Higher Levels Of Disability Research Articles

Остеопороз у чоловіків: стан проблеми, фактори ризику, діагностика, сучасні підходи до лікування

Остеопороз (ОП) у чоловіків — це гетерогенне захворювання, якому сьогодні приділяється мало уваги. Традиційно ОП вважався захворюванням, вражаючим лише жінок. Сформоване ставлення до чоловічого ОП як до рідкісної патології, тому відсутність настороженості призводить до того, що багато пацієнтів залишаються без лікування. Однак під час проведених досліджень установлено, що третина всіх переломів проксимального відділу стегна припадає на частку чоловічого населення, зумовлюючи високий рівень інвалідизації та первинної смертності. Проблема діагностики й лікування ОП останнім часом стає все актуальнішою у зв’язку зі старінням населення та виникненням ускладнень, властивих цій хворобі. Частота ОП-асоційованих переломів у чоловіків аналогічна частоті інфаркту міокарда і перевершує навіть частоту карциноми легенів і раку передміхурової залози. Результати для чоловіків-пацієнтів після перелому стегна виглядають гнітюче: одна третина (32 %) помирає протягом першого року, і тільки 21 % здатні самостійно жити в суспільстві через рік після перелому. Ця проблема найпоширеніша в осіб старше 70 років. Етіологія ОП у чоловіків може бути ідіопатичною або вторинною внаслідок гіпогонадизму, дефіциту вітаміну D і недостатнього вживання кальцію, гормонального лікування раку передміхурової залози, супутньої патології, використання лікарських препаратів, що впливають на метаболізм кісток. У даному огляді на основі сучасних європейських та американських рекомендацій розглянуті питання епідеміології ОП у чоловіків, основні принципи діагностики захворювання, засновані на даних оцінки клінічних проявів, анамнезу, включаючи цілеспрямований скринінг. Використання алгоритму FRAX дозволяє призначити лікування пацієнтам на етапі, коли показники мінеральної щільності кісткової тканини знаходяться в ме­жах остеопенічних значень і наявні додаткові фактори ризику. Детально описані методи інструментального та лабораторного обстеження пацієнтів. Підкреслені основні методи лікування, препаратами першого вибору для лікування ОП у чоловіків є бісфосфонати (алендронат, ризендронат, золедронова кислота) і терипаратид, другої лінії — деносумаб. Незважаючи на те, що доказова база цих препаратів саме в чоловіків є малою, сучасні дані не передбачають наявності гендерної різниці результатів лікування при аналогічних значеннях мінеральної щільності кісткової тканини. Своєчасна діагностика та профілактика ОП у чоловіків сприятимуть більш ранньому його виявленню, дозволять розпочати адекватну терапію та зменшити кількість переломів у таких пацієнтів.

A Survey of Cannabis Use in a Large US-Based Cohort of People with Multiple Sclerosis.

As cannabis products become increasingly accessible across the United States, it is important to understand the contemporary use of cannabis for managing multiple sclerosis (MS) symptoms. We invited participants with MS from the North American Research Committee on Multiple Sclerosis (NARCOMS) Registry (aged 18 years or older) to complete a supplemental survey on cannabis use between March and April 2020. Participants reported cannabis use, treated symptoms, patterns, preferences, methods of use, and the factors limiting use. Findings are reported using descriptive statistics. Of the 6934 participants invited, 3249 responded. Of the respondents, 31% reported having ever used cannabis to treat MS symptoms, with 20% currently using cannabis. The remaining 69% had never used cannabis for MS symptoms, for reasons including not enough data about efficacy (40%) and safety (27%), and concerns about legality (25%) and cost (18%). The most common symptoms current users were attempting to treat were spasticity (80%), pain (69%), and sleep problems (61%). Ever users (vs never users) were more likely to be younger, be non-White, have lower education, reside in the Northeast and West, be unemployed, be younger at symptom onset, be currently smoking, and have higher levels of disability and MS-related symptoms (all P < .001). Despite concerns about insufficient safety and efficacy data, legality, and cost, almost one-third of NARCOMS Registry respondents report having tried nonprescription cannabis products in an attempt to alleviate their symptoms. Given the lack of efficacy and safety data on such products, future research in this area is warranted.

