Physical Function Outcome Measures Research Articles

HEALTH-SEEKING BEHAVIOR OF COMMUNITY-LIVING OLDER ADULTS RELATES TO AWARENESS OF COMMUNITY SERVICES

Abstract Research has shown that older adults desire to age in their homes. To age at home safely and comfortably, there are a variety and number of community support services available, however, previous studies show older adults do not utilize these services fully. There is a need for clarity about this gap between availability and use. Understanding the construct of health-seeking behaviour by community-living older adults may provide insights into this identified gap. Therefore, the objective was to determine whether health-seeking behaviour in community-living older adults is related to: dimensions of wellness; awareness of community support services; living as an older man or woman; or being younger or older than 75 years. A cross-sectional study design involving 99 community-living older adults (≥ 65 years, without impaired executive function) employed validated outcome measures of physical function, fear of falling, personal resilience, social well-being, spiritual well-being, awareness of community support services, and health-seeking behaviour. Relationships were calculated using multiple linear regression. Health-seeking behaviour was positively correlated (R= 0.40, p<.01) with awareness of community support services. Health-seeking behaviour was not correlated with dimensions of wellness (i.e., physical function, fall risk, personal resilience, spiritual wellbeing, or social wellbeing). No difference between age groups (U=986.5, n1=68, n2=31, p=0.61) nor sex (U=931.5, n1=66, n2=33, p=0.24) was found for health-seeking behaviour. The findings indicate that awareness of community support services positively influenced health-seeking behaviour. The healthcare system should ensure equitable, accessible, age-friendly, and relevant information and distribution strategies to increase awareness of older adults for local supportive services.

Equipercentile equating of scores from common patient-reported outcome measures of physical function in patients with cancer

ObjectiveTo provide equipercentile equating of physical function (PF) scores from frequently used patient-reported outcome measures (PROMs) in cancer patients to facilitate data pooling and comparisons. Study Design and SettingAdult cancer patients from five European countries completed the European Organization for Research and Treatment of Cancer (EORTC) computer adaptive test (CAT) Core, EORTC Quality of Life Questionnaire Version 3.0 (QLQ-C30), Functional Assessment of Cancer Therapy - General (FACT-G), 36-item Short Form Health Survey (SF-36), and the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function 20a short form. The R package “equate” was used to establish conversion tables of PF scores on those measures with a bivariate rank correlation of at least 0.75. ResultsIn total, 953 patients with cancer (mean age 58.9 years, 54.7% men) participated. Bivariate rank correlations between PF scores from the EORTC CAT Core, EORTC QLQ-C30, SF-36, and PROMIS were all above 0.85, but below 0.69 for the FACT-G. Conversion tables were established for all measures but the FACT-G. These tables indicate which score from one PROM best matches the score from another PROM and provide standard errors of converted scores. ConclusionOur analysis indicates that linking of PF scores from both EORTC measures (CAT and QLQ-C30) with PROMIS and SF-36 is possible, whereas the physical domain of the FACT-G seems to be different. The established conversion tables may be used for comparing results or pooling data from clinical studies using different PROMs.

Physical function in children and adolescents pre- and 1-year post-liver transplant.

Several studies describe poorer motor developmental motor outcomes post-liver transplant (LT) in younger children. Limited studies examine physical function in older children and adolescents pre- and post-LT. Retrospective review of standard of care physical function outcome measures pre- and 1-year post-LT in children ≥6 years at LT. Measures include: 6-minute walk test (6MWT), grip strength, Bruininks-Oseretsky Test of Motor Proficiency-2 (BOT-2) components, Physical Activity Questionnaire (PAQ), and Paediatric Quality of Life Multidimensional Fatigue Scale. Association of medical variables with outcomes was explored. The study cohort included 23 (8 male, median (interquartile range) age 11.67 (8.25, 13.92) years at LT) participants. Top two primary diagnoses included biliary atresia (30.4%) and fulminant hepatic failure (21.7%). At 1-year post-LT, over one-third (36%) were overweight or obese. Compared with healthy norms, children had significantly lower pre-LT PAQ scores (p = .002), pre- and post-6MWT scores (p < .001) and post-LT BOT-2 strength and agility scores (p < .001). Pre-LT, lower balance scores were associated with abdominal distention/ascites (p = .009) and splenomegaly (p = .017). Lower pre-LT platelet count correlated with poorer balance (r = .532, p = .017) and lower strength and agility scores (r = .446, p = .043). Significant moderate inverse correlations were found between weight/body mass index z-scores and BOT-2 components. Post-LT children continue to demonstrate decreased levels of motor proficiency and functional capacity but report less fatigue and increased physical activity. Older children and adolescents undergoing LT are at risk of decreased physical function, highlighting the need for pre- and post-LT rehabilitation to optimize long term outcomes.

