associated with smaller discrepancy scores could be used to identify PwD who might benefit from targeted interventions to support their independence.

Effects of music therapy on functional ability in people with cerebral palsy: a systematic review.

Objective: This review aimed to investigate the effects of music therapy on functional ability in people with cerebral palsy.Materials and Methods: An electronic search of the CENTRAL, MEDLINE, and EMBASE databases was conducted. Randomized controlled trials that examined the effects of music therapy in patients with cerebral palsy were included.Results: Eight trials were eligible for inclusion in this study. We found a low risk of bias in random sequence generation and allocation concealment in all trials. The risk of bias in blinding of the outcome assessment was low in all studies. We found that music therapy had a significant effect on the Gross Motor Function Measure score (standardized mean difference [SMD] −0.42), Functional Independence Measure for Children score (SMD 0.38), and Goal Attainment Scale score (SMD −1.43). Music therapy had no significant effect on any of the other items.Conclusion: There is limited evidence that music therapy improves gross motor function and activities of daily living in patients with cerebral palsy. However, this was insufficient to allow for generalizable conclusions. Further studies with larger sample sizes are required to confirm the effects of music therapy in this population.

Effects of Joint Mobilization Versus Acupuncture on Pain and Functional Ability in People with Chronic Neck Pain: A Randomized Controlled Trial of Comparative Effectiveness.

Chronic Neck Pain (CNP) is one of the main contributing factors to disability in people of working age. The aim of this randomized clinical trial was to compare the efficacy between acupuncture and joint mobilization on pain and disability in patients with CNP. The study involved 45 men and women with CNP, divided into three groups of 15 each. The first group followed a manual therapy protocol with joint mobilization for eight weeks three times per week. The second group followed an acupuncture protocol of equal duration and frequency, while the third group did not follow any treatment. Pain with the Visual Analog Scale (VAS) for pain and functional limitations with the Neck Disability Index (NDI) questionnaire were assessed before and after an 8-week intervention. Analysis of variance was applied while post-hoc comparisons were made to determine the differences among the groups at each time of measurement. Both intervention groups showed statistically significant differences compared to the control group after the end of the intervention in both the VAS and the NDI scores (p< .001). Furthermore, the acupuncture group showed a statistically significant improvement compared to the joint mobilization team after the end of the intervention in the VAS score (p< .001) and the NDI score (p< .05). Both joint mobilization and acupuncture appear to be effective interventions in reducing pain and improving functional ability in people with CNP. However, acupuncture appears to have a greater analgesic effect than joint mobilization.

Supportive Systems Needed for the Functioning of People with Traumatic Brain Injury

Introduction: People with traumatic brain injury (TBI) have been found to have significant cognitive challenges which negatively impact their psychosocial life. This calls for efficient supportive systems and coping mechanisms to enable them to function in the society. This study, therefore, examined the (1) supportive systems that affect people with TBI and (2) essential coping mechanisms for psychosocial activities among people with TBI. Methods: A total of forty participants with a mean age of 35.30 (standard deviation = 11.90) years, mostly males (70%) and married (55%) were recruited for this cross-sectional study. They completed measures on TBI severity, coping strategies, social support, religious coping activities, and psychosocial activities. Results: There were significant interrelationships between coping strategies, social support, religious coping activities, psychosocial activities, and severity of TBI. Coping strategies, religious coping, and psychosocial activities were the supportive systems that affect people with TBI. Coping strategies was the only factor that affects the psychosocial activities of people with TBI. Conclusion: Based on these findings, different supportive systems may be needed for different functional abilities of people with TBI. Hence, clinicians may have to individualize assessment in order to offer bespoke support systems needed for improvement.

