Higher Levels Of Physical Functioning Research Articles

Exploring the Perceived Difficulty and Importance of Lower Limb Physical Activities for People With and Without Osteoarthritis: A Discrete Choice Experiment.

Many outcome measures used in lower-limb osteoarthritis (OA) present ceiling effects. This compromises the ability of those measures to accurately assess people with higher levels of physical function. Understanding of the difficulty and importance of physical activities would enable the inclusion of challenging and meaningful activities in new outcome measures. To explore the perceived difficulty and importance of 40 physical activities by people with and without lower limb OA. We conducted a discrete choice experiment (DCE) using 1000minds software. We recruited people with and without OA using OA databases and social media. Participants were asked to complete two comparison tasks, first about the relative difficulty and then about the importance of the physical activities. Pairwise comparisons were presented (i.e., two alternatives at a time), and participants selected the most difficult/important. We analysed data from 613 participants, of whom 215 had OA. Rankings of difficulty and importance were obtained. No major differences existed in the difficulty ranking between people with and without OA. People with OA rated activities like kneeling and balancing activities as more important than those without OA. In contrast, people without OA rated jogging, squatting, and running as more important than those with OA. Challenging activities were generally rated as less important. A DCE ranked 40 different lower limb physical activities in terms of difficulty and importance. Challenging activities were found to be less important than easier ones. People with OA gave more importance to easier activities than people without OA.

Trends in Patient-Reported Physical Function After Hip Fracture Surgery.

Background Hip fractures carry significant morbidity and mortality, yet studies assessing post-surgical functional recovery from the patient's perspective are scarce, lacking benchmarks against age-matched populations. This study aimed to identify factors influencing postoperative functional outcomes, compared to the lower 25th percentile of normal age-matched populations, and to compare postoperative physical function with one-year mortality following hip fracture surgery. Methodology A retrospective review of 214 hip fracture patients reporting to the emergency department (ED) from July 2020 to June 2023 was conducted, with all completing a three-month postoperative Patient-Reported Outcomes Measurement Information System-Physical Function (PROMIS-PF) survey. Primary outcomes included three-month PROMIS-PF scores, with secondary outcomes focusing on one-year mortality. Factors such as demographics, comorbidities, procedures, time to surgery, length of stay, and postoperative outcomes were analyzed for correlation. Multivariate logistic regression assessed predictors of achieving a PROMIS-PF T-score of at least 32.5, representing the bottom 25th percentile for age-matched populations, and the relationship between three-month PROMIS PF T-scores and one-year mortality. Results Surgery was performed within 24 hours of ED arrival in 118 (55.1%) patients, the average length of stay was 5.2 days, and 64 (29.9%) were discharged home. Total hip arthroplasty and home discharge correlated with higher physical function scores. In contrast, older age, higher American Society of Anesthesiologists scores, certain comorbidities, specific surgical procedures, and longer hospital stays were associated with lower scores. Fewer than half (102 [47.7%]) achieved functional levels comparable to the 25th percentile of age-matched populations. Multivariate analysis indicated chronic obstructive pulmonary disease and home discharge as predictors of achieving this threshold, while higher PROMIS-PF T-scores were associated with reduced one-year mortality. Conclusions Patients undergoing hip fracture surgery are unlikely to achieve high levels of physical function within the three-month postoperative period. Fewer than half of these patients will reach functional levels, and decreased early function is associated with an increased risk of one-year mortality.

An Integrated Stroke Transitional Care Intervention Improves Physical Functioning, Self-Management and Patient Experience in Older Adults with Stroke and Multimorbidity: A Multisite Pragmatic Randomized Controlled Trial

Background: The hospital-to-home transition for older adults with stroke is often fragmented, resulting in hospital readmissions and reduced quality of life, patient satisfaction and safety. There is limited evidence for strategies to improve transitions in care for older adults with stroke and multimorbidity. This study aimed to test, in real-world clinical practice, the effectiveness of the Transitional Care Stroke Intervention (TCSI) versus usual care on health outcomes, patient experience, and health and social service use costs in older adults (> 55 years) with stroke and multimorbidity (> 2 chronic conditions).
 Methods: This pragmatic randomized controlled trial was conducted among older adults with a stroke and multimorbidity discharged from the hospital to the community using outpatient stroke rehabilitation services in two communities in Ontario, Canada. Participants were randomized 1:1 to usual care (control group) or usual care plus the 6-month TCSI (intervention group). The TCSI was delivered virtually by an interprofessional team from hospital-based outpatient stroke rehabilitation clinics (Physiotherapist, Occupational Therapist, Speech Language Pathologist, Registered Nurse, and Social Worker). The TCSI is a complex, integrated intervention which includes care coordination/system navigation support, phone/video visits, monthly interprofessional case conferences, and an online resource to support system navigation. Data analysis was performed by intention to treat. The primary outcome was risk of hospital readmission (all-cause) after 6 months. Secondary outcomes were mental and physical functioning, depressive symptoms, stroke self-management, patient experience, number of hospital days and readmissions, number of ED visits, survival rates to first hospital and ED visit, risk of ED visits, and health and social service use costs. Older adults with stroke were engaged as co-investigators and informed the research design, implementation, and evaluation through participation in the Patient Partner Advisory and the TCSI Steering Committees.
 
