Long-term Physical Disability Research Articles

Long-term physical disability in the sickest of the sick: Assessment of persons treated with Extracorporeal Membrane Oxygenation (ECMO) and early mobilization

Long-term physical disability in the sickest of the sick: Assessment of persons treated with Extracorporeal Membrane Oxygenation (ECMO) and early mobilization

Study of utilisation pattern and adverse reaction monitoring of drugs used for relief of musculoskeletal pain in a tertiary care teaching hospital in Eastern Odisha

Musculoskeletal conditions are the most common cause of long-term pain and physical disability. The burden of musculoskeletal conditions is not only in terms of global numbers but also in terms of physical and psychosocial disability. Pain arising from musculoskeletal conditions of the major joints like back, neck, shoulder, knee or multi-site involvement results in diminished quality of life. Evidence for the effectiveness and safety of the various drugs used to alleviate MSP is uncertain.The present study was an observational, cross-sectional study which included patients with complaints of musculoskeletal pain attending Regional Spine Injury Centre, S.C.B Medical College and Hospital. A total of 100 patients were included in the study. Demographic data of all the patients was collected and their level of significance in the causation of musculoskeletal pain was assessed. The prescription pattern of the drugs for musculoskeletal pain was analysed. All the patients taking the drugs were monitored for any adverse drug reaction and the same was documented.Low back ache (28%) was the most common type of musculoskeletal pain observed. Aceclofenac was the most common analgesic prescribed, followed by paracetamol and etoricoxib. Aceclofenac and paracetamol was the most common combination used. Pain abdomen was the most common ADR encountered.

The Relationship of Exercise, Psychosocial Factors, and Social Participation Among Adults Aging With Long-Term Physical Disability: A Cross-Sectional Study.

This study investigated the relationships among exercise engagement, psychosocial factors, and social participation for adults aging with physical disabilities (AAwPD). A cross-sectional study within a community-based cohort study of participation among AAwPD was conducted. A comprehensive survey was administered online or via telephone. Participants were 474 individuals between the ages of 45-65, primarily living in the Midwestern United States, who reported living with a physical disability for at least 5years. Survey questions created based on prior consolidation of activity domains assessed exercise engagement. Psychosocial health and social participation were measured using the Patient Reported Outcomes Measurement Information System. Chi-square tests, t-tests, and a general linear model were used to examine differences between exercisers and non-exercisers. Participants who exercised reported less pain (P < .001), fatigue (P < .001), and depression (P < .001) and greater self-efficacy for management of chronic conditions (P = .002), satisfaction with participation in social roles and activities (P < .001), and ability to participate in social roles and activities (P < .001) compared with non-exercising participants. AAwPD who exercised reported fewer secondary conditions and greater social participation. Although causal relationships cannot be drawn, and the frequency, duration, and intensity of exercise were not examined, this study lays important groundwork for future research to determine the health and participation benefits of exercise for AAwPD. Future studies should also focus on the development of exercise interventions to support successful aging with disability.

Associated Factors of Suicidal Behavior Among Persons with Physical Disability: A Systematic Review

Background: Suicide is common among persons with physical disabilities as they face several physical, social, psychological, and economic problems. They are at risk for suicidal thoughts, behaviors, and death by suicide. We aimed to systematically review empirically published articles and identify the associated factors of suicidal ideation and suicide attempts in persons with physical disabilities. Methods: A systematic search was carried out on the literature published from January 1, 2000 to January 19, 2023 in PubMed, Cochrane, Web of Science, Google Scholar, Shodh Ganga, and so on. All the synonyms of keywords or MeSH terms for suicidal ideation, suicide attempt, and physical disability were used. Two hundred thirty-six articles were found, and after following inclusion and exclusion criteria, 12 remained. Result: The associated factors of suicidal behavior were disability status (11/12 studies), burdensomeness (8/12 studies), felt stigma (4/12 studies), depressive symptoms (6/12 studies), loneliness (2/12 studies), lack of social and emotional connectedness (2/12 studies), long-term physical or mental disability (2/12 studies), congenital disability (1/12 studies), and aggression (1/12 studies). Conclusion: Timely, evidence-based, low-cost interventions can provide great assistance and address the specific needs of this vulnerable population as they have higher risk for suicidal behavior.