Perioperative Predictors in Patients Undergoing Lateral Lumbar Interbody Fusion for Minimum Clinically Important Difference Achievement

To identify perioperative predictors of minimum clinically important difference (MCID) for patients undergoing lateral lumbar interbody fusion (LLIF) for the patient-reported outcome measures (PROMs) of Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS-PF), Visual Analog Scale (VAS) Back, VAS Leg, Oswestry Disability Index (ODI), and Patient Health Questionnaire-9 (PHQ-9). Patients undergoing LLIF were identified through retrospective review of a single-surgeon database. Overall MCID achievement was determined as the number of unique patients achieving ΔPROM thresholds of PROMIS-PF=4.5, VAS Back=2.1, VAS Leg=2.8, ODI=14.9, and PHQ-9=3.0 over a 2-year postoperative time period. Univariate and multivariable logistic regression were utilized to determine perioperative predictors for MCID achievement. Two-hundred and ninety patients were identified. For PROMIS-PF MCID achievement, increased preoperative PROMIS-PF and POD 1 VAS pain were significant negative predictors. For VAS Back, primary fusion with revision decompression was a negative predictor, while increased preoperative VAS Back was a positive predictor of MCID achievement. For VAS Leg, increased preoperative VAS Leg was a positive predictor. For ODI, increased POD 0 VAS pain was a negative predictor, while increased preoperative ODI was a positive predictor. For PHQ-9, increased preoperative PHQ-9 was a positive predictor. In patients undergoing LLIF, perioperative predictors for MCID achievement were highly dependent on PROM. Preoperative PROM was the most consistent perioperative predictor for achieving MCID. Elevated acute postoperative pain and primary fusion after failed index decompression were significant predictors of failing to achieve MCID. Surgeons may use these findings in prognostication and management of postoperative expectations.

Effect of exercise interventions in adults with cancer receiving palliative care: a systematic review and meta-analysis.

Previous publications showed the effectiveness of exercise in adults with cancer receiving palliative care, but evidence for palliative care research on exercise is lacking. The purpose is to examine the effects of an exercise intervention on exercise capacity, physical function, and patient-reported outcome measures in adults with cancer receiving palliative care. We searched databases including EMBASE, PubMed, and Web of Science from inception until 2021. We used the Cochrane criteria to assess the risk of bias within studies. Using RevMan, mean difference (MD) and 95% confidence intervals or standardized mean difference (SMD) and 95% confidence intervals were calculated. A total of 14 studies and 1034 adults with cancer receiving palliative care are included in this systematic review and meta-analysis. Half of the studies were deemed to have high risk of bias. All of the interventions used aerobic and/or resistance exercises. The results indicated that exercise interventions significantly improved exercise capacity (mean difference: 46.89; 95% confidence interval: 4.51 to 89.26; Z = 2.17; P = 0.03), pain (standardized mean difference: - 0.29; 95% confidence interval: - 0.54 to - 0.03; Z = 2.18; P = 0.03), fatigue (standardized mean difference: - 0.48; 95% confidence interval: - 0.83 to - 0.12; Z = 2.66; P = 0.008), and quality of life (standardized mean difference: 0.23; 95% confidence interval: 0.02 to 0.43; Z = 2.12; P = 0.03). Exercise training, with aerobic exercise, resistance exercise, or combined aerobic and resistance exercise, helps to maintain or improve exercise capacity, pain, fatigue, and quality of life in adults with cancer receiving palliative care.

OPTIMIZING PATIENT WEIGHT MANAGEMENT PRIOR TO ARTHROPLASTY: A FEASIBILITY STUDY

Obesity is associated with worse outcomes following total knee/hip arthroplasty (TKA/TKA). This study aimed to determine the feasibility of a dietitian-led low-inflammatory weight-loss program for people with obesity awaiting arthroplasty.Quasi-experimental pilot study enrolled people with obesity waitlisted for primary TKA/THA into ‘usual care’ (UC) or weight-loss (low-inflammatory diet) program (Diet). Recruitment occurred between July 2019 and February 2020 at Fairfield and Campbelltown Hospitals. Assessments at baseline, pre-surgery, time of surgery and 90-days following surgery included anthropometric measurements, patient-reported outcomes, serum biomarkers and 90-day postoperative complication rate.97 people consented to the study (UC, n=47, mean age 67, BMI 37, TKA 79%; Diet, n=50, mean age 66, BMI 36, TKA 72%). Baseline characteristics indicated gross joint impairments and poor compliance with a low-inflammatory diet. Study feasibility criteria included recruitment rate (52%), proportion of diet patients that improved compliance to low-inflammatory diet by ≥10% (57%) and had ≥60% attendance of dietitian consultations (72%), proportion of patients who undertook serum biomarkers (55%).By presurgery assessments, the diet group had more patients who cancelled their surgery due to symptom improvement (4 vs 0), reduced waist-circumference measurements, increased compliance with the Low-Inflammatory diet and preservation of physical activity parameters. More usual care participants experienced at least one postoperative complication to 90-days (59% vs 47%) and were discharged to inpatient rehabilitation (21% vs 11%). There was no difference in weight change, physical function, and patient-reported outcome measures from pre-surgery to 90-days post-surgery, and length of hospital stay.Using pre-determined feasibility criteria, conducting a definitive trial is not feasible. However, intervention audit demonstrated high intervention fidelity.Pilot data suggest our program may promote weight loss but the clinical effects for most are modest. Further research utilising a stronger intervention may be required to assess the effectiveness of a pre-arthroplasty weight-loss intervention.

