Mean Activities Of Daily Living Score Research Articles

Evaluation of activities and instrumental activities of daily living and correlated factors of traumatic brain injury patients in Vietnam

Traumatic brain injury (TBI) is among the leading causes of death in Vietnam. Survivors of TBI suffer from functional and cognitive deficits. Understanding that Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs) are crucial in measuring the treatment and health-related quality of life among patients with TBI. This study aims to evaluate ADLs and IADLs among the TBI population in Vietnam and determine the correlated factors to these two indices. A cross-sectional study was conducted on 212 patients with TBI in Vietnam from February to September 2020. ADLs and IADLs scales were applied. Depression, quality of sleep, and social support scales were used. Multivariate Tobit regression was adopted to identify factors associated with ADLs and IADLs. Patients who received first aid had higher ADLs scores than those who had not, by a statistical difference with a p value = 0.04. The mean ADLs score was 5.4 (SD = 1.4). The mean score of IADLs was 7.3 (SD = 1.7). Female patients (Mean = 7.6, SD = 1.1) performed better in IADLs than male patients (Mean = 7.1, SD = 1.9). Both ADLs and IADLs were affected strongly by depression and Injury Severity scores (p < 0.01), whereas IADLs were significantly correlated to caregiver types and quality of sleep (p < 0.01). Family support was observed as a negatively correlated factor to IADLs. Findings from the study provided evidence for authorities to adjust the health strategies among patients with TBI. Proper prehospital care, a basic low-cost hospital care model, and mental health counseling services should be considered when developing health interventions in Vietnam.

Assessment of Dependency in Activities of Daily Living (ADL) and its Predictors: A Cross-Sectional Study among the Elderly Rural Population in a Sub-Himalayan UT of India.

With an increase in life expectancy over the last few decades, there has been a parallel increase in the prevalence of disabilities among the elderly population. To estimate the prevalence of dependency in activities of daily living (ADL) and its predictors among the rural elderly population. This was a cross-sectional study carried out in the community among the rural geriatric population in the field practice area of PG Department of Community Medicine, Government Medical College Jammu. The Barthel Scale Index was used to measure ADL dependency. PSPP software was used to analyze the data. The mean age of study participants was 68.31 ± 7.9 years. ADL dependency was observed in 46.3% of the subjects, with the majority demonstrating mild to moderate dependence. Only 2.5% of the respondents reported a severe degree of ADL dependence. The mean ADL score was 94.47 ± 8.98. On multivariate logistic regression analysis, age, educational status, the presence of stress in the family, personal history, and the presence of co-morbidities emerged to be independent predictors of ADL dependence. High prevalence of physical disability in the geriatric population is now an area of major concern. This emphasizes the significance of setting up geriatric care centers especially in rural areas preferably integrating with health and wellness centers.

Clinical Characteristics of Older Adults Living in Foster Families in the French West Indies: Baseline Screening of the KArukera Study of Aging in Foster Families (KASAF) Cohort.

Foster families for older adults could represent a transitional or alternative model to nursing homes. The aim of this study was to describe the clinical characteristics of older adults in foster families and to compare them with those of residents in nursing homes in French West Indies. This study is a cross-sectional analysis of the KArukera Study of Aging in Foster Families (KASAF) cohort. Sociodemographic and clinical characteristics were extracted. Dependency was assessed using the Activities of Daily Living (ADL) scale and cognition using the Mini-Mental State Examination (MMSE) scale. Age, gender, ADL, and MMSE scores were compared with nursing home residents from a twin study of KASAF (n = 332). A total of 107 older adults (mean age 81.8 years; 61.7% women) were recruited in 56 foster families between September 2020 and May 2021. In all, 25.5% had diabetes mellitus and 45.8% suffered from hypertension. The mean MMSE score was 9.3±10.1 and 76.0% had major cognitive impairment (MMSE score <18); 12.5% were diagnosed with Parkinson's disease, and 42.0% of the residents were confined to bed or in a wheelchair, with a mean ADL score of 1.5±1.8. Almost all the residents (96.3%) benefited from a medical follow-up by a nurse who visited once or twice a day. Compared to older adults living in nursing homes, those in foster families were more frequently women (61.7% vs 49.4%) and had lower ADL score (1.5 vs 2.4) and lower MMSE score (9.3 vs 11.3). The clinical profile of foster families' residents was quite similar to that of nursing home residents in terms of demographics, dementia, and dependency. Foster families might represent an interesting strategy to address the unmet clinical and social needs of dependent older adults, especially in countries where nursing homes are not sufficiently developed. NCT04545775.

