Lower Levels Of Physical Functioning Research Articles

Comparing Mental and Physical Health of Full-Service Sex Workers in the United States to the Health of the General Population in 2019-2020

Introduction: Full-service sex workers (FSSWs) are relatively prevalent in the U.S. and are known to face criminalization, stigma, and other factors relating to poor health. The main aim of this study was compare the mental and physical health of full-service sex workers in the United States in 2019-2020
 Methods: In this prospective cohort study, participants were recruited through national community samples from U.S.-based FSSW advocacy and community organizations. Data were collected from November 2019 to February 2020. The study sample (n=83) included mostly of the white (81.9%), cisgender females (66.3%), who were relatively young (28.01 [4.25]), and identified as a sexual minority (57.8%). Participants completed an online survey on mental (e.g., depression, anxiety) and physical (e.g., sleep, fatigue) health, using the patient-reported outcomes measurement information system (PROMIS-29). Mean (SD) and Frequency (%) were used for description and for data analysis z-tests in SPSS version 27 with 5% significant level were used.
 Results: The sample of FSSWs reported significantly poorer health in all health domains compared to the U.S. general population reference indices. FSSWs showed higher levels of depression (p <.001), anxiety (p <.001), fatigue (p <.001), sleep difficulties (p <.001), lower levels of physical functioning (p <.001) and the ability to participate in social activities (p =.03) compared with the U.S. reference indices.
 Conclusions: FSSWs experience significant mental and physical health disparities compared to general population. the need for further investigation of the social-ecological determinants of health for members of this marginalized community, many of whom are known to face health inequities.

Characteristics of prostate cancer survivors exposed to ADT and enrolled in a fall prevention exercise trial: Comparison of men with confirmed fall history to men with fall risk factors.

81 Background: Androgen deprivation therapy (ADT) for prostate cancer may result in accelerated aging that increases the risk for falls. Falls are higher in men with a history of ADT use, even if treatment is discontinued, compared to men never on ADT. Less is known, however, about the specific patient characteristics that might be associated with falls. Methods: We analyzed data from prostate cancer survivors with a history of ADT and who had enrolled in an ongoing NIH-funded fall prevention exercise trial (NCT03741335). To be eligible for the trial, men were 1) currently or previously treated with ADT and 2) reported a fall in the previous 6 months or had evidence of fall risk. Fall risk was assessed through slow times on a 5 time sit-to-stand test (5XSTS; sec) or timed up and go walk test (TUG; sec). For this analysis we compared men with a positive fall history to men with no recent falls but evidence of fall risk. We compared age, ADT history (past vs current), body mass index (BMI), self-report comorbidities from the Charlson Comorbidity Index, physical function and disability from the LLFDI, pain from the BPI, anxiety from PROMIS, depressive symptoms from the CES-D, fear of falling and activity restrictions from the SAFFE, and physical activity from CHAMPS, as well as objective measures of strength and mobility using 5XSTS and TUG. Results: A total of 171 cases (mean age 73.1 +/- 7.1 years of age) were available for analysis, with 58 men (34%) reporting a fall in the 6 months prior to enrollment. Of reported falls, 11% were injurious falls, with 4% requiring medical attention. Injuries included fractures (n = 4), head injury (n = 2), joint injury (n = 3), and bruises/scrapes (n = 8). Fallers reported significantly lower levels of physical functioning (p < 0.001), greater levels of disability (p < 0.01), greater fear of falling (p < 0.001), more activity restrictions due to falls worry (p < 0.02) and slower TUG times (p < 0.03), than men who had not recently fallen. There were no significant differences between men with established fall history and men with fall risk only on age, ADT history, comorbidities, BMI, pain, anxiety, depressive symptoms, physical activity, or 5XSTS (p for all > 0.05). Conclusions: Among our preliminary sample of men with a history of ADT use and enrolled in an ongoing fall prevention trial, men with an established fall history functioned less independently, were more worried about falls and apt to restrict their activities accordingly, and had poorer mobility than men who hadn’t recently fallen. From our cross-sectional design we cannot determine whether poorer functioning and mobility and greater fear of falling were antecedents or consequences of a recent fall. Regardless, interventions designed to prevent falls in men exposed to ADT are critical to prevent potential injurious falls and to keep men functioning independently.

