Higher Functional Limitation Research Articles

Predictors of functional limitation trajectories after injury in a nationally representative U.S. older adult population

PurposeStudies examining postinjury functional status have demonstrated that individuals with severe injuries often do not return to baseline levels of physical functioning. We sought to investigate the impact injuries have on changes in physical functioning across the life course of older adults. The study's objectives were to (1) identify trajectories of long-term functional limitations after injury in the older adult population to better characterize the recovery process and (2) predict which individuals are most at risk for poor functional trajectories after injury. MethodsA retrospective cohort study was conducted using six waves of data from the Health and Retirement Study, which surveys Americans older than 50 years every two years. A group-based trajectory model was used to identify trajectories of functional limitations in injured participants. Using multivariate regression, we identified significant predictors of each trajectory. ResultsFive distinct trajectories were identified: Trajectory 1—consistently low functional limitations scores (18.9%), Trajectory 2—increase in functional limitations after injury followed by a gradual, incomplete recovery (46.3%), Trajectory 3—increase in functional limitations followed by further decline in functioning (10.5%), Trajectory 4—increase in functional limitations after injury followed by a gradual, complete recovery (13.4%), and Trajectory 5—consistently high functional limitations scores (10.8%). Gender, multiple health conditions, and insurance status predicted trajectory membership. ConclusionsFunctional limitations after injury follow distinct trajectories that can be predicted by baseline individual characteristics.

Preoperative Predictors of Pain Following Total Knee Arthroplasty

Total knee arthroplasty has provided dramatic improvements in function and pain for the majority of patients with knee arthritis, yet a significant proportion of patients remain dissatisfied with their results. We performed a prospective analysis of 215 patients undergoing TKA who underwent a comprehensive array of evaluations to discover whether any preoperative assessment could predict high pain scores and functional limitations postoperatively. Patients with severe pain with a simple knee range-of-motion test prior to TKA had a 10 times higher likelihood of moderate to severe pain at 6months. A simple test of pain intensity with active flexion and extension preoperatively was a significant predictor of postoperative pain at 6months after surgery. Strategies to address this particular patient group may improve satisfaction rates of TKA.

The relationship between oral conditions, masticatory performance and oral health-related quality of life in children

ObjectiveTo evaluate the association between oral conditions, masticatory performance (MP) and oral health-related quality of life (OHRQoL) in 8–12 year-old children. Design150 Brazilian scholars were examined for caries and malocclusions. MP was evaluated based on the ability to comminute an artificial test food followed by the determination of the median particle size (X50) and particle distribution in different-sized sieves (“b”). OHRQoL was measured using the Brazilian versions 8–10 and 11–14 of the child perceptions questionnaire (CPQ), considering the following domains: oral symptoms (OS), functional limitations (FL), emotional well-being (EW) and social well-being (SW). Higher scores indicated worse OHRQoL. Data were submitted to Spearman's correlation test and multiple linear regression analysis. ResultsThere were significant positive correlations between the psychosocial and OS domains scores of the CPQ8–10 and the number of decayed and missing teeth, respectively. The number of decayed teeth positively correlated with the number of missing teeth and the CPQ11–14 scores. The number of decayed and missing teeth was significantly associated with higher CPQ8–10 scores. Higher CPQ11–14 overall scores were associated with female gender, higher FL domain scores were associated with the number of missing teeth, and higher X50 values and EW domain scores were associated with female gender and the number of decayed teeth. ConclusionsA higher number of missing teeth correlated with an inferior MP in older children. Children with a higher number of caries rated their oral health less favourably. Older females and those who broke the test material into smaller sizes were also more likely to report a worse OHRQoL, suggesting that the time allowed to reduce food appears to be a more influential factor on children’ perception of oral health than their ability to break down the test material into smaller sizes. Moreover, the subjectivity of functional domain and artificial nature of chewable test material could have influenced the test sensitivity.