 Results: Ninety participants were enrolled (44 intervention, 46 control); 11 (12%) participants were lost to follow-up, leaving 79 (39 intervention, 40 control). Most participants were men (60%), with an average of 7 comorbid conditions, and 78% had experienced their first-ever stroke. No significant group differences were seen for the baseline to six-month risk of hospital readmission (all-cause). However, stroke survivors in the intervention group reported higher levels of physical functioning (SF-12 Physical Component Summary Score mean difference: 5.10; 95% CI: 1.58-8.62, p=0.005), stroke self-management (Southampton Stroke Self-Management Questionnaire mean difference: 6.00; 95% CI: 0.51—11.50, p=0.03), and patient experience (Person-Centred Coordinated Care Experiences Questionnaire mean difference: 2.64, 95% CI: 0.81, 4.47, p=0.005) compared with the usual care group. No significant group differences were seen for the other secondary outcomes.
 Discussion: The TCSI improved physical functioning, stroke self-management and patient experience in older adults with stroke and multimorbidity without increasing total healthcare costs compared to usual care.
 Conclusion:The results provide evidence for the effectiveness of an integrated intervention to optimize transitional care outcomes for older adults with stroke and multimorbidity receiving outpatient stroke rehabilitation services.
 Suggestions for future research: Future research is needed to further evaluate this intervention in diverse settings and populations, with a larger sample size and a full economic evaluation. 
 
 

Achilles Tendon Ruptures: From Treatment to the Playing Field

Abstract: Achilles tendon ruptures are significant injuries that require intensive treatment and rehabilitation to return to full function. This statement is especially true for high-level athletes that seek to return to the highest levels of physical function. Outcomes after Achilles tendon ruptures have historically been good, although perhaps more guarded in those that require high levels of physical function. Essentially, the primary issue from a rehabilitation standpoint relates to strength and its relationship with the appropriate tension on the Achilles tendon. For reasons that remain somewhat elusive, patients with Achilles ruptures get profoundly weak after injury and well into recovery. Indeed, recovery is often protracted due to the length of time required to achieve full strength. In this review, we will focus on optimal rehabilitation of these injuries, how we can perhaps best prevent these injuries, and finally look at outcomes with a special focus on high-level athletes. Level of Evidence: Level V—Review.

Steady-State Hemoglobin Is Associated with Self-Reported Ability to Perform Challenging Physical Function Activities, but Not Global Physical Function in Individuals with Sickle Cell Anemia

Introduction People living with sickle cell disease (SCD) need high levels of physical function to support independent living. Researchers should prioritize identifying modifiable targets that improve physical function. People with SCD who have physical limitations and low muscular capacity are at risk of poor function and lower quality of life. This abstract describes domain-specific and global self-reported physical function among adults living with SCD and identifies cross-sectional associations between hemoglobin and physical function. Methods Respondents consented to chart abstraction and completed the PROMIS Physical Function Short Form 8b survey. We operationalized domain-specific function as binary variables indicating no impairment versus any impairment in 8 activities. We calculated participants' global physical function using PROMIS' HealthMeasures web tool calibrated to the US population and converted to t-scores (range: 20.3 [worst] to 60.1 [best]). Eligible participants met the following criteria: age 18+ when surveyed,labs drawn during a non-acute encounter within +/- 30 days of the survey, no pregnancy-related outcome the year before survey, no history of bone marrow transplant, and available covariate data. We estimated cross-sectional associations between hemoglobin and 8 physical function sub-domains using multivariable logistic regression. We fit heteroscedastic tobit regressions to estimate the association between hemoglobin and global physical function. We adjusted the models for age, sex, recruitment site, history of renal damage, disease-modifying therapy (DMT) use, body mass index, and lactate dehydrogenase (LDH). We used STATA/SE 18.0 to perform the analyses separately by SCD subtype: sickle cell anemia (SCA) - HbSS/HbSβ 0, versus other subtypes (variant SCD). Results Between 2016 and 2023, 331 people with SCD at 7 GRNDaD sites completed the survey; 119 adults met eligibility criteria (52% female). The median age was 31 years (IQR: 24 , 39 years); 95% identified as Black, and 65% had SCA [Table 1]. Seventeen percent reported no limitation in any domain. Those with While For those with SCA, the hardest activity was heavy housework (74% reported limitation), while the easiest was running errands (39% reported limitation). For those with variant SCD, the hardest activity was heavy housework (88% reported limitation), while the easiest was climbing stairs (64% reported limitation). In adjusted logistic regression models among those with SCA, higher steady state hemoglobin was associated with higher odds of full function when carrying groceries (OR = 1.59, 95% CI = 1.05 , 2.41), performing 2 hours of labor (OR = 2.17, 95% CI = 1.29 , 3.65), and heavy housework (OR = 1.78, 95% CI = 1.04 , 3.06) [Figure 1]. Hemoglobin was not associated with any function sub-domains for individuals with variant SCD. In adjusted tobit regression models, hemoglobin was not associated with global physical function for those with SCA (β= 0.23 95% CI = -0.99 , 1.45) nor with variant SCD (β= -0.10, 95% CI= -0.77 , 0.58). Conclusions People with SCA reported better age-adjusted subjective function than those with variant disease, perhaps reflecting availability of treatments for SCA. In SCA, hemoglobin was positively associated with higher function in the 3 PROMIS sub-domains that respondents ranked as most challenging. Hemoglobin was not associated with global physical function for either SCD subtype. research in larger longitudinal samples is needed to explicate potential mechanisms linking hemoglobin to self-reported function sub-domains, corroborate the observed patterns of self-reported function by subtype, investigate associations between hemoglobin and objectively measured physical function, and identify how within-person changes in hemoglobin may contribute to changes in performing challenging everyday physical function activities.