ASSESSMENT OF THE INFLUENCE OF MEDICAL AND SOCIAL FACTORS ON THE ADHERENCE OF PATIENTS WITH DIABETES MELLITUS TO LIFESTYLE MODIFICATION

Introduction. Diabetes mellitus is one of the most common noncommunicable diseases worldwide. At the same time, the high prevalence of various risk factors for the development of diabetes mellitus is one of the reasons for the increase in the number of patients with diabetes in all countries of the world, a high level of disability and premature mortality of people of working age. An important component of achieving the required therapeutic effect is the compliance of the patient with diabetes mellitus with the prescribed treatment and change in the usual way of life in many spheres of life. Thus, various factors related to both the quality and availability of medical care and the individual characteristics of the patient himself can affect adherence (change) to lifestyle modification.&#x0D; Purpose. To explore the medico-social factors, which influencing the adherence of patients with diabetes mellitus to their lifestyle modification.&#x0D; Materials and methods. The research involved 434 respondents with an established diagnosis of diabetes mellitus aged 18 to 80, including 221 women (50.92%) and 213 men (49.08%). The questionnaire consisted 2 parts, the first part, developed by the assistant M.V. Vodolagin, included 54 questions about the health status of respondents, the level of knowledge about diabetes mellitus, the presence of risk factors, the use of information and communication technologies in the treatment of diabetes mellitus and others, the second part included the “Russian universal questionnaire for quantifying adherence to treatment” (KOP-25) (developed by N. Nikolaev and Yu.P. Skirdenko, 2008). The level of adherence of patients with diabetes mellitus to lifestyle modification (change) was assessed, the main factors influencing the level of their adherence were assessed.&#x0D; Results. According to the results of the survey, almost every second patient with diabetes mellitus had a low level of adherence to lifestyle modification (47.70%, n = 207, 95% CI 43.03–52.40%), statistically significant differences in the level of adherence to lifestyle modification among respondents: by type of diabetes mellitus (p &lt;0.001), among respondents who attended Diabetes Schools (p &lt;0.001), among respondents with a high level of knowledge about diabetes (p &lt;0.001), among respondents who answered that they adhere to the prescribed treatment regimen (p = 0.001); among respondents who visit their attending physician more often (p = 0.009), among respondents who used remote forms of interaction with their attending physician (p &lt;0.001), among respondents in younger age groups (p &lt;0.001), among respondents with less long experience of diabetes mellitus (p = 0.006).&#x0D; Conclusion. Due to the fact that the effectiveness of the treatment of chronic diseases depends on maintaining a high level of patient motivation, careful adherence to treatment regimens and lifestyle modifications for a long time, only the active involvement and participation of patients in the treatment process, including using modern information and communication technologies will help improve the quality of life of patients with diabetes mellitus, reduce the rate of disability and premature mortality.

A hospital-based self-harm register in Mysore, South India: Is follow-up of survivors feasible in low and middle income countries?

Background: In high-income countries, dedicated self-harm surveillance systems are regarded as a key component in suicide prevention strategies, which suggests they may be important in low- and middle-income countries where rates of suicide are higher and risk factors for self-harm are different, provided they can be shown to be feasible in those settings.Methods: We established a hospital based self-harm register in Mysore, South India. A subset of participants was followed-up after two years. Results: Of the 453 who were examined at baseline, the vast majority (80%) were from rural areas, nearly a quarter were illiterate and 65 (14%) were diagnosed with depression. Compared to men, women tended to be younger, single, from rural areas, unemployed, with lower levels of educational attainment and higher levels of disability. Of the 453, 371 (80%) were successfully contacted by cellphone at 2 years. There were no significant differences in baseline variables between those followed-up and those who were not, including sociodemographic features, rates of depression, severity of disability and severity of suicidal intent. All participants reported that psychosocial assessment offered at baseline was helpful and that they would recommend assessment to othersConclusions: Findings from this study indicate that our self-harm register was a feasible and useful resource, and that contact and follow up are acceptable and feasible.

