Measures Of Functional Ability Research Articles

Exploring functional abilities and competing risks among stroke patients: a longitudinal and survival analysis study at Felege Hiwot Referral Hospital, Ethiopia

ObjectivesThis study aimed to evaluate competing risks and functional ability measures among patients who had a stroke.DesignA joint model comprising two related submodels was applied: a cause-specific hazard submodel for...

Efficacy of cognitive training on cognition, symptoms and functioning: Impact of motivation and attendance

While cognitive remediation therapy (CRT) and compensatory strategy training both have large literature bases supporting their efficacy on both proximal and distal outcomes, the research base on stand-alone cognitive training (CT) is smaller and less consistent, with little information about factors associated with better outcomes. In this study, we examined the efficacy of CT on training task, cognitive, symptom, and functional ability measures as well as the impact of motivational interviewing (MI), motivation level, and session attendance on treatment outcomes. Adults with psychotic spectrum disorders (n = 114) were randomized to MI or a sham control interview (CI), followed by 4 months of computerized CT. In whole sample analyses, participants improved on training tasks, cognitive performance, and psychiatric symptoms, but self-reported cognition, self-reported depression, and functional ability did not change. Compared to CI, MI was associated with greater reductions in self-reported depressive symptoms. Motivation level and session attendance did not significantly influence outcomes. Findings support the efficacy of CT on several key outcomes, and its simplicity may be advantageous in uptake in community clinics with limited staffing. The lack of functional gains underscores the need to incorporate treatment ingredients that promote generalization and real-world implementation of learned skills. We also speculate that engagement during course of training may be a better predictor of training success than baseline task-specific motivation.

Effects of Hop Stabilization versus Balance Training on Disability and Balance in Chronic Ankle Instability among Basketball Players

Background: Ankle sprains, which often lead to chronic ankle instability (CAI), are common within the young, athletic population, particularly among basketball players. Rehabilitation programs frequently employ hop stabilization and balance training to mitigate the complications associated with CAI. This research was undertaken to compare the effectiveness of these two training approaches in improving disability and balance in affected individuals. Objective: The study aimed to evaluate and contrast the impact of hop stabilization versus balance training on disability and balance in basketball players with CAI. Methods: The randomized clinical trial was conducted at Ranger’s Teaching Hospital in Lahore, targeting young basketball players aged between 25 to 35 years with a history of recurrent ankle sprains and at least 8 months of playing experience. Through a non-probability convenient sampling technique, the participants were randomized into two groups: Group A underwent 6 weeks of hop stabilization training in addition to general training, while Group B participated in 6 weeks of balance training coupled with their general training regimen. The efficacy of these interventions was quantified using the Star Excursion Balance Test, Functional Ankle Disability Index, Functional Ankle Ability Measure questionnaire, and Multiple Single Leg Hop Stabilization Test (MSLHST). Results: Post-training assessments within groups indicated significant enhancements in disability and balance scores, with p-values below 0.05, suggesting notable improvements. However, when comparing the two groups, the Functional Ankle Ability Measure, Ankle Disability Index, and Star Excursion Balance Test showed no significant differences, with p-values exceeding 0.05. Notably, the MSLHST exhibited a significant contrast, with Group B showing a mean score decrease from 10.7857 to 5.7857, reflecting a 46% improvement, whereas Group A displayed a reduction in mean score from 13.625 to 11.7, a 14% enhancement, resulting in a significant p-value of 0.0289. Conclusion: The study concluded that balance training surpasses hop stabilization training in terms of efficacy, significantly improving balance and reducing disability in basketball players with chronic ankle instability.

Visual acuity and reading print size requirements in children with vision impairment