Efficacy of rehabilitation after provision of ICRC lower limb prostheses in low-income and middle-income countries: A quantitative assessment from Myanmar.

Low-income and middle-income countries (LMICs) have poorly resourced health services. Lack of access to assistive devices, such as prosthetics, may limit the functional outcomes of persons with amputation and affect quality of life (QoL). The objective of this study was to assess the functional level and QoL of prosthetic users in LMICs when prescribed a prosthesis made from International Committee for Red Cross (ICRC) components. The study design included a quantitative descriptive methodology assessing functional outcomes and QoL after prosthetic provision. Participants were identified from the prosthetic service in Mandalay, Myanmar. Included participants were those with unilateral, traumatic, lower limb amputations, with ICRC devices delivered at least 6 months earlier. Participants attended the prosthetic service and were assessed using the Amputee Mobility Predictor with Prosthesis tool and the World Health Organization Quality of Life Brief and Disability modules. Thirty-five participants completed the study; of them, 63% were persons with transtibial level amputation and 37% were with transfemoral level amputation. Approximately 83% achieved a score of more than 37 using the Amputee Mobility Predictor with Prosthesis. There is a strong positive correlation between QoL and physical health (r = 0.55; p < 0.001), social relationships (r = 0.66; p < 0.001), and inclusion (r = 0.53; p < 0.001). Participants had a better QoL and overall health when they had better psychological health. The patient-based results presented within this study could be considered as a contribution to the evidence base and importance of provision of prosthetic services in LMICs. It was observed that participants with an amputation were able to achieve a high level of physical function with the ICRC prostheses while also reporting a high QoL.

Effects of a return to work program on the health and barriers to returning to work in head and neck cancer patients: A randomized controlled trial

ObjectiveThe aim of the study was to evaluate the effects of a return to work (RTW) program on perceived health status, barriers to returning to work, fear of cancer progression, social support, physical function, and psychosocial function in head and neck cancer (HNC) patients. MethodsA randomized controlled trial with repeated measures was conducted. The 70 HNC patients were randomly assigned into two groups: 35 in the experimental group (RTW) and 35 in the control group (usual care). Patients were assessed at four time points: baseline (T0) (6 months after completing treatment), and then at 9-, 12-, and 15-months (T1, T2, and T3, respectively) after completing treatment. Patients completed a self-reported questionnaire, including measures of perceived health status, barriers to returning to work, fear of cancer progression, social support, physical function, and psychosocial function. ResultsPatients in the experimental group had significantly greater perceived health status and better psychosocial function compared to those in the control group. Compared to T0, at T4, participants in both groups had significantly lower levels of barriers to returning to work, fear of cancer progression, social support, and higher levels of physical function. ConclusionsThe RTW program effectively improved perceived health status and psychosocial function in HNC patients. Survivorship care should include a transitional return-to-work program to help patients transition back to work. Trial registrationNCT04322695.

Effect of Lower Extremity Osteoarthritis on Outcomes of Lumbar Decompression.

