Mobility Score Research Articles

A retrospective analysis of a clinician-initiated high-intensity locomotor training implementation project in an inpatient rehabilitation facility.

The Academy of Neurologic Physical Therapy's Intensity Matters campaign recommends the implementation of high-intensity locomotor training for all patients with neurologic dysfunction with goals to improve walking. Retrospectively determine the effectiveness of a clinician-initiated implementation project on the adoption, reach, and fidelity of high-intensity locomotor training for patients with stroke during inpatient rehabilitation and, determine whether the project led to changes in patient outcomes. Retrospective analysis of electronic medical records from 1 year before and after the project. Patients admitted with a stroke diagnosis were included. Demographic information, the number of high-intensity sessions, the percentage of time spent in the target heart rate zone, standardized assessment scores for motor function, functional mobility, balance, gait speed and endurance, and discharge destination were extracted for descriptive and linear mixed model analysis. Clinician reach was 75%, and adoption of high-intensity training varied between clinicians from 47.1% and 83.3%. Of eligible patients, 55% received the target intervention at least once, reflecting the patient reach. Implementation fidelity was 18.84%. Linear mixed effects modeling revealed a statistically significant effect of time (p < .001) but not group allocation or group × time interaction. Although statistically significant differences in patient outcomes compared to pre-implementation were not found, results highlight the limitations associated with adopting high-intensity locomotor training for patients post-stroke in this setting .It remains unclear whether the implementation fidelity achieved was sufficient to impact patient outcomes. Further research is needed to establish fidelity targets and identify barriers to successful implementation projects by clinicians.

Prognostic nutritional index (PNI) is an independent predictor for functional outcome after hip fracture in the elderly: a prospective cohort study

SummaryThe prognostic nutritional index (PNI) is a useful tool for assessing nutritional status using serum albumin and lymphocyte count. This study indicates that a higher preoperative PNI correlates with improved mobility and health-related quality of life during the initial postoperative period in elderly patients with hip fractures.PurposeTo investigate the prognostic value of the prognostic nutritional index (PNI) in predicting mobility and health-related quality of life (HRQoL) in elderly hip fracture patients after surgery.MethodsWe prospectively involved patients aged 65 and above, who could walk freely before injury and underwent surgery between 2018 and 2019. Admission PNI was calculated as serum albumin (g/L) + 5 × total lymphocyte count (× 109/L). Patients were classified into two groups based on PNI median value. All patients were followed up by telephone for four times (30-day, 120-day, 1-year, and 3-year after surgery). The Fracture Mobility Score (FMS) and EuroQol 5-Dimension 5-Level (EQ-5D 5L) were used to evaluate mobility and HRQoL, respectively.ResultsOf 705 eligible patients, 487 completed all assessments. Patients in the higher PNI group had a significantly increased possibility of achieving unrestricted mobility at the 120-day follow-up (OR 1.69, 95% CI 1.10–2.61, P.adj = 0.017), while no significant differences were observed at other follow-ups. Additionally, patients in the higher PNI group had a significantly higher EQ-5D utility value at the 30-day follow-up (P.adj = 0.015). A linear regression model with adjusting for all confounders showed that admission PNI value was positively associated with EQ-5D utility values at 30-day, 120-day, and 1-year follow-up assessments (P.adj = 0.011, P.adj = 0.001, and P.adj = 0.030, respectively). However, this correlation was not observed at the 3-year time point (P.adj = 0.079).ConclusionThe PNI is a valuable predictor of functional outcomes in elderly patients with hip fractures following surgery.

Optimal sliding distance in femoral neck system for displaced femoral neck fractures: a retrospective cohort study