Evaluation of an exercise-enabling control interface for powered wheelchair users: a feasibility study with Duchenne muscular dystrophy

BackgroundPowered wheelchairs are an essential technology to support mobility, yet their use is associated with a high level of sedentarism that can have negative health effects for their users. People with Duchenne muscular dystrophy (DMD) start using a powered wheelchair in their early teens due to the loss of strength in their legs and arms. There is evidence that low-intensity exercise can help preserve the functional abilities of people with DMD, but options for exercise when sitting in a powered wheelchair are limited.MethodsIn this paper, we present the design and the feasibility study of a new version of the MOVit device that allows powered-wheelchair users to exercise while driving the chair. Instead of using a joystick to drive the wheelchair, users move their arms through a cyclical motion using two powered, mobile arm supports that provide controller inputs to the chair. The feasibility study was carried out with a group of five individuals with DMD and five unimpaired individuals. Participants performed a series of driving tasks in a wheelchair simulator and on a real driving course with a standard joystick and with the MOVit 2.0 device.ResultsWe found that driving speed and accuracy were significantly lowered for both groups when driving with MOVit compared to the joystick, but the decreases were small (speed was 0.26 m/s less and maximum path error was 0.1 m greater). Driving with MOVit produced a significant increase in heart rate (7.5 bpm) compared to the joystick condition. Individuals with DMD reported a high level of satisfaction with their performance and comfort in using MOVit.ConclusionsThese results show for the first time that individuals with DMD can easily transition to driving a powered wheelchair using cyclical arm motions, achieving a reasonable driving performance with a short period of training. Driving in this way elicits cardiopulmonary exercise at an intensity found previously to produce health-related benefits in DMD.

Mental Practice Combined With Physical Practice to Enhance Upper Extremity Functional Ability Poststroke: A Systematic Review

Background: Upper extremity deficits are one of the most common impairments in individuals with stroke. Mental practice is exercised cognitively in the absence of the physical trials. The effects of the combination of mental and physical practice remain unclear. Objectives: This study aimed to examine the effects of combined physical practice and mental practice on the upper extremity functional ability poststroke, to identify which stroke population is most likely to benefit from the intervention, and to determine the effective treatment dosage. Methods: We searched in the PubMed, SCOPUS, National Rehabilitation Information REHABDATA, PEDro, and Web of Science until February 2020. Randomized clinical trials examined the effects of combined physical practice and mental practice on the upper extremity functional ability in people with a stroke. The risk of bias was evaluated and the effect sizes were calculated. Results: Nine studies met our inclusion criteria. In total, 230 stroke survivors were included in this analysis (mean age: 60.84 years). This review found that combining physical practice and mental practice has beneficial effects in improving the upper extremity functional ability poststroke. Conclusion: Combining physical practice and mental practice improves the upper extremity functional ability poststroke, this improvement can extend for 3 months after the treatment intervention. We propose that using 30 to 60 min of physical practice followed by 30 min of mental practice, 2 to 3 times weekly for 6 to 10 weeks, may give meaningful effects in individuals with stroke.

Efficacy of whole body vibration therapy on pain and functional ability in people with non-specific low back pain: a systematic review

BackgroundWhole body vibration (WBV) is currently increasing in popularity as a treatment modality for musculoskeletal disorders and improving health-related quality of life. Recent research has shown that WBV can reduce low back pain and improve the functional abilities for patients, however, optimal frequency and duration of vibration for therapeutic use is unclear. This review was conducted to summarize and determine the efficacy of whole body vibration therapy on individuals with non-specific low back pain (NLBP) and evaluated methodological quality of the included studies.MethodsOnline literature searches through the Web of Science, PubMed, Cochrane Library databases, PEDro, Ovid, EBSCO (Medline) and Scopus were conducted up to December 2019. Randomized controlled trials investigating the effect of WBV on pain intensity and/or functional ability in individuals with non-specific low back pain (NLBP) were included. Details of the sample characteristics, treatment of the comparison group, WBV parameters and outcome measures were recorded, and methodological quality appraised using the PEDro scale.Results7 published RCTs (418 patients) were included in the systematic review. Due to heterogeneity in vibration parameters and prescriptions, and small number of studies, no meta-analysis was performed. Four out of the six included studies using pain as an outcome measure showed that WBV had a beneficial effect on pain compared with the control group, whereas only two trials were considered to be of high methodological quality. Among the six studies which measured functional ability, three studies with good quality reported significant between-group differences in favor of WBV.ConclusionsThere is limited evidence suggests that WBV is beneficial for NLBP when compared with other forms of interventions (stability training, classic physiotherapy, routine daily activity). Due to the small sample sizes and statistical heterogeneity, we still cannot draw conclusions that WBV is an effective intervention. Further high-quality studies are needed before clinical recommendations can be provided to support its use in a general population with NLBP and to explore the optimal treatment protocol.Trial registrationPROSPERO registration number: CRD42017074775.