Measures of functional status in older patients treated with palbociclib for advanced breast cancer

IntroductionLimited data are available on the effects of treatment for advanced breast cancer (ABC) in older patients because this population has limited enrollment in clinical trials. Data generated from the prospective, noninterventional POLARIS study of patients with hormone receptor-positive/human epidermal growth factor receptor 2–negative ABC may help bridge the gap in our understanding of the tolerability and outcomes in this vulnerable population. Materials and MethodsWe evaluated measures of geriatric impairments and activities of daily living in patients with ABC aged ≥70 years in POLARIS to evaluate the change within six months of palbociclib initiation. Geriatric impairments and activities of daily living (functional) status were assessed using the Geriatric 8 (G8) and Activities of Daily Living (ADL) screening tools. The G8, ADL, and Eastern Cooperative Oncology Group performance status (ECOG PS) scores were assessed at baseline and month six through end of treatment with palbociclib. ECOG PS scores were also stratified by G8 and ADL score severity subgroups (G8: ≤14 = impaired subgroup; >14 = not at all impaired subgroup; ADL: <18 = dependent subgroup, 18 = independent subgroup). ResultsAt data cutoff in November 2020, of 1282 POLARIS patients of all ages, 287 (22.4%) were ≥ 70 years old and completed ≥6 months of palbociclib therapy. At baseline, 117 (45%; n = 260) of these patients had an ECOG PS score of 0, 143 (55%; n = 260) had ECOG PS score > 0, 248 (86%) had G8 scores (mean [SD] 13.6 [2.14]), and 256 (89%) had ADL scores (17.7 [1.03]) among the available 287 patients. At six months, 102 (40%; n = 255) had an ECOG PS score of 0, 153 (60%; n = 255) had ECOG PS score > 0, 198 (69%) had G8 scores (13.6 [1.99]), and 211 (74%) had ADL scores (17.6 [1.22]) among the 287 available patients. There was no mean change (standard deviation) from baseline to 6 months in mean ECOG PS scores (0.0 [0.61], P = 0.24), G8 scores (0.0 [2.17], P = 0.89), or ADL scores (0.0 [1.00], P = 0.62). DiscussionIn this subgroup analysis of older patients with ABC from POLARIS, functional status and impairment outcomes were preserved in older patients receiving palbociclib. G8, ADL, and ECOG PS scores were generally maintained during the first six months of palbociclib therapy.ClinicalTrials.govidentification number.NCT03280303

Medical Cannabis Is Not Associated with a Decrease in Activities of Daily Living in Older Adults.

The proportion of older adults using medical cannabis is rising. Therefore, we aimed to assess the effects of herbal medical cannabis on the functional status of older adults. We conducted a prospective observational study of patients aged 65 years or older that initiated cannabis treatment for different indications, mostly chronic non-cancer pain, during 2018-2020 in a specialized geriatric clinic. The outcomes assessed were activities of daily living (ADL), instrumental activities of daily living (IADL), pain intensity, geriatric depression scale, chronic medication use, and adverse events at six months. A cohort of 119 patients began cannabis treatment: the mean age was 79.3 ± 8.5 and 74 (62.2%) were female. Of the cohort, 43 (36.1%) experienced adverse effects due to cannabis use and 2 (1.7%) required medical attention. The mean ADL scores before and after treatment were 4.4 ± 1.8 and 4.5 ± 1.8, respectively (p = 0.27), and the mean IADL scores before and after treatment were 4.1 ± 2.6 and 4.7 ± 3, respectively (p = 0.02). We concluded that medical cannabis in older adults has a number of serious adverse events, but was not associated with a decrease in functional status, as illustrated by ADL and IADL scores after six months of continuous treatment.

Fibroset™ and neuromuscular pain: a multicentric, real world, observational, post-marketing surveillance study in Indian patients suffering from neuromuscular pain

Background: Neuromuscular disease (NMD) is a condition due to abnormality or damage to muscles and nerves causing painful symptoms. Symptomatic management involves use of conventional painkillers, but desirable relief is not achieved due to multimodal pathophysiology of disease. This study evaluated the efficacy and safety of Fibroset™ tablets in subjects with neuromuscular pain. Methods: Subjects with neuromuscular pain, previously unsatisfied with standard therapies, were enrolled. Subjects were advised to take Fibroset™ one tablet BID for 2 weeks with their standard therapy. Efficacy was evaluated on pain, stiffness, swelling, weakness, tenderness, and difficulty in activity of daily living (ADL) as per the visit schedule. Tolerability of therapy was also evaluated. Results: 59 patients were enrolled in study and 46 patients were included in the final analysis. Fibroset™ supplementation significantly reduced all evaluated parameters (p&lt;0.05 vs baseline). The mean pain score from 2.50 to 0.89, while mean stiffness score was reduced to 0.55 from 1.87 at end of study. The mean swelling score was reduced to 0.81 from 2.04, while the mean weakness score was reduced to 0.64 from baseline score of 1.79. The mean tenderness score was reduced from baseline score of 1.90 to 0.65 and the mean ADL score was reduced to 0.63 from baseline score of 2.00. No treatment related side effects were observed. Conclusions: Fibroset™ is a potentially effective and safe therapy for subjects with neuromuscular pain. It can be used to reduce symptoms in patients with unsatisfactory results with conventionally standard care therapy.