Age-, Sex-, and Graft-Specific Reference Values From 783 Adolescent Patients at 5 to 7 Months After ACL Reconstruction: IKDC, Pedi-IKDC, KOOS, ACL-RSI, Single-Leg Hop, and Thigh Strength.

OBJECTIVE: To describe age-, sex-, and graft source-specific reference values for patient-reported, physical function, and strength outcome measures in adolescents at 5 to 7 months after anterior cruciate ligament reconstruction. DESIGN: Cross-sectional study. METHODS: Data were collected at 3 universities and 2 children's hospitals. The participants completed at least one of the International Knee Documentation Committee (IKDC) Subjective Evaluation Form, Pediatric IKDC (Pedi-IKDC), Knee Injury and Osteoarthritis Outcomes Score (KOOS), and Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI) Scale. Participants also completed single-leg hop tests and/or isokinetic quadriceps and hamstrings strength assessments (at 60°/s). Reference values were summarized using descriptive statistics and stratified for age, sex, and graft source. RESULTS: Reference values were reported for common patient-reported outcomes and measures of physical function and strength from 783 participants (56% females, age = 16. 4 ± 2.0 years) who were in early adolescence (12-14 years, N = 183, 52% females), middle adolescence (15-17 years, N = 456, 58% females), or late adolescence (18-20 years, N = 144, 55% females). Three hundred seventy-nine participants (48.4%) received a bone-patellar tendon-bone autograft, 292 participants (37.3%) received hamstring tendon autograft, and 112 participants (14.3%) received autograft or allograft from an alternative source. CONCLUSION: Reference values for common patient-reported outcomes and measures of physical function and strength differed depending on a patient's age, sex, and graft source. Using patient-specific reference values, in addition to previously described age-appropriate cutoff values, may help clinicians monitor and progress patients through rehabilitation and return to physical activity after anterior cruciate ligament reconstruction. J Orthop Sports Phys Ther 2023;53(4):1-8. Epub: 23 January 2023. doi:10.2519/jospt.2023.11389.

Minimum Clinically Important Difference in Patients Undergoing Minimally Invasive Transforaminal Lumbar Interbody Fusion.

Few studies have established the minimum clinically important difference (MCID) in patients undergoing minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for physical function and pain. To establish MCID for physical function and pain patient-reported outcome measures (PROMs) for MIS-TLIF through anchor- and distribution-based methods using the Oswestry Disability Index (ODI) as the anchor. Ninety-eight patients undergoing primary MIS-TLIF with preoperative and 1-year postoperative ODI scores were identified. MCID was calculated using anchor- and distribution-based methods. ODI responders were classified as patients who decreased by 1 disability classification. PROMs of Patient-Reported Outcome Measurement Information System-Physical Function (PROMIS-PF), 12-Item Short Form Physical Component Score (SF-12 PCS), Visual Analog Scale (VAS) back/leg, and ODI were collected preoperatively and 1-year postoperatively. Anchor-based methods were average change, minimum detectable change, change difference, receiver operating characteristic curve, and cross-sectional analysis. Distribution-based methods were standard error of measurement, receiver change index, effect size, and 0.5 ∗ ΔSD. Anchor-based methods ranged from 4.2 to 11.9 for PROMIS-PF, 6.0 to 15.8 for SF-12 PCS, 1.8 to 4.6 for VAS back, and 2.1 to 4.0 for VAS leg. The area under the curve for receiver operating characteristic analysis ranged from 0.66 to 0.81. Distribution-based methods ranged from 1.1 to 3.9 for PROMIS-PF, 1.6 to 10.4 for SF-12 PCS, 0.5 to 1.6 for VAS back, and 0.6 to 1.8 for VAS leg. Patients undergoing MIS-TLIF had a wide range of MCID values. The receiver operating characteristic curve was selected as the most clinically appropriate method. The corresponding MCID values were 4.2 for PROMIS-PF, 6.8 for SF-12 PCS, 1.8 for VAS back, and 2.4 for VAS leg.

Establishing minimum clinically important difference for patient-reported outcome measures in patients undergoing lateral lumbar interbody fusion.