ABSTRACT Clinical Relevance The support of students with a vision impairment throughout education could be enhanced by assessing the functional reading ability of the individual. This visual assessment could inform educators of individualised student needs and potentially improve the academic achievement for these students. Background Support for children with a vision impairment within a classroom is typically based on clinical findings of distance visual acuity and visual fields. Therefore, determining optimal print size for reading is essential to ensure best academic outcomes. Secondary aims were to investigate the possible impact of underlying pathology on reading ability. Methods Forty-seven participants were recruited from a state-wide support service for children with a vision impairment in South Australia. Three visual acuity groups were formed based on World Health Organisation definitions of mild, moderate, and severe vision impairment. Correlation between clinical measures of distance visual acuity using the Freiburg Visual Acuity Test, were compared with reading acuity and critical print size (smallest font before reading speed reduced) using Minnesota low vision reading chart (MNREAD). Results No significant correlations were found for mild (0.20–0.49 logMAR) and severe (1.00–1.52 logMAR) vision impairment groups between distance visual acuity and reading acuity read (p = .64, CI [−.585, .395]/p = .82, CI [−.48, .58]) or critical print size (p = .78, CI [−.57, .45]/p = .43, CI [−.34, .68]. A significant correlation was found for the moderate vision impairment group: 0.50–0.99 logMAR for minimum reading acuity (p < .001, CI [.44, .91]) and critical print size (p = .03, CI [.05, .80]). Conclusions Standard clinical measures of distance visual acuity are an unpredictable estimate of reading ability in children with mild and severe vision impairment. Additional measures of functional near reading ability could provide a more meaningful indicator of reading ability and help provide optimum support to students through education.

9 Predictive Ability of the Performance Assessment of Self-Care Skills (PASS) in a Sample of Predominantly Low-Income, Community Dwelling, African American Older Adults

Objective:Mild decline in independent functioning is a core diagnostic criterion for Mild Cognitive Impairment. Performance-based assessments have been considered the gold standard to identify subtle deficits in functioning. Existing assessments were largely designed using demographically homogenous samples (white, highly educated, middle class) and often assume tasks are performed similarly across populations. The current study aimed to validate the utility of the Performance Assessment of Self-Care Skills (PASS) in determining cognitive status in a sample of predominantly African American, low-income older adults.Participants and Methods:Cognition and functional capacity were measured in n=245 older participants (aged 50+ years) who were recruited from a larger community study located in Pittsburgh, PA. Cognitive status was defined by a mean split on the Modified Mini Mental Status Examination (3MS) score (84/100). Participants above the cutoff were classified as unlikely cognitive impairment (UCI) and those below classified as potential cognitive impairment (PCI). Functional capacity was assessed using the number of cues provided on three PASS subtasks: shopping, medication management, and critical information retrieval (higher score = worse functioning). Self-reported cognitive and functional decline was assessed via the Everyday Cognition (ECog) questionnaire (higher score = greater decline). Generalized linear models compared performance scores between groups adjusting for literacy (WRAT3), age, and education. Receiver operating characteristic curve (ROC) analyses were run for select functional performance scores to assess their predictive ability in discriminating between PCI and UCI.Results:Compared to the UCI group (N = 179), the PCI group (N = 66) was older (68 vs. 65 years, p = 0.05), less educated (11 years vs. 12 years, p &lt; 0.01), had lower WRAT3 z-scores (0.19 vs. -0.55, p &lt; .01), and required more cues on the shopping (4.33 vs. 8.54, p &lt; 0.01) and medication management PASS subtasks (2.74 vs. 6.56, p &lt; .01). Both groups reported elevated levels of subjective cognitive complaints on the ECog (1.46 vs. 1.56, p = .09) and performed similarly on the critical information retrieval PASS subtask (0.25 vs 0.54, p = .06). When discerning between UCI and PCI groups, the PASS Shopping subtask had an optimal cut-off score of 4, sensitivity of 0.86, specificity of 0.47, positive predictive value (PPV) of 0.37, and area under the curve (AUC) of 0.71. PASS Medication Management had an optimal cut-off score of 3, sensitivity of 0.77, specificity of 0.56, PPV of 0.39, and AUC of 0.74.Conclusions:Subjective functional decline and performance on the critical information retrieval subtask were not associated with cognitive groups. PASS shopping and medication management had moderately high AUCs, suggesting they can reliably distinguish between groups. However, both tasks also exhibited low PPVs, low levels of specificity, and high levels of sensitivity, making them strong “rule-out” tests but poor “rule-in” tests in this sample. Because accurate assessment of functioning is useful for MCI and critical to dementia diagnosis, it is imperative we understand how these tasks function across different populations. Future work should 1) validate measures of functional ability across different populations and 2) develop population-appropriate assessments for use in clinical and research settings.