Anti-Epileptic Medication Exposure Influences Functional Status in New Zealand Stroke Patients: A Retrospective Population-Level Study.

BackgroundPatients who develop seizures after stroke have disproportionately poorer outcomes and increased mortality.ObjectiveOur objective was to investigate whether exposure to anti-epileptic medications influenced long-term functional status after stroke.MethodsWe used linked health administrative data from a cohort of adult stroke patients in New Zealand. Demographics and prescription information were obtained from the National Minimum Dataset and Pharmaceutical Collection, respectively. Activities of daily living (ADL) scores for the same patients were obtained using the International Resident Assessment Instrument. Beta regression was used to investigate the relationship between anti-epileptic drug (AED) exposure and functional status.ResultsThe study included 3606 patients with a single ischaemic stroke between 2012 and 2017. In total, 15% were dispensed an AED in the 3 months before or after stroke. The adjusted odds ratio (OR) for AED exposure was 1.29 (95% confidence interval [CI] 1.15–1.45). Overall AED exposure, categorical body mass index (BMI), ethnicity, length of hospital stay, and exposure to paracetamol, opioids, anti-psychotics, and anti-nausea medications were significantly associated with changes in the mean ADL score percentages. Considering the exposure timeframe, the ORs for AED exposure only after stroke and for exposure both before and after stroke were 1.52 (95% CI 1.31–1.78) and 1.09 (95% CI 0.93–1.27), respectively.ConclusionStroke patients with AED exposure had greater odds of a higher ADL score, indicating a poorer long-term functional status than those unexposed to AEDs. The timeframe of exposure impacted on functional status, with patients exposed only after stroke having increased odds of higher ADL scores than those exposed both before and after stroke.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40801-021-00280-5.

Patterns and predictors of rehabilitation therapy among older patients with advanced cancer admitted to nursing homes: A SEER-Medicare analysis.

6585 Background: Functional impairments affect &gt; 40% of hospitalized patients (pts) with advanced cancer. After hospital discharge, about 20% of pts received rehabilitation (rehab) in nursing homes (NHs) to maintain functional independence. There is evidence from broad pt cohorts that Medicare Prospective Payment (PP) financially incentivizes NHs to provide extra rehab. This study examines rehab utilization among pts with advanced cancer admitted to NHs. Methods: The 2011-2016 SEER-Medicare data were linked with NH Minimum Data Set 3.0 data, which includes sociodemographic and clinical characteristics at admission. Study cohort included traditional Medicare pts with stage IV breast, lung, and colorectal cancer who were admitted to NHs after hospital discharge. Outcomes: total weekly rehab minutes of physical therapy, occupational therapy, and speech-language pathology; ultra-high rehab (≥720 min/wk); and rehab within 10 minutes of threshold (720-730 min/wk). Function and cognition were assessed by Activities of Daily Living (ADL) [7 domains; total score ranges 0 to 28 (higher = dependent)] and Cognitive Function Scale (intact, mild, moderate, severe impairment). Charlson Comorbidity Index (CCI) and survival from NH admission were computed. Generalized linear mixed models examined predictors of rehab outcomes adjusting for NH random effects. Results: A total of 7,453 pts were included (mean age 78.0, 85.8% White, 74.1% lung/ 16.1% colorectal/ 9.7% breast cancer; 76.1% had surgery, 8.9% had chemotherapy; mean CCI 1.9). The mean ADL score was 18.0, with on average 4.7 impairments; 40.2% reported ≥ mild cognitive impairment. Pts received on average 498 (SD = 245) min/wk rehab, but the distribution was trimodal. The number of pts who received 720-730 min/wk rehab was 2.7 times of the secondary peak at 500-510. From 2011-2016, the proportion of pts receiving ultra-high therapy (19.5%-48.4%) and within-threshold rehab (11.0%-32.0%) more than doubled. Only 5.9% of pts were documented on admission as having a life expectancy &lt; 6 months, yet 32.1% and 74.3% died in 30 days and 6 months, respectively. Multivariable regressions indicate that compared to pts with ≥6 months’ expectancy, those with &lt; 6 months’ expectancy received less rehab (β = -117.6), especially ultra-high rehab (odds ratio = 0.31). Pts with cognitive impairments received less rehab. Conclusions: Rehab utilization in older NH pts with advanced cancer mirrors patterns found in broader cohorts. Under PP, rehab minutes provided strongly followed payment thresholds. Over 5 years, more pts were provided 720-730 min/wk rehab, and 1/3 of these pts were at the end of life. Poor prognostication might contribute to the use of ultra-high rehab. Future work should evaluate whether the new Patient Driven Payment Model avoids excessive rehab use in patients with limited life expectancies.