Influence of falls, fall-related injuries, and fear of falling on social participation in people aging with long-term physical disability: a cross-sectional study

Purpose This study examined prevalence and relationships among falls, injuries, fear of falling, and social participation in people aging with long-term physical disability (PAwLTPD). Materials and methods A convenience sample of 474 PAwLTPD recruited from community agencies and social media as baseline of a longitudinal cohort study. Inclusion criteria: 45–65 years, self-reported physical disability for ≥5 years, and English-speaking. Self-report surveys of physical/mental health, falls in the past year, fear of falling, and Patient-Reported Outcomes Measurement Information System (PROMIS) ability and satisfaction with participation in social roles and activities measures were collected. Results Mean age 56.8 years; participants were mostly female (66.7%) and White (61.4%). Nearly 65% reported a fall; 56.6% of falls resulted in injury. Falls and fall-related injuries were associated with worse physical/mental health and presence of >5 health conditions. Seventy-five percent of participants reported fear of falling. Lower ability and satisfaction with participation were found in participants who fell and worried about falls. Conclusions PAwLTPD are at increased risk of falls, fall-related injuries, and fear of falling, which affects their ability to engage in social activities. Future research is needed to understand circumstances associated with falls and to develop effective interventions to address falls in PAwLTPD.

Aging with long-term physical disability: Cohort analysis of survey sample in the U.S.

Chronic health conditions, secondary conditions, and decreasing functional ability related to aging and/or changes in underlying impairment may influence participation for persons aging with long-term physical disability (AwD). To examine sample integrity and baseline findings through exploration of associations of sociodemographic, health, and disability factors with social participation for persons AwD. This is a longitudinal cohort study following persons AwD over three years, reporting baseline cohort study data. A convenience sample of 474 persons AwD aged 45-65 reporting physical disability of ≥5 years' duration was recruited through community organizations and social media. The cohort was majority female (66.7%) and single (62.0%), and over one-third (38.6%) was non-White. Pain, fatigue, depression, ability to participate in, and satisfaction with, social roles and activities were measured with the Patient Reported Outcomes Measurement Information System. Results were manually compared against AwD study samples identified through a focused literature review and national census data. Participants aged 55-60 and 61-65 had significantly lower rates of employment and marriage and higher rates of living alone than participants aged 45-54. Participants reported higher rates of fatigue, pain, and depression and lower ability to participate in, and satisfaction with, participation in, social roles and activities than the general population. Ability to participate and satisfaction with participation were highest among Black/African American participants. Participants reported higher rates of common AwD symptoms and lower ability to participate and satisfaction with participation than the general population, consistent with prior studies of AwD samples. This cohort reflects the AwD population and can be considered an AwD sample, comparable to those found in existing literature. The focus of future analyses will be to gain a greater understanding of chronic health conditions, incidence of falls, engagement in everyday life activities, and the impact of the environment.

Primates and disability: Behavioral flexibility and implications for resilience to environmental change.

Congenital malformations, conditions, injuries, and illness can lead to long-term physical impairment and disability in nonhuman primates. How individual primates change their behaviors flexibly to compensate for their disabilities can inform our understanding of their resilience and ability to adjust to environmental change. Here, we synthesize the literature on nonhuman primates and disability, addressing the questions: how does disability influence behavior in primates? What insights can we take from the literature to better understand and predict the capacity of primates to modify their behaviors in the face of human-induced environmental change? We conducted a systematic review of the literature on spontaneous physical impairment and disability in captive, free-ranging, and wild primates. We surveyed 2807 articles on Web of Science and Scopus and identified 114 studies that fit our predetermined inclusion criteria. Behavioral plasticity, maternal and conspecific care, and the potential for innovation of novel behaviors allow many primates with disabilities to compensate when faced with challenges that are outside the scope of usual circumstances. We also found that 60% of the publications connected primate physical impairment and disability to human activities, suggesting an entangled relationship among humans, the environment, and primate disability. Disability and physical impairments provide an opportunity to examine how primates modify their behavior when presented with challenging conditions, and their potential resilience to a changing environment.

Mechanisms associated with post-stroke depression and pharmacologic therapy.