BackgroundDisplaced femoral neck fractures frequently result in considerable patient morbidity, with complications such as postoperative femoral neck shortening occurring in up to 39.1% of cases. This shortening is associated with reduced hip function and mobility. The Femoral Neck System (FNS), which allows for controlled sliding to facilitate fracture reduction and healing, may mitigate these issues. However, the ideal sliding distance to balance fracture healing and minimize complications is not well defined.MethodsWe performed a retrospective cohort study of 179 patients who underwent FNS fixation for displaced femoral neck fractures at our institution from September 2019 to September 2023. Patients were categorized into three groups based on the intraoperative sliding distance allowed by the FNS: the Minimal Slide group (≤ 5 mm), the Moderate Slide group (> 5 to ≤ 10 mm), and the Extensive Slide group (> 10 to 20 mm). Primary outcomes included postoperative femoral neck shortening, the incidence of moderate to severe shortening, time to fracture union, and hip joint function as assessed by the Harris Hip Score (HHS) and the Parker Mobility Score. Secondary outcomes included complication rates such as implant cut-out, nonunion, avascular necrosis of the femoral head, and the need for secondary surgery.ResultsThe Extensive Slide group of moderate to severe shortening at 32.31%, which was 1.59-fold and 8.88-fold that of the Moderate Slide (20.34%) and Minimal Slide group’s (3.64%), respectively (P < 0.01). The sliding predominantly occurred within the first three months postoperatively and had substantially ceased by six months. At one year postoperatively, the median shortening was 2.7 mm (IQR, 0.7 to 3.5 mm) for the Minimal Slide group, a value that was notably lower compared to the 3.2 mm (IQR, 2.4 to 4.6 mm) for the Moderate Slide group and the 3.5 mm (IQR, 1.3 to 8.1 mm) for the Extensive Slide group. The average time to achieve union was similar across all groups, with no significant differences. Functional outcomes, as assessed by the Harris Hip Score (HHS) and the Parker Mobility Score, the Harris Hip Score (HHS) demonstrated statistical significance, the Parker Mobility Score did not reach statistical significance.ConclusionsRestricting FNS slide to ≤ 5 mm in surgery may reduce shortening, improve hip function, and not hinder fracture healing or implant stability. Considering the key 3-month sliding timeline postoperatively is advisable in clinical practice. Further research with a broader patient cohort is vital to confirm these findings and to anchor them in evidence-based practice.

Contribution of cognitive status on admission to mobility and balance at discharge from acute rehabilitation for stroke

Acute inpatient rehabilitation is crucial for improving mobility and balance for individuals with stroke. A potentially important factor in the recovery of mobility and balance is cognition. The purpose of this study was to determine the effect of cognition on mobility and balance in acute stroke rehabilitation. This was a longitudinal cohort study based on an inpatient rehabilitation unit at a large academic medical center. Participants were individuals with stroke admitted to acute rehabilitation after an acute care hospital stay (N = 281). Demographic data and predictor variables were collected on admission to the unit. Outcomes were collected at discharge from the unit. Multiple regression analyses were used to determine the associations between cognition (Montreal Cognitive Assessment) on mobility (Functional Independence Measure mobility subscale) and balance (Berg Balance Scale). Subtests from the Montreal Cognitive Assessment were also examined to determine if specific dimensions of cognition could predict balance after controlling for covariates. Dominance analysis was used to determine the relative importance of baseline predictors. In separate models, cognition was a significant predictor of mobility (B = 0.19) and balance (B = 0.28) at discharge after adjusting for admission mobility and balance, as well as age, sex, and length of stay. The most important predictors in both models were baseline mobility and balance, but cognition contributed to the models independently of baseline scores. Cognition was generally more important than age and sex while about equally important as length of stay. In separate models, the visuospatial/executive (B = 0.42) and the delayed recall (B = 0.37) subtests were also significant predictors of mobility. The models’ most important predictors were baseline mobility and balance scores. Cognition is a clinically relevant predictor of mobility and balance in acute stroke rehabilitation. Specific dimensions of cognition, such as executive function, visuospatial function, and delayed recall, may be especially important. Cognitive challenges and meta-cognitive strategies should be included in mobility and balance tasks when possible. Studies that evaluate the efficacy of dual-task training and meta-cognitive approaches are needed.

The Benefits of a Rehabilitation Program Following Medial Patellofemoral Ligament Reconstruction

The medial patellofemoral ligament (MPFL) is critical for patellar stability. This study investigates the efficacy of a one-year physical therapy rehabilitation program following MPFL reconstruction using Synthetic Graft (SG) and Quadriceps Tendon Autograft (QTA). Thirty-five patients aged 18–38 underwent MPFL reconstruction (20 SG, 15 QTA). They participated in a structured rehabilitation program to improve their range of motion (ROM), muscle strength, pain management, and overall quality of life (QoL). The program included physiotherapy and MLS laser, Game Ready Therapy, EMS, TENS, TECAR, and lymphatic drainage. Before and after the program, assessments included knee flexion and extension using goniometry, muscle strength via the Medical Research Council (MRC) scale, knee circumference, pain intensity on the Visual Analogue Scale (VAS), and QoL with the EQ-5D instrument. Significant improvements were observed in knee flexion (37.57° vs. 114.71°, p &lt; 0.001), muscle strength (MRC scale 1–4 points vs. 4–5 points, p &lt; 0.001), and pain reduction (VAS 6.66 vs. 0.46, p &lt; 0.001). The functional coefficient of mobility and QoL scores also markedly increased. Patients with QTA improved some parameters better than those with SG. These findings support the effectiveness of a comprehensive rehabilitation program in enhancing knee functionality, reducing pain, and improving QoL post-MPFL reconstruction. Personalized rehabilitation protocols are recommended to optimize recovery outcomes.