Screw Only Fixation vs Plate Fixation For 1st MTPJ Arthrodesis: A Comparative Retrospective Study

Category: Midfoot/Forefoot; Other Introduction/Purpose: First metatarsolphalangeal joint (MTPJ) arthrodesis is a commonly performed surgical procedure for end- stage arthritis. Various fixation techniques have been described. The most commonly used are screw-only fixation (either crossed or parallel) or plate fixation (with or without independent lag-screws). A recent systematic review reported that union rates for screw fixation were lower compared to plate constructs. The aim of this study was to compare union rates, complication rates and functional outcomes between screw-only fixation and plate fixation in a recent cohort of patients undergoing first MTPJ arthrodesis at a tertiary foot ankle orthopaedic institution. Methods: This was a retrospective cohort study. After institutional review board approval, a database search was conducted to identify patients who underwent primary first MTPJ arthrodesis between 2015 and 2022. All patients had a dorsal approach, preparation of joint surfaces with cup and cone reamers and fixation with either crossed cannulated screws or a dorsal pre- contoured locking plate (with or without an independent lag-screw). Demographic, operative (fixation type) and outcome data was collected. The primary outcome was the incidence of arthrodesis at 6 months postoperatively. Secondary outcomes included complications at 6 months postoperatively and change in functional outcome scores from preoperatively to 6 months postoperatively as assessed by the Functional Ankle Ability Measure (FAAM) and Visual Analog Pain scores (VAS). Statistical analyses included descriptive statistics as well as univariable and multivariable analyses to determine if one fixation method was associated with a higher incidence of arthrodesis. Results: There were 108 patients identified, 54 in the screw-only group (mean age 62.9 years, 79.6% female, mean body-mass index (BMI) 28.6 kg/m2) and 54 in the plate-fixation group (mean age 63.2 years, 81.5% female, mean BMI 30.0kg/m2). Arthrodesis at 6 months in the screw-only group occurred in 52 of 54 patients (96.3%) and in 50 of 54 patients (92.6%) in the plate-fixation group, p=0.68. Fixation type was not a predictor of non-union on multivariable analysis. The complication rate was 11.1% (n=6) in screw-only patients (four hardware removals, two non-unions) and 14.8% (n=8) in plate-fixation patients (four non-unions, two hardware removals, two wound infections), p=0.57. Both groups reported increases in VAS and FAAM scores at 6 months from baseline, with no significant between-group differences. Conclusion: The arthrodesis rate for screw-only fixation was higher than patients receiving plate-fixation, however, this difference did not reach statistical significance. Similar complication rates were observed in each group. These results provide evidence for the safety and efficacy of screw-only fixation constructs, however, further adequately powered prospective studies are required. Future studies should also include a cost effectiveness analysis and a comparison of radiation exposure and operative time between groups to determine the optimal fixation method for patients undergoing this procedure.

Effect of Stretching Exercise to Increase Joint Range of Motion and Functional Ability in Post-Burn Shoulder Contracture Patients: A Case Report

Burns are tissue damage or loss caused by contact with high temperatures, such as heat, radiation, electricity, and chemicals. Causes damage to the epidermis and underlying soft tissue, bone, and muscle, placing burn victims at risk for contractures and joint deformities. Upper extremity function is critical to the performance of activities of daily living. Interventions such as surgery, pharmacological therapy, and nutritional support are important in aiding recovery and improving clinical outcomes after severe burns. The aimed to determine the effect of stretching exercises on increasing range of motion and functional ability in post-burn shoulder contracture. This study used the case study method which was conducted on post-shoulder contracture burn patients at Central General Hospital Dr. I.G.N.G Ngoerah Bali in February 2023. Pain measurements were taken using the Numeric Rating Scale (NRS). Measurement of muscle strength using Manual Muscle Testing (MMT). Goniometer to measure the Range of Joint Motion (ROM). Shoulder Pain and Disability Index (SPADI) to measure functional ability. SPADI is a quality of life questionnaire consisting of 13 items to evaluate 5 items for pain and 8 items for impairment. After 3 times of physiotherapy, the results showed a decrease in silent pain at T0 = 2 to T3 = 1. Tenderness at T0 = 4 to T3 = 2. Movement pain T0 = 5 to T3 = 3. Increased muscle strength T0 value 2, that is not full ROM to T3 value 3, namely full ROM and can fight gravity. Increased range of motion in active and passive flexion, extension, abduction, adduction, horizontal, abduction and horizontal adduction, internal and external rotation. The increase in the functional ability of SPADI T0 = 53% then decreased to T3 = 35%. There is a significant decrease in the measurement of functional ability using SPADI, which means the patient's functional ability is increasing. The conclusion is stretching exercises are effective for increasing the range of motion and functional ability of patients with post-burn shoulder contractures. Therefore, stretching exercises should be used to provide proper burn care to patients in hospitals and burn centers.