Sex-specific differences in the prevalence of sarcopenia among pre-frail community-dwelling older adults in Saudi Arabia.

ObjectivesTo assess sex differences in the prevalence of sarcopenia among pre-frail community-dwelling older adults in Saudi Arabia.MethodsThis was a cross-sectional study conducted at a tertiary-level hospital in Riyadh, Saudi Arabia, in 2019. The study participants were pre-frail community-dwelling older adults, according to the Edmonton Frail Scale. The SARC-F questionnaire was used to diagnose sarcopenia. The Katz Activities of Daily Living (ADL) was used to rank the adequacy of performance in six functions: bathing, dressing, toileting, transferring, continence, and feeding, while the Lawton Instrumental Activities of Daily Living scale was used to assess the more complex ADL necessary for living in the community.ResultsIn total, 283 community-dwelling older adults were recruited for this study, with a mean (±SD) age of 70.77 (±6.26) years; 72.7% of the total were female participants. The majority (85.5%) of the patients reported that they needed home care assistance. The mean ADL score of the participants was high, indicating high function and independence (KATZ-ADL: M 4.60 SD 1.75; Lawton Brody: 60%). The overall prevalence of sarcopenia among the studied participants was 65.7%, which was significantly higher among females (71.9%) than among males (59.1%), with a P-value of 0.007. Among the demographic characteristics of the participants, there was a significant difference in the need for home care assistance in female sarcopenic and non-sarcopenic participants (74.1% vs. 25.9%, p = 0.017), but without demonstrable difference in males. Additionally, there was a significant difference (P < 0.05) in the prevalence of sarcopenia between male and female participants according to ADL scores. The strongest predictor for sarcopenia prevalence in males was an ADL score <2 according to the Katz index, with an odds ratio of 6.5, while the need for home care was the only significant predictor of sarcopenia among female participants (OR 3.25, CI: 1.14–9.25, p = 0.02).ConclusionOverall, almost two-thirds of the studied pre-frail community-dwelling older adult population were sarcopenic. The prevalence of sarcopenia was significantly higher among females than males. The strongest predictor of sarcopenia was an ADL score <2 based on the Katz index in males and the need for home care assistance in females.

Outcomes of Arthroscopic All-Inside Meniscal Root Repair vs. Observation in Older Patients