Repetitive Peripheral Magnetic Stimulation for Patients After Stroke

Repetitive peripheral magnetic stimulation (rPMS) is a noninvasive treatment method that can penetrate to deeper structures with painless stimulation to improve motor function in people with physical impairment due to brain or nerve disorders. The effectiveness and safety of this intervention for people after stroke currently remain uncertain. Our recent Cochrane review1 update assessed the effects of rPMS in improving activities of daily living and functional ability in people after stroke.

Repetitive peripheral magnetic stimulation for impairment and disability in people after stroke.

Repetitive peripheral magnetic stimulation (rPMS) is a non-invasive treatment method that can penetrate to deeper structures with painless stimulation to improve motor function in people with physical impairment due to brain or nerve disorders. rPMS for people after stroke has proved to be a feasible approach to improving activities of daily living and functional ability. However, the effectiveness and safety of this intervention for people after stroke currently remain uncertain. This is an update of the review published in 2017. To assess the effects of rPMS in improving activities of daily living and functional ability in people after stroke. On 7 January 2019, we searched the Cochrane Stroke Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL), in the Cochrane Library; MEDLINE; Embase; the Cumulative Index to Nursing and Allied Health Literature (CINAHL); PsycINFO; the Allied and Complementary Medicine Database (AMED); Occupational Therapy Systematic Evaluation of Evidence (OTseeker); the Physiotherapy Evidence Database (PEDro); ICHUSHI Web; and six ongoing trial registries. We screened reference lists, and we contacted experts in the field. We placed no restrictions on the language or date of publication when searching electronic databases. We included randomised controlled trials (RCTs) conducted to assess the therapeutic effect of rPMS for people after stroke. Comparisons eligible for inclusion were (1) active rPMS only compared with 'sham' rPMS (a very weak form of stimulation or a sound only); (2) active rPMS only compared with no intervention; (3) active rPMS plus rehabilitation compared with sham rPMS plus rehabilitation; and (4) active rPMS plus rehabilitation compared with rehabilitation only. Two review authors independently assessed studies for inclusion. The same review authors assessed methods and risk of bias, undertook data extraction, and used the GRADE approach to assess the quality of evidence. We contacted trial authors to request unpublished information if necessary. We resolved all disagreements through discussion. We included four trials (three RCTs and one cross-over trial) involving 139 participants. Blinding of participants and physicians was well reported within all trials. We judged the overall risk of bias across trials as low. Only two trials (with 63 and 18 participants, respectively) provided sufficient information to be included in the meta-analysis. We found no clear effect of rPMS on activities of daily living at the end of treatment (mean difference (MD) -3.00, 95% confidence interval (CI) -16.35 to 10.35; P = 0.66; 1 trial; 63 participants; low-quality evidence) and at the end of follow-up (MD -2.00, 95% CI -14.86 to 10.86; P = 0.76; 1 trial; 63 participants; low-quality evidence) when comparing rPMS plus rehabilitation versus sham plus rehabilitation. We found no statistical difference in improvement of upper limb function at the end of treatment (MD 2.00, 95% CI -4.91 to 8.91; P = 0.57; 1 trial; 63 participants; low-quality evidence) and at the end of follow-up (MD 4.00, 95% CI -2.92 to 10.92; P = 0.26; 1 trial; 63 participants; low-quality evidence) when comparing rPMS plus rehabilitation versus sham plus rehabilitation. We observed a significant decrease in spasticity of the elbow at the end of follow-up (MD -0.48, 95% CI -0.93 to -0.03; P = 0.03; 1 trial; 63 participants; low-quality evidence) when comparing rPMS plus rehabilitation versus sham plus rehabilitation. In terms of muscle strength, rPMS treatment was not associated with improved muscle strength of the ankle dorsiflexors at the end of treatment (MD 3.00, 95% CI -2.44 to 8.44; P = 0.28; 1 trial; 18 participants; low-quality evidence) when compared with sham rPMS. No studies provided information on lower limb function or adverse events, including death. Based on the GRADE approach, we judged the quality of evidence related to the primary outcome as low, owing to the small sample size of the studies. Available trials provided insufficient evidence to permit any conclusions about routine use of rPMS for people after stroke. Additional trials with large sample sizes are needed to provide robust evidence for rPMS after stroke.