Early clubfoot recurrence can lead to more frequent and earlier second recurrences.

The frequency of multiple clubfoot recurrences following Ponseti casting and the effect on final outcomes have not been well studied. This study aims to evaluate the effect of early recurrence (during the first 2 years) on the timing and rate of subsequent recurrences. A retrospective review was conducted of children treated with Ponseti casting at a single institution from 2002 to 2023 with minimum follow-up until age 5. Patients who required comprehensive soft tissue surgery to obtain initial correction were excluded. Patient-Reported Outcomes Measurement Information System data were collected when available. A total of 86 patients were included; 69.8% (60) had idiopathic clubfoot. Average follow-up was 5.8 years. Early recurrence (recurrence before age 2) occurred in 26.7% (23). The rate of late recurrence (recurrence after age 2) was higher in the early recurrence group, 73.9% (17) vs. 39.7% (25), P = 0.005. Survival analysis revealed that patients with early recurrence experience late recurrence at a younger age of 3.9 vs. 6.7 years, P ≤ 0.001. The early recurrence group experienced more frequent recurrences, with a median of 3 [interquartile range (IQR): 1-5] total recurrences vs. 0 (IQR: 0-1), P ≤ 0.001. Patients with early recurrence had lower final mobility scores, 40.83 ± 10.88 vs. 48.00 ± 10.60, P = 0.029. In conclusion, this study suggests that early clubfoot recurrence leads to more frequent subsequent recurrence and earlier second recurrence. Patients with early recurrence had comparatively lower outcome scores, primarily due to multiple recurrences. Care providers could use this knowledge to educate parents about the natural history of recurrent clubfeet and emphasize the importance of brace compliance and routine monitoring.

Single-centre results of a randomised controlled trial comparing the Gamma3 nail and a sliding hip screw to treat AO type 31-A1 and 31-A2 trochanteric fractures.

The primary goal of this randomised controlled trial was to investigate whether there are differences in the outcome between the Gamma3 nail and a sliding hip screw (SHS) regarding quality of life 1 year after surgery. In a controlled randomised trial, we compared the Gamma3 nail (Stryker) and a SHS(Omega, Stryker) in the treatment of 193 patients with pertrochanteric fractures. The follow-up period was 12 months. The outcomes included the surgical duration, health-related quality of life measured with the EQ-5D Index and a Visual Analogue Scale (VAS), the living situation and use of walking aid before trauma and 52 weeks after surgery; the Parker Mobility Score; the Harris Hip Score; and the revision, complication and mortality rates. The Gamma3 group had a significantly shorter surgical duration than the SHS group (p < 0.0001). Implant-related complications were significantly lower in the Gamma3 group (p > 0.05). The revision rate was significantly lower in the Gamma3 group based on intention-to-treat (p = 0.0336) as well as as-treated (p = 0.0302) analyses. Otherwise, we did not find significant difference between the two groups regarding the EQ-5D Index and VAS scores, the Parker Mobility Score, the Harris Hip Score, the mortality rate, the use of walking aids and the living situation. There were no detectable differences between the groups in terms of quality of life and clinical scores 12 months after surgery. The surgical duration and revision rate were superior for the Gamma3 group.

Association between mobility limitations and cognitive decline in community-dwelling older adults: the English Longitudinal Study of Ageing.

