Mobility Interventions Research Articles

Looking into mobility in the Covid-19 ‘eye of the storm’: Simulating virus spread and urban resilience in the Wuhan city region travel flow network

Recent urban and regional studies have focused on identifying positive spillover effects from intensifying flows of people in city region networks. However, potential negative spillover effects have lacked attention. The article addresses this research gap focusing on the negative spillover effects represented by Covid-19 contagion in the Wuhan regional travel flow network, China. Drawing on central place theory and central flow theory, Covid-19 spatial spread simulation scenarios are explored using a combined micro-level epidemic compartment model and urban network approach. It is found that not only centrally positioned primate but secondary cities are highly risk exposed to contagion. In addition, these cities have enhanced transmission capacity in a balanced, well-connected travel flow network, whereas a centralised or locally clustered network would be more spread resilient. Both hierarchical position and horizontal flows are found relevant for explaining Covid-19 uneven spread and for informing mobility interventions for a potential future outbreak.

69 Early Post-operative Mobilization After Treatment of Burn Wounds with Autologous Skin Cell Suspension

IntroductionEarly mobilization has become popular in the literature and the benefits in critically ill patients are well-documented. However, early mobilization in burn care is undefined. Clinical practice guidelines regarding post-operative mobilization (POM) of patients with burn injury, especially after autografting, are limited, resulting in significant practice variance among burn centers. Furthermore, data on mobilization after treatment with autologous skin cell suspension (ASCS), is even more limited, and wider practice variation exists. We hypothesize early POM is safe and does not compromise healing or lead to graft loss.MethodsA retrospective chart review was performed to examine mobility interventions utilized for patients, with mixed partial and full thickness burns, who received ASCS with polylactic acid sheet, with or without meshed splint-thickness skin grafting (STSG), over 6 months. Data included demographics, operative procedure, dressing, post-operative restrictions, POM date by burn therapy, and presence of graft loss ( >25% of grafted area with need for regrafting). The data was analyzed to corelate POM day and graft success. Initially, the authors utilized manufacturer splinting guidelines before becoming more judicious with aggressive early mobilization. Patients at risk of noncompliance and graft sheer were splinted.ResultsFifteen patients were included in the study. In those patients, 25 body areas were grafted with 17 areas receiving ASCS with polylactic acid sheet and 8 areas additionally receiving STSG. On post-operative day (POD) 0, four areas were splinted and no range of motion (ROM) was performed at the joint. The authors splinted 3 out of 4 patients (75%) due to initial manufacturer splinting guidelines. The 4th patient was splinted due to compliance concerns. For the other 21 areas, active ROM, functional mobility and performance of activities of daily living with functional movement was allowed on POD 0. A burn therapist actively treated 64% of patients on POD 0-1 and 100% of patients were treated by POD 2. Minimal patchy graft loss (median 1.5%) was noted in 6 grafted areas including 1 area which crossed a knee despite immobilization. No graft loss was related to POM and was attributed to factors including infection or wound conversion and, by definition, no significant graft loss was found.ConclusionsWhile the sample size is limited, this study suggests early POM of ASCS is safe and does not lead to graft loss. Considerations for mobilization techniques, such as ROM and functional mobility, should include joint involvement, presence of STSG with ASCS overspray, and other patient factors such as health literacy and compliance. Additional prospective studies should be dedicated to the examination of POM to develop clinical practice guidelines which can be widely utilized across burn therapy.

Differential Relationships Between Brain Structure and Dual Task Walking in Young and Older Adults.