Promoting mealtime function in people with dementia: A systematic review of studies undertaken in residential aged care

BackgroundDementia is one of the most prevalent conditions in older adults in residential aged care. Dementia has a significant impact on a person’s ability to eat, drink and participate in mealtime activities. Dementia impacts memory, appetite, gross and fine motor skills, communication skills, mood and social behaviours, all of which can decrease the person’s ability to engage in a meal. ObjectivesThe objective was to review the literature on strategies to promote mealtime function in people with dementia living in residential aged care and assess their effectiveness. The review considered studies reporting outcome measures that related to nutritional status, communication, behaviour and eating skills and ability. DesignSystematic review using the Joanna Briggs Institute review methods. Data sourcesSeven databases (MEDLINE, CINAHL, Cochrane Database of Systematic Reviews, EMBASE, Current Contents, PsycINFO and Allied and Complementary Medicine Database) were searched for research published 2000–2017 in English. Eligible studies included quantitative studies reporting a mealtime intervention delivered to people with dementia in residential aged care compared with standard care reporting nutritional, behavioural or functional outcomes, including observation studies with no comparator. Review methodsStudies were screened and independently appraised by two reviewers using Joanna Briggs Institute (JBI) critical appraisal tools based on study design. Data was extracted from eligible studies using JBI extraction tables that assess study design, population characteristics, intervention and comparator, outcome measures and findings. Results related to mealtime function were tabulated and reported in narrative format. Results136 studies were identified, of which 20 were eligible for inclusion. Studies reported strategies related to: food presentation; meal styles; environment adaptations; skills training; music therapy and animal-assisted therapy. Outcomes included measures of nutritional status, communication and behavioural and psychological symptoms of dementia. Low quality evidence suggested that playing music and introducing fish to the dining room may improve the food intake of people with dementia by a small amount. Montessori and spaced retrieval programs also demonstrated some positive impact on eating skills and nutritional intake. Animal-assisted therapy also demonstrated small statistically significant improvements in weight and body mass index. ConclusionThere is insufficient evidence to highly recommend any specific intervention to improve mealtime functional ability in people with dementia. Further research is required through robust study designs using valid and reliable outcome measures to demonstrate clinically significant effects for mealtime interventions.