Association between sleep, depressive symptoms, and pain with physical activity and physical functioning in the oldest old: CAIDE 85+ study

AbstractBackgroundThe aim was to investigate 1) the associations of sleep, depressive symptoms, and pain with physical activity and physical functioning in the oldest old age group (85 years and older); 2) the effects of Covid‐19 related restrictions on physical activity in the oldest old.MethodThe data is from Cardiovascular Risk Factors, Aging and Dementia (CAIDE 85+) longitudinal cohort study in Eastern Finland. From the original cohort, participants were invited to follow‐up visit during 2019‐2020. Self‐reported measures were physical activity (active: ≥2 times a week/inactive: <2 times a week), sleep duration (hours/night). We also assessed depressive symptoms (BDI‐21 scale), sleep quality (PSQI), pain (RAND‐36), physical functioning (Short Physical Performance Battery (SPPB)) and Clinical Dementia Rating (CDR). Cross‐sectional associations of sleep quality and duration, depressive symptoms, and pain with physical activity and physical functioning were assessed using logistic regression, adjusted for age, sex, education and CDR.ResultAltogether 194 individuals participated in the CAIDE 85+ study. The mean age was 88 (SD 4.5) years, and 90% (n=170) were community‐dwellers, and 66% (n=124) were physically active. Participants with long sleep duration (<8 hours/night) were less likely to be physically active (OR 0.10, 95% CI 0.03–0.40) compared to participants with normal sleep duration (6‐8 hours/night). Also, participants with pronounced pain (3rd tertile of RAND‐36 pain score) were also less likely to be physically active (OR 0.33, 95% CI 0.12–0.90) compared to the group with lowest level of pain. Participants with elevated depressive symptoms (BDI‐21 score ≥10) were more likely to have lower level of physical functioning (SPPB score ≤6), (OR 0.32 95% CI 0.12–0.84), compared to participants with no depressive symptoms. The results were similar when participants with CDR score ≥1 were not included in the analysis. Furthermore, of the 96 participants who answered questions about Covid‐19 related restrictions, 47% (n=38) reported no effects on physical activity, and 36% (n=29) reported physical activity level was decreased.ConclusionThese preliminary results suggest that long sleep duration and pronounced pain are associated with physical inactivity. However, only elevated depressive symptoms are associated with low levels of physical functioning in the oldest old.

Burden of disease in myasthenia gravis: taking the patient’s perspective

BackgroundMyasthenia gravis (MG) leads to exertion-dependent muscle weakness, but also psychological and social well-being are limited. We aim to describe the burden of disease in MG including sociodemographic, economical, psychosocial as well as clinical aspects, to compare health-related quality of life (HRQoL) of patients with MG to the general population (genP) and to explore risk factors for a lower HRQoL.MethodsThis case–control study was conducted with MG patients of the German Myasthenia Association. A questionnaire-based survey included sociodemographic and clinical data as well as standardized questionnaires, e.g. the Short Form Health (SF-36). HRQoL was compared to genP in a matched-pairs analysis. Participants of the German Health Interview and Examination Survey for Adults (DEGS1) served as control group.ResultsIn our study, 1660 MG patients participated and were compared to 2556 controls from the genP. Patients with MG showed lower levels of physical functioning (SF-36 mean 56.0, SD 30.3) compared to the genP (mean 81.8, SD 22.1, adjusted difference: 25, 95% CI 22–29) and lower mental health sub-score (SF-36 mean 67.3, SD 19.8, vs. 74.1, SD 16.7, adjusted difference: 5, 95% CI 2–8). Female gender, higher age, low income, partnership status, lower activities of daily life, symptoms of depression, anxiety and fatigue and self-perceived low social support were associated with a lower HRQoL in MG patients.DiscussionHRQoL is lower in patients with MG compared to genP. The burden of MG on patients includes economic and social aspects as well as their emotional well-being. New therapies must achieve improvements for patients in these areas.Trial registration informationClinicaltrials.gov, NCT03979521, submitted: June 7, 2019, first patient enrolled: May 1, 2019, https://clinicaltrials.gov/ct2/show/NCT03979521

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).