Almost 25% of all older adults experience difficulty walking. Mobility difficulties for older adults are more pronounced when they perform a simultaneous cognitive task while walking (i.e., dual task walking). Although it is known that aging results in widespread brain atrophy, few studies have integrated across more than one neuroimaging modality to comprehensively examine the structural neural correlates that may underlie dual task walking in older age. We collected spatiotemporal gait data during single and dual task walking for 37 young (18–34 years) and 23 older adults (66–86 years). We also collected T1-weighted and diffusion-weighted MRI scans to determine how brain structure differs in older age and relates to dual task walking. We addressed two aims: (1) to characterize age differences in brain structure across a range of metrics including volumetric, surface, and white matter microstructure; and (2) to test for age group differences in the relationship between brain structure and the dual task cost (DTcost) of gait speed and variability. Key findings included widespread brain atrophy for the older adults, with the most pronounced age differences in brain regions related to sensorimotor processing. We also found multiple associations between regional brain atrophy and greater DTcost of gait speed and variability for the older adults. The older adults showed a relationship of both thinner temporal cortex and shallower sulcal depth in the frontal, sensorimotor, and parietal cortices with greater DTcost of gait. Additionally, the older adults showed a relationship of ventricular volume and superior longitudinal fasciculus free-water corrected axial and radial diffusivity with greater DTcost of gait. These relationships were not present for the young adults. Stepwise multiple regression found sulcal depth in the left precentral gyrus, axial diffusivity in the superior longitudinal fasciculus, and sex to best predict DTcost of gait speed, and cortical thickness in the superior temporal gyrus to best predict DTcost of gait variability for older adults. These results contribute to scientific understanding of how individual variations in brain structure are associated with mobility function in aging. This has implications for uncovering mechanisms of brain aging and for identifying target regions for mobility interventions for aging populations.

Viability of compact cities in the post-COVID-19 era: subway ridership variations in Seoul Korea.

COVID-19 exposed the vulnerability of compact cities against shock events. As the impact of COVID-19 not only persists, but also expands throughout the world, this study questions whether the compact city model would be sustainable in the post-COVID-19 era. As such, this study examines the dynamics among major COVID-19 outbreak events, government interventions, and subway ridership in two compact cities, Seoul and New York City. Then, to gain thorough understanding of the impact of risks on compact urban form, it narrows the scope to Seoul in comparing subway ridership patterns in 2019 and 2020, and identifying characteristics that affect the volatility of subway ridership levels. The results affirm that individual mobility, COVID-19 outbreaks, and government interventions are closely related, and reveal that the extent of social distancing measures in compact cities is limited. This finding aligns with existing literature that link diseases transmission with dense population and mixed land use, accentuating the vulnerability of the compact city model against shocks. As a result, a multidimensional urban planning approach that incorporates polycentric and decentralized urban form is recommended to effectively and sustainably control disease outbreaks in compact cities.

Mobility Interventions on Urban Streets in North America During a Pandemic

Mobility Interventions on Urban Streets in North America During a Pandemic

Occupational Therapy and the IMPACT Act: Part 2. A Systematic Review of Evidence for Functional Status, Medication Reconciliation, and Skin Integrity Interventions.

Interventions that promote function, medication reconciliation, and skin integrity assist occupational therapy practitioners in demonstrating professional value, improving quality, and reducing health care costs. In this systematic review, we focus on three outcome areas of the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014: functional status, medication reconciliation, and skin integrity. We conducted a search of the literature published between 2009 and 2019 in CINAHL, Cochrane, MEDLINE, PsycINFO, OTseeker, and Scopus. We also hand searched the systematic reviews and meta-analyses in our search results for articles that met our inclusion criteria. Study Selection and Data Collection: This study used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We found 47 articles that address the three outcome areas. Regarding functional status, low strength of evidence is available for cognition and functional mobility interventions to support functional performance, moderate strength of evidence supports interventions for vision, and moderate evidence supports task-oriented and individualized interventions to promote activities of daily living (ADL) outcomes among people with neurological conditions. Strong strength of evidence supports individualized occupational therapy interventions focusing on medication adherence. Low strength of evidence was found for occupational therapy interventions to reduce pressure ulcers and promote skin integrity. Conclusion and Relevance: The evidence supports occupational therapy interventions to improve functional status in ADLs and medication management. Additional research is needed that examines the outcomes of occupational therapy interventions for other areas of function and skin integrity. What This Article Adds: We found evidence to support occupational therapy interventions that align with value-based measures in the three outcome areas of interest. The effectiveness of these interventions highlights the viability of occupational therapy as an essential profession and the worth of occupational therapy to the public, potential clients, and payers.

Trajectories of stroke recovery of impairment, function, and quality of life in response to 12-month mobility and fitness intervention.