Health-related quality of life in family members of cancer survivors: A comparison with general population norms.

e16529 Background: Family caregiver burden is emerging as an important issue as number of cancer survivors increase. We hypothesized that presence of cancer survivor may influence the health-related quality of life (HRQL) of family members. Thus, we examined the HRQL of family members with cancer survivors in comparison with general population norms. Methods: Using the Fourth Korea National Health and Nutrition Examination Surveys (KNHANES IV) (2007–2009) data, we performed matching analysis to compare characteristics of cancer family vs. non-cancer family. The primary outcomes were EQ-5D and EQ-visual analogue scale (VAS) scores and generalized linear model was used. Results: Compared with general population norms, cancer family members were less employed (57.9% vs. 63.0%, P<0.001) and had higher functional limitation (20.2% vs. 16.5%, P=0.032). Moreover, cancer family members had higher level of stress (70.5% vs. 65.4%, P=0.008) and history of depression (12.9% vs. 10.2%, P=0.035). The mean EQ-5D and EQ-VAS scores were similar between the two groups. In multilevel models, EQ-5D was significantly associated with household income and education level (all P<0.001). EQ-VAS was associated with presence of cancer survivor (β=3.393, 95% confidence interval [CI] 1.018~5.769, P=0.052) along with household income (β=3.815, 95% CI 0.662~6.696, P=0.018), education level (β=5.663, 95% CI 2.663~8.662, P<0.001), employment status (β=5.624, 95% CI 2.858~8.390, P<0.001), functional limitation (β=-10.83, 95% CI -13.509~-8.151, P<0.001), and level of stress (β=-4.555, 95% CI -7.030~-2.080, P=0.003). Conclusions: EQ-VAS was significantly associated with presence of cancer survivor in a family. More attention should be given to family caregivers of cancer survivors and dynamic approaches to evaluate cancer survivorship and its influence on family members are required in the future.

Effects and predictors of shoulder muscle massage for patients with posterior shoulder tightness

BackgroundClinical approaches like mobilization, stretching, and/or massage may decrease shoulder tightness and improve symptoms in subjects with stiff shoulders. We investigated the effect and predictors of effectiveness of massage in the treatment of patients with posterior shoulder tightness.MethodsA randomized controlled trial was conducted in a hospital-based outpatient practice (orthopedic and rehabilitation). Forty-three women and 17 men (mean age = 54 years, range 43-73 years) with posterior shoulder tightness participated and were randomized into massage and control groups (n = 30 per group). A physical therapist provided the massage on the posterior deltoid, infraspinatus, and teres minor of the involved shoulder for 18 minutes [about 6 minutes for each muscle] two times a week for 4 weeks. For the control group, one therapist applied light hand touch on the muscles 10 minutes two times a week for 4 weeks. Glenohumeral internal rotation ROM, functional status, and muscle tightness were the main outcomes. Additionally, the potential factors on the effectiveness of massage were analyzed by multivariate logistic regression. For this analysis, patients with functional score improvement at least 20% after massage were considered responsive, and the others were considered nonresponsive.ResultsFifty-two patients completed the study (29 for the massage and 23 for the control). The overall mean internal rotation ROM increased significantly in the massage group compared to the control (54.9° v.s. 34.9°; P ≤ 0.001). There were 21 patients in the responsive group and 8 in the nonresponsive group. Among the factors, duration of symptoms, functional score, and posterior deltoid tightness were significant predictors of effectiveness of massage.ConclusionsMassage was an effective treatment for patients with posterior shoulder tightness, but was less effective in patients with longer duration of symptoms, higher functional limitation, and less posterior deltoid tightness.Trial registrationThis clinical trial is registered at Trial Registration "Trial registration: Clinicaltrials.gov NCT01022827".

Factors associated with suicidal ideation: Role of emotional and instrumental support

ObjectivesSuicidal ideation is an important phase in the suicidal process, preceding suicide attempts and completed suicide. Weak social ties and low support from friends or relatives have been significantly associated with suicidal ideation. This study investigated the relationship between social support and suicidal ideation among young and middle-aged adults in Korea. MethodsThe Seoul Citizens Health and Social Indicators Survey conducted face-to-face interviews with 10,922 self-reporting adults. Questions were asked to assess suicidal ideation, and several questions focused on social support, social networks, health behaviors, and health status. ResultsThe strongest association in middle-aged adults was that between suicidal ideation and lack of social support. Poor emotional support significantly influenced suicidal ideation in middle-aged men, whereas lack of instrumental support significantly affected suicidal thoughts in middle-aged women, after controlling for sociodemographic factors, health behaviors, and health status. High alcohol use, functional limitations, and stress were related to suicidal thoughts in young adults, whereas depressive feelings had the strongest association with suicidal ideation in middle-aged women. ConclusionsSocial support is a crucial independent correlate of suicidal ideation, especially in middle-aged adults in an urban community setting. This study shows that it is essential to provide gender-specific social support to prevent suicide.

