Functional Limitations In Patients Research Articles

Limitation of Functional Status after COVID 19 Infection: A Cross-Sectional Study

Background: The whole world has been struggling with the COVID 19 pandemic since 2019 and has become a global health problem. Various extent of long term effects have been reported. A substantial proportion of patients suffered from functional impairment after recovery from COVID 19 infection. The objective of this study was to determine the degree of functional limitation in patients recovered from COVID 19.Methods: A cross sectional study was conducted in the Department of Anaesthesia, Analgesia and Intensive Care Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. Patients aging ≥ 18 years with RT-PCR for COVID-19 positive were included in this study. Post-COVID-19 Functional Status scale (PCFS) was used to assess patients with functional limitation. All statistical analysis were performed using the Statistical Package for Social Sciences version 23.0 for Windows.Results: A total of 76 patients were enrolled in this study. The mean PCFS score was 1.9±1.0. The majority of patients 30 (39.5%) had PCFS score one (negligible functional limitation), 26 (34.2%) patients had PCFS score two (slight functional limitation), 11(14.5%) patients had PCFS score three (moderate functional limitation), 7(9.2%) patients had PCFS score four (severe functional limitation).Conclusion: This study demonstrated limited functional status after recovery from COVID-19. A comprehensive management strategy is needed to improve functional limitation in the post COVID 19 period.

Reduced muscle strength in patients with long-COVID-19 syndrome is mediated by limb muscle mass.

Understanding the impact of COVID-19 on muscle strength may help to elucidate the organ systems that contribute to acute and chronic COVID-19 sequelae. We questioned whether patients with postdischarge symptoms after COVID-19 had compromised muscle strength compared with a control group, and if this potential relationship was mediated by the lower appendicular lean mass index (ALMI). A total of 99 patients with long-COVID-19 and 97 control participants were screened. Maximal grip strength was assessed with a TKK 5101 digital dynamometer, and leg extension 1RM was measured using EGYM Smart Strength machines. Body composition (fat mass percentage, lean mass, visceral fat, and appendicular lean mass index) was determined using a whole body dual-energy X-ray densitometer. Results showed that grip strength and leg extension strength were significantly higher in controls than in COVID-19 survivors (mean [SD], 32.82 [10.01] vs. 26.94 [10.33] kg; difference, 5.87 kg; P < 0.001) and (mean [SD], 93.98 [33.73] vs. 71.59 [33.70] kg; difference, 22.38 kg; P < 0.001), respectively). The relationship between long-COVID syndrome and grip/leg strength levels was partly mediated by ALMI, which explained 52% of the association for grip strength and 39% for leg extension. Our findings provide novel insights into the mechanisms underlying the relationship between long-COVID syndrome and grip/leg strength levels, supporting the negative effects of long-COVID syndrome on muscle function.NEW & NOTEWORTHY The causes of post-COVID-19 syndrome are uncertain. Limb muscle wasting common to patients with COVID-19 limits daily activities and exercise. In this cross-sectional study, we found that patients with long-COVID-19 syndrome had significantly lower absolute and relative muscle strength measurements than control participants. Interestingly, we identified that these relationships were mostly mediated by limb muscle mass. Our data thus suggest that the evident reduced upper and lower muscle mass is a putative cause of-or contributor to-the functional limitation of patients with long-COVID-19 syndrome.

The post-VTE functional status scale for assessment of functional limitations in patients with venous thromboembolism: Construct validity and responsiveness in a prospective cohort study

BackgroundA large proportion of patients experience functional limitations after an acute episode of venous thromboembolism (VTE). Recently, the post-VTE functional status (PVFS) scale was proposed to capture these limitations. We performed a prospective cohort study to validate this scale. MethodsThe PVFS scale, PROMIS physical function 10a, EQ-5D-5L, and disease-specific quality of life (VEINES-QOL/Sym, PEmb-QoL) were assessed within three weeks of VTE diagnosis and after a median (IQR) follow-up of 13.4 (12.7–15.9) weeks. To evaluate construct validity of the PVFS scale, we determined correlations of PVFS scale with the other health measurements and investigated differences in patients above/below 70 years. Responsiveness was evaluated with a linear regression model, predicting change in PROMIS with change in PVFS scale. ResultsWe included 211 patients (median (IQR) age: 55.1 (44.1–67.6) years, 40 % women). Pulmonary embolism was diagnosed in 105 (49.8 %) patients and 62.6 % of events were unprovoked. The PVFS scale correlated with PROMIS physical function (Spearman's rho (r): −0.67 and −0.63, p < 0.001) and EQ-5D-5L index (r = −0.61 and −0.61, p < 0.001) at baseline and follow-up. Furthermore, PVFS correlated moderately to strongly with disease-specific quality of life. Patients >70 years had significantly higher PVFS grades at follow-up (median (IQR): 2 (0–3) vs. 1 (0–2), p = 0.010). Changes in PVFS scale over time were significantly associated with changes in PROMIS physical function. ConclusionsThe PVFS scale showed adequate construct validity and responsiveness in a prospective cohort study of patients with VTE, suggesting that it can be incorporated as additional health measurement and outcome parameter in research and clinical practice.