Mobility limitations has been linked to cognition. However, little is known about the relationship between mobility decline and cognitive decline. This study investigated the effect of mobility limitations and decline on cognitive decline in a population-based cohort of older adults. A population-based cohort of 9695 cognitively intact participants (mean age = 65.4 years, standard deviation [SD] = 10.4) was assessed. Mobility limitation scores ranging from 0-10 were assessed at baseline (wave 4) by using self-reporting difficulty in a set of 10 activities, and a higher score indicated worse mobility. A subset of 9250 participants underwent two mobility assessments at waves 3 and 4, and were categorized into normal mobility or mobility decline (defined as wave 4 - wave 3 > 1 SD of wave 3). Linear mixed models were used to assess the longitudinal contribution of mobility limitations and decline to cognitive decline. During a median follow-up period of 9.4 years (SD 1.8), the participants in the highest quartile of mobility scores displayed an accelerated cognitive decline (-0.191 SD/year, 95% CI = -0.223, -0.159) compared with those in the lowest quartile. Notably, individuals experiencing mobility decline exhibited a marked cognitive decline (-0.179 SD/year, 95% CI = -0.220, -0.139), potentially influenced by factors such as physical activity and depression. Mobility limitations and decline significantly correlate with cognitive decline in older adults, highlighting that mobility-focused interventions in healthcare strategies to preserve cognition.

Explainable artificial intelligence on safe balance and its major determinants in stroke patients

This study develops explainable artificial intelligence for predicting safe balance using hospital data, including clinical, neurophysiological, and diffusion tensor imaging properties. Retrospective data from 92 first-time stroke patients from January 2016 to June 2023 was analysed. The dependent variables were independent mobility scores, i.e., Berg Balance Scales with 0 (45 or below) vs. 1 (above 45) measured after three and six months, respectively. Twenty-nine predictors were included. Random forest variable importance was employed for identifying significant predictors of the Berg Balance Scale and testing its associations with the predictors, including Berg Balance Scale after one month and corticospinal tract diffusion tensor imaging properties. Shapley Additive Explanation values were calculated to analyse the directions of these associations. The random forest registered a higher or similar area under the curve compared to logistic regression, i.e., 91% vs. 87% (Berg Balance Scale after three months), 92% vs. 92% (Berg Balance Scale after six months). Based on random forest variable importance values and rankings: (1) Berg Balance Scale after three months has strong associations with Berg Balance Scale after one month, Fugl-Meyer assessment scale, ipsilesional corticospinal tract fractional anisotropy, fractional anisotropy laterality index and age; (2) Berg Balance Scale after six months has strong relationships with Fugl-Meyer assessment scale, Berg Balance Scale after one month, ankle plantar flexion muscle strength, knee extension muscle strength and hip flexion muscle strength. These associations were positive in the SHAP summary plots. Including Berg Balance Scale after one month, Fugl-Meyer assessment scale or ipsilesional corticospinal tract fractional anisotropy in the random forest will increase the probability of Berg Balance Scale after three months being above 45 by 0.11, 0.08, or 0.08. In conclusion, safe balance after stroke strongly correlates with its initial motor function, Fugl-Meyer assessment scale, and ipsilesional corticospinal tract fractional anisotropy. Diffusion tensor imaging information aids in developing explainable artificial intelligence for predicting safe balance after stroke.

Effects of 60 degrees of flexion and perioperative use of tranexamic acid on recovery after knee replacement

Abstract OBJECTIVE To explore the effect of 60 knee flexion combined with multiple tranexamic acid application on postoperative recovery of knee replacement patients. METHODS Knee replacement patients admitted to our hospital from October 2020 to September 2022 were selected as the study subjects, and randomly divided into two groups. Postoperative D-dimer, prothrombin time and partial thrombin time were recorded in the two groups, and the differences between the two groups were compared. Erythrocyte, hemoglobin and erythrocyte volume were recorded before, 1 day and 3 days after surgery and the affected limb circumference were also assessed. RESULTS On the 1st and 3rd day after surgery, the red blood cells, hemoglobin, and hematocrit levels in the experimental group were higher than those in the control group, and the differences were statistically significant(P&amp;lt;0.05). The difference in VAS score and circumference between the two groups on the 1st day and 3rd day after surgery was compared, and the difference was statistically significant. The difference in VAS score and circumference was lower in the control group(P&amp;lt;0.05). After surgical treatment, knee joint function recovered, knee joint mobility and HSS score improved, and the difference between the experimental groups was statistically significant (P&amp;lt;0.05). CONCLUSION Perioperative 60-degree flexion combined with multiple tranexamic acids can significantly reduce blood loss in patients undergoing knee replacement surgery, increase red blood cells, hemoglobin levels and red blood cell volume on postoperative days 1 and 3, and reduce postoperative swelling of the affected limb.

Hospital 4Ms: Documentation and association with patient characteristics.