The purpose of this study is to evaluate how hip or knee osteoarthritis (OA) and total joint arthroplasty impact the outcomes of patients undergoing lumbar decompression. A retrospective review of 342 patients undergoing lumbar decompression without fusion from January 2019 and June 2021 at a single institution was performed. Univariate and multivariate analyses were used to compare outcomes between patients with and without concomitant hip or knee OA. Forty-six percent of patients had a hip or knee OA diagnosis and were higher risk as they were older, had higher BMIs, were more likely to be former smokers, had higher ASA scores, and were more likely to undergo 3+ level surgery. Postoperatively, after adjusting for differences between groups, hip or knee OA patients were more likely to be readmitted (OR=12.45, p=0.026) or have a complication (OR=13.77, p=0.031). However, patient reported outcomes as measured by Patient Reported Outcomes Measurement Information System-physical function. were similar at 1-3 months and 3-6 months. Higher levels of physical function were observed at 3-6 months postoperatively in hip OA patients with a history of THA. Patients with concomitant hip or knee OA are at higher risk for readmission and postoperative complications but may achieve similar levels of physical function as those without OA.

How Are Age, Gender, and Country Differences Associated With PROMIS Physical Function, Upper Extremity, and Pain Interference Scores?

The interpretation of patient-reported outcomes requires appropriate comparison data. Currently, no patient-specific reference data exist for the Patient-Reported Outcome Measurement Information System (PROMIS) Physical Function (PF), Upper Extremity (UE), and Pain Interference (PI) scales for individuals 50 years and older. (1) Can all PROMIS PF, UE, and PI items be used for valid cross-country comparisons in these domains among the United States, the United Kingdom, and Germany? (2) How are age, gender, and country related to PROMIS PF, PROMIS UE, and PROMIS PI scores? (3) What is the relationship of age, gender, and country across individuals with PROMIS PF, PROMIS UE, and PROMIS PI scores ranging from very low to very high? We conducted telephone interviews to collect custom PROMIS PF (22 items), UE (eight items), and PI (eight items) short forms, as well as sociodemographic data (age, gender, work status, and education level), with participants randomly selected from the general population older than 50 years in the United States (n = 900), United Kingdom (n = 905), and Germany (n = 921). We focused on these individuals because of their higher prevalence of surgeries and lower physical functioning. Although response rates varied across countries (14% for the United Kingdom, 22% for Germany, and 12% for the United States), we used existing normative data to ensure demographic alignment with the overall populations of these countries. This helped mitigate potential nonresponder bias and enhance the representativeness and validity of our findings. We investigated differential item functioning to determine whether all items can be used for valid crosscultural comparisons. To answer our second research question, we compared age groups, gender, and countries using median regressions. Using imputation of plausible values and quantile regression, we modeled age-, gender-, and country-specific distributions of PROMIS scores to obtain patient-specific reference values and answer our third research question. All items from the PROMIS PF, UE, and PI measures were valid for across-country comparisons. We found clinically meaningful associations of age, gender, and country with PROMIS PF, UE, and PI scores. With age, PROMIS PF scores decreased (age ß Median = -0.35 [95% CI -0.40 to -0.31]), and PROMIS UE scores followed a similar trend (age ß Median = -0.38 [95% CI -0.45 to -0.32]). This means that a 10-year increase in age corresponded to a decline in approximately 3.5 points for the PROMIS PF score-a value that is approximately the minimum clinically important difference (MCID). Concurrently, we observed a modest increase in PROMIS PI scores with age, reaching half the MCID after 20 years. Women in all countries scored higher than men on the PROMIS PI and 1 MCID lower on the PROMIS PF and UE. Additionally, there were higher T-scores for the United States than for the United Kingdom across all domains. The difference in scores ranged from 1.21 points for the PROMIS PF to a more pronounced 3.83 points for the PROMIS UE. Participants from the United States exhibited up to half an MCID lower T-scores than their German counterparts for the PROMIS PF and PROMIS PI. In individuals with high levels of physical function, with each 10-year increase in age, there could be a decrease of up to 4 points in PROMIS PF scores. Across all levels of upper extremity function, women reported lower PROMIS UE scores than men by an average of 5 points. Our study provides age-, gender-, and country-specific reference values for PROMIS PF, UE, and PI scores, which can be used by clinicians, researchers, and healthcare policymakers to better interpret patient-reported outcomes and provide more personalized care. These findings are particularly relevant for those collecting patient-reported outcomes in their clinical routine and researchers conducting multinational studies. We provide an internet application ( www.common-metrics.org/PROMIS_PF_and_PI_Reference_scores.php ) for user-friendly accessibility in order to perform age, gender, and country conversions of PROMIS scores. Population reference values can also serve as comparators to data collected with other PROMIS short forms or computerized adaptive tests. Level II, diagnostic study.