Exercise unmasks impaired vascular and cardiac hemodynamic in patients with hypertrophic cardiomyopathy

Abstract Background/Introduction Exertional dyspnea is a common finding in patients with Hypertrophic Cardiomyopathy (HCM), yet little data is available regarding the hemodynamic disturbances that lead to symptom development in this population. Purpose To investigate the mechanisms involved in the functional limitation of patients with HCM. Methods We prospectively studied 20 symptomatic patients with confirmed diagnosis of HCM. Assessment included NT-pro BNP levels, echocardiogram, and invasive characterization, where subjects also underwent invasive cardiopulmonary exercise testing. Results Median patient age was 57 (48–66) years old and 15 (75%) were male. Basal NT-pro BNP was elevated (748 pg/mL [406–1082]) and 8 (40%) subjects had NYHA functional Class III despite optimal medical treatment. Sarcomeric abnormal mutations were identified in 12 subjects (60%), most frequently in MYBPC3. Ultrasound imaging showed marked left ventricle (LV) hypertrophy (LV Mass Index 140 g/m2 [109–161]), with signs of LV outflow obstruction in 13 (65%) subjects. All patients displayed preserved ejection fraction (68% [61–73]). Significant mitral regurgitation was present in 5 subjects and median E/e' was 9.87 [6.43–13.14]. At rest, biventricular filling pressures were relatively normal, with upper limit mean Pulmonary Pressure (Table). Patients exercised for 6.4 (95% CI: 5.6–7.2) min, achieving a respiratory exchange ratio of 1.11 (1.02–1.17). All subjects displayed normal cardiac output at rest (5.6 L/min (3.7–7.5)), that increased during exertion, due mostly to a rise in heart rate (p&amp;lt;0.0001). Exercise doubled LV End-Diastolic Pressure from 15.3 (11.5–19.1) mmHg at baseline to 30.4 (26.6–34.3) mmHg at peak VO2 (p&amp;lt;0.0001), whereas mean pulmonary pressure increased from 21 (14–29) mmHg to 40 (33–47) mmHg (p&amp;lt;0.0001). Remarkably, although arterial hemodynamics were relatively normal at baseline, exercise induced significant increases both in the continuous (systemic vascular resistance) and pulsatile components of vascular load (Impedances, p&amp;lt;0.05; Table 1) (Figure 1). This increase in afterload during exertion has not been previously documented in HCM. The decreased compliance derived, can also play a role in the elevated filling pressures documented on exertion. Conclusion Exercise unmasks adverse hemodynamics in HCM, severely increasing LV filling pressures and showing systemic arterial dysfunction. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Instituto de Salud Carlos III, Spain.

Synovial Inflammation in Patients with Hallux Valgus is Similar to Changes Seen in Those with Hallux Rigidus

Category: Basic Sciences/Biologics; Bunion Introduction/Purpose: Hallux valgus and hallux rigidus are common disorders that can have functional limitations for patients. Although both involve pathology centered around the first metatarsophalangeal joint (MTPJ), the surgical management for both greatly varies. Inflammatory changes in a joint play a critical role in the development of pain and dysfunction. It has been postulated previously that patients with bunion deformity can develop arthritic changes in the long-term. The purpose of this work is to study and compare the synovial tissue inflammation in patients with hallux valgus and hallux rigidus. Methods: A prospective study of patients aged 25 to 75 years undergoing either surgical management of hallux valgus or hallux rigidus between January 2021 and December 2021 was conducted following IRB approval. Tissue samples from the synovium were collected at the time of procedure and sent for processing and histology. The samples were graded in a blinded fashion based on the degree of inflammation. Morphological features of the synovectomy specimens undergoing histopathologic analysis were scored by synovial lining cell layer hyperplasia, the extent of inflammatory synovium infiltration, as well as pannus formation via activation of synovial stroma and resident cells. All parameters were graded from 0 (absent), 1 (slight), 2 (moderate), to 3 (strong). Statistical analysis was conducted to compare the level of inflammation between patients who had hallux valgus and those that had hallux rigidus. Results: A total of twenty-one samples were collected. One sample was excluded as there was inadequate tissue for analysis. There were eight patients with hallux rigidus and twelve patients with hallux valgus. Mean age at the time of sample collection was 59.3 years (SD=11.9). There was no significant difference in the synovium inflammatory scores (M=5.0, SD=2.25) between the two groups, t(18)= 1.704, p=.106, ([CI .95]: -0.388, 3.722). Moreover, Cohen's effect size value (d=0.78) suggests medium to high practical significance. Conclusion: Understanding the intra-articular impact of hallux valgus is important when considering treatment options. The amount of inflammation in the synovial tissue of hallux valgus patients in this study was similar to that of patients with hallux rigidus suggesting that there is intra-articular inflammation in patients with hallux valgus. Further work will need to be performed to determine if this increased inflammation influences outcomes or has an effect on treatment.