111 The Systemic Effects of Intra-Articular Steroid Injections- Should COVID-19 Change Our Practice?

Abstract Aim The COVID-19 pandemic prompted us to review and often suspend services, while patients continue to suffer with painful musculoskeletal conditions. The diagnostic and therapeutic value of intra-articular corticosteroid injections (IACSI) cannot be denied. Current BOA guidelines advise giving the lowest effective dose for inflammatory arthritis and limit use in osteoarthritis to patients with high levels of pain and disability. We aimed to evaluate the literature pertaining to the use of IACSI and the potential systemic immunosuppressive effects. Method We searched Medline, using the terms “systemic effects of intra-articular steroid” and “clinical course of Coronavirus infection in patients with steroid use”, between 1997 and 2020. Results No studies specifically looked at the systemic effects of intra-articular steroids in the presence of COVID-19 infection; however, four studies were identified which concluded that intra-articular steroid injections resulted in sufficient systemic absorption to cause suppression of the hypothalamic-pituitary-adrenal axis and endogenous cortisol production. These effects are dose dependent and are more common in patients with inflammatory joint diseases. A further four RCT’s, including one systematic review, showed that suppressed cortisol concentration was associated with a significant increase in mortality. Conclusions There is a lack of evidence in relation to the use of intra-articular steroids in COVID-19. However, evidence suggests that intra-articular steroids can result in systemic absorption and suppression of endogenous cortisol production thus increasing the potential risk of complications of COVID-19. We therefore support cautious use of low dose steroid injections in patients with inflammatory arthritis, where no alternative treatment is available.

Patient and Clinical Factors Associated With Response to Medications for Posttraumatic Stress Disorder.

Objective: Fluoxetine, paroxetine, sertraline, topiramate, and venlafaxine have previously shown efficacy for posttraumatic stress disorder (PTSD) in randomized clinical trials. Two prior studies using Department of Veterans Affairs (VA) medical records data show these medications are also effective in routine practice. Using an expanded retrospective cohort, we assessed the possibility of differential patterns of response based on patient and clinical factors.Methods: We identified 6,839 VA outpatients with clinical diagnoses of PTSD between October 1999 and September 2019 who initiated one of the medications and met pre-specified criteria for treatment duration and dose, combined with baseline and endpoint PTSD checklist (PCL) measurements. We compared 12-week changes in PCL score within clinical subgroups defined by sex, race and ethnicity, and military exposures, as well as comorbidities. Comorbidities were identified using International Classification of Diseases diagnostic codes and grouped according to major diagnostic classifications in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (eg, Psychotic Disorders, Depressive Disorders). We used a propensity score weighting approach to balance covariates among medication arms within each clinical subgroup. In our exploratory analyses using unweighted data for the overall cohort, we built penalized logistic regression models to identify covariates that predicted meaningful improvement.Results: There were no significant differences between medications in our weighted subgroup analyses. In unweighted exploratory analyses, higher baseline PCL scores and concurrent receipt of evidence-based psychotherapy predicted meaningful improvement, while high levels of disability predicted not realizing meaningful improvement.Conclusions: In the largest real-world study of medications for PTSD to date, we did not observe a pattern of differential response among clinical subgroups. All patients taking medications for PTSD, especially those with the highest levels of disability, should consider combined treatment with evidence-based psychotherapy.

Pain and cervical disability among public workers who use data visualization display terminals

Work-related neck/shoulder disorders are considered an important health issue. This study is aimed at establishing the pain and cervical disability patterns of workers with visual display terminals, as well as at determining the factors that mostly affect the onset of a new episode of back pain. A descriptive, correlational study was carried out on a sample of 88 workers who use visual display terminals, of the Ministry of Health (Xunta de Galicia). The workers completed the following questionnaires: "Neck Disability Index Scale," "Visual Analog Scale," "12-item Short Form Health Survey," and an individual postural analysis was conducted. For the comparative analysis, the Student's t-test, and the Mann-Whitney U test were performed. A binary logistic regression analysis was used to extract a predictive model of a cervical pain episode, and 58% reported cervical pain. There were no differences between men and women. The variables that best predict the onset of a new episode of pain are the level of disability, and the quality of physical life. Study results indicate that a worker who uses visual display terminals, with high levels of cervical disability and low values of physical quality of life, is more likely to suffer an episode of back pain.

One-Year Changes in Activities of Daily Living, Usability, Falls and Concerns about Falling, and Self-Rated Health for Different Housing Adaptation Client Profiles.