Interactional effects of depressive symptoms and physical function on daily physical activity in ambulatory patients receiving hemodialysis

BackgroundClarification of the factors associated with decreased physical activity is crucial for effective disease management in patients undergoing hemodialysis. Although evidence suggests that physical activity may be associated with physical function or depressive symptoms, limited studies have demonstrated these factors to be independently associated with the former in patients undergoing hemodialysis. This study aimed to examine whether physical function and depressive symptoms were independently or interactively associated with daily physical activity in patients undergoing hemodialysis.MethodsThis cross-sectional study analyzed 157 clinically stable outpatients (median age: 68 years) receiving hemodialysis. Physical activity (steps/day) was measured using an accelerometer for four consecutive non-dialysis days. Physical function was evaluated by calculating usual walking speed along a 10-m walkway. The 10-item version of the Center for Epidemiologic Studies for Depression Scale was used to assess depressive symptoms.ResultsThe hierarchical multiple regression model (Model 2), constructed by adding physical function to Model 1 (clinical characteristics), showed a significant increase in coefficient of determination (R2), compared to Model 1 (ΔR2 = 0.15, P < 0.01). There was no significant increase in R2 between Models 2 and 3, where depressive symptoms were added to Model 2. The interaction term of physical function with depressive symptoms in Model 4 indicated an increase in R2 (ΔR2 = 0.01, P = 0.03), compared with Model 3. The simple slope analysis demonstrated that the difference in physical activity between patients with or without depressive symptoms at higher levels of physical function was greater than that at its lower levels.ConclusionsPhysical function was a strong and independent factor associated with physical activity, but no independent relationship between depressive symptoms and the physical activity was observed in patients undergoing hemodialysis. In contrast, physical function and depressive symptoms were interactively associated with daily physical activity in patients undergoing hemodialysis who were capable of walking independently. Our findings suggested that a two-step screening, primarily based on physical function and then depressive symptoms, can be useful to identify factors associated with physical inactivity in hemodialysis patients.

283 Gait: a biomarker for pain and function in chronic low back pain

OBJECTIVES/GOALS: Chronic low back pain (cLBP) is associated with gait impairments. Gait may serve as an important biomarker for improvement following therapy interventions; however, gait has not been sufficiently studied in relationship to pain and function in cLBP. METHODS/STUDY POPULATION: Adults with cLBP completed a two-minute-walk-test around a 37.5 m oval track while wearing an inertial measurement unit (IMU—Lifeware LLC, Pittsburgh, PA) over the L5 spinous process. Step time average, step time variability, step length, and symmetry (harmonic ratio) were calculated based on linear trunk accelerations, and gait speed was calculated based on distance walked. Participants completed the PEG tool (Pain, Enjoyment, General activity; scores closer to 10 indicate worse pain) to quantify pain intensity/interference and the PROMIS Physical Function SF-6b tool (mean t-scores=50 +/- 10; higher scores indicate better function) to quantify physical function. Pearson correlation coefficient (r) was used to determine strength of associations between gait and pain/physical function. RESULTS/ANTICIPATED RESULTS: Eleven adults (8 female, age 40 +/- 17, pain duration≥3 months) with cLPB participated in this study after completing an informed consent process approved by the University of Pittsburgh Institutional Review Board. Participants with a history of cancer, spinal cord compression, discitis, or activity restrictions prohibiting them from protocol completion were excluded. The mean PEG scores and PROMIS Physical Function t-scores were 2.8 +/- 1.8 and 47.8 +/- 8.2 respectively. There was a moderate-strong correlation between step time average and PEG (r=0.67, p=0.02), and a moderate-strong correlation between gait speed and PROMIS Physical Function (r=0.62, p=0.04). There were no other significant associations. DISCUSSION/SIGNIFICANCE: Gait speed and step time may be important movement biomarkers to consider when evaluating patients with cLBP. Generalizability of results are limited by the small study cohort and this cohort's relatively low pain burden and high level of physical function.

Abstract P229: The Associations Between Muscular Strengthening Activity, Physical Function, and All-Cause Mortality Among Older Adults With Cardiovascular Disease

Background: CVD is the leading cause of mortality in the US. Strong evidence suggests that aerobic physical activity (PA) is associated with reducing the risk of mortality among those with CVD. However, the extent to which muscular strengthening activity (MSA), as well as measures of physical functioning (PF), is related to mortality risk reduction is unknown in those with CVD. Purpose: To examine the associations between MSA and PF with all-cause mortality among a representative sample of the US with CVD. Methods: Participants aged ≥50 years (n=5,531; mean age 64.3 years, 52% female) from the 1999-2006 NHANES with complete covariates and outcomes were included. A subset (n=2,094) had MEC-measured PF data (time to peak force in seconds [TPF]; peak force in newtons [PF-N]; time to complete a 20-foot walk in seconds [TCW]) available at baseline through 2002. MSA volume was dichotomized as meeting (≥2 days/week) vs not meeting current MSA guidelines (&lt;2 days/week). Multivariable Cox proportional hazards regression models estimated associations (HR) between (1) MSA categories, and (2) quartiles of PF [TPF, TCW, PN-F], with all-cause mortality in the overall sample, and then stratified by enrollment age (&lt;50-64 years and ≥65 years). Results: A total of 2,046 deaths from any cause were identified over the 69,386 person-years of follow-up. Null associations were observed between MSA categories with mortality in multivariable models. Age stratified models revealed lower risk of all-cause mortality in adults ≥65 years meeting MSA guidelines versus insufficient MSA (HR 0.85, 0.73-0.99); however this association was not observed in adults aged 50-64 (HR 1.17, 0.82-1.65). Dose-response reductions in all-cause mortality risk were found across all quartiles for TCW and PF-N but not for TPF. These findings were consistent in adults aged 50-64 years and ≥65 years. Conclusions: Results suggest that meeting MSA recommendations is particularly beneficial for lowering all-cause mortality risk among those ≥65 years. Further, higher levels of PF appear to be associated with lower all-cause mortality risk among adults, supporting the role of assessing PF a potential indicator of future mortality risk. These findings collectively underscore the importance of including MSA in exercise prescriptions for older adults with CVD.