Stroke is one of the most common cerebrovascular diseases, which is the cause of long-term mental illness and physical disability, Post-stroke depression (PSD) is the most common neuropsychiatric complication after stroke, and its mechanisms are characterized by complexity, plurality, and diversity, which seriously affects the quality of survival and prognosis of patients. Studies have focused on and recognized neurotransmitter-based mechanisms and selective serotonin-reuptake inhibitors (SSRIs) can be used to treat PSD. Neuroinflammation, neuroendocrinology, neurotrophic factors, and the site of the stroke lesion may affect neurotransmitters. Thus the mechanisms of PSD have been increasingly studied. Pharmacological treatment mainly includes SSRIs, noradrenergic and specific serotonergic antidepressant (NaSSA), anti-inflammatory drugs, vitamin D, ect, which have been confirmed to have better efficacy by clinical studies. Currently, there is an increasing number of studies related to the mechanisms of PSD. However, the mechanisms and pharmacologic treatment of PSD is still unclear. In the future, in-depth research on the mechanisms and treatment of PSD is needed to provide a reference for the prevention and treatment of clinical PSD.

The Potential Role of Mesenchymal Stem Cells Derived Exosomes on the Healing of Grade II Experimentally Induced Skeletal Muscle Injury in Adult Male Albino Rats. Histological Study

Abstract Background Musculoskeletal injuries are the most common cause of severe longterm pain and physical disability. However, there is still no efficient treatment that leads to prevention of muscle fibrosis. Cell-Free therapy using mesenchymal stem cells (MSCs) derived exosomes could provide a new promising therapy. Aim To study the potential role of MSCs-derived exosomes on the healing of experimentally induced grade II skeletal muscle injury in adult male albino rats. Materials and Methods Forty male albino Wister rats were used in this study. Five out of them were used for isolation of exosomes. The rest were randomly divided into three groups. Group I (Sham group), Group II (muscle injury group left for spontaneous healing), Group III (muscle injury treated with exosomes). Rats from each group were subdivided into two subgroups; subgroup “a and b” in which rats were sacrificed after ten days and twenty days, respectively. Muscle specimens were collected and prepared for proper histological techniques. Immuno-histochemical staining for detection of collagen type I and developmental myosin (MHCd) were also done. Morphometric study and statistical analysis were also performed. Results Granulation tissue and inflammatory cellular infiltration with significant increase in the mean area percentage of collagen fibers were noticed in subgroups of untreated muscle injury compared to the corresponding exosomes treated subgroups. This was confirmed by collagen type I immune histochemical reaction. Group III (treated with exosomes) showed better muscle regeneration and significant decrease in muscle fibrosis. Significant increase in immunohistochemical reaction of developmental myosin was noticed in exosomes treated subgroups compared to corresponding untreated muscle injury subgroups. Conclusions Exosomes enhance muscle regeneration after induced muscle injury. Exosomes also decreased muscle fibrosis and improve muscle healing.

Treat-to-Target in Pediatric Rheumatic Diseases.

To summarize the current evidence on the adoption of the treat-to-target (T2T) strategy in pediatric rheumatic diseases (PRD). The recent advances in the management of PRD have markedly increased the ability to achieve disease remission. Complete disease quiescence is regarded as the ideal therapeutic goal because its attainment leads to lesser long-term damage and physical disability, and to optimization of quality of life. Studies in adult rheumatic diseases have shown that patient outcomes are improved if complete suppression of the inflammatory process is aimed for by frequent adjustments of therapy according to quantitative indices. This approach, which underlies the T2T concept, has been applied in strategic trials in rheumatoid arthritis (RA). Furthermore, recommendations for the T2T have been issued for RA and other adult rheumatic diseases. There is currently a growing interest for the introduction of T2T in PRD, and recommendations for treating juvenile idiopathic arthritis (JIA) to target were promulgated. A similar initiative has been undertaken for childhood-onset systemic lupus erythematosus. Preliminary therapeutic studies have explored the T2T design in JIA. The T2T strategy is a modern therapeutic approach that holds the promise of improving the outcomes in patients with PRD.