The purpose of this study was to investigate one-year changes and differences in changes in activities of daily living (ADL), usability, a history of falls, concerns about falling, and self-rated health across five housing adaptation (HA) client profiles identified previously using a cluster analysis approach: older adults with low level of disability (n = 59); older adults with medium/high level of disability (n = 26); adults with low level of disability (n = 10); adults with high level of disability (n = 8); and older adults with medium level of disability including at least moderate cognitive impairment (n = 5). Comparisons between the five profiles include secondary analyses aggregating those with low level of disability and those with medium/high level of disability. Changes within the client profiles demonstrate a complex pattern of improvements and declines, depending on outcome, with no profile showing consistent improvement or decline across all outcomes. The risks of deterioration over one year were the highest among those with cognitive impairments at baseline, but no recommendation of prioritization decisions based on baseline profiles can be made. Instead, it seems that all HA clients, independently of baseline profile, are at risk of increasing disability over time and require follow-up evaluations regularly.

Neurophysiological Markers of Internet Gaming Disorder: A Literature Review of Electroencephalography Studies.

Pathological online gaming is a relatively newer psychiatric disorder. It is the second behavioral addiction (after internet gambling disorder) included in the Diagnostic and Statistical Manual of Psychiatric Disorders (DSM), 5th edition as “Internet Gaming Disorder” (IGD). Recent research is showing high morbidity associated with IGD, thus encouraging researchers to find valid and reliable biomarkers of IGD. So that, early diagnosis and proper treatment could limit the high disability level accompanying excessive online gaming. As electroencephalography (EEG) is a non-invasive and relatively easily available diagnostic technique, we aimed at collecting EEG studies that investigated EEG changes associated with IGD, with a specific focus on finding diagnostic and predictive neurophysiological biomarkers of IGD. We searched PubMed and Google Scholar for EEG studies of IGD. We eliminated those EEG studies that were not focused on finding biomarkers. Scale for the Assessment of Narrative Review Articles (SANRA) is followed in the writing of this review article. Our results showed that increased slow-wave resting-state activity and reduced P300 and N100 can serve as useful IGD diagnostic markers of IGD. Moreover, increased resting-state theta activity can be a predictive biomarker of IGD. Lastly, increased late low potentials (LLPs) can be specific trait markers of cue-induced cravings in IGD.

Predictors of pain persistence and disability in high-school students with chronic neck pain at 6-month follow-up.

Neck pain tends to persist for periods of 1 to 4years of follow-up in adolescents, and a high percentage of them report disability. However, studies assessing the factors associated with persistent neck pain and disability in this age group are scarce. This study aimed to explore the association between psychosocial factors, sleep, and symptoms of central sensitization at baseline and the persistence of neck pain and disability at 6-month follow-up. A total of 710 adolescents with chronic neck pain were assessed at baseline with an online questionnaire that collected information on sociodemographic data, presence of musculoskeletal pain, pain intensity, physical activity, functional disability, depression, anxiety, stress, quality of sleep, catastrophizing, kinesiophobia, self-efficacy, and symptoms of central sensitization. At 6-month follow-up, adolescents were reassessed for disability and pain intensity and categorized as recovered or reporting persistent neck pain. Of the 710 participants with neck pain at baseline, 334 were classified as having persistent neck pain and 375 adolescents as being recovered at 6-month follow-up. Multivariable analysis showed that female gender (OR 1.47; p = 0.04) and symptoms of central sensitization (OR 1.02; p = 0.001) at baseline were positively associated with the persistence of neck pain at 6-month follow-up. Similarly, higher levels of disability (β = 0.41; p < 0.001) and symptoms of central sensitization (β = 0.28; p < 0.001) at the baseline were positively associated with disability. Symptoms of central sensitization and disability at baseline should be considered in the assessment and design of interventions for adolescents with chronic neck pain as an attempt to minimize its future impact on pain persistence and disability.