Modified Eden-Lange Triple Tendon Transfer Procedure for Idiopathic Spinal Accessory Nerve Palsy and Scapular Winging

The scapula serves as the transition point at which the energy from the lower body and core transmits through the scapulothoracic articulation and the upper extremity. Spinal accessory nerve palsy leads to lateral winging of the scapula and abnormal scapulothoracic motion. Resultant abnormal motion and asynchrony of the scapulothoracic articulation can disrupt the upper extremity kinetic chain, leading to pain, atrophy, and dysfunction of the shoulder. Disruption of this kinetic chain can severely impair patients and athletes who engage in physically demanding activities. Conservative management alone with anti-inflammatories, lifestyle changes, and physical therapy has not produced encouraging results. Surgical management options include a tendon transfer (Eden-Lange, triple tendon transfer) or nerve repair. We present a case of an active duty service member with idiopathic spinal accessory nerve palsy treated with triple tendon transfer. After the triple tendon transfer, this patient experienced improvements in pain, range of motion, and function at 1-year postoperatively, also maintaining enough strength and function to pass their physical fitness assessments and remain on active duty. As such, these findings may suggest the triple tendon transfer procedure offers a viable option in the treatment of spinal accessory nerve palsy in the active patient populations who require a high level of physical function.

Impact of malnutrition and its correction on mortality in older adults

BACKGROUND: Malnutrition is associated with decreased levels of physical function, cognitive decline, and an increased risk of all-cause mortality, making it important to identify risk factors for malnutrition, especially in old age. AIM: To identify factors associated with an increase and decrease in the risk of developing malnutrition, as well as to assess the impact of malnutrition and its correction on mortality in older adults. MATERIALS AND METHODS: A prospective cohort study of a random sample of 611 people aged 65 years and older. Mini Nutritional Assessment, Geriatric Depression Scale, Mini-Mental State Examination, dynamometry, Barthel Index, chronic noncommunicable diseases, clinical blood count, C-reactive protein. 2 examinations, 9 years of total follow-up. RESULTS: Risk factors for deterioration in nutritional status are decrease in emotional status (odds ratio 5.439; 95% confidence interval 2.79410.588), progression of autonomy decline (odds ratio 2.428; 95% confidence interval 1.3424.393), low physical function (odds ratio 2.877; 95% confidence interval 1.5775.250). A high level of physical function reduces the risk of malnutrition by 64.1%. Malnutrition increases the risk of five-year mortality by 2.7 times. A normal nutritional status reduces the risk of nine-year mortality by 50.2%. Improve nutrition status leads to a lower risk of mortality. CONCLUSIONS: The main factors in the deterioration of nutritional status are a decrease in emotional status, loss of autonomy and a low level of physical function. Early detection of older adults with malnutrition and its correction can reduce the risk of mortality.

Changes in Activity Levels In The First Three Months After Mild And Moderate Stroke