Effectiveness of High Intensity Hilthera 4.0 Laser Treatment on Patients with Plantar Fasciitis

Plantar fasciitis is one of the most common causes of heel pain. Conservative lines of treatment include non-steroidal anti-inflammatory drugs, corticosteroid injections, Physiotherapy, stretching exercises and using heel pads or orthotics. The purpose of the study is to investigate the effects of high intensity Hilthera 4.0 laser treatment on pain and functional capacity in patients with acute plantar fasciitis. Total 30 participants were randomly recruited and were evaluated before the first treatment session and after 8 sessions of treatment with Hilthera 4.0 Laser. Treatment Parameters are frequency (Hz) 25, one shot emission (MJ) 500, and a total energy 3000W for 15 minutes each session. Outcome measures are VAS score for measuring Pain and Foot Function Index score for measuring Foot Function. IBM SPSS version 16.0 software was used for statistical analysis. Paired sample t-tests are used to measure the pre and post test results. Results shows that there is a significant difference in VAS Score and Foot Function Score pre and post treatment with ‘p’ value &lt; 0.05 when Hilthera 4.0 laser is used for pain and Foot function in patients with Plantar Fasciitis. In conclusion Hilthera 4.0 Laser Therapy is effective in treating pain and Functional limitation in patients with Plantar Fasciitis. KEY WORDS: Plantar Fasciitis, Hilthera 4.0 Laser Therapy, VAS Score, Foot Function Index Score

Virtual reality and motor control exercises to treat chronic neck pain: A randomized controlled trial

AimTo compare the effects of virtual reality (VR) and motor control (MC) exercises. MethodsForty-one participants with chronic neck pain (CNP) were randomized into the VR or MC group. Both groups performed 18 sessions over 6 weeks. The primary outcomes were pain intensity (visual analogue scale), pain pressure thresholds (PPTs), joint position sense error (JPSE), and muscle performance. The secondary outcomes were the Profile Fitness Mapping Questionnaire (ProFitMap-Neck), Hospital Anxiety-Depression Scale (HADS), and quality of life (SF-36). Data were analysed using T-Tests, and Fisher's Exact Test. Mean (standard deviation), median (interquartile range), effect size and %95 confidence interval (CI) were reported. ResultsThe results of Independent T-Tests showed that VR was advantageous in terms of PPTs of the C1/C2 and C5/C6 articular pillar bilaterally and large effect size (Cohen's d > 0.8, p < 0.05). Moreover, VR was more effective in decreasing JPSE (Cohen's d > 0.08; mean difference changes between −2.91 and −1.24, %95 CI -4.47 to 0.80) and functional limitation (ProFitMap-Neck) (Cohen's d = 0.7, mean difference 8.27, %95 CI 0.20 to 16.35). The results of T-Tests demonstrated that neither intervention was superior in terms of pain intensity, muscle performance, symptoms (ProFitMap-Neck), HADS, or SF-36 (Cohen's d < 0.5). ConclusionsVR can be applied for improving proprioception and for decreasing cervical articular pain in CNP patients. In addition, VR may be more effective for decreasing functional limitations in patients. Clinicians can choose MC exercises with or without VR for improving pain, muscle performance, symptoms, anxiety/depression, and quality of life.