Assessment of Quality of Life in Chinese Patients with Chronic Lymphocytic Leukemia

Background: Despite the changing landscape of treatment of chronic lymphoma leukemia (CLL) and in contrast to the large number of quality of life (QoL) and psychosocial studies in patients with solid tumors, relatively few studies have reported QoL in patients with CLL. This study aims to assess depression, anxiety, stress and QoL in a Chinese CLL cohort.Patients and Methods: Taking advantage of the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 accompanying CLL-specific module QLQ-CLL17 questionnaire and DASS-21 questionnaire, a total of 50 Chinese patients with CLL completed self-reported questionnaires from December 2019 to July 2021, assessing the level of depression, anxiety, stress and QoL.Results: Among the 50 CLL patients, 34 patients were male. The median age was 57 (22-77) years old. 66% of the patients were uncertain about the staging of the disease. 36% of the patients were uncertain about therapeutic implications of CLL. According to EORTC QLQ-C30, patients had low level of physical functioning, role functioning, emotional functioning, cognitive functioning and social functioning were 80%, 32%, 68%, 66%, 64%, respectively. Patients in active-treatment group had significantly lower level of physical function than “watch and wait” group (90% vs. 65%, P=0.03). The proportion of patients with cognitive problems was significantly higher in female patients than in male patients (93.8% vs. 52.9%, P=0.004). According to QLQ-CLL17, patients with symptom burden, physical condition and worries about health were 94% (47/50), 86% (43/50), 98% (48/50). Patients under 60 years old had higher scores for worries about health than patients older than 60. According to DASS-21 questionnaire, 86% of the patients had depression symptomatic scores (mild grade: 2%, medium grade: 52%, severe grade: 20%, very severe grade: 12%). 84% of the patients had anxiety symptomatic scores ( mild grade: 6%, medium grade: 14%, severe grade: 30%, very severe grade: 34%). 64% of the patients had stress symptomatic scores ( mild grade: 18%, medium grade: 22%, severe grade: 16%, very severe grade: 8%). And these psychosocial issues had no significant correlation with gender, age, household income and treatment . The same questionnaires were completed by 5 patients for the second time after median 8（2-18）months. Compared to the initial assessment, they scored significantly worse on the emotional scales (P=0.0237). No significant difference regarding physical functioning, role functioning, cognitive functioning and social functioning were observed between the former and the latter.Conclusions: The majority of CLL patients had impaired QoL and psychosocial issues. Active-treatment patients had worse physical condition than “watch and wait” patients. Male patients had better cognitive functioning. Younger patients had more worries about health than the elderly. Greater efforts should be made in management of CLL patients. DisclosuresNo relevant conflicts of interest to declare.

Well-Being of Ambulatory Adults With Cerebral Palsy: Education, Employment, and Physical Function of a Cohort Who Received Specialized Pediatric Care.

Introduction: The transition from pediatric health care and school systems presents enormous challenges for young adults with cerebral palsy (CP). The lack of strong societal support during this seminal life event is well-documented and leads many adults with CP to struggle with independence, higher education, and employment. Despite the relatively high prevalence of CP, information about the experiences and function of adults with CP in our society continues to be limited. The purpose of this project was to describe well-being by assessing education, employment, physical function, walking activity, and utilization of health care in an ambulatory adult cohort with CP who received specialized pediatric care at our center.Method: In this Institutional Review Board-approved prospective study, we invited former patients from our tertiary care pediatric CP center to complete a set of patient-reported outcomes including (1) the Patient-Reported Outcomes Measurement Information System domains of physical function and pain interference, (2) the Satisfaction with Life Scale, and a project-specific demographic questionnaire about education, employment, income, independence, pain, and health care utilization. Participants also wore a pedometer for 8 days to monitor community walking activity. Chi-squared pairwise or t-tests were used as appropriate to compare survey responses and walking activity data between three groups: participants who self-reported, those who reported by proxy, and published normative data from age-matched typically developing adult (TDA) samples.Results: One hundred twenty-six adults with CP consented to participate; 85 self-reported [age 29.7 ± 4.3 years; Gross Motor Function Classification System: I (28%), II (47%), and III, (25%)] and 41 reported by proxy [age 29.7 ± 4.1 years; Gross Motor Function Classification System: I (10%), II (68%), and III (22%)]. For the group who self-reported, high school graduation rate (99%) was similar to TDA (92%; p = 0.0173) but bachelor's degree achievement rate (55%) was higher than TDA (37%; p < 0.001). Despite more advanced education, the unemployment rate in this group was higher than national levels at 33% and was associated with high utilization of Social Security Disability Insurance (33%). Within the self-reporting group, 13% required a caregiver. For the group who reported by proxy, educational levels (73% high school graduates, 0 bachelor's degree) were lower than the general population (p < 0.001) and unemployment was higher than the national level, at 64%. Unemployment in this group was associated with high utilization of Social Security Disability Insurance (85%). Within the proxy-reporting group, 71% required a caregiver. The full cohort demonstrated lower levels of physical function according to the Patient-Reported Outcomes Measurement Information System and less community walking activity compared with TDA references (p < 0.001). This cohort of adults with CP reported significantly higher frequency of chronic pain (48 vs. 12% for TDA; p < 0.001), but less pain interference with daily activities than TDA based on Patient-Reported Outcomes Measurement Information System results (p < 0.001). This cohort reported good to excellent overall health (93%) and high utilization of primary care (98%), but limited utilization of specialty care, specifically orthopedic care (21%) and physical therapy (15%).Discussion: This cohort of adults with CP had similar levels of education as the general population, but had relatively high rates of unemployment, caretaker need, and Social Security Disability Insurance utilization. Although chronic pain was frequent, the impact of pain on work and independent living did not exceed reports from a typically developing reference. Better targeted societal resources for adults with physical disabilities are urgently needed to allow equitable access to employment, promote opportunities for independence, and enable full participation in community life.