Disaster planning for mass trauma care: implications for low income countries

Disasters are an important public health issue with an excessive mortality, high survivor morbidity and functional limitations on daily living. According to the International Strategy for Disaster Reduction (ISDR), the total number of reported people killed between 1991 to 2005 were 960,502 [1]. The total number of reported people affected by a disaster in the same time period was 3.5 billion with economic costs totaling $1193 billion dollars [1]. The number of disasters around the world has increased by more than four times in the last 20 years [2]. Furthermore, the increasing disaster rate has disproportionately affected poorer nations and communities [2]. This has contributed significantly to the downward spiraling effect on the economic, political and public health conditions of several developing nations.

Management Decisions in Nontraumatic Complaints of Arm, Neck, and Shoulder in General Practice

OBJECTIVE We wanted to evaluate associations between diagnosis and characteristics of the patient, complaint, and general practitioner (GP), as well as 6 common management decisions, in patients with nontraumatic arm, neck, and shoulder complaints at the time of the first consultation with their physician. We undertook an observational cohort study set in 21 Dutch general practices, including 682 patients with nontraumatic complaints of arm, neck, and shoulder. The outcome measure was application (yes/no) of a specific management option: watchful waiting, additional diagnostic tests, prescription of medication, corticosteroid injection, referral for physiotherapy, and referral for medical specialist care. Separate multilevel analyses showed that overall, the diagnostic category, having long duration of complaints, and reporting many functional limitations were most frequently associated with the choice of a management option. For watchful waiting, only complaint variables played a role (long duration of complaints, high complaint severity, many functional limitations, recurrent complaint). All these variables were negatively associated with watchful waiting. When opting for 1 of the 5 other management options, several physician characteristics played a role as well. Less clinical experience was associated with additional diagnostic tests and referral to a medical specialist. GPs working in a solo practice more frequently referred to a medical specialist. GPs working in a rural area more frequently referred for physiotherapy. Female GPs prescribed medication less frequently. Physicians with special interest in musculoskeletal complaints gave corticosteroid injections more frequently. Diagnostic category, long duration of complaints, and high functional limitations were key variables in management decisions with these complaints. In addition, several physician characteristics played a role as well.

Longitudinal predictors of attitudes toward aging among women with multiple sclerosis.

The purpose of the study was to explore the impact of change in functional limitation (FL), controlling for social support (SS), on attitudes toward aging using longitudinal survey data collected over a 7-year period. The 503 women with multiple sclerosis (MS; age, M=57 years, SD=10.25) were mostly Anglo (93%) and married (69%). First, the authors identified a quadratic growth model as the best for describing change in FL. Next, they considered SS as a time-varying covariate of FL to assess both within- and between-individual effects of SS on FL over time. Within individuals, higher FL levels were associated with lower SS levels. Between individuals, level of but not change in FL was associated with average SS level. Finally, average SS and response level and change in FL were studied as predictors of attitudes toward aging, accounting for 38% of the variance. Women with higher FL and lower SS scores had more negative views of aging. Negative views of aging among women with MS may have long-term consequences for their health outcomes as well as for the quality of their later years.

Physical complaints in ageing persons with spinal muscular atrophy

While life expectancy is improving for persons with spinal muscular atrophy, new physical complaints may arise. To investigate this, we studied persons with a long duration and severe course (high functional limitations) of the disease. Cross-sectional descriptive study. Persons with spinal muscular atrophy. Questionnaires and structured interviews on prevalence of physical complaints and their duration. Of 190 questionnaires 99 were returned; of 23 persons (with the longest disease duration and high functional limitation level) selected for structured medical interviews 9 participated. Patterns common within and different between the different types of spinal muscular atrophy were identified. Of the 10 most common complaints, types 1-2 had a significantly higher prevalence of kyphoscoliosis, difficulty in coughing, joint contractures and voice/speech problems, while type 3 had a significantly higher prevalence of fatigue. No statistically significant correlation was found between the appearance of physical complaints and disease duration. However, sleeping and swallowing problems were in the 5 most common complaints with the shortest mean time of appearance. The structured interview revealed hypermobility in the hand, suffusion of the eyes, and itching as new complaints with high prevalence. There are indications that the frequency of less well-known physical complaints increases with ageing.