Gait deficits and functional disability are persistent problems for many stroke survivors, even after standard neurorehabilitation. There is little quantified information regarding the trajectories of response to a long-dose, 12-month intervention. We quantified treatment response to an intensive neurorehabilitation mobility and fitness program. The 12-month neurorehabilitation program targeted impairments in balance, limb coordination, gait coordination, and functional mobility, for five chronic stroke survivors. We obtained measures of those variables every two months. We found statistically and clinically significant group improvement in measures of impairment and function. There was high variation across individuals in terms of the timing and the gains exhibited. Long-duration neurorehabilitation (12 months) for mobility/fitness produced clinically and/or statistically significant gains in impairment and function. There was unique pattern of change for each individual. Gains exhibited late in the treatment support a 12-month intervention. Some measures for some subjects did not reach a plateau at 12 months, justifying further investigation of a longer program (>12 months) of rehabilitation and/or maintenance care for stroke survivors.

Environment in institutional care settings as a promoting factor for older individuals' mobility: A systematic review.

BackgroundMobility is important for health and well‐being; however, older individuals in institutional care settings are relatively sedentary. The environment has an increased influence on mobility in older age due to changes in individual functioning; thus, environmental mobility support solutions for this population are needed.ObjectivesThe aim of this systematic review was to identify elements of the environment that have been used in the content and delivery of interventions to promote mobility and to assess the effects of these interventions on mobility outcomes.DesignA systematic literature search was conducted using CINAHL and MEDLINE from the earliest date through 30 September 2020 for randomised controlled trials, quasi‐experimental and pre‐post design studies. Inclusion and critical appraisal of articles were conducted by two independent researchers. Data were extracted and synthesised.Setting and participantsStudies were included if they had employed some element of the environment in the content and/or delivery of the intervention and had assessed mobility‐related outcomes of older individuals in institutional long‐term care settings providing full‐time care.MeasuresStudies were included if they reported data on mobility‐related outcomes including aspects of physical activity, physical function, life space and functional autonomy.ResultsEight studies were included. Physical, social and symbolic elements of the environment were utilised in the interventions. Positive effects on mobility outcomes were reported in exercise interventions utilising environmental elements mostly as supportive components.Conclusions and implicationsEmpirical evidence about effective mobility interventions employing elements of the environment as main intervention components is lacking. A serious dilemma exists about the need for older individuals’ independence and mobile/active late life and the lack of support for such initiatives in long‐term care. Given the emphasised relationship of the environment and mobility with age due to changes in functioning, environmental solutions require further examination.

Mobilizing Ventilated Neurosurgery Patients: An Integrative Literature Review.

BACKGROUND: Lack of mobilization in ventilated neurosurgery patients is problematic due to significant consequences. Although early mobility addresses these complications, few studies have been conducted in this population, resulting in infrequent mobilization efforts. Nurses prioritize and implement patient care interventions, including mobilization, with multidisciplinary teams. This integrative literature review examines what is known regarding nursing perceptions on mobilization and their role within a multidisciplinary team for mobilization in ventilated neurosurgery patients. METHODS: A comprehensive literature search was conducted using online databases to identify research articles on early mobility studies in ventilated critically ill and neurosurgical patients from 2010 to 2020. RESULTS: Twenty studies were identified and indicated a paucity of research specific to mobilizing ventilated neurosurgery patients. Nurses understand the purpose and benefits of early mobility in critically ill and mechanically ventilated patients. Mixed perceptions exist regarding the responsibility for prioritizing and initiating mobilization. Main barriers include patient safety concerns, untimeliness due to limited resources, unit culture, lack of nursing knowledge, and need for improved teamwork. Associations between teamwork-based interventions and decreased length of stay, increased rates of mobility, and faster time to early mobilization exist. Nurse-led interventions showed additional benefits including positive perceptions such as empowerment, confidence, increased knowledge, and a progressive shift in unit culture. CONCLUSION: This review demonstrates a continued need for understanding nursing perceptions and role in teamwork to mobilize ventilated neurosurgery patients. Future research should focus on testing nurse-led mobility interventions so higher rates of mobilization and provision of holistic patient care can be achieved.

Fuzzy Cognitive Scenario Mapping for Causes of Cybersecurity in Telehealth Services.