707High levels of back disability,but not back pain,are associated with reduced physical activity in women

Abstract Background Although clinical guidelines recommend physical activity for low back pain (LBP), our understanding of the physical activity undertaken by people with LBP is limited. We examined the amounts, intensities and types of physical activity performed by community-based women with different levels of pain and disability. Methods 542 women were invited to participate. Physical activity was measured using the International Physical Activity Questionnaire, and LBP and disability were assessed using the Chronic Pain Grade Questionnaire. Participants were categorised into no/low or high pain intensity and disability groups. Results Women with high levels of back disability performed half the total physical activity of those with no/low levels of back disability (MET(hours/week): median(95%CI)=27.3(13.2-41.4) vs. 53.9(44.9-62.8),p=0.002), including less moderate (17.5(10.4-24.7) vs. 32.1(26.8-37.4),p&amp;lt;0.001) and domestic and gardening activity (14.4(7.2- 21.7) vs. 23.5(19.0-28.0), p = 0.02). Moreover, fewer women with high disability participated in vigorous (3(8.11%) vs. 134(32.0%),OR(95%CI)=0.17(0.04-0.75),p=0.02) and leisure activities (17(45.9%) vs. 294(70.2%),OR(95% CI)=0.44(0.21-0.94),p=0.03) compared to those with no/low disability. There were no differences in physical activity between women with no/low and high pain intensity (all p &amp;gt; 0.05). Conclusions High levels of back disability, but not back pain intensity, were associated with reduced physical activity, including less total activity, moderate and vigorous intense activity, and discretionary activity. Key messages These findings highlight the impact of high levels of disability on physical activity. Further work is needed to determine whether targeting these types and intensities of physical activity will help in reducing back disability.

Body Image Concerns and Associated Impairment Among Adults Seeking Body Contouring Following Bariatric Surgery.

The current study examined a range of body image concerns and associated distress and impairment in patients who have undergone bariatric surgery and are seeking subsequent body contouring surgery. The aim of this study was to investigate the hypotheses that individuals seeking body contouring endorse a broad pattern of body image concerns and that overall body image concern is associated with greater impairment and disability. The participants were 56 adults seeking body contouring surgery after bariatric surgery. All participants completed a self-report questionnaire designed for the present study to assess body image concerns specific to patients who have undergone bariatric surgery and a battery of established measures of disability, impairment, and eating-disorder psychopathology. The most commonly endorsed concerns were related to loose skin (body dissatisfaction, feeling embarrassed in public, and skin rashes) whereas the least endorsed items included concerns related to scars from bariatric surgery (body dissatisfaction, avoidance of social situations, and difficulty concentrating). Participants endorsed a broad pattern of frequent distress and impairment related to physical body image changes post-bariatric surgery. Greater body image concerns were associated significantly with higher levels of disability, work-related impairment, and eating-disorder psychopathology. Patients seeking body contouring surgery reported a range of body image concerns with significant associated distress, disability, and impairment related to physical changes post-bariatric surgery. The present findings underscore that although bariatric surgery is effective for reducing weight and metabolic disturbances, additional interventions for addressing body image concerns that are frequently distressing and impairing may be needed.

Product Quality Control Analysis with Statistical Process Control (SPC) Method in Weaving Section (Case Study PT.I)

Abstract - PT.I is a company that produces synthetic rattan furniture on an export scale. The various products at PT.I are an attraction for consumers, such as classic and modern weaving models. However, the number of defects produced is higher than the tolerance limit company. Based on data from the weaving section, it shows that there are 5 types of defects that are not in accordance with the standards and quality that have been determined by the company. The purpose of this study is to identify the types of defects that often occur in PT. I and identify the main factors causing product defects using the SPC method. The seven tools consist of a check sheet, histogram, stratification, scatter diagram, p control chart, Pareto diagram, and fishbone diagram. The results showed that the number of defects in October and November exceeded the limit set by the company. The highest level of disability occurred in October. The higher the number of production, the higher the number of product defects. Based on the results of the p control chart, it can be seen that the product is outside the control limits that it should have. The process is in a state of uncontrollability or is still experiencing deviations. To suppress or reduce the number of product defects that occur in production, 3 types of dominant defects can be applied, namely the woven model (254 units), loose woven (122 units), and nail-looking woven (119 units). Factors causing defects in production are derived from human factors/workers, methods, materials/raw materials and work environment.