For the thousands of health systems recognized as Age-Friendly, considerable progress has been made to integrate 4Ms into clinical care. This study evaluated associations between 4Ms documentation and patient characteristics in an inpatient setting. In this prospective cohort, hospitalizations included were from patients in an Acute Care for Elders (ACE) unit where the 4Ms were adopted and implemented. Each M (What Matters, Medication, Mentation, and Mobility) was stratified into three categories (not documented, partly documented, and fully documented) reflecting "assessment" and "action" clinical care processes. Electronic health records were reviewed for patient and hospitalization characteristics. Descriptive statistics evaluated these characteristics across categories of each M. There were 620 hospital encounters (573 patients) included in the cohort. Patients had a median age of 80 years [IQR 76, 86] and 85% were White. Of all 4Ms, What Matters had the lowest documentation with 413 (67%) of encounters falling into the not documented group. Medication had the highest documentation with 453 (73%) of encounters in the fully documented group. Significant differences in documentation were associated with age and partlyversus fully documented Mobility (80 [76, 86] and 82 [77, 88] (p = 0.019)). Hospital length of stay was differentially associated with documentation of all 4M categories. Initial mobility scores were associated with not versus partly documented Medication (6 [2, 7] and 2 [2, 6] (p = 0.041)). We developed a structured way to categorize "assessment" and "action" 4Ms care processes reflective of three documentation categories in the hospital (not, partly, and fully) and identified important patient and hospital characteristics associated with each. These results offer opportunities for future improvement efforts and insight to which characteristics may be important to measure with wider 4Ms adoption and uptake.

7070 Nephrolithiasis and Hypercalciuria in Adults with Osteogenesis Imperfecta

Abstract Disclosure: V.R. Simões: None. M. Daly: None. M.G. Rocha-Braz: None. R.M. Martin: None. B. Ferraz-de-Souza: None. Osteogenesis imperfecta (OI) is a heterogeneous bone fragility disorder. Extra-skeletal manifestations have been well documented in children with OI, including renal complications, but studies in adults lack. Here we investigate the prevalence of nephrolithiasis and hypercalciuria in adults with OI.After informed consent, adult patients with OI attending a tertiary clinic were included in this prospective study. Disease severity score, mobility score, BMD, and molecular diagnosis, if available, were registered. Evaluation of nephrolithiasis comprised history, dietary record, and medication and supplement use. Imaging was performed in all patients with renal US and/or CT, and laboratory investigations encompassed serum (Ca, P, ALP, 25OHD, PTH, CTX, P1NP) and 24-h urine (Ca, P, citrate, oxalate, sodium, uric acid) analyses. IBM SPSS v20 was used for statistical analysis.In total, 94 adults (57 F, 37 M) with OI were evaluated, with ages ranging from 21-76 yr (50% between 20-29). Molecular diagnosis was available for 61 subjects, 79% of whom had collagen defects. Most subjects had moderate to severe OI (70%) and 48% required walking support/aid or did not walk. Excessive total (diet + supplement) daily calcium intake was identified in only 6%. Renal CT and US were available for 50 subjects (53%), CT only for 11 (12%) and US only for 33 (35%). Nephrolithiasis was identified in 26 subjects (28%). Of those, 13 (14%) had symptoms. A trend towards a higher occurrence of nephrolithiasis in subjects with moderate/severe OI was identified (p=0.059), and, reassuringly, no association with calcium intake or use of supplements was seen. ROC curve analysis revealed that 24-h U Ca &amp;gt;144.25 mg and 24-h U citrate &amp;lt;235 mg were significantly associated with nephrolithiasis (p=0.024 &amp; p=0.048). Logistic regression identified a 5.6x increased likelihood of nephrolithiasis for 24-h U oxalate &amp;gt;19 mg (p=0.047). Nephrolithiasis was identified in 28% female and 27% male subjects. Because nephrolithiasis is usually more common in males, analyses were repeated according to sex. In female subjects, nephrolithiasis was significantly associated with OI severity (p=0.01) and with higher mean OI severity scores (p=0.001). Strikingly, hypercalciuria (defined as 24-h U Ca &amp;gt;200 mg) was identified in 36% of the cohort. Significant but weak positive correlations between 24-h U Ca and mobility score (r=0.214, p=0.041) and 24-h U Na (r=0.426, p=0.001) were found, as were negative correlations with CTX (r=-0.257, p=0.015) and P1NP (r=-0.251, p=0.018). In conclusion, high prevalence of nephrolithiasis and hypercalciuria were identified in adults with OI. While Ca supplementation did not seem to be associated with risk for nephrolithiasis in this population with mostly adequate total daily intake levels, OI severity, low U citrate and high U oxalate levels seemed to increase risk, prompting attention in the care of adults with OI. Presentation: 6/1/2024