Durable functional limitation in patients with coronavirus disease-2019 admitted to intensive care and the effect of intermediate-dose vs standard-dose anticoagulation on functional outcomes

IntroductionPatients affected with severe forms of coronavirus disease 2019 (COVID-19) suffer from a wide range of sequelae, from limited airway diseases to multiple organ failure. These sequelae may create exercise limitation, impair the daily activity and thus impact the mental health and the social life. However, the extent of functional limitations and depressive symptoms are understudied especially in patients with COVID-19 after intensive care unit (ICU) hospitalization. MethodsThe Intermediate versus Standard-dose Prophylactic anticoagulation In cRitically-ill pATIents with COVID-19: An opeN label randomized controlled trial (INSPIRATION) was a clinical trial that randomized ICU patients with COVID-19 to intermediate-dose vs standard-dose anticoagulation. In the current study, we assessed the interval change in 30-day and 90-day functional limitations based on the post-COVID-19 functional status scale (PCFS) and depressive symptoms based on the Patient Health Questionnaire-2 (PHQ-2) in the trial participants. We also assessed the effect of intermediate-dose vs standard-dose prophylactic anticoagulation on the functional outcomes and depressive symptoms. ResultsOf 600 randomized patients in INSPIRATION, 375 (age: 62 years; 42% women) participated in the functional status study. 195 patients died during the 90-day follow up (191 by day 30). Among survivors, between day 30 and day 90, the proportion of patients with moderate-to-severe functional limitation (PCSF grade 3-or-4) decreased from 20.0% to 4.8% (P <0.001) and PHQ-2 ≥ 3 decreased from 25.5% to 16.6% (P = 0.05). The proportion of patients with no functional limitations (PCFS grade 0) increased (4.2% to 15.4%, P<0.001). Intermediate-dose compared with standard-dose prophylactic anticoagulation did not impact the 90-day proportion of patients with PCFS grade 3-or-4 (5.3% vs 4.2%; odds ratio (OR), 1.20, [95% CI, 0.46–3.11]; P = 0.80) or PHQ-2 ≥ 3 (17.9% vs 15.3%; OR, 1.14, [95% CI, 0.79–1.65]; P = 0.14), with similar results when accounting for study center. ConclusionIn patients with COVID-19 admitted to the ICU, functional limitations and depressive symptoms were common at 30-day follow-up and had some improvement by 90-day follow-up among survivors. Intermediate-dose compared to standard-dose prophylactic anticoagulation did not improve functional outcomes.

Successful psychopharmacotherapy of anxiety and depressive disorders improve functional limitations in patients with rheumatoid arthritis

To compare changes in functional limitations in patients with rheumatoid arthritis (RA) and comorbid anxiety and depressive disorders (ADD) treated with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) alone or in combination with biologic DMARDs (bDMARDs) and/or psychopharmacotherapy (PPT), and to determine predictors of HAQ treatment response. 128 RA-patients were enrolled, 86% were women with a mean age of 47.411.3 (MSD) years and a median of RA duration 96 [48; 228] months. Disease activity was assessed using DAS28, functional limitations using Health Assessment Questionnaire (HAQ). The Minimal Clinical Important Difference in HAQ was considered to be 0.22. ADD were diagnosed by a licensed psychiatrist in 123 (96.1%) of RA-pts in accordance with ICD-10 in semi-structured interview. Severity of depression and anxiety was evaluated with MontgomeryAsberg Depression Rating Scale and Hamilton Anxiety Rating Scale. RA-pts with ADD were divided into the following treatment groups: 1 сsDMARDs (n=39), 2 сsDMARDs + PPT (sertraline or mianserine; n=43), 3 сsDMARDs + bDMARDs (n=32), 4 сsDMARDs + bDMARDs + PPT (sertraline or mianserine; n=9); 83 (67.5%) patients were assessed at 5-years follow-up. Multivariable logistic regression was performed to determine predictors of HAQ treatment response. Only remission of anxiety and depressive symptoms at 5-yrs endpoint (OR 6.6, 95% CI 1.7824.43, p=0.005), higher baseline HAQ (OR 2.61, 95% CI 1.126.11, p=0.027) and lower baseline BMI (OR 0.9, 95% CI 0.850.96, p=0.001) were independently associated with HAQ treatment response at 5-years follow-up. While ADD do affect functional limitations in patients with RA, PPT tends to attenuate the negative impact of ADD on RA outcomes, and RA patients with functional limitations should therefore be screened for depression and long-term PPT should be recommended.

P286. Functional Limitations in Patients With Single and Multiple Psychiatric Disorders

Psychiatric disorders are characterized by high levels of comorbidity. Both the severity of the psychiatric symptoms and the level of functional limitations (disability) are an indication of the impact of psychiatric disorders. In this study we aim to assess: 1) the impact of the number of psychiatric disorders on the level of functional limitations, 2) the association between various types of psychiatric comorbidity and functional limitations, and 3) whether the severity of psychiatric symptoms is an explanatory factor of the association between psychiatric comorbidity and functional limitations.