State Expenditures on Home and Community Based Services and Use of Formal and Informal Personal Assistance: A Multilevel Analysis

Despite wide state variation in commitment to home and community-based services (HCBS) for functionally impaired older persons, little is known about how such variation affects older adults' strategies to compensate for their functional limitations. This study examines the association of state HCBS expenditures with use of formal and informal personal assistance among non-institutionalized older Americans aged 70 and older with functional limitations. We conducted multilevel multinomial logistic regression analysis using data from the first wave of the Assets and Health Dynamics among the Oldest Old Survey, combined with data on state HCBS expenditures. Controlling for individuals' demographic, socioeconomic, and care needs factors, persons residing in states with higher HCBS expenditures were more likely to use formal personal assistance, but not less likely to use informal assistance. Our study suggests state variation in HCBS expenditures leads to inequitable access to formal personal assistance, especially among those with high functional limitations.

Injury severity associated with nonfatal construction falls

This study evaluated injury severity in a group of construction workers who sustained nonfatal falls at work. The sample consisted of 255 adults who were identified from Doctor's First Reports (DFRs) submitted to the California Department of Industrial Relations. For those that fell from heights (n = 195), the mean height of fall was 9.2 feet (SD = 7.1). The mean number of lost work days was 44.3 days (SD = 58.6) and the median was 10 days. Two measures of injury severity were used—the Injury Severity Score and the disability section of the Health Assessment Questionnaire (HAQ). Seventeen participants (7%; 95% CI, 4–10%) were deemed permanently disabled. A simultaneous multiple regression model, using five independent variables, explained approximately 21% of the variance in HAQ scores. Nonunion status and safety climate scores indicating increased risk were positively correlated with higher functional limitation as measured by HAQ scores, as were greater heights and impact on concrete surface. Higher scores on both injury severity measures were significantly and moderately associated with a greater number of days lost from work. These findings suggest that injury severity and permanent disability associated with falls in construction are notable, and identify key target areas for intervention and prevention. Am. J. Ind. Med. 32:647–655, 1997. © 1997 Wiley-Liss, Inc.

Injury severity associated with nonfatal construction falls.

This study evaluated injury severity in a group of construction workers who sustained nonfatal falls at work. The sample consisted of 255 adults who were identified from Doctor's First Reports (DFRs) submitted to the California Department of Industrial Relations. For those that fell from heights (n = 195), the mean height of fall was 9.2 feet (SD = 7.1). The mean number of lost work days was 44.3 days (SD = 58.6) and the median was 10 days. Two measures of injury severity were used--the Injury Severity Score and the disability section of the Health Assessment Questionnaire (HAQ). Seventeen participants (7%; 95% CI, 4-10%) were deemed permanently disabled. A simultaneous multiple regression model, using five independent variables, explained approximately 21% of the variance in HAQ scores. Nonunion status and safety climate scores indicating increased risk were positively correlated with higher functional limitation as measured by HAQ scores, as were greater heights and impact on concrete surface. Higher scores on both injury severity measures were significantly and moderately associated with a greater number of days lost from work. These findings suggest that injury severity and permanent disability associated with falls in construction are notable, and identify key target areas for intervention and prevention.

Nutrition Survey of the Elderly in New York State

LEARNING OUTCOME: To describe the need for home delivered meals, and the extent and distribution of nutritional risk, food insecurity and functional limitations among the elderly of New York State. The number of New York State (NYS) elderly eligible for home delivered meals (HDMs) and the extent and distribution of nutritional risk, food insecurity and functional limitations among NYS elderly were assessed using a random sample telephone survey. A representative sample of 4570 individuals from 3305 households with one or more persons aged 60 plus were interviewed to determine HDM eligibility of all those in these households. A supplemental survey was completed by 554 persons, in two groups: (1) a particularly vulnerable subset of homebound HDM eligibles; and (2) a random sample of ineligibles. Of all NYS elderly, 6.6% were eligible for HDMs and 3.5% comprised the particularly vulnerable homebound subset of HDM eligibles. Based on the 10-item Nutrition Screening Initiative Checklist, 16% of NYS elderly were at high nutritional risk compared to approximately 40% of the vulnerable subset Using a 3-item index, 11.4% experienced food insecurity compared to 25.5% of the subset 4.6% reported limitations with one or more activities of daily living and 25% reported limitations with one or more instrumental activities of daily living, compared to 25% and 60% of the subset, respectively. The findings indicate that the subset of eligibles experience multiple vulnerabilities including poor health, high nutritional risk and functional limitations compared to all NYS elderly. Solutions to improving the quality of the lives of the vulnerable subset and reducing their health care costs will require not only providing HDMs as needed, but also by managing their care through the network of home and community-based services for the elderly.