Foot structure, pain and functional ability in people with gout in primary care: cross-sectional findings from the Clinical Assessment Study of the Foot

BackgroundGout frequently affects the foot yet relatively little is known about the effects of gout on foot structure, pain and functional ability. This study aimed to describe the impact of gout in a UK primary care population.MethodsA cross-sectional study was nested within an observational cohort study of adults aged ≥50 years with foot pain. Participants with gout were identified through their primary care medical records and each matched on age (±2 years) and gender to four participants without gout. Differences in person-level variables (SF-12 Physical Component Score, Manchester Foot Pain and Disability Index and Short Physical Performance Battery) between gout and non-gout participants were determined using regression models. Differences in foot-level variables (pain regions, skin lesions, deformities, foot posture, and non-weightbearing range of motion) were determined using multi-level regression models. All models were adjusted for body mass index. Means and probabilities with 95% confidence intervals were calculated.ResultsTwenty-six participants with gout were compared to 102 participants without gout (77% male; mean age 66 years, standard deviation 11). Subtalar joint inversion and eversion and 1st metatarsophalangeal joint (MTPJ) dorsiflexion range of motion were significantly lower in the gout participants compared to the non-gout participants. Gout participants were more likely to have mallet toes and less likely to have claw toes compared to non-gout participants. There were no statistically significant differences in person-level variables, foot posture, ankle dorsiflexion range of motion, hallux valgus, pain regions, or skin lesions.ConclusionsNon-weightbearing range of motion at the subtalar joint and 1st MTPJ was reduced in people with gout. Patients with gout who present with chronic foot problems should therefore undergo appropriate clinical assessment of foot structure.

Критерии контроля оценки адекватности силовых нагрузок функциональным возможностям организма людей различного уровня физической подготовки в процессе занятий фитнесом

Критерии контроля оценки адекватности силовых нагрузок функциональным возможностям организма людей различного уровня физической подготовки в процессе занятий фитнесом

Effects of a 12-Week Aerobic Exercise Program Combined with Music Therapy and Memory Exercises on Cognitive and Functional Ability in People with Middle Type of Alzheimer's Disease

Background: The Alzheimer's disease is the most common form of dementia and represents 60% of its cases. The disease is characterized by cognitive, non-cognitive and functional deficits and it’s incurable. The main of this study was to examine the effects of the aerobic exercise in combination with the music therapy and memory exercises in functional and cognitive ability on a patient with that have been affected by middle type (Second stage) of Alzheimer's disease.Methods: Thirty patients from Chronic Diseases Center, with Alzheimer's disease, divided between an intervention and a control group, participated in this randomized controlled study. (Thirty patients with Alzheimer's were chosen from chronic disease center, and are divided into an intervention and a control group). The intervention requires 30 minutes of aerobic exercise, 10 minutes of memory games and music therapy, three times a week, for the duration of 12 weeks. The outcome measures the “Mini Mental State Examination” (MMSE) scale and the “Alzheimer's Disease Assessment Scale cognitive test” (ADAS) for the cognitive ability, “Katz Index Independence in Activities of Daily Living” (ADL), “Get up and Go test” and “One leg standing balance test” (OLST) for the functionality. A three-way analysis of variance designs was applied to compare changes in each outcome measure before and after the intervention between the groups.Results: The MMSE score decrease significantly for the control group (males: 16.00 ± 4.04 to 15.14 ± 4.01 and for females: 16.00 ± 1.85 to 15.25 ± 1.98 before and after intervention) but not for the intervention group (p > 0.05) (males: 16.25 ± 2.71 to 16.12 ± 2.94 and females: 12.85 ± 2.67 to 12.57 ± 2.93). The ADAS score on intervention experimental therapy group was significantly low (males: 39.00 ± 7.98 to 37.50 ± 8.12 and females: 49.85 ± 6.54 to 48.28 ± 6.79). In the Get up and Go test (males: 18.87 ± 5.24 to 17.87 ± 4.15 and females: 19.85 ± 4.94 to 18.57 ± 4.64) and in the OLST(males: 4.57 ± 3.10 to 6.00 ± 2.77 and females: 4.00 ± 3.26 to 5.28 ± 3.40) there was a sign of progress in the results, while in the ADL no difference was observed in any group. (experimental group males: 3.50 ± 1.19 to 3.50 ± 1.19 and females: 2.57 ± 1.13 to 2.57 ± 1.13, control group males: 3.57 ± 1.51 to 3.57 ± 1.51 and females: 3.50 ± 0.75 to 3.50 ± 0.75).Conclusion: The aerobic exercise combined with the music therapy and the memory tests offer some improvement in cognitive and functional ability and contribute to the deteriorating delay of the symptoms of patients that suffer from Alzheimer and are hospitalized.