Prevalence of poststroke fatigue and its relationship with clinical characteristics among community-dwelling stroke survivors: A cross-sectional survey

Background and objectivePoststroke fatigue is widely overlooked due to a lack of awareness, definite cause, and cure. It is influenced by cultural variance in psychosocial factors and stroke epidemiology patterns across different countries. To date, the prevalence of poststroke fatigue has not been determined in the Indian setting. Hence our objective was to estimate the prevalence of fatigue among community-living late subacute and chronic stroke survivors. Additionally, we determined the association between poststroke fatigue and participants’ clinical and demographic data. MethodsA cross-sectional survey was conducted among first-time stroke survivors following discharge from two tertiary care hospitals. Medical records were screened and included if they met the criteria for age >18 years, able to follow a two-step command with no existing neurological or systemic conditions that would influence fatigue scores. Telephonic consent was obtained, and an interview was conducted to obtain the scores for fatigue, daytime sleepiness, depression, functional mobility, and disability. ResultsA total of 323 participants (mean age: 60.3 ± 12.6 years, mean stroke duration: 8.6 ± 4.4 months) completed the interview. Poststroke fatigue was reported in 11.8 % (n = 38) of the population. Occupational status (χ2 = 5.73), functional mobility (χ2 = 5.84), and disability scores (χ2 = 8.00) were significantly associated (p < 0.05) with fatigue scores. Individuals with disability exhibited five times (OR = 5.00, CI: 1.45–17.23, p = 0.01) higher odds of experiencing fatigue than those without disability. ConclusionOur study reported a relatively lower prevalence of fatigue among community-living late subacute and chronic stroke survivors. Implementing strategies to address these contributing factors could effectively ease fatigue in individuals recovering from stroke.

Mobility Loss in Hospitalized Adults Predicts Poor Clinical Outcomes.

The Johns Hopkins Activity and Mobility Program is a systematic approach to measure and improve patient mobility. The purpose of this study was to evaluate the relationship between mobility loss and quality outcomes. A retrospective cohort study design was used. Patients were categorized into 3 groups (gain, loss, no change in mobility) using the Johns Hopkins Highest Level of Mobility (JH-HLM) scores. The association between mobility loss and falls risk, in-hospital mortality, delirium, discharge to a facility, length of stay, and 30 day readmissions were assessed. Those who lost mobility were more at risk of being a high fall risk, in-hospital mortality, delirium, discharging to a facility, and had 48% longer lengths of stay. There was no association between mobility loss and 30-day readmissions. Loss of mobility assessed using JH-HLM scores is associated with worse patient outcomes.

Readmission and mortality before and after introduction of orthogeriatric home visits: A retrospective cohort study in hip fracture patients

IntroductionOrthogeriatric collaboration in hip fracture patients during admission is well established, however, orthogeriatric involvement after discharge is not common. The aim of this study was to explore the association of orthogeriatric home visits with 30-day and 120-day readmission and mortality in ≥ 65-year-old patients surgically treated for hip fractures. Materials and MethodsA cohort of patients who underwent acute hip fracture surgery in an usual care period from January 2018 to December 2018 was compared with a cohort of patients in an intervention period from June 2020 to June 2021. During the intervention period, patients were offered orthogeriatric home visits at day 2 and 9 after discharge. The home visits were performed by orthogeriatric nurses, in close collaboration with geriatricians and orthopedic surgeons based in the local hospital. Readmission was defined as ≥ 12 h hospital stay, regardless of reason. For the main analysis, we applied Cox-regression models adjusted for age, sex, New Mobility Score, Cumulated Ambulation Score regained, cognitive function, Charlson Comorbidity Index, complications, medication, discharge destination and emergency department visits. ResultsIn total, 292 patients were included during the usual care period, and 308 patients during the intervention period. Thirty- and 120-day readmission rates were 27.7 % and 41.4 % in the usual care cohort vs. 21.8 % and 35.1 % in the home visit cohort. Adjusted Hazard Ratios for readmission in the intervention cohort after 30 and 120 days were 0.67 (CI95 %: 0.48–0.93) and 0.71 (CI95 %: 0.54–0.93) respectively. Thirty- and 120-day mortality rates were 7.2 % and 20.9 % in the usual care cohort versus 5.8 % and 13.3 % in the intervention cohort. Adjusted Hazard Ratios for mortality in the intervention cohort after 30 and 120 days were 0.68 (CI95 %: 0.35–1.31) and 0.56 (CI95 %: 0.37–0.84) respectively. ConclusionsIn a period where hip fracture patients were offered two home visits after discharge, we observed lower 30- and 120- day readmission, and lower 120-day mortality, calling for more studies with a randomized design.