Prevalence of musculoskeletal problems in caregivers handling non-ambulatory spinal cord injury patients

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Spinal cord injury (SCI) is a distressing disorder that can cause of loss of physical, psychological and social functioning, that can cause high level of disability in patients. Due to disability, they are dependent on caregivers for their daily activities. Caregivers of SCI can be family or professional caregivers. Due to lack of training and awkward posture, caring for SCI patients may be burdensome which results in musculoskeletal problems in caregivers so it is important to find out the prevalence of musculoskeletal problems. The objectives were to find out the prevalence of musculoskeletal problems in caregivers handling non-ambulatory SCI patients and most common site of injury.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A cross sectional study was carried out on 80 caregivers including both professional and family caregivers. Self-structured validated questionnaire used to interview the caregivers based on convenient sampling. The data was analysed by descriptive statistics.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The prevalence of musculoskeletal problems is 95% in caregivers including both family and professional caregivers. Low back pain was the commonest site of symptoms (53%) followed by 15% neck, 12% upper back pain, right shoulder (10%), right wrist (5%) and no pain (5%).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The prevalence of musculoskeletal problems in caregivers handling non ambulatory SCI is high. Most affected area is low back pain and neck pain. The findings of the study indicated that proper training and exercise are required, on means of preventing musculoskeletal problems.&lt;/p&gt;&lt;p&gt; &lt;/p&gt;

The association of selected multiple sclerosis symptoms with disability and quality of life: a large Danish self-report survey

BackgroundPeople with multiple sclerosis (MS) experience a wide range of unpredictable and variable symptoms. The symptomatology of MS has previously been reported in large sample registry studies; however, some symptoms may be underreported in registries based on clinician-reported outcomes and how the symptoms are associated with quality of life (QoL) are often not addressed.The aim of this study was to comprehensively evaluate the frequency of selected MS related symptoms and their associations with disability and QoL in a large self-report study.MethodsWe conducted a cross-sectional questionnaire survey among all patients at the Danish Multiple Sclerosis Center, Copenhagen University Hospital, Denmark. The questionnaire included information on clinical and sociodemographic characteristics, descriptors of QoL and disability, as well as prevalence and severity of the following MS symptoms: impaired ambulation, spasticity, chronic pain, fatigue, bowel and bladder dysfunction, and sleep disturbances.ResultsQuestionnaires were returned by 2244/3606 (62%). Participants without MS diagnosis or incomplete questionnaires were excluded, n = 235. A total of 2009 questionnaires were included for analysis (mean age 49.4 years; mean disease duration 11.7 years; and 69% were women).The most frequently reported symptoms were bowel and bladder dysfunction (74%), fatigue (66%), sleep disturbances (59%), spasticity (51%) and impaired ambulation (38%). With exception of fatigue and sleep disturbances, all other symptoms increased in severity with higher disability level. Invisible symptoms (also referred to as hidden symptoms) such as fatigue, pain and sleep disturbances had the strongest associations with the overall QoL.ConclusionWe found invisible symptoms highly prevalent, even at mild disability levels. Fatigue, pain and sleep disturbances had the strongest associations with the overall QoL and were more frequently reported in our study compared with previous registry-based studies. These symptoms may be underreported in registries based on clinician reported outcomes, which emphasizes the importance of including standardized patient reported outcomes in nationwide registries to better understand the impact of the symptom burden in MS.

Hand Function, Participation, &amp; Quality of Life Among People With Hand Conditions

Abstract Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. The goal of the study was to examine the implications of a variety of hand-related diagnoses using the broad prospective of the International Classification of Functioning, Disability and Health. The hand-condition group reported significantly (p &amp;lt; .05) lower perceived quality of life (QoL), higher levels of disability, and reduced hand strength and dexterity in comparison with a healthy control group. Personal factors, hand function, and pain explained 29% of the variance in QoL. The results support the application of a broader biopsychosocial approach in hand therapy practice. Primary Author and Speaker: Danit Langer Contributing Authors: Avigayil Horwitz, Hanna Melchior, and Adina Maeir

Functional Status Examination Yields Higher Measurement Precision than the Glasgow Outcome Scale-Extended after Moderate-to-Severe Traumatic Brain Injury.