The minimum clinically important difference (MCID) has not been established in lateral lumbar interbody fusion (LLIF). Our study aims to establish MCID for patient-reported outcome measures (PROMs) of physical function and pain for LLIF through anchor-based and distribution-based approaches. Patients undergoing LLIF with preoperative and 6-month postoperative Oswestry Disability Index (ODI) scores were identified. PROMs of Patient-Reported Outcome Measurement Information System Physical Function (PROMIS-PF), 12-Item Short Form Physical Component Score (SF-12 PCS), Veterans RAND 12-Item Short Form Physical Component Score (VR-12 PCS), visual analog scale (VAS) back, and VAS leg were collected at preoperative and 6-month postoperative time points. Anchor-based MCID calculations were average change, minimal detectable change, change difference, receiver operating characteristic curve, and cross-sectional analysis using ODI as the anchor. Distribution-based calculations were standard error of measurement, reliable change index, effect size, and 0.5 ∗ ΔSD. Fifty patients were included. Anchor-based approaches MCID ranges were PROMIS-PF 1.1-9.6, SF-12 PCS 6.4-16.5, VR-12 PCS 5.9-12.9, VAS Back 1.4-4.6, and VAS Leg 1.3-4.3. The area under curve for receiver operating characteristics (ROC) analysis ranged from 0.63 to 0.71. Distribution-based MCID ranges were PROMIS-PF 1.4-4.5, SF-12 PCS 1.9-12.7, VR-12 PCS 2.0-6.6, VAS Back 0.4-1.4, and VAS Leg 0.5-2.0. MCID thresholds varied widely depending on the calculation method. The closest to (0,1) ROC approach was the most clinically appropriate MCID calculation. The corresponding MCID values for LLIF were PROMIS-PF at 7.8, SF-12 PCS at 6.4, VR-12 PCS at 9.3, VAS Back at 4.6, and VAS Leg at 4.3.

TECHNOLOGY AND GROUP EXERCISE INTERVENTIONS FOR PEOPLE WITH DEMENTIA OR MILD COGNITIVE IMPAIRMENT: A SCOPING REVIEW

Abstract We conducted a scoping review to analyze evidence about online group-based exercise programs. We searched six electronic databases and conducted team analysis with patient and family partners. Of 1,166 screened articles, the final review included 8 publications. Results identified three types of technology-based group exercise interventions for people with dementia or mild cognitive impairment (MCI): (a) exergames, (b) virtual cycling, and (c) video-conferencing platforms. These studies used psychosocial, physical function, biomarker, and cognitive outcome measures. The review identified three key impacts: (a) feasibility and accessibility; (b) physical, psychosocial, and cognitive benefits; and (c) adaptations necessary for persons with dementia or MCI. Over all, technology-based group exercise interventions were found to be accessible, feasible, and acceptable to persons with dementia or MCI. However, a “one-size-fits-all” game approach often did not work, suggesting that exercise interventions should be adaptable to meet the various needs of individual participants.

REMOTE TELEASSESSMENT AND TELEREHABILITATION OF A COMPREHENSIVE EXERCISE TRAINING PROTOCOL FOR OLDER ADULTS

Abstract Background With the increased implementation of interactive technologies for assessment and rehabilitation, it would be optimal to exhibit the reliability of physical assessment measures via tele-assessment. Aim: To determine the test-retest and intra-rater reliability of physical function outcome measures routinely used in the balance and gait rehabilitation using real-time online tele-assessment. Methods Community-dwelling healthy older adults (N=30) participated in three experimental tele-assessment sessions. During each session, a real-time online tele-assessment was performed on five major domains that evaluate balance and gait function: lower limb strength and endurance (30-second chair stand test), aerobic endurance (2-minute step test), static balance (One-legged stand test), dynamic balance (4-step square test), and gait (Tinetti). Results Coefficient of determination (R2) was used to determine the test-retest (TRT) and intra-rater (IR) reliability for all outcome variables. Excellent reliability was shown by Tinetti (TRT-1.0; IR-1.0) and one-legged stand test (non-dominant leg TRT-0.92; IR-0.97 and dominant leg TRT-0.89; IR-0.92). Excellent to good reliability was shown by 4-step square test (TRT-0.89; IR-0.74), 2-min step in place test (TRT-0.85; IR-0.78), and 30-second chair stand test (TRT-0.86; IR-0.80). Conclusion The reliability of individual outcome measures ranged from good to excellent, suggesting that these outcomes have sufficient sensitivity for detecting change with telerehabilitation.

Robot-assisted rehabilitation for total knee or hip replacement surgery patients: A systematic review and meta-analysis.

Background:This study was performed to update the current evidence and evaluate the effects of robot-assisted rehabilitation (RAR) in comparison with conventional rehabilitation (CR) in patients following total knee (TKR) or hip replacements (THR).Methods:PubMed Central, OVID Medline, Cochrane Collaboration Library, and EMBASE for a comprehensive search for all relevant studies, from database inception to July 2022. The following inclusion criteria were used to determine eligibility for studies: randomized and matched controlled trials recruiting men and women who underwent TKR and THR; and studies examining the effect of RAR on outcome measures of physical function and pain.Results:A total of 9 studies (230 patients) were included in this review and 4 were included in the meta-analysis. The meta-analysis of 2 studies showed that Hybrid Assistive Limb (HAL) training for 5 days, significantly improved pain measured on a visual analogue scale, compared to CR in patients following TKR (SMD = 1.05, 95% confidence interval [Cl] 0.39–1.71). Heterogeneity for I2 value was lower than moderate (tau^2 = 0.0121; I2 = 5%; P = .30). There were 2 studies that assessed self-selected walking speed. The meta-analysis of these studies showed that HAL training was significantly superior to CR in patients following TKR (SMD = 48.70, 95% Cl -50.53 to 147.94) at 2 months. A high heterogeneity was detected (P < .01; I2 = 97%).Conclusion:The result of this systematic review and meta-analysis suggest that RAR may be an effective treatment in TKR and THR patients. However, high-quality studies are needed to verify the long-term effect on their recovery.