Organizations’ Perspectives on Successful Aging with Long-Term Physical Disability

In recent decades, there has been considerable discussion surrounding what it means to age successfully, and what supports, services, and programs are needed to facilitate successful aging. Rehabilitation scholars advocate for models of successful aging that take into account the unique needs and priorities of those aging with long-term physical disability. The aim of this study is to explore how organizations that serve those with physical disability define successful aging for this population, and whether their understanding of successful aging is consistent with the needs and priorities identified by those aging with physical disability. To do so, we analyze qualitative data from a national online survey of disability organizations (N = 106 organizations). Organizations described the following domains of successful aging for those with physical disability: (a) autonomy and/or maximized independence; (b) living arrangement; (c) health and well-being; and (d) social connection and meaningful community engagement. Overall, organizations’ understandings of successful aging are consistent with the priorities identified by those aging with long-term physical disability. We discuss strategies that organizations can adopt to ensure that the programs and services that they offer facilitate these elements of successful aging.

Cognitive Processing Speed Predicts Disability Milestones in Multiple Sclerosis (P5-3.014)

Cognitive Processing Speed Predicts Disability Milestones in Multiple Sclerosis (P5-3.014)

RETURN TO SPORTS FOLLOWING LOWER LIMB MUSCULOSKELETAL TUMOUR SURGERY: A SYSTEMATIC REVIEW

Primary malignant bone and soft tissue tumours often occur in the lower extremities of active individuals including children, teenagers and young adults. Survivors routinely face long-term physical disability. Participation in sports is particularly important for active young people but the impact of sarcoma treatment is not widely recognised and clinicians may be unable to provide objective advice about returning to sports. We aimed to identify and summarise the current evidence for involvement in sports following treatment of lower limb primary malignant bone and soft tissue tumours.A comprehensive search strategy was used to identify relevant studies combining the main concepts of interest: (1) Bone/Soft Tissue Tumour, (2) Lower Limb, (3) Surgical Interventions and (4) Sports. Studies were selected according to eligibility criteria with the consensus of three authors. Customised data extraction and quality assessment tools were used.22 studies were selected, published between 1985 – 2020, and comprising 1005 patients. Fifteen studies with data on return to sports including 705 participants of which 412 (58.4%) returned to some form of sport at a mean follow-up period of 7.6 years. Four studies directly compared limb sparing and amputation; none of these were able to identify a difference in sports participation or ability.Return to sports is important for patients treated for musculoskeletal tumours, however, there is insufficient published research to provide good information and support for patients. Future prospective studies are needed to collect better pre and post-treatment data at multiple time intervals and validated clinical and patient sports participation outcomes such as type of sports participation, level and frequency and a validated sports specific outcome score, such as UCLA assessment. In particular, more comparison between limb sparing and amputation would be welcome.

Safety and Feasibility Assessment of Repetitive Vascular Occlusion Stimulus (RVOS) Application to Multi-Organ Failure Critically Ill Patients: A Pilot Randomised Controlled Trial.

Muscle wasting is implicated in the pathogenesis of intensive care unit acquired weakness (ICU-AW), affecting 40% of patients and causing long-term physical disability. A repetitive vascular occlusion stimulus (RVOS) limits muscle atrophy in healthy and orthopaedic subjects, thus, we explored its application to ICU patients. Adult multi-organ failure patients received standard care +/− twice daily RVOS {4 cycles of 5 min tourniquet inflation to 50 mmHg supra-systolic blood pressure, and 5 min complete deflation} for 10 days. Serious adverse events (SAEs), tolerability, feasibility, acceptability, and exploratory outcomes of the rectus femoris cross-sectional area (RFCSA), echogenicity, clinical outcomes, and blood biomarkers were assessed. Only 12 of the intended 32 participants were recruited. RVOS sessions (76.1%) were delivered to five participants and two could not tolerate it. No SAEs occurred; 75% of participants and 82% of clinical staff strongly agreed or agreed that RVOS is an acceptable treatment. RFCSA fell significantly and echogenicity increased in controls (n = 5) and intervention subjects (n = 4). The intervention group was associated with less frequent acute kidney injury (AKI), a greater decrease in the total sequential organ failure assessment score (SOFA) score, and increased insulin-like growth factor-1 (IGF-1), and reduced syndecan-1, interleukin-4 (IL-4) and Tumor necrosis factor receptor type II (TNF-RII) levels. RVOS application appears safe and acceptable, but protocol modifications are required to improve tolerability and recruitment. There were signals of possible clinical benefit relating to RVOS application.