Meniscal root tears occur in a bimodal distribution, affecting both young healthy athletes and older patients with early degenerative knees. Root tears lead to de-tensioning of the meniscus and have been associated with increased contact forces and cartilage damage. Management of older patients with root tears is controversial and the efficacy of different treatment options is unclear. The primary aim of this study is to compare the clinical outcomes of patients undergoing an all-inside arthroscopic repair technique versus non-operative management for posterior meniscal root tears. 48 patients diagnosed with a posterior meniscal root tear between 2006 and 2015 were identified and divided into 2 groups: the arthroscopic repair group (AR, 30 knees) and the observation group (O: 18 knees). The AR group underwent a meniscal root repair technique where two all-inside sutures were used to reduce the root back to its remnant (reduction sutures) thereby re-tensioning the meniscus. One mattress suture was then added to strengthen the repair by re-approximating the construct to the posterior capsule. KOOS subscores (Symptoms, Pain, Activities of Daily Living (ADL), Sports and Rec, Quality of Life), Lysholm, Tegner, and VR12 PCS questionnaires were used as the primary outcome measures at a minimum 2 years follow-up. Differences in baseline patient characteristics between the surgical and non-surgical group were examined using Fisher’s exact tests for categorical variables and Mann-Whitney U tests for continuous variables. For changes from baseline to follow up between the surgical and non-surgical group, independent sample t-tests or Mann-Whitney U tests were conducted depending on normality. A Fisher’s exact test was also utilized to analyze the rates of conversation to total knee arthroplasty (TKA) between the surgical and non-surgical group. There were significant changes in all baseline to follow up mean KOOS (all subscores: p < 0.001), Lysholm (p < 0.001), Tegner (p = 0.0002), and VR12 PCS (p < 0.001) scores for the AR group, while the O group had a significant difference in only mean KOOS pain (p = 0.003), KOOS ADL (p = 0.006), and VR12 PCS (p = 0.038) scores from baseline to follow-up. The AR group had a significantly larger increase from baseline to follow up in mean KOOS pain scores (32.0) compared to the O group (15.7) (p = 0.009), KOOS symptom scores (AR: 24.2, O: 9.3, p = 0.029) as well as in Lysholm scores (AR: 27.3 and O: 7.1; p = 0.016). During the follow-up period, 3.3% of patients in the AR group underwent a TKA, which was significantly lower than the 33.3% of patients in the O group (p = 0.008). The hazard of TKA conversion is estimated to be 93.2% lower for patients in the AR group compared to the O group (p = 0.013). Our study found a significant improvement in all clinical outcome scores in the AR group at 2-year follow-up. There was a significantly larger increase in KOOS pain, KOOS symptom, and Lysholm scores in the AR group compared to the O group. The AR group also had a significantly lower conversion to TKA and significantly lower hazard of TKA conversion as compared to the O group. Surgical management showed higher functional outcomes and decreased TKA conversion rates as compared to observation and should be considered as a treatment option for the treatment of meniscal root tears in the older population.

Early integration of palliative care in a long-term care home: A telemedicine feasibility pilot study.

Palliative care plays an essential role in enhancing the quality of life and quality of death for residents in long-term care homes (LTCHs). Access to palliative care specialists is one barrier to providing palliative care to LTCHs. This project focused on palliative telemedicine, specifically evaluating whether integration of early palliative care specialist consultation into an LTCH would be feasible through the implementation of videoconferencing during routine interdisciplinary care conferences. This was a mixed-methods evaluation of a pilot program implementation over 6 months, to integrate early palliative care into an LTCH. There were two pilot communities with a total of 61 residents. Resident demographics were collected by a chart review, and palliative telemedicine feasibility was evaluated using staff and family member surveys. For the 61 residents, the average age of the residents was 87 years, with 61% being female and 69% having dementia as the primary diagnosis. The mean CHESS (Change in Health, End-Stage Disease, Signs, and Symptoms) and ADL (Activities of Daily Living) scores were 0.8 and 4.0, respectively, with 54% having a Palliative Performance Scale score of 40. Seventeen clinical staff surveys on palliative teleconferences were completed with the majority rating their experience as high. Ten out of the 20 family members completed the palliative teleconference surveys, and the majority were generally satisfied with the experience and were willing to use it again. Clinical staff confidence in delivering palliative care through telemedicine significantly increased (P = 0.0021). The results support the feasibility of videoconferencing as a means of palliative care provision. Despite technical issues, most clinical staff and families were satisfied with the videoconference and were willing to use it again. Early integration of palliative care specialist services into an LTCH through videoconferencing also led to improved self-rated confidence in the palliative approach to care by clinical staff.

MR-guided focused ultrasound cerebellothalamic tractotomy for chronic therapy-resistant essential tremor: anatomical target reappraisal and clinical results.

In addition to the well-recognized ventral intermediate nucleus (Vim) thalamotomy for the treatment of chronic therapy-resistant essential tremor (ET), an alternative approach targeting the posterior part of the subthalamus was proposed in the 1960s and early 1970s and then was reactualized as cerebellothalamic tractotomy (CTT) with the advent of MR-guided focused ultrasound (MRgFUS) surgery. The goal of this study was to improve target coverage and thus efficacy (i.e., tremor control and its consistency). The authors undertook a histological reappraisal of the CTT target and proposed a targeting strategy of the MRgFUS CTT based on 1) the MR visualization of the center of the red nucleus and 2) the application of preplanned target subunits realized with short sonications under thermal dose control. This study was aimed at demonstrating the efficacy and risk profile of this approach against chronic therapy-resistant ET. Ten consecutive patients suffering from chronic therapy-resistant ET benefited from a unilateral MRgFUS CTT and were followed over the course of 1 year. Primary endpoints were subjective tremor relief, Clinical Rating Scale for Tremor (CRST) score, activities of daily living (ADL) score, and the hand function (HF) scores HF16 and HF32. Histological reappraisal of the target led the authors to propose a standardized targeting protocol for MRgFUS CTT. Thermal doses for 18 and 240 cumulative equivalent minutes at 43°C were calculated and correlated with intraoperative and 2 days postoperative T2-weighted MR images. The mean ± SD for the baseline CRST score was 48 ± 12; the score was 16 ± 7 at 3 months, and 17 ± 8 at 1 year. The mean tremor relief rated by the patients for the operated side was 95% after 2 days, 96% at 3 months, and 93% at 1 year. The mean HF16 was 11.0 ± 2.1 at baseline, 0.7 ± 0.7 at 3 months, and 0.8 ± 0.9 at 1 year (93% mean reduction). The minimum reduction for the HF16 at 1 year was 78%. There was a 51% reduction of the mean ADL score at 1 year. There was no bleeding or infection. Gait difficulties, only detectable on tandem gait, were increased in 3 patients and reduced in 2 patients at 1 year. There was no dysarthria. The authors' results suggest that MRgFUS CTT is a very effective treatment option for therapy-resistant ET.