Hospital organizations have adopted telehealth systems to expand their services to a portion of the Brazilian population with limited access to healthcare, mainly due to the geographical distance between their communities and hospitals. The importance and usage of those services have recently increased due to the COVID-19 state-level mobility interventions. These services work with sensitive and confidential data that contain medical records, medication prescriptions, and results of diagnostic processes. Understanding how cybersecurity impacts the development of telehealth strategies is crucial for creating secure systems for daily operations. In the application reported in this article, the Fuzzy Cognitive Maps (FCMs) translated the complexity of cybersecurity in telehealth services into intelligible and objective results in an expert-based cognitive map. The tool also allowed the construction of scenarios simulating the possible implications caused by common factors that affect telehealth systems. FCMs provide a better understanding of cybersecurity strategies using expert knowledge and scenario analysis, enabling the maturation of cybersecurity in telehealth services.

Evaluation of Results of City Sustainable Transformation Projects in the Fields of Mobility and Energy Efficiency with Real Application in a District in Valladolid (Spain)

This paper presents a novel evaluation framework to assess the effectiveness of city transformation projects related to energy efficiency and sustainable mobility actions. The evaluation framework is part of an Urban Regeneration Model designed to accelerate the urban transformation toward the smart city concept, taking into account all aspects of sustainability. This model has been developed and validated in the three EU cities (Valladolid, Spain; Nottingham, United Kingdom; and Tepebaşı, Turkey) where interventions in the energy, mobility, and ICT fields have been deployed. This model relies on an Evaluation Framework to support its main phases considering two levels of evaluation: city level, to assess globally the smartness and sustainability of the city, and project level, to support the decision-making and assess the impacts of specific implementations. This paper is focused on the second level and its application through the evaluation-supporting tool STILE in the assessment of the energy efficiency and sustainable urban mobility actions implemented in the city of Valladolid. The assessment analysis has allowed assessing how the energy efficiency interventions carried out in the Valladolid district have reduced the energy consumption, increased the use of renewable energies, and reduced the CO2 emissions. In addition, it has allowed evaluating other aspects such as the air quality, thermal comfort, and energy bill, which have been also improved for the residents. Considering the analysis of the sustainable mobility interventions, the evaluation framework supports the assessment of the reduction of emissions and air pollutants and how the actions have converted electro-mobility into a real option for citizens. The evaluation of results after the implementation of this kind of actions is key to ensuring that successful actions can be replicated in other places achieving smarter and more sustainable cities.

Evaluation of China\u2019s Hubei control strategy for COVID-19 epidemic: an observational study

BackgroundTo fight against COVID-19, many policymakers are wavering on stricter public health interventions. Examining the different strategies both in and out of China’s Hubei province, which contained the epidemic in late February 2020, could yield valuable guidance for the management of future pandemics. This study assessed the response process and estimated the time-varying effects of the Hubei control strategy. Analysis of these strategies provides insights for the design and implementation of future policy interventions.MethodsWe retrospectively compared the spread and control of COVID-19 between China’s Hubei (excluding Wuhan) and non-Hubei areas using data that includes case reports, human mobility, and public health interventions from 1 January to 29 February 2020. Static and dynamic risk assessment models were developed to statistically investigate the effects of the Hubei control strategy on the virus case growth after adjusting importation risk and policy response timing with the non-Hubei strategy as a control.ResultsThe analysis detected much higher but differential importation risk in Hubei. The response timing largely coincided with the importation risk in non-Hubei areas, but Hubei areas showed an opposite pattern. Rather than a specific intervention assessment, a comprehensive comparison showed that the Hubei control strategy implemented severe interventions characterized by unprecedentedly strict and ‘monitored’ self-quarantine at home, while the non-Hubei strategy included physical distancing measures to reduce contact among individuals within or between populations. In contrast with the non-Hubei control strategy, the Hubei strategy showed a much higher, non-linear and gradually diminishing protective effect with at least 3 times fewer cases.ConclusionsA risk-based control strategy was crucial to the design of an effective response to the COVID-19 outbreak. Our study demonstrates that the stricter Hubei strategy achieves a stronger controlling effect compared to other strategies. These findings highlight the health benefits and policy impacts of precise and differentiated strategies informed by constant monitoring of outbreak risk.