Frequent absent mindedness and the neural mechanism trapped by mobile phone addiction

IntroductionWith the increased availability and sophistication of digital devices in the last decade, young people have become mainstream mobile phone users. Heavy mobile phone dependence causes affective problems (depression, anxiety) and loss of attention on current activities, leading to more cluttered thoughts. Problematic mobile phone use has been found to increase the occurrence of mind wandering, but the neural mechanism underlying this relationship remains unclear. MethodThe current study aimed to investigate the neural mechanism between mobile phone use and mind wandering. 459 university students (averaged age, 19.26 years) from datasets (ongoing research project named Gene-Brain-Behavior project, GBB) completed psychological assessments of mobile phone addiction and mind wandering and underwent resting-state functional connectivity (FC) scanning. FC matrix was constructed to further conduct correlation and mediation analyses. ResultsStudents with high mobile phone addiction scores were more likely to have high mind wandering scores. Functional connectivity among the default mode, motor, frontoparietal, basal ganglia, limbic, medial frontal, visual association, and cerebellar networks formed the neural basis of mind wandering. Functional connectivity between the frontoparietal and motor networks, between the default mode network and cerebellar network, and within the cerebellar network mediated the relationship between mobile phone addiction and mind wandering. ConclusionThe findings of this study confirm that mobile phone addiction is a risk factor for increased mind wandering and reveal that FC in several brain networks underlies this relationship. They contribute to research on behavioral addiction, education, and mental health among young adults.

Outcomes of Ponseti Method for the Treatment of Clubfeet in Children With Spina Bifida.

While the Ponseti method is the primary treatment for idiopathic clubfoot, its application in treating myelodysplastic clubfeet is less certain. Myelodysplastic clubfoot tends to be more severe and difficult to treat. Although the Ponseti method can initially correct these cases, there is conflicting evidence about recurrence rates and the need for additional treatment. This study aims to assess the effectiveness of the Ponseti method in treating myelodysplastic clubfeet compared with idiopathic clubfeet over a 20-year period. The study conducted a retrospective review of medical records from patients treated for clubfoot at a single institution (2002 to 2021), comparing children with myelodysplastic and idiopathic clubfoot. Included patients were under 18, initially treated with Ponseti-casting, and had a minimum 2-year follow-up. Data on demographics, treatment details, recurrence, and Patient-reported Outcomes Measurement Information System (PROMIS) scores were analyzed. Forty-nine myelodysplastic and 512 idiopathic clubfeet in 366 patients met the inclusion criteria. Myelodysplastic cases had a median age of 5 months at presentation versus 2 months for idiopathic cases ( P =0.002). Initial correction was achieved in 95% of idiopathic and 87.8% of myelodysplastic feet ( P =0.185). Recurrence rates were higher in the myelodysplastic cohort, 65.3% versus 44.1% ( P =0.005). Surgery was necessary to treat recurrence in 59.2% of myelodysplastic and 37.7% of idiopathic cases, P =0.003. Follow-up was 3.9±1.8 years for myelodysplastic and 3.3±1.5 years for idiopathic feet, P =0.030. Myelodysplastic feet had lower PROMIS mobility scores; 31.94±7.56 versus 49.21±8.64, P <0.001. To the best of our knowledge, we report the largest series of myelodysplastic clubfeet treated by Ponseti casting and the first to assess PROMIS data. Overall, the Ponseti method is as effective in obtaining initial correction in myelodysplastic clubfoot as it is in idiopathic clubfoot. However, myelodysplastic clubfeet has a higher risk of relapse and increased need for surgical interventions. Children with spina bifida may need closer follow-ups and more stringent adherence to bracing. Level III-therapeutic studies-investigating the results of treatment.

A comprehensive assessment tool of acute-phase rehabilitation is associated with clinical outcomes in patients after cardiovascular surgery.