Assessment of Functional Health Status for Patient undergoing Hemodialysis

Abstract Background: Patients with chronic kidney disease are characterized by low levels of physical functioning, which, along with low biopsychosocial Functional activity, predict poor outcomes in those treated with hemodialysis. Aim: To assess of functional health status for patients undergoing hemodialysis. Design: Descriptive research design. Setting: Hemodialysis unit at Om-Alkosur University Hospital. Sample: A purposive sample of 100 adult patients. Tools (1): Personal characteristics and medical data and (2): Biopsychosocial functional health status assessment sheet which composed of 3 parts; I. physical, II. psychological and III. social health status. Results: Majority of the studied patients had a partially physical function, a moderate psychological function, mild social function and totally had warning zoon. There was no statistically significant difference between totally biopsychosocial Functional and their demographic and clinical data there was statistically significant difference except regarding residence and duration of dialysis (0.002 and 0.001 respectively). Conclusion and Recommendations: Functional health impairment is a major obstacle among hemodialysis patients. There is need for collaborative approach to improve function health status for patients undergoing heamodialysis.

Ratio of serum creatinine to cystatin C is related to leg strength in predialysis CKD patients.

Chronic kidney disease (CKD) patients have lower levels of physical function. Especially, leg strength is important for daily living and preventing falls. However, physical function screenings are difficult to perform at clinical sites. To find clinically useful method to evaluate physical function in predialysis CKD patients, we tried to evaluate the relationship between the ratio of serum creatinine to serum cystatin C (Cre/CysC), and knee extensor muscle strength/body weight (KEMS) which reflects their leg strength. We recruited 147 outpatients with CKD (87 men; mean age, 61.6 ± 9.8years; mean eGFRcreat, 40.7 ± 12.9mL/min/1.73m2) in this cross-sectional study. KEMS was assessed using a wire strain gauge dynamometer. Skeletal muscle mass and body fat mass were assessed by bioelectrical impedance analysis. The mean value of Cre/CysC was 1.01 ± 0.18. The mean value of KEMS was 1.60 ± 0.47 Nm/kg. In multivariate linear regression analysis, skeletal muscle mass (p < 0.01), body fat mass (p < 0.01), hemoglobin (p = 0.01), and Cre/CysC (p < 0.01) was independently related to KEMS. The correlation between Cre/CysC and KEMS is stronger in high quantile of Cre/CysC. In predialysis CKD patients, KEMS showed lower as CKD stage advanced. Cre/CysC is significantly related to KEMS independently. Cre/CysC may be an alternative marker for leg strength in CKD patients and even more valuable to utilize in cases with high Cre/CysC.

More flexible response functions for the PROMIS physical functioning item bank by application of a monotonic polynomial approach.

In developing item banks for patient reported outcomes (PROs), nonparametric techniques are often used for investigating empirical item response curves, whereas final banks usually use parsimonious parametric models. A flexible approach based on monotonic polynomials (MP) provides a compromise by modeling items with both complex and simpler response curves. This paper investigates the suitability of MPs to PRO data. Using PROMIS Wave 1 data (N = 15,725) for Physical Function, we fitted an MP model and the graded response model (GRM). We compared both models in terms of overall model fit, latent trait estimates, and item/test information. We quantified possible GRM item misfit using approaches that compute discrepancies with the MP. Through simulations, we investigated the ability of the MP to perform well versus the GRM under identical data collection conditions. A likelihood ratio test (p < 0.001) and AIC (but not BIC) indicated better fit for the MP. Latent trait estimates and expected test scores were comparable between models, but we observed higher information for the MP in the lower range of physical functioning. Many items were flagged as possibly misfitting and simulations supported the performance of the MP. Yet discrepancies between the MP and GRM were small. The MP approach allows inclusion of items with complex response curves into PRO item banks. Information for the physical functioning item bank may be greater than originally thought for low levels of physical functioning. This may translate into small improvements if an MP approach is used.

A Mediation Appraisal of Catastrophizing, Pain-Related Outcomes, and Race in Adults With Knee Osteoarthritis

The current cross-sectional study investigates whether pain catastrophizing mediates the relationship between ethnicity/race and pain, disability and physical function in individuals with knee osteoarthritis. Furthermore, this study examined mediation at 2-year follow-up. Participants included 187 community-dwelling adults with unilateral or bilateral knee pain who screened positive for knee osteoarthritis. Participants completed several self-reported pain-related measures and pain catastrophizing subscale at baseline and 2-year follow-up. Non-Hispanic Black (NHB) adults reported greater pain, disability, and poorer functional performance compared to their non-Hispanic White (NHW) counterparts (Ps < .05). NHB adults also reported greater catastrophizing compared to NHW adults. Mediation analyses revealed that catastrophizing mediated the relationship between ethnicity/race and pain outcome measures. Specifically, NHB individuals reported significantly greater pain and disability, and exhibited lower levels of physical function, compared to NHW individuals, and these differences were mediated by higher levels of catastrophizing among NHB persons. Catastrophizing was a significant predictor of pain and disability 2-years later in both ethnic/race groups. These results suggest that pain catastrophizing is an important variable to consider in efforts to reduce ethnic/race group disparities in chronic pain. The findings are discussed in light of structural/systemic factors that may contribute to greater self-reports of pain catastrophizing among NHB individuals. PerspectiveThe current study examines whether pain catastrophizing mediates the relationship between ethnicity/race and OA-related pain, disability, and functional impairment at baseline and during a 2-year follow-up period in non-Hispanic Black and non-Hispanic White adults with knee pain. These results point to the need for interventions that target pain catastrophizing.

Quality of Life in SMA Patients Under Treatment With Nusinersen.

Background: Spinal Muscular Atrophy (SMA) is a severe neurodegenerative disease, characterized by progressive muscle weakness and atrophy. The approval of the antisense oligonucleotide (ASO) nusinersen now provides an effective pharmacological approach with the potential to slow down or stop disease progression with a potentially major impact on patients' well-being.Objective: This study evaluates quality of life (QoL) in pediatric and adult patients over the course of therapy with nusinersen.Methods: Twenty-six SMA patients treated with nusinersen were evaluated regarding global QoL (gQoL), health-related QoL (HRQoL) and depressiveness. Assessments were conducted three times over the first 6 months of treatment. Applied were different questionnaires: the Anamnestic Comparative Self-Assessment (ACSA) for gQoL, the Short Form-36 Health Survey (SF-36) for HRQoL in adult patients and the ALS Depression Inventory 12 Items (ADI-12) for depressiveness. The sample was matched with 22 healthy controls.Results: Despite severe physical restrictions, patients reported high levels of QoL and low levels of depressiveness at study entry. Early disease onset and low levels of physical functioning were associated with better gQoL and lower levels of depressiveness. A significant decrease of gQoL in patients was evident over the course of the study. Still, adult patients reported a significant increase in perceived health.Conclusions: Our study provides first insight that SMA patients experience a gQoL superior to healthy controls at start of therapy. This might indicate patients' high hopes and expectations toward treatment. gQoL returns to a level similar to that of healthy controls over the course of therapy.

Association between vitamin D deficiency and exercise capacity in patients with CKD, a cross-sectional analysis

BackgroundEvidence is growing for a role of vitamin D in regulating skeletal muscle mass, strength and functional capacity. Given the role the kidneys play in activating total vitamin D, and the high prevalence of vitamin D deficiency in Chronic Kidney Disease (CKD), it is possible that deficiency contributes to the low levels of physical function and muscle mass in these patients. MethodsThis is a secondary cross-sectional analysis of previously published interventional study, with in vitro follow up work. 34 CKD patients at stages G3b-5 (eGFR 25.5 ± 8.3 mL/min/1.73m2; age 61 ± 12 years) were recruited, with a sub-group (n = 20) also donating a muscle biopsy. Vitamin D and associated metabolites were analysed in plasma by liquid chromatography tandem-mass spectroscopy and correlated to a range of physiological tests of muscle size, function, exercise capacity and body composition. The effects of 1α,25(OH)2D3 supplementation on myogenesis and myotube size was investigated in primary skeletal muscle cells from vitamin D deficient donors. ResultsIn vivo, there was no association between total or active vitamin D and muscle size or strength, but a significant correlation with V̇O2Peak was seen with total vitamin D (25OHD). in vitro, 1α,25(OH)2D3 supplementation reduced IL-6 mRNA expression, but had no effect upon proliferation, differentiation or myotube diameter. ConclusionsVitamin D deficiency is not a prominent factor driving the loss of muscle mass in CKD, but may play a role in reduced exercise capacity.

Gambaran Activity Daily Living (ADL) Pasien Penyakit Ginjal Kronis yang Menjalani Hemodialisis di RS Setia Mitra Jakarta

Background: In many studies, patients with Chronic Kidney Disease (CKD) who undergoing Hemodialysis (HD) have been evident to have low levels of physical functioning as well as difficulty performing activities of daily living (ADL) compared to the healthy population. This study aims to describe the activities of daily living performance among CKD patients with HD. Methods: Subjects were 42 CKD outpatients (27 men, 15 women; mean age 50 ± SD=9,49) undergoing maintenance HD one to two times a week. This study employed a cross-sectional descriptive study design. Data were collected from September to October 2020 in Setia Mitra Hospital, Jakarta, Indonesia. Assessment of Activity Daily Living (ADL) was administered using the Katz Index.Result: In this study, we assessed six items of patient’s functional status including bathing, dressing, toileting, transferring, continence, and feeding. The majority of participants (33 people, 79%) had complete independence in performing activities of daily living. However, there were 9 participants (21%) who still need assistance in performing activities of daily living. Conclusion: Although this study found that most participants did not have difficulty in ADL, some participants reported that they needed assistance while performing ADL. Physiotherapy is an important element in the management of CKD patients with HD. The physiotherapy program can help to improve patient’s health, independence in carrying out activities of daily living, reduce stress and depression, improve self-esteem as well as quality of life.

Profile of Older Adults Who Received Wound Care by a Family Caregiver: The NHATS-NSOC 2017

A gap in knowledge exists related to the socio-demographic and health characteristics of older adults receiving wound care from a family caregiver in the home. We created a cohort (N=992) of older adults from NHATS who lived in the community or residential care (non-nursing home) and had a family caregiver complete the NSOC question “provides help with skin care related to wounds or sores”. Approximately one third (32%) of these older adults received wound care from a family caregiver. These older adults were more likely to be men, live with others, have lower levels of physical function, be malnourished (OR = 1.63 [95% CI = 1.02-2.60]), and have inflammation (hsCRP > median 1.89), P < .05. These findings can inform the needs of older adults receiving wound care from a family caregiver and lead to development of additional supports for caregivers (e.g., multi-component interventions).

Patterns of change in physical functioning and posttraumatic stress disorder with cognitive processing therapy in a randomized controlled implementation trial

ABSTRACT Background: Physical health concerns (e.g. chronic pain, fatigue) are common among clients with posttraumatic stress disorder (PTSD). Prior research has indicated that clients report improved physical functioning and fewer physical health symptoms after receiving Cognitive Processing Therapy (CPT) for PTSD. However, less is known about the impact of physical functioning on the clients’ PTSD symptom improvement in CPT. Objective: The current study examined the patterns of change of and between physical functioning and PTSD symptoms over the course of CPT among a diverse military, veteran, and community sample. Method: We collected clients’ (N = 188) physical functioning and PTSD symptom severity prior to and during CPT using the 12-Item Short Form Health Survey and the PTSD Checklist. We used multilevel modelling to 1) evaluate the impact of baseline physical functioning on the PTSD symptom trajectory, 2) examine the trajectory of physical functioning, and 3) assess the dynamics between physical functioning and PTSD symptoms over the course of CPT. Results: Our multilevel analyses indicated that 1) physical functioning significantly improved for those with low levels of functioning prior to treatment, 2) poorer baseline physical functioning predicted slower improvements in PTSD symptoms, and 3) poorer physical functioning in one session predicted less PTSD symptom improvement by the next session. Conclusions: Our findings demonstrate that while physical functioning can interfere with PTSD symptom improvement, physical functioning can also improve over the course of CPT. In light of the interconnected nature of physical health and PTSD symptoms, clinicians may need to attend to lower levels of physical functioning when providing CPT or other trauma-focused therapies. Future research to determine whether specific treatment adaptations may benefit such clients is needed.

Baseline Characteristics Of Older Hispanics With Type 2 Diabetes Participating In An Intervention Study

Type 2 Diabetes mellitus (DM2) affects 9.3% of the U.S. population. Health disparities are evident in DM2; twice as many Hispanics as non-Hispanic Whites have DM2. PURPOSE: The goal of this study was to describe the baseline characteristics of older Hispanics with DM2 participating in a diet and exercise study in 3 senior centers. METHODS: Data from 38 older Hispanics with DM2 was collected. The variables included age, body mass, height, waist circumference, Hemoglobin A1C, glucose, blood pressure, chair stands in 30s, grip strength, balance, and preferred gait characteristics. RESULTS: The characteristics of the 38 participants (29 women, 9 men) that completed the baseline assessments to date were: age = 79±7 yrs (♀78±7; ♂80±7), body mass = 75±16 kg (♀73±13; ♂85±23), height = 157±10 cm (♀154±8; ♂168±6), body mass index = 31±6 kg/m2 (♀30±5, ♂30±7), waist circumference = 103±13 cm (♀101±11; ♂109±19); A1C = 7±1% (♀7±1; ♂6±1), non-fasting blood glucose = 140±47 g/dL (♀135±5; ♂157±30), systolic = 140±19 mmHg (♀139±18; ♂145±20) and diastolic blood pressure = 78±10 mmHg (♀78±10; ♂78±10). Their physical characteristics presented in Table 1 indicate frailty (e.g. chair stands ≤8, grip strength ≤ ♀21, ♂32 kg, and gait velocity ≤ 80cm/s). CONCLUSION: The results indicate that at baseline the participants had high prevalence of obesity (abdominal and total), low levels of glycemic control, borderline high blood pressure, and have low levels of physical function that are indicative of frailty. Supported by Wertheim Innovation Faculty Grant from the FIU Nicole Wertheim College of Nursing and Health SciencesTable 1.: Characteristic of the physical function baseline characteristics of older Hispanics with DM2Note: A95: Area 95 - Eyes Open and Closed; VA: Velocity Average - Eyes Open and Closed; CP: Cadence Preferred; SL: Step Length (mean right and left); Data are presented as mean±SD

AB0276 DIFFERENCES BETWEEN IMPACT OF BIOLOGICAL THERAPY AND IMPACT OF CONVENTIONAL TREATMENT ON PRODUCTIVITY AND QUALITY OF LIFE IN PATIENTS WITH RHEUMATOID ARTHRITIS

Background:Number of patients with rheumatoid arthritis in Montenegro amounts around 3,000, while 8% of them are on biological therapy. This percent is similar, or even higher in comparison to countries that are highly comparable to Montenegro. However, the percentage is still lower than in European countries.Objectives:Objective of the study was to identify the differences between impact of biological and conventional therapy on quality of life of RA patients, their work ability and productivity, mental health, emotional state and social inclusion.Methods:The analysis was based on data gathered from the questionnaires filled by RA patients in Montenegro: 92 patients treated with biological therapy and 78 treated with conventional therapy. More insights and information from examined patients were gathered on two focus groups. Following indicators were used in the study: two indicators that measure work ability and productivity: one monetized – Work Productivity and Activity Impairment Questionnaire General Health V2.0 (WPAI-GH) and one non-monetized – RA Work Instability Scale (RA WIS), and two indicators that measure quality of life – Health Assessment Questionnaire (HAQ-DI) and RAND 36-Item Health Survey (SF-36).Results:WPAI-GH results are used in evaluation of absenteeism and presentism costs per RA patient per annum, which are caused exclusively by rheumatoid arthritis. WPAI-GH results are presented in the following figure. Total cost of absenteeism and presenteeism of RA patients in Montenegro amounts to 3.8 million EUR per annum. Results of RA WIS indicator suggest that patients treated with biological therapy are characterized by low to moderate level of work instability, and patients treated with conventional therapy by moderate level. Patients treated with biological therapy have shown 25% lower level of work instability. HAQ-DI indicator shows that both groups of patients are characterized by mild difficulties to moderate disability in performing everyday activities. However, patients treated with conventional therapy deal with higher level of difficulties, even though their level of RA progression is lower, on average. SF-36 indicator shows that patients treated with conventional therapy have lower level of physical functioning, followed by 26% higher pain intensity. They are 25% more exposed to limitations due to physical health problems caused by RA, and 20% more to limitations due to emotional problems. Patients treated with biological therapy, on average, rate their health with 50% higher rank in comparison to subjective health rate of patients treated with conventional therapy. They also feel that their health has improved during the past year, or stayed approximately the same, while patients treated with conventional therapy feel that their health condition has aggravated, or stayed unchanged.Conclusion:Results show that health condition, emotional state and life quality are better among the patients treated with biological therapy. Also, their productivity is higher compared to patients treated with conventional therapy. This conclusion is additionally supported by the fact that there is more progression of disease among RA patients treated with biological therapy, as well as by the fact that the average duration of RA is almost two times longer among examinees who are on biological therapy than among examinees who are on conventional therapy. Accordingly, access to biological therapy for greater number of patients in earlier stage of disease would result in reduction costs of lost productivity and work disability connected to RA, as well as in mitigation of RA impact on lives and functionality of patients.Figure 1.WPAI-GHDisclosure of Interests:None declared

Everyday Discrimination in Adults with Knee Pain: The Role of Perceived Stress and Pain Catastrophizing.

PurposeResearch indicates pain-related disparities in the impact of knee osteoarthritis (OA) across both sex and ethnicity/race. While several factors likely contribute to these disparities, experiences of discrimination are associated with poor OA-related pain, disability, and functional performance. However, the mechanisms that mediate experiences of discrimination and OA-related outcomes are unclear. The current cross-sectional study examined the associations between everyday experiences of discrimination and clinical pain, disability and functional performance among non-Hispanic Black (NHB) and non-Hispanic White (NHW) persons with or at risk of knee OA and assessed the serial mediated model of perceived stress and pain catastrophizing on these relationships in women only.Patients and MethodsParticipants were 188 community-dwelling adults who presented with unilateral or bilateral knee pain and screened positive for clinical knee pain. Participants completed several measures including experiences of discrimination, Perceived Stress Scale, Coping Strategies Questionnaire-Revised (CSQ-R): Pain Catastrophizing subscale, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Graded Chronic Pain Scale (GCPS), and Short Physical Performance Battery (SPPB).ResultsAs compared to NHW participants, NHB individuals reported experiencing significantly higher levels of discrimination (F(1, 175)=26.660, p<0.001), greater levels of pain catastrophizing (F(1, 180)=12.919, p<0.001), higher levels of clinical pain and disability, and lower levels of physical function (ps<0.05). However, perceived stress was positively correlated with discrimination in the NHW group only (NHW females: r=0.40, p<0.01; NHW males: r=0.37, p<0.05). Further, perceived stress and pain catastrophizing mediated the relationship between discrimination and outcome variables (WOMAC pain, GCPS interference [pain disability], and SPPB function) in female participants after controlling for relevant sociodemographic variables (study site, age, race, income, and body mass index).ConclusionThese results may have implications for the treatment of perceived stress and catastrophizing as a means to reduce the negative impact of experiences of discrimination on the experience of chronic pain, particularly for women.

To the issue of the health comprehensive assessment of children who underwent surgical correction of congenital heart diseases

Aim. To find out the problems in children health in long-time postoperative period after cardiosurgery using the comprehensive method for creating rehabilitation program.Methods. A prospective investigation of group of children was done before (n = 88) and in a year (n = 115), in 2 years (n = 90) and in 3 years (n = 58) after the surgical correction of congenital heart defects on the base of Kuzbass cardiological center. The anamnesis, clinical and hemodynamic aspects were studied as well as the postoperative period, residual problems after the correction, social status of the family and the comprehensive assessment was done in the both groups.Results. Before the correction the most part of children had low and very low levels of physical functioning, but there was a positive dynamic right after the surgery: the most part of children had high and middle levels (13% and 44% in a year), while the amount of children with low and very low data were reduced. Nevertheless, in 3 years after the surgery the amount of children with low and very low data was increased while the hemodynamic became better. Such tendency was mentioned with all aspects of the health.Conclusion. Despite of hemodynamic normalization the quality of life with all aspects still suffers. It predicts dangers in development and quality of life in general.