Early Intervention Program Through Bibliotherapy Approach For Reducing Fear In Orientation And Mobility Of Children With Visual Impairment

Orientation and mobility skills are special skills that must be mastered by children with visual impairment, thus an orientation and mobility intervention program is important to develop. Fear or anxiety in children with visual impairment related to orientation and mobility can be caused by fear from within the children or from the environment. Personality, motivation, psychosocial factor, and family and community attitudes all contribute to one's reaction to mobility activities independently. This research aims to reduce the fear of children with visual impairment in performing orientation and mobility activities by implementing an intervention program through bibliotherapy technique. This research is a case study research with a qualitative approach. Bibliotherapy was carried out on two young children with visual impairment. The results of the program implementation show that children's fear or anxiety could be reduced in both cases in this research as seen by autonomous moves of the two children from the mother and caregiver and began to learn to trace the walls of the room.

WHAT CAN BE LEARNT FROM 130 CHILDREN'S DREAM WHEELCHAIR DESIGNS? ELICITING CHILD-CENTRED INSIGHTS USING AN INTERDISCIPLINARY DESIGN ANALYSIS FRAMEWORK

AbstractThe design of inclusive paediatric mobility (IPM) interventions, such as children's wheelchairs, are entangled with technological, health and social considerations. As narratives around childhood, disability and mobility shift and transform, these entanglements evolve. In order to optimise the experience of childhood mobility, IPM designers must understand and respond to such changes and channel children's own requirements, desires and 'dreams' into the design process; this can be achieved by utilising a child-centred design approach. This paper identifies meaningful child-centred IPM design insights and opportunities through the interdisciplinary analysis of 130 dream wheelchair designs by disabled children, aged 4 to 17 years. A novel interdisciplinary and child-centred design analysis framework is developed to dissect, categorise and code the topics and features expressed through visuals and written descriptions in each of the children's dream wheelchair designs. Children's mobility narratives, desires and requirements are elicited and trending topics are discussed. It is proposed that valuing children's voices in the IPM design process could alter both the process of designing IPM interventions as well as the product outcomes.

How Much did Sri Lankans Move During Covid-19 Crisis? Community Mobility and Public Health Interventions in Retrospect

Official publication of the College of Community Physicians of Sri Lanka and was established in 1995. Full text articles available.Journal of the College of Community Physicians of Sri Lanka (JCCPSL) has been recognised by the International Committee of Medical Journal Editors (ICMJE) as a publication following the ICMJE Recommendations. The journal is indexed in DOAJ.Manuscripts are only accepted online through the portal of the JCCPSL https://jccpsl.sljol.info/ . The prospective authors must read carefully the section on Author Guidelines and prepare their manuscript accordingly. To submit a manuscript or to check the status of a submission the authors must first be registered in the JCCPSL Editorial Management System using an existing or newly created username and password. Next, choose the ‘Start Submission’ link and follow the five-step article submission process which is a simple and self-guided process.

Health, social care and technological interventions to improve functional ability of older adults living at home: An evidence and gap map.