The Functional Balance Ability Measure: A Measure of Balance Across the Spectrum of Functional Mobility in Persons Post-Stroke

ObjectiveTo determine whether the measurement properties of an instrument that combines items from the Berg Balance Scale (BBS) and the Functional Gait Assessment (FGA) called the Functional Balance Ability Measure (FBAM) supports measuring balance across the functional mobility spectrum. DesignRetrospective cohort. SettingItem-level data were from an archival research database. ParticipantsAmbulatory individuals (N=93, BBS=50 [29-56], FGA=16 [0-30], Fugl-Meyer Assessment of Lower Extremities=27 [14-34], self-selected walking speed=0.4±0.2 m/s, mean age ± SD, 61.7±11.3y; 30.1% female) with chronic stroke (≥6 months). InterventionsNot applicable. Main Outcome MeasuresUnidimensionality was evaluated with a principal components analysis (PCA) of residuals. FBAM rating-scale characteristics, item hierarchy, item and person fit, and person separation were investigated using the Andrich Rating Scale Model. ResultsPCA findings indicate the FBAM is sufficiently unidimensional. Rating scale structure was appropriate without modifying the original BBS and FGA scoring systems. Item hierarchy aligned with clinical and theoretical predictions (hardest item: FGA-gait with narrow base of support, easiest item: BBS-sitting unsupported). One item (BBS-standing on 1 foot) misfit, however, removal marginally affected person measures and model statistics. The FBAM demonstrated high person reliability (0.9) and 6 people (∼6%) misfit the expected response pattern. The FBAM separated participants into 4 statistically distinct strata, without a floor or ceiling effect. ConclusionsThe FBAM is a unidimensional measure for balance ability across a continuum of functional tasks. Rating-scale characteristics, item hierarchy, item and person fit, and person separation support the FBAM's measurement properties in persons with chronic stroke. Future work should investigate measurement with fewer items and whether the FBAM addresses barriers to adoption of standardized balance measures in clinical practice.

Factors associated with persistent pain in college athletes with a history of lateral ankle sprain

ObjectivesTo determine the factors associated with and prevalence of persistent pain in college athletes with chronic ankle instability (CAI) and with previous lateral ankle sprain (LAS) without CAI. DesignCross-Sectional Study. SettingOnline survey at one university. ParticipantsOf the 385 respondents surveyed online, 140 were identified as having experienced at least one LAS (CAI group: 69, coper group: 24, LAS group not classified as either: 47). Main outcome measuresFactors associated with the presence of pain during activities of daily living (ADL) and sports were identified using multivariate logistic regression analyses. Independent variables were demographics, injury characteristics, the Identification of Functional Ankle Instability (IdFAI) score, the Foot and Ankle Ability Measure Sports (FAAM-Sports) and ADL subscales, and the Tampa Scale for Kinesiophobia-11 score. ResultsThe prevalence of pain during ADL and sports in the three groups was 16.7%–42.0% and 33.3%–56.5%, respectively. FAAM-Sports and IdFAI score were significantly associated with pain during ADL and sports in the CAI group (odd ratio: 0.923 and 1.145), respectively. No significant pain-related factors were found in the coper and LAS groups. ConclusionsLower self-reported function and greater perceived ankle instability may be important factors in pain management in athletes with CAI.

Evaluating functional abilities within the context of memory assessment: A practice survey of neuropsychologists

Objective: Functioning in daily life is an important consideration when differentiating between individuals with normal cognition, mild neurocognitive disorder, and major neurocognitive disorder. Despite this, there is no gold standard measurement approach for assessing functional abilities and few guidelines on how to do so. The objective of this study was to examine neuropsychologists’ practices regarding the assessment of functional abilities across the spectrum of memory ability. Method: A total of 278 psychologists who routinely conduct neuropsychological assessments completed an online survey (estimated 15% response rate) querying their practices and perspectives with respect to the assessment of functional abilities. Results: Respondents identified that changes to several components of daily functioning, including activities of daily living, were important when evaluating functional abilities. Respondents reported utilizing a variety of instruments to assess functioning, with an overwhelming majority indicating the use of semi-structured interviews. Although most respondents are satisfied with existing tools, a quarter of respondents felt strongly that there was a need for more instruments of everyday functioning. Respondents further indicated that their recommendations to patients, particularly regarding compensatory strategies and follow-up with other professionals, were informed by results of their functional assessment. Conclusions: Overall, our survey results indicate that neuropsychologists perceive multiple factors of daily life to be important considerations when evaluating functioning, use a variety of techniques to assess functioning, and perceive a need for more measures of functional abilities.