Ergonomic assessment of male street hawker

Working culture and ergonomics of any individual plays an important role in the physical and mental health of the person. The study about male street hawkers and the ergonomics assessment which carries hawkers’ musculoskeletal condition along with physical condition are combined and their impact is widespread. They are the most common cause of severe long-term pain and physical disability affecting the psychosocial status of affected people as well as their families and caretakers. In all occupations, incorrect body posture is the most important cause of musculoskeletal disorders. The study was aimed to examine 40 random street hawkers and their working posture using the Rapid Entire Body Assessment (REBA) method. It was analyzed that around 70 % of hawkers had a medium to high risk of developing work related musculoskeletal disorder. Trunk, upper arm and lower arm postures were mainly contributing to the REBA score, putting street hawkers at high risk of developing a musculoskeletal disorder. Ergonomic intervention to reduce musculoskeletal disorders includes engineering improvements which include rearranging, modifying, redesigning equipments which eliminates and reduces the hazard due to improper body posture and long working hour cycles. Mechanization of the stalls to reduce the musculoskeletal strain is possible. In areas, where mechanization is not possible, ergonomically correct measures to avoid musculoskeletal disorders are to be taken.

Psychotic experiences among informal caregivers: findings from 48 low- and middle-income countries.

PurposeInformal caregivers may be at high risk for psychotic experiences (PE) due to caregiving related stress, sleep issues, or other potential mechanisms, but this has not been previously investigated in the general adult population. Thus, we examined the association between caregiving and PE, and its mediators, in a large sample of adults from 48 low- and middle-income countries (LMICs).MethodsCross-sectional, community-based data from the World Health Organization (WHO) World Health Survey were analyzed. Informal caregivers referred to those who provided help to a relative or friend (adult or child) in the past year, because this person has a long-term physical or mental illness or disability, or is getting old and weak. PE were assessed using the WHO Composite International Diagnostic Interview psychosis screen. Multivariable logistic regression and mediation analyses were conducted.ResultsData on 224,842 individuals were analyzed. The mean (SD) age was 38.3 (16.0) years (range 18–120 years) and 50.7% were females. After adjustment for age, sex, and country, in the overall sample, caregiving was associated with 1.67 (95%CI = 1.56–1.79) times higher odds for PE. Sleep/energy explained the largest proportion of the association between caregiving and PE (13.9%), followed by pain/discomfort (11.5%), perceived stress (7.6%), depression (6.2%), and cognition (3.5%).ConclusionCaregivers in LMICs are at higher risk of PE. Future studies are warranted to gain a further understanding of the underlying mechanisms, and to assess whether addressing the identified mediators can lead to lower risk for PE among caregivers.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00127-022-02312-z.

Analgesic Efficacy of Oral Aspirin/Ketamine Combination for Management of Acute Musculoskeletal Pain in the Emergency Department – A Proof of Concept Pilot Study

BackgroundMusculoskeletal pain (MSK) affects one out of three adults and is the most common source of significant long-term pain, physical disability, and under-treatment in the emergency department (ED). ObjectiveWe aimed to assess the analgesic efficacy of a combination of oral VTS-Aspirin® (Vitalis Analgesics, New York, NY) and ketamine in managing acute MSK pain in adult ED patients. MethodsThis was a prospective, proof-of-concept, single-arm, pilot study evaluating the analgesic efficacy of a single dose of oral combination of VTS-Aspirin and ketamine in adult ED patients with acute moderate-to-severe MSK pain. The primary outcome included the difference in pain scores on an 11-point numeric pain rating scale at 60 min. Secondary outcomes included the need for rescue analgesia, the occurrence of adverse events at 60 min, and a change in pain scores at 120 min. ResultsWe enrolled 25 subjects in the study. The mean baseline pain score was 8.6 and the mean pain score at 60 min decreased to 4.8. The oral ketamine dose ranged from 24 mg to 50 mg, with a mean dose of 37.8 mg. No clinically concerning changes in vital signs were noted. No serious adverse events occurred in any of the subjects. Majority of adverse effects were transient and weak in intensity. ConclusionWe demonstrated that administration of an oral combination of VTS-Aspirin and ketamine to adult ED patients with acute MSK pain resulted in clinically significant pain relief in 80% of enrolled subjects.