Association between working memory impairment and activities of daily living in post-stroke patients

Aim Stroke is one of the leading causes of adult disability and functional impairment worldwide. Cognitive impairments including memory dysfunction are common after stroke and may have a negative impact to the functional status and activities of daily living (ADL). The study aimed to determine the impact of working memory impairment after stroke on ADL. Methods This cross-sectional study involved post-stroke patients who underwent neurologic examination and mini mental state examination (MMSE), forward digit span (FDS) and backward digit span (BDS) to assess cognitive function, and assessment of daily life activities (ADL) and instrumental activities of daily living (IADL) scales. Results This study included 38 patients, 23 (60.5%) males and 15 (39.5%) females. The mean MMSE, FDS and BDS scores were 24.60±4.49, 4.87±1.166 and 3.47±1.158, respectively. There were 17 (44.7%) patients with cognitive impairment (MMSE Score was lower than 24). The mean ADL and IADL scores were significantly higher in patients with cognitive impairment, showing greater dependency in this group of patients. There was a significant negative correlation between global cognitive function, working memory and ADL and IADL scores in post-stroke patients. Conclusion Cognitive impairment has a negative impact on daily life activities in post-stroke patients.

Outcomes of Arthroscopic Repair versus Observation in Older Patients

Objectives: Meniscal root tears occur in a bimodal distribution, affecting both young healthy athletes and older patients with early degenerative knees. Root tears lead to de-tensioning of the meniscus and have been associated with increased contact forces and cartilage damage. Management of older patients with root tears is controversial and the efficacy of different treatment options is unclear. The primary aim of this study is to compare the clinical outcomes of patients undergoing an all-inside arthroscopic repair technique versus non-operative management for posterior meniscal root tears. Methods: 48 patients diagnosed with a posterior meniscal root tear between 2006 and 2015 were identified and divided into 2 groups, the arthroscopic repair group (AR, 30 knees), and the observation group (O: 18 knees). The AR group underwent a meniscal root repair technique where two all-inside sutures were used to reduce the root back to its remnant (reduction sutures) thereby re-tensioning the meniscus. One mattress suture was then added to strengthen the repair and repair the construct to the posterior capsule. KOOS subscores (Symptoms, Pain, Activities of Daily Living (ADL), Sports and Rec, Quality of Life), Lysholm, Tegner, and VR12 PCS questionnaires were used as the primary outcome measures at a minimum 2 years follow-up. Differences in baseline patient characteristics between the surgical and non-surgical group were examined using Fisher’s exact tests for categorical variables and Mann-Whitney U tests for continuous variables. For changes from baseline to follow up between the surgical and non-surgical group, independent sample t-tests or Mann-Whitney U tests were conducted depending on normality. A Fisher’s exact test was also utilized to analyze the rates of conversation to total knee arthroplasty (TKA) between the surgical and non-surgical group. Results: There were significant changes in all baseline to follow up mean KOOS subscores (all subscores: p &lt; 0.001), Lysholm (p &lt; 0.001), Tegner (p = 0.0002), and VR12 PCS (p &lt; 0.001) scores for the AR group, while the O group had a significant difference in only mean KOOS pain (p = 0.003), KOOS ADL (p = 0.006), and VR12 PCS (p = 0.038) scores from baseline to follow-up. The AR group had a significantly larger increase from baseline to follow up in mean KOOS pain scores (32.0) compared to the O group (15.7) (p = 0.009), KOOS symptom scores (AR: 24.2, O: 9.3, p = 0.029) as well as in Lysholm scores (AR: 27.3 and O: 7.1; p = 0.016). During the follow-up period, 3.3% of patients in the AR group underwent a TKA, which was significantly lower than the 33.3% of patients in the O group (p = 0.008). The hazard of TKA conversion is estimated to be 93.2% lower for patients in the AR group compared to the O group (p = 0.013). Conclusion: Our study found a significant improvement in all clinical outcome scores in the AR group at 2-year follow-up. There was a significantly larger increase in KOOS pain, KOOS symptom, and Lysholm scores in the AR group compared to the O group. The AR group also had a significantly lower conversion to TKA and significantly lower hazard of TKA conversion as compared to the O group. Surgical management showed higher functional outcomes and decreased TKA conversion rates as compared to observation and should be considered as a treatment option for the treatment of meniscal root tears in the older population.