By 2030, the global population of people older than 60 years is expected to be higher than the number of children under 10 years, resulting in major health and social care system implications worldwide. Without a supportive environment, whether social or built, diminished functional ability may arise in older people. Functional ability comprises an individual's intrinsic capacity and people's interaction with their environment enabling them to be and do what they value. This evidence and gap map aims to identify primary studies and systematic reviews of health and social support services as well as assistive devices designed to support functional ability among older adults living at home or in other places of residence. We systematically searched from inception to August 2018 in: MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, CENTRAL, CINAHL, PsycINFO, AgeLine, Campbell Library, ASSIA, Social Science Citation Index and Social Policy & Practice. We conducted a focused search for grey literature and protocols of studies (e.g., ProQuest Theses and Dissertation Global, conference abstract databases, Help Age, PROSPERO, Cochrane and Campbell libraries and ClinicalTrials.gov). Screening and data extraction were performed independently in duplicate according to our intervention and outcome framework. We included completed and on-going systematic reviews and randomized controlled trials of effectiveness on health and social support services provided at home, assistive products and technology for personal indoor and outdoor mobility and transportation as well as design, construction and building products and technology of buildings for private use such as wheelchairs, and ramps. We coded interventions and outcomes, and the number of studies that assessed health inequities across equity factors. We mapped outcomes based on the International Classification of Function, Disability and Health (ICF) adapted categories: intrinsic capacities (body function and structures) and functional abilities (activities). We assessed methodological quality of systematic reviews using the AMSTAR II checklist. After de-duplication, 10,783 records were screened. The map includes 548 studies (120 systematic reviews and 428 randomized controlled trials). Interventions and outcomes were classified using domains from the International Classification of Function, Disability and Health (ICF) framework. Most systematic reviews (n = 71, 59%) were rated low or critically low for methodological quality.The most common interventions were home-based rehabilitation for older adults (n = 276) and home-based health services for disease prevention (n = 233), mostly delivered by visiting healthcare professionals (n = 474). There was a relative paucity of studies on personal mobility, building adaptations, family support, personal support and befriending or friendly visits. The most measured intrinsic capacity domains were mental function (n = 269) and neuromusculoskeletal function (n = 164). The most measured outcomes for functional ability were basic needs (n = 277) and mobility (n = 160). There were few studies which evaluated outcome domains of social participation, financial security, ability to maintain relationships and communication.There was a lack of studies in low- and middle-income countries (LMICs) and a gap in the assessment of health equity issues. There is substantial evidence for interventions to promote functional ability in older adults at home including mostly home-based rehabilitation for older adults and home-based health services for disease prevention. Remotely delivered home-based services are of greater importance to policy-makers and practitioners in the context of the COVID-19 pandemic. This map of studies published prior to the pandemic provides an initial resource to identify relevant home-based services which may be of interest for policy-makers and practitioners, such as home-based rehabilitation and social support, although these interventions would likely require further adaptation for online delivery during the COVID-19 pandemic. There is a need to strengthen assessment of social support and mobility interventions and outcomes related to making decisions, building relationships, financial security, and communication in future studies. More studies are needed to assess LMIC contexts and health equity issues.

Optimizing MObility for critically ill patiEnts undergoing Continuous Renal Replacement Therapy (MOvE CRRT): An audit of mobility interventions in the intensive care unit

BACKGROUND: CRRT is common in the ICU. This intervention has been shown to contribute to reduced mobilization due to fear of adverse events. This study sought to evaluate the degree of mobilization in patients receiving CRRT and to develop a procedure checklist to enhance mobilization in these patients. METHODS: A retrospective observational matched cohort audit of adult patients admitted to the General Systems ICU at the University of Alberta Hospital from April 1, 2015, and April 1, 2017 was conducted. A total of 50 CRRT patients were matched to 37 critically ill patients and their mobilization events compared. Data was analyzed descriptively. A protocolized mobilization procedure checklist was subsequently developed. RESULTS: Higher levels of mobility were achieved in patients not receiving CRRT. The highest level of mobility in CRRT patients was ambulation in 1 (2%), active mobilization in 17 (34%), passive mobilization in 13 (26%) and none in 19 (38%); whereas, in controls, the highest level of mobility was ambulatory in 22 (59%), active in 10 (27%), passive in 2 (5%) and none in 3 (8%). Four (8%) of the CRRT patients had a PT program delay attributed to CRRT. Adverse events were uncommon and unrelated to CRRT, occurring in 1 (2%) of CRRT patients and in 3 (8%) control patients. No critical adverse events occurred, and no CRRT was delayed or paused. Alarms limited or postponed treatment in 7 (14%) patients. CONCLUSIONS: Mobilization while on CRRT is feasible and safe. It is conducted less frequently and to a lesser degree when compared to similarly acute patients not receiving CRRT. A procedure checklist has been developed to improve mobilization while on CRRT that can be safely implemented in critically ill patients.