Educational needs in patients with knee osteoarthritis using the SpENAT questionnaire

IntroductionKnee osteoarthritis (KOA) is a major public health issue because it causes pain and functional limitation in patients. Engagement with self-management may, however, minimize the impact of KOA on the health of patients suffering this illness. To be fully engaged with self-management activities, knowledge about KOA is a prerequisite. There is data on people’s understanding of KOA and their needs for information about KOA. The Educational Needs Assessment Tool-Spanish version (SpENAT) is a self-reported questionnaire that assesses educational needs (Ned) in order to provide information adapted and focused on patients with knee KOA. It comprises 39 questions grouped into seven domains: Pain, Movement, Feelings, Osteoarthritis, Medical treatment, Non-medical treatment, Help. ObjectivesTo estimate the Ned in patients with knee KOA using the SpENAT. Material and methodAn observational, descriptive, and cross-sectional study was carried out in 215 patients with a diagnosis of knee KOA according to the criteria of the American College of Rheumatology who attended the service’s protocolized consultation of knee conditions of rheumatology at the “Hermanos Ameijeiras” Surgical Clinical Hospital during the study period between January 2017 and August 2020. Demographic data, educational level and characteristics of the disease were recorded. All patients completed the SpENAT and were questioned about the sources they turn to obtain information on their disease. ResultsWomen over 50 years of age and overweight with a diagnosis of OA predominated. Major Ned were observed in the domains of movement, help, pain, feeling, KOA. Patients over 50 years of age, female, normal weight, and active workers showed greater interest in the movement domain. The most used source of information was the rheumatologist (91.60%). ConclusionThe Ned in patients with knee KOA are high, and are higher in the domains of movement, pain, help and feeling. The rheumatologist is the main source of information for patients with KOA, it seems wise to design a targeted strategy to educate people about KOA to provide, support and prepare them for self-management.

Which psychosocial factors are related to severe pain and functional limitation in patients with low back pain?: Psychosocial factors related to severe low back pain

BackgroundLow back pain (LBP) is a global public health issue. Psychosocial factors are linked to LBP. However, there is a lack of knowledge about the relation of psychosocial factors to clinical outcomes of patients with severe LBP. ObjectiveTo investigate the relationship between specific psychosocial factors with severe pain and functional limitation of patients with LBP. MethodsA cross-sectional study of 472 participants with LBP was conducted. Participants completed self-reported questionnaires, including psychosocial factors, characteristics of pain, and functional limitations. Two multivariable logistic regression models were performed with severe pain intensity (≥ 7 out of 10) and functional limitation (≥ 7 out of 10) (dependent variables) and 15 psychosocial factors (independent variables). ResultsOne hundred twenty-five (26.5%) participants had severe LBP. Patients with catastrophising symptoms were 2.21 [95%Confidence Interval (CI): 1.30, 3.77] times more likely to have severe pain and 2.72 (95%CI: 1.75, 4.23) times more likely to have severe functional limitation than patients without catastrophising symptoms. Patients with maladaptive beliefs about rest were 2.75 (95%CI: 1.37, 5.52) times more likely to present with severe pain and 1.72 (95%CI: 1.04, 2.83) times more likely to have severe functional limitation. Patients with kinesiophobia were 3.34 (95%CI: 1.36, 8.24) times more likely to present with severe pain, and patients with social isolation were 1.98 (95%CI: 1.25, 3.14) times more likely to have severe functional limitation. ConclusionCatastrophising, kinesiophobia, maladaptive beliefs about rest, and social isolation are related to unfavourable clinical outcomes of patients with LBP.

COMPARISON OF DRY NEEDLING WITH CONVENTIONAL PHYSIOTHERAPY IN PATIENTS WITH KNEE OSTEOARTHRITIS FOR PAIN AND FUNCTIONAL IMPROVEMENTS

Background: Knee Osteoarthritis is a degenerative disease that affects many individuals in their forties or later and can lead towards impairment of physical functions and poor quality of life. Our study aimed to compare the effectiveness of dry needling with conventional physical therapy in patients with knee osteoarthritis (OA). Methods: It was a non-randomized clinical study conducted after ethical approval at Syed Medical Complex and Amin Welfare and Teaching Hospital Sialkot in 6 months. Sample size was calculated to be 58 using WHO calculator. Purposive sampling technique was used to enrol the participants according to predetermined eligibility criteria. They were allocated into two groups. Group A received conventional physical therapy treatment and group B received dry needling for 3 weeks, 2 sessions per week. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scale and Numeric Pain Rating Scale (NPRS) were used to measure the outcomes before 1st treatment session and after last session. Paired sample t-test and independent sample t-test were applied to compare the results, and p?0.05 was considered significant. Results: Pre-treatment WOMAC score in group A was 50.07±11.835 and in group B it was 45.87±12.512. Post-treatment WOMAC score in group A was 38.87±13.731 and in group B it was 24.33±8.926. The scores improved in both groups, but group B showed significant improvement. Conclusion: Both conventional physical therapy and dry needling are effective to manage pain and functional limitation in patients with knee OA. Dry needling proved more effective compare to conventional physical therapy. Pak J Physiol 2022;18(1):48–52