<h3>Research Objectives</h3> To investigate changes in physical activity in the first three months post mild/moderate stroke, and to explore the relationship between time spent on moderate-to-vigorous physical activity (MVPA) and cardiorespiratory fitness, fatigue, mood and quality of life. <h3>Design</h3> Longitudinal observational study. <h3>Setting</h3> Community. <h3>Participants</h3> Thirty adults diagnosed with mild/moderate stroke admitted to an acute stroke ward in Melbourne, Australia were included in this study. All participants gave written consent. Stroke survivors with severe cardiac or musculoskeletal disease, or neurological disease other than stroke were excluded. <h3>Interventions</h3> Not applicable. <h3>Main Outcome Measures</h3> The main outcome was daily time spent in MVPA measured using a multi-sensor armband. The device collects data on movement, body position and galvanic skin reactions. Each participant wore the armband for 3-7-days at three time-points: < 14 days post-stroke (T1), one month (T2) and three-months (T3) post-stroke. Additionally, cardiorespiratory fitness, fatigue, mood and quality of life were assessed at each time-point. <h3>Results</h3> Thirty participants were included (24 male/6 female) with a median age of 69 years (IQR 56.5-75.0), and a median time post-stroke at baseline of 8.5 days (IQR 5-11). Twenty-nine participants were included in the analysis at T1, n=28 at T2 and n=25 at T3. Median daily time (7AM and 10PM) spent in MVPA (>3.0 Metabolic Equivalent of Task) did not change over time with a median of 42 minutes (IQR 21-99), 58 minutes (40-111), and 51 minutes (IQR 25-102) at T1, T2, and T3 respectively. No changes were identified in cardiorespiratory fitness, fatigue, mood or quality of life. <h3>Conclusions</h3> Time spent in MVPA did not change in people after mild/moderate stroke in the first three months post-stroke. All participants had a high level of physical function however, the range of time spent in MVPA varied between individuals ranging from 3-280 minutes. These results indicate that levels of PA might be associated to other factors such as motivation, self-efficacy and fatigue and need to be further investigated in larger samples. <h3>Author(s) Disclosures</h3> None of the authors have any conflict of interest to disclose.

The enlightenment of American Firefighter Physical Ability Evaluation System to Our country

The physical fitness level of firefighters is the basic element of the comprehensive combat effectiveness of the national fire fighting force, and the highly stressful working condition of firefighters determines that they need to have a higher level of physical function. This paper compares the development and standards of firefighter fitness evaluation system in the United States in recent years, combines the actual situation of firefighter fitness level and evaluation system in China, integrates China's national conditions, puts forward some suggestions to help improve the physical fitness level of firefighters in China, and provides theoretical support for the construction of firefighter fitness evaluation system.

Unbiased proteomics, histochemistry, and mitochondrial DNA copy number reveal better mitochondrial health in muscle of high-functioning octogenarians.

Master athletes (MAs) prove that preserving a high level of physical function up to very late in life is possible, but the mechanisms responsible for their high function remain unclear. We performed muscle biopsies in 15 octogenarian world-class track and field MAs and 14 non-athlete age/sex-matched controls (NA) to provide insights into mechanisms for preserving function in advanced age. Muscle samples were assessed for respiratory compromised fibers, mitochondrial DNA (mtDNA) copy number, and proteomics by liquid-chromatography mass spectrometry. MA exhibited markedly better performance on clinical function tests and greater cross-sectional area of the vastus lateralis muscle. Proteomics analysis revealed marked differences, where most of the ~800 differentially represented proteins in MA versus NA pertained to mitochondria structure/function such as electron transport capacity (ETC), cristae formation, mitochondrial biogenesis, and mtDNA-encoded proteins. In contrast, proteins from the spliceosome complex and nuclear pore were downregulated in MA. Consistent with proteomics data, MA had fewer respiratory compromised fibers, higher mtDNA copy number, and an increased protein ratio of the cristae-bound ETC subunits relative to the outer mitochondrial membrane protein voltage-dependent anion channel. There was a substantial overlap of proteins overrepresented in MA versus NA with proteins that decline with aging and that are higher in physically active than sedentary individuals. However, we also found 176 proteins related to mitochondria that are uniquely differentially expressed in MA. We conclude that high function in advanced age is associated with preserving mitochondrial structure/function proteins, with underrepresentation of proteins involved in the spliceosome and nuclear pore complex. Whereas many of these differences in MA appear related to their physical activity habits, others may reflect unique biological (e.g., gene, environment) mechanisms that preserve muscle integrity and function with aging. Funding for this study was provided by operating grants from the Canadian Institutes of Health Research (MOP 84408 to TT and MOP 125986 to RTH). This work was supported in part by the Intramural Research Program of the National Institute on Aging, NIH, Baltimore, MD, USA.

Clinical Management and Functional Outcomes of Postoperative Achilles Tendon Infections: How Do These Really Do?