Factors associated with gait speed: results from the RolE of AST120 (Renamezin) in sarCOpenia preVEntion in pRe-dialYsis chronic kidney disease patients (RECOVERY) study.

Gait speed is an important measure of functional ability. This study aimed to investigate the factors associated with gait speed in patients with chronic kidney disease. The study focused on sarcopenic components, plasma uremic or inflammatory marker levels, and quality of life effects. The RolE of AST120 (Renamezin) in sarCOpenia preVEntion in pRe-dialYsis chronic kidney disease patients is a 48-week, randomized controlled, parallel-group, open-label, multicenter trial to determine the role of Renamezin (Daewon Pharmaceutical Co., Ltd.) in patients with chronic kidney disease. The participants were classified into four groups according to gait speed: ≤0.8, 0.8-1.0, ≤1.0-1.3, and ≥1.3 m/sec. Linear regression analysis was performed to identify the factors associated with gait speed. The group with a gait speed of ≤0.8 m/sec was the oldest and had the highest proportion of participants with low education level and medical aid. Participants with a gait speed of ≤0.8 m/sec showed the lowest physical and mental component scale scores. The interleukin-6 (IL-6) level tended to be the higher trend in the lowest gait speed group. In the multivariate linear regression analysis adjusted for age, sex, diabetes mellitus, and estimated glomerular filtration rate, insurance status, handgrip strength, IL-6 level, hemoglobin level, mental component scale score, and physical component scale score were significantly associated with gait speed. In conclusion, gait speed is associated with handgrip strength, IL-6 level, and various components of quality of life in predialysis chronic kidney disease patients.

Original research: longitudinal evaluation of cognitively demanding daily function using performance-based functional assessment highlights heterogeneous trajectories in cognitive and functional abilities in people with Parkinson's disease.

Longitudinal assessment of functional abilities in Parkinson's disease (PD) is needed to determine the efficacy of cognitive interventions in providing meaningful improvements in daily life. Additionally, subtle changes in instrumental activities of daily living may precede a clinical diagnosis of dementia and could aid earlier detection of and intervention for cognitive decline. The primary goal was to validate the longitudinal application of the University of California San Diego Performance-Based Skills Assessment (UPSA). An exploratory secondary goal was to determine whether UPSA may identify individuals at higher risk of cognitive decline in PD. Seventy participants with PD completed the UPSA with at least one follow-up visit. Linear mixed effects modeling was used to identify associations between baseline UPSA score and cognitive composite score (CCS) over time. Descriptive analysis of four heterogeneous cognitive and functional trajectory groups and individual case examples was performed. Baseline UPSA score predicted CCS at each timepoint for functionally impaired and unimpaired groups (p < 0.01) but did not predict the rate change in CCS over time (p = 0.83). Participants displayed heterogenous trajectories in both UPSA and CCS during the follow-up period. Most participants maintained both cognitive and functional performance (n = 54), though some displayed cognitive and functional decline (n = 4), cognitive decline with functional maintenance (n = 4), and functional decline with cognitive maintenance (n = 8). The UPSA is a valid measure of cognitive functional abilities over time in PD. Given the heterogeneity of functional and cognitive trajectories, this performance-based assessment did not predict cognitive decline with this relatively short follow-up. Further work is needed to understand longitudinal functional assessments in PD-associated cognitive impairment.

Application of Rasch Analysis to Timed Instrumental Activities of Daily Living in Low Vision: A Validation Study.