Seniors’ Mobility and Perceptions in Different Urban Neighbourhoods: A Non-Aggregative Approach

In order to highlight the subjective criticality of each neighbourhood to inspire future policy actions, we propose an analysis comparing the perceptions of over-65s residents in the neighbourhoods that make up the Municipality of Genoa. We suggest a new approach based on a quantitative non-aggregative method, Partially Ordered Set (Poset), to measure the levels of satisfaction related to local public transport (LPT), pedestrian mobility, and quality of life in the 25 districts of Genoa. Final data of the analysis come from 401 questionnaires, distributed to residents over 65 years old in the Municipality of Genoa. This approach allows to address the multidimensionality of the phenomenon, as well as its different conceptual spheres. The findings highlight a great variance in local public transport needs perception between different neighbourhoods. In particular, the analysis shows that the types of intervention requested by respondents differ from district to district, so that a common urban transport policy would be ineffective. Some neighbourhoods stress the need for improving pedestrian mobility, whilst local public transport faults dominate in others. There is no significant relation between the three dimensions: Perceived quality of LPT, perceived quality of pedestrian mobility, and perceived quality of neighbourhood. Therefore, interventions should be carefully modulated, according to the specific needs expressed by the residents of each neighbourhood. We conclude that the importance of urban mobility intervention is reduced, whereas the concept of neighbourhood analysis and intervention becomes more relevant.

PND68 Healthcare Resource Utilization (HCRU) for Early-, Middle- and Late-Stage Amyotrophic Lateral Sclerosis (ALS) Patients: Results from a Real-World Point-in-Time Survey

ALS is a rare, degenerative neuromuscular disease, leading to loss of motor control, speech and swallowing difficulties, respiratory insufficiency, and ultimately death. Advancing disease stage is associated with greater burden on the healthcare system and requirement for assistive devices. We assessed healthcare resource utilization (HCRU) in early-, middle- and late-stage ALS patients. Data were drawn from the Adelphi ALS Disease Specific Programme™, a point-in-time survey of neurologists and their ALS patients in France, Germany, Italy, Spain, the UK and the USA. Data were collected between July–October 2020. Neurologists reported patient demographics, HCRU including consultations with healthcare professionals (HCPs), ALS-related hospitalizations, use of mobility, ventilatory or feeding interventions, and overall caregiver requirement. Neurologists identified whether patients were in the early, middle, or late stage of ALS. Comparisons among the three disease stages were conducted using analysis of variance and chi-squared tests. 62 neurologists recorded data on 399 ALS patients (France=60; Germany=77, Italy=46; Spain=124; UK=19, USA=73), of whom 33%, 47% and 20% of patients were considered as having early-, middle- and late-stage ALS, respectively. Significant differences were observed among disease stages (all P<0.0001): Patients at later stages were older (58.1, 62.0, 66.6 years), had longer time since diagnosis (11.4, 20.6, 27.6 months), had more HCP consultations (12.5, 16.3, 23.1) and ALS-related hospitalizations (0.2, 0.4, 1.0) in the last 12 months. Later stage patients more frequently required mobility aids (36%, 81%, 81%), ventilation devices (3%, 34%, 76%), feeding tubes (2%, 10%, 71%) and caregiver assistance (45%, 88%, 100%), and necessitated increased professional caregiver hours/week (15.9, 17.2, 45.0). Later-stage ALS was associated with higher patient HCRU compared to earlier stages. These findings highlight the potential value of identifying individuals with early-stage ALS and preventing progression into a more resource-intensive stage. Data collection is ongoing, with a larger dataset expected in early 2021.

Policy and weather influences on mobility during the early US COVID-19 pandemic

As the novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continues to proliferate across the globe, it is a struggle to predict and prevent its spread. The successes of mobility interventions demonstrate how policies can help limit the person-to-person interactions that are essential to infection. With significant community spread, experts predict this virus will continue to be a threat until safe and effective vaccines have been developed and widely deployed. We aim to understand mobility changes during the first major quarantine period in the United States, measured via mobile device tracking, by assessing how people changed their behavior in response to policies and to weather. Here, we show that consistent national messaging was associated with consistent national behavioral change, regardless of local policy. Furthermore, although human behavior did vary with outdoor air temperature, these variations were not associated with variations in a proxy for the rate of encounters between people. The independence of encounters and temperatures suggests that weather-related behavioral changes will, in many cases, be of limited relevance for SARS-CoV-2 transmission dynamics. Both of these results are encouraging for the potential of clear national messaging to help contain any future pandemics, and possibly to help contain COVID-19.