Perme intensive care unit (ICU) mobility score is a comprehensive mobility assessment tool; however, its usefulness and validity for patients after cardiovascular surgery remain unclear. We investigated the association between the Perme Score and clinical outcomes after cardiovascular surgery. We retrospectively enrolled 249 consecutive patients admitted to the ICU after cardiac and/or major vascular surgery. The Perme Score contains categories on mental status, potential mobility barriers, muscle strength and mobility level and was assessed within 2days after surgery. The outcomes of physical recovery were the number of days until 100-m ambulation achievement and 6-min walk distance (6MWD) at hospital discharge. The endpoint was a composite outcome of all-cause mortality and/or all-cause unplanned readmission. We analyzed the associations of the Perme Score with physical recovery and the incidence of clinical events. After adjusting for clinical confounding factors, a higher Perme Score was an independent factor of earlier achievement of 100-m ambulation (hazard ratio: 1.039, 95% confidence interval [CI]: 1.012-1.066) and higher 6MWD (β: 0.293, P = .001). During the median follow-up period of 1.1years, we observed an incidence rate of 19.4/100 person-years. In the multivariate Poisson regression analysis, a higher Perme Score was significantly and independently associated with lower rates of all-cause death/readmission (incident rate ratio: 0.961, 95% CI: 0.930-0.992). The Perme Score within 2days after cardiovascular surgery was associated with physical recovery during hospitalization and clinical events after discharge. Thus, it may be useful for predicting clinical outcomes.

Safety and efficacy of intra-articular triamcinolone acetonide injection versus standard of care in patients with rheumatoid arthritis flare

Triamcinolone acetonide is a commonly used corticosteroid for rheumatoid arthritis (RA) flares, providing extended relief. However, there is limited data from controlled trials comparing the efficacy of intra-articular corticosteroid (IACS) injections to standard care, particularly with non-steroidal anti-inflammatory drugs (NSAIDs). This non-randomized, single-center, open-label study evaluated the safety and efficacy of IACS injections in RA patients experiencing knee joint flare-ups. A total of 64 patients were screened and 44 received IACS (triamcinolone acetonide) and 15 were included in the control group. Significant improvements were observed in the IACS group in pain, swelling, and morning stiffness at week 2, which were sustained through weeks 6 and 12. The swollen joint count significantly reduced by week 12, while the tender joint count showed improvement by week 2. Pain reduction was substantial, as indicated by significant decrease in visual analog scale scores for pain, swelling, and mobility. The disease activity score-28 improved significantly across all time points. In addition, the C-reactive protein level decreased significantly at week 2 and its decreasing trend continued until weeks 6 and 12. By week 2, all patients had ceased NSAID use. The study demonstrated the effectiveness of IACS in reducing RA flare severity, particularly in terms of pain, swelling, and functional impairment, with no major safety concerns reported.

The Comparison of Scar Mobilization Techniques with and without Core Stability Exercises on Scar Tissue Mobility and Lumbopelvic Pain

Abdominal adhesions and lumbopelvic pain can occur after a caesarean section. Many treatment approaches, such as injections, massage, surgical release, soft tissue release, strengthening, stretching and core stability exercises are available for abdominal scars. Physiotherapy treatments are considered safer and more convenient. The study aims to compare the effects of scar mobilization techniques with and without core stability exercises on scar tissue mobility and lumbopelvic pain. The study was a randomized clinical trial conducted at the Rafiqa Hospital and Fatima Hospital, Sargodha, Pakistan. A sample of 30 participants was allocated in Group A and B. Group A received scar mobilization and core stability exercises, while Group B received only scar mobilization, with both groups undergoing 3 sessions per week for total three weeks. The groups were assessed at baseline after the 5th and 9th sessions, using Oswestry Low Back Pain Disability Questionnaire (ODI), Numeric Pain Rating Scale (NPRS), Manual Scar Mobility Testing (MSMT), and Vancouver Scar Scale (VSS). Moreover, the data were analyzed using SPSS 25. The mean age of participants was 27.22 ± 4.21, and their body mass index was 27.10 ± 3.53. Both groups showed significant differences within the subject’s scores of disability, pain and scar mobility (p&lt;0.05). Between-group comparison of both groups at post-treatment II showed considerable improvement in pain scores (NPRS score, p&lt;0.05). Whereas non-significant results were in other outcome measures (disability and scar mobility p&gt;0.05) in post-treatment II. Scar mobilization techniques with core stability exercises were more effective than scar mobilization techniques alone in the conservative treatment of females with lumbopelvic and scar pain after caesarean section.