The characteristics and associated factors of functional limitation in patients with rheumatoid arthritis

Objective: To investigate the characteristics of functional limitation and associated factors in patients with rheumatoid arthritis (RA). Methods: Consecutive patients with RA were recruited from August 2015 to June 2019 at Department of Rheumatology, Sun Yat-Sen Memorial Hospital. Demographic and clinical characteristics including age, gender, erythrocyte sedimentation rate (ESR), visual analogue scale (VAS) of pain, clinical disease activity index (CDAI), modified total Sharp score were collected. Physical function was assessed by the Stanford health assessment questionnaire disability index (HAQ-DI).Ordered logistic regression was used to analyze the related factors of HAQ-DI. Results: A total of 643 RA patients were finally recruited including 114 males and 529 females with mean age (49.7±12.9) years. There were 399 (62.1%) patients having different degrees of functional limitation, who were classified as mild (293, 45.6%), moderate (73, 11.4%) and severe (33, 5.1%). The prevalence of functional limitation was positively correlated with age and disease activity. The most restricted activity was walking [43.5% (280/643)], followed by gripping [36.1% (232/643)], reaching [35.5% (228/643)], daily activities [33.4% (215/643)], hygiene [33.0% (212/643)], dressing and grooming [29.7% (191/643)] and arising [29.1% (187/643)], and the last eating [18.4% (118/643)]. Multivariate ordered logistic regression analysis showed that age (OR=1.019, 95%CI 1.004-1.035),pain VAS (OR=1.820, 95%CI 1.616-2.050), ESR (OR=1.009, 95%CI 1.001-1.017), CDAI (OR=1.080, 95%CI 1.059-1.102) and modified total Sharp score (OR=1.010, 95%CI 1.004-1.015) were associated factors of functional limitation. Conclusion: The majority RA patients have functional limitation. Age, pain and active disease are independent associated factors. Therefore, target treatment and control of pain should be emphasized in RA patients.

Dysfunctional Network and Mutation Genes of Hypertrophic Cardiomyopathy.

Background Hypertrophic cardiomyopathy (HCM) is a group of heterogeneous diseases that affects the myocardium. It is also a common familial disease. The symptoms are not common and easy to find. Objective In this paper, we aim to explore and analyze the dysfunctional gene network related to hypertrophic cardiomyopathy, and the key target genes with diagnostic and therapeutic significance for HCM were screened. Methods The gene expression profiles of 37 samples (GSE130036) were downloaded from the GEO database. Differential analysis was used to identify the related dysregulated genes in patients with HCM. Enrichment analysis identified the biological function and signaling pathway of these differentially expressed genes. Then, PPI network was built and verified in the GSE36961 dataset. Finally, the gene of single-nucleotide variants (SNVs) in HCM samples was screened by means of maftools. Results In this study, 920 differentially expressed genes were obtained, and these genes were mainly related to metabolism-related signaling pathways. 187 interacting genes were identified by PPI network analysis, and the expression trends of C1QB, F13A1, CD163, FCN3, PLA2G2A, and CHRDL2 were verified by another dataset and quantitative real-time polymerase chain reaction. ROC curve analysis showed that they had certain clinical diagnostic ability, and they were the potential key dysfunctional genes of HCM. In addition, we found that PRMT5 mutation was the most frequent in HCM samples, which may affect the pathogenesis of HCM. Conclusion Therefore, the key genes and enrichment results identified by our analysis may provide a reference for the occurrence and development mechanism of HCM. In addition, mutations in PRMT5 may be a useful therapeutic and diagnostic target for HCM. Our results also provide an independent quantitative assessment of functional limitations in patients with unknown history.