This work validates Rasch analysis of a performance-based low vision outcome measure evaluated in patients' own homes to ensure real-world relevance. Inclusion of sources of variance from the patient's home environment in functional outcome measures introduced nonuniform variance in measurements but did not preclude estimation of valid measures. This study aimed to validate Rasch analysis of a performance-based outcome measure with real-world relevance. Low vision patients (N = 161) receiving services from an occupational therapist performed Timed Instrumental Activity of Daily Living (TIADL) tasks in their homes. Rasch analysis was applied to error count and performance time data. Internal validity was assessed with evaluations of the accuracy and precision of estimated measures. External validity was assessed by comparing TIADL measures with measures estimated from the Activity Inventory (i.e., from self-reported difficulty ratings). Task measures were well targeted to person measures estimated from task performance time but were poorly targeted for measures estimated from task performance errors, for which most task trials (72%) were performed without error at baseline. Error-based person measures had larger standard errors with a smaller pseudo- R2 than time-based person or task measures and error-based task measures. Person measure infits for time- and error-based estimates conformed to expected values. The linear regressions between time-based person and task measures and corresponding error-based estimates had slopes of approximately 0.5, an observation consistent with larger estimation error variance for error-based measures than for time-based measures. Time-based TIADL person measures ( x ) and Activity Inventory person measures (estimated from all items, y ) were colinear but weakly correlated ( R = 0.19). Functional ability measures estimated from performance times of instrumental activity of daily living tasks in patients' homes demonstrate good internal and external validity. The ceiling effect from the infrequency of task performance errors in our data set limits use of TIADL error data to measure rehabilitation outcomes.

321 Paired associative stimulation: a tool for assessing sensorimotor neural signaling and lower limb function post-stroke

OBJECTIVES/GOALS: A stroke can impair neural communication between sensory and motor pathways thus compromising walking function. Paired associative stimulation (PAS) is a useful assay of sensorimotor integration (SMI) with limited use post-stroke. The objective of this study will be to determine lower extremity PAS effectiveness and reliability post-stroke. METHODS/STUDY POPULATION: This study will use a pre-post, cross-sectional design. Ten healthy controls and 10 individuals with chronic stroke (&gt;6 months) will be recruited. PAS protocols will be individualized to account for between-subject variability in sensorimotor signaling by first measuring cortical sensory signaling using electroencephalography. Post-stroke participants will then receive PAS targeting the paretic tibialis anterior muscle; healthy controls will receive PAS targeting the non-dominant TA. Changes in cortically derived muscle responses will be characterized by absolute motor-evoked potential amplitude (MEPAmp) change, elicited by transcranial magnetic stimulation, over two sessions separated by &gt;24 hours. Clinical measures of sensorimotor function and walking ability will also be performed. RESULTS/ANTICIPATED RESULTS: By individualizing PAS protocols, we expect to see significant increases in MEPAmp pre to post PAS, determined using paired t-tests. We also anticipate reliable PAS-induced increases in MEPAmp, which will be assessed using two reliability statistics: intraclass correlation coefficient and coefficients of variation of method error. Lastly, the increases in MEPAmp will be correlated with measures of sensorimotor function and walking ability, anticipating that greater increases in MEPAmp will be related to better walking ability and sensorimotor functioning. Correlations will be assessed via a Pearson’s correlation. A preset alpha = 0.05 will be used to determine significant findings. DISCUSSION/SIGNIFICANCE: The importance of this study is that establishing individualized PAS protocols could potentially provide a reliable and clinically relevant measure of SMI. Understanding post-stroke lower extremity SMI is necessary for furthering targeted and personalized interventions to combat walking deficits.

Chronic Ankle Instability and Associated Self-Reported Function in South African Professional Ballet Dancers.