Very early versus delayed mobilisation after stroke.

Very early versus delayed mobilisation after stroke.

Balloon aortic valvuloplasty to improve candidacy of patients evaluated for transcatheter aortic valve replacement.

Evaluate the role of balloon aortic valvuloplasty (BAV) in improving candidacy of patients for transcatheter aortic valve replacement (TAVR). Patients who are not candidates for TAVR may undergo BAV to improve functional and clinical status. 117 inoperable or high-risk patients with critical aortic stenosis underwent BAV as a bridge-to-decision for TAVR. Frailty measures including gait speed, serum albumin, hand grip, activities of daily living (ADL); and NYHA functional class before and after BAV were compared. Mean age was 81.6 ± 8.5 years and the mean Society of Thoracic Surgeons predicted risk of mortality was 9.57 ± 5.51, with 19/117 (16.2%) patients non-ambulatory. There was no significant change in mean GS post-BAV, but all non-ambulatory patients completed GS testing at follow-up. Albumin and hand grip did not change after BAV, but there was a significant improvement in mean ADL score (4.85 ± 1.41 baseline to 5.20 ± 1.17, P = 0.021). The number of patients with Class IV congestive heart failure (CHF) was significantly lower post BAV (71/117 [60.7%] baseline versus 18/117 [15.4%], P = 0.008). 78/117 (66.7%) of patients were referred to definitive valve therapy after BAV. When evaluating frailty measures post BAV, we saw no significant improvement in mean GS, however, we observed a significant improvement in non-ambulatory patients and ADL scores. We also describe improved Class IV CHF symptoms. With this improved health status, the majority of patients underwent subsequent valve therapy, demonstrating that BAV may improve candidacy of patients for TAVR.

Evaluation of activities of daily living following pseudophakic presbyopic correction

BackgroundPseudophakic presbyopic correction is among the prevalent methods for regaining near vision capacity. The purpose of this study is to compare the impact of pseudophakic monovision correction and multifocal lens implantation on the performance in a series of activities of daily living (ADL) of presbyopic patients.MethodsAn ADL research framework (10 ADLs) was constructed and validated in a sample of patients divided into three validation groups according to their near visual acuity. Sixty-two participants that underwent mini-monovision (MoG) cataract extraction and 60 that underwent bilateral multifocal lenses implantation (MfG) populated study groups and addressed the ADLs. Binocular uncorrected distant (BdUVA) and near (BnUVA) visual acuity were associated with ADL scores and with subjective satisfaction using the VF-14 questionnaire.ResultsTest-retest reliability [all Intraclass Correlations Coefficients (ICC) >0.90] and construct validity (all p < 0.05) tests indicated sufficient psychometric performance of the ADL framework. Both study groups presented comparable mean ADL scores (p = 0.07) however, MoG patients had lower performance in demanding ADLs (p = 0.02). ADL scores demonstrated significant correlation with BnUVA (r2 = −0.67, p < 0.01) VF-14 scores (r2 = 0.53, p < 0.01).ConclusionsBoth methods provide sufficient near vision capacity for the majority of activities of daily living. However, only multifocal lens implantation can address demanding near vision tasks.Trial registrationClinicalTrials.gov Identifier: NCT02431156.

Does physical exercise improve ADL capacities in people over 65 years with moderate or severe dementia hospitalized in an acute psychiatric setting? A multisite randomized clinical trial.