A study protocol for a randomised controlled trial on the efficacy of yoga as an adjuvant therapy for patients with Ankylosing spondylitis amidst COVID-19 pandemic

BackgroundAmidst the adversities of the COVID-19 pandemic, the health care system has seen a new paradigm shift towards e-health or telehealth services. In the advent of catering to the geometrically increasing health care needs of the patients suffering from various chronic health conditions when in social isolation, the need for such shifts is paramount. Patients with Ankylosing spondylitis using immunosuppressants with variable degrees of disabilities are at higher risk from this isolated status. This study aims to assess the efficacy of e-Yoga as a treatment option for these patients. MethodsThe proposed study is a single-center, parallel-group prospective randomized, open-blinded end-point trial. Patients aged between 30 and 50 years will be recruited from the members of Antardhwani: A society of ankylosing spondylitis based in Ahmedabad, Gujarat. Yoga experts will administer a scientifically developed and validated Yoga module via e-Yoga modalities. A total of 135 patients will be recruited and randomly allocated to Yoga and control groups. Data will be recorded at baseline and three months on disease activity, degree of functional limitations in patients, quality of life, inflammatory biomarkers, depression, and anxiety using Bath AS Disease Activity Index (BASDAI), Bath AS Functional Index (BASFI), AS Quality of Life index (ASQOL), C reactive protein (CRP), Erythrocyte sedimentation rate (ESR), Physical health questionnaire-4 (PHQ-4), respectively. DiscussionThe study will report the efficacy of e-Yoga in catering to the physical and mental insufficiencies of inpatients with Ankylosing spondylitis amidst COVID-19 pandemic. The study is prospectively registered in the Clinical Trial Registry of India (CTRI/2020/08/027215)

Does Intrathecal Baclofen Therapy Lead to an Improvement in Impairments and Functional Limitations in Patients With Acquired Brain Injury (ABI)? A Retrospective Study

Research Objectives To investigate effects of intrathecal baclofen (ITB) therapy on impairments and functional limitations in the acquired brain injury population(ABI). Design A retrospective study using chart reviews using a standardized data collection form on inpatient brain injury units to collect data on effects of ITB therapy on the ABI population with defined inclusion and exclusion criteria. A standardized data collection form was utilized along with a procedural manual for data abstraction. Setting Specialized acute and sub acute brain injury units. Participants Initially, 59 subjects were considered and a total of 15 medical records had sufficient data to analyze which met our criteria. 12 male patients (80%) and three female patients (20%). The mean age for ITB pump implantation was 35.5 years and the range was 18-67 years of age. Interventions Intrathecal Baclofen Pump Therapy with adjunctive therapies (for example skilled therapy, local Botox injections, serial casting, medication). Main Outcome Measures Modified Ashworth Scores, Passive Range of Motion, Mobility, JFK Coma Recovery Scale- Revised. Results The most significant change was noted with Modified Ashworth Scale (MAS) scores in the proximal hip muscle groups. Modified Ashworth Scale (MAS) scores with high significance (p-values ≤0.05) and large effect size (Cohen's D values >0.8) included right hip flexors, right hip extensors and R hip adductors. No statistically significant findings were found in other muscle groups, functional mobility, PROM and CRS-R (Coma Recovery Scale-Revised©) scales. Conclusions There were no significant changes noted in regards to functional status. However, data reflects improvements in spasticity of proximal hip musculature. This may result in improved positioning in bed or wheelchair as well as ease of hygiene and improved comfort. More research is recommended with a larger sample size and additional focus on pain and caregiver burden. Author(s) Disclosures All authors of this research study have no conflicts to disclose. To investigate effects of intrathecal baclofen (ITB) therapy on impairments and functional limitations in the acquired brain injury population(ABI). A retrospective study using chart reviews using a standardized data collection form on inpatient brain injury units to collect data on effects of ITB therapy on the ABI population with defined inclusion and exclusion criteria. A standardized data collection form was utilized along with a procedural manual for data abstraction. Specialized acute and sub acute brain injury units. Initially, 59 subjects were considered and a total of 15 medical records had sufficient data to analyze which met our criteria. 12 male patients (80%) and three female patients (20%). The mean age for ITB pump implantation was 35.5 years and the range was 18-67 years of age. Intrathecal Baclofen Pump Therapy with adjunctive therapies (for example skilled therapy, local Botox injections, serial casting, medication). Modified Ashworth Scores, Passive Range of Motion, Mobility, JFK Coma Recovery Scale- Revised. The most significant change was noted with Modified Ashworth Scale (MAS) scores in the proximal hip muscle groups. Modified Ashworth Scale (MAS) scores with high significance (p-values ≤0.05) and large effect size (Cohen's D values >0.8) included right hip flexors, right hip extensors and R hip adductors. No statistically significant findings were found in other muscle groups, functional mobility, PROM and CRS-R (Coma Recovery Scale-Revised©) scales. There were no significant changes noted in regards to functional status. However, data reflects improvements in spasticity of proximal hip musculature. This may result in improved positioning in bed or wheelchair as well as ease of hygiene and improved comfort. More research is recommended with a larger sample size and additional focus on pain and caregiver burden.