Ankle sprains are the most common acute injury among dancers and may result in the development of chronic ankle instability (CAI). Chronic ankle instability is characterized by recurrent ankle sprains, incidents of the ankle "giving way," and sensations of instability and has been reported to negatively impact functioning and psychosocial status. The large number of ankle sprains in addition to contextual factors relating to professional dancing, suggests that CAI may be a significant problem in professional ballet dancers. This study aimed to determine the prevalence of CAI and describe the ankle injury history and level of self-reported function in South African ballet dancers. This descriptive, cross-sectional study included all professional ballet dancers employed by three professional South African ballet companies (n = 65). The Identification of Functional Ankle Instability Questionnaire (IdFAI), Foot and Ankle Ability Measure (FAAM), Dance Functional Outcome Survey (DFOS), and a researcher-developed injury history questionnaire were completed by consenting participants. Descriptive statistics were calculated. A CAI prevalence of 73.3% CI [55.6%, 85.8%] was calculated among 30 participants. Twenty-five (83.3%) participants reported sustaining at least one significant ankle sprain with 88% (n = 22) indicating dance related activities as the cause. Dancers with CAI demonstrated a tendency to have less control over their ankles giving way and tended to take longer to recover from their ankles giving way than those dancers not affected. Eight participants (36.4%) with CAI were identified as having a significant level of disability on the FAAM activities of daily living (ADL) subscale and six participants (27.3%) on the sport subscale. Participants with CAI had a median total score of 83.5; IQR [80 - 90] on the DFOS. The self-reported function of South African professional ballet dancers is not severely affected, however, the high prevalence of CAI and reported symptoms is concerning. Education on CAI symptoms, prevention, and evidence-based management is recommended.

Myostatin and follistatin as monitoring and prognostic biomarkers in dysferlinopathy

Myostatin is a myokine which acts upon skeletal muscle to inhibit growth and regeneration. Myostatin is endogenously antagonised by follistatin. This study assessed serum myostatin and follistatin concentrations as monitoring or prognostic biomarkers in dysferlinopathy, an autosomal recessively inherited muscular dystrophy. Myostatin was quantified twice with a three-year interval in 76 patients with dysferlinopathy and 38 controls. Follistatin was quantified in 62 of these patients at the same timepoints, and in 31 controls. Correlations with motor function, muscle fat fraction and contractile cross-sectional area were performed. A regression model was used to account for confounding variables. Baseline myostatin, but not follistatin, correlated with baseline function and MRI measures. However, in individual patients, three-year change in myostatin did not correlate with functional or MRI changes. Linear modelling demonstrated that function, serum creatine kinase and C-reactive protein, but not age, were independently related to myostatin concentration. Baseline myostatin concentration predicted loss of ambulation but not rate of change of functional or MRI measures, even when relative inhibition with follistatin was considered. With adjustment for extra-muscular causes of variation, myostatin could form a surrogate measure of functional ability or muscle mass, however myostatin inhibition does not form a promising treatment target in dysferlinopathy.

Age Differences in Heritability of a Latent Dementia Index Score in Men and Women

AbstractBackgroundHeritability estimates of dementia are ∼50‐60% of the total variance across older adulthood. Earlier age of onset, however, might be associated with greater genetic influence whereas older age of onset might be associated with greater environmental influences. The categorical nature of dementia diagnosis outcomes has made testing the relative importance of genetic and environmental influences on dementia difficult due to low statistical power. To overcome this methodological limitation, we tested linear and quadratic effects of age on genetic and environmental variance underlying a continuous measure of dementia likelihood in men and women.MethodThe analytic sample was 5,670 (53% female) pairs of twins from 10 studies in the Interplay of Genes and Environment Across Multiple Studies (IGEMS) consortium. Dementia likelihood is quantified continuously using a latent dementia index measure that is estimated from twins’ available cognitive, memory‐specific, and functional ability measures. Linear and quadratic age differences in genetic and environmental influences on dementia likelihood were tested by modeling univariate correlation between twins’ dementia scores as a linear function of zygosity and age in Mplus. Separate models were estimated for male and female twin groups.ResultsAge moderated genetic and environmental influences on dementia likelihood scores. Both genetic and nonshared environmental variance increased as a function of age, whereas common environmental variance declined. Sex significantly moderated the effect of zygosity on the twin correlations (monozygotic male: .57, monozygotic female: .51, dizygotic male: .19, dizygotic female: .25). Notably, MZ twin correlations were consistent with previously reported heritability estimates for dementia. The pattern of age moderation was the same in men as women, although the linear effect of age on both genetic and common environmental influences was greater in men than women (see Figure 1).ConclusionAge linearly moderated genetic and environmental variance underlying dementia likelihood similarly for both men and women, despite quantitative genetic and environmental sex differences in dementia likelihood. Genetic variance accounted for similar proportions of total variance at younger ages, whereas genetic variance accounted for greater variance in men than in women at older ages.

Rehabilitation of Post-COVID-19 Musculoskeletal Sequelae in Geriatric Patients: A Case Series Study.