Several studies on the effect of physical exercise on activities of daily living (ADL) for people with dementia exist; yet, data concerning the specific context of acute psychiatric hospitals remain scant. This study measured the effect of a physical exercise program on ADL scores in patients with moderate to severe dementia hospitalized in an acute psychiatric ward. A multicenter clinical trial was conducted in five Swiss and Belgian psychiatric hospitals. Participants were randomly allocated to either an experimental group (EG) or a control group (CG). Members of the EG received 20 physical exercise sessions (strengthening, balance, and walking) over a four-week period while members of the CG participated in social interaction sessions of equivalent duration and frequency, but without physical exercise. The effect of exercise on ADL was measured by comparing scores of the Barthel Index and the Functional Independence Measure in the EG and CG before and after the intervention, and two weeks later. Hundred and sixty patients completed the program. Characteristics of participants of both groups were similar at the inception of the study. The mean ADL score of EG decreased slightly over time, whereas that of the CG significantly decreased compared to initial scores. Overall differences between groups were not significant; however, significant differences were found for mobility-related items. ADL scores in elderly with moderate to severe dementia deteriorate during acute psychiatric hospitalization. An exercise program delays the loss of mobility but does not have a significant impact on overall ADL scores.

Low skeletal muscle mass index is associated with function and nutritional status in residents in a Turkish nursing home

Introduction: To determine the prevalence of low muscle mass (LMM) and the relationship between LMM with functional and nutritional status as defined using the LMM evaluation method of European Working Group on Sarcopenia in Older People (EWGSOP) criteria among male residents in a nursing home.Methods: Male residents aged >60 years of a nursing home located in Turkey were included in our study. Their body mass index (BMI) kg/m2, skeletal muscle mass (SMM-kg) and skeletal muscle mass index (SMMI-kg/m2) were calculated. The participants were regarded as having low SMMI if they had SMMI <9.2 kg/m2 according to our population specific cut-off point. Functional status was evaluated with Katz activities of daily living (ADL) and Lawton Instrumental Activities of Daily Living (IADL). Nutritional assessment was performed using the Mini Nutritional Assessment (MNA). The number of drugs taken and chronic diseases were recorded.Results: One hundred fifty-seven male residents were enrolled into the study. Their mean age was 73.1 ± 6.7 years with mean ADL score of 8.9 ± 2.0 and IADL score of 8.7 ± 4.6. One hundred twelve (71%) residents were aged >70 years. Thirty-five men (23%) had low SMMI in group aged >60 years, and twenty-eight subjects (25%) in the group aged >70 years. MNA scores were significantly lower in residents with low SMMI compared with having normal SMMI (17.1 ± 3.4 versus 19.6 ± 2.5, p = 0.005). BMI was significantly lower in the residents with low SMMI compared with normal SMMI (19.6 ± 2.7 versus 27.1 ± 4.1, p< 0.001). ADL scores were significantly different between residents with low SMMI and normal SMMI in those aged >70 years (8.1 ± 2.6 versus 9.1 ± 1.6, p = 0.014). In regression analyses, the only factor associated with better functional status was the lower age (p = 0.04) while the only factor associated with better nutrition was higher SMMI (p = 0.01).Conclusions: Low SMMI detected by LMM evaluation method of EWGSOP criteria is prevalent among male nursing home residents. There is association of low SMMI with nutritional status and probably with functional status within the nursing home setting using the EWGSOP criteria with Turkish normative reference cut-off value.

Dementia care in Ontario, Canada: evidence of more timely diagnosis among persons with dementia receiving care at home compared with residential facilities

ObjectiveHome care (HC) has been promoted as an efficient alternative to residential care (RC). However, little is known about the individuals who receive HC. This study compared the cognitive and functional statuses of persons with dementia receiving HC or RC at the time of diagnosis with dementia. It was hypothesized that persons with dementia receiving RC would have declined further, both cognitively and functionally. Study designPopulation-based secondary data analysis. MethodsData from the Canadian Institute for Health Information's Continuing Care Reporting System and the Home Care Reporting System, 2009–2011, were used. Respective populations of 39,604 and 21,153 persons with dementia who received either RC or HC were included. Cognitive and functional statuses were measured using a cognitive performance scale (CPS) and an activities of daily living (ADL) scale, respectively. ResultsThe mean CPS score was higher for the RC group (3.2 vs 2.5). The proportion of individuals diagnosed when impairment was moderate to very severe (CPS ≥ 4) was higher in the RC group (32.0% vs 13.3%). The mean ADL score was also higher for the RC group (3.5 vs 1.6). The proportion of individuals diagnosed when they required extensive assistance or were totally dependent (ADL ≥ 3) was markedly higher in the RC group (72.3% vs 27.3%). All findings were statistically significant (P < 0.0001). Multivariable analysis suggested that RC clients were nearly four times more likely than HC clients to be diagnosed at a later stage (odds ratio = 3.74, 95% confidence interval 3.54–3.95). ConclusionsPersons with dementia in RC facilities in Ontario are diagnosed when their cognitive and functional statuses have declined more than those of their HC counterparts.