Identification of disability status in persons with multiple sclerosis by lower limb neuromuscular function – Emphasis on rate of force development

BackgroundNeurodegeneration is an inevitable consequence of multiple sclerosis (MS) leading to impaired neuromuscular function, especially of the lower extremities. Whilst maximal muscle strength (or force; Fmax) is the most examined feature of neuromuscular function, the ability to rapidly increase muscle force (= rate of force development; RFD) appear to be preferentially sensitive towards neurodegeneration and potentially also of great importance for physical function. The purpose of the present study was to comprehensively examine and compare different outcome measures of neuromuscular function (with specific emphasis given to RFD) across disability status in persons with MS (pwMS), and in comparison, to age- and sex-matched healthy controls (HC). MethodsA total of n=34 HC and n=99 pwMS were enrolled in the study, with the latter being divided into Expanded Disability Status Scale (EDSS) subgroups: MSmild (EDSS 0–2.5, n=51), MSmoderate (EDSS 3.0-4.5, n=33), and MSsevere (EDSS 5-6.5, n=15). Knee extensor neuromuscular function was assessed by Fmax and RFD (RFD50ms and RFD200ms, respectively; calculated in the interval 0–50 ms and 0–200 ms relative to the onset of contraction) with simultaneous electromyography (maximal EMG (EMGFmax) and rate of EMG rise (rEMG50ms and rEMG200ms, respectively)). Voluntary muscle activation derived from the interpolated twitch technique was also determined during additional Fmax trials. Lastly, physical function was assessed by the 5 x sit-to-stand test (5STS), the timed 25-foot walk test (T25FWT), and the 2-min walking test (2MWT). ResultsSubstantial differences (∼deficits) (p<0.05) were observed for all pwMS subgroups compared to HC across all neuromuscular function outcome measures; RFD50ms (MSmild -22%, MSmoderate -36%, MSsevere -66%), RFD200ms (-12%, -21%, -51%), and Fmax (-11%, -14%, -33%). Somewhat comparable differences (∼deficits) (p<0.05) were observed for voluntary muscle activation (rEMG50ms, rEMG200ms, EMGFmax, and activation) and for physical function (5STS, T25FWT, and 2MT). Deficits in neuromuscular function were strongly associated with EDSS (p<0.05) (RFD50ms: slope steepness -13% per 1 point increase in EDSS, r2=0.79; RFD200ms: slope steepness -10%, r2=0.84; Fmax: slope steepness -6%, r2=0.82). Fmax and RFD were associated with physical function outcome measures (p<0.05) to a comparable extent (r2-values ranging from 0.21 to 0.35). ConclusionLower extremity neuromuscular function is impaired in pwMS compared to HC with differences (∼deficits) becoming greater with increasing disability status. RFD was preferentially sensitive in capturing differences (∼deficits) across disability status and by showing strong associations with EDSS. Altogether, knee extensor RFD could serve as a simple objective marker of disability status or even progression in pwMS, that may be helpful to both researchers and clinicians.

Frequently Used Patient-Reported Outcome Measures of General Physical Function Were Highly Correlated With a Multitask Performance Outcome Test Battery

ObjectivesThis study aimed to determine the relationship between frequently used patient-reported outcome (PRO) measures and a multitask performance outcome (PerfO) measure of general physical function (PF) and to examine the association of these measures with depressive mood, pain, and age. MethodsFrequently used PRO measures of general PF (Patient-Reported Outcomes Measurement Information System [PROMIS] PF item bank, PROMIS PF Short Form 20a, Short Form 36 Physical Function Scale) and a PerfO test battery, namely, the Physical Performance Test (PPT), were administered to 78 adult patients from 3 inpatient clinics (cardiology and angiology, rheumatology and clinical immunology, and psychosomatic medicine) at Charité – Universitätsmedizin Berlin. Pearson correlations were used to investigate the associations between PRO measures and the PPT. To explore the predictive value of age, depressive symptoms, and pain intensity, we conducted multiple linear regression analysis for each PF measure. ResultsWe found strong linear relationships between PRO measures and PPT sum scores. Correlations between PPT sum scores and PROMIS PF T-scores were r > 0.75. For all PRO and PerfO measures, age was a predictor of general PF whereas depressive mood was not found to be a relevant predictor. Moreover, pain intensity was found to be a significant predictor of PRO measures but not for PPT sum scores. ConclusionsOur findings suggest that frequently used PRO measures and a multitask PerfO measure of general PF can be used to measure a common PF construct. Nevertheless, PF scores based on PRO measures should ideally be controlled for self-rated pain intensity.

Gait, Function, and Strength Following Lower Limb Salvage Surgery for a Primary Malignant Bone Tumor: A Systematic Review

Background: Primary malignant bone tumors are a rare form of cancer, treated with limb salvage surgery (LSS), which includes sacrifices of muscle and bone. Purpose: To systematically appraise outcomes of gait, physical function (including dynamic balance, transfers, sit-to-stand, and stair climbing) and muscle performance related to the trunk and lower limb in current literature for individuals who have undergone LSS due to a primary bone tumor. Data Sources: Medline, Cochrane, and PEDro databases were searched from inception to June 2020. Study Selection: Following PRISMA guidelines, articles were screened by 2 reviewers independently (J.N. and C.H.) to determine eligibility based on population of interest (adults who have had LSS) and outcomes (gait, trunk, and lower limb physical function or muscle performance). Discrepancies were resolved with a third reviewer until a mutual consensus was reached (S.H.). Data Extraction: Data on gait, function, and muscle strength were extracted and grouped based on the surgical location (ankle, proximal tibia, distal femur, proximal femur/hip, or pelvic region). Data Synthesis: Data were extracted into tables and grouped first based on participants' surgical site and then based on a domain of outcomes (individual or mean group results for gait measures, strength, balance, use of walking aids, or ability to complete a task such as balance or stairs). Results: One thousand four hundred and forty-five abstracts were screened with 32 studies (354 participants) included in the review. Gait speed was reported in 16 studies and use of walking aids reported in 14 studies; these were the most reported outcomes in the review. Knee extensor strength was reported in 6 studies. Following internal hemipelvectomy surgery, 42% of participants ambulated without a walking aid and gait speed was reported as 0.61 to 1.6 m/s. For those who underwent surgery at the hip, 71% ambulated independently with an average gait speed of 0.94 to 1.20 m/s. Of participants who underwent surgery at the knee, 89% ambulated independently with an average gait speed of 0.36 to 1.32 m/s. Following knee LSS, knee extensor strength of the operated limb varied from 2% to 84% compared with the nonoperated side. Physical function outcome measures that were reported in the studies included the Timed Up and Go (TUG), single-leg balance and stair climbing. Two studies reported the TUG for participants who underwent LSS at the knee and 1 study for participants who underwent LSS at mixed locations on the lower limb. Single-leg balance and stair climbing were both reported in the same study on participants who had undergone LSS at the ankle. Discussion: Approximately 50% of people following hemipelvectomy surgery required a walking aid, with majority of the participants (58%) displaying a gait speed less than 1.1 m/s. Conversely, few people who underwent LSS at the knee and ankle required the use of walking aids. Knee and ankle-related LSS may more likely lead to independent ambulation when compared with surgical procedures at more proximal locations on the lower limb or pelvis. Gait speed is a relevant outcome and was most commonly reported in these participants. Muscle strength in participants varied widely, and physical function was not often measured, limiting insights into these domains. Limitations: Large variability in age, time since surgery, and surgical techniques across patients as well understanding of participants' comorbidities were limitations. Conclusions: Following internal hemipelvectomy surgery, individuals generally have greater functional limitations in gait independence and speed when compared with more distal surgical locations. Further investigation of other functional activities such as sit-to-stand and stair climbing in subacute timeframes is required.

P266 Secukinumab provides clinical improvements in patients with active oligoarticular psoriatic arthritis: results from a pooled analysis of five phase 3 studies

Abstract Background/Aims Evidence for the efficacy of biologics in patients with oligoarticular psoriatic arthritis (PsA) is limited. We evaluated the efficacy of the interleukin 17 inhibitor secukinumab in patients with oligoarticular PsA pooled from 5 phase 3 studies. Methods This post hoc analysis included patients with oligoarticular PsA from the FUTURE 2-5 and MAXIMISE trials (NCT01649375, NCT01989468, NCT02294227, NCT02404350, and NCT02721966). Oligoarticular PsA was defined as the presence of 1-4 tender joints and 1-4 swollen joints at baseline as measured by the tender joint count of 78 joints (TJC78) and the swollen joint count of 76 joints (SJC76), respectively. Patients were pooled by treatment received at week 12 and week 52 in the following groups: week 12 (secukinumab 300 mg, secukinumab 150 mg with or without loading dose [LD], or placebo) and week 52 (any secukinumab 300 mg or any secukinumab 150 mg). Efficacy was assessed by the proportion of patients achieving 50% improvement in Disease Activity in Psoriatic Arthritis (DAPSA50), DAPSA75, DAPSA-based low disease activity (LDA; DAPSA ≤14) and remission (REM; DAPSA ≤4), resolution of TJC78, resolution of SJC76, and a ≥ 0.35-point improvement in the Health Assessment Questionnaire-Disability Index score. Descriptive statistics are provided for each endpoint. Logistic regression analysis was used to identify potential predictors of DAPSA response at weeks 12 and 52; multivariate logistic regression analyses were performed thereafter. Results 84 patients were included: 48 with active PsA from the FUTURE 2-5 trials and 36 with active PsA and axial manifestations from the MAXIMISE trial. Demographics and baseline disease characteristics were comparable across groups. At week 12, notable improvements were observed for the secukinumab 300 and 150 mg versus placebo groups across all the assessed outcome measures and were sustained or increased through week 52. More than 78% of patients who received secukinumab 300 mg or secukinumab 150 mg achieved LDA or REM at week 12. More than 90% of patients who received any secukinumab 300 mg or secukinumab 150 mg achieved LDA or REM at week 52. At week 52, a higher proportion of patients who received any secukinumab 300 mg versus any secukinumab 150 mg achieved higher hurdle endpoints of DAPSA75 (58.1% versus 43.6%, respectively) and DAPSA REM (61.3% versus 37.5%, respectively). At week 12, younger age was a predictor for the achievement of DAPSA LDA or REM and the achievement of DAPSA50, while lower baseline SJC was a predictor of the achievement of DAPSA REM (P &amp;lt; 0.05). No predictors were identified at week 52. Conclusion Secukinumab provides greater improvements versus placebo across a number of disease activity and physical function outcome measures in patients with oligoarticular PsA at week 12, with sustained responses through week 52. Disclosure L.C. Coates: Honoraria; AbbVie, Amgen, Celgene, Galapagos, Gilead, Janssen, Eli Lilly, Novartis, Pfizer, UCB. Grants/research support; AbbVie, Celgene, Eli Lilly, Novartis, Pfizer. A. Ogdie: Consultancies; Amgen, AbbVie, BMS, Celgene, Novartis, Lilly, Janssen, Gilead, Pfizer, UCB. Grants/research support; National Institutes of Health/National Institute of Arthritis and Musculoskeletal and Skin Diseases, Rheumatology Research Foundation, National Psoriasis Foundation, Amgen, Pfizer, Novartis. D.D. Gladman: Consultancies; AbbVie, Amgen, Bristol Myers Squibb, Celgene, Galapagos, Gilead, Janssen, Eli Lilly, Novartis, Pfizer, UCB. Grants/research support; AbbVie, Amgen, Celgene, Eli Lilly, Novartis, Pfizer, UCB. E. Pournara: Shareholder/stock ownership; Novartis. Other; Employee of Novartis. X. Meng: Other; Employee of Novartis. B. Parikh: Other; Employee of Novartis. P.J. Mease: Consultancies; AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Galapagos, Gilead, GlaxoSmithKline, Janssen, Eli Lilly, Novartis, Pfizer, Sun Pharma, UCB. Member of speakers’ bureau; AbbVie, Amgen, Janssen, Eli Lilly, Novartis, Pfizer, UCB. Grants/research support; AbbVie, Amgen, Bristol Myers Squibb, Celgene, Gilead, Janssen, Eli Lilly, Novartis, Pfizer, Sun Pharma, UCB.

Implementing Standard Physical Therapy Guidelines with Patients Acutely Post Single or Bilateral Lung Transplant: A Quality Initiative

<h3>Purpose</h3> As a quality initiative, we evaluated the impact of standardized physical therapy (SPT) for LT recipients, during their admission for LT as measured by change in 6 Minute Walk Test (6MWT), 30 Second Chair Stand Test (30s-CST) and gait speed (GS). <h3>Methods</h3> Evidence-based guidelines (SPT) created by a team of physical therapists consisting of gait training, power and strength exercises, timed endurance activities, hospital exercise programs, and functional outcome measures were implemented with all patients who received LT after March 8, 2021. There were two groups, a control group (CG) with routine care and intervention group (IG) where SPT was implemented. 6MWT, 30s-CST, and GS were measured during the outpatient PT evaluation following discharge from the inpatient setting. Demographic data was obtained via an electronic medical record (EMR). Descriptive statistics were used for analysis. <h3>Results</h3> Total of 33 patients were enrolled in the study. Control group (CG) had 21 patients. Intervention group (IG) had 13 patients. (Table 1). The CG had a mean 6MWT of 859 feet, mean 30s-CST of 5 repetitions and mean GS of 0.72 meters/second. IG had a mean 6MWT of 1,128 feet (p = 0.01), mean 30s-CST of 9 repetitions (p = 0.07) and mean GS of 0.95 meters/second (p = 0.01). <h3>Conclusion</h3> All physical function outcome measures improved with the 6MWT and gait speed being statistically significant. Standardized PT guidelines with LT recipients in the acute hospital setting may improve functional outcome measures indicative of activity tolerance, power, strength, and functional endurance, however limited conclusions can be made at this time. These preliminary findings need to be confirmed with larger sample size and longer follow up.

Effects of Cardiac Rehabilitation on Physical Fitness, Physical Function, and Self-reported Outcomes in Patients ≥80 yr: A RANDOMIZED CONTROLLED TRIAL.

The beneficial effects of exercise-based cardiac rehabilitation (CR) after an acute coronary syndrome (ACS) are well known, but patients ≥80 yr have been less studied. The aim was to evaluate the effects of CR on patients with ACS ≥80 yr on peak cardiorespiratory fitness (CRF), physical function, and patient-reported outcome measures (PROMs) compared with a control group. A total of 26 patients with ACS, median age 82 (81, 84) yr, were randomized to hospital-based CR combined with a home-based exercise program (CR group) or to a control group (C) for 4 mo. Outcomes were assessed at baseline and 4 mo and included the peak CRF (primary outcome), 6-min walk test (6MWT), muscle endurance, Timed Up and Go (TUG), Short Physical Performance Battery (SPPB), one-leg stand test, and PROMs. There were no significant differences between the groups in peak CRF. The CR group improved significantly in terms of the 6MWT ( P = .04), isotonic muscle endurance ( P < .001), one-leg stand test ( P = .001), SPPB total score ( P =.03), Activities-specific Balance Confidence ( P =.01), and anxiety ( P =.03), as compared with C. There were no significant intergroup differences in the TUG, the self-reported health question or depression. Patients with ACS ≥80 yr improved in walking distance, muscle endurance, physical function, and PROMs, but not in peak CRF, by participating in a CR program. These results suggest an increased referral to CR for this growing group of patients to enable preserved mobility and independence in daily living, but this needs to be confirmed in larger studies.

Recovery and prediction of physical function 1year following hip fracture.

ObjectivesTo investigate the recovery of physical function, health related quality of life (HRQoL), and pain for people following hip fracture for the initial 12 months, and to examine whether postoperative outcome measures of physical function, HRQoL, and pain can predict physical function at 3 and 12 months.DesignA prospective single‐center observational study, as part of the HIPFRAC trial. Settings: One hospital with two associated municipalities in Norway. Subjects: 207 participants with hip fracture included in the study (140 participants transferred to a short‐term nursing home placement and 67 transferred directly home at discharge from hospital).MethodOutcome measures were Short Physical Performance Battery (SPPB), Timed Up & Go (TUG), Stair climbing test (SC), Numeric Rating Scale (NRS) for pain at rest and in activity, and EQ‐5D‐5L index and health score. Data were analysed by repeated measures of variance and multivariate regression analyses.ResultsThere were statistically significant improvements in physical function (SPPB total score and TUG), NRS‐pain in activity, and HRQoL (EQ‐5D‐5L) from hospital discharge to 3‐month follow‐up for the whole cohort and the two groups (p < 0.001). However, the largest improvements occurred within the first 3 months. Further statistically significant improvements occurred between 3 and 12 months (p < 0.05). The strongest predictors of physical function at 3 and 12 months post‐fracture were physical function (SPPB) at hospital discharge and pre‐fracture requirement of a walking aid.ConclusionThe recovery of physical function, HRQoL, and pain in participants after hip fracture indicates gradual improvements during the initial 12‐month follow‐up, with the largest improvements within the first 3 months.

83 The Impact of Tracheostomy on Long-term Patient Outcomes: A Burn Model System National Database Study

IntroductionManagement of the upper airway is crucial to burn care, especially in the setting of inhalation injury or burns to the face or neck. Endotracheal intubation is often performed to secure the airway; however, tracheostomy may be necessary in patients requiring prolonged ventilatory support. This study compares long-term outcomes of burn patients with and without tracheostomy.MethodsData from the Burn Model System National Database, collected from 2013 to 2020, were analyzed. Demographic and clinical data were compared between those with and without tracheostomy. The following patient-reported outcome measures, collected at 6-, 12-, and 24-months, were analyzed: Veterans Rand 12 Physical Component Summary Score (VR-12 PCS), Veterans Rand 12 Mental Component Summary Score (VR-12 MCS), Satisfaction with Life (SWL), Community Integration Questionnaire (CIQ), Patient-Reported Outcomes Measurement Information System (PROMIS-29), employment status, and number of days to return to work. Regression models were used to assess the impact of tracheostomy status on long-term outcome measures, controlling for demographic and clinical variables.ResultsOf the 714 patients included in this study, 39 (5.46%) received a tracheostomy and 675 (94.54%) did not. The two groups were similar across all demographic data collected. Tracheostomy patients were more likely to have flame injury, inhalation injury, larger burn size, more trips to the operating room, longer hospital stay, and greater number of days on a ventilator (p< 0.001). Regression model analyses demonstrated that tracheostomy was associated with worse VR-12 PCS scores at 6-, 12-, and 24-months (6.6 [95% CI 1.5, 11.8], p=0.012; 11.5 [6.2, 16.8], p< 0.001; 10.8 [4.2, 17.5], p=0.001). Tracheostomy was also associated with worse scores in two PROMIS-29 domains, physical function and pain interference. For physical function, the association was seen at 6-, 12-, and 24-months (7.4 [3.0, 11.8], p=0.001; 9.6 [5.2, 14.0], p< 0.001; 11.3 [5.8, 16.9], p< 0.001). For pain interference, the association was only seen at 12-months (-5.3 [-10.0, -0.55], p=0.029).ConclusionsAfter burn injury, patient-reported outcome measures of physical function and pain interference were significantly worse with tracheostomy.