Category:Sports; OtherIntroduction/Purpose:Achilles tendon repairs and reconstructions have historically been associated with high wound infection rates due to poor vascularity in this region. The risk of postoperative infection, a potentially devastating complication, has led surgeons to pursue non-operative treatment when possible for a range of Achilles tendon pathology. However, new surgical techniques have allowed for smaller incisions and modern, aggressive infection control strategies have limited the morbidity associated with these complications. The present study will review a large case series of Achilles infections, evaluating treatment strategies and outcomes for patients who developed a postoperative infection following treatment for Achilles pathology.Methods:This is a retrospective case series including all patients who experienced a postoperative Achilles tendon infection at a single hospital. Cases from 11 surgeons performed between 2011 and 2020 were reviewed for infection requiring a return to the operating room for irrigation, debridement, and any other necessary interventions. Cases that presented to our institution with an existing infection were also included. Thorough chart review was performed for all patients to determine pathology and initial treatment method, infection management, and clinical outcomes. For patients undergoing Achilles reconstruction with a graft, operative notes were reviewed to determine whether the graft was infected and thus removed during debridement. Clinical follow-up was performed and Patient-Reported Outcomes Measurement Information System (PROMIS) surveys were sent to all patients who were over 1 year out from surgery.Results:33 patients experienced a postoperative Achilles infection, including 10 who developed infection after surgery at an outside hospital. For patients treated initially at our institution, 8 presented with an acute rupture and 15 with chronic pathology. 12 of 15 chronic cases underwent reconstruction with a graft. For 3 reconstructions and 1 acute repair (12%) the entire Achilles was infected and removed. The graft was partially removed in 2 reconstruction cases (6%) and remained fully intact in the remaining 27 cases (82%). In 2/4 cases in which the Achilles was removed, it ultimately reconstituted as confirmed on MRI. A skin graft or flap was required in 5 of 33 cases (15%) for adequate soft-tissue coverage. In 14 cases (42%), the infection was controlled after a single debridement, 17 cases (52%) required a second debridement, and 2 cases (6%) a third. Postoperative PROMIS scores were available for 17 patients (Table 1).Conclusion:To our knowledge, this case series represents the largest number of postoperative infections analyzed following Achilles tendon surgery. Relatively high postoperative PROMIS scores indicate that infected patients can ultimately reach high levels of physical function with minimal pain when managed appropriately. In many cases the Achilles or graft could be salvaged and in those where it was not, the tendon did at times reconstitute.

Physical and mental health of family caregivers of older parents and grandchildren in China

BackgroundFamilies have been recognized as the primary source of care for younger and older family members in Chinese tradition. The aim of this study was to examine the association between informal caregiving for aging parents and/or grandchildren and health outcomes of family caregivers in mainland China. MethodsUsing data from the 2013 and 2018 waves of China Health and Retirement Longitudinal Study (CHARLS), we conducted univariate comparisons of demographics characteristics between informal caregivers and non-caregivers using t-test and chi square test. We used linear regression and negative binomial regression to examine the physical and mental health outcomes of family caregivers aged 45 and over living in mainland China. This cross-sectional study was based on the self-reported measures of caregiving status, demographic factors, and health outcomes. ResultsCompared to non-caregivers, informal caregivers were more likely to be women, younger in age, married, living in rural areas, and with less years of education. Older age, being male, being married, living in an urban area, having a higher level of education, and having better self-reported health were associated with better mental health outcomes among family caregivers. Being male, younger age, and working, and having better self-reported health, were associated with better physical function among family caregivers. Caregivers who only cared for their grandchildren reported greater life satisfaction, fewer depressive symptoms, and a higher level of physical function than non-caregivers. In addition, caregivers who cared for only their parents reported fewer depressive symptoms than non-caregivers. ConclusionsHealth practitioners and policymakers should consider the needs for additional resources for family caregivers of older adults and children. Targeted policies and programs may improve family caregivers’ health, especially for female family caregivers living in rural areas.

Work participation in patients with systematic lupus erythematosus: a systematic review.

ObjectivesThis systematic review assessed which variables are associated with or are predictors for work participation outcomes in patients with systematic lupus erythematosus (SLE).MethodsA literature search using MEDLINE, The Cochrane Library, Embase and CINAHL was conducted to identify all studies published from inception (1947) to June 2021 on factors related to and/or predicting employment status, absenteeism and/or presenteeism in SLE patients aged ≥18 years. The quality of included articles was assessed using the QUIPS tool. Narrative summaries were used to present the data.ResultsFifteen studies (nine on associations, four on predictions, and two assessing both) were included, encompassing data of 3800 employed patients. Younger age, Caucasian ethnicity, higher educational level, lower disease activity score, shorter disease duration, absence of specific disease manifestations, higher levels of physical functioning and less physical job demands and higher levels of psychological/cognitive functioning were associated with or predicted favorable work outcomes. Older age, non-Caucasian ethnicity, female gender, never being married, poverty, lower educational level, higher disease activity score, longer disease duration, specific disease manifestations, lower levels of physical functioning, more physical job demands and low job control, less job tenure and lower levels of cognitive functioning were associated with or predicted an unfavorable work outcome. Limitations of the evidence were the quality of the studies and the use of heterogeneous outcome measures, applied statistical methods and instruments used to assess work participation.ConclusionWe recommend applying the EULAR points to consider for designing, analysing and reporting on work participation in inflammatory arthritis also to SLE studies on work participation, to enhance the quality and comparability between studies and to better understand the impact of SLE on work participation.Trial registrationregistration in PROSPERO (CRD42020161275; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=161275).