Effect of Home Exercise Training in Patients with Nonspecific Low-Back Pain: A Systematic Review and Meta-Analysis.

Background: Exercise therapy is recommended to treat non-specific low back pain (LBP). Home-based exercises are promising way to mitigate the lack of availability of exercise centers. In this paper, we conducted a systemic review and meta-analysis on the effects of home-based exercise on pain and functional limitation in LBP. Method: PubMed, Cochrane, Embase and ScienceDirect were searched until April 20th, 2021. In order to be selected, studies needed to report the pain and functional limitation of patients before and after home-based exercise or after exercise both in a center and at-home. Random-effect meta-analyses and meta-regressions were conducted. Results: We included 33 studies and 9588 patients. We found that pain intensity decreased in the exclusive home exercise group (Effect size = −0.89. 95% CI −0.99 to −0.80) and in the group which conducted exercise both at-home and at another setting (−0.73. −0.86 to −0.59). Similarly, functional limitation also decreased in both groups (−0.75. −0.91 to −0.60, and −0.70, −0.92 to −0.48, respectively). Relaxation and postural exercise seemed to be ineffective in decreasing pain intensity, whereas trunk, pelvic or leg stretching decreased pain intensity. Yoga improved functional limitation. Supervised training was the most effective method to improve pain intensity. Insufficient data precluded robust conclusions around the duration and frequency of the sessions and program. Conclusion: Home-based exercise training improved pain intensity and functional limitation parameters in LBP.

Translation and cultural adaptation of the Persian version of Vestibular Disorders Activities of Daily Living scale (VADL): a validity and reliability study

Background Vestibular disorders can lead to functional limitations and deficits in performing routine daily life tasks. The Vestibular Disorders Activities of Daily Living scale (VADL) is a useful tool for impact assessment level of functional limitations in patients with vestibular disorders. Objective Translation, cultural adaptation and evaluation of the reliability and validity of VADL to Persian. Methods In this analytical–descriptive study, VADL was translated based on the native protocol of the International Quality of Life questionnaire and adapted to the conditions found in Iranian culture. Upon confirmation of face validity, this scale was performed on 90 Persian patients with vestibular disorders (aged between 25 and 85 years). After one week, 53 participants were asked to complete the questionnaire again. Finally, reliability was evaluated with both methods of internal consistency and test-retest reproducibility. Results Five items out of 28 were modified to adapt the scale to the culture of Iranians, and they were approved by the original designer of the questionnaire. Internal consistency was confirmed by Cronbach’s alpha coefficient of 0.94, and repeatability was confirmed by the Interclass Correlation Coefficient of 0.97. Conclusion The Persian version of VADL was relatively equivalent to the original content and it was in compliance with the terms of Persian culture with high validity and reliability. Therefore, it may be a useful tool for the assessment of functional limitation in some patients with vestibular disorders.

Disturbed sleep may be a core risk factor for jaw functional limitation in patients with painful temporomandibular disorders.

Pain related to temporomandibular disorder (TMD) usually affects jaw function. In patients with TMD, little is known about the biopsychosocial relevance to jaw functional limitations. This study explored the impact of biopsychosocial risk factors on jaw functional limitation in patients with painful TMD. A comprehensive set of patient-reported outcomes (PROs), consisting of pain severity (Brief Pain Inventory), psychological stress (Symptom Checklist-90-Revised), catastrophising thought (Pain Catastrophizing Scale), kinesiophobia (Tampa Scale for Kinesiophobia-TMD), sleep quality (Pittsburgh Sleep Quality Index) and jaw functional limitation (Jaw Functional Limitation Scale-20), were administered, and clinical examinations were performed in patients with TMD. This study included the data obtained from 131 patients with painful TMD. In the logistic regression analysis, biomedical factors (age, sex, pain duration and TMD phenotype) were not associated with jaw functional limitation. Correlations were higher in the order of sleep quality (ρ=0.946), pain severity (ρ=0.582), pain catastrophising (ρ=0.535), kinesiophobia (ρ=0.486) and emotional distress (ρ=0.268). Multiple regression analysis demonstrated three predictors, including pain severity (p=.001), kinesiophobia (p=.023) and sleep quality (p<.001) for jaw functional limitation. In the mediation analysis, the indirect effect of pain severity on the association between sleep and limitation was significant (p<.0001). Jaw functional limitation is associated with biopsychosocial factors. In particular, sleep may be a core risk factor for functional limitation in patients with painful TMD.