The musculoskeletal system is affected in over 40% of patients with Coronavirus disease 2019 (COVID-19). There is an increased need for post-acute rehabilitation after COVID-19, especially in elderly people with underlying health problems. The aim of this study was to evaluate the benefits of an early and goal-orientated rehabilitation program using combined approaches, robotic medical devices together with other rehabilitation techniques and therapies, in elderly people after acute COVID-19. Ninety-one patients (62.64 ± 14.21 years) previously diagnosed with severe SARS-CoV-2 infection were admitted to the Medical Rehabilitation Clinical Hospital Baile Felix, Romania, for medical rehabilitation, but only six patients (85.33 ± 3.07 years) met the inclusion criteria and participated in the study. The rehabilitation treatment was complex, performed over 4 weeks, and included combined approaches: exercise therapy, robotic gait training, occupational therapy, and massages. Activity and participation evaluation were performed using the Barthel Index and Functional Independence Measure for activities of daily living (ADLs). Assessments were performed at admission and discharge from the rehabilitation clinic. Lokomat patients' reports revealed that the patients had improved motor control (with one exception). The measurement of functional ability revealed an improvement in most cases. This study presents some of the first data on outcomes of COVID-19 patients' musculoskeletal rehabilitation in our country. Early complex medical rehabilitation improved functional independence and autonomy in ADLs in very old patients, post-COVID-19.

Reliability and Validity of Patient-Reported Outcome Measures for Ankle Instability in Hebrew.

BackgroundThe International Ankle Consortium has recommended several instruments for assessing and diagnosing chronic ankle instability. These include the Ankle Instability Instrument (AII), Cumberland Ankle Instability Tool (CAIT), Identification of Functional Ankle Instability (IdFAI), and Foot and Ankle Ability Measure (FAAM). This study aimed to translate, culturally adapt, and assess the reliability, validity, discriminative power, and classification agreement of the Hebrew online versions of the AII, CAIT, IdFAI, and FAAM.Material/MethodsAfter translation and cross-cultural adaptation of the questionnaires, we recruited 87 participants with self-reported ankle disorders to evaluate the psychometric properties of the questionnaires. To evaluate each questionnaire’s discriminative power, we recruited 75 healthy participants. Reliability was assessed by calculating internal consistency (Cronbach’s alphas) and test-retest intraclass correlation coefficients. Convergent and divergent validity were assessed by Spearman’s correlation between each instrument and the Short-Form-12 (SF-12) score for physical and mental components, respectively.ResultsAll instruments had acceptable internal consistency (α>0.7) and good test-retest reliability (ICC2,1>0.8), except for the IdFAI (ICC2,1=0.73). All instruments had moderate convergent validity (ρ>0.4 with SF-12 physical component) except for AII (ρ=0.36). No instrument was correlated with the SF-12 mental component score (good divergent validity, ρ<0.3). All instruments had excellent discriminative power (area under the receiver operator characteristic curve >0.9). Strong correlations were found between all instruments.ConclusionsThe Hebrew online versions of the AII, CAIT, IdFAI, and FAAM are valid, consistent, and reliable and may be used in research or clinical settings.

Distinguishing apathy and depression in dementia: A longitudinal study.

Apathy is a common symptom in dementia, though can be difficult to distinguish from depression due to shared features and frequent co-occurrence. As such, a significant limitation of much previous research on apathy is the failure to control for depression. The current study sought to address this by examining the trajectory and clinical correlates of apathy after controlling for depression. Seven hundred and seventy-nine patients with dementia were recruited from nine memory clinics around Australia. Measures of dementia severity, cognition, functional ability, neuropsychiatric symptoms, caregiver burden and medication use were completed at baseline and at regular intervals over a 3-year period. Driving and institutionalisation data were obtained throughout the study. Mortality data were obtained from state registries 8 years after baseline. Of the 662 patients with completed measures of neuropsychiatric symptoms, 342 (51.7%) had apathy and 332 (50.2%) had depression at baseline, while 212 (32.0%) had both. Whereas apathy increased over time, depression remained relatively stable. Apathy, but not depression, was associated with greater dementia severity, poorer cognition and function, driving cessation and mortality. Both apathy and depression were associated with greater neuropsychiatric symptoms, psychosis, caregiver burden and institutionalisation. Apathy increases over the course of dementia and is associated with worse clinical outcomes independent of depression. Distinguishing apathy and depression appears important given their different implications for prognosis and management.