Repetitive peripheral magnetic stimulation for activities of daily living and functional ability in people after stroke.

Repetitive peripheral magnetic stimulation (rPMS) is a form of therapy that creates painless stimulation of deep muscle structures to improve motor function in people with physical impairment from brain or nerve disorders. Use of rPMS for people after stroke has been identified as a feasible approach to improve activities of daily living and functional ability. However, no systematic reviews have assessed the findings of available trials. The effect and safety of this intervention for people after stroke currently remain uncertain. To assess the effect of rPMS for improving activities of daily living and functional ability in people after stroke. We searched the Cochrane Stroke Group Trials Register (August 2016), the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 8) in the Cochrane Library (August 2016), MEDLINE Ovid (November 2016), Embase Ovid (August 2016), the Cumulative Index to Nursing and Allied Health Literature (CINAHL) in Ebsco (August 2016), PsycINFO Ovid (August 2016), the Allied and Complementary Medicine Database (AMED) Ovid (August 2016), Occupational Therapy Systematic Evaluation of Evidence (OTseeker) (August 2016), the Physiotherapy Evidence Database (PEDro) (October 2016), and ICHUSHI Web (October 2016). We also searched five ongoing trial registries, screened reference lists, and contacted experts in the field. We placed no restrictions on the language or date of publication when searching the electronic databases. We included randomised controlled trials (RCTs) conducted to assess the therapeutic effect of rPMS for people after stroke. Comparisons eligible for inclusion were (1) active rPMS only compared with 'sham' rPMS (a very weak form of stimulation or a sound only); (2) active rPMS only compared with no intervention; (3) active rPMS plus rehabilitation compared with sham rPMS plus rehabilitation; and (4) active rPMS plus rehabilitation compared with rehabilitation only. Two review authors independently assessed studies for inclusion. The same review authors assessed methods and risk of bias and extracted data. We contacted trial authors to ask for unpublished information if necessary. We resolved all disagreements through discussion. We included three trials (two RCTs and one cross-over trial) involving 121 participants. Blinding of participants and physicians was well reported in all trials, and overall risk of bias was low. We found no clear effect of rPMS on activities of daily living at the end of treatment (mean difference (MD) -3.00, 95% confidence interval (CI) -16.35 to 10.35; low-quality evidence) and at the end of follow-up (MD -2.00, 95% CI -14.86 to 10.86; low-quality evidence). Investigators in one study with 63 participants observed no statistical difference in improvement of upper limb function at the end of treatment (MD 2.00, 95% CI -4.91 to 8.91) and at the end of follow-up (MD 4.00, 95% CI -2.92 to 10.92). One trial with 18 participants showed that rPMS treatment was not associated with improved muscle strength at the end of treatment (MD 3.00, 95% CI -2.44 to 8.44). Another study reported a significant decrease in spasticity of the elbow at the end of follow-up (MD -0.48, 95% CI -0.93 to -0.03). No studies provided information on lower limb function and death. Based on the GRADE approach, we judged the certainty of evidence related to the primary outcome as low owing to the small sample size of one study. Available trials provided inadequate evidence to permit any conclusions about routine use of rPMS for people after stroke. Additional trials with large sample sizes are needed to determine an appropriate rPMS protocol as well as long-term effects. We identified three ongoing trials and will include these trials in the next review update.

Yoga could help people with chronic lower back pain.

Practising yoga can reduce pain and increase functional ability in people with chronic, non-specific lower back pain, suggest the results of a Cochrane Review.