A limited evidence base supports the Functional Status Examination (FSE) as superior to the more commonly used Glasgow Outcome Scale-Extended (GOSE) for precisely characterizing injury-related functional limitations. The aim of this study was to use modern psychometric tools to test the hypothesis that the FSE is more precise than the GOSE in characterizing individual differences in functional limitations after moderate-to-severe traumatic brain injury (TBI). Secondarily, we sought to confirm that the type of interviewee (patient, significant other) does not affect the test performance of the FSE. Using data from 357 individuals with TBI who participated in the Magnesium Sulfate clinical trial and had six-month outcome data, we performed item response theory (IRT) analyses comparing the FSE and GOSE at six months post-injury. Results showed that the FSE yielded higher measurement precision (IRT test information) than the GOSE across most of the disability severity spectrum. The GOSE yielded more information than the FSE at a very high level of disability, because of the GOSE's assignment of a unique score for individuals who are in a vegetative state. Finally, the FSE showed no evidence of differential item functioning by interviewee, indicating it is appropriate to interview either persons with TBI or significant others and combine data across respondents as is typically done. The findings support the FSE as a viable and oftentimes advantageous substitute for the GOSE in clinical trials and translational studies of TBI.

Functional status in postural tachycardia syndrome

Introduction Postural tachycardia syndrome is a form of orthostatic intolerance that often leads to functional impairment. Methods This survey explored functional status and impact of symptoms in adults ( n = 958) ages 18 to 60 (M = 32.63 ± 10.52 years, 96.7% female) with postural tachycardia syndrome. Results Individuals reported an average of 11 daily life activities impacted by postural tachycardia syndrome with high levels of self-perceived disability. Additionally, 93.4% reported some degree of cognitive impairment and falls occurred in 55.3% of participants annually. Despite frequent falls and functional impairment, participants infrequently (26.9%) utilized therapy services. Conclusion Individuals with postural tachycardia syndrome are at an increased risk of experiencing disability and often require assistance with daily activities. Further research is necessary to understand the potential role of therapy in improving function and quality of life.

Survival and outcomes for stroke survivors living in care homes: a prospective cohort study.

BackgroundStroke survivors living in care homes require high levels of support with everyday living. The aims of this study were to describe the survival, health status and care received by stroke survivors living in care homes at 1-year post-stroke, compared with those in their own homes.MethodsA total of 3,548 stroke survivors with a first ever stroke between 1998 and 2017 in the South London Stroke Register were identified for survival analysis. A total of 2,272 were included in the 1-year follow-up analysis. Cox regression and Kaplan–Meier plots were used to describe survival, stratified into four 5-year cohorts. Health status, medications and rehabilitation received at 1-year post-stroke were compared using descriptive statistics.ResultsOver the 20-year period, survival improved for stroke survivors discharged to their own home (P < 0.001) but not for those discharged to care homes (P = 0.75). Care home residents were highly disabled (median Barthel index: 6/20, interquartile range: 2–10). Rates of secondary stroke prevention medications at 1-year follow-up increased over time for care home residents, including antiplatelets from 12.3 to 38.1%, although still lower than for those in their own homes (56.3%). Speech and language problems were common in the care home population (40.0%), but only 16% had received speech and language therapy.ConclusionsRates of secondary stroke prevention prescribing increased over 20 years but remained lower in care home residents. The lower levels of rehabilitation received by stroke survivors in care homes, despite their higher levels of disability, suggest a gap in care and urgent need for restorative and/or preventative rehabilitation.

Performance validity in outpatients with multiple sclerosis and cognitive complaints

Background: Suboptimal performance during neuropsychological assessment renders cognitive test results invalid. However, suboptimal performance has rarely been investigated in multiple sclerosis (MS). Objectives: To investigate potential underlying mechanisms of suboptimal performance in MS. Methods: Performance validity testing, neuropsychological assessments, neuroimaging, and questionnaires were analyzed in 99 MS outpatients with cognitive complaints. Based on performance validity testing patients were classified as valid or invalid performers, and based on neuropsychological test results as cognitively impaired or preserved. Group comparisons and correlational analyses were performed on demographics, patient-reported, and disease-related outcomes. Results: Twenty percent displayed invalid performance. Invalid and valid performers did not differ regarding demographic, patient-reported, and disease-related outcomes. Disease severity of invalid and valid performers with cognitive impairment was comparable, but worse than cognitively preserved valid performers. Lower performance validity scores related to lower cognitive functioning, lower education, being male, and higher disability levels (p < 0.05). Conclusion: Suboptimal performance frequently occurs in patients with MS and cognitive complaints. In both clinical practice and in cognitive research, suboptimal performance should be considered in the interpretation of cognitive outcomes. Identification of factors that differentiate between suboptimal and optimal performers with cognitive impairment needs further exploration.