Musculoskeletal Pain Is Associated with Dietary Diversity Score among Community-Dwelling Older Adult: A Cross-Sectional Study.

Background Musculoskeletal pains (MSP) are the most common cause of long-term severe pain and physical disability among older adults. This study is aimed at determining the relationship between dietary diversity score (DDS) and MSP in Tehran's older adults. Methods The study was a cross-sectional one that employed 213 participants with and without MSP complaints between May and October 2019 in Tehran, Iran. A 100 mm length visual analog scale questionnaire was used to assess pain along with a validated 147-item food frequency questionnaire for DDS evaluation. Statistical analyses included descriptive analysis and multiple linear regression with a significance level of p < 0.05. Results 85% of the participants had a range of MSP with a low but insignificant DDS compared to individuals without pain (p = 0.12, 3.24 (±0.86) vs. 3.43 (±0.85), respectively). A significant association was observed among the quartiles of DDS that most of the subjects with MSP were in the lowest quartile relative to the highest one (p = 0.02). Moreover, the association between DDS and MSP remained significant in the adjusted model (OR = 0.28, 95%(CI) = 0.08 − 0.99). Conclusion A high-quality diet is important. Our study showed that a higher dietary diversity might be associated with lower MSP in older adults. More robust interventional studies are thus warranted to confirm the results.

Magnetic Resonance Imaging as a Prognostic Disability Marker in Clinically Isolated Syndrome and Multiple Sclerosis: A Systematic Review and Meta-Analysis

To date, there are no definite imaging predictors for long-term disability in multiple sclerosis (MS). Magnetic resonance imaging (MRI) is the key prognostic tool for MS, primarily at the early stage of the disease. Recent findings showed that white matter lesion (WML) counts and volumes could predict long-term disability for MS. However, the prognostic value of MRI in the early stage of the disease and its link to long-term physical disability have not been assessed systematically and quantitatively. A meta-analysis was conducted using studies from four databases to assess whether MS lesion counts and volumes at baseline MRI scans could predict long-term disability, assessed by the expanded disability status scale (EDSS). Fifteen studies were eligible for the qualitative analysis and three studies for meta-analysis. T2 brain lesion counts and volumes after the disease onset were associated with disability progression after 10 years. Four or more lesions at baseline showed a highly significant association with EDSS 3 and EDSS 6, with a pooled OR of 4.10 and 4.3, respectively. The risk increased when more than 10 lesions were present. This review and meta-analysis confirmed that lesion counts and volumes could be associated with disability and might offer additional valid guidance in treatment decision making. Future work is essential to determine whether these prognostic markers have high predictive potential.

Aging with long-term physical disability: Cohort analysis of survey sample in the U.S.

Background: Chronic health conditions, secondary conditions, and decreasing functional ability related to aging and/or changes in underlying impairment may influence participation for persons aging with long-term physical disability (AwD). Objective: To examine sample integrity and baseline findings through exploration of associations of sociodemographic, health, and disability factors with social participation for persons AwD. Methods: This is a longitudinal cohort study following persons AwD over three years, reporting baseline cohort study data. A convenience sample of 474 persons AwD aged 45–65 reporting physical disability of ≥5 years’ duration was recruited through community organizations and social media. The cohort was majority female (66.7%) and single (62.0%), and over one-third (38.6%) was non-White. Pain, fatigue, depression, ability to participate in, and satisfaction with, social roles and activities were measured with the Patient Reported Outcomes Measurement Information System. Results: Participants aged 55–60 and 61–65 had significantly lower rates of employment and marriage and higher rates of living alone than participants aged 45–54. Participants reported higher rates of fatigue, pain, and depression and lower ability to participate in, and satisfaction with, participation in, social roles and activities than the general population. Ability to participate and satisfaction with participation were highest among Black/African American participants. Conclusions: Participants reported higher rates of common AwD symptoms and lower ability to participate and satisfaction with participation than the general population, consistent with prior studies of AwD samples. This cohort reflects the AwD population and can be considered an AwD sample, comparable to those found in existing literature. The focus of future analyses will be to gain a greater understanding of chronic health conditions, incidence of falls, engagement in everyday life activities, and the impact of the environment.