Lower Functional Performance Research Articles

Facile fabrication of sulfonated bacterial cellulose-silane composite aerogels via in suit polymerization for enhanced oil/water separation performance

Cellulose-based aerogels have emerged as highly promising materials for oil-water separation because of their highly porous nature, low bulk density, cost-effectiveness, and functional performance. In this study, a novel, robust, and hydrophobic bacterial cellulose aerogel (HBCA) was reported for highly efficient oil/water separation, which was formed by incorporating methyltrimethoxysilane (MTMS) into sulfonated nano-fibrillated bacterial cellulose (SNBC) matrix through freeze-drying method. The structural integrity of the SNBC/MTMS aerogel was ensured by its three-dimensional linked network structure. The resultant aerogel demonstrated superior hydrophobicity with a contact angle of 152.4°. As an oil-absorbing material, it selectively adsorbed different types of oils and organic solvents, with a saturation adsorption capacity ranging from 42.14 to 85.37 g·g−1. Additionally, this composite aerogel demonstrated outstanding separation efficiency (98.48 %) in continuous oil-water mixture processes, suggesting promising potential applications in the treatment of industrial oil pollution and oil spill accidents. This study indicates that the proposed HBCA with sulfonated nano-fibrillated bacterial cellulose is a potential and effective material for addressing environmental challenges related to oil contamination.

Functional performance of patients submitted to cardiac surgery with different levels of sleep quality: an observational study

ObjectiveTo describe pulmonary function, muscle strength and functional performance in the different qualities of sleep and the impact of this on the number of physiotherapeutic assistances. MethodsThis is an observational study. In the pre and post operative period, sleep behavior was evaluated using the Pittsburgh questionnaire. Patients were divided into three groups: Good Sleep Quality (GSQ), Poor Sleep Quality (PSQ) and Sleep Disordered (SDB). At this time, other tests were also performed, such as: 6-Minute Walk Test (6MWT), Sit and Stand Test (SST), gait speed test and Timed Up to Go (TUG), Medical Research Council (MRC), maximal inspiratory pressure and maximal expiratory, vital capacity and peak expiratory flow. The functional performance and lung function of each group were compared. ResultsA total of 105 people, undergoing cardiac surgery and admitted to hospital were evaluated, 33 with GSQ, 41 with PSQ and 31 with SD. Patients who were in the SDB group had a lower functional performance than the other groups. 6MWT (meters) in the GSQ was 499 ± 87, versus 487 ± 91 in the PSQ and 430 ± 78 in the SD (p = 0.02). In the SST (seconds) it was 10.4 ± 1.1 in the GQS, 11.1 ± 2.3 in the PSQ and 15.4 ± 2.1 in the SD (p = 0.04). Lung function and muscle strength did not differ between groups. Regarding the refusal to perform physical therapy, the SD group was more incident, the main reason being drowsiness. ConclusionBased on the results, we found that sleep quality interferes with functional performance and physical therapy assistance during the hospital stay in patients undergoing cardiac surgery.

Gait Function and its Association with Functional Independence, Quality of Life, and Community Reintegration in Stroke Survivors.

Background and Aims: The major outcome of stroke rehabilitation is the recovery of the ability to walk. However, a large proportion of stroke survivors are discharged to the community with gait deficiency which impairs their functional independence, and quality of life increasing the burden of care on caregivers especially their lack of functioning in the community. This study assessed the gait functional performance in community-dwelling stroke survivors and explored its association with functional independence, quality of life, and community reintegration in community-dwelling stroke survivors. Materials and methods: This study involved 115(59 males and 56 females) community-dwelling stroke survivors. Their gait functional performance was assessed using the 10-meter walk test (10MWT) while their functional independence was assessed with the functional independence measure (FIM). Their quality of life (QoL) was assessed using the Stroke-specific QoL scale while community functioning and productivity were assessed using the community integration questionnaire (CIQ). Their scores on the assessments were compared with the normative data of their age and sex-matched healthy individuals. Data was analysed using Spearman’s correlation coefficient and Chi-Square at p<.05. Results: Participants’ ages ranged between 27 to 78 years (mean=60.48±37.84 years). More participants (56.7%) had right hemispheric lesions and 43.3% had lesions in the left hemisphere. Their gait function, functional independence performance, QoL, and community reintegration functions were significantly (p<0.05) lower than their age and sex-matched normative data. There was a significant (p<0.05) association and relationship between their gait functional performance and each of the functional independence performance, QoL, community reintegration, and productivity. Conclusion: Gait functional performance in community-dwelling stroke survivors is significantly lower than in age and sex-matched healthy individuals and it is significantly associated with low functional independence performance, low quality of life, poor community functioning, and lack of productivity in stroke survivors, Abnormal gait pattern is related to poor functional independence, poor quality of life and low productivity.

Access to University Studies: A New Form of Discrimination for Low-Functioning People

Although it would seem that we are currently in a more inclusive society, the reality is quite different, since discriminatory models continue to be perpetuated based on the level of functional performance of each person. In this sense, the purpose of this study is to find out the degree of discrimination that people with low functional performance have in relation to the rest of the population on the basis of sex and level of studies. To this end, through a thorough investigation based on the scientific method and articulated via statistical analysis (the modelling of categorical data), this study reveals the situations of inequality to which people with low functional performance are subjected in terms of higher education. This study used the survey on Employment of People with Disabilities (EPD), carried out by the National Statistics Institute (INE), and conducted annually with a sample size of 60,000 households, equivalent to some 200,000 people. The statistical analysis was carried out using R software and the main techniques used were contingency table modelling, log-linear models, and logistic models. Finally, some recommendations are offered to contribute to social awareness, for which the role of teachers is a crucial element for educational equity and their training is of vital importance, as teachers are a key element in adapting contents to different abilities, especially for people with lower functional performance. The quality of the initial training they receive will depend on their achievement.

Question Classification for Intelligent Question Answering: A Comprehensive Survey

In the era of GeoAI, Geospatial Intelligent Question Answering (GeoIQA) represents the ultimate pursuit for everyone. Even generative AI systems like ChatGPT-4 struggle to handle complex GeoIQA. GeoIQA is domain complex IQA, which aims at understanding and answering questions accurately. The core of IQA is the Question Classification (QC), which mainly contains four types: content-based, template-based, calculation-based and method-based classification. These IQA_QC frameworks, however, struggle to be compatible and integrate with each other, which may be the bottleneck restricting the substantial improvement of IQA performance. To address this problem, this paper reviewed recent advances on IQA with the focus on solving question classification and proposed a comprehensive IQA_QC framework for understanding user query intention more accurately. By introducing the basic idea of the IQA mechanism, a three-level question classification framework consisting of essence, form and implementation is put forward which could cover the complexity and diversity of geographical questions. In addition, the proposed IQA_QC framework revealed that there are still significant deficiencies in the IQA evaluation metrics in the aspect of broader dimensions, which led to low answer performance, functional performance and systematic performance. Through the comparisons, we find that the proposed IQA_QC framework can fully integrate and surpass the existing classification. Although our proposed classification can be further expanded and improved, we firmly believe that this comprehensive IQA_QC framework can effectively help researchers in both semantic parsing and question querying processes. Furthermore, the IQA_QC framework can also provide a systematic question-and-answer pair/library categorization system for AIGCs, such as GPT-4. In conclusion, whether it is explicit GeoAI or implicit GeoAI, the IQA_QC can play a pioneering role in providing question-and-answer types in the future.

Cross-linked Polyimide Nanofibrous Aerogels with Hierarchical Cellular Structure for Thermal Insulation

Due to their low bulk density, high porosity, and functional performance, aerogels are ideal candidates for a variety of applications. However, their potential application in a variety of fields is limited by their time-consuming and costly complex fabrication process. In this study, electrospun 3-aminopropyltriethoxysilane-grafted polyimide (PI@APTES) nanofibers were used to construct nanofibrous aerogels (NFAs) via freeze-drying a dispersion of cross-linked-PI short fibers and a binder (PI@APTES), resulting in improved properties and functionalities. A highly siloxane cross-linked network structure was formed by hydrolysis and condensation reactions to generate stable nanofibrous aerogels. The obtained polyimide nanofibrous aerogels (PiNFAs) had a hierarchically three-dimensional (3D) microporous structure, high porosity (over 98%), tunable densities (10.6 ± 0.7–13.6 ± 0.2 mg cm–3), solvent resistance, superhydrophobicity (water contact angle over 163°), low thermal conductivity (as low as 33.2 mW m–1 K–1), and mechanical stability. These PiNFAs are promising candidates for potential applications in thermal insulation, lightweight construction, filtration, and sensors.

Low Correlation between Gait and Quality of Life in Advanced Knee Osteoarthritis

Advanced knee osteoarthritis patients’ gait usually undergoes alterations leading to decreased mobility and lower functional performance, which can result in a worsening of their quality of life (QoL). While several authors have reported a moderate correlation between gait parameters and QoL assessed by generic questionnaires, the literature is scarce. This study aimed to explore the relationship between gait and QoL parameters assessed by a generic and a disease-specific questionnaire in patients with advanced knee osteoarthritis. In this single-centre, prospective, observational study, 129 patients with advanced knee osteoarthritis scheduled for elective total knee replacement were selected. The patients’ gait was evaluated by means of a validated wireless device while they walked 30 m at a comfortable speed. Patient function was also analysed using the Knee Society Score (KSS). QoL was measured with the EQ-5D and the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaires. Patients showed a mean walking speed of 0.95 ± 0.19 m/s, a mean cadence of 105.6 ± 9.9 steps/min, and a mean stride length of 1.25 ± 0.17 m on both legs. They presented poor knee status (KSS < 60) and poor QoL, with an EQ-5D of 0.44 ± 0.24 and a total KOOS of 29.77 ± 13.99. Positive low correlations (r <0.5, p <0.5) were found only between the speed, propulsion and stride length of both legs, and the overall and ADLs subscale scores of the total KOOS questionnaire. In conclusion, several gait parameters have a significant low correlation with the QoL of patients with advanced knee osteoarthritis, as assessed by an osteoarthritis-specific questionnaire.

Previously Undiagnosed Anemia and Iron Deficiency Anemia among Preschool Children at Taif City

Introduction: In the Arab Gulf countries, anemia, including iron deficiency anemia )IDA(, considered one of the main public health problems. Although, the World Health Organization reported that IDA as the most common type of anemia, which made up half of all anemic cases all over the world, there were limited research performed among preschool children about anemia in Saudi Arabia. Thus, the aim of this study was to investigate the prevalence of previously undiagnosed anemia and IDA among children between 2 to 6 years old. In this study, several risk factors that might contribute to the high prevalence of anemia were assessed. Methods: The study was carried out in Taif city during the period from January 2023 to April 2023. Blood samples were collected from 200 preschool children and analyzed for hematological parameters as well as related biochemistry tests to investigate the prevalence of previously undiagnosed anemia and IDA. Results: The majority of the study participants were Saudi 99% and aged 4 to 6 years 72.5%. Most of children participants, 92.5% had normal haemoglobin (Hb) concentration and normal levels of red blood cells (RBCs) and normal hematocrit indicating their non-anemia health status. In this study, previously undiagnosed anemia were reported within 6% of children indicated by low Hb concentration, low RBC count and abnormal low hematocrit level. Out of these undiagnosed anemic children, there were 25% diagnosed with IDA. Conclusions: Since, anemia and IDA are still a public health problem among preschool children in Saudi Arabia this study suggested that the hematological blood examination should be done to students as a requirement before school which may reveal the presence of previously undiagnosed anemia and might associated with low mantle and functional performance among children. Moreover, further studies are recommended at all regions of the Kingdome to investigate the underlying related risk factors, which will provide more insight ....

Non-linear variations in glutamate dynamics during a cognitive task engagement in schizophrenia

To investigate the role of glutamate in psychosis, we employ functional magnetic resonance spectroscopy at an ultra-high magnetic field (7T) and employ fuzzy-approximate entropy (F-ApEn) and Hurst Exponent (HE) to capture time-varying nature of glutamate signaling during a cognitive task. We recruited thirty first-episode psychosis patients (FEP) with age- and gender-matched healthy controls (HC) and administered the Color-Word Stroop paradigm, providing 128 raw MRS time-points per subject over a period of 16 min. We then performed metabolite quantification of glutamate in the dorsal anterior cingulate cortex, a region reliably activated during the Stroop task. Symptoms/cognitive functioning was measured using Positive and Negative Syndrome Scale-8 score, Social and Occupational Functioning (SOFAS) score, digit symbol) coding score, and Stroop accuracy. These scores were related to the Entropy/HE data from the overall glutamate time-series. Patients with FEP had significantly higher HE compared to HC, with individuals displaying significantly higher HE having lower functional performance (SOFAS) in both HC and FEP groups. Among healthy individuals, higher HE also indicated significantly lower cognitive function through Stroop accuracy and DSST scores. F-ApEn had an inverse Pearson correlation with HE, and tracked diagnosis, cognition and function as expected, but with lower effect sizes not reaching statistical significance. We demonstrate notable diagnostic differences in the temporal course of glutamate signaling during a cognitive task in psychosis.

The Frail Elderly Patient and the Need for a Video Store on Regional Anaesthesia Blocks

The Frail Elderly Patient and the Need for a Video Store on Regional Anaesthesia Blocks

Use of health care services according to functional performance in community-dwelling older adults in Spain. An approach using GAMLSS models.

Functional performance in older adults is a predictor of survival and other health outcomes and its measurement is highly recommended in primary care settings. Functional performance and frailty are closely related concepts, and frailty status is associated with the use of health care services. However, there is insufficient evidence on the utilization of services profile according to the functional performance of older adults. The aim of this study was to assess the relationship between functional performance and the use of a wide range of health services in community-dwelling older adults. Generalized additive models for location, scale and shape were used to study these complex data of services utilization, from primary to hospital care. A total of 749 participants from two Spanish regions were followed up for 2 years. Of those, 276 (37%) presented low functional performance and 473 (63%) normal performance according to the Timed Up and Go test. The results showed that even after adjusting for burden of comorbidity and polypharmacy, participants with low functional performance used primary and secondary care health services more intensively, visited emergency rooms more often, and were hospitalized more frequently and for longer periods of time. A negative binomial distribution and a variant thereof were found to be the best models to describe health service utilization data. In conclusion, functionality should be considered as an important health indicator for tailoring the provision of health services for older adults.

Functional Performance, Leg Muscle Strength, and Core Muscle Endurance in Multiple Sclerosis Patients With Mild Disability: A Cross-Sectional Study.

This study aimed to investigate the relationship of sit-to-stand and walking performance with leg muscle strength and core muscle endurance in people with multiple sclerosis (PwMS) with mild disabilities. In this study, 49 PwMS (Expanded Disability Status Scale score = 1.59 ± 0.79) and 26 healthy controls were enrolled. The functional performances, including sit-to-stand and walking performances, were evaluated with the five-repetition sit-to-stand test, timed up and go test, and 6-min walking test. The PwMS finished significantly slower five-repetition sit-to-stand, timed up and go, and 6-min walking test than the healthy controls. In addition, the significant contributors were the weakest trunk lateral flexor endurance for five-repetition sit-to-stand; the Expanded Disability Status Scale score, and the weakest hip adductor muscle for timed up and go; the weakest hip extensor muscles strength for 6-min walking test. The functional performances in PwMS, even with mild disabilities, were lower compared with healthy controls. Decreases in both leg muscle strength and core muscle endurance are associated with lower functional performance in PwMS.

Factors related to the accumulation of healthy behavior among older adults attending primary Health Care.

The adoption and maintenance of healthy behaviors contribute for its accumulation throughout life, which require more than information disclosure and recommendations. Biopsychosocial factors may work as barriers to adherence to healthier behaviors, and yet have been underexplored. The objective was to investigate the factors related to the accumulation of healthy behavior among older adults attending Primary Health Care. Cross-sectional analysis with 201 older adults from baseline of Longitudinal Investigation of Functioning Epidemiology (LIFE) was performed in a Southeastern Brazilian city. The Healthy Behavior Score (HBS), ranging from 0 to 8, was calculated by the sum of the following habits: Physical activity practice, healthy eating, water consumption, night sleep time, not smoking, not drinking alcohol, frequent social relations, and spirituality. A linear multivariate regression was performed to test the influence of biopsychosocial aspects on HBS, with 95% confidence interval. Higher number of healthy behaviors was related to high social support, better cognitive status, less depressive symptoms and lower functional performance. Additionally, age and resilience score were correlated to healthy behaviors, which were higher among women and those with sufficient income. Multivariate analysis revealed depressive symptoms, functional performance and education as independent predictors of HBS. Depressive symptoms, functional performance and education are predictors of accumulation of health behaviors, independently of health status, contextual and sociodemographic aspects. Higher social support partially contributed to the higher number of healthy behaviors, and should be considered in public health policies for healthy longevity.

Barriers to consumer adoption of sustainable products – an empirical analysis

Purpose This paper aims to identify and study the effect of identified eight barriers to sustainable consumption on consumers’ intention to purchase sustainable products. Design/methodology/approach Data were collected from a self-administered field survey in India, and 315 valid responses were obtained from the survey process. Partial least square structural equation modeling analysis was carried out to establish the validity of the measures used and to examine the impact of the identified barriers on sustainable purchase intentions. Findings The results of this study indicate that barriers such as low willingness to pay, low functional performance, low availability of sustainable products and difficulty of integration in the normal route have a statistically significant negative impact on consumers’ sustainable purchase intentions. Practical implications The findings of this study are useful for marketers and policymakers who want to increase the consumer adoption of sustainable products in emerging markets. Originality/value This study develops measures to capture the consumers’ perception of barriers to the adoption of sustainable products.

Body composition and functional performance of older adults

ObjectivesTo determine if anthropometric variables, body composition, medication and gender are associated with functional performance and to compare these variables between octogenarians with high and low functional performance. MethodsObservational, cross-sectional study. Weight, height, body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR) were evaluated. Handgrip strength (HGS) was assessed. Participants’ body composition was assessed by dual-energy X-ray absorptiometry (DXA) and functional performance by Short Physical Performance Battery (SPPB). A binomial logistic regression was performed. ResultsOne hundred and twenty-two octogenarians were included and separated into high and low function groups. The high function group showed lower values of WHtR (mean difference [MD] = 0.047, P = 0.025) and body fat (BF%) (MD = 3.54, P = 0.032) and higher values of apendicular skeletal muscle mass (ALM) (MD = 3.03, P = 0.001), HGS (MD = 6.11, P = 0.001) and SPPB score (MD = 4.20, P = 0.001). Women were more likely to be classified as low function (OR = 3.66, P = 0.002) and males showed 5.21 odds ratio (P = 0.021) of having high functional performance compared to females. Also, each decrease in age and medication use displayed 1.30 (P = 0.007) and 1.26 odds ratio increases (P = 0.008) in high functional performance. ConclusionsOlder males display better functional performance than women, and decrements in age and medications increase the high functional performance odds ratio. Octogenarians with high functional performance displayed lower BF measurements and higher values of muscle mass and strength.

The Right to Inclusive Quality Education: Primary School Teachers’ Perceptions Based on the EPREPADI-1 Scale

The following study aimed to describe the perception of primary education teachers regarding pupils who are discriminated against on the grounds of low functional performance. In this way, the EPREPADI-1 scale (primary education teachers’ perception of their training and professional practice in relation to pupils with disabilities) was applied with a purposive and non-probabilistic sampling aimed at teachers in the Region of Murcia, obtaining a sample with a confidence level of 95% and a sampling error of 5% (410 participants). Being quantitative descriptive research, an exploratory factor analysis was carried out to determine the existence of seven key factors, of which three were considered, due to their high significance for the objectives of this study, to determine their correlation by means of the Pearson test, as well as the Chi-square test and Cramer’s V test to determine the correlation between the factors and the ordinal variables of the scale. These tests allowed us to analyse the existing relationships between the specific training received (initial and continuous), and the effects that this training had on the performance of their professional practice. At the same time, we investigated the perception teachers have of their use of the language of negation, and to what extent the semantics used can lead to situations of exclusion.

Insufficient physical activity and multimorbidity was associated with low physical functional performance in older adults: a cross-sectional study

Objective: Aging, physical inactivity, and chronic disease can decrease strength and muscle mass and affect mobility and autonomy in older adults. This study aimed to analyze the prevalence and associated factors of low physical functional performance among older adults in the city of Pomerode, in southern Brazil. Methods: This is a cross-sectional population-based study with data on 733 older adults from the Study of Health in Pomerode — SHIP-Brazil. Low functional physical performance was defined as handgrip strength ≤ 32 kg for men or ≤ 20 kg for women and/or a Timed Up and Go test ≥ 11 seconds for men or ≥ 13 seconds for women. Associations were analyzed by multiple logistic regression. Results: The prevalence of low physical functional performance was 43.7% (42.2% among women and 45.5% among men). Low physical functional performance was associated with the 70–79 years age group (odds ratio [OR] = 2.07) and insufficient physical activity (OR = 2.73) in men, and with the 70–79 years age group (OR = 2.09) and multimorbidity (OR = 1.87) in women. In general, older age, insufficient physical activity, and multimorbidity were associated with low physical functional performance in older adults. Conclusion: Our findings suggest that while insufficient physical activity is crucial for physical functional performance in older men, multimorbidity appears to be crucial for older women.

Activity Space and Functional Outcomes in Frail Older Persons Using GPS analysis

With increasing age, walking becomes a main functional ability to participate in activities of daily living and supports independence and mobility. Frailty in older, multimorbid patients has a negative impact on physical activity and may reduce the personal activity space (AS). In this pilot study, GPS data were used to identify walking tracks to define individual AS and to compare functional performance in frail older persons. GPS data of 20 community-dwelling adults (84.5(±5.2)years, 85% women, mean frailty phenotype 1.9 (70% ≥2)points) were analyzed using a customized software to assess individual AS over a ten-months period. A geriatric home assessment including Short Physical Performance Battery (SPPB), gait speed (GS) and Timed-up-and-Go (TUG) was conducted monthly. GPS analysis revealed three different walking types presenting AS similarities: Type A walkers prefer smaller short walks nearby the home while Type B can be characterized by taking larger regular walks. Type C presents the widest AS using different transportation modes, but only a moderate number of walks. Mean group difference in functional performance of Type A walkers showed significantly reduced GS (0.45(±0.1)m/s), TUG (23.4s(±4.9)) and SPPB scores (3.8(±0.8) points; p<0.05) compared to Type C (0.82(±0.1)m/s (GS); 13.2(±1.4)s (TUG); 7.0(±1.3) points (SPPB)). Functional performance of Type B walkers (0.63(±0.2)m/s (GS); 17.1(±4.4)s (TUG); 6.5(±2.4)points (SPPB)) revealed significantly higher SPPB scores compared to Type A (p<0.05). Walks and individual AS can be mapped via GPS under everyday conditions. High heterogeneity within frail older people was observed. Persons with lower functional performance showed a reduced AS and physical activity.

Primary School Teachers’ Perception of Low Functioning Students: Validation of the EPREPADI-1 Scale

This research contributes to the knowledge and understanding of some aspects of the professional practice of primary education teachers in the Region of Murcia (Spain), and its possible effect on the creation of situations of educational exclusion. For this purpose, an instrument called EPREPADI-1 (Scale of Perception of Primary Education Teachers on their Training and Professional Practice in relation to Pupils with Disabilities) has been developed. The design and structure of the instrument includes important aspects that seek to highlight teachers’ views and knowledge of educational legislation (international, national and regional), their views on nomenclatures (such as those of persons with disabilities and inclusive education), as well as their assessment of the use of language of denial in relation to pupils with lower functional performance. Furthermore, after the statistical tests carried out for the validation of the scale (Kendall’s W test and Cronbach’s Alpha), values were obtained that give the instrument excellent validity and reliability (both for the group of experts and also for the pilot group), which is why its use and application is recommended.

Symptom burden and functional performance in patients with chronic obstructive pulmonary disease

BackgroundThe burden of COPD is growing, and it is one of the leading disease burdens worldwide. Studies on symptom burden as a multidimensional concept in COPD and functional performance are lacking, and little is known about the effect of multiple symptoms and symptom burden on functional performance. MethodsA descriptive, cross-sectional correlational survey design was used. The Memorial Symptom Assessment Scale (MSAS) and the Functional Performance Inventory-Short Form (FPI-SF) were used to measure the symptom burden and functional performance. Data were analyzed using descriptive and inferential statistics. Participants (n = 214) were recruited from the respiratory outpatient clinic in one of the teaching hospitals in Ireland. ResultsPatients with COPD, regardless of classification, experienced significant physical and psychological symptom burden. A total of 20 symptoms were negatively correlated with overall functional performance, indicating a high symptom burden for those symptoms was associated with low overall functional performance. A statistically significant negative correlation between physical symptom burden, psychological symptom burden, total symptom burden, and functional performance was found. ConclusionPatients with COPD experience a significant symptom burden and low functional performance. Decreased functional performance was not related only to a single burdensome symptom, but may also be related to the contribution of several physical/psychological burdensome symptoms, or both. Assessment and management of these symptoms are essential and imply that alleviating these symptoms' burden may promote improved functional performance. This study supported the growing body of evidence of the need for patients with advanced